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Accurately confirming surgical trainees have met the requirements of entrusted professional activities (EPAs) will require rigorous staff input. We pondered whether such simulation-driven evaluations might prove useful to the current ABS/APDS pilot effort on EPA analysis. Our surgical trainees participate biannually in a 59-min simulation-based assessment (X-Games) which covers surgical technique, knowledge and critical thinking in a host of domains. The content and difficulty of the stations differed between the PGY levels. Only 4 EPA topics (inguinal hernia repair, appendectomy, cholecystectomy, and trauma resuscitation) were tabulated for this study. 16-PGY-2s, 8-PGY-3s, 10-PGY-4s, and 10-PGY-5s surgical residents completed the X-Games. Performance within and between PGY levels was variable. The mean(SD) EPA scores for all PGY levels are listed in Table- 1. Analysis gleaned from a 59-min OSCE in a simulated-setting offers objective data that appears to have construct-validity. Refining our Surgical X-Games to cater to the specific EPA scoring system may better allow objective analysis of when trainees cross the threshold from “can do with some help” to “can do autonomously”. •A 59-min OSCE objectively differentiates General Surgery trainees in relation to EPAs.•Simulated settings may offer insight into how trainees are progressing along an EPA continuum.•Direct observation of trainees allows immediate and granular feedback.

We sought to determine if endocrine anatomy could be learned with the aid of a hands-on, low-cost, low-fidelity surgical simulation curriculum and pre-emptive 60-second YouTube video clip. A 3-hour endocrine surgery simulation session was held on back-to-back Fridays. A video clip was made available to the 2nd group of learners. A comprehensive 40-point test was administered before (pre-test) and after (post-test) the sessions. General surgery interns (n = 26) participated. The video was viewed 19 times by 80% (12 of 15) of interns with access. Viewers outperformed nonviewers on subsequent post-testing (mean [SD], 29.7 [1.3] vs 24.4 [1.6]; P = .015). Mean scores on the anatomy section of the post-test were higher among viewers than nonviewers (mean [SD] 14.2 [.9] vs 10.3 [1.0]; P = .012). Low-cost simulation models can be used to teach endocrine anatomy. Pre-emptive viewing of a 60-second video may have been a key factor resulting in higher post-test scores compared with controls, suggesting that the video intervention improved the educational effectiveness of the session.

This case presentation involves a 57-year-old-male who suffered multiple adverse sequels from the delayed diagnosis of a large presacral mass. He initially presented with lower extremity deep vein thrombosis (DVT). Several months later, he had developed a pulmonary embolus. Imaging demonstrated a 13 × 14 cm presacral pelvic mass that occluded the right-sided venous return from the leg and caused the DVT and pulmonary embolism. An inferior vena cava filter was placed and eventually clotted. He then was referred to our institution for surgical consultation. The patient received lytic therapy and unfortunately developed hematemesis and a significant hemoglobin drop. An esophagogastroduodenoscopy (EGD) showed a black esophagus. A transthoracic echocardiogram showed a patent foramen ovale. The patient eventually stabilized and a repeat EGD a week later showed resolution of the ischemic esophagus. The patient later underwent a resection of the pelvic mass. The surgical approach and the surgical decision-making will be discussed.

While minimally invasive parathyroidectomy is an advantage to many properly selected patients, longer incisions and even wide skin resection may be optimal in a select few. We present an 80-year-old woman with primary hyperparathyroidism and bothersome excess neck skin and subcutaneous fat. The parathyroid adenoma was easily excised through a vertically-oriented cervical excision that removed an ellipse of fat and skin. Midline wound closure with a small Z-plasty to avoid wound tethering facilitated a cosmetic closure well within the surgical capabilities of endocrine surgeons. This technique is useful for select patients and their surgeons and may avoid the expense of cosmetic surgery. We offer this controversial case to highlight the pros and cons of maximizing efficient surgical care to our endocrine surgery patients.

We present a 62-year-old male with a recurrent cyst in the left posterior chest. MRI demonstrated a fluid-filled cavity measuring 23 cm in length and 11 cm in width. The cyst was aspirated demonstrating clear serous fluid. However, the cyst returned and he was referred to us for further treatment. The cyst was excised through a minimally invasive approach using a combination of blunt and electrocautery dissection. The cystic lesion was circumferentially freed from the trapezius muscle and cervical structures. Pathologic examination revealed a benign, fibrous-walled cyst without a true epithelial lining. There are no published reports of a deep thoracic wall cyst resembling this case in terms of histology or location. This patient is free of recurrence 1 year later.

Biotinidase deficiency is an autosomal recessive metabolic disorder whose diagnosis currently depends on clinical symptoms and a biotinidase enzyme assay. This study aimed to investigate the mutational status and enzymatic activity of biotinidase deficiency in seven unrelated Jordanian families including 10 patients and 17 healthy family members. Amplified DNA was analyzed by the automated Sanger sequencing method, and the enzymatic assay was performed using a colorimetric assessment. Biotinidase level was significantly lower (p < 0.001) in BTD children compare to their non-affected family members. Genetic sequencing revealed six different mutations in Jordanian patients. One mutation was novel and located in exon 4, which could be a prevalent mutation for biotinidase deficiency in the Jordanian population. Identification of these common mutations and combing the enzymatic activity with genotypic data will help clinicians with regard to better genetic counseling and management through implementing prevention programs in the future.