Awareness Of Surgeons Research Articles

Screening tools for body dysmorphic disorder in a cosmetic surgery setting

Body dysmorphic disorder (BDD) is a well-established psychiatric disorder characterized by a marked, distressing, and impairing preoccupation with an imagined or slight defect in appearance. Despite the growing interest in and awareness of aesthetic surgeons for BDD, diagnosing BDD during a preoperative consultation remains challenging. This review provides an overview of the existing screening tools for BDD and assesses their quality and feasibility in an aesthetic surgery population. Systematic review. An electronic bibliographic search was conducted to identify all screening tools for BDD in a cosmetic setting. We investigated their development and validation processes and investigated whether the screening tool had a predictive value on subjective outcomes after treatment. We identified six different screening tools for BDD in a cosmetic setting. Only two of them were validated in a cosmetic dermatology setting: the Body Dysmorphic Disorder Questionnaire-Dermatology Version (BDDQ-DV) and the Dysmorphic Concern Questionnaire (DCQ). Outside the dermatologic surgery setting, no screening tools were validated. For the BDDQ-DV, no influence on subjective outcome after cosmetic treatment was found. The limited availability of good screening tools for BDD in patients seeking aesthetic surgery stands in remarkable contrast to the estimated high prevalence of BDD in this setting. Among the currently used screening tools, the BDDQ-DV and the DCQ seem the most suitable for further research on prevalence of BDD in cosmetic surgery and the impact of BDD on treatment outcome.

A matrix for comprehensive surgical education

From bench to bedside, and from the care of individuals to the health of populations, the scope of general surgery has exploded in recent years, as new scientific and technical insights have come to light and as greater focus on outcomes have identified new opportunities to improve patient care.1,2 Surgeons of the twentieth century could not have predicted how technology would fundamentally and immediately reshape surgical practice, how complex multimodal therapies would be coordinated with airline industry–level precision or how organized systems of care would transform access to treatment and surgical outcomes.1 As surgical progress accelerates, the next generation of surgeons will have exciting opportunities and will face unprecedented expectations and challenges.3,4 Remarkably, even in this era of rapid growth, the basic principles of surgical education outlined by William Halsted more than a century ago have endured and continue to produce surgeons with superb knowledge, technical skills and professionalism.5 Surgical residents still go through a fixed period of time for training, are expected to master structured educational content and face escalating operative and perioperative responsibility. But a strong foundation of knowledge and skill, while fundamentally important, is only one aspect of comprehensive surgical training and practice. Optimal surgical care increasingly depends on rigorous and continuous adaptation of the scientific literature into clinical practice; skillful communication with patients, families and colleagues; insightful and decisive leadership of multidisciplinary teams; and dedicated advocacy for patients as they attempt to navigate the complex health care environment. Effective physicians and surgeons instinctively possess many of these attributes. In fact, a formal survey of Fellows of the Royal College of Physicians and Surgeons of Canada identified 7 fundamental roles of medical specialists (the CanMEDS framework, Fig. 1).6,7 This deconstruction of clinical excellence brought the essential attributes of modern physicians and surgeons into sharp focus for the first time and opened new avenues to improve surgical education.7 Unfortunately, articulation of the CanMEDS roles also appeared to make surgical education much more complicated.8,9 Surgical training programs struggled to find time in their already brimming curricula to devote to specific training in the CanMEDS roles, and surgical residents questioned the relevance and urgency of these newly mandated priorities.10 Fig. 1 In 1990, the Royal College of Physicians and Surgeons of Canada polled its members to identify “a comprehensive definition of the competencies needed for medical education and practice.” This process ultimately led to the Canadian Medical ... However, as experience with the CanMEDS roles has grown in surgical programs and skepticism among surgeons and residents has receded, the inherent relevance and role of the CanMEDS framework in daily surgical education has become increasingly apparent. All teaching surgeons have caught glimpses of CanMEDS roles in action during routine duties, such as obtaining consent (Communicator), running a trauma resuscitation or operative slate (Manager), teaching a medical student how to write postoperative orders (Scholar) or even discharge planning (Collaborator, Health advocate). These are exciting insights because they begin to inform the process of seamless integration of teaching CanMEDS roles during surgical training, and they increase the awareness of trainees and surgeons to the educational richness of everyday interactions.

