Background: Naviculectomy was originally described for resistant congenital vertical talus deformity but was later expanded to use in rigid cavus deformity. This study reviews the operative outcomes of complete excision of the navicular for recurrent deformity in the talipes equinovarus (TEV) population. Methods: After institutional review board approval, all patients undergoing naviculectomy at a single institution were identified. Clinical, radiographic, and pedobarographic data (minimum 2 years’ follow-up) were reviewed. Results: Twelve patients (14 feet) with TEV from 1984 to 2019 were included. All feet had minimum 1 prior operative intervention on the affected foot (mean age = 4.0 years, range 0.2-14.5), with 8/14 having at least 3 prior operative procedures. Complete navicular excision with concomitant procedures was performed in all patients (mean age = 11.7 years, range 5.5-16.1). Mean clinical follow-up from naviculectomy was 5.1 years (range, 2.2-11.2). During follow-up, 6 patients required subsequent surgery, most often secondary to pain and progressive deformity. One patient underwent elective below-knee amputation of the affected extremity. Of the remaining 11 patients, 7 of 11 reported continued pain and 8 of 11 maintained adequate range of motion at the ankle at the most recent follow-up. Conclusion: Clinical follow-up demonstrated deteriorating results in a large percentage of patients. The high rate of additional procedures and continued pain in the current series suggests that even as a salvage procedure, naviculectomy may not provide adequate results for patients. Level of Evidence: Level IV, case series.

Retroperitoneal liposarcoma is often asymptomatic but sometimes attention is drawn to the neoplasm due to clinical manifestations. These include fever, flu-like symptoms, nausea or vomiting due to pressure or hypoglycemia related to paraneoplastic disease. We present a rare case of a massive retroperitoneal liposarcoma presenting with refractory dry cough. The patient underwent resection of the mass with complete resolution of her cough. Histopathological examination of the mass demonstrated a well-differentiated tumor with myxomatous features. No evidence of metastatic disease to the lungs was observed. This case points to the need for a thorough and careful evaluation of unexplained cough.

Retroperitoneal liposarcoma is often asymptomatic but sometimes attention is drawn to the neoplasm due to clinical manifestations. These include fever, flu-like symptoms, nausea or vomiting due to pressure or hypoglycemia related to paraneoplastic disease. We present a rare case of a massive retroperitoneal liposarcoma presenting with refractory dry cough. The patient underwent resection of the mass with complete resolution of her cough. Histopathological examination of the mass demonstrated a well-differentiated tumor with myxomatous features. No evidence of metastatic disease to the lungs was observed. This case points to the need for a thorough and careful evaluation of unexplained cough.

OBJECTIVE: Simulation offers an important avenue for surgical and anesthesia training. This is especially important for crisis management scenarios where individuals need to act quickly and efficiently for optimal patient care. Practice based performance can be measured and real time feedback provided during debriefing scenarios. METHODS: In this paper, we highlight a dual anesthesia and otolaryngology cavernous carotid injury scenario. The trials were run three different times with inter-trial debriefing. RESULTS: The focused debriefing improved resident performance in terms of blood loss on subsequent trials. Furthermore, the learners provided important feedback regarding the utility of training and how it improved their ability to handle crisis management scenarios in the future. CONCLUSION: Debriefing for crisis management in a simulation trial improves performance and trainee confidence. Follow up studies will evaluate real world effectiveness over a longer follow up period.

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