A Misdiagnosis Led to an Extensive Skull Base Surgery: Infratemporal Tuberculosis Mimicking Giant Cell Tumor

Tuberculosis is a major health problem in developing countries. Tuberculosis of the infratemporal region is not common and the diagnosis could be complicated because of the similarity of the presentation to neoplasm. In our paper, we report a 49 year old male presented with a preauricular mass with extension to parotid in right side of the face. The primary histologic diagnosis was giant cell tumor with bony involvement and radical surgery was taken. After 16 months the patient was developed recurrence of the primary lesion in association with post auricular fistula. Ultimately, infratemporal tuberculosis was diagnosed according to result of the drained discharge by AFB microscopy. Therefore, tuberculosis should be considered as an important differential diagnosis of mass lesions in head and neck area, even when there is no history of significant exposure and no systemic signs or symptoms of tuberculosis.     

Introducing a model for optimal design of sequential objective structured clinical examinations

In a sequential OSCE which has been suggested to reduce testing costs, candidates take a short screening test and who fail the test, are asked to take the full OSCE. In order to introduce an effective and accurate sequential design, we developed a model for designing and evaluating screening OSCEs. Based on two datasets from a 10-station pre-internship OSCE and considering three factors, namely, the number of stations, the criteria for selecting the stations, and the cut-off score, several hypothetical tests were proposed. To investigate their accuracy, the positive predictive value (PPV), the pass rate, and the negative predictive value (NPV) were calculated. Also, a “desirable” composite outcome was defined as PPV = 100 %, pass rate ≥50 %, and NPV ≥25 %. Univariate and multiple logistic regression analyses were conducted to estimate the effects of independent factors on the occurrence of the desirable outcome. In half of the screening tests no false positive result was detected. Most of the screening OSCEs had acceptable levels of pass rate and NPV. Considering the desirable composite outcome 20 screening OSCEs could have successfully predicted the results of the corresponding full OSCE. The multiple regression analysis indicated significant contributions for the selection criteria (p values = 0.019) and the cut-off score (p values = 0.017). In order to have efficient screening OSCEs with the lowest probability of the error rate, careful selection of stations with high values of discrimination or item total correlation, and use of a relatively stringent cut-off score should be considered.     

Noonan syndrome associated with neuroblastoma: a case report

We report a case of a child with Noonan phenotype and incidental radiographic findings of mediastinal neuroblastoma. Recent studies have reported an increased association of Noonan syndrome with some malignancies, and the case we present here is the first reported case to our knowledge of an association of neuroblastoma with Noonan syndrome. Received: 23 January 1996 Accepted: 27 March 1996     

Overload blunts baroreflex only in overreached athletes

Objectives

Heart rate variability (HRV) is commonly used to diagnose overreaching and monitor athletes’ responses to training. Baroreflex sensitivity (BRS) is modified by changes in training load and might be another means to detect overreaching. The goal of this study was to assess BRS and HRV changes in two groups of athletes responding either negatively (FOR) or positively (AF) to similar training overload.