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\"In a city not quite of any particular era, a distant and calculating man named Lenz Buchmann works as a surgeon, treating his patients as little more than equations to be solved: life and death no more than results to be worked through without the least compassion. Soon, however, Buchmann's ambition is no longer content with medicine, and he finds himself rising through the ranks of his country's ruling party...until a diagnosis transforms this likely future president from a leading player into just another victim.\"--P. [4] of cover.

Blending the twin goals of embracing the diversity of College membership with surgical research is the theme of this edition of the Annals. The Global Surgical Frontiers (GSF) conference, hosted by the RCS England this June aims to bring together all stakeholders delivering surgical care in resource-limited settings.2 This forum will afford bilateral learning in understanding the challenges and the evidence-based solutions that exist. Furthermore, no one can claim to practice surgery in an environment that is not, to some extent, resource-limited. Whether this is a review of ‘Nutcracker Syndrome’ (Trinidad), a randomised control trial of negative pressure therapy following lower limb amputation (India) or a 15-year study of superficial femoral artery aneurysms (Italy).

Norman Bethune was a surgeon, medical inventor, tumultuous romantic, and advocate for the poor.

It is with profound sorrow that we announce the passing of our esteemed colleague and cherished friend, Dr Vicky Jennings.

Objectives: A DFO can be performed via two techniques: a lateral opening wedge (LOW) osteotomy and a medial closing wedge (MCW) osteotomy. Small case series have looked at how leg length is affected by a lateral opening wedge DFO, however, there is a lack of research comparing these leg length changes to medial closing DFO. Additionally, no studies have presented a model for predicting the leg length changes that will occur following DFO of either technique. Given that limb length differences can lead to accelerated osteoarthritis, back pain, hip pain, and other issues, being able to predict which technique can help prevent this pathology without a secondary procedure would be an important finding. Finally, the medial closing wedge osteotomy can allow for immediate weight-bearing while the lateral opening wedge does not and typically has associated cost with bone grafting. Therefore, we designed this study to validate a tool designed to predict leg length changes after distal femoral osteotomy (DFO) and compare changes following medial closing wedge (MCW) and lateral opening wedge (LOW) techniques. Methods: A collaborative retrospective review was performed of patients from Rush and Mayo Clinic databases who received a DFO and had full-length standing radiographs both pre-and postoperatively. For each preoperative radiograph, the region on the medial (for LOW) or lateral (for MCW) distal femur cortex that would be the “hinge point” during DFO was identified. The distances from the center of the femoral head to the hinge point (“A”), from the hinge point to the center of the tibial plafond (“B”), and the resultant angle at the hinge point (“α”) were measured (Figure 1). Figure 2 demonstrates the equation used to plot a graph of the predicted leg length changes corresponding to the change in α angle produced by DFO. Final leg length was calculated on postoperative radiographs, and the difference between predicted and true leg length changes was compared using paired Wilcoxon signed rank exact tests. Results: 10 MCW and 10 LOW patients were included. For both LOW (n=10) and MCW (n=10) osteotomies, the predicted leg length change was equivalent to the true change measured on postoperative radiographs (LOW P=0.16; MCW P=0.85). LOW DFO’s had 5.10 ± 2.77 mm (range: 1.45-10.87 mm) of leg lengthening, compared to 2.61 ± 1.25 mm (range: 0.50-4.56 mm) of leg shortening (p<0.001) for MCW (Figure 3). On average, there was 0.85 mm of lengthening (range 0.5-1.3 mm) for every 1° of mechanical axis correction with LOW DFO, compared to 0.45 mm of shortening (range: 0.1-1.4 mm) per 1° of MCW correction. Conclusions: This study presents a tool to accurately and reliably predict the leg length changes seen after both medial closing and lateral opening wedge DFO’s. Knowing what leg length changes to expect with each DFO technique is a useful tool that surgeons can utilize during surgical planning. Preoperative radiographic imaging can be used to predict leg length change following DFO with high reliability and accuracy. Surgeons can expect approximately 0.85mm of lengthening per 1° of DFO correction when performing LOW, compared to 0.45mm of shortening per 1° correction for MCW osteotomies.

