Study Objectives: Each year, residency programs dedicate a significant amount of time, effort and financial resources to selecting and interviewing applicants for residency.Despite the importance of an interview day, factors that the applicants find most valuable are poorly identified.Methods: An anonymous Web-based survey was sent to all applicants interviewed during the 2012-2013 cycle at one EM residency program.The survey assessed activities they found most valuable on the interview day.Results: The survey was sent to 211 applicants, with a response rate of 43%.When evaluating the academic merits of a residency program, factors that the applicants found most helpful included program reputation, the ability to attend the weekly morbidity and mortality conference, and the completion of an away rotation.Additionally, when evaluating social activities on an interview day, 81% of respondents felt that the opportunity to have breakfast with the program leadership improved their experience.Fifty-six percent of respondents reported they preferred an applicant dinner at a resident's home.Additionally, dinner at residents' homes received a higher overall rating than dinner at a restaurant.Conclusions: Residency programs place a lot of effort into recruiting the best candidates for their institution.During interview days, programs work to provide the applicants with information on both the educational aspects and wellness aspects of the program.According to our survey, applicants are interested in participating in rigorous academic activities such as morbidity and mortality conference.These activities give insight into resident and faculty interactions within the program and the educational mission of the program.When learning about the more social aspects of the program, applicants prefer more casual settings such as a casual breakfast with the program leadership or dinner at resident's homes.These activities provide a venue for applicants to determine their comfort level and fit within the membership of the residency program.

Warfarin therapy is associated with a variety of haemorrhagic complications. We report a representative series of six cases of warfarin-induced bleeding in non-cerebral sites admitted to one unit. In all of these cases, there was inadequate control of anticoagulation, resulting in major morbidity and one death. In particular, closer attention must be paid to the indications for and duration of warfarin treatment.

Sixty-eight patients with gunshot and blast injuries who had sustained 200 wounds were treated in a single surgical unit over an 18-month period. Many of these were low velocity injuries to the soft tissues of the lower limbs. A change of policy was adopted for this selected group which involved minimum wound debridement under local anaesthesia in association with antibiotics. This policy enables early discharge from hospital and has resulted in a low infection rate with no significant morbidity.