Orthopedic surgeon's awareness can improve osteoporosis treatment following hip fracture. A prospective cohort study

Orthopedic surgeon's awareness can improve osteoporosis treatment following hip fracture. A prospective cohort study

The Angry Face Syndrome

The Angry Face Syndrome

Orthopedic surgeon's awareness can improve osteoporosis treatment following hip fracture: a prospective cohort study.

Through retrospective Jeju-cohort study at 2005, we found low rates of detection of osteoporosis (20.1%) and medication for osteoporosis (15.5%) in those who experienced hip fracture. This study was to determine the orthopedic surgeons' awareness could increase the osteoporosis treatment rate after a hip fracture and the patient barriers to osteoporosis management. We prospectively followed 208 patients older than 50 yr who were enrolled for hip fractures during 2007 in Jeju-cohort. Thirty four fractures in men and 174 in women were treated at the eight hospitals. During the study period, orthopedic surgeons who worked at these hospitals attended two education sessions and were provided with posters and brochures. Patients were interviewed 6 months after discharge using an evaluation questionnaire regarding their perceptions of barriers to osteoporosis treatment. The patients were followed for a minimum of one year. Ninety-four patients (45.2%) underwent detection of osteoporosis by dual energy x-ray absorptiometry and 67 (32.2%) were prescribed medication for osteoporosis at the time of discharge. According to the questionnaire, the most common barrier to treatment for osteoporosis after a hip fracture was patients reluctance. The detection and medication rate for osteoporosis after hip fracture increased twofold after orthopedic surgeons had attended the intervention program. Nevertheless, the osteoporosis treatment rate remains inadequate.

Cholecystoduodenal Fistula is not the Contraindication for Laparoscopic Surgery

Cholecystoduodenal fistula is the complication of gallstone and it is difficult to diagnose this condition preoperatively, which is the reasonfor conversion of laparoscopic to open cholecystectomy. Earlier laparoscopic cholecystectomy was considered unsuitable for suchdifficult bilioenteric procedures. The laparoscope is fast becoming an important tool for the general surgeon, it make us capable ofhandling the unforeseen events. This review article is to demonstrate the cholecystoduodenal fistula is not the contraindication for thelaparoscopy, now it can be performed without higher rate of risk with the innovation of better modalities available.5 The goal of study isto introduce the proper awareness in laparoscopic surgeons regarding the feasibility and safety of the procedure.

Lateral Rectus Muscle Injury, Orbital Fracture, Mouth Locking, and Facial Palsy Resulting From Reduction Malarplasty

I report here on a patient with serious complications (lateral rectus muscle injury, orbital fracture, mouth locking, and facial palsy) that were caused by reduction malarplasty. A 32-year-old woman was referred to our department with complaints of inability to move her right eyeball laterally and inability to open her mouth. She has undergone reduction malarplasty 30 days previously at a local clinic. On examination, her maximal mouth opening was less than 3 mm. Her upper lip deviated to the left side when whistling. The orbit was displaced laterally and inferiorly. The upward and lateral gaze were limited. Computed tomography revealed fracture of the right orbital floor and lateral orbital wall extending to the orbital roof. The right lateral rectus muscle showed disconnection. The osteotomized segments were displaced inferiorly, and they pressed on the masseter muscle and coronoid process on the left side. On the 43rd postoperative day, a revision operation for the zygoma and orbit was carried out. Four days after the revision operation, surgery was performed for the myorrhaphy of the lateral rectus muscle and transposition of the medial rectus muscle. This case suggests the possibility of orbital fracture that can occur as a result of sawing in the wrong direction when using the intraoral approach. Although orbital fracture is extremely rare, it is hoped that this case will heighten the awareness of surgeons for this potential orbital fracture.

High- and Extra-High-Projection Breast Implants: Potential Consequences for Patients

All breast implants can potentially have deleterious effects on patients' tissues. Limiting negative tissue consequences and potential uncorrectable deformities requires that surgeons be aware and educate patients regarding potential consequences of various implant designs. High-profile implants have been available for decades, and during the current decade, extra-high-profile implants have become available, but no valid peer-reviewed and published studies have compared the potential tissue consequences of these designs to those of other breast implant designs. Valid comparative studies are exceedingly difficult to perform because of the number of variables that must be addressed to establish valid comparative cohorts. Nevertheless, the potential occurrence of negative tissue consequences from high- and extra-high-profile implants in primary breast augmentation and breast augmentation reoperation cases is well known to experienced aesthetic breast surgeons. This article addresses potential negative effects on patients' tissues of high- and extra-high-profile breast implants used for breast augmentation. This Special Topic article is not structured or intended as a scientific article. It is written as a Special Topic and not an Editorial at the editor's request. The cases presented are selected examples to illustrate potential clinical eventualities. The rate of occurrence of uncorrectable tissue deformities relates directly to surgeon and patient awareness of the potential consequences of implant selection decisions and requests. To minimize risks of negative tissue consequences for patients, surgeon awareness, patient education, and optimal implant selection decision processes are essential.

