Clinico-Pathological Quiz

Dr. Pradeep Shenoy, MD, DLO, FRCS, FACS, is the ENT service chief, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.
Dr. Lyew Warren, MD, FRCSC, Consultant Pathologist, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.

Abstract
A case of a fleshy, granular, pedunculated growth from the oral cavity will be presented. A differential diagnosis of similar growths from the oral cavity and the treatment options will be discussed.
Key Words: congenital epulis, epulis fissuratum, granular cell tumour, immunohistochemistry S-100, vimentin, neurone specific enolase, CO2 laser excision.

A Strange Looking Toenail

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Green nail syndrome is a paronychia caused by Pseudomonas aeruginosa. The affected toenail may show discoloration that ranges from greenish-yellow, greenish-brown, and greenish-black. Differential diagnosis includes other conditions causing nail plate discolouration such as subungual hematoma, malignant melanoma or infections by other pathogens including Aspergillus, Candida, and Proteus. Gram stain and culture of the subungual scrapings confirm the diagnosis of suspected pseudomonas aeruginoa infection. Topical antibiotics, such as bacitracin, silver sulfadiazine, or gentamicin, applied 2 to 4 times daily will treat most patients within 1 to 4 months. Oral ciprofloxacin for 2 to 3 weeks has been successful in treating patents who fail topical therapies.

Identification of Potential or Preclinical Cognitive Impairment and the Implications of Sophisticated Screening with Biomarkers and Cognitive Testing

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

The last decade has seen an enormous growth in the interest in the recognition of and intervention in those diagnosed and living with the whole range of cognitive impairment and frank dementia. In the western world, the recognition of the impact on patients, families, health care systems, and societies that dementia poses has led to great efforts to help define the indicators for current and future dementia with the intention to treat those already afflicted even with the primarily symptomatic medications that exist and to recognize those at future risk with the hope of providing counselling to forestall its future development. The idea of "early diagnosis" appears at first glance to be attractive for the purposes of future planning and research studies, but it is not clear what the benefits and risks might be if screening processes define people at risk when beneficial interventions might not yet be determined. The ethical as well as financial implications must be explored and defined before implementation of such screening becomes a normal standard of practice.practice.
Key Words: cognitive impairment, dementia, screening, biomarkers, cognitive testing.

Cholesteatoma with Right Facial Paralysis A Case Report

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

Dr.K.B.Bali, MBBS, MS, FACS, Senior ENT Specialist, Al Ain Hospital, Al Ain, UAE.

Abstract
Cholesteatoma is a benign growth of skin in abnormal location such as the middle ear or the petrous apex which is located deep in the inner ear and is known to cause a variety of complications. We describe a patient with a cholesteatoma who had right facial paresis that improved after the removal of the cholesteatoma. Review of the literature regarding cholesteatoma is discussed.
Key Words: cholesteatoma, labrynthine fistula, facial paresis, attic defect, primary acquired, secondary acquired.

The Cost of Dementia in the United States

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

The prevalence of dementia appears to be increasing in most western countries. That when coupled with the increased average age of the older population has leads to an expectation that projections of financial costs to individuals, families and to society will grow over the next few decades. The current study, out of the United States, based on a number of robust data bases coupled with in-depth interviews has resulted in projections of the current true costs of caring for elderly people living with dementia. It also allowed for the projection of future costs over the next three decades. The results are quite mind-boggling: "We found that dementia leads to total annual societal costs of $41,000 to $56,000 per case, with a total cost of $159 billion to $215 billion nationwide in 2010. Our calculations suggest that the aging of the U.S. population will result in an increase of nearly 80% in total societal costs per adult by 2040."

Something is Wrong with Her Back

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Erythema ab igne (EAI) is a localized hypermelanosis with erythema in a reticulated pattern. It is triggered from repeated exposure to heat and infrared radiation. Actinic keratosis, squamous cell carcinoma, and Merkel cell carcinoma have been reported in patients after chronic exposure to infrared radiation. EAI is diagnosed based on clinical symptoms. If the diagnosis is uncertain, a skin biopsy may be performed. Early in the disease process, elimination of the heat source may lead to complete resolution of the symptoms.

Personality and Neuropsychological Correlates of Male and Female Sexual Offenders

John W. DenBoer, MA, PhD¹, Frederick L. Coolidge, PhD², Daniel L. Segal, PhD³, & Sean Ahlmeyer, MA⁴,
^1,2,3Department of Psychology, The University of Colorado at Colorado Springs (Colorado Springs, CO, USA).
⁴Colorado State Department of Corrections (Colorado Springs, CO, USA).

Abstract
The present study examined the personality and neuropsychological correlates of convicted male and female sex offenders. The investigators measured DSM-IV-TR psychopathology and neuropsychological dysfunction among rapists and child molesters using the Coolidge Axis II Inventory, a valid and reliable assessment instrument. Male child molesters displayed significantly higher Apathy scores than age-matched male controls. Male non-sexual offenders scored significantly higher than male child molesters, rapists, and controls on Histrionic Personality Disorder, Impulsivity, and Disinhibition. Female child molesters reported significantly elevated levels of psycho and neuropathology when compared to female non-offenders. Specifically, female child molesters reported greater Language Problems and Executive Dysfunction, along with greater levels of Psychoticism and Paranoia, when compared to female controls. The implications of these findings are discussed.
Key Words: personality, neuropsychology, sexual offenders, executive dysfunction, child molestation, rape.

Clinico-Radiological Quiz

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

Dr.K.B.Bali, MBBS, MS, FACS, Senior ENT Specialist, Al Ain Hospital, Al Ain, UAE.

Abstract
A 7-week-old child presented with left periorbital swelling. Clinical features, investigations, and treatment are discussed. If this condition is not treated properly, it can lead to a series of serious complications. A review of the literature is presented to avoid such complications.
Key Words: PCC (periorbital cellulitis with chemosis), OC (orbital cellulitis), preseptal cellulitis, OA (orbital abscess), SPA (subperiosteal abscess), ethmoidal sinusitis, periorbital swelling.

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