Two cases of Rapunzel syndrome in adult males.

Trichobezoar are foreign bodies formed from undigested hairs that accumulate in the gastrointestinal tract and cause obstruction. Trichobezoar are usually found in the stomach but when the tail of the bezoar extends into the small intestine it is referred to as Rapunzel syndrome. Patients are usually females and have a history of psychiatric illness. However, in this study, we present two cases of Rapunzel syndrome in adult male patients that were managed with surgery. Trichobezoar should be considered in all patients with a history of psychiatric illness presenting with abdominal symptoms regardless of gender.

Three Dimensional Modelling in the Optimisation of Chest Wall Resection and Reconstruction Following Metastatic Breast Cancer.

Two-dimensional computed tomography scans no longer offer the level of detail that many surgeons desire for more accurate and precise surgical intervention. Computed tomography image reconstruction into three dimensional (3D) virtual models with interactive capability is providing an enhanced understanding of the patient's anatomy and pathology allowing the surgeon to create tailored intraoperative plans, minimizing complications and maximizing the intended therapeutic outcome. In this case report we demonstrate the use of 3D image reconstruction software in the management of a 36-year-old female with metastatic breast cancer affecting the chest wall.

Endobronchial Valves in the Management of Persistent Air Leak in Coronavirus Disease 2019.

Pneumothorax and persistent air leak are documented complications of severe acute respiratory syndrome coronavirus 2 infection. Patients who fall into this category are often poor candidates for invasive thoracic surgical intervention. Endobronchial valves offer an effective and less invasive treatment option and can successfully treat persistent air leak and support the weaning of patients with severe acute respiratory syndrome coronavirus 2 pneumonia off ventilation.

Antibiotic-loaded Bone Cement in the Management of Neosternal Osteomyelitis.

Antibiotic-loaded bone cement is an alternative treatment option that can be used in the surgical management of osteomyelitis requiring bone resection and reconstruction. Current literature provides a focus on its use within the orthopedic patient group with scarce literature surrounding the cardiothoracic patient demographic. We hereby demonstrate the use of an antibiotic-loaded bone cement in the definitive management of neosternal osteomyelitis and nonunion, avoiding the need for further complex autografting and internal fixation.

Chest Wall Silicone Granuloma Following Ruptured Silicone Breast Implant Causes Giant Chest Wall Abscess and Osteomyelitis: The First Report.

Silicone breast implant ruptures have been widely reported in the literature. Granuloma formation is a known complication of such ruptures with reported sites including the axillae, limbs, chest wall muscles, and internal organs, such as the lungs and the liver. To the best of our knowledge, there are no reported cases of a silicone granuloma causing osteomyelitis of the sternum and multiple ribs in the absence of infection. We therefore report on the case of an 81-year-old patient who presented with an anterior chest wall discharging sinus tract on the background of a ruptured silicone breast implant. We raise awareness about the potentially devastating complications resulting from a ruptured silicone implant with relevance to cardiothoracic practice.

Older people and technology: Time to smarten up our act.

The NHS faces challenges today that it was not designed to tackle at its conception in 1948. The UK demographic has changed considerably with higher life expectancy and 'an ageing population'. Keeping this demographic healthy through prevention and management of age-related degeneration is crucial to their independence and improving resource utilisation. The Department of Health and Social Care's agenda for digital transformation of the NHS is facilitating a move towards preventative healthcare and greater community care, which will likely be supported by virtual healthcare delivery models. Despite views on digital illiteracy in the older population, this demographic may stand to benefit the most. Research has shown that the older demographic adopts technology in line with the technology acceptance model if their needs are carefully considered. Executed successfully, the deployment of virtual healthcare could save transformational costs to the NHS and support better quality of life for the senior members of society. This is particularly relevant in the current COVID-19 pandemic with patients facing challenges in accessing outpatient appointments. With many hospitals kickstarting virtual outpatient clinics to ensure continuity of care during a time of social isolation; we await to see the ingenuities that arise from the current pandemic.

Pilot training and surgical education: flying towards a brighter future.

AIM: Human factors, surgery and aviation are intimately tied together by the common threads of error, risk and interpersonal relationships. A plethora of research abounds in all disciplines individually. The lessons learnt in one domain however are not unique and can be shared between all to promote best practice, further research and a greater understanding at a fundamental level. METHODS: A structured, thematic, literature review was performed. PubMed, EMBASE and Ovid MEDLINE databases were interrogated directly. The Health Foundation, National Health Service and Department of Health online databases were used through querying intrinsic search functions. RESULTS: With expanding use of technologies such as checklists, there is a gap left to better address and understand the nuances and roles of stress, communication and emotion on both learning and clinical practice. These can be prominent in the high-pressure environments shared between aviation and surgery. CONCLUSIONS: The authors explore lessons learnt from aviation, the human factors applicable to both and how they can be extrapolated to improve patient safety outcomes and promote the use of the 'Software, Hardware, Environment, Liveware' tool to aid practice.