Intraoperative Techniques to Reduce the Potential of Set-screw Loosening in Long Spinal Constructs

The purpose of this study was to investigate the effects of implant selection and set-screw tightening technique on the loosening torques in long scoliosis constructs after long-term biaxial fatigue loading. Expanded use of pedicle screws in the correction of long scoliotic curves and the mechanical demands on segmental fixation systems requires surgeon awareness of revisiting set screws to ensure full screw/rod engagement and minimize the potential of set-screw loosening and/or rod slippage postoperatively. Biomechanical tests were performed to evaluate the effect of set-screw tightening techniques and rod approximation on screw/rod interface strength. Rod reduction test shows the force required to approximate a rod to a pedicle screw is statistically lower with uniplanar or polyaxial screws, when compared with monoaxial screws. This ease of approximation in both polyaxial and uniplanar screws directly correlate to improvement in the axial slippage resistance. In the simulated spinal model construct, rod/screw securement can vary based on the number of tightening torques applied to the system. Sequential revisiting of sets crews in long scoliosis constructs resulted in a statistically significant increase in loosening torque for monoaxial and polyaxial screw systems. Intraoperative securement assessment of set screws is recommended. The use of polyaxial and uniplanar screws at the distal ends in long constructs is recommended to increase the screw/rod interface strength.

Automation in Surgery: The Impact of Navigated-Control Assistance on the Performance, Workload and Situation Awareness of Surgeons

The present study investigates performance consequences of a new approach of automated support for surgeons. “Navigated-Control” (NC) represents an advancement of image-guided navigation that does not only support the surgeon in navigating through a patient's anatomy, but also can stop the surgical device if it comes too close to risk structures which need to be protected to ensure patient safety. It is explored, how NC affects different aspects of surgical outcome, workload and stress, and situation awareness. Fourteen advanced students of medicine performed a simulated Mastoidectomy with and without NC support. The results reveal that NC support can reduce both, the risk of intra-operative injuries, as well as the physiological stress level of surgeons. However, “cost effects” emerged with respect to subjective workload, and a reduced spare capacity compared to unsupported surgeries. These latter effects do not seem to be related to the principle of NC but technical constraints of current implementations.

Serious life-threatening complication 5 years after laparoscopic totally extraperitoneal hernia repair: case report and discussion of the literature

The purpose of this paper is to report the case of a serious life-threatening infection of the mesh occurring 5 years after totally extraperitoneal (TEP) hernia repair and to highlight the persistent risk of infection that may exist even after a long period following the primary repair. We also aim to raise the awareness of surgeons to the subtle presentation. We have reviewed the clinical presentation, past medical history and relevant pre-operative and post-operative investigations in a case of mesh infection 5 years after primary surgery. We have also reviewed the literature regarding long-term complications that may occur after TEP repair. A 62-year-old man presented with severe mesh infection 5 years and 4 months after primary bilateral TEP hernia repair. He rapidly progressed into septic shock and had to be managed in the intensive care unit. He is a current smoker of 30 pack years. Post-operative contrast computed tomography (CT) revealed previously undiagnosed diverticuli scattered throughout the colon with points of minor narrowing at the sigmoid and transverse colons. Although the risk of mesh infection following TEP hernia repair is small, it persists for more than 5 years and probably as long as the mesh remains in the body. Our report also raises the question as to whether there is a specific long-term risk of mesh infection following TEP hernia repair in patients with underlying inflammatory bowel disease and/or chronic heavy smoking. This needs to be studied prospectively.

