A 44-year-old man was admitted after being found suspended by his ankles from a bridge for 5 days. The events leading to it was not clearly known initially. On examination, the patient was hypotensive and hypothermic, airway was oedematous and both lower limbs were mottled with dusky feet. Both foot pulses were impalpable, with prolonged capillary refill time and sensation barely present. Doppler signals were not heard in the feet, but groin pulses and popliteal signals were present. On CT, the patient had bilateral pneumothoraxes, extensive subcutaneous emphysema throughout the body from the subcutaneous tissue of the scalp to both lower limbs and pneumomediastinum and pneumoperitoneum. CT angiogram showed opacification up to proximal crural vessels and absence beyond. After multispeciality input and optimisation of his physiology, he underwent bilateral below knee amputations as they were non-salvageable.

Background Obesity needs to be included in medical school curriculum in the context of the obesity pandemic Methods A multiple-choice survey was sent out to students in a medical school attached to a university teaching hospital. Respondents provided information on demographics and perceptions about obesity and bariatric surgery. Results were presented as frequencies and analysed. Results There were 223 respondents with M:F = 93:130. 61.8% were in years 1–3 and 65.9% were in normal BMI range. 8 had BMI of 35 and above. 16.0% were not aware obesity is classified as a disease, but 87.9% understood the term bariatric surgery. 73.9% defined obesity as BMI more than 30. 23.8% felt that obesity is a self-inflicted disease. 23.6% felt that bariatric surgery should not be funded by the NHS with 6.3% feeling that bariatric surgery is a waste of money. 54.0% students agreed that bariatric surgery is an effective treatment for obesity. Conclusions Though overall perceptions were positive, a quarter of medical students felt that obesity is self-inflicted and just over 50% of students thought bariatric surgery was effective, indicating the need to include obesity and bariatric surgery in the curriculum in order to change firmly entrenched views around obesity.

Background There is anecdotal evidence to suggest that patients with obesity face stigma in the NHS Methods A multiple-choice survey was sent out to consultants in a university teaching hospital with an established bariatric surgery unit. Respondents provided information on demographics and perceptions of obesity and bariatric surgery. Results were presented as frequencies and this was analysed. Results There were 167 consultant respondents with M:F = 114:53. 58% belonged to medical speciality and the rest belonged to the surgical speciality. 90% had over 10 years of NHS experience. 46.7% were in the normal BMI range and 3.5% had BMI 35 and above. 1.8% were not aware that obesity is classified as a disease. 42.5% felt that obesity is a self-inflicted disease. 73.4% agreed that bariatric surgery should be funded by the NHS, but 12% disagreed. 4.2% were of the opinion that bariatric surgery is a waste of money. 97% agreed that bariatric surgery resulted in weight loss and resolution of comorbidities. Conclusions There is a significant negative perception that obesity is a self inflicted life style disease even amongst the consultant work force reinforcing the premise that perhaps obesity is the last bastion of prejudice in the NHS.

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.