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Introduction: Obstructed colon cancer is not an uncommon surgical emergency. Many other surgical diseases may overlap their presenting symptoms. This paper aims to report a colon cancer case with delayed diagnosis due to a long-standing para-umbilical hernia (PUH)., Case Report: 60-year-old female patient presented to our emergency department (ED) with an obstructed PUH. The patient underwent watchful conservative management many times before due to associated comorbidities. This history of recurrent intestinal obstruction and incomplete regain of regular bowel habits after every hospital admission raises the possibility for concealed pathology. Further investigations, including computed tomography (CT), revealed a suspicion of an obstructed malignant mass at the colon's splenic flexure accompanied with complete bowel obstruction. The patient and their family consulted for exploratory laparotomy and the possibility of stoma formation. The intra-operative finding was constant with a small ventral defect, and a dilated bowel loops up to a left colon transition zone. We achieved left hemicolectomy with a primary anastomosis after intra-operative bowel lavage. The postoperative period was uneventfully, and the patient was discharged home after seven days of admission. Follow up in the outpatient surgical clinic for three months revealed no recordable complications. The patient had transferred to the oncology center for the completion of adjuvant therapy., Discussion: This case had a small PUH with recurrent obstruction. The delay in its management was due to the patient's comorbidities. However, the incomplete resolution of patient symptoms during watchful oversight increases the likelihood of another hidden pathology that required further investigation. We expanded CT indication in such patients to find the exact cause of patient symptoms, especially chronic constipation and incomplete recovery after every admission. While concurrent pathology is the norm in elective surgery and can be dealt with safely, in non-elective surgery, a thorough search about the patient's exact complaints is mandatory to decrease morbidity and mortality rates., Conclusion: In the same patient, both colon cancer and abdominal wall hernias can produce conflicting symptoms and delay diagnosis. However, with a high index of suspicion and correlation of patient symptoms, can be safely managed without morbidity., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The cosmetic appearance of a facial scar is a concern for patients undergoing Mohs micrographic surgery (MMS). Although suturing technique may influence scar cosmesis, few studies have been published comparing suturing methods for MMS repair., Objective: To compare the cosmetic appearance of facial MMS scars sutured with either continuous or interrupted percutaneous nylon sutures., Materials and Methods: Patients with facial MMS defects were randomized to have half their scar sutured with interrupted 5-0 nylon stitches, whereas the other half of the scar was closed with running 5-0 nylon stitches. The appearance of each half of the scar was assessed at 1 week, 8 weeks, and 6 months by the principal investigator. Blinded photographic evaluation at 1 week and 6 months was completed by a plastic surgeon and general dermatologist., Results: A total of 105 patients were entered into the trial, and 101 completed all time point assessments. There was no statistically significant difference in scar outcome using each of the 3 scar assessment scales, at any time point, for any assessor (blinded and nonblinded)., Conclusion: Interrupted and continuous 5-0 nylon sutures result in an equivalent final cosmetic appearance of facial MMS scars. Given its advantages, running sutures may be the preferred closure technique for facial repair.

Propylene glycol (PG) is considered to be a ubiquitous formulary ingredient used in many personal care products and pharmaceutical preparations. It is an organic compound commonly found in topical corticosteroids (CS). Cutaneous reactions to PG are mostly irritant, but allergic contact dermatitis to PG is well-documented. Cosensitization to PG and topical CS can occur, making it challenging to choose the appropriate topical CS in a PG-allergic patient. This review is aimed at guiding clinicians in the selection of a suitable topical corticosteroid when presented with patients allergic to PG.

We describe a retrospective analysis of critical incident reports in two teaching hospitals. We included significant observations, involving unsafe practices during cardio-pulmonary resuscitation intensive care management and during anesthesia. Of the 143 critical incidents reported, 87% did not lead to negative out-come, out of these 13% were reports on deaths of patient resuscitated by CPR team or emergency department, underwent surgery, and or managed in the intensive care unit. Human errors and lack of communications were common factors for the majority of the incidents. Wrong drug labeling and irresponsible behavior were the most frequent among the human errors. The analysis aimed to regularize the method of reporting and also to determine the causes of complications, offer solutions and prevent occurrence of such incidents in the future.