Variation in faculty evaluations of clerkship students attributable to surgical service.

Objective: The purpose of this study was to determine whether students' performance evaluations by faculty were influenced by the clinical service on which the student was evaluated.

Methods: Third-year medical students spent 8 weeks rotating on 3 (or 2) surgical services. Typically, students rotate on one 4-week general surgery service and two 2-week subspecialty services.

Factors in faculty evaluation of medical students' performance.

Context: Faculty members often use global rating scales as a method of assessing various characteristics of medical students' clinical performance. The purpose of this study was to determine if some performance characteristics are more highly associated with the overall faculty grade than others.

Methods: The clinical performance of 211 surgery clerkship students was evaluated by 2 or 3 faculty preceptors.

What do faculty observe of medical students' clinical performance?

Background: An earlier study of our faculty's evaluation of junior medical students indicated that performance ratings were unreliable and reflected 1 underlying dimension. Other researchers have obtained similar results.

Purpose: The purpose of this study was to identify which aspects of students' clinical performance faculty actually observe.

Are multiple objective measures of student performance necessary?

Background: This study examines the effect of using multiple modalities to evaluate medical students.

Methods: Thirty-four students were evaluated by a complex model utilizing National Board of Medical Examiners (NBME) shelf examination, Objective Structured Clinical Examination (OSCE), Computer Patient Simulation (CPS), faculty and peer evaluation. Results were compared with a traditional model based on NBME and faculty evaluation alone.

Testicular regression syndrome: a clinical and pathologic study of 11 cases.

Context: The vanishing or regressed testis is an entity well known to urologists and pediatric surgeons, affecting approximately 5% of patients with cryptorchidism. However, there is little review and discussion of this entity among pathologists with only 2 of 40 published reviews of testicular regression syndrome (TRS) found in the pathologic literature.

Objectives: To assess recognition of TRS among a subset of pathologists and to determine the applicability of histologic criteria for TRS as published.

Separation of complex pygopagus conjoined twins.

Pygopagus twins were born with a unique spectrum of anomalies including a conjoined distal spinal cord, single kidney (in twin A), single rectum (in twin A), single vagina (in twin B), and severe central nervous system anomalies in twin B that precluded her independent survival. Separation at 10 weeks of age was tailored toward Twin A's survival. This report discusses the surgical modifications necessary in view of the unique anatomy, including salvaging the distal spinal cord and vagina for twin A.

Locally invasive aspergillosis of the bowel.

Locally invasive aspergillosis of the bowel and peritoneal cavity is a rare complication of immunosuppression, broad-spectrum antibiotic therapy, and corticosteroid administration. We present the case of a 9-year-old boy with acute lymphocytic leukemia who presented with a small bowel obstruction. Surgical treatment of the aspergillosis required multiple aggressive resections of all involved bowel segments.

Broviac central venous catheters inserted via the saphenous or femoral vein in the NICU under local anesthesia.

We present our experience with 92 Broviac central venous catheters inserted into 84 infants over a 31-month period. Our technique specifies placement in the neonatal intensive care unit under local anesthesia, with insertion to the inferior vena caval-atrial junction via the saphenous or femoral vein, with a subcutaneous tunnel to an exist site on the anterior thigh. We conclude this technique to be safe, efficient, convenient, cost-effective, and minimally uncomfortable to the infant, with no increase in morbidity or mortality in comparison to previously described methods.

Ventricular sepsis and abdominally related complications in children with cerebrospinal fluid shunts.

In a retrospective study of 300 children who underwent placement or revision of cerebrospinal fluid (CSF)-peritoneal shunts during a 10-year period, 15 (5%) developed shunt-related abdominal complications with ventricular sepsis and two developed acute perforated appendicitis. Abdominal complications and associated shunt infections suggested two potential modes of development: (1) descent of contaminated CSF from an infected shunt into the abdomen (CSF ascites--four patients, CSF pseudocysts--four patients, and shunt-induced abscess/peritonitis--five patients); and (2) ascent of bacteria into the shunt from an abdominal source (visceral perforation by the shunt catheter--two patients and acute perforated appendicitis--two patients). Three types of shunt systems were placed during the study period; five of the seven (71%) most serious septic complications were associated with the use of Raimondi spring-reinforced catheters.

Ischemic extremities due to compartment syndromes in a septic neonate.

The clinical presentation and diagnostic evaluation of a septic neonate with sclerema neonatorum and impending tissue loss secondary to compartment syndromes is presented. Vascular disease leading to tissue loss is uncommon in children. To our knowledge, this is the only reported case of a compartment syndrome leading to tissue loss in a neonate.

Effects of total parenteral nutrition and semi-starvation on the liver of beagle puppies.

The effects on hepatic growth of fat-free TPN and semistarvation have been studied in newborn beagle puppies. Our data indicate that liver growth during TPN is characterized by normal deposition of protein and minerals, with increased glycogen and decreased lipid content. While the lipid pattern of TPN livers is normal, the phospholipid fraction contains an abnormal fatty acid pattern, consistent with the development of essential fatty acid deficiency.