Earlier this month, I presented the updated colon cancer screening guidelines and commented how virtual colonoscopy may improve screening rates due to its less invasive nature than the traditional colonoscopy. My premise was that patient discomfort served as a primary deterrent to higher rates of colonoscopy use. Data from a recently published Vanderbilt study, however, beg to differ and suggest that other factors account for the inadequate rates of colon cancer screening in the United States.

The study population was derived from the Southern Community Cohort Study (SCCS), a large research endeavor to characterize cancer trends and disparities across racial and socioeconomic backgrounds. The group comprises 51,454 patients (ages 40-79 years) collected from 48 community health centers. The exclusion criteria for this particular study included the following: race other than African-American or Caucasian; uncertainty of whether the patient has had a sigmoidoscopy or colonoscopy; and, uncertainty of family cancer history. This left 41,830 participants, who were surveyed on personal demographics, personal history of colorectal polyps, family history of colon cancer, patterns of undergoing screening endoscopy, and last visit to a health care provider.

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The figurative use of the word “airhead” originated in the late 1970’s and signified a simple-minded or stupid person. But what are the characteristics of the literal “airhead” (or in medical jargon, pneumocephalus)? Does this person also exhibit similar deficits in cognitive function?

The New England Journal of Medicine recently featured the case of an Argentinian patient who spontaneously developed the so-called pneumocephalus. She is a 54 year-old woman who experienced progressive visual, auditory, and speaking abnormalities. A head radiograph demonstrated an air pocket along her left temporal region (enlarged image). A computed tomography (CT) scan revealed similar findings, with the pocket measuring 4 cm x 3 cm x 5 cm. There was no evidence of fracture or trauma.

The cause of the woman’s sensory and speech deficits can be explained by the air compressing against her brain, with indirect compromise of her brainstem. Her symptoms resolved soon after undergoing neurologic surgery to decompress the air and to repair a defect in an adjacent bone (mastoid). No tumor or infection was noted. Although most cases of pneumocephalus occur secondary to head trauma, it is possible the mastoid bone defect discovered during surgery may have been the source for air to enter the skull.

On a lighter note, the next time someone accuses you of being an airhead, you could refute him figuratively and literally with the following response: “I do not manifest the typical characteristics of pneumocephalus”.

• Sources
• Villa RA, Capdevila A. Spontaneous otogenic pneumocephalus. NEJM 2008;358:e13.
• Image Copyright: New England Journal of Medicine

Today is Residency Match Day, the moment when over 20,000 applicants learn where they have “matched” to pursue residency training come July. For the uninitiated, here are more articles on match day and the residency match process.

You can imagine the amount of jubilation surrounding this event. Stress- and anxiety-ridden medical students discover the light that follows their four years of slavery through medical school (little do they know that the slavery continues into residency, but let’s not spoil the moment). Families proudly rejoice the significant achievements of their loved ones. Friends find another reason to capture the excitement over a pint or two. And then … there are the overworked, overstressed, over-everything interns who look forward to their replacements arriving soon.

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On The Wards participates in this week’s Grand Rounds with our report on the weight loss management (WLM) clinical trial. Version 4.26 of Grand Rounds is hosted at Polite Dissent, and comes packaged with a theme of the Wild Wild West. The blog’s author is a family physician from Southwestern Illinois whose love for comics is also apparent in his other writings. Many previous posts provide excerpts of medical themes found in traditional comic book genres. This is indeed a unique and interesting feature of his blog.

It almost seems that a million-and-one books are published everyday touting the secret to rapid and sustained weight loss. But, how many of these diet schemes have been verified to produce the results they advertise? In the latest JAMA (Journal of the American Medical Association) issue, a group of academic centers involved in the Weight Loss Maintenance (WLM) initiative published their results from a three-year study comparing strategies for sustaining weight loss. The project is sponsored by the National Heart, Lung, and Blood Institute (NHLBI), and includes four clinical centers: Duke University, Johns Hopkins University, Pennington Biomedical Research Center, and the Kaiser Permanente Center for Health Research.

The design of the WLM clinical trial involves two phases. Phase 1 comprises a 6-month period where all participants undergo similar intervention to obtain weight loss. Working closely with a trained interventionist, the group strives to achieve a weekly weight loss goal of 1-2 pounds per week through a combination of strategies, such as caloric reduction, dietary modification, and increased physical activity. After having lost weight in phase 1, participants in the 30-month phase 2 trial are randomly divided into three groups, each with a different level of intervention to encourage maintenance of weight loss: 1) minimal intervention; 2) technology-based intervention, with use of an interactive website which sets personal goals, action plans, and provides an online support community; and 3) personal-contact intervention, involving monthly contact with a weight-loss interventionist.

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TechCrunch, a technology blog focused on Internet-related products and companies, reports on the brewing partnership between Healthline (medical information portal) and Aetna (health insurance company) to create a personalized health portal. Similar to the Google and Cleveland Clinic deal, Healthline will benefit from a rapid infusion of new users, comprising the thousands of individuals insured by Aetna. It is unclear what Aetna gains from this marriage, as additional details surrounding the collaboration are yet sparse. It seems that dynamic duos are now the trend to remain competitive in the personal health record (PHR) industry.

Related Posts:

• Google Health collaborates with Cleveland Clinic
• Industry giants vie for your online health records

Late last year, I met my new 64 year-old clinic patient who just moved into town. During a brief discussion about preventive health, I asked her when she had her last colonoscopy for colon cancer screening. She emphatically responded: “Never. I will probably be dead in 10 years anyway [from an unrelated cause]“. Her view on life may have been surprising, but her reluctance to obtain a colonoscopy wasn’t. Who could blame her? The prospect of having a scope inserted into the rectum and advanced through the colon is not appealing. Fortunately, there are alternate modalities for colon cancer screening, two of which (stool DNA and virtual colonoscopy) have just been added to official guidelines.

A consortium of specialty organizations (American Cancer Society, US Multi-Society Task Force on Colorectal Cancer, and American College of Radiology) recently published in CA: A Cancer Journal for Clinicians¹ the first consensus guidelines for colorectal cancer (CRC) screening. The guidelines are designed for asymptomatic average-risk adults over the age of 50; these criteria exclude individuals with a personal or family history of CRC, adenomas, inflammatory bowel disease (IBD), or other genetic risk factors.

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