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Biomedical subjects

I M Rutkow

Publications and source records attributed to I M Rutkow.

13 recordsLinked to original sources
PubMed1979

Surgical decision making. The reliability of clinical judgment.

Elective surgery second opinion programs are predicted on strict acceptance of the accuracy of the consultant's surgical judgment. The reliability and reproducibility of clinical judgment, therefore, become basic to the effectiveness of such programs. This aspect, however, has received little attention. We report a randomized and controlled survey of surgical specialists which defines agreement/disagreement patterns in surgical decision-making for seven elective surgical procedures. For each disease process, four case histories, including at least one control, were developed by specialty panels of physicians. The case summaries described fictional patients who were seeking professional consultation. The histories were mailed to a random sample of Board-certified specialists from the State of Maryland and the District of Columbia. The response rate was approximately 80% for all five specialties. The respondents were asked to indicate whether they would (Yes) or would not (No) perform the surgical procedure in question. Factual knowledge was not sought, but instead the application of that knowledge and experience to decide on the need for surgical intervention. By comparing the responses for each case history, the agreement/disagreement patterns of inter-observer surgical judgment were determined. Analysis of the data revealed a marked divergence of opinion concerning the need for surgery. The significant point of this study is that surgical judgment differs to a major degree from one surgeon to the next. In a second-opinion program the number of consultants needed to provide a reliable clinical decision probably exceeds the number who are logistically available and that the patient would be willing to visit. Surgical decision-making is a semi-exact scientific process, and it is unreasonable to expect exact answers to clinical problems.

Certification↗
PubMed1979

Valentine Mott (1785-1865), the father of American vascular surgery: a historical perspective.

Valentine Mott was one of the most eminent physicians of the first half of the 19th century. Recognized as a pioneer vascular surgeon, he is credited with having performed at least eight original surgical procedures. Included within his lifetime operative record are ligations of the innominate artery, the common and external carotids, the right subclavian artery, the common, external and internal iliac arteries, the femoral artery, and the popliteal a;tery for the treatment of aneurysmal disease. In addition, he was highly regarded for his innovative approach to venous problems. This is most remarkable in that all of this work was done prior to the discovery of anesthesia, antisepsis, and the use of transfusions. Through research, utilizing primary archival and secondary source material in the form of previously unpublished manuscripts, correspondence, and background information, a biography of his life is presented. When his many surgical successes are placed in proper historical perspective, Valentine Mott can truly be called the Father of American Vascular Surgery.

History, 18th Century↗
PubMed1979

The application and interviewing process for surgical house officership.

The application and interviewing procedure for surgical house officership is an important process to both the medical student and the clinical department. Up-to-date, informative, and honest appraisals of the training programs under evaluation must be obtained. A survey was undertaken to compare and contrast students' and surgical department members' perceptions of nationwide surgical residency application procedures. It is concluded from this sampling that the majority of medical students applying to university-sponsored surgical training programs and the training institutions themselves generally are satisfied with the present application and interviewing experience. Certain areas in need of reform were elucidated, and the following recommendations are offered to aid in the development of a more effective process: (1) if possible, the descriptive information brochure should be updated on a yearly basis and must be comprehensive in scope; (2) when "en masse" interviewing is conducted, it should be held on a number of dates during the year, not just one, and a limited time for "walk-in" interviews should be allowed; (3) an opportunity should be available for the spouse or fiance'(e) to accompany the applicant; (4) an interviewer should prepare for an interview by having read the applicant's file beforehand; and (5) the interviewing schedule should be arranged so that the applicant is able to meet either the department chairperson and/or program director.

General Surgery↗
PubMed1979

Gonococcal perihepatitis (the Fitz-Hugh-Curtis syndrome): a diagnostic dilemma.

Three case histories of patients who were treated for gonococcal perihepatitis (Fitz-Hugh-Curtis syndrome) are reviewed. The incidence rate of this disease process is believed to be increasing, and a surgical consultation is often asked for in the evaluation of these individuals. The diagnosis of FHCS requires a high index of suspicion. However, if a patient has signs and symptoms of acute cholecystitis plus the recent onset of a purulent genitourinary infection, the diagnosis of FHCS is suggested. Confirmation of this diagnosis is obtained with the culturing of N. gonorrheae from urethral or cervical secretions. The clinical presentation may vary from a moderately symptomatic to an acutely ill individual. Most commonly there is an abrupt onset of sharp right upper quadrant pain. The finding of any degree of lower abdominal or pelvic tenderness in addition to the upper abdominal pain, should make one highly suspicious of pelvic inflammatory disease and concommitant FHCS. Although no deaths have been reported from this syndrome, it is important to make a prompt clinical diagnosis and commence appropriate antibiotic therapy. The currently recommended therapeutic regimen is procaine penicillin, 1,200,000 U, twice a day for 10 days.

Adult↗
PubMed1978

Rupture of the spleen in infectious mononucleosis: a critical review.

Spontaneous rupture of the spleen in infectious mononucleosis is a well-known clinical phenomenon. However, when strict criteria concerning the presence or absence of trauma and the diagnosis of infectious mononucleosis are applied to the 107 cases in the world literature, only 18 true spontaneous ruptures are found. In these, the survival rate was 100%. In addition to pain referral to the left shoulder (Kehr's sign), right shoulder and scapular pain from diaphragmatic irritation, caused by free intraperitoneal blood, can be a valuable sign in determining splenic rupture. Because the spleen remains susceptible to rupture even after recovery based on all clinical, hematologic, and serological criteria, it is recommended that full normal activities not be resumed for two to three months by the nonathlete and for six months by the athlete.

Adolescent↗
PubMed1978

William Halsted and Theodor Kocher: "an exquisite friendship".

William Halsted and Theodor Kocher were friends on both a professional and personal level. They greatly admired each other's surgical skills and judgment, and Halsted was a frequent visitor to Kocher in Switzerland. This is of interest in that both men have been described as introverted personalities with very few intimate acquaintances. An analysis of their personal correspondence, which has not been previously published, clearly demonstrates this unique relationship between the two reknowned surgeons.

General Surgery↗
PubMed1978

Thrombotic thrombocytopenic purpura (TTP) and splenectomy: a current appraisal.

Thrombotic thrombocytopenic purpura (TTP) is a disease process characterized by microangiopathic anemia, fever, neurologic manifestations, renal abnormalities, and thrombocytopenia. These clinical findings are caused by vascular occlusions of the microcirculation. At present the utilization of splenectomy, in the treatment of this illness, remains a highly controversial subject. However, review of the literature reveals that 70% of the long term survivors of TTP had undergone splenectomy. This report presents five patients with TTP, four of whom had been splenectomized. Long term survival (greater than one year) was achieved in three individuals. It is recommended that splenectomy be considered as part of the initial management of all patients with TTP, in addition to high dose corticosteroids and antiplatelet drugs.

Adult↗
PubMed1975

An evaluation of the application procedure for surgical house officership.

The application procedure for surgical house officership was evaluated at 25 university affiliated surgical training programs. Major inadequacies were found with the present system. The prospective house officer often does not receive relevant, up-to-date or useful literature, and interviews and tours were frequently conducted in a haphazard manner. Recommendations are offered to improve the application process and criteria are provided, which should assure adequate levels of information and help the candidate arrive at an appropriate decision with regard to postgraduate training.

Education, Medical, Graduate↗