Recurrent Juvenile Nasopharyngeal Angiofibroma Treated with Gamma Knife Surgery

Radiosurgery has been rarely applied for juvenile nasopharyngeal angiofibroma (JNA) and cumulative reports are lacking. The authors report a case of successful treatment of recurred JNA with gamma knife surgery (GKS). A 48-yr-old man was presented with right visual acuity deterioration and brain magnetic resonance images (MRI) disclosed a 3 cm-sized intraorbital mass in the right orbit. He underwent a right fronto-temporal craniotomy and the mass was subtotally removed to preserve visual function. Histological diagnosis confirmed JNA in typical nature. However, the vision gradually worsened to fail four years after operation. MRI then showed regrowth of the tumor occupying most of the right orbit. GKS was done for the recurred lesion. A dose of 17 Gy was delivered to the 50% isodose line of tumor margin. During the following four-year follow-up period, the mass disappeared almost completely without any complications. Usually JNA can be exclusively diagnosed by radiological study alone. So this report of successful treatment of JNA with GKS may provide an important clue for the novel indication of GKS

Do community medicine residency trainees learn through journal club? An experience from a developing country

BACKGROUND: Journal clubs are an internationally recognized teaching tool in many postgraduate medical education fields. In developing countries lack of funds for current print materials may have limited journal club use. But with advancing information technology trainees in developing countries increasingly have more access to high quality journals online. However, we are aware of no studies describing journal club existence and effectiveness in postgraduate medical training in Pakistan. Also we have found no published effectiveness studies of this teaching modality in Community Medicine (Public Health) in any country. This study evaluated the effectiveness of Community Medicine (Public Health) Resident Journal Club (CMR-JC) in Aga Khan University, Pakistan using international criteria for successful journal clubs (2 years continuous existence and more than 50% attendance) and examining resident and alumni satisfaction. METHODS: Journal club effectiveness criteria were searched using electronic search databases. Departmental records were reviewed from September1999–September 2005. Ninety percent of residents and alumni of Community Medicine Residency Programme participated voluntarily in a confidential survey. RESULTS: The CMR-JC was regularly conducted. More than 95% of residents attended. (Total residents in the CMR-Programme: 32). Twenty-seven out of 29 current residents/alumni responded to the anonymous questionnaire. Acquisition of critical appraisal skills (23 respondents) and keeping up with current literature (18 respondents) were the two most important objectives achieved. Respondents recommended improved faculty participation and incorporating a structured checklist for article review. CONCLUSION: CMR-JC fulfils criteria for effective journal clubs. Residents and alumni agree CMR-JC meets its objectives. Incorporating suggested recommendations will further improve standards. The journal club learning modality should be included in residency training programs in developing countries. Effective use of online resources to support journal clubs is demonstrated as a successful alternative to excessive expenditure for obtaining print journals. Those trying to start or improve journal clubs can benefit from our experience

Intensity modulated radiotherapy (IMRT) in the treatment of children and Adolescents - a single institution's experience and a review of the literature

<p>Abstract</p> <p>Background</p> <p>While IMRT is widely used in treating complex oncological cases in adults, it is not commonly used in pediatric radiation oncology for a variety of reasons. This report evaluates our 9 year experience using stereotactic-guided, inverse planned intensity-modulated radiotherapy (IMRT) in children and adolescents in the context of the current literature.</p> <p>Methods</p> <p>Between 1999 and 2008 thirty-one children and adolescents with a mean age of 14.2 years (1.5 - 20.5) were treated with IMRT in our department. This heterogeneous group of patients consisted of 20 different tumor entities, with Ewing's sarcoma being the largest (5 patients), followed by juvenile nasopharyngeal fibroma, esthesioneuroblastoma and rhabdomyosarcoma (3 patients each). In addition a review of the available literature reporting on technology, quality, toxicity, outcome and concerns of IMRT was performed.</p> <p>Results</p> <p>With IMRT individualized dose distributions and excellent sparing of organs at risk were obtained in the most challenging cases. This was achieved at the cost of an increased volume of normal tissue receiving low radiation doses. Local control was achieved in 21 patients. 5 patients died due to progressive distant metastases. No severe acute or chronic toxicity was observed.</p> <p>Conclusion</p> <p>IMRT in the treatment of children and adolescents is feasible and was applied safely within the last 9 years at our institution. Several reports in literature show the excellent possibilities of IMRT in selective sparing of organs at risk and achieving local control. In selected cases the quality of IMRT plans increases the therapeutic ratio and outweighs the risk of potentially increased rates of secondary malignancies by the augmented low dose exposure.</p

An Examination of the Own-Age Bias Using a Visual Search Paradigm

From the Washington University Senior Honors Thesis Abstracts (WUSHTA), Spring 2015. Published by the Office of Undergraduate Research. Joy Zalis Kiefer, Director of Undergraduate Research and Associate Dean in the College of Arts & Sciences; Stacy Ross, Editor; Kristin G. Sobotka, Undergraduate Research Coordinator; Jennifer Kohl. Mentor: Sandra Hal

Optic Nerve-Pettern Electroretinogram

Recently, the electroretinogram (ERG) recorded in response to patterned stimuli (PERG) were shown to be sensitive to pattern contrast and spatial frequency unlike the diffuse flash ERG. These findings coupled with experimental animal work suggest that the PERG reflects functioning of the ganglion cells which are the cell bodies of the axon of the optic nerve. Subjects with optic neuropathies should be ideally suited to this hypothesis. PERG, flash ERG, and visual evoked potentials (VEP) were studied in cases with unilateral optic nerve diseases secondary to tumors or optic neuritis. The PERG was absent in the affected eyes with poor acuity (less than 20/60) while the flash ERG was normal. A second group with acuity better than 20/40 showed reductions in the PERG amplitude of the affected compared to the normal eye. These interocular differences were especially marked when pattern contrast was reduced. Such results underscore the diagnostic value of the PERG in detecting mildly affected cases of optic nerve disease. These findings provide additional evidence regarding the ganglion cell origin of the PERG

The Neurophysiology of Vision

Electrophyslologlcal testing Is often an Important adjunct to the neuro-ophthalmlc examination In a patient with visual loss. This paper reviews techniques and dinlcal applications of electroretinography and visual evoked potential (YEP) recording

Extracts from The Cochrane Library: Antibiotics for acute maxillary sinusitis.

The "Cochrane Corner" is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology-head and neck surgery, with invited commentary to highlight implications for clinical decision making. This installment features a Cochrane Review entitled "Antibiotics for acute maxillary sinusitis," which concludes a small treatment effect in patients with uncomplicated acute sinusitis in a primary care setting with symptoms for more than seven days