Knowledge Only (knowledge + only)

Distribution by Scientific Domains

Selected Abstracts

Redefining Emergency Medicine Procedures: Canadian Competence and Frequency Survey

FRCPC, Ken Farion MD
Objective: To redefine the Royal College of Physicians and Surgeons (RCPS) procedural skills list for Canadian emergency medicine (EM) residents through a national survey of EM specialists to determine procedural performance frequency and self-assessment of competence. Methods: The survey instrument was developed in three phases: 1) an EM program directors survey identified inappropriate or dated procedures, endorsing 127 skills; 2) a search of EM literature added 98 skills; and 3) an expert panel designed the survey instrument and finalized a list of 150 skills. The survey instrument measured the frequency of procedure performance or supervision, self-reported competence (yes/no), and endorsement of one of four training levels for each skill: undergraduate (UG), postgraduate (PG), knowledge only, or un-necessary (i.e., too infrequently performed to maintain competence). Results: All 289 Canadian EM specialists were surveyed by mail; 231 (80%) responded, 221 completed surveys, and 10 were inactive. More than 60% reported competence in 125 (83%) procedures, and 55 procedures were performed at least three times a year. The mean competence score was 121 (SD 17.7, median = 122) procedures. Competence score correlation with patient volume was r= 0.16 (p = 0.02) and with hours worked was r= 0.19 (p = 0.01). Competence score was not associated with year or route (residency vs grandfather) of certification. Each procedure was assigned to a training level using response consensus and decision rules (UG: 1%; PG: 82%; unnecessary: 17%). Conclusions: A survey of EM clinicians reporting competence and frequency of skill performance defined 127 procedural skills appropriate for Canadian RCPS postgraduate training and EM certification. [source]

Leiomyosarcoma of the Penis Presenting as a Cutaneous Lesion

Thomas L. Cibull
We report a case of a 68-year-old man with cutaneous leiomyosarcoma of the penis. Leiomyosarcoma of the penis is an extremely rare neoplasm that usually presents in middle to old age, and to our knowledge only approximately 30 cases have been reported in the literature to date. This is an important diagnosis in the differential diagnosis of cutaneous spindle cell neoplasms of the male genital tract. [source]

Familial cerebral cavernous haemangioma diagnosed in an infant with a rapidly growing cerebral lesion

Summary Cavernous haemangiomas of the central nervous system are vascular malformations best imaged by MRI. They may present at any age, but to our knowledge only 39 cases in the first year of life have previously been reported. A familial form has been described and some of the underlying genetic mutations have recently been discovered. We present the clinical features and serial MRI findings of an 8-week-old boy who presented with subacute intracranial haemorrhage followed by rapid growth of a surgically proven cavernous haemangioma, mimicking a tumour. He also developed new lesions. A strong family history of neurological disease was elucidated. A familial form of cavernous haemangioma was confirmed by identification of a KRIT 1 gene mutation and cavernous haemangiomas in the patient and other family members. We stress the importance of considering cavernous haemangiomas in the context of intracerebral haemorrhage and in the differential diagnosis of rapidly growing lesions in this age group. The family history is also important in screening for familial disease. [source]

Concurrent xanthogranulomatous orchiepididymitis and seminoma in the same testis

J. Fernando Val-Bernal
Xanthogranulomatous orchiepididymitis (XGO) is a rare inflammatory and destructive disease of the testis that may simulate testicular malignancy. To the authors' knowledge only 19 cases of XGO have been previously reported. Herein is reported the case of a 52-year-old man with XGO who presented with a left testicular mass and pyogenic discharge from the scrotum. Ultrasound examination indicated heterogeneous testicular areas suggestive of neoplasia. Testicular tumor markers were normal. Orchidectomy was performed and histopathology showed XGO and a concurrent, occult typical seminoma. As far as the authors know the coincidence of these two lesions has not been documented previously. XGO may mimic testicular malignancy and may coexist with it. Pathologists should be aware of this concurrence of lesions to avoid potential misdiagnosis. Wide sampling of the orchidectomy specimens with XGO is mandatory to exclude an occult seminoma. [source]