Can technology optimise the pre-operative pathway for elective hip and knee replacement surgery: a qualitative study.

BACKGROUND: An ageing population has resulted in a rise in the number of hip and knee replacement surgeries in the UK. The pre-operative pathway is plagued with issues causing long delays and cancellations. Virtual healthcare technologies have a growing evidence base to help solve these issues. One problem of implementing these technologies is the resistance to change mentality from healthcare professionals. By getting their opinions on the place of these technologies within the pre-operative pathway, a united front can be formed to help deliver change. METHODS: Sixteen semi-structured interviews were conducted with key stakeholders within the orthopaedic pre-operative pathway at Imperial College Healthcare NHS Trust. General topics included the different technologies that could be used within the pathway, their uses and associated benefits and problems. Interviews were audio-recorded, before being manually transcribed and then analysed to form categories and themes. RESULTS: Various uses, benefits and problems were identified by healthcare professionals for each modality of technology. E-forms were seen as a high reward, low-risk intervention. Remote patient monitoring and teleconsultations had their bonuses, but feasibility was a primary concern. Web-based interventions were seen as an intervention of the past, whereas virtual reality was seen as perhaps being ahead of its time. M-health was very positively viewed due to its all-encompassing nature. Digital illiteracy emerged as a consistent problem for most technologies. CONCLUSIONS: Current literature, the results from this study and technology trends within society highlight both M-health and E-forms as the 2 most promising virtual healthcare technologies for use in the pre-operative pathway for orthopaedics. Areas such as pre-operative assessment, triaging and prehabilitation are prime candidates for virtual intervention. Future research should also consider including patient opinions on any proposed interventions, as well as taking into account barriers to implementation.

Delayed post-traumatic presentation of severe sternal osteomyelitis: A strong multidisciplinary effort and a novel reconstruction technique for a challenging case.

Sternal osteomyelitis is a morbid and challenging condition, which can rarely occur after trauma, with no established consensus over best therapeutic options. In this case, a 47-year-old man with history of intravenous drug use presented 11 weeks after a minor blunt chest trauma with a severe necrotizing osteomyelitis involving sternum, muscles, fascia and subcutaneous tissue and positive blood cultures for Methicillin Sensitive Staphylococcus aureus. Alongside tailored antibiotic therapy, extensive surgical debridement was performed, leaving a full thickness 3 × 4 cm sternal defect and a large skin defect. After 4 weeks of antibiotics and Vacuum-Assisted-Closure pump, a novel reconstruction technique was utilized, with full collaborations of thoracic surgeons, orthopaedic surgeons and plastic surgeons. An autologous tricortical iliac crest bone graft was harvested and shaped to fit the full-thickness sternal defect, while two titanium sigmoid-shaped clavicle plates were used for internal fixation of the autograft. The large skin defect was covered with a pedicled myocutaneous latissimus dorsi flap. Integrity and stability of the chest wall was fully restored, and infection was completely eradicated. No complications occurred and the patient was well at the 18 months follow-up. To the best of our knowledge, this is the first report on autologous iliac crest bone graft in the treatment of sternal osteomyelitis. In this case, it proved to be a viable therapeutic option, providing good long-term clinical and cosmetic results.

Frequency and impact of incidental findings on computed tomography during work-up for transcatheter aortic valve implantation: single centre experience and review of the literature.

OBJECTIVE: To assess the frequency and impact of incidental findings (IF) on CT during work-up for transcatheter aortic valve intervention (TAVI). METHODS: A consecutive cohort of patients referred for consideration of TAVI who underwent a CT scan between 2009 and 2018 were studied retrospectively. CT reports were reviewed for the presence of IFs and categorised based upon their clinical significance: (a) insignificant-findings that did not require specific treatment or follow-up; (b) intermediate-findings that did not impact on the decision-making process but required follow-up; (c) significant-findings that either required urgent investigation or meant that TAVI was clinically inappropriate. RESULTS: A total of 652 patients were included, whose median age was 82 years. One or more insignificant IF was found in 95.6% of patients. Intermediate IFs were documented in 5.4%. 91 (14%) patients had at least one significant IF. These included possible malignancy in 67 (74%). The ultimate decision to offer aortic valve intervention was only changed by the presence of an IF in 3.5% of cases. CONCLUSION: Clinically significant IFs are detected in more than 1 in 10 of patients undergoing CT as part of a TAVI work-up, although just over half of these patients still receive aortic valve intervention. ADVANCES IN KNOWLEDGE: This study is the largest UK cohort, which, when combined with a review of existing literature, provides a clear picture of the frequency and clinical impact of IFs found at CT for TAVI assessment.