Applying Expectancy Theory to residency training: proposing opportunities to understand resident motivation and enhance residency training.

Medical resident education in the United States has been a matter of national priority for decades, exemplified initially through the Liaison Committee for Graduate Medical Education and then superseded by the Accreditation Council for Graduate Medical Education. A recent Special Report in the New England Journal of Medicine, however, has described resident educational programs to date as prescriptive, noting an absence of innovation in education. Current aims of contemporary medical resident education are thus being directed at ensuring quality in learning as well as in patient care.

Nonoperative management of blunt traumatic cardiac rupture: considerations of a novel approach.

Blunt traumatic cardiac rupture carries a dismal prognosis. Patients who survive to presentation are treated with prompt surgical repair. Operative intervention carries significant morbidity and mortality, as these patients present in extremis.

Are roadside pedestrian injury patterns predictable in a densely populated, urban setting?

Background: Roadside pedestrian injuries represent a significant portion of trauma team activations, especially at urban trauma centers. Patient demographics and severity of injury vary greatly in this patient population. Herein, we hypothesize that injury patterns may be predictable, especially with respect to age.

Port site metastasis of B-cell lymphoma: a first occurrence or an underreported complication?

Minimally invasive techniques have been accepted as safe and reliable in the work-up of patients with lymphoproliferative disorders. As the oncologic indications of laparoscopy expand, many authors have raised concerns regarding the occurrence of port site metastases after minimally invasive procedures for a multiform array of neoplastic diseases. A review of the existing literature demonstrates no mention of port site occurrence following staging laparoscopy for malignant hematologic disorders.

Thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest injury.

Purpose: The purpose of this study is to describe our experience with thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest trauma.

Methods: Over a 9-month period, eight patients at two institutions were treated for empyema thoracis that developed following penetrating chest injury. Seven patients sustained gunshot wounds and one a stab wound.

A technique for securing transperitoneal tubes.

A simple technique for securing transperitoneal tubes is described. We believe this technique results in a tube fixation that is less traumatic to the surrounding skin, is difficult to remove accidentally and is easier to replace.

Patterns of alcohol and drug abuse in an urban trauma center: the increasing role of cocaine abuse.

Alcohol continues to play a major etiologic role in blunt trauma. It is involved in 65-70% of fatal highway crashes. The role of illicit drugs, although accepted as an etiologic factor in trauma, is less well described.

Effect of cocarboxylase in dogs subjected to experimental septic shock.

We examined the effects of cocarboxylase treatment on both the hemodynamic variables and metabolic function during endotoxic shock in dogs. Cocarboxylase inhibited deterioration in metabolic function as reflected by improved pH and base excess as well as maintenance of normal oxygen consumption. Significant improvements in mean arterial pressure and cardiac index were also seen.

Value of creatine phosphokinase isoenzyme determinations in the diagnosis of myocardial contusion.

Myocardial contusion is an injury often missed in the patient with severe multisystem trauma. Fifty patients with physical findings or mechanisms of injury that were suggestive of possible nonpenetrating injury to the heart were studied with serial creatine phosphokinase isoenzyme (CPK/MB), continuous arrhythmia monitoring, and ECGs for at least 72 hours. Two-dimensional echocardiograms were obtained on all patients within 48 hours of admission.

Diagnosis and management of traumatic ventricular septal defect.

Four cases of ventricular septal defect secondary to stab wounds of the heart are presented. One of three patients arriving at the Emergency Department in shock and who were resuscitated required an emergency thoracotomy. These patients had immediate repair of their external cardiac wounds in the Operating Room.

[Interactions between human blood serum inhibitors and native and modified dextran proteinases--terrilytin and trypsin].

Interactions between native terrylytin and trypsin and their derivatives modified by water-soluble dextrans on one hand and human blood serum inhibitors on the other, were studied. It was shown that modification of the enzymes results in changes in the type of their inhibition by blood serum due to a decrease of affinity of polymeric enzyme forms for alpha 2-macroglobulin and alpha 1-antitrypsin. The inhibition constants for native and modified forms of terrylytin and trypsin were calculated.

[Physico-chemical and enzymatic properties of polymeric trypsin derivatives based on dextran].

The molecular weight distribution, thermal stability during autolysis, resistance to human serum inhibitors as well as temperature optimum of native and dextran-modified trypsin were investigated. The seeming constants of autolytic inactivation and inhibition of native and modified trypsin were calculated. Trypsin polymer derivatives had higher molecular weight than the native enzyme.