Category Archives: Neurology

High-dose aspirin (?500 mg daily) reduces long-term incidence of colorectal cancer, but adverse effects (bleeding) might limit its potential for long-term prevention. The long-term effectiveness of lower doses (75-300 mg daily) is unknown. This study in The Lancet assessed the effects of aspirin on incidence and mortality due to colorectal cancer over 20 years.

In the four trials of aspirin versus control (mean duration of treatment 6 years), 2·8% of 14,000 patients had colorectal cancer during a follow-up of 18 years.

Aspirin reduced the 20-year risk of colon cancer (incidence hazard ratio [HR] 0·76, but not rectal cancer (0·90).

Where subsite data were available, aspirin reduced risk of cancer of the proximal colon (0·45), but not the distal colon (1·10). Benefit increased with duration of treatment - aspirin taken for 5 years or longer reduced risk of proximal colon cancer by 70% and also reduced risk of rectal cancer (0·58).

There was no increase in benefit at doses of aspirin greater than 75 mg daily. However, risk of fatal colorectal cancer was higher on 30 mg versus 283 mg daily.

Aspirin taken for several years at doses of at least 75 mg daily reduced long-term incidence and mortality due to colorectal cancer. Benefit was greatest for cancers of the proximal colon, which are not otherwise prevented effectively by screening with sigmoidoscopy or colonoscopy.

References:
Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. The Lancet, Volume 376, Issue 9754, Pages 1741 - 1750, 20 November 2010.

Decompression illness is caused by intravascular or extravascular bubbles that are formed as a result of reduction in environmental pressure (decompression).

Types of decompression illness

The term decompression illness covers 2 entities:

- arterial gas embolism, in which alveolar gas or venous gas emboli (via cardiac shunts or via pulmonary vessels) are introduced into the arterial circulation

- decompression sickness, which is caused by in-situ bubble formation from dissolved inert gas

Both syndromes can occur in divers, compressed air workers, aviators, and astronauts, but arterial gas embolism also arises from iatrogenic causes unrelated to decompression.

Risk of decompression illness is affected by immersion, exercise, and heat or cold.

Clinical features of decompression illness

Manifestations of this condition include a wide range of symptoms and signs:

Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.

1. Take the stairs as often as possible.
2. Drink plenty of water.
3. Park as far from the front door as possible.
4. Clean your home regularly.
5. Gardening and yardwork.
6. Disconnect your cable for the summer.
7. Buy a pedometer.
8. Use active transportation and public transit.
9. Have “walk-meetings”.
10. Go for a family walk after dinner.

"Health Promotion" video: Benefits of exercise:

From the NYTimes:

The average time patients spend waiting to see a health-care provider is 22 minutes. Orthopedists have the longest waits, at 29 minutes; dermatologists the shortest, at 20.

Patient satisfaction dropped significantly with each 5 minutes of waiting time. Even the term "waiting room" has a bad connotation. Many offices prefer "reception area" instead.

"I live my life in seven-minute intervals," says Laurie Green, a obstetrician-gynecologist in San Francisco who delivers 400 to 500 babies a year and says she needs to bring in $70 every 15 minutes just to meet her office overhead.

Measures the health-care industry is trying to minimize waiting time include:

- "Open-access" scheduling
- Minimize office visits
- Advance preparation
- Huddling up: "Mr. Jones is in a 15-minute slot, but we know he's a 45-minute guy"
- Teamwork
- Cutting "cycle time"
- Keep patients informed
- Survey patients

References: