NEJM 14 Dec 2006

2513 Apart from the threat posed by a new strain of pandemic influenza, there’s the irksome fact of antigenic drift in existing subtypes of influenza A, which means that most circulating viruses are now dissimilar to those included in the vaccines. But this big US study shows that they are nonetheless still protective, the inactivated vaccine a bit more so than the live attenuated vaccine.

Most influenza vaccine is still given to protect at-risk individuals, but there are some who argue that we could do more good by encouraging wider vaccination and so creating herd immunity (see editorial). The chosen calves of the herd in this study were children at 28 infant of elementary schools in two American states, and the families of immunised children duly showed a slight reduction in flu-like illnesses. But if you want the idea to work properly, I’d suggest you give intranasal flu vaccine at school, with sneezing powder for use at home.

The advent of screening colonoscopy puts a premium on speed on the part of the colonoscopist, and this is often welcomed by their victims too. In this study, colonoscopists dallied in the bowel for anything between three minutes and seventeen after making their way to the caecum and without removing any polyps. Those who spent less than six minutes were more likely to miss adenomas than those who went a bit more slowly. For more about adenomatous polyps of the colon, see this article.

As medical students, we were taught to spot acromegaly by its combination of coarse features, big hands and large shoe sizes. This sometimes caused confusion when we first encountered orthopaedic surgeons. People with growth-hormone secreting adenomas are often only recognised at an advanced stage of their disease, as this useful review points out. The diagnosis is made by measuring circulating levels of growth hormone, and the treatment is still usually transsphenoidal surgery. There are a number of medical treatments too, which you might like to look up if you have a patient with the condition.