Mid-thoracic Nodular Fasciitis: A Diagnostic Dilemma.

Nodular fasciitis (NF) is a rare, benign, yet rapidly proliferative myofibroblastic soft tissue tumor that often mimics malignant lesions and presents significant diagnostic challenges. This case report describes a 16-year-old female whose mid-thoracic mass was initially mismanaged in an emergency setting as a sebaceous cyst. The misdiagnosis and subsequent inappropriate incision and drainage led to an iatrogenic flare-up, exacerbating the patient's condition and complicating her management course. The complexities encountered in this case underscore the critical need for stringent diagnostic protocols and multidisciplinary management to avoid iatrogenic complications and improve clinical outcomes in patients presenting with unusual soft tissue lesions. This report highlights the importance of adhering to established protocols for soft tissue lump evaluation and the potential pitfalls of misdiagnosis.

Malignant Melanoma Presenting as Spinal Cord and Pleural Lesions.

Primary spinal cord melanoma (PSCM) and primary pleural melanoma (PPM) are extremely rare entities with scarce cases reported in the literature. We present a case of a 54-year-old male diagnosed with possible primary pleural melanoma and primary spinal melanoma, managed with partial surgical resection, postoperative radiotherapy, and chemotherapy consisting of Ipilimumab, nivolumab, and temozolomide. This leads to decreased symptoms and improved quality of life of the patient. In this case report, we review the literature on PSCM and PPM in detail, addressing the pertinent clinical aspects as well as current and upcoming therapeutic options.

Outcomes Assessment of Hypospadias Repair.

INTRODUCTION: Hypospadias is a congenital malformation, which involves the displacement of the urethral orifice on the underside of the penis. The mainstay treatment of hypospadias is surgery. Currently, there is no literature broadly assessing hypospadias repair outcomes in the Kingdom of Bahrain. This study aims to provide descriptive data on cosmetic, functional, and surgical outcomes of hypospadias repair at a single medical institute in the Kingdom of Bahrain. METHOD: Data on patients who underwent hypospadias repair from January 2012 to December 2020 by a single surgeon were reviewed. Parents of patients were contacted via telephone for consent. All consenting participants returned for an outpatient assessment of functional and cosmetic outcomes using an original questionnaire and the Pediatric Penile Perception Score, respectively. All responses were recorded using a four-point Likert scale. Surgical outcomes were assessed by reviewing postoperative notes. All collected data were anonymized. The study was approved by the King Hamad University Hospital institutional review board. RESULTS: Of the 29 patients who underwent surgical repair for hypospadias, 15 patients consented to participate. The mean age of the study population was 2.466 (SD = 0.496). Both parent and physician cosmetic assessments had similar results with the majority of participants very satisfied with all cosmetic parameters. Physician assessment reported higher satisfaction compared to parents. There were no reported cases of poor satisfaction. In terms of functional outcomes, there were no reported cases of straining on initiation, and a smooth and continuous urinary stream was reported in 80%. Only four patients reported post-void dribbling. When assessing surgical outcomes, 53.30% had coronally located urethra with no cases of postoperative complications. More than half of our patients were discharged after one day. CONCLUSION: Our study noted overall high satisfaction in terms of surgical, cosmetic, and functional outcomes. Physicians reported better cosmetic outcomes when compared to parents. Further analysis with a larger sample size across various medical institutes will be required to better assess post-repair outcomes.

Benign cystic mesothelioma: A case report on the presentation of an unusual tumor.

INTRODUCTION: Benign cystic mesothelioma of the peritoneum is a rare, benign abdominal tumor. It can present with vague signs and symptoms and is often found on imaging or incidentally during surgery. PRESENTATION OF CASE: We report the case of a 30-year-old man presenting with acute abdominal pain that radiated to the right iliac fossa. No masses were found on superficial or deep palpation or on conducting a sonography. The patient underwent a diagnostic laparoscopy with an appendectomy, which revealed a perforated appendix and two cysts in the pelvis and iliac fossa. DISCUSSION: A benign cystic mesothelioma is an inclusion cyst found in the peritoneal cavity and has no specific clinical presentation. It can be symptomatic or found incidentally during surgery. Benign cystic mesotheliomas have a high recurrence rate and may undergo malignant transformation. CONCLUSION: Complete surgical excision of benign cystic mesothelioma must always be the first step of the treatment plan for this condition. It is difficult to treat with no evidence-based treatment modality available; thus, treatment should only be undertaken in a specialized center.

A novel technique for NGT fixation: Secure, simple, and safe.

Nasogastric tubes are often vitally important in post-operative management. Usually required for short term use, they are easily taped to the nose and face. Occasionally, longer term use is needed, such as in post esophageal reconstruction, where substitution and fixation of the NGT becomes an issue. We describe a novel method of NGT fixation that can be used for prolonged periods of time with minimal risk of dislodgement and without the need for suturing. INTRODUCTION: Nasogastric tubes (NGT) are a common practice in many clinical scenarios, and an easy and available method that is often essential for the prevention of life-threatening adverse complications such as aspiration pneumonia [1]. A common challenge arises in securing the NGT in place. Here, we describe a simple method to securely anchor an NGT tube for a prolonged period without the need to suture. METHOD: Steps of tube Fixation: 1. Distance between xiphisternum and mastoid process is measured and marked [Position A, Fig. 1]. This mark will correspond to the portion of the tube in the pharynx once the NGT is inserted. 2. A silk suture is tied to the NGT at the point marking the pharynx [Position A]. The two loose ends are not cut. 3. The NGT is inserted routinely through the nose. 4. Through the mouth, the NGT (and marked suture) is visualized using a laryngoscope. 5. Using a Magill forceps, the loose ends of the suture are pulled through the mouth. 6. The two loose ends are fed through a sleeve (small size feeding tube, cut to size) as to not cause irritation to the lips or the mucosa of the mouth and palate. 7. The two ends of the suture are tied around the nasal end of the NGT [Position B, Fig. 1] This method effectively creates a mini- "A-shaped"- double loop around the nasopharynx without interrupting the patency of the NGT, securing the tube safely without risk of dislodgement [Fig. 1]. It is of note that when marking the pharyngeal level on the NGT prior to insertion, it should be done with an overestimation of the distance by about 1,2 cm as the tube will be minimally pulled out after securing it using the method we described. (Fig. 1) DISCUSSION: Commonly used method of NGT fixation includes the triangular/Butterfly taping of the NGT to the tip of the nose. This can be challenging in patients with facial burns, facial hair, or simply uncooperative patients, where prolonged restraining is not a feasible option. Stitching of the NGT to the face or cheek has also been used in practice, but this could raise many complications including bleeding, or facial scarring [2]. With the method we described above, the NGT can be safely and easily secured in place without anchoring material on the face. It also negates the need for stitching. Additionally, it can be done with readily available tools and materials, without the need for high levels of training. While possible without sedation or anesthesia, this technique is best performed at the primary operation while the patient is under general anesthesia. CONCLUSION: This method of Nasogastric Tube fixation is a safe and secure method to maintain the long-term positioning of an NGT. When using this method, we did not note any dislodgement, minimal mucosal and lip irritation, and only minimal patient discomfort. It obviates the need for suture fixation.