Dr. Hamilton Hall, MD, FRCSC, is a Professor in the Department of Surgery at the University of Toronto. He is the Medical Director, CBI Health Group and Executive Director of the Canadian Spine Society in Toronto, Ontario.
Greg McIntosh, MSc, completed his Masters in Epidemiology from the University of Toronto's Faculty of Medicine. He is currently the Director of Clinical Research for CBI Health Group and research consultant to the Canadian Spine Society.

Abstract
This article highlights the myths and misunderstandings surrounding the straight leg raise (SLR) test for sciatica. Unfortunately, neither intra- nor inter-observer reliability of the passive SLR test has ever been agreed upon. In addition, there is poor consensus about what constitutes a positive SLR test in terms of pain location, leg elevation limitation or clinical significance. Until there are stricter performance standards and uniform agreement, researchers and clinicians should interpret the test with caution. We believe a true positive SLR should be the reproduction or exacerbation of the typical leg dominant pain in the affected limb at any degree of passive elevation. Those with only increased back pain or any leg pain other than that presenting as the chief complaint should be regarded as false positives.
Key Words: low back pain, straight leg raise, sciatica, irritative test.

Curtis M. Marcoux, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
Dr. Pradeep Shenoy, MD, DLO, FRCS, FACS, is the ENT service chief, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.

Abstract
Dizziness is the third most common symptom seen in patients of all age groups who present to emergency departments, outpatient clinics and physicians offices. Assessing dizziness requires a differentiation of potential causes through a comprehensive medical history and thorough physical exam. The most common causes of dizziness are peripheral vestibular disorders, however disorders of the central nervous system must be ruled out. Understanding how to distinguish between various underlying causes of vertigo is essential for the timely diagnosis and effective management of patients with this symptom. In this review, an overview of the epidemiology, etiology, presentation, diagnosis and treatment of the most common causes of vertigo will be presented, touching on some of the more rare determinants.
Key Words: Vertigo, dizziness, BPPV, vestibular neuronitis, Meniere's disease, vestibular migraine, vertebrobasilar insufficiency.

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

Abstract
A case of pyogenic granuloma of gingiva is presented. Aetiology factors, clinical presentations and different treatment modalities are discussed after reviewing the literature.
Key Words: Pyogenic granuloma, Gingival hyperplasia, Peripheral giant cell granuloma, peripheral ossifying fibroma, lobular capillary haemangioma.

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

Abstract
Physicians are used to using language in very special ways. We combine the normal syntax, grammar and rules of our mother tongue along with the special clinical terms derived from Latin or Greek which are often anglicized in North America. But there are terms used in the English language that we tend to avoid because they have associated with them negative stereotypes about certain groups of individuals and over time, no one would use some of these terms in public. The term tsunami has entered the lexicon recently of terms used to describe the challenges of the aging population. Its use has entered the popular media and amongst policy makers. Physicians must be attuned to the negative stereotype associated with the use of this term to describe the older patients that we collectively care for.
Key Words:Language and negative stereotypes, media use of terms, stigmatizing the elderly with words.

Jordan Isenberg,¹ Tessa Weinberg,² Nowell Solish,^3
1McGill University, Faculty of Medicine, Montreal, Quebec; ²The Royal College of Surgeons in Ireland, Faculty of Medicine, Dublin, Ireland;
³University of Toronto, Department of Dermatology, Toronto, Ontario.

Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous malignancy. It is seen most frequently in those over 60 years old and in Caucasian males. It usually presents as an asymptomatic rapidly growing violatious nodule on a sun exposed area. The mainstay of treatment is surgical by standard wide local excision or MOHs chemosurgery. Radiation is added frequently for local control. The only factor significantly associated with overall survival is the stage of disease at presentation. This stresses the importance of early diagnosis and treatment.
Key Words: Merkel cell carcinoma, wide local excision, MOHs chemosurgery, adjuvant radiotherapy, review, case.