Mycobacterium fortuitum Infection Following Patellar Tendon Repair

Mycobacterium fortuitum is a ubiquitous, rapidly growing mycobacterial species that is infrequently reported in the surgical literature. Clinically important infection with this organism has been described following trauma, injections, augmentation mammoplasty, and ultrasound hydrolipoclasia1-3. In the field of orthopaedic surgery, Mycobacterium fortuitum infection has been encountered only following prosthetic arthroplasty or fracture surgery with internal fixation4-9. We report the case of an otherwise healthy man who underwent patellar tendon repair that was complicated by Mycobacterium fortuitum infection. While an accurate diagnosis was delayed by several weeks, aggressive surgical and specific antimicrobial therapy resulted in a favorable outcome. We emphasize the importance of surgeon awareness of this pathogen in order to facilitate accurate diagnosis and appropriate treatment. The patient was informed that data concerning the case would be submitted for publication, and he consented. A forty-year-old man who worked as an attorney was referred to one of us from another institution two months after surgical repair of the left patellar tendon. Three weeks before the referral, the patient had surgical wound erythema and drainage, accompanied by fever and chills. Oral cephalexin was prescribed but resulted in no improvement. Culture specimens were not obtained at that time. The medical history was otherwise unremarkable. Examination revealed that the patient was 180 cm tall and weighed 95 kg. The systemic temperature, pulse rate, and blood pressure were normal. The patient had an anterior longitudinal left knee incision with diffuse, severe surrounding erythema. The wound was open and draining, with granulation tissue exposed both proximally and in the center. The range of knee motion was from 0° to 70°. The patellar height appeared to be symmetrical on both sides, and the patient could perform an active straight leg raise. Distal motor and sensory function was …

Secondary medical prevention in patients with peripheral arterial disease - Prescriptions of vascular surgeons and medical doctors (angiologists) in a multidisciplinary vascular centre

We compared medical secondary prevention in patients with peripheral arterial disease stage II (Fontaine) located in the femoro-popliteal artery managed by vascular surgeons and medical doctors / angiologists in our multidisciplinary vascular center. We retrospectively analyzed demission protocols of in-hospital treatments between 01.01.2007 and 20.06.2008. We surveyed 264 patients (54.2 % women; mean age 67.52 +/- 8.98 yrs), 179 (67.8 %) primarily treated by medical doctors / angiologists and 85 (32.2 %) primarily managed by vascular surgeons. Medical doctors / angiologists treated more women (n = 109) than men (n = 34), (p = 0.002) and documented smoking and diabetes mellitus more often (p < 0.001) than vascular surgeons. Besides, patients had similar cardiovascular risk profiles and concomitant diseases, vascular surgeons prescribed 5.47 +/- 2.26 drugs, medical doctors / angiologists 6.37 +/- 2.67 (p = 0.005). Overall, 239 (90.5 %) patients were on aspirin, 180 (68.2 %) on clopidogrel, and 18 (6.9 %) on oral anticoagulants. Significantly more patients treated by medical doctors / angiologists received clopidogrel (169 versus 11; p < 0.001), significantly more surgical patients received oral anticoagulants (11 versus 7; p = 0.016). The number of patients without prescriptions for any antithrombotic therapy was 6 (6.9 %) in patients treated by vascular surgeons and 0 (0 %) in patients managed by medical doctors / angiologists (p = 0.001). Prescription-rates of beta-blockers, ACE-inhibitors, Angiotensin II-antangonists, calcium channel blockers, and diuretics were statistically not different between the two disciplines, but statins were prescribed significantly more often by medical doctors / angiologists (139 versus 49; p < 0001). With the exceptions of Clopidogrel (women > men) and diuretics (men > women) we observed no gender-specific prescriptions. We observed high prescriptions rates of secondary medical prevention in patients primarily treated by medical doctors / angiologists and vascular surgeons. We believe that this result is highly influenced by our multidisciplinary approach. Nevertheless, efforts have to be made to raise vascular surgeons awareness of statin use and complete prescription of antithrombotic and antiplatelet drugs.

Are Your Liposuction Cannulas and Handle-Cannulas a Potential Problem if Used for Autologous Fat Graft/Transfer?

