Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion.

Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The "surgeon champion" can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.

Pneumoscrotum after tracheal intubation.

Air in the scrotum is an unusual clinical finding and a thorough search should be done in order to locate the air leak or source of gas production. We report an 81-year-old patient who developed severe acute respiratory failure after fiberoptic bronchoscopy and was intubated immediately. After tracheal intubation, excessive subcutaneous emphysema from the head to the scrotum was obvious. Chest tube thoracostomies were placed to treat pneumothorax. The emphysema was absorbed after 13 days without any sequela. Air or gas inside the scrotum may originate from intraperitoneal, extraperitoneal, or local sources. The majority of the cases can be managed conservatively, but emergent intervention is needed in life-threatening situations.

Myxoma of the small intestine complicated by ileo-ileal intussusception: Report of an extremely rare case.

INTRODUCTION: Myxomas of the small intestine are extremely rare types of primary bowel neoplasms. Their presence can trigger intestinal intussusception in the adults. We present the eighth case of intestinal myxoma reported in the English literature. PRESENTATION OF CASE: Our patient is a 44-year-old Caucasian female who presented with clinical and imaging findings of intestinal intussusception. Laparotomy revealed ileo-ileal intussusception caused by an intramural mass of the middle-ileum which was resected. Histological and immunohistochemical studies pointed to the diagnosis of benign intestinal myxoma, while imaging studies of the heart excluded a synchronous cardiac myxoma. Twenty months after surgery she remains disease-free. DISCUSSION: The myxoma is a benign, true neoplasm which resembles primitive mesenchyme. It occurs predominantly in the heart and is also found in several soft tissues and bones. Myxomas seem to grow at different rates of speed, they infiltrate adjacent structures and they do not metastasize, apart from cardiac variants. Intestinal myxomas share some clinical characteristics which are emphasized. CONCLUSION: Myxomas of the small intestine should be included in the differential diagnosis of ileal tumors in middle-aged women manifesting as intestinal intussusception. Treatment should include wide resection of the affected intestinal segment with primary anastomosis. A close follow-up control of the patients along with cardiac imaging evaluation is recommended postoperatively, in order to detect and treat any possible recurrence of the tumor or a synchronous cardiac myxoma.

Pneumoscrotum as complication of blunt thoracic trauma: a case report.

Introduction. Pneumoscrotum is a rare clinical entity. It presents with swollen scrotal sac and sometimes with palpable crepitus. It has many etiologies. One of them is due to blunt trauma of the thoracic cage, causing pneumothorax and/or pneumomediastinum. Case Presentation. We report the case of an 82-year-old male who was transferred to the Emergency Department with signs of respiratory distress after a blunt chest trauma. A CT scan was obtained, and bilateral pneumothoraces with four broken ribs were disclosed. Subcutaneous emphysema expanding from the eyelids to the scrotum was observed, and a chest tube was inserted on the right side with immediate improvement of the vital signs of the patient. Discussion. Pneumoscrotum has three major etiologies: (a) local introduction of air or infection from gas-producing bacteria, (b) pneumoperitoneum, and (c) air accumulation from lungs, mediastinum, or retroperitoneum. These sources account for most of the cases described in the literature. Treatment should be individualized, and surgical consultation should be obtained in all cases. Conclusion. Although pneumoscrotum itself is a benign entity, the process by which air accumulates in the scrotum must be clarified, and treatment must target the primary cause.