As you may have inferred from the dearth of timely updates, I have been quite busy with non-blogging responsibilities. Such is usually the case, but April and May have been particularly hectic months, as I am inundated with manuscript deadlines–on top of other professional and personal responsibilities. I am nevertheless pleased to have made some progress: I submitted a preliminary research draft a few weeks ago, and completed the final version of another manuscript today. There are still a few more items in the pipeline.

Naturally, On The Wards takes a back seat during these time crunches. I suspect that for the millionth-and-second time I will need to revisit my time management strategies and contemplate how On The Wards will fit into the grand scheme of life.

The Digital Pathology Blog (”a weblog for the digital pathology community and laboratory professionals”) hosts today’s edition of the Medicine 2.0 blog carnival, which derives its name from the “Web 2.0″ reference to current trends in Internet design and technologies. Not surprisingly, the carnival focuses on Internet-based technologies applied in the health care industry. On The Wards makes a brief appearance with our February report on the collaboration between Google Health and the Cleveland Clinic.

The venerable MedBlogs Grand Rounds circulates every Tuesday, which coincidentally falls on April Fools Day this year. Today’s edition (4.28) is primarily hosted by GruntDoc. As an added twist to commemorate this foolhardy occasion, GruntDoc conspired with a few other medical bloggers to scatter the featured articles among multiple sites. The purposeful chaos is reminiscent of a carnival-like atmosphere where the multitude of loud, flashy booths are scattered throughout the carnival grounds (how appropriate for a blog carnival).

Our article for this week’s Grand Rounds discusses low colonoscopy screening rates and can be found at Musings of a Distractible Mind. The distractible Dr. Rob hosts part 6 of “Mutant Grand Rounds”, where he includes pictures of oversized or overcolored mutants. He jokingly posits “the dangers these mutants pose are beyond description”. He follows …

The same can be said for insufficient screening for colon cancer. This is raised in the blog On the Wards. Who is to blame for such poor screening in our society? Katie Couric? Alan Thicke? Nick Genes? No, it is the physician who need to be identifying those at risk and encouraging colonoscopy.

This is quite an amusing yet discombobulating Grand Rounds, quite appropriate for April Fools Day. If you have no idea what I just presented above, don’t worry. I’m still left dazed and confused myself.

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.

Read more … »

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