Malformations of the bronchopulmonary foregut can lead to the formation of bronchogenic mediastinal cysts (BMC). BMC are rare congenital malformations usually found in the middle or posterior mediastinum. Only one-third of patients with BMC are symptomatic. We report a case of BMC in a 48-year-old female who was referred to the cardiothoracic surgeons due to an incidental finding of an anterior mediastinal mass on investigation for intermittent chest pain. The mass was treated surgically with a partial median sternotomy and mass excision. The patient’s symptomology and mass histology were atypical for BMC. At follow-up, the patient reported no residual symptoms. This case demonstrates the significance of considering BMC, especially the anterior subtype, as a differential diagnosis in the findings of patients with intermittent chest pain and computerized tomography findings of a mediastinal mass.

introduction: Communication impairment, as a result of mechanical ventilation, is a significant emotional stressor for critically ill patients and is a significant risk factor for preventable adverse events. The study purposes were to 1) describe interaction behaviors and factors (augmentative and Alternative Communication (AAC) strategies) that may influence communication between older patients and nurses and 2) explore associations between interaction behaviors and nursing care quality indicators (restraint use, pain management, sedation use and level). Methods: This expanded secondary study employed a descriptive correlational design utilizing data collected on a subset of 38 intubated, ICU patients > 60 years of age and their nurses (N=24) who participated in the Study of Patient-Nurse Effectiveness with Communication Strategies (SPEACS). Patients were: (1) intubated for at least 48 hours, (2) able to understand English, and (3) scored 13 or above on the Glasgow Coma Scale to be eligible for the SPEACS study. Behaviors were measured by rating videotaped observations between nurses and patients (four observations per dyad, total=152 observation) using the Communication Interaction Behavior Instrument (CIBI), which delineates positive and negative interaction behaviors of patients and nurses. Demographic and clinical characteristics and quality indicators were obtained from the SPEACS dataset and medical chart abstraction Descriptive statistics, group comparative statistics, and repeated measures analysis were utilized to explore the association between interaction behaviors and nursing care quality. results: All positive behaviors occurred at least once; while negative behaviors were rare. The use of positive nurse behaviors was associated with an increase in positive patient behaviors (p<.001). The most frequently utilized strategies included: head nods, non-verbal but communicative action, gestures, and mouthing, The use of patient unaided AAC strategies was positively associated with the count of positive nurse behaviors (p=.002) and individual patient unaided AAC strategies were associated with individual nurse positive behaviors (p<0.05). Finally, count of different positive nurse behaviors was positively associated with the absence of reported pain (p=.011) and the count of different positive patient behaviors the association with the patient being calm (p<.001). conclusions: Findings provide evidence that nurse and patient interaction behaviors impact the number and type of communication methods used by nonvocal patients to convey messages and may be associated with nursing care quality.

Background The prevalence of adrenal incidentaloma (AI) is increasing, with pressure on healthcare systems. While earlier guidelines recommended repeat endocrine testing to ensure stability, the recent European guidelines suggest that is not necessary if initial tests were reassuring. Aim To explore the utility of this guidance on repeat endocrine testing of AI. Methods Retrospective unselected review of AI cases reviewed before the European guidelines, based on local protocol (baseline overnight dexaethasone suppression test [ONDST] and plasma metanephrines +/- aldosterone: renin ratio [ARR] if hypertension or hypokalemia were present). At two years, the endocrine tests were repeated. We compared the baseline with the two-year follow-up data. Results We collected data on 54 patients initially identified (2011-2016). Post-ONDST cortisol (nmol/L): At baseline, 37/52 (71.1%), 12/52 (23.1%) and 3/52 (5.8%) had values &lt;50, 51-138 and &gt;138 respectively. After 2 years, 20/28 (71.4%) had results of &lt;50, of which 18 were originally &lt;50 and 2 were 51-138. The remaining 8 had values of 51-138, of which 6 had values of &lt;50 at baseline and the other 2 had values of 51-138. Where there appeared some discordance, analysis of agreement (kappa statistics) showed an agreement of 71% (P=0.153). Wilcoxon signed-rank test to explore changes in the raw cortisol values showed that there was no significant difference (P=0.281). ARR: Data was available data on 40 patients, all of whom had normal ARR results. At 2 years there were data on 25 cases, 19 of which also had baseline values, while 6 had 2-year values but no baseline data. In all cases, 2-year ARR values were normal. Plasma metanephrines: Metanephrine: Data was available at baseline on 43 patients, with 8 (18.6%) having values above the reference range (&gt;0.33 nmol/L). Of these 8, 7 had values between 0.33 and 0.46, with the remaining one having a single markedly raised value at 206.8 nmol/L. At 2 years, we had data on 23 of these 43 patients, out of whom 20 had normal levels at both baseline and 2 years, 2 had abnormal results at baseline but normal at 2 years and one normal baseline value but slightly raised (0.36 nmol/L) at two years, with normal normetanephrines (0.33 nmol/L). Normetanephrine: Of the 43 cases with baseline results, only one was abnormal at 802 nmol/L (the same patient with a plasma metanephrine of 206.8 nmol/L). In this case, the normetanephrine became unremarkable after 2 years indicative of successful surgery. The remaining 22 cases with data at 2 years all had values within the reference range. Conclusion There was no significant change in function after two-year follow up, as defined by abnormal endocrine test results. Therefore, our findings support the European guidelines advice that repeat testing is not warranted. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Background Adrenal incidentaloma (AI) is an increasingly recognised finding, with pressure on healthcare systems. Earlier guidelines recommended interval scanning and testing to ensure stability. However, the recent European guidelines do not recommend the need for repeat scanning if initial assessment is reassuring. Aim To explore the utility of this guidance on need for interval scanning of benign AI. Methods A retrospective unselected review of AI cases seen in our unit before the launch of the European guidelines was conducted. At that time, a local protocol was in use to characterise scan and test adrenal functions at baseline, and at two years, the scan and endocrine tests were repeated. We compared the baseline scan results with those at two-years. Results We collected data on 54 patients initially identified between 2011 and 2016. Of these, 31 had left-sided lesions, 15 had right-sided lesions and 8 bilateral. Of the left-sided lesions, 16 increased in size over the 2.2-year follow-up period, 4 decreased in size and 17 remained the same. Of the right-sided lesions, 3 increased in size over the follow-up period, 6 decreased in size and 13 remained the same. Of those that increased (left- or right-sided), the largest increase was 5mm. Taking 2 mm as the cut-off for a significant change: on the left, 32/37 (86%) had a change ≤2mm (P&lt;0. 001 for no increase). On the right, 21/22 (95%) had a change ≤2mm (P&lt;0. 001). Using a ≤5% increase as cut-off: 28/37 on the left (P=0. 028) and 20/22 on the right (p&lt;. 001) showed ≤5% increase. There was no statistical difference in change in lesion size in terms of laterality, being indeterminate on initial scanning, gender, age or initial size on presentation. Conclusion We found that there was no significant change in size after two years. Therefore, our data support the European guidelines that repeat scanning is unnecessary. This should be reassuring to patients and provide a more cost-effective service. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.