A Practical Review of the Diagnosis and Management of Small Renal Masses

Stanley A. Yap,¹ Shabbir M.H. Alibhai,^2,3Antonio Finelli,^1
1Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada. ²Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. ³Department of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract
The incidence of small renal masses (SRMs) has risen steadily over time, and SRMs now represent the majority of newly diagnosed renal lesions. Approximately 80% of newly diagnosed SRMs will be malignant. However, identifying a benign versus malignant lesion non-invasively can be difficult since no distinct imaging characteristics or growth patterns exist between the two. We have witnessed concurrent improvements in treatment strategies for small, localized tumors and have gained a better understanding of their natural history. Along with these changes there has been a shift in the manner in which we diagnose and treat SRMs. Although surgery remains the standard of care, we can now offer a variety of therapies individualized to the patient.
Keywords: kidney cancer, small renal mass, diagnosis, treatment.

From Science to Smartphones: Boosting Memory Function One Press at a Time

Eva Svoboda, PhD,^1,2 Gillian Rowe, PhD,^1,2 Kelly Murphy, PhD,^1,2
1Neuropsychology and Cognitive Health Program, Baycrest Centre, Toronto, ON.
²Department of Psychology, University of Toronto, Toronto, ON.

Abstract
Memory problems can be devastating as they limit independent functioning and disrupt social, family, and occupational roles. One form of remembering, prospective memory - remembering to attend to a task or event in the future—is particularly vulnerable to disruption. Fortunately memory is not a singular ability and patients can learn to compensate for memory difficulties by using preserved memory systems. Combining smartphone technology with appropriate training techniques has been shown to be effective in supporting prospective memory function even in individuals with amnesia. We have evidence that such technology may be used in a similar fashion to promote memory in mild cognitive impairment with the aim of delaying or preventing dementia onset. Even in dementia, memory training or support in forming new habits and routines which tap into preserved memory systems can be effectively used to help patients learn new names, reduce repetitive questions and remain oriented to the present. The best prevention is early intervention. Older adults presenting with memory complaints, no matter how mild, should be directed to maintain, reestablish, or institute habits of organization and written reminders, both to support current memory functioning and to preserve functional independence into the future should their concerns turn out to be the early manifestations of a neurodegenerative condition.
Keywords: amnesia, technology, dementia, mild cognitive impairment, memory intervention.

“Acute Tonsillitis”—if Left Untreated Can Result in Severe Fatal Complications

A Clinical Presentation and Review of the Literature

Pradeep K. Shenoy, MD, DLO, FRCS, FACS, ENT Service Chief, Campbellton Regional Hospital, NB, Campbellton, Canada.

Abstract
A case of acute tonsillitis is reported where proper antibiotic treatment was not given because of a negative throat culture, and the patient presented with complications. Review of the literature regarding acute tonsillitis, its presentation, treatment and various complications are discussed.
Keywords: acute tonsillitis, throat swab, peritonsillar abscess, retropharyngeal abscess, parapharyngeal abscess, GABHS, MRSA, PANDAS, Lemierre’s syndrome.

Editor's Note, Volume 2 Issue 4

Recognizing Dementia can be Tricky

Kelly J. Murphy, PhD, C.Psych., Neuropsychologist, Neuropsychology & Cognitive Health, Baycrest; Assistant Professor, Psychology, University of Toronto.
Angela K. Troyer, PhD, C.Psych, Professional Practice, Chief of Psychology, Baycrest, Assistant Professor, Psychology, University of Toronto.

Abstract
Dementia is characterized by multiple cognitive impairments that cause significant functional decline. Based on this brief definition, the initial expectation might be that recognizing dementia in a patient is straightforward. Not true. Recognizing dementia can be tricky, particularly in patients who present as alert, socially appropriate, and capable of providing reasonable answers to questions. We briefly outline signs on casual observation that would prompt investigation into a patient's current cognitive and functional status to determine the presence of dementia during a routine visit. Approaches to screening for cognitive and functional decline are described along with first-step recommendations to connect patients and families with resources. The front-line clinician plays a pivotal role in identifying dementia with earlier intervention having the most potential to offset the burden on patients, families, and society.
Keywords: dementia, activities of daily living, functional decline, cognitive decline.