Anand Mohapatra

Effect of font size and glare on computer tasks in young and older adults.

Purpose At a fixed viewing distance (VD), reading speed increases with print size. It is not known if this holds for computer tasks when postures are not constrained. Reflective glare on a monitor may reduce productivity. The effects of both may be modified by age. We evaluated effects of age, font size, and glare on performance for visually demanding text-based tasks on a computer. Methods Nineteen young (18 to 35 years old) and eight older (55 to 65 years old wearing progressive lenses that correct for presbyopia) subjects participated in a study with two trial factors: font size (1.78, 2.23, and 3.56 mm) and glare (produced by bright light-emitting diode task light reflective off a matte liquid crystal display monitor). The monitor location was fixed but subjects were allowed to change their posture and move the chair. Subjects performed visual tasks that required similar visual skills to common tasks such as Internet use, data entry, or word processing. Results Productivity, accuracy, and VD increased as font size increased. For each 1-mm increase in font size, there was a mean productivity gain of 3 correct clicks/min and an improvement in accuracy of 2%. Font size increase also led to lowered perceived task difficulty. Adding reflective glare on the monitor surface led to a reduced VD but had no effect on productivity or accuracy. With visual corrections for presbyopia, age had no effect on these relationships. Conclusions Productivity is improved when the font is increased from 1.78 or 2.23 to 3.56 mm for text-based computer tasks. The largest font size corresponds to a visual angle of font of 23.4 arcmin. This visual angle of font is above the high end of ISO recommendations (International Organization for Standardization, 1992, 2011). The findings may be useful for setting the font sizes for computers and for training office workers.

Transmesenteric robot-assisted pyeloplasty for ureteropelvic junction obstruction in horseshoe kidney

CAsE The patient is a 28-year old female with an obstructed ureteropelvic junction (UPJ) of the left moiety of a horseshoe kidney. The Da Vinci S robotic platform was used. After transperitoneal access was obtained, a window in the mesentery was identified, and the renal pelvis was exposed. A dismembered, spatulated pyeloplasty was performed with transposition of the UPJ to a more dependent portion of the renal pelvis. A ureteral stent and closed surgical drain were placed.

Metastatic Granulosa Cell Tumor of the Testis: Clinical Presentation and Management

Granulosa cell tumors (GCTs) of the testis are rare sex cord-stromal tumors that are present in both juvenile and adult subtypes. While most adult GCTs are benign, those that present with distant metastases manifest a grave prognosis. Treatments for aggressive GCTs are not well established. Options that have been employed in previous cases include retroperitoneal lymph node dissection (RPLND), radiation, chemotherapy, or a combination thereof. We describe the case of a 57-year-old man who presented with a painless left testicular mass and painful gynecomastia. Serum tumor markers (alpha fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase) and computed tomography of the chest and abdomen were negative. The patient underwent left radical orchiectomy. Immunohistochemical staining was consistent with a testicular GCT. He underwent a left-template laparoscopic RPLND which revealed 2/19 positive lymph nodes. Final pathological stage was IIA. He remains free of disease 32 months after surgery.

Effects of Font Size and Reflective Glare on Text-Based Task Performance and Postural Change Behavior of Presbyopic and Nonpresbyopic Computer Users

Nineteen young (18-35 year-old) and seven older presbyopic (55-65 year-old, wearing bifocal or progressive glasses) subjects with the same average visual acuity at near distance participated in this full-factorial, repeated measures study with two trial factors: font size (capital letter heights of 1.78, 2.23, and 3.56 mm) and reflective glare. The monitor location was fixed, but subjects were allowed to move their bodies and the chair while performing visually demanding tasks. The productivity improved up to 30% when using a large font size (average visual angle 23.4 arcmin) compared to a smaller font size (14.2 or 16.4 arcmin, p < .0001). The relative contributions of torso flexion (78%), head forward (3%), and chair reposition (4%) to changes in the viewing distance remained constant across font size conditions. Reflective glare had no effect on productivity measures but led to reduction of viewing distance (p < .0001). There were no significant differences between the two age groups.

