A 73-year-old man presented to the emergency department twice with nonspecific abdominal pain. He was diagnosed as having mild diverticulitis and was discharged. Four days later he presented to the emergency department in severe abdominal pain with scrotal and penile ecchymoses. After an initial urologic consultation the correct diagnosis of ruptured abdominal aortic aneurysm was made. We discuss the pathogenesis of the genital discoloration and make the correct historical attribution of this sign to John Henry Bryant, a turn-of-the-century physician at Guy's Hospital.

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Tissue fragments passed after colonoscopic polypectomy.

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Outcome after in-patient detoxification for alcohol dependence: a naturalistic comparison of 7 versus 28 days stay.

Research has tended to show that the gains of residential rehabilitation are short-term and cost-inefficient. This study compares the outcomes of two samples, one group staying at a non-statutory sector alcohol detoxification unit for < or =7 days (short stay: SS) with a second group also admitted for detoxification but who stayed at the Unit for a further 8-21 days (long stay: LS). Allocation was not at random: the longer stay was either at the request of the client, referring or treatment agency itself and then had to be approved by an external funding agency. Sixty-four DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) alcohol-dependent subjects were studied. Baseline data included socio-demographic information, illicit drug use during the past 12 months, severity of alcohol dependence, alcohol problems, physical/psychological symptoms, depression and indices of quality of life. At baseline, LS subjects reported more recreational cannabis use than SS subjects. Sixty-two (97%) subjects were re-interviewed 12 weeks after baseline assessment. During follow-up, equal proportions of each group relapsed (> or =21 units/7 day period fo males; > or =14 units/7day period for females). There was a trend for SS clients to have consumed less alcohol in total than the LS clients. The trend was towards improvement in the study measurements for the SS group, though none of the changes was significant. In the LS group, all variables tended towards a deterioration in health status. The longer stay did not appear to confer any extra benefit to the LS group. Cannabis use and illicit drug use at baseline, while commoner in the LS group, did not predict drinking or social adjustment in the follow-up period in this sample and thus could not be used to explain the lack of a better outcome in the LS group.

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