Brenner Tumor of the Ovary: A 10-Year Single Institution Experience and Comprehensive Review of the Literature.

Brenner tumors (BTs) are surface-epithelial stromal cell tumors that are categorized by the World Health Organization as benign, borderline, and malignant. Due to the rarity of BTs, the published literature on these tumors is comprised primarily of case reports and small retrospective studies. We performed a pathology database review spanning the last ten years at our institution revealing nine reported benign BTs. We collected the clinical and pathological data of patients associated with those BTs, describing the clinical presentation and imaging results, and assessing the possible risk factors associated with them. The average age at diagnosis was 58 years. BTs were discovered incidentally in 7/9 cases. The tumor was multifocal and bilateral in 1/9 cases and ranged in size from 0.2 cm to 7.5 cm. Associated Walthard rests were found in 6/9 cases and transitional metaplasia of surface ovarian and/or tubal epithelium was found in 4/9 cases. One patient had an associated mucinous cystadenoma in the ipsilateral ovary. Another patient had an associated mucinous cystadenoma in the contralateral ovary. In conclusion, we found that Walthard rests and transitional metaplasia are common findings in association with BTs. Additionally, pathologists and surgeons need to be aware of the association between mucinous cystadenomas and BTs.

Neural Contributions to the Cochlear Summating Potential: Spiking and Dendritic Components.

Using electrocochleography, the summating potential (SP) is a deflection from baseline to tones and an early rise in the response to clicks. Here, we use normal hearing gerbils and gerbils with outer hair cells removed with a combination of furosemide and kanamycin to investigate cellular origins of the SP. Round window electrocochleography to tones and clicks was performed before and after application of tetrodotoxin to prevent action potentials, and then again after kainic acid to prevent generation of an EPSP. With appropriate subtractions of the response curves from the different conditions, the contributions to the SP from outer hair cells, inner hair cell, and neural "spiking" and "dendritic" responses were isolated. Like hair cells, the spiking and dendritic components had opposite polarities to tones - the dendritic component had negative polarity and the spiking component had positive polarity. The magnitude of the spiking component was larger than the dendritic across frequencies and intensities. The onset to tones and to clicks followed a similar sequence; the outer hair cells responded first, then inner hair cells, then the dendritic component, and then the compound action potential of the spiking response. These results show the sources of the SP include at least the four components studied, and that these have a mixture of polarities and magnitudes that vary across frequency and intensity. Thus, multiple possible interactions must be considered when interpreting the SP for clinical uses.

Customizable Curriculum to Enhance Resident Communication Skills.

Communication remains challenging to teach and evaluate. We designed an online patient survey to assess anesthesia residents' communication skills from August 2014 to July 2015. In December 2014, we implemented a customized, simulation-based curriculum. We calculated an overall rating for each survey by averaging the ratings for the individual questions. Based on the Hodges-Lehmann 2-sample aligned rank-sum test, overall ratings, reported as the median (interquartile range) of residents' average overall ratings, differed significantly between the preintervention (3.86 [3.76-3.94]) and postintervention (3.91 [3.84-3.95]) periods (P = .025). Future studies should assess the intervention's effectiveness and generalizability.