In the developed world, trauma is the principal cause of death under the age of 40 and is the third largest overall killer. In the UK, approximately 25,000 people die each year as a result of major injury, 25% as a result of head injuries alone. Despite improved diagnosis and management, infection remains the commonest complication in those patients surviving the initial injury. Some 5% are reported to die as a result of septic complications. Prolonged periods of intensive care and respiratory support predispose to infective respiratory complications. These patients in the absence of significant systemic injury and, as a result of severe head injury, are unable to mount an effective immune response. This literature review examines the changes that have been reported to occur in the immune system following isolated severe head injury and explores the relationship these changes may have to the increased development of infective complications.

This work explores what Fast Field-Cycling Nuclear Magnetic Resonance (FFC-NMR) relaxometry brings for the study of sarcoma to guide future in vivo analyses of patients. We present the results of an ex vivo pilot study involving 10 cases of biopsy-proven sarcoma and we propose a quantitative method to analyse 1 H NMR relaxation dispersion profiles based on a model-free approach describing the main dynamical processes in the tissues and assessing the amplitude of the Quadrupole Relaxation Enhancement effects due to 14 N. This approach showed five distinct groups of dispersion profiles indicating five discrete categories of sarcoma, with differences attributable to microstructure and rigidity. Data from tissues surrounding sarcomas indicated very significant variations with the proximity to tumour, which may be attributed to varying water content but also to tissue remodelling processes due to the sarcoma. This pilot study illustrates the potential of FFC relaxometry for the detection and characterisation of sarcoma. Magnetic Resonance Imaging (MRI) is a powerful method used in the medical diagnosis of a range of different soft tissue pathologies. The principle of MRI lies in detecting differences in the behaviour of nuclear spins (in most cases from 1 H) between pathological tissues and their healthy counterparts, which can be exploited as a source of contrast to form images. Spin-lattice and spin-spin relaxation times, denoted as T 1 and T 2 respectively, are two important sources of MRI contrast that describe how fast tissues return to magnetic equilibrium after excitation. To simplify calculations one often uses their reciprocal values, R 1 = 1/T 1 and R 2 = 1/T 2 , which are referred to as spin-lattice and spin-spin relaxation rates, respectively 1-3 but convey the same information. R 1 usually shows much better contrast at fields below 0.5 T but most clinical scanners operate at 1.5 T or 3 T to achieve high spatial resolution. Paramagnetic contrast agents are commonly used to improve contrast 4,5 , providing relaxation enhancement caused by strong magnetic dipole-dipole interactions between protons (hydrogen nuclei, 1 H) from the tissues and the paramagnetic centre (typically gadolinium or manganese ions). Despite the huge progress in advanced contrast agents and MRI technology, the early diagnosis and treatment of patients with musculoskeletal (MSK) malignancies (sarcomas) remains a major challenge. Initial detection of MSK malignancies depends upon clinical examination, fine needle aspiration cytology or core biopsy and MRI. MRI is also used in the follow-up and surveillance of patients with suspected local recurrence following treatment. Unfortunately, the imaging characteristics of tissues using conventional MRI are not diagnostic for a large number of soft tissue tumours and therefore careful multidisciplinary interpretation of the combined results are required in reaching a final diagnosis. Despite this, it can still be challenging to estimate tumour aggressiveness or resection margins.

PURPOSE In Scotland, approximately 350 sarcoma cases are diagnosed per year and treated in one of the five specialist centers. Many patients are required to travel long distances to access specialist care. The COVID-19 pandemic brought a number of rapid changes into the care for patients with cancer, with increasing utilization of telemedicine. We aimed to evaluate how the utilization of telemedicine affects professionals and patients across Scotland and care delivery, at the Beatson West of Scotland Cancer Centre Sarcoma Unit. METHODS Between June 8 and August 25, 2020, we invited patients and professional sarcoma multidisciplinary team members to participate in separate online anonymous survey questionnaires, to assess their attitudes toward telemedicine. Data were extracted, and descriptive statistics were performed. RESULTS Patient satisfaction (n = 64) with telemedicine was high (mean = 9.4/10) and comparable with traditional face-to-face appointments (mean = 9.5/10). Patients were receptive to the use of telemedicine in certain situations, with patients strongly opposed to being told bad news via telemedicine (88%). Providers recommended the use of telemedicine in certain patient populations and reported largely equivalent workloads when compared with traditional consultations. Providers reported that telemedicine should be integrated into regular practice (66%), with patients echoing this indicating a preference for a majority of telemedicine appointments (57%). CONCLUSION Telemedicine in sarcoma care is favorable from both clinician and patient perspectives. Utilization of telemedicine for patients with rare cancers such as sarcomas is an innovative approach to the delivery of care, especially considering the time and financial pressures on patients who often live a distance away from specialist centers. Patients and providers are keen to move toward a more flexible, mixed system of care.

We describe a case of cranial fascitis presenting as an incidental finding. A 2 1/2-year-old girl had skull radiographs performed after sustaining a minor head injury, which revealed a lytic skull lesion. We describe the salient features of the case and review the current literature of this rare benign inflammatory condition.

Restorative proctocolectomy with ileal pouch-anal anastamosis (IPAA) is the operation of choice to avoid permanent ileostomy in the surgical management of patients with ulcerative colitis and familial adenomatous polyposis coli. IPAA with two loops of small intestine (J-pouch) is the most common configuration. Mortality rates are low, and despite significant morbidity patient satisfaction remains high. Functional results are good in most cases. We present two cases of hydronephrosis following IPAA. Loin pain was the presenting symptom in both cases, with one patient developing impaired renal function. Hydronephrosis has not been reported following IPAA, but with other forms of pelvic and retroperitoneal surgery it is believed to remain largely asymptomatic. We discuss the etiology of this previously unrecognized complication and suggest that it may be more prevalent following IPAA than is realized.