A Case of Radiation-Induced Multifocal Laryngeal Angiosarcoma Presenting as a Diagnostic Dilemma

Head and neck sarcomas are relatively rare tumors, with angiosarcomas representing a small subset. Angiosarcoma is a malignant endothelial neoplasm characterized by atypical, multilayered, or solid endothelial proliferation with vasoformative architecture. The global incidence of irradiation-associated sarcoma is estimated as between 0.03% and 0.08%. Here we reported the case of an elderly woman previously treated with radiation more than 20 years ago for an unknown primary of head and neck. This interesting case presented as a diagnostic challenge, and multiple biopsies were required to eventually establish the diagnosis of laryngeal angiosarcoma. We additionally have confirmation from our prior radiation records that the patient did, in fact, receive a substantial dose of radiation to the site previously. To our knowledge, this case represents the first report of a documented radiation-induced multifocal laryngeal angiosarcoma

Costs Associated with Recurrent Epistaxis in a Patient with a Ventricular Assist Device

Mucosal bleeding is a well-known complication of having a ventricular assist device and commonly presents with epistaxis. Although the frequency of epistaxis as a complication in patients with a ventricular assist device has been documented in the literature, to our knowledge the cost of this complication has not been reported. This case report examines the financial burden of ventricular assist device-associated epistaxis in a single patient from September 2018 to December 2019 using ICD 10 diagnostic codes. The patient was found to have accumulated $138,020 in costs over 38 encounters. This case report not only highlights the recurrent nature and potential high cost of epistaxis in this patient population, but also identifies a target to reduce healthcare spending. Further research is needed to assess whether cheap and simple preventative measures such as nasal hygiene regimen can decrease the frequency and/or severity of epistaxis in the patients with a ventricular assist device

Reducing “Treble” with Performance Focused Music Programs in Medical School: A Student Driven Needs Assessment to Clarify Participation Barriers Amongst Undergraduate Medical Students

Introduction: The beneficial impact of performing arts involvement within undergraduate medical education, such as music, has been studied, but support for the arts varies significantly by institution. Research has suggested that medical student involvement in the arts can help develop their identities as physicians and may reduce stress and burnout, an increasingly difficult problem within the medical student community. Methods: We used a mixed-method cross-sectional study design, using a questionnaire and semi-structured interview designed amongst a team of music professionals and healthcare providers with music backgrounds. Out of 511 enrolled medical students, 93 students participated in the study for a response rate of 18.2%. Questions were piloted among eight medical students, with modifications made in response to feedback. Participants were recruited to participate in an online survey via social media. Results: Within our sample, the most popular background instrument was piano (58.5%) and voice (50.0%). Of those who responded, most preferred to perform alone (85.7%) or in small groups (51.4%). 78.8% of respondents agreed that music was essential to their wellbeing. Only 62.5% of the respondents with musical backgrounds still play music or sing. Of those who no longer play music, 90.5% of respondents reported time constraint as the limiting factor, followed by lack of access to instruments (42.9%). Conclusion: This study suggests there are diverse music backgrounds and interests amongst the medical student population. Although most participants believed music was a form of stress relief, undergraduate medical training demands impose time restrictions on student engagement. Investments in music programs that enable adequate involvement and meet student demand have the potential to improve medical student engagement with the arts, alleviate stress, and may even lead to stronger/more empathetic physicians. Periodic needs assessments may be a powerful tool to better align programming to address student desires and reduce barriers

Doc’Apella: A Vocal Performance Group Designed to Reduce Stress And Prevent Burnout Among Medical and Health Sciences Students

Introduction: Burnout is common among health professions trainees characterized by emotional exhaustion induced by repeated stressors. Although traditional stress management activities to promote wellness are effective in reducing stress short-term, alternative approaches are needed with the potential for long-term impact. To address burnout among students at the University of Nebraska Medical Center (UNMC), a vocal group was formed to provide a creative outlet. The purpose of this study was to determine the students’ motivation for joining Doc’Apella and assess the impact on burnout. Methods: Students enrolled in a health sciences program were invited to participate during the 2018-19 academic year (August-May). Two volunteer students arranged the music, recorded individual practice tracks, and directed the group during rehearsals two nights/week from 5:30-6:30. Group members selected arrangements and performed in a variety of settings. At the end of the year, participants were invited to complete an anonymous online survey. Results: Of the 98 students on the roster, 18 (18.4%) responded to the survey. Participants included medical students (n = 9, 50.0%), three graduate students (16.7%), two public health students (11.1%), one pharmacy student (5.5%), and three classified as “other” (16.7%). Nine (50.0%) indicated the aspect of the group that was MOST important was “escaping my stress or frustration with a creative activity.” Thirteen (72.2%) felt Doc’Apella was very or extremely beneficial to their “own sense of wellbeing” and 94.4% (n = 17) reported Doc’Apella “helped reduce stress and burnout” somewhat or very much. Conclusion: Creating music with others may provide an effective way for medical trainees to not only to express creative energy but also to connect with others across health professions. Although the results support structured creative activities to reduce stress and burnout, a large-scale study is needed will strengthen empirical evidence and highlight the impact for health professions trainees

