Diffusion-weighted magnetic resonance imaging in the management of cholesteatoma.

Diffusion-weighted (DW) MRI has recently increasingly gained popularity in the diagnosis of post-operative cholesteatoma. The aim of this study is to prospectively evaluate the usefulness of echo-planar imaging (EPI) for the diagnosis of residual cholesteatoma. Fifty patients underwent DW-EPI before surgery. Fifteen patients had a scan before their first surgery and 35 patients underwent neuroimaging prior to their second look surgery. In the first preoperative group of 15 patients, DW-EPI confirmed cholesteatoma in all the patients. In the post-operative group DW-EPI identified or excluded cholesteatoma correctly in 29 out of 35 patients. Our study has demonstrated a sensitivity of 83% and specificity of 82% of DW-EPI for the diagnosis of residual cholesteatoma. DW-EPI can be a value imaging modality and may help the surgeon in selecting patients for revision surgery.

Short and long multiple-choice question stems in a primary care oriented undergraduate medical curriculum.

In this study Year 1 students in a new, primary care-oriented undergraduate course were offered a practice multiple-choice question (MCQ) examination with two question item formats--with and without brief primary care-based clinical scenarios--with the same correct answers. Data collected included: completion time; number correct; and responses to a questionnaire seeking student perception on the time required, clarity, ease of choice, and curriculum relevance. The mean scores for both groups of students were no different, although about 20% more time was required to complete clinical scenario stem question sets. Students perceived that the clinical scenarios had little effect on choosing the correct answer, improved question clarity and increased relevance to the curriculum. This study suggests that it is possible to assess junior medical students studying integrated undergraduate medical curricula by using MCQs containing brief clinical scenario stems, so long as either item numbers or timing are adjusted. This item format better reflects the learning process and may better prepare students for later professional practice assessment. GPs have an important role in developing assessment items that reflect early clinical integration.

The surgical approach to retrosternal goiters: the role of computerized tomography.

OBJECTIVE: To assess preoperative CT scans of patients with a retrosternal goiter, with an objective of identifying features that are likely to predict the need for sternotomy at operation. STUDY DESIGN AND SETTING: A retrospective review of clinical notes and CT scans of patients who underwent thyroidectomy for retrosternal goiter at a large district general hospital in the United Kingdom between 1998 and 2002. RESULTS: Extension of the goiter to the level of the aortic arch, particularly when combined with tracheal involvement or major vessel displacement, increases the likelihood of requiring median sternotomy. CONCLUSIONS: Most retrosternal goiters can be approached through a cervical incision alone. However, extension of the goiter to the level of the aortic arch does appear to increase the likelihood of requiring sternotomy. SIGNIFICANCE: In such cases in which sternotomy is anticipated, the availability of cardiothoracic services would be helpful to avoid patient morbidity.

Malformaçöes vasculares do canal vertebral: estudo comparativo com ressonância magnética e angiografia em 17 casos / MRI appearances of intraspinal vascular malformations: review of 17 cases in comparative study with angiography

As malformaçöes vasculares do canal vertebral säo lesöes relativamente infreqüentes e a avaliaçäo dessas lesöes por ressonância magnética tem sido advogada como o melhor método diagnóstico de "screening" atualmente disponível. No presente trabalho, os autores apresentam 17 casos de malformaçöes vasculares do canal vertebral analisados retrospectivamente e classificados em dois grupos: grupo I, que inclui 12 casos de informaçöes vasculares angiograficamente diagnosticadas, e grupo II, com cinco casos de lesöes angiograficamente ocultas (angiomas cavernosos). Em todos os casos foram realizados exames de ressonância magnética e angiografia espinhal. Nas lesöes do grupo I os autores däo ênfase às características anatômicas das lesöes encontradas, tais como a presença de um ninho vascular nas malformaçöes arteriovenosas, localizaçäo do ponto de fístulas arteriovenosas e análise das alteraçöes medulares. No grupo II, a elevada sensibilidade da ressonância do diagnóstico dessas lesöes foi confirmada por meio de cirurgia em três dos cinco casos.