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This report documents a rare case of an extracranial meningioma on the posterior scalp without apparent dural connection. Additionally, a sebaceous steatocystoma of the anterior scalp presented alongside the meningioma. A steatocystoma localized to the scalp is also remarkably rare. To our knowledge, this is the first report documenting both an extracranial meningioma and a steatocystoma presenting concurrently on the scalp. A male patient in his thirties presented with a mass lesion on the scalp. A CT scan revealed one posterior scalp mass with no intracranial abnormalities. Post excision histologic examination confirmed an extracranial meningioma (meningothelial variant, WHO Grade I). A second anterior scalp mass, not revealed by CT scan, was discovered during surgery. It was excised and diagnosed as a steatocystoma. Meningiomas predominantly occur intracranially but, in some instances, may present as a standalone extracranial tumor without intracranial abnormalities. Because extracranial meningioma is uncommon, it may be overlooked during clinical diagnosis of scalp masses. We recommend that this neoplasm be routinely considered in the differential diagnosis of extracranial tumors. The discovery of another rare tumor-a steatocystoma located in immediate proximity on the scalp-is further remarkable. We briefly review relevant case reports and etiologies and consider a potential relationship between the two neoplasms. However, it remains more likely that the concurrence of these tumors in our patient was simply coincidental.

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OBJECTIVE: To assess the necessity of routine preoperative type and screen testing before a cholecystectomy, hernia repair, or appendectomy based on the risk of transfusion in our department. METHOD: We conducted a retrospective analysis of the surgical database of patients who underwent a cholecystectomy, a hernia repair, or an appendectomy at Maimonides Medical Center over a 2-year period and examined the number of patients who actually received transfusions either on the day of surgery or on postoperative day 1. RESULT: We examined 3424 patients who underwent a cholecystectomy, hernia repair, or appendectomy over a 2-year period and examined how many patients required an RBC transfusion on the day of surgery or on postoperative day 1. Of our 3424 patients, 11 required a transfusion (1 appendectomy, 5 cholecystectomy, and 5 hernia repair) in the aforementioned time frame. Consequently, the risk of undergoing a transfusion in this perioperative period is 0.32%. CONCLUSION: With this low probability of requiring blood products during or immediately after surgery, our data and supporting literature firmly support the elimination of the routine type and screens before cholecystectomy, hernia repair, and appendectomy without diminishing the quality of patient care.

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PURPOSE: Recently, the Accreditation Council for Graduate Medical Education (ACGME) has developed and enforced a complex set of regulations limiting resident duty hours (RDHs). One potential method to comply with these stringent regulations and better document resident work hours would be to use text message (TM)/short message service (SMS), allowing rapid, inexpensive, and interactive 2-way delivery of information. The purpose of this study was to document the successful implementation of TM to enhance compliance with the ACGME RDH regulations. METHODS: Our TM system uses TSHEETS (TS; Meridian, Ohio), which is an online time- and labor-management service. After our general surgical residents were registered with the system, the documentation of entry into (texting "t start" to a predetermined number) and exit out of (texting "t stop" to the same number) the hospital could easily be accomplished. The goals of this pilot study were to determine (1) the feasibility of implementing a program such as this and (2) if use of such a program was associated with high resident satisfaction and improved compliance. RESULTS: We registered 39 residents with TS. Within 3 days, compliance rose from 76.9% to 96.2%. After implementation of TM reminders, compliance increased to 100%. A time-tracking resident satisfaction survey was distributed after 8 weeks of data collection. Twenty six of 39 (67%) residents participated in the survey, with 25 (96%) being more satisfied with the current application as compared with either of the previous (manual or swipe card) systems, specifically regarding ease of use and overall ACGME RDH compliance. Self-reported resident scores of their ability to be compliant with ACGME RDH before versus after implementation increased from 47% to 75% (p < 0.05). CONCLUSIONS: We were able to implement successfully a novel technique for ACGME RDH documentation and compliance in a general surgery residency program through the use of TM; this approach employed a state-of-the-art time-tracking method that was associated with high levels of resident work-hour compliance and overall satisfaction.

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CONTEXT: Congenital cystic lesions of the pancreas are rare findings. Furthermore, a dermoid cyst of the pancreas is exceptionally uncommon. A review of the world literature shows 18 documented cases. The pre-operative evaluation of this lesion is rather questionable, with definitive diagnosis taking place intra-operatively. CASE REPORT: A 52-year-old male with a symptomatic, 3-cm cystic-type mass in the pancreas. CONCLUSIONS: From our case presentation and review of the world literature, we hope to establish an increased awareness in the diagnostic evaluation of these patients.

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Although fiberoptic colonoscopy has gained wide popularity as a diagnostic and therapeutic tool, there remains an inherent complication rate following colonoscopic evaluation. Endoscopically induced bowel perforation and uncontrolled bleeding often necessitate immediate surgical intervention. Another often-unrecognized complication is the introduction of air into the vertebral venous system. A case of vertebral venous air embolism after routine diagnostic colonoscopy is reported with a review of current literature.

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The development of a cholecystoduodenal fistula may complicate 5% of all patients with cholelithiasis. It has been theorized that a cholecystoduodenal fistula may represent a significant risk factor in the development of gallbladder carcinoma because of the chronic reflux of duodenal contents. We report the case of a patient with a cholecystoduodenal fistula and an early gallbladder cancer to support this theory. Once developed, gallbladder cancer has a very poor prognosis. Early detection with timely resection is necessary to improve the survival rate in gallbladder carcinoma patients.

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