Barriers to endoscopic colorectal cancer screening: are women different from men?

OBJECTIVES: The goals of this study were to compare women and men's understanding of screening flexible sigmoidoscopy (FS) and to identify predictors of endoscopic colorectal cancer (CRC) screening. METHODS: We mailed a 36-item questionnaire to asymptomatic patients aged 50 years or older who were scheduled for routine health assessments at a large multispecialty health-care group. Data collection included demographics, health behaviors, psychosocial factors, and CRC screening compliance. We followed participants for 1 year and assessed completion of endoscopic CRC screening. Both cross-sectional results examining previous screening and prospective results examining screening 1 year later were evaluated. RESULTS: 554 (54%) of 998 patients responded to the survey. Responses of 13 patients were excluded in the analyses due to unverifiable screening outcome. The majority of the respondents were white, and their average age was 62 years. Women reported significantly more embarrassment and fear about having FS than men. Women were more willing to consider having a FS if a female endoscopist performed the procedure. Of the 334 participants who were eligible to have endoscopic CRC screening, 53 (16%) had the procedure within a year. The odds of having the endoscopic procedures increased with the length of time the patients were under the care of their primary care providers and how strongly patients believed that one should have an FS even without symptoms. CONCLUSION: Our findings suggest some unique gender-specific attitudes and beliefs that act as potential barriers for CRC screening and further support the important role of primary care providers in facilitating timely completion of screening.     

Stereotaxic localization of corticosterone to the amygdala enhances hypothalamo-pituitary-adrenal responses to behavioral stress

The amygdala is involved in behavioral, autonomic, and neuroendocrine responses to stressful stimuli. The goal of the current study was to determine the effect of directly elevating glucocorticoids in the amygdala on hypothalamo-pituitary-adrenocortical (HPA) responses to the elevated plus maze, a behavioral stressor known to activate the amygdala. Micropellets (30 microg) of crystalline corticosterone or cholesterol (control) were implanted bilaterally at the dorsal margin of the CeA in male Wistar rats; vascular catheters were also placed at this time. Five days post-surgery, blood samples were drawn at 07:00 and 19:00 h to assess diurnal rhythm of plasma corticosterone. At 7 days post-implantation, rats were subjected to behavioral stress using an elevated plus maze and blood was collected 15 min prior to stress, and at 15, 45, and 90 min after the initiation of the stressor. Corticotropin releasing factor (CRF) and arginine vasopressin (AVP) mRNA levels were analyzed by in situ hybridization in the medial parvocellular division of the hypothalamic paraventricular nucleus (mpPVN) in corticosterone- and cholesterol-implanted rats either not exposed to the elevated plus maze (control) or 4 h post-behavioral stress. Localization of corticosterone to the amygdala had no effect on diurnal rhythm of corticosterone secretion. Behavioral stress significantly increased peak plasma corticosterone levels in both groups to a similar level. However, in the corticosterone implanted rats, plasma corticosterone concentrations at 45 and 90 min post-stress were significantly greater compared to control rats indicating a prolonged corticosterone response to behavioral stress. In non-stressed rats, corticosterone delivery to the amygdala elevated basal CRF mRNA in the mpPVN to levels similar to those observed post-stress in control animals; no further increase was observed in CRF mRNA following stress. Behavioral stress resulted in a significant elevation in CRF mRNA in cholesterol controls. Basal AVP mRNA levels were unaffected by corticosterone implants. AVP mRNA did not increase in cholesterol implanted rats in response to behavioral stress. However, AVP mRNA levels were higher in corticosterone implanted rats post stress compared to cholesterol treated controls. In conclusion, direct administration of corticosterone to the amygdala increases plasma corticosterone in response to a behavioral stressor without altering the diurnal rhythm in plasma corticosterone. Elevated basal levels of mpPVN CRF mRNA, and the induction of a mpPVN AVP mRNA response to the behavioral stressor implicate enhanced ACTH secretagogue expression in the increased HPA response to corticosterone modulation of amygdala function.     

