Biomedical subjects
Publications and source records attributed to G Dunnington.
We report the fifth case of a graft appendiceal fistula. The four previously reported cases are reviewed. This is the first report of the utility of the tagged red blood cell study in the evaluation of a patient with a graft appendiceal fistula.
To assess the natural history of cholelithiasis in patients with cirrhosis, 32 charts coded for both diseases were retrospectively reviewed. Cholecystectomy was performed in 22 patients. Only two patients met criteria for acute cholecystitis and two patients had suspected choledocholithiasis. Despite the high incidence of preoperative jaundice (32%), no common duct stones were documented. There was no operative mortality. The complication rate was 45%. In 10 patients not operated upon, two patients died of liver failure and the remaining eight patients are alive 8 months to 13 years after diagnosis (mean: 46 months) with no active biliary disease. It is concluded that: jaundice in this subpopulation most often reflects hepatocellular injury and rarely biliary tract obstruction, there appears to be a much lower incidence of acute cholecystitis and choledocholithiasis in cirrhotic patients with cholelithiasis than in the normal population, and patients with cirrhosis and asymptomatic cholelithiasis can be safely managed without operation.
A prospective study was designed to assess the teaching effectiveness of active learning in problem-oriented small group sessions (POSGS) compared with passive learning in didactic lectures (DL). Third-year medical students participated in a POSGS on breast disease and a standardized DL on thyroid disease (N = 23) or participated in a POSGS on thyroid disease and a DL on breast disease (N = 19). Students were tested with a multiple-choice examination (MCQ) and a highly structured oral examination (OE) administered by faculty members blinded about student group. Results of a between-within analysis of variance performed separately for breast and thyroid disease yielded significant group differences because of instructional method for thyroid disease (p = 0.003) and approached significance for breast disease (p = 0.095). Although no significant interactions were detected with percentage scores, a significant interaction between group membership and test type was noted for thyroid disease when the percentage scores were transformed to Z scores. We conclude that regardless of topic or testing method, students in POSGS tended to perform better than students in a DL and that the POSGS offers significant advantages over the DL in teaching surgery to third-year medical students.
Tumors may develop in both testes, either concomitantly or sequentially. We herein report 3 cases of bilateral testicular neoplasms. One patient had concomitant seminomas of the testes and another had sequential germ cell tumors separated by an 11-year interval. The third patient is an unusual case in that he had bilateral testicular germ cell tumors diagnosed concomitantly 8 years after irradiation of an extragonadal, histologically proved, seminoma in the mediastinum. Evidence suggests that all 3 sites, each testis and the mediastinum, were primary lesions. Standard methods of therapy should be used in the treatment of malignancies.
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A growing concern about the deterioration of the clinical skills of physicians has stimulated a renewed interest in the teaching and assessment of these skills. Standardized patients can be an effective means to teach or assess a physician's competence in clinical skills, such as history taking, physical examination, and patient-physician interaction skills. This article will describe this new method and delineate its emerging role in medical school education, residency training, and its potential role in continuing education and quality assurance for practicing physicians within a managed care setting.