What makes them different? An exploration of mentoring for female faculty, residents, and medical students pursuing a career in surgery.

BACKGROUND: This qualitative study examines the roles of mentoring and gender in choosing and continuing in a surgical career for women across the continuum. METHODS: Semi-structured interviews were held with a purposive sample of 24 female surgical faculty, residents, and aspiring medical students from one institution between November 2018 and January 2019. Interview transcripts were analyzed using traditional thematic analysis methods aided by computerized software. RESULTS: The use of a mosaic approach in seeking mentoring to match one's personal and career-relevant support needs was described frequently. Same-gender role models were more important for early career women, while leadership mentoring and coaching were more desired by later career women. Gender differences in mentoring were identified but some of these differences may apply equally to women and men. CONCLUSIONS: Study findings contribute mentoring insights relevant to both women and men interested in pursuing and thriving in surgical careers.

Curettage and graft alleviates athletic-limiting pain in benign lytic bone lesions.

BACKGROUND: Solitary bone cysts (SBC), nonossifying fibromas (NOF), and fibrous dysplasia (FD) create benign intramedullary lytic bone lesions. They are typically asymptomatic and treated conservatively. We present a series of lesions that caused performance-limiting pain in young athletes, a symptom phenomenon and possible treatment indication that has been poorly described in the literature. QUESTIONS/PURPOSES: We asked whether intralesional curettage and defect grafting of these lesions would alleviate pain in young athletes and permit their return to unrestricted athletic activities. PATIENTS AND METHODS: We retrospectively identified 29 patients (30 lesions) who underwent curettage and grafting for SBC (12 patients), NOF (nine), or FD (eight). All patients had pain predominantly with athletic involvement. The mean age of the patients was 18 years (range, 12-31 years). Tumor locations were the femur (eight lesions), humerus (seven), tibia (six), fibula (five), pubic ramus (two), ulna (one), and calcaneus (one). Signs/symptoms were pain alone (24 patients) and pain plus fracture (five). Surgery involved curettage and packing with allograft cancellous chips, bone substitute, or demineralized bone matrix. Two patients required internal fixation. The mean followup was 21 months (range, 2-114 months). RESULTS: Twenty-four patients had no pain and five had occasional mild pain at last followup. All patients resumed full activity at a mean of 3.3 months (range, 1.5-8.3 months), excluding two who required repeat surgery. CONCLUSIONS: Our observations suggest curettage and packing with bone graft/substitute can provide pain relief and allow full athletic recovery for young athletes with benign lytic bone lesions. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Treatment of adult rhabdomyosarcoma.

OBJECTIVES: Rhabdomyosarcoma is an exceedingly rare tumor in adults, and standard chemotherapy used for children is much less effective in adults. This study examines short-term outcomes using doxorubicin, ifosfamide, and vincristine for adult rhabdomyosarcoma. METHODS: Pathology records were searched for adults (age, >18) with rhabdomyosarcoma treated at our musculoskeletal tumor center. Treatment involved surgical resection, radiation therapy, and chemotherapy with doxorubicin, ifosfamide, and vincristine. Eleven met inclusion criteria. Mean age was 49 (range: 19-72). Tumors sites included upper extremity (4 patients), lower extremity (6), and cervix (1). Subtypes were pleomorphic (7), alveolar (1), embryonal (1), and mixed alveolar/embryonal (2). RESULTS: Of the 7 patients with nonmetastatic disease, 6 had no evidence of disease posttreatment, but 1 died of myelodysplastic syndrome after 51 months. Three patients who received neoadjuvant chemotherapy had 100% tumor necrosis. One patient with positive margins scheduled for adjuvant chemotherapy had local recurrence and metastasis within 2 weeks and died 5 months later. Of the 4 patients with metastatic disease on presentation, 1 had complete response, 2 had partial response with later progression and death at 8 and 24 months, and 1 had immediate progression and died at 12 months. Mean overall survival was 24 months with 6 of 11 (55%) alive at last follow-up. Mean disease-free survival was 17 months for all patients and 23 months for the 7 patients who had remission of all disease. CONCLUSIONS: When combined with surgery and radiation therapy, chemotherapy using doxorubicin, ifosfamide, and vincristine yielded 55% overall and 64% disease-free survival at 2 years.