Antithrombin (AT III), a major circulating anticoagulant, may be influenced by ischemia-induced changes in microvascular integrity and contribute to localized hypercoagulability. In a nonheparinized intact canine hindlimb model we determined AT III activity by chromogenic substrate assay (S-2238); coagulation changes with fibrinogen, activated partial thromboplastin time (aPTT), and prothrombin time (PT); and transvascular exchange by lymph-to-plasma total protein concentration ratio. Femoral venous plasma and lymph samples were assayed during 1 hour of steady state (C), 6 or 8 hours of aortoiliac occlusion (I), and 1 or 3 hours of reperfusion (R). Four groups were studied: GI, sham operated (n = 5); GII, moderate ischemia (n = 7), arterial pressure 30% to 45% C, GIII, 6 hours of severe ischemia (n = 7), arterial pressure 5% to 20% C; and GIV, 8 hours of severe ischemia (n = 5), arterial pressure 5% to 20% C. All parameters varied near baseline in the control group and the group with moderate ischemia. Fibrinogen decreased after 3 hours of ischemia in GIII from 218 +/- 38 to 175 +/- 46 mg/dl (mean +/- SEM) and in GIV from 254 +/- 39 to 201 +/- 44 mg/dl (p less than 0.005) as aPTT and PT increased. All parameters returned to baseline on R in GIII only. Plasma AT III decreased in GIV from 89% +/- 4.6% to 53.6% +/- 16.2% (p less than 0.005) after 3 hours and remained low during late I and R.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of ibuprofen (I) and methylprednisolone (M) were studied in the Pseudomonas porcine model of adult respiratory distress syndrome (ARDS). Four groups of animals were anesthetized and ventilated with 0.5 FIO2, 5 cm PEEP, and 20 cc/kg tidal volume: a control group given saline alone; Pseudomonas infusion alone (P); Pseudomonas with ibuprofen (I), 12.5 mg/kg given at 20 and 120 min; and P with methylprednisolone (M), 30 mg/kg given at 20 and 120 min. We compared the alteration in pulmonary hemodynamics with the alteration in the plasma concentration of thromboxane (TxB2) and 6-keto PGF1 alpha in the treated and untreated groups. Hemodynamic parameters measured included the pulmonary (PAP) and systemic (SAP) arterial pressures, cardiac index (C1), thermal-cardiogreen extravascular lung water (EVLW), and PaO2. Albumin Flux was measured by a gamma scintigraphic method (slope index; SI). P produced a dramatic increase in PAP (P less than 0.05) with a progressive increase in EVLW and SI (P less than 0.05) and fall (P less than 0.05) in PaO2, CI, and SAP. The acute pulmonary hypertension was associated with a significant rise in TxB2 and 6-keto PGF1 alpha in the Pseudomonas group. I effectively blocked the elevation of TxB2 and caused a significant but transient improvement in PAP and rise in PaO2. Albumin flux and water leak as measured by SI and EVLW were not affected by ibuprofen. M reduced the elevation of TxB2 and 6-keto PGF1 alpha but failed to block these prostaglandins significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Postischemic limb swelling following reperfusion may be related to microvascular changes associated with ischemia. We used lymph-to-plasma total protein concentration ratios (LP) and lymph flow (QL) as an index of transvascular exchange in the intact dog hindlimb during steady state (C) (1 hr), ischemia (I) (6 hr), and reperfusion (R) (3 hr). Central pressures, femoral arterial and venous pressures (PA, PV), and QL were recorded every 15 min. Lymph was collected from a femoral lymphatic in the passively flexed leg (50 cycles/min). Three groups of animals were studied: GI, sham-operated (N = 5); GII, moderate ischemia (N = 7, PA = 30–45% C); and GIII, severe ischemia (N = 7, PA = 5–20% C). In GI, QL gradually increased over 10 hr without change in LP. Moderate ischemia produced a decrease in QL, 3.55 ± 2.02 mg/hr to 0.92 ± 0.53 mg/hr (P < 0.0001), and QL remained below baseline during R with no change in LP over the 10 hr. Severe ischemia produced a similar decrease in QL, 1.91 ± 2.05 mg/hr to 0.15 ± 0.1 mg/hr (P < 0.01); however, an increase to 2.56 ± 2.14 mg/hr occurred during R. Severe ischemia increased LP 0.42 ± 0.08 to 0.64 ± 0.23 (P < 0.001) and remained elevated during R at 0.63 ± 0.18 (P < 0.001). An increase in the wet-to-dry weight ratio of ischemic to nonischemic muscle after reperfusion was noted only in GIII, 3.82 ± 1.17 vs 2.60 ± 0.45 (P < 0.04). Severe ischemia produces changes in vascular integrity which augment protein flow. Prevention of these vascular changes may help to minimize the muscle swelling of reperfusion.

In a trial of 20 patients with bilateral varicose veins, one limb was randomly allocated to wound closure with disposable metal staples while the wounds on the contralateral limb were closed with silk sutures. Each patient thus acted as his own control. Wound healing was assessed at two and five days for the presence of erythema, necrosis or infection and the cosmetic result was assessed at one month. The time taken for operative insertion and removal of sutures and staples was recorded. Postoperative pain was assessed using a visual analogue scale, while the sutures were in place and again at time of suture removal. The staples were quicker to insert but the wound healing, cosmetic results and pain of both methods was similar.

Journal Article Calcific enterolith in a vitello-intestinal duct Get access C F Harvey, C F Harvey Vascular Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK Search for other works by this author on: Oxford Academic Google Scholar J M Hood J M Hood Vascular Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 71, Issue 4, April 1984, Page 316, https://doi.org/10.1002/bjs.1800710424 Published: 07 December 2005 Article history Accepted: 29 June 1983 Published: 07 December 2005

A case of traumatic pancreatic fistula complicated by gastric and colonic fistulous tracts is presented, and management is discussed.