Close margin of adverse histologic factors with a negative primary tumor margin is not associated with increased locoregional recurrence in colon cancer.

PURPOSE: Locoregional recurrence after resection of colon cancer is increased when primary tumor margin is positive (<1 â€‹mm). Data is limited regarding the risk of locoregional recurrence with close margin (<1 â€‹mm) of histologic factors, such as intravascular tumor, intranodal tumor, tumor deposits, or extranodal extension. We hypothesized that close margin of these factors doesn't affect locoregional recurrence. METHODS: A retrospective review of all colon cancer surgical resections for adenocarcinoma from 2007 to 2020 was performed. Inclusion criteria were specimens with a negative primary tumor margin but a close margin of adverse histologic factors, defined as intravascular tumor, intranodal tumor, tumor deposits, or extranodal extension within 1 â€‹mm of a mesenteric or circumferential margin. RESULTS: Among 4435 pathology reports reviewed, 45 (1 â€‹%) of cases met inclusion criteria. Average follow-up was 38 months. The adverse histologic factor was identified as intranodal tumor in 24 (53 â€‹%) cases, intravascular tumor in 8 (17.8 â€‹%), tumor deposits in 5 (11.1 â€‹%), and more than one pathologic feature in 6 (13.3 â€‹%). There were 9 (20 â€‹%) recurrences; 6 (13 â€‹%) had distant recurrences only, 2 (4 â€‹%) patients had locoregional recurrences only, and 1 (2 â€‹%) patient had both locoregional and distant recurrence. The adverse histologic factor in these three patients was intravascular in two and both intravascular and intranodal in one. CONCLUSION: Based on our results, we do not have evidence that the presence of intravascular tumor, intranodal tumor, tumor deposits, or extranodal extension within 1 â€‹mm of a mesenteric or circumferential margin is associated with increased risk of locoregional recurrence.

Training Future Surgeon Leaders in Environmental Stewardship: A Review of a Decade of the Health Care Sustainability Fellowship.

OBJECTIVE: Since the inception of Ken Lee Memorial Fellowship (KLMF) in 2013, our institution has achieved 10 years of trainee led sustainability projects. The ability of health care organizations to drive sustainability depends on organizational and human capacity. This qualitative study presents the first decade of sustainability fellows' projects, the challenges associated with implementing them, and the environmental and cost impact of these initiatives. DESIGN, SETTING, PARTICIPANTS: All residents in the General Surgery residency program at the Cleveland Clinic, a quaternary hospital, regardless of postgraduate year (PGY) level, are invited to apply for the KLMF program with a short project proposal. One fellow is selected per year. Each project since the program's inception was reviewed qualitatively, relying on data derived from observation, interview of prior fellows, and supervising staff, and analysis of documentation from the annual fellow presentation and abstract, Grand Rounds recording, and fellowship leadership. RESULTS: A targeted approach by each sustainability fellow is encouraged, with the following action cycle for change implementation throughout the 1-year fellowship: identification and discovery of an issue, collaborative planning of an intervention, implementation of the intervention, and evaluation. Projects range from water and waste reduction to education of surgical staff, with positive implications for environmental stewardship in our hospital. However, multiple barriers to completing, scaling, and maintaining sustainability initiatives remain, as demonstrated by challenges faced by our Ken Lee Fellows. CONCLUSIONS: Our goal is that this intensive educational experience within the framework of a graduate medical education curriculum will ensure future generations of surgeons who are thoughtful leaders in environmental stewardship.

Gender representation in the Central Surgical Association: A call to action.

BACKGROUND: Organizations such as the Central Surgical Association are important for promulgating advances in general surgery, but diversity and inclusion profoundly affect what is presented and discussed. The objective of this study was to evaluate gender representation trends at the Central Surgical Association and its annual meetings over the past 13 years. METHODS: Publicly available Central Surgical Association meeting proceedings from 2010 to 2022 were reviewed for society leaders, new members, invited speakers and moderators, and contributors to scientific sessions (first authors, senior authors). Gender identity was assessed through professional online platforms. The 2017 and 2021 meetings were conjoined with the Midwest Surgical Association. Incomplete data were obtained from 2013 and 2020-2022. RESULTS: A total of 2,158 individuals were reviewed, 554 (25.7%) of which were women. The overall trend of the absolute proportion of women participation increased by 1.8% per year (R2 = 0.7, P < .01). For leadership roles, 42/205 (20%) were women, with a 2.4% per year increase (R2 = 0.45, P = .02). For speaker roles, 82/384 (21.4%) were women, with a 2.2% increase per year (R2 = 0.6, P < .01). For scientific contributions, 253 first (35.9%) and 136 (19.3%) senior authors of 704 were women, with 1.5% (R2 = 0.4, P = .02) and 1.3% (R2 = 0.4, P = .03) increase per year, respectively. CONCLUSION: There has been a positive trend in women's involvement at Central Surgical Association meetings for leaders, speakers, and scientific authors. Diversity allows variate experiences to contribute to surgical advancements; thus, measures by the Central Surgical Association to ensure adequate representation should continue.

Splenic flexure colonic lipoma causing intussusception.

Colonic lipomas are rare benign tumours that are usually asymptomatic. However, giant colonic lipomas tend to be symptomatic and can occasionally result in intussusception and intermittent colonic obstruction. As adult intussusception is an uncommon occurrence, the identification of the underlying aetiology is essential due to its high association with malignancy. Computed Tomography remains the tool of choice for the diagnosis of colonic lipomas. Surgical excision remains the mainstay treatment of giant symptomatic colonic lipomas. We hereby present the case of a 51-year-old male found to have a colonic lipoma causing recurrent intussusception. We discuss the approach, diagnostic tools and available treatment modalities for colonic lipomas. We also provide a brief literature review of intussusception in adults.