Ethanol sclerotherapy reduces pain in symptomatic musculoskeletal hemangiomas.

UNLABELLED: Hemangiomas, benign vascular lesions, require intervention if causing pain or functional limitations. Functional deficits are common after excision, favoring minimally invasive treatments. To determine whether ethanol sclerotherapy reduces pain and lesion size and to assess complications in symptomatic musculoskeletal hemangiomas, we retrospectively reviewed 19 patients (six males, 13 females; mean age, 34 years) meeting criteria of confirmed hemangioma, treatment with ethanol sclerotherapy, and minimum of 6 weeks of followup. Fourteen were primary lesions and five were recurrent; all were painful. Thirty-eight sclerotherapy procedures were performed, with each patient undergoing a maximum of three procedures. Mean followup was 24 months (range, 2-95 months). Four patients reported full pain relief, 11 had partial relief, and four had no relief. With recurrent lesions, one patient had full pain relief, one had partial relief, and three had no relief. For patients with lesions larger than 5 cm, two had full relief, six had partial relief, and three had no relief. Lesion shrinkage occurred in 12 patients. Temporary complications included paresthesiae (three), tendon contracture (one), skin breakdown (one), and deep vein thrombosis (one). Ethanol sclerotherapy afforded prompt pain relief in 15 of 19 patients with hemangioma, making it a reasonable option for initially avoiding surgical excision. However, the short followup of our patients requires additional long-term studies to assess the duration of the results. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Chondromyxoid fibroma involving the metacarpophalangeal joint.

Chondromyxoid fibroma is a rare benign bony tumor classically occurring in the metaphyseal region of the long bones surrounding the knee, but also found with relative frequency in other long bones, the pelvis, ribs, and small foot bones. The small bones of the hand, however, are rarely involved. The tumor is considered a physeal plate remnant and may involve the epiphysis, diaphysis, or both along with its metaphyseal origin. It may cause cortical expansion and destruction, but consistently respects the periosteal boundary. We report a case of histopathologically confirmed chondromyxoid fibroma involving a metacarpal, proximal phalanx, and synovial tissues of the metacarpophalangeal joint. A 29-year-old woman presented with pain, weakness, and a mass of the right ring finger metacarpophalangeal joint that had persisted since prior surgery to remove an extraosseous chondroma. Prominent soft tissue swelling and limited range of motion were noted, corresponding to magnetic resonance imaging findings of lytic changes in the right ring finger metacarpal and proximal phalanx, surrounded by an irregularly enhancing mass with soft tissue extension. Open biopsy revealed calcified cartilaginous synovial deposits suspicious for synovial chondromatosis, with erosion into surrounding bones. Histologic examination revealed an unusual chondromyxoid fibroma with joint involvement. The patient is >15 months out from synovectomy, intralesional curettage, and placement of demineralized bone matrix and allograft cancellous chips, and is without signs of recurrence. This benign, curable lesion should be included in the differential diagnosis of a bony lesion, even when a joint and adjacent bones are involved.

Increasing the efficiency of in-capillary electrophoretically mediated microanalysis reactions via rapid polarity switching.

We report herein a new approach to enhance the sensitivity or speed of CE-based methods that involve in-line reactions. Rapid polarity switching (RPS) is used as a novel means for in-line mixing of two reactant solutions via rapid (1-5 s) and sequential switching of the applied potential field. By employing the RPS approach with a model chemical reaction, that between creatinine and alkaline picrate, significant enhancement in sensitivity (or a decrease in analysis time) is realized. Both increased convection and electrophoretic stacking of the ionic reagent appear to contribute to the rise in apparent reaction rate. When coupled with in-line chemistry of the Jaffe method for creatinine, the RPS methodology allows for 3-fold faster determination of creatinine in the concentration range needed for the analysis of clinical blood serum specimens. The new approach also allows the analysis to be performed without the need for the cumbersome and problematic enhanced sensitivity cell.