September 2005

Dextrocardia with situs inversus is an uncommon congenital anomaly that may not be diagnosed until later in life. It can be found in conjunction with other conditions, such as primary ciliary dyskinesis, but there are usually no associated severe cardiovascular anomalies. Other types of disturbances of symmetry, such as situs ambiguus, can result in severe anomalous development and varying degrees of cardiovascular compromise. Recent research has greatly expanded our understanding of the link between ciliary action and asymmetric expression of gene products in the development of cardiac asymmetry. Medical care is directed toward associated problems, such as respiratory infections with ciliary disorders and additional congenital anomalies.

Many studies have shown higher rates of depressive disorders in women than in men, with a female-to-male ratio of approximately 2:1. We examined gender characteristics in a jail setting to test the hypothesis that depression is much more common in men than has previously been reported. This setting provided a unique opportunity to diagnose and treat men with depressive disorders who would be less likely to be diagnosed with depression outside prison.

Upper gastrointestinal bleeding is a common medical emergency that continues to be a significant cause of morbidity and mortality. It requires rapid and appropriate intervention to control the associated hemodynamic instability and prevent continued or recurrent bleeding. Etiology is the key to prognosis. Lower gastrointestinal bleeding usually ceases spontaneously but may also result in hemodynamic instability or symptomatic anemia. Recognizing the signs and symptoms of upper versus lower gastrointestinal bleeding is crucial for prompt and appropriate treatment.