A large proportion of patients are being discharged with considerable levels of difficulty in four of the five EQ-5D dimensions. This stresses the importance of providing good follow-up and support of patients and their families.

Background:Medulloblastoma is a highly malignant embryonal tumor which commonly arises in the cerebellum. It is relatively rare and accounts for less than 2% of all primary brain tumors. The tumor primarily occurs in childhood; however, rarely, it may be found in adult population. In addition, medulloblastoma in adult population shows features which are quite distinct from the pediatric group.Case Description:We report the case of a 33-year-old man who presented to our institution with a history of blurred vision of both eyes for 5 months preceded by intermittent headache since the previous year. Preoperative investigation suggested a posterior fossa mass and we suspected an ependymoma. The patient underwent ventriculoperitoneal shunt and craniotomy tumor removal, followed by radiotherapy. Histopathological and immunohistochemical examination were performed, and the results showed a diagnosis of medulloblastoma.Conclusion:This case is exceptional because adult medulloblastoma occurrence in our center is extremely rare, and the diagnosis can only be established through histopathological and immunohistochemical studies.

Background: Coronary arterial stenosis, the major cause of acute myocardial infarction (AMI), induces shear stress to surrounding arteriolar endothelium. This stimulates changes in endothelial cells, smooth muscle cells and fibroblast to create collaterals that can provide alternative blood flow to the jeopardized myocardial area. However, coronary collateralization is various among AMI patients. The aim of this study was to analyze the correlation between coronary risk factors and collateral sirculation in AMI patients. Methods: A retrospective cross-sectional study was carried out to 148 medical records of hospitalized AMI patients in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. All patients were assessed for coronary collateral circulation which were graded as good (Rentrop score 2-3) and poor (Rentrop score 0-1). Risk factors noted in this study were age group, sex, hypertension, diabetes mellitus and diagnosis (ST-segment Elevation Myocardial Infarction (STEMI) or Non STEMI (NSTEMI)) according to the medical record data. Results: Hypertension was found to be associated with the presence of good coronary collateral circulation (p=0.02, PR=1.410 [95% CI 1.030-1.930]). Sex, age group, diabetes mellitus and STEMI or NSTEMI diagnosis were not statistically significant. Conclusions: Hypertension was the only coronary risk factor associated to the presence of well-developed coronary collaterals. The increase of myocardial oxygen demand and flow of collateral feeding coronary artery in the setting of hypertension may contribute to the results. [AMJ.2015;2(4):529-33]