Renal Cell Carcinoma Presenting as an Isolated Eyelid Metastasis.

Background: Renal cell carcinoma (RCC) has a propensity to metastasize with the most common sites of metastasis being the lungs and bones. Cutaneous metastasis of RCC to the eyelid is exceedingly rare, with only six cases reported in the past decade. We are reporting a case of metastatic renal cell carcinoma (mRCC) that presented with a painless eyelid mass. Case Presentation: We describe a case of a 66-year-old man with a history of chronic kidney disease stage III presenting with a rapidly growing left lower eyelid lesion thought to be a capillary hemangioma. Biopsy revealed polygonal clear cells with small central nuclei with thin-walled vasculature and strong immunostaining with PAX8 consistent with mRCC, clear cell type. Subsequent abdominal CT scan revealed a 5.1 × 4.7 × 4.3 cm heterogeneously enhancing mass with central necrosis in the upper pole of the left kidney. The patient was treated with excision of the eyelid lesion followed by robotic partial nephrectomy of the primary tumor. Follow-up CT scan at 3 and 6 months showed no evidence of recurrence. Conclusion: Isolated eyelid metastasis is an extremely rare form of presentation of mRCC. Interestingly, that patient did not have any other site of metastasis. Cytoreductive partial nephrectomy has been previously reported to be oncologically safe in selected patients.

Reimbursement Incentives to Improve Adherence to Follow-Up of Cervical Cancer Cytology Screening Results in Peru.

OBJECTIVE: The purpose of this study was to determine Peruvian women's attitudes toward novel reimbursement incentives used to improve adherence to obtaining cervical cytology test results. MATERIALS AND METHODS: Women presenting for cervical cancer screening in Peru completed a 34-item Investigational Review Board-approved questionnaire. The questionnaire determined their attitudes toward various reimbursement incentives to improve adherence to obtaining cervical cytology results. Descriptive statistics, generalized linear models, and Kruskal-Wallis tests were used in the analyses. RESULTS: Completed questionnaires were available for 997 women. Most women (51%) would be more likely to return for their Pap result if an incentive was provided, 79% (759/956) agreed that they would pay for the Pap test, and 51% (402/859) would be willing to pay 10 Soles or less. Quechua-speaking women considered follow-up more difficult (p < .0001) but were less likely to return for their Pap results (p < .0001), pay for the Pap test (p < .0001), and afford paying more than 5 Soles (p < .0001) than women who spoke Spanish or both languages. More women who earn 1000 Soles/year or less would likely return if incentivized (p < .0001), felt the incentive would help them remember to return (p = .0047), and would be willing to pay whether there was a rebate (p = .010) as compared with women earning more money. CONCLUSIONS: A reimbursement incentive program designed to improve follow-up of cervical cytology test results was acceptable to most Peruvian women. Such a behavioral-modifying program may improve patient follow-up after cervical cytology testing. Implementation may reduce the morbidity and mortality of cervical cancer in remote regions of the country.

Comparing the Use of Single vs. Multiple Combined Abilities in Conducting Complex Computer Tasks Hands-free.

OBJECTIVE: Assistive technologies often focus on a remaining ability of their users, particularly those with physical disabilities, e.g. tetraplegia, to facilitate their computer access. We hypothesized that by combining multiple remaining abilities of the end users in an intuitive fashion, it is possible to improve the quality of computer access. In this study, 15 able-bodied subjects completed four computer access tasks without using their hands: center-out tapping, on-screen maze navigation, playing a game, and sending an email. They used the multimodal Tongue Drive System (mTDS), which offers proportional cursor control via head motion, discrete clicks via tongue gestures, and typing via speech recognition simultaneously. Their performances were compared against unimodal tongue gestures (TDS), and Keyboard & Mouse combination (KnM), as the gold standard. RESULTS: Center-out tapping task average throughputs using mTDS and TDS were 0.84 bps and 0.94 bps, which were 21% and 22.4% of the throughput using mouse, respectively, while the average error rate and missed targets using mTDS were 4.1% and 25.5% less than TDS. Maze navigation throughputs using mTDS and TDS were 0.35 bps and 0.46 bps, which were 16.6% and 21.8% of the throughput using mouse, respectively. Participants achieved 72.32% higher score using mTDS than TDS when playing a simple game. Average email generating time with mTDS was ~2x longer than KnM with a mean typing accuracy of 78.1%. CONCLUSION: Engaging multimodal abilities helped participants perform considerably better in complex tasks, such as sending an email, compared to a unimodal system (TDS). Their performances were similar for simpler task, while multimodal inputs improved interaction accuracy. Cursor navigation with head motion led to higher score in less constrained tasks, such as game, than a highly constrained maze task.