Ex-professional association footballers have an increased prevalence of osteoarthritis of the hip compared with age matched controls despite not having sustained notable hip injuries

OBJECTIVE: To compare the prevalence of self reported, physician diagnosed osteoarthritis (OA) of the hip in ex-professional footballers with that in age matched controls in the general public. METHOD: A questionnaire was sent to the 92 football league and premiership managers to assess the prevalence of OA of various joints. The prevalence of OA of the hip in those managers that were ex-professional footballers was assessed. Radiographic controls were obtained and used to assess the prevalence of OA of the hip in the general population. The results of the two groups were compared statistically using chi(2) tabulation. RESULTS: Seventy four (80%) of the managers responded to the questionnaire. Nine of the 68 ex-professional footballers who replied had OA of the hip, and six of these had undergone a total of eight total hip replacements. Of the 18 managers who did not respond, 12 were known to be ex-professionals. In the control group of 136, two had OA of the hip. The two groups differed significantly (p<0.001). The odds ratio for OA of the hip was 10.2 (95% confidence interval 2.1 to 48.8). CONCLUSION: The ex-professional footballers had a significantly higher prevalence of OA of the hip than an age matched group of radiographic controls.     

Radiology-Pathology Conference: Xanthogranulomatous cholecystitis

We report the radiology and pathology of a patient with xanthogranulomatous cholecystitis (XC) and review the literature on this unusual condition.     

Impact of diet-induced weight loss on the cardiac autonomic nervous system in severe obesity

OBJECTIVE: To determine the impact of diet-induced weight loss on cardiac autonomic nervous system modulation and arrhythmias in subjects with severe obesity and the influence of a high-fat or a high-carbohydrate diet regimen on heart rate variability in reduced-obese individuals. RESEARCH METHODS AND PROCEDURES: Eight severely obese subjects (BMI > or = 40.0 kg/m(2)) underwent a 3-month weight loss program followed by a 3-month reduced-weight maintenance regimen. Thereafter, each subject was admitted for an inpatient period of 17 days on two separate occasions. A high-carbohydrate (60%) or high-fat (55%) diet of appropriate energy content for weight maintenance was prescribed during each inpatient phase. Heart rate variability was derived from a 24-hour Holter monitoring system in all subjects during their inpatient stay. Cardiac Holter monitoring was performed at three occasions (baseline, diet phase I, and diet phase II), including the second night of a two overnight calorimetry chamber stay. RESULTS: After the diet regimen, there was a 10% decrease in weight. There were no significant changes in systolic and diastolic blood pressure, arrhythmias, glucose, insulin, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, respiratory exchange ratio, and resting energy expenditure between experiments. Mean heart rate was lower after weight loss compared with baseline (p < 0.001). After weight loss, there was an increase in the parasympathetic indices of heart rate variability showing an increase in cardiac vagal modulation (all p < 0.05). DISCUSSION: Weight loss is associated with significant improvement in autonomic cardiac modulation through enhancement of parasympathetic modulation, which clinically translates into a decrease in heart rate.     

Evaluation of the nonneoplastic pathology in tumor nephrectomy specimens: predicting the risk of progressive renal failure

Pathologic changes in nonneoplastic renal parenchyma of nephrectomy specimens for renal tumors and the significance of these changes with regard to the outcome of contralateral kidney function have not been studied previously. We examined the nonneoplastic renal parenchymal changes in 110 consecutive tumor nephrectomy specimens, and we correlated our findings with patients' clinical information. The material was examined for the presence of any glomerular, tubulointerstitial, or vascular pathology. In our analysis, only about 10% of cases had unremarkable renal parenchyma and vasculature. A further 28% of cases had unremarkable parenchyma, but some degree of vascular sclerosis was noted. The remaining cases (>60%) had evident pathologic abnormalities, most commonly related to vascular disease or diabetes mellitus. Regardless of the type of renal cancer they have, the majority of our cases can be placed in one of three principal groups: 1) unremarkable kidney parenchyma, with or without vascular sclerosis (38%); 2) parenchymal scarring and marked vascular changes, including cases of atheroembolic disease, and chronic thrombotic microangiopathy (28%); and 3) changes related to diabetes mellitus, such as glomerular hypertrophy, mesangial expansion, and diffuse glomerulosclerosis (24%). Follow-up data on serum creatinine 6 months postoperatively were available in a third of our patients. Patients with severe histopathologic findings (parenchymal scarring with >20% global glomerulosclerosis and advanced diffuse diabetic glomerulosclerosis) showed a significant change in serum creatinine from the preoperative period to 6 months after radical nephrectomy (P=0.001), indicative of progressive worsening of renal function; this change is significantly greater than that seen in patients with unremarkable renal parenchyma (P=0.01). We conclude that adequate examination of nonneoplastic renal parenchyma is an important tool in recognizing patients at risk for progressive renal disease after nephrectomy and could be an essential step in providing early preventive and treatment measures and better medical care of patients undergoing nephrectomy for neoplastic processes.