Objectives: To create surgeon awareness that some liposuction instruments should not be used for harvest and reinjection during autologous fat grafting (AFG), to outline which instruments need special cleaning techniques, and to increase awareness of available customized devices that will eliminate the accumulation of debris in defect areas. Methods: The author examined 13 common liposuction handles and 22 liposuction cannulas noting their construction and ease of cleaning by brush and pressured water. Internal examination of the handles was done by cutting them in half longitudinally observing the pathway of the fat during harvest. The cannulas were examined by probing the tips of the cannulas to determine if blind pockets were present. Results: A few of the instruments had an acceptable continuous pathway and no problem cleaning areas. However, 10 of the 13 liposuction handles had severe drop-offs and cracks that would be very difficult to clean, and 18 out of the 22 cannulas contained a blind pocket in their distal tip. The most common structural problem for the handles was the severe drop-off but the most serious problem for the handles was the crack. The most common and serious problem for the cannulas was the tip blind pocket. These areas would require special cleaning efforts to qualify for use during AFG/T. Discussion: When AFG became a more popular procedure, surgeons adapted by using liposuction instruments for harvest and reinjection. However, because fat transfer involves reinjecting fat back into the body, the instruments must be easy to clean. Most liposuction instruments are built to transport liposuction waste fat only; thus, they have a crude interior design with drop-offs and pockets that make them difficult to clean. Some of these devices can harbor pockets of old tissue. In general, if the pathway is continuous and is not interrupted by drop-offs or blind pockets, the instrument can be used for both liposuction and AFG. If, however, there are drop-offs and/or blind pockets, the surgeon should make certain the unit is dismantled and every area cleaned manually between procedures or should turn to the many customized instruments for AFG. Conclusions: The decision to purchase and use liposuction instruments for AFG should be made only after the surgeon has examined the product and is confident that the pathway has no drop-offs and/or blind pockets that make it difficult to clean. Custom AFG instruments are available that are constructed in a manner that negates the need for special cleaning procedures.

Anomalous V-shape Palmaris Longus Tendon: Two Cases

We describe an incidental rare finding of V-shape tendon of Palmaris Longus (PL) in two cases. Examination of 253 subjects/506 hands for detection of PL Tendon by the standard clinical tests was undergone. The sample mean age was 21 years and M/F ratio was 1:3.The identification of V-shape bifid tendon was revealed only by Schaeffer’s test whiles both Thompson’s and Mishra’s tests failed to demonstrate the anomaly. These two cases with anomalous tendon did not provoke any symptom. The importance of this finding being a potential source of V-shape support that can be used as tendon transfer to extensor tendons, in restoration procedure of radial palsy, and as free transplant in reanimation of oral and lid angles in facial palsy or any where when a V-shape support is required. Therefore surgeon awareness of this anomalous tendon and pre-operative identification is warranted. J Med Cases. 2010;1(2):68-70 doi: https://doi.org/10.4021/jmc114e

Anomalous V-shape Palmaris Longus Tendon: Two Cases

We describe an incidental rare finding of V-shape tendon of Palmaris Longus (PL) in two cases. Examination of 253 subjects/506 hands for detection of PL Tendon by the standard clinical tests was undergone. The sample mean age was 21 years and M/F ratio was 1:3.The identification of V-shape bifid tendon was revealed only by Schaeffer’s test whiles both Thompson’s and Mishra’s tests failed to demonstrate the anomaly. These two cases with anomalous tendon did not provoke any symptom. The importance of this finding being a potential source of V-shape support that can be used as tendon transfer to extensor tendons, in restoration procedure of radial palsy, and as free transplant in reanimation of oral and lid angles in facial palsy or any where when a V-shape support is required. Therefore surgeon awareness of this anomalous tendon and pre-operative identification is warranted. doi:10.4021/jmc114e

Nasal Tip Complications of Primary Cleft Lip Nasoplasty

Complications of primary nasoplasty, at the time of definitive primary cheiloplasty, are underreported in the literature. This study endeavors to examine the occurrences of these complications at our cleft-craniofacial center, in an effort to identify causative factors and management strategies. A case series of patients with postoperative nasal complications after primary cleft lip nasal surgery is presented. A retrospective chart review of primary cleft lip nasal repairs was conducted at our cleft-craniofacial center between January 2003 and December 2007. Consecutive cases of 3 staff surgeons were evaluated. Specific data points included number and type of complications, subsequent required interventions, and relevant history, with particular attention paid to the details of the primary nasoplasty. Eighty-six primary cleft lip nasoplasties were completed between the years 2003 and 2007. Six complications (6.9%) related to the primary cleft lip nasoplasty were identified. Four patients (4.6%) experienced nasal tip infections; all 4 required surgical drainage. Twenty-four patients (27.9%) undergoing primary cleft lip and nose repair had postoperative nostril conformers placed, and 2 (8.3%) of them experienced complications deemed conformer related. Postoperative nasal complications of primary cheiloplasty occur and are likely underreported. In this series, complications resulted from infection, often occurring late, and secondary to the use of nostril conformers. Surgeon awareness and caregiver education, to identify the early signs of postoperative nasal complications, are critical to the successful treatment of these occurrences. Although this study did not intend on examining antibiotic use, the significance of nasal tip infections might support the regular use of antibiotics in this population, and the use of postoperative nostril conformers must be followed closely.

