Search

Background:. Despite rules set forth by the National Resident Matching Program and American Association of Medical Colleges (AAMC), prohibited questions during the residency interview process are well documented. This study describes the prevalence of these encounters by surveying residency applicants to integrated plastic and reconstructive surgery (PRS) programs for the 2022 match cycle. Methods:. An anonymous 16-question REDCap survey was distributed to 2022 cycle applicants of a single PRS program. The applicants were queried about demographic information, interview experience, and questions deemed illegal by the AAMC/NRMP guidelines. Results:. One hundred survey responses were attained for a 33.1% response rate. The majority of respondents were aged 26-30 (76%), women (53%), and white (53%); 33% received 15+ interviews for the application cycle. Seventy-eight percent of respondents reported being asked a prohibited question during at least one interview, with the most common "illegal" question categories being number/ranking of interviews (42%), marital status (33%), career balance (25%), and race/ethnicity (22%). Only 25.6% of applicants considered the subject matter inappropriate, whereas 42.3% were unsure. Although no applicant took action to report the potentially illegal scenarios, 30% said that their experiences influenced their rank list. Conclusions:. Our survey study revealed that prohibited interview questions in PRS residency interviews are common. Permissible lines of questioning and discussion between programs and applicants during residency interviews have been defined by AAMC. Institutions should provide guidance and training to all participants. Applicants should be made aware of and empowered to utilize available anonymous reporting tools.

Summary:. Epithelioid sarcoma is a rare, high-grade malignant soft tissue tumor that is often misdiagnosed. Classified as a mesenchymal malignancy, it exhibits both mesenchymal and epithelial markers. Occurrence in children under age 10 is extremely rare. This report describes the clinical course and management of a 5-year-old girl who presented with epithelioid sarcoma in the distal extremity. The lesion was initially misdiagnosed and treated for over a year as a common wart.

Summary:. Premature fusion of a cranial suture is known to result in characteristic changes in the head shape, even when the synostosis involves only part of the suture. We report an unusual case of a patient seen at the age of 2 months for an abnormal head shape that was present at birth. The phenotype was consistent with an isolated fusion of the frontosphenoidal suture, but the suture was open on a high-resolution computed tomography scan finding. There was no improvement in cranial form after 6 months of helmet therapy, and a follow-up computed tomography scan image taken at age 10 months showed the development of bilateral isolated frontosphenoidal synostosis. This case highlights that an abnormal head shape may, in some patients, predate radiographic evidence of craniosynostosis.

Purpose: Sagittal craniosynostosis (SC) is usually diagnosed during early childhood due to the presence of an abnormal head shape termed scaphocephaly. However, patients with radiographic evidence of a prematurely fused sagittal suture but normal head shape (normocephalic) have been reported. A recent study from our group found that 3.3% of normal children under 5 years of age have partially or completely fused sagittal sutures by computed tomography but no corresponding changes in cranial form. The purpose of this paper is to validate our preliminary study with a larger cohort of patients, and to analyze factors that may be associated with incidental finding of early suture fusion. Methods: We reviewed computerized tomography (CT) scans of patients from 0 to 71 months of age who presented to the emergency department (ED) of our tertiary care institution between 2008 and 2020. Patients who were found to have syndromes related with craniosynostosis, phenotypes consistent with craniosynostosis, VP shunt placement, brain or cranial abnormalities, were excluded. A panel of two craniofacial surgeons reviewed the CT scans for presence of craniosynostosis (CS). Demographic information, gestational age, past medical and family history, medications, chief complaint and fusion type were recorded as covariates. Possible medical or demographic differences between patients with and without craniosynostosis were analyzed using unpaired t-test and Chi-square/Fisher’s exact test; Firth logistic regression was performed to determine the association between the independent covariates and the presence of CS in two sub-cohorts; patients ≤ 24 months of age and patients over 24 months of age. Results: We identified 870 patients with a mean age of 30.1 months. 41 patients (4.71%) had fusion the sagittal suture (25 complete, 16 incomplete); all patients had a normal cranial index (width/length >0.7). The prevalence increased from 0-24 months, then was constant from 25-71 months. In the affected patients under two years of age, those with family history of neurodevelopmental disease had 49.32 (95% CI [4.28, 567.2]) times higher odds of developing CS. Sub-cohort encompassing patients above 24 months of age showed no variable as independent predictor for developing CS. Conclusion: Normocephalic SC in young children is common. While the impact of this condition is unknown, the correlation with family history of neurodevelopmental disease is concerning.