Set against the backdrop of an antibiotic apocalypse in near future London. Rosa Scott, a brilliant and obsessive surgeon becomes Surgeon X, a vigilante doctor who uses experimental surgery and black market drugs to treat patients. But as Surgeon X, Rosa soon develops a godlike-complex, deciding who will live and who will die. Ultimately, she believes that to survive in this compromised world her own warped moral code is the one she must follow--even if it endangers those closest to her.

Tracheobronchial ruptures can be extremely dramatic and life threatening and are encountered in approximately 5 out of 100,000 cases after orotracheal intubation. They can occur as a result of intubation, tracheostomy, and bronchoscopy. In this case report, we presented a 56-year-old female patient with a history of thyroid surgery 27 years prior who presented to our clinic with recurrent multinodular goiter. The patient underwent a complementary complication-free thyroidectomy assisted by intermittent intraoperative nerve monitoring. After hemostasis, final controls involving digital palpation of the possible remnants of the thyroid gland and a search for pathological lymph nodes in the central compartments, a mass structure with a rubbery consistency suspicious for residue thyroid tissue was palpated in both posterolateral aspects of the trachea, but more prominently in the left. The anesthesia team was asked to decrease the cuff pressure, assuming that the palpated mass could be the cuff of the endotracheal tube, and the mass was noted to shrink. The membranous tracheal rupture due to the endotracheal tube cuff was closed with sutures running superiorly, and a superiorly based strap muscle flap was placed over during thyroid surgery. The patient was discharged on day 7. A simple routine digital examination by the attending surgeon dealing with the thyroid surgery would contribute favorably to prognosis, as such a precaution would allow early repair in cases where such injuries occur. Keywords: Endotracheal tube cuff; thyroidectomy; tracheal rupture. Balikesir Universitesi Tip Fakultesi, Genel Cerrahi Ana Bilim Dali, Balikesir, Turkiye Trakeobronsiyal ruptur son derece dramatik ve yasami tehdit edici olabilir ve orotrakeal entubasyon sonrasi yaklasik 100.000 vakanin 5'inde gorulur. Entubasyon, trakeostomi ve bronkoskopi sonucunda meydana gelebilir. Bu olgu sunumunda 27 yil once bir tiroid cerrahisi gecirmis olan ve klinigimize nuks multinoduler guatr sebebiyle basvuran 56 yasinda bir kadin hastayi sunduk. Aralikli intraoperatif sinir monitorizasyonu esliginde tamamlayici tiroidektomi operasyonu komplikasyonsuz olarak uygulanan hastada hemostaz sonrasinda, olasi rezidu tiroid dokusu ve santral kompartmanlarda olasi patolojik lenf nodlarinin parmak palpasyonu ile aranmasini iceren son kontroller sirasinda solda daha belirgin olmak uzere trakeanin her iki posterolateralinde rezidu tiroid dokusu oldugundan suphe edilen lastik kivaminda kitle yapisi palpe edildi. Palpe edilen kitlenin endotrakeal tupun kafi olabilecegi dusunulerek anestezi ekibinden endotrakeal tup manson basincinin dusurulmesi istendi ve manson basincinin dusurulmesiyle birlikte palpe edilen kitlenin kuculdugu gozlendi. Endotrakeal tup mansonunun neden oldugu membranoz trakeal ruptur suturlerle kapatildi ve uzerine superior bazli strap kas fleb ile rekonstruksiyon uygulandi. Hasta 7. gun saglikla taburcu edildi. Tiroid cerrahisi ile ugrasan cerrahlar tarafindan ameliyat sonunda yapilacak basit bir rutin dijital muayene bu tur yaralanmalarin meydana geldigi durumlarda erken onarima izin verecegi icin prognoza olumlu katkida bulunacaktir. Anahtar sozcukler: Endotrakeal kaf; trakeal ruptur; tiroidektomi.