Complicated penetrating foreign body neck injury.

Penetrating neck injury is associated with significant morbidity due to the several structures (neurological, vascular and aerodigestive) within close proximity to one another. This case highlights an uncommon presentation of an embedded foreign body following penetrating neck trauma and the decision-making required during management.

Surgical Management in a Paediatric Case of Endobronchial Mucoepidermoid Carcinoma Involving the Carina.

Although mucoepidermoid carcinoma (MEC) is the most diagnosed malignancy of the salivary gland, it rarely localises to the bronchus, accounting for only 0.1-0.2% of all primary lung malignancies. Of those pulmonary MECs, most are found in segmental or lobar bronchi, and they are rarely found in mainstem bronchi, highlighting the novelty of this presentation for thoracic specialists. We present a case report of a seven-year-old female who underwent a carinal resection and a right upper lobectomy for the management of an endobronchial MEC causing right middle lobe (RML) obstruction. Intraoperatively, an exophytic mass originating from the junction of the right main bronchus and bronchus intermedius was identified, causing a partial obstruction of the RML bronchus. Frozen sections demonstrated clear margins and follow-up bronchoscopies have been unremarkable. Given their rarity, endobronchial MECs can be diagnostically difficult and cause uncertainty with respect to their management. Low-grade tumours have a much more favourable prognosis than their high-grade counterparts, with surgical resection being the gold standard of care. Therefore, the index of suspicion, time to diagnosis, and definitive treatment are critical to the outcome.

Rapidly evolving gangrenous vasculitis in a critically ill patient with ulcerative colitis: a case report.

Ulcerative colitis is a disease characterised by non-granulomatous submucosal inflammation ranging from isolated proctitis to colitis. Extra-intestinal manifestations of the condition occur in multiple organ systems, with dermatological complications occurring commonly. This case report aims to highlight an uncommon dermatological complication of ulcerative colitis with particular focus on patient care and management.

Comparative validity of three simulation platforms for objective assessment of otoscopy skills.

OBJECTIVES: To assess the face, construct and content validity of three different platforms for otoscopy skills assessment, using a traditional otoscope with manikin, digital otoscope (Tympahealth) with manikin, and traditional otoscope with a low-cost model ear (SimEar). DESIGN: Prospective mixed methods study. SETTING: Tertiary hospital. PARTICIPANTS: Postgraduate trainees and expert assessors. MAIN OUTCOME MEASURES: Face and Content validity based on expert assessor ranking on each model and their feedback from semi-structured interviews. Construct validity based on Objective Structured Clinical Examination scores. RESULTS: Each platform differed in face, construct and content validity scores, with no one platform consistently outperforming others. Three main themes were identified during thematic analysis of expert assessor interviews: ability to assess what is seen, anatomical reality, and ease of use. The low-cost model showed greatest potential, where modification to include a silicone ear could lead to high validity with marginal increase in cost. CONCLUSION: Several modalities for assessing otoscopy skills exist, each with advantages and disadvantages. Modifications to a low-cost model, for use with either a traditional or digital otoscope, could prove to be the best model.

The Feasibility and Effects of a Telehealth-Delivered Home-Based Prehabilitation Program for Cancer Patients during the Pandemic.

Patients awaiting cancer treatment were classified as "vulnerable" and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during the pandemic. Eligible patients were referred from multiple centers to a regional prehabilitation unit providing home-based prehabilitation. The enrolled patients received telehealth-delivered prehabilitation prior to surgery and/or during non-surgical cancer treatment, which included personalized training exercises, dietary advice, medical optimization therapies, and psychological support. The primary outcome was to investigate the feasibility of our program. The secondary outcome was to investigate the relationship between our program and patient-reported outcomes (PROs). The patients completed two questionnaires (the EQ-5D-3L and the FACIT-Fatigue Scale) pre- and post-intervention. A total of 182 patients were referred during the study period. Among the 139 (76%) patients that were enrolled, 100 patients completed the program, 24 patients have still to complete, and 15 have discontinued. A total of 66 patients were able to return completed questionnaires. These patients were recruited from colorectal, urology, breast, and cardiothoracic centers. The patients significantly improved their self-perceived health (p = 0.001), and fatigue (p = 0.000). Home-based prehabilitation is a feasible intervention. The PROs improved post-intervention.

Sporting activity after craniosynostosis surgery in children: a source of parental anxiety.

PURPOSE: Craniosynostosis correction involves major skull surgery in infancy-a potential source of worry for parents when their treated children begin involvement in sports. METHODS: Electronic multiple choice survey of parents of children who had undergone craniosynostosis surgery in infancy using 5-point Likert scales. RESULTS: Fifty-nine completed surveys were obtained from parents of children who had undergone previous craniosynostosis surgery. Mean age of children was 7.8 years (range 3 months to 22 years), with 36 non-syndromic and 23 syndromic cases. The most common surgery was fronto-orbital remodelling (18). Fifty-two of 59 were involved in athletic activity. The most intense sport type was non-contact in 23, light contact in 20, heavy contact in 4 and combat in 5. Participation level was school mandatory in 12, school club in 17, non-school sport club in 21 and regional representative in 2. One child had been advised to avoid sport by an external physician. Mean anxiety (1-5 Likert) increased with sport intensity: non-contact 1.7, light contact 2.2, heavy contact 3.5 and combat 3.6. Twenty-nine of 59 parents had been given specific advice by the Craniofacial Team regarding athletic activity, 28 of which found useful. Three sport-related head injuries were reported, none of which required hospitalisation. CONCLUSION: Little information exists regarding sports for children after craniosynostosis surgery. This study suggests that parental anxiety remains high, particularly for high impact/combat sports, and that parents would like more information from clinicians about the safety of post-operative sporting activities.

Development of a "Surgical Shadowing Scheme" to improve undergraduate experiences of surgery.

PURPOSE: To establish a sustainable model for a "Surgical Shadowing Scheme" (SSS) and assess how this affects undergraduate attitudes to surgical careers. PATIENTS AND METHODS: Surgeons at university teaching hospitals associated with UCL Medical School and UCL Partners, United Kingdom, were approached for their willingness to participate in the scheme. Medical students were then invited to apply for the scheme, where students were individually matched to operating theater sessions with surgeons in their specialty of choice. Feedback was subsequently obtained, evaluating experiences of the placement and the effect this had on future career aspirations. RESULTS: After running for four consecutive years, approximately 220 students have participated in the scheme across a range of surgical units and specialties. A total of 91.5% of the students were pre-clinical (years 1-3), whilst the remainder were clinical (years 4-6). Fifty-four percent were female and 46% male. Eighty-three percent of the students did not have any previous experience of the specialty that they shadowed, and 67% agreed that participating in the scheme had either "increased" or "strongly increased" their desire to pursue a surgical career. Ninety-four percent said they would "recommend" or "strongly recommend" the SSS to a peer. Over a third of students reported scrubbing-up during their placements and 35% of these directly assisted the lead surgeon. Traditionally male-dominated surgical sub-specialties recruited a high proportion of female students. CONCLUSION: This is the first published example of an established "Surgical Shadowing Scheme" for medical undergraduates. Our SSS has been highly valued by students and indicates that even a single high-quality surgical exposure is sufficient to increase the desire of undergraduates to pursue a surgical career. We hope that this SSS will act as a blueprint for other centers to develop their own shadowing schemes, in turn helping to ensure that surgery continues to inspire and attract the very best candidates for the future.