Trends in the Management of Small Renal Masses: A Survey of Members of the Endourological Society

Treatment modalities for small renal masses (SRMs) include open or minimally invasive radical or partial nephrectomy, and laparoscopic or percutaneous ablations. Members of the Endourological Society were surveyed to evaluate how practitioner and clinical practice characteristics may be associated with the management of SRMs over time. The survey assessed characteristics of urologists (recency of residency and fellowship training, clinical practice type and location, and treatment modalities available) and their management of SRMs over the past year and over the course of the year 5 years prior. Of the 1495 surveys e-mailed, there were 129 respondents (8.6%). Comparing the past year to 5 years prior, there was increasing utilization of robotic partial nephrectomy (p < 0.001) and robotic radial nephrectomy (p = 0.031). In contrast, there was decreasing utilization of open partial nephrectomy (p < 0.001), open radical nephrectomy (p = 0.039), laparoscopic partial nephrectomy (p = 0.002), and laparoscopic radical nephrectomy (p = 0.041). Employment of laparoscopic ablation decreased (p = 0.001), but that of percutaneous ablation did not change significantly. For masses treated with image-guided therapy, there was increasing utilization of microwave ablation (p = 0.008) and decreasing usage of radiofrequency ablation (p = 0.002). Future studies should focus on the most effective treatment modalities based on provider, patient, and tumor characteristics.

Atlantoaxial subluxation and nasopharyngeal necrosis complicating suspected granulomatosis with polyangiitis.

Granulomatosis polyangiitis (GPA, formerly Wegener granulomatosis) is a vasculitis that typically involves the upper respiratory tract, lungs, and kidneys. The 2 established methods to confirm a suspicion of GPA are the antineutrophil cytoplasmic antibody (ANCA) test and biopsy. However, ANCA-negative cases have been known to occur, and it can be difficult to find biopsy evidence of granulomatous disease.We report a case of suspected granulomatosis with polyangiitis limited to the nasopharynx. With a negative ANCA and no histological evidence, our diagnosis was founded on the exclusion of other diagnoses and the response to cyclophosphamide therapy. This case is unique because the patients lesion resulted in atlantoaxial instability, which required a posterior spinal fusion at C1-C2. This is the first reported case of suspected GPA producing damage to the cervical spine and threatening the spinal cord.

Posterior-Only Vertebral Column Resection for Fused Spondyloptosis.

STUDY DESIGN Retrospective review. OBJECTIVES To describe 3 cases of a posterior-only vertebral column resection (pVCR) for the treatment of spondyloptosis in the setting of prior spinal fusions. Lumbosacral spondyloptosis is a rare spinal deformity with a number of surgical options, none of which demonstrate clear superiority. The use of an L5 vertebral column resection, via combined anterior and posterior approaches, to restore lumbosacral alignment has been described though is accompanied by high rates of neurological deficit. METHODS Review of 3 cases of spondyloptosis with prior spinal fusions in which a staged pVCR was used for deformity reconstruction. RESULTS Three females, ages 39, 54, and 28, developed spondyloptosis with progressive lumbosacral kyphosis and sagittal malalignment after prior in-situ posterolateral spinal fusions. All were treated with staged pVCRs. At ultimate follow-up, imaging revealed improvement in sagittal balance of 6.1 cm (56%) in the 39-year-old and 12 cm (67%) in the 54-year-old, 21.1 cm (92%) in the 28-year-old. All patients had improvement in outcome scores with perfect satisfaction scores despite the 54-year-old having a persistent right foot drop. CONCLUSION Posterior-only VCR for spondyloptosis is a technically demanding surgical option offering significant radiographic and clinical improvement, but carries a risk for L5 nerve root deficit as in any spondyloptosis treatment.STUDY DESIGN Retrospective review. OBJECTIVES To describe 3 cases of a posterior-only vertebral column resection (pVCR) for the treatment of spondyloptosis in the setting of prior spinal fusions. SUMMARY OF BACKGROUND DATA Lumbosacral spondyloptosis is a rare spinal deformity with a number of surgical options, none of which demonstrate clear superiority. The use of an L5 vertebral column resection, via combined anterior and posterior approaches, to restore lumbosacral alignment has been described though is accompanied by high rates of neurological deficit. METHODS Review of 3 cases of spondyloptosis with prior spinal fusions in which a staged pVCR was used for deformity reconstruction. RESULTS Three females, ages 39, 54, and 28, developed spondyloptosis with progressive lumbosacral kyphosis and sagittal malalignment after prior in-situ posterolateral spinal fusions. All were treated with staged pVCRs. At ultimate follow-up, imaging revealed improvement in sagittal balance of 6.1 cm (56%) in the 39-year-old and 12 cm (67%) in the 54-year-old, 21.1 cm (92%) in the 28-year-old. All patients had improvement in outcome scores with perfect satisfaction scores despite the 54-year-old having a persistent right foot drop. CONCLUSION Posterior-only VCR for spondyloptosis is a technically demanding surgical option offering significant radiographic and clinical improvement, but carries a risk for L5 nerve root deficit as in any spondyloptosis treatment.