Prevalence of antibiotic-resistant organisms among hospitalized patients at a tertiary care center in Lebanon, 2010-2018.

BACKGROUND: Infections due to antibiotic resistant organisms (ARO) among hospitalized patients are associated with increased morbidity, mortality, and healthcare costs. Longitudinal data about antimicrobial resistance are scarce in Lebanon and the region. The objective of this study is to describe the temporal trends of resistance of selected pathogens among hospitalized patients at a tertiary care center in Lebanon. METHODS: We conducted a retrospective review of surveillance data from 2010 until 2018. Six target organisms isolated from hospitalized patients were included: carbapenem-resistant Escherichia coli (CREC), carbapenem-resistant Klebsiella spp. (CRKP), multi-drug resistant Pseudomonas aeruginosa (MDRPA), carbapenem-resistant Acinetobacter baumannii (CRAB), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus spp. (VRE). Correlation analysis was performed to evaluate for temporal trends. RESULTS: A total of 15,901 isolates were examined, most of which were obtained from urinary specimens. Among Gram-negative organisms, the highest resistance was found among CRAB (81.7%), followed by CRKP (6.5%) and CREC (3.3%). MDRPA overall prevalence was 0.8%. Among Gram-positive organisms, the prevalence of MRSA and VRE was 26.2% and 2.6%, respectively. CREC, MRSA, and VRE showed statistically significant increasing temporal trends, while CRAB decreased significantly from 2013 to 2018. CONCLUSION: These data are helpful in characterizing the epidemiology of antimicrobial resistance in Lebanon and show that controlling emerging resistance is achievable with concerted infection control and antimicrobial stewardship efforts. Caution should be exercised to contain early on the spread of CREC and of resistant Gram-positive pathogens.

Long-term results of endovenous laser ablation of saphenous vein reflux: Up to nine years of follow-up.

INTRODUCTION: Endovenous laser ablation (EVLA) has become the gold standard for the treatment of saphenous vein reflux. We report the long-term clinical and ultrasound results of EVLA. METHODS: This study is a retrospective review of patients who underwent EVLA of saphenous vein over four years. Clinical results were assessed using venous clinical severity score (VCSS), and ultrasound results were classified according to Bush classification. RESULTS: Over a median follow-up time of 4.4 years, 168 EVLA-treated patients showed a drop in VCSS from 4.38 to 1.39. Ultrasound results of 140 treated great saphenous veins showed that 64% had one or more cause of recurrence. The presence of neovascularization correlated well with the lack of improvement of VCSS. CONCLUSION: EVLA resulted in drop in VCSS from 4.38 to 1.39. Among 140 treated great saphenous veins, reflux in the anterior accessory saphenous vein was the primary cause (23.5%) of recurrence.

Case report: Back pseudocyst of unknown origin.

INTRODUCTION: Soft tissue masses are fairly encountered clinical entities. Among the rare forms of soft tissues masses are non-pancreatic pseudocysts which are defined as encapsulated fluid collections not lined by epithelium. We are presenting a rare case of a pseudocyst of the back located within the paravertebral muscles at a tertiary care center. CASE DESCRIPTION: Patient presented with a progressively enlarging painless back mass. CT scan was done which showed a 10 × 10 cm cystic lesion along the paravertebral muscles of the back. Surgical excision of the mass was performed revealing an irregularly shaped multilocular cyst. Final pathology showed the lesion to be a pseudocyst. DISCUSSION: Pseudocysts can arise in a variety of locations such as omentum, adrenal glands, spleen or lungs. The etiology of these pseudocysts is highly variable and can be related to trauma, inflammation, or surgery. The diagnosis of these entities requires proper imaging and histopathologic examination. CONCLUSION: Pseudocysts arise due to a myriad of conditions and their diagnosis remains a challenge. Our case comprises the first reported case of idiopathic pseudocyst of the back. Although rare, pseudocysts should be considered in the differential of unexplained masses.

Differentiation of Urothelial Carcinoma into Two Distinct Subtypes, Glandular and Squamous, in Three Different Organs.

Urothelial carcinoma (UC) is a unique entity with different histological variants: squamous, glandular, small cell, micropapillary, sarcomatoid, and plasmacytoid. Each of those subtypes behaves differently. As such, and in many scenarios, an accurate histological diagnosis is of paramount importance to dictate the therapeutic approach. We hereby present a unique case of urothelial carcinoma that differentiated into two distinct histological subtypes, squamous and glandular, in three different organs within the genitourinary tract. We also describe the pathological and clinical differences entailed between the two histological variants in bladder and upper urinary tract urothelial carcinoma.

Seldom Differential of Dysuria in Northern America.

Human schistosomiasis or bilharzia is a parasitic disease that highly impacts a country's health and economic systems specifically when it affects individuals residing in underdeveloped countries. Daughter eggs produced by colonized Schistosoma can lead to multisystem immune-mediated response, one of them is an intravesicular granulomatous reaction leading to intramural lesions. Such outcome is directly related to the incubation of adult worms within the perivesical urogenital venous plexus. We hereby report an incidental discovery of calcified bladder wall lesions in a female patient residing in the United States for the last 27 years who presented with lower urinary tract symptoms. Despite a negative past medical history of schistosomiasis, intraoperative biopsies confirmed the presence of a calcified Schistosoma haematobium ova. Following that, a brief literature review of the pathogenesis and urogenital manifestations of Schistosoma is highlighted.