Syringocystadenoma papilliferum: case series and review of the literature.

Syringocystadenoma papilliferum (SCAP) is a rare, hamartomatous tumor of the apocrine glands, which typically manifests in the head and neck region. We present a case of 60-year-old male with a several-year history of the lesion located on the abdominal wall and a second case of a 58-year-old male with a history of a slow-growing lesion located on the tragus. Despite varying presentations and locations, both patients were identified to have SCAP on pathological evaluation. Appropriate treatments of SCAP range from CO2 laser treatment to surgical excision; we recommend surgical excision due to the risk of malignant transformation.

Case report-successful management of acute buried bumper syndrome.

Percutaneous gastrostomy (PEG) tube placement is often the preferred approach to addressing nutritional deficits in patients requiring long-term feeding access. Numerous major and minor complications may occur with PEG tube insertion; buried bumper syndrome is a rare, long-term outcome of PEG tube placement, comprising <2.4% of complications. We present the case of a 60-year-old female with laryngeal cancer whom developed acute buried bumper syndrome after PEG tube insertion which was managed successfully with surgical intervention.

Cecal Adenoma Presenting as a Large Bowel Intussusception in an Adult.

An adult intussusception is a relatively rare entity and is more commonly confined to the small bowel when it is found. The majority of the colonic intussusceptions in adults are caused by malignant neoplasms. Here we present the case of a 65-year-old female with a cecal adenoma as the lead point causing intussusception all the way to the splenic flexure. Controversy still exists regarding optimal treatment strategies, specifically the question of if it is safe or not to perform preoperative reduction prior to surgical resection in adult large bowel intussusceptions.

Communication Skills of Grandview/Southview Medical Center General Surgery Residents.

CONTEXT: In the transition of osteopathic programs to the single-accreditation graduate medical education (GME) system, residents are required to demonstrate skill in a set of core competencies identified by the Accreditation Council of Graduate Medical Education (ACGME) prior to graduation. Included in those core competencies are interpersonal and communication skills along with professionalism. OBJECTIVES: To assess strengths and weaknesses of residents' interpersonal communication skills and professionalism in the Grandview/Southview Medical Center (Dayton, OH) osteopathic general surgery program using the validated Communication Assessment Tool (CAT). METHODS: From November 2014 to June 2018, all patients who presented for an appointment at the Cassano General Surgery Clinic were asked by a medical assistant to complete a CAT questionnaire following their encounter with a resident physician. Patients at Cassano, an outpatient office-based facility directed to the underserved local community, are seen first by an intern, then by a 4th or 5th year resident and later by an attending physician. Patients 18 years of age or older were included; patients were excluded if they were unable to understand or read English. Patient demographics were collected, including age, gender, race/ethnicity, and previous exposure to this resident physician. Each resident's name was replaced on the CAT with a number for data analysis. The resident variables collected for this study included year of training, gender, and native language. RESULTS: The mean response for all CAT items was 4.5 out of 5, indicating that responses to resident performance were largely positive. Patients responded to 4 of the 14 CAT items with only excellent, very good, or good responses and no fair or poor responses. Four items had only 1 fair or poor response. The remaining 6 items received more than 1 fair or poor response: "greeted me in a way that made me feel comfortable" (#1), "talked in terms I could understand" (#8), "encouraged me to ask questions" (#10), "involved me in decisions as much as I wanted" (#11), "showed care and concern" (#13), and "spent the right amount of time with me" (#14). CONCLUSIONS: Attending surgeons evaluate residents in multiple areas from a doctor's perspective, but there is a potential lack of correlation between that evaluation and a patient's experience, which is paramount in osteopathic medicine. Patient responses to the CAT questionnaire can be used by program directors to identify deficiencies in milestone/competency achievement and facilitate improvement both individually and programmatically for residents according to ACGME standards.