Retropharyngeal Abscess and Pott’s Disease Due to Tuberculosis: A Case Report

Introduction: Extrapulmonary mycobacterial infection can lead to vertebral spondylitis and osteomyelitis (Pott’s disease). Retropharyngeal abscess with concurrent spinal osteomyelitis is a rare presentation of tuberculosis in the US. Chart review on a patient was completed, and the relevant published literature was reviewed. Case Presentation: A previously healthy 34-year-old male originally from Sudan presented to an outside hospital with a 2-month history of neck pain, sore throat, odynophagia, fevers, and chills. MRI showed a retropharyngeal abscess and suspected cervical spine osteomyelitis. Acid-fast bacillus (AFB) smear was positive from a neck drain specimen, but sputum was negative. Chest imaging did not show findings consistent with pulmonary tuberculosis. He was treated with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) along with moxifloxacin and linezolid due to concern for possible multidrug resistant tuberculosis and transferred to our center for further care. Culture isolated Mycobacterium tuberculosis. CT neck showed vertebral tuberculous osteomyelitis (Pott’s disease) of C1-C3 with a multiloculated retropharyngeal and prevertebral abscess (Figure 1). The patient was taken to the OR for posterior spinal fusion from occiput to C4 and transoral incision and drainage of the abscess. The post-operative course was uneventful, and moxifloxacin and linezolid were discontinued when Xpert MTB/RIF test revealed rifampin susceptibility. At follow-up the patient’s symptoms had resolved. Patient consent was obtained to utilize this case for educational purposes. Conclusions: This report presents the multidisciplinary treatment of this patient requiring infection control measures and antibiotic therapy by infectious disease, posterior spine fusion by orthopedic surgery, and retropharyngeal abscess drainage by otolaryngology

Reducing Treble with Performance Focused Music Programs in Medical School: A Student Driven Needs Assessment to Clarify Participation Barriers Amongst Undergraduate Medical Students

Integration of the arts into medical education has numerous benefits, including reducing burnout and producing empathetic physicians. Investment in arts-related activities has expanded considerably. However, funding remains a common limitation for further integration of arts into medical education. Clarifying student preferences and barriers to music programs can optimize such limited resources to best suit medical student needs.https://digitalcommons.unmc.edu/emet_posters/1033/thumbnail.jp

Removal of a Wire Brush Bristle from the Hypopharynx Using Suspension, Microscope, and Fluoroscopy

Wire brush bristles are an increasingly recognized hazard that can present as a foreign body in the aerodigestive tract. Due to their small size and tendency to become embedded in surrounding tissue, these small metallic bristles present a unique operative challenge to otolaryngologists. Here we present a case of a 40-year-old woman who underwent endoscopic extraction of a wire bristle from the posterior pharyngeal wall using suspension, microscopy, and C-arm fluoroscopy. We believe this is the first published case of an endoscopic removal of a buried foreign body in the hypopharynx using these methods of localization concurrently. By leveraging multiple techniques for visualization, surgeons can avoid open exploration while ensuring complete removal of the object. Additionally, this case highlights the importance of regulatory oversight and consumer awareness of the hazards of grill brushes

Assessing the Educational Quality of Training Videos for Collection of a Nasopharyngeal Swab

Introduction: The SARS-CoV-2 pandemic has forced healthcare systems to disseminate their training materials quickly and broadly, including instruction on identifying cases of infection through correct nasopharyngeal swabbing. Incorrect nasopharyngeal swabbing technique leads to substandard sampling, patient discomfort, and increased risk of complications. We set out to evaluate the quality of educational videos on the nasopharyngeal swab procedure. Methods: Using video search engines, videos on nasopharyngeal swabbing were identified and distributed to two reviewers. The quality of videos was assessed using a scoring system that examined indications, contraindications, personal protective equipment use, swab depth, swab angle, and audiovisual quality. Descriptive statistics and Spearman’s correlation coefficients were utilized to analyze video quality and its association with individual video characteristics. Results: Videos received an average composite score of 5.4 (range: 0-10), with about half of all videos properly discussing and demonstrating the nasopharyngeal swab technique. Over 62% of reviews indicated that the reviewer would not recommend the video to a trainee, with the vast majority identifying improper swab technique as the main factor. There were no statistically significant associations between video score and publication date, number of views, and subscribers to the publisher. Conclusion: Our study shows a glaring lack of quality educational videos on the nasopharyngeal swab procedure. Health care providers should be cautious when using educational videos to learn procedures as popularity may not be associated with accuracy

Diffuse Spontaneous Laryngeal Hemorrhage with Trastuzumab

Drug-induced epithelial hemorrhage of the endolarynx is an unusual etiology of hemoptysis. We present a case of hemoptysis in a young female patient undergoing treatment for metastatic breast cancer with trastuzumab emtansine. Though previously associated with diffuse spontaneous hemorrhage of the gingiva, there have not been reports of laryngeal hemorrhage with trastuzumab emtansine treatment. In this case report, we suggest that trastuzumab emtansine played a contributory role in the development of diffuse epithelial laryngeal hemorrhage and describe the pathophysiology, history, laryngoscopic findings, and management of this condition