The authors report four non-tuberculous granulomatous lymphadenitis cases with temporal and geographic clustering, unresponsive to medical management that warranted modified neck dissection to facilitate cure.

Radiation forms a vital part of neoadjuvant treatment in locally advanced rectal cancer (LARC) and recurrent rectal cancers. The adverse effects of radiation are well recognized; however, radiation-induced perforation at the tumour site is very rare and is poorly understood. A symptomatic rectal perforation requires an emergency surgical intervention. However, it may present silently and can give rise to suspicion of disease progression and/or residual disease on imaging. The authors present two cases of silent perforations. Both gave rise to a considerable diagnostic dilemma, which was resolved by careful evaluation with MRI.

The authors proposed a new less invasive island flap, namely the first metatarsal artery capillary perforator flap. The advantages of this flap include the preservation of the first metatarsal artery and the adiposal tissue in the web space, thereby preventing compression around the remaining deep peroneal nerve.

The authors present a revised application of the composite iliac crest bone free flap for hemimaxillectomy defects. This flap solely can give a support to the eye globe and the dental implants without osteotomies and titanium meshes. The upper ridge of the flap can be shaped to replicate the curvature of the orbital floor. The inner oblique muscle and the deep fascia can serve as an additional material for separation of the oral cavity from the nasal airway. Utilization of the Customized Contour Implants gives a surgeon a refining instrument for aesthetic correction of facial projection.

The authors have addressed comments and concerns about a recent article, by Nasr et al, which reported the clinical characteristics and outcome of 34 patients with Takotsubo syndrome triggered by cerebral disease and collected during five years from a neurological ICU.

Supraclavicular flap is an excellent fasciocutaneous flap for head and neck reconstruction due to its close color and texture match. In general, long flaps are required, but with the risk of distal necrosis. The aim of this study is to assess the relationship between the length and distal end necrosis of the supraclavicular flap.

Most isolated syndromes of Eight-and-a-Half Syndrome are associated with vascular etiology. Symptomatic trigeminal neuralgia due to infarction is rare. The author reports a patient with left-sided facial pain. It was followed by one-and-a-half syndrome with facial nerve palsy during the next day. Diffusion-weighted magnetic resonance imaging of his head revealed restricted diffusion in the left inferior pontine tegmentum neighboring the fourth ventricle extending ventrally. This case is the first report of Eight-and-a-Half Syndrome presented with recurrent attacks of unilateral facial pain, fulfilling criteria for classical trigeminal neuralgia.

Management of children with severe tracheomalacia is very difficult. Most cases require mechanical ventilation; the mortality rate from severe tracheomalacia is as high as 80%. Crying is often triggered, the respiratory condition gets worse, and eventually, it leads to death. For severe cases, surgical treatment should be considered immediately. Meanwhile, the prevention of fatal attacks by medical treatment is indispensable while waiting for surgery. In this report, a method to manage the patients with severe tracheomalacia using muscle relaxant was discussed. Based on clinical experience, continuous administration of 7 μg/kg/min of rocuronium was required to prevent life-threatening cyanotic attacks. However, the infusion requirements of rocuronium would show patient-to-patient variability. Further, case reports and evaluation of the effectiveness of muscle relaxants for the treatment of severe tracheomalacia were required.

Authors present a case report of a patient with history of RYGB who underwent thyroidectomy and parathyroidectomy with postoperative development of severe recalcitrant hypocalcemia. Hypocalcemia was managed conservatively initially but subsequently required gastrostomy tube placement with successful resolution of hypocalcemia.

Delirium is an acute disorder of arousal and attention that is commonly encountered, incompletely understood, and associated with adverse outcomes including increased morbidity and mortality, reduced health-related quality of life, and increased healthcare costs. In this narrative review, authors examine the epidemiology, potential pathophysiological mechanisms, assessment, prevention, and treatment of this cognitive disorder.