Survey of spine surgeons on attitudes regarding osteoporosis and osteomalacia screening and treatment for fractures, fusion surgery, and pseudoarthrosis

Background context Osteoporosis and osteomalacia are significant risk factors for fracture and spine instrumentation failure. Low-energy fractures are becoming increasingly more common because of an increase in life expectancy and age of the population. Decreased bone density is an independent risk factor for instrumentation failure in spinal fusion operations. Purpose To assess the awareness and practice patterns of spine surgeons regarding metabolic bone disorders and osteoporosis with emphasis on fracture care and arthrodesis. Study design/setting Questionnaire study. Patient sample Spine surgeons attending the “Disorders of the Spine” conference (January 2007, Whistler, British Columbia, Canada). Outcome measures Respondent reported frequencies of diagnostics, screening, and treatment methods for patients with low-energy spine fractures, pseudoarthrosis, and those undergoing spinal arthrodesis. Methods A ten-question survey was administered to orthopedic surgeons and neurosurgeons who treated spine fractures and degenerative spine conditions in their practice. The survey was given to those who were attending a continuing medical education spinal disorders conference. The survey asked about treatment patterns with respect to osteoporosis and osteomalacia workup and treatment for patients with low-energy spine fractures, pseudoarthrosis, and those undergoing spinal arthrodesis. Results Of the 133 surgeons to whom the questionnaire was distributed at this meeting, 114 questionnaires were returned that corresponds to a response rate of 86%. Twenty-one surveys were excluded because of incomplete biographical information, resulting in a total of 93 completed questionnaires that were available for analysis. When treating patients with low-energy spine fractures, 60% checked dual-energy X-ray absorptiometry (DEXA) and 39% checked metabolic laboratories (of those who did not order laboratories and DEXA about 63% refer for treatment). Before instrumented fusion, 44% of those queried checked DEXA and 12% checked metabolic laboratories (vitamin D, parathyroid hormone [PTH], and calcium [Ca]). Before noninstrumented fusion, 22% checked DEXA and 11% checked metabolic laboratories. Before addressing pseudoarthrosis, 19% checked DEXA and 20% checked metabolic laboratories. Conclusions Despite of the large number of elderly patients undergoing spine care and the high incidence of osteoporosis and/or osteomalacia in this population, a large portion of the spine surgeons who responded to the survey reported that they do not perform routine osteoporosis/osteomalacia workups. Of those who do perform workups, some commented that it will change their surgical plan or preoperative treatment. It appears that there is a need for increased awareness among spine specialists regarding osteoporosis screening and treatment. Osteoporosis practice patterns may also be affected with newly evolving government quality reporting regulations.

Bilateral coronary ostial disease following mediastinal irradiation: a case report

IntroductionOstial coronary artery disease is rare with a reported incidence of 0.07 to 0.25% in all patients undergoing angiography. It has a strong association with previous mediastinal irradiation, which induces specific histological changes distinct from atherosclerotic lesions. The radiation also affects the myocardium and surrounding structures, which can alter the surgical approach.Case presentationWe present a case of a 62-year-old female who developed bilateral ostial coronary artery stenosis 32 years following therapeutic radiotherapy for Hodgkin’s disease. She underwent successful coronary artery bypass surgery using a combination of arterial and venous conduits. Postoperatively she developed a clinical picture of diastolic impairment not detected pre-operatively. She was managed appropriately and made a successful recovery.ConclusionsThis case highlights the cardiac pathology associated with mediastinal irradiation, which should be suspected during surgical assessment, especially in long-term survivors. It heightens the surgeon’s awareness so a more thorough evaluation of coronary anatomy, ventricular function and potential conduits is made prior to surgery.

Odontoameloblastoma: Report of two cases

Odontoameloblastoma (OA) is a very rare mixed odontogenic neoplasm, characterized by the simultaneous occurrence of an ameloblastoma and a compound or complex odontoma in the same tumor mass. To date, less than 50 cases of OA and/or ameloblastic odontoma have been reported in the English dental literature. This neoplasm was called ameloblastic odontoma. The term OA was included in the 1971 WHO classification. In this study, we present two cases of OA, which we hope will contribute to the awareness and knowledge of surgeons regarding the existence of this odontogenic tumor so that patients having it may be treated and followed-up properly.