Trends in the utilization of imaging for upper tract urothelial carcinoma.

OBJECTIVES To evaluate the changes in use of the different imaging modalities for diagnosing upper tract urothelial carcinoma (UTUC) and assess how these changes have affected tumor stage at the time of surgery. MATERIALS AND METHODS We assessed the Surveillance, Epidemiology, and End Results (SEER) cancer registry and linked Medicare claims data (1992-2009) for 5377 patients who underwent surgery for UTUC. We utilized International Classification of Disease-Oncology 3 codes to identify UTUC. International Classification of Disease, ninth Revision, Clinical Modification and Current Procedure Terminology codes identified surgical treatment and imaging modalities. We assessed for use of intravenous pyelography, retrograde pyelography (RGP), computed tomography urography (CTU), magnetic resonance urography (MRU), and endoscopy. For each modality, patients were categorized as having received the modality at least once or not at all. Patient characteristics were compared using chi-squared tests. Usage of imaging modalities and tumor stage was trended using Cochran-Armitage tests. We stratified our data into 2 multivariate logistic regression models to determine the effect of imaging modalities on tumor stage: 1992 to 1999 with all modalities except MRU, and 2000 to 2009 with all modalities. RESULTS Our patient population was predominantly White males of more than 70 years old. Intravenous pyelography and RGP declined in use (62% and 72% in 1992 vs. 6% and 58% in 2009, respectively) while computed tomography urography, MRU, and endoscopy increased in use (2%, 0%, and 37% in 1992 vs. 44%, 6%, and 66% in 2009, respectively). In both regression analyses, endoscopy was associated with lower-stage tumors. In the 2000 to 2009 model, RGP was associated with lower-stage tumors, and MRU was associated with higher-stage tumors. Finally, our data showed an increasing number of modalities utilized for each patient (1% receiving 4 modalities in 1992 vs. 20% in 2009). CONCLUSIONS We found trends toward the utilization of newer imaging modalities to diagnose UTUC and more modalities per patient. Endoscopy and RGP were associated with smaller tumors, whereas MRU was associated with larger tumors. Further studies are needed to evaluate the utility of the different modalities in diagnosing UTUC.

Granulomatosis with polyangiitis (Wegener's granulomatosis) causing atlantoaxial instability: a case report

BACKGROUND CONTEXT No previous cases of atlantoaxial instability due to granulomatosis with polyangiitis have been reported. PURPOSE The aim of this study was to report a case of granulomatosis with polyangiitis causing atlantoaxial instability. STUDY DESIGN This is a case report. PATIENT SAMPLE A 45-year-old woman participated in this study. OUTCOME MEASURES The patients pain and atlantoaxial instability were resolved. METHODS A 45-year-old Caucasian woman with a large ulcerative lesion in her oropharynx initially presented with chronic sinusitis, pharyngitis, and severe odynophagia. Years after her original symptoms began, she developed neck pain radiating into her upper trapezial region and shoulders. RESULTS Atlantoaxial fusion was performed on the patient, resolving her neck, upper trapezial, and shoulder pain. She was diagnosed with granulomatosis with polyangiitis (formerly Wegeners granulomatosis) and treated with cyclophosphamide. CONCLUSIONS Granulomatosis with polyangiitis should be part of the working differential diagnosis for non-traumatic cervical spine injury. The atlantoaxial instability can be managed with stabilization, and the disease process itself can be treated with cyclophosphamide.