Surgeons' learning style in comparison to their medical colleagues

Objectives: To present the learning style of surgeons and compare it to their medical colleagues

Methods: This study was conducted at King Hussein Medical Center between 1-15/July 2014. An equal number of randomly selected surgeons and physicians received Honey and Mumford learning style questionnaire. The participants were asked to fill the questionnaire with their name initials, age, gender, specialty [surgeon or physician] and scientific medical level [specialist or consultant]. The results between these two groups were compared using statistical methods

Results: A total number of 40 participants filled the questionnaire, 20 in each group. Thirty six [90%] were males, with a mean age of 37.6 years [SD +/- 6.32]. There were 7 consultants and 33 specialists. The majority [80-90%] of surgeons and physicians showed reflector and theorist learning styles. When grouping them into activist/ pragmatist, reflector/ theorist or mixed learning styles; 80% of surgeons and 90% of physicians demonstrated mixed learning style

Conclusion: Both surgeons and physicians demonstrated a mixed learning style. This means that doctors in both specialties use all four learning styles which inevitably will bring the best learning results. We suggest the application and appreciation of all learning styles in the surgical curriculum as the most educational and practical approach

Management of fistula-in-ano at King Hussein medical center

To describe the treatment of fistula-in-ano in the newly formed colorectal unit at King Hussein Medical Center. This is a descriptive, retrospective review of case medical records of 91 patients with different types of fistula-in-ano treated surgically between March 2009 and May 2011. Anatomic classification and operative procedure of all fistulae were recorded. Eighty-five patients underwent surgery for fistula-in-ano. There were 93 fistulae in our study group; with eight patients having two fistulae tracts. There were 76 [89%] males, with a mean age of 39.1 years [range 19-76]. Eleven patients had superficial, 5 patients had inter-sphincteric, 68 patients had trans-sphincteric, 3 patients had supra-sphincteric and 5 patients had extra-sphincteric fistulae. Thirty-eight patients [45%] had complex fistulae. The radial site of fistulae was detected, with 44 [47%] presenting with an internal opening in the posterior anal canal, 19 [21%] opening into the anterior canal and 30 [32%] opening laterally. Fistulotomy was the commonest procedure [n=40] with marsupialization in 20 patients, followed by loose Seton [n=33], endorectal advancement flap [n=5], tight Seton [n=4] and ligation of the intersphincteric fistula tract [LIFT] procedure [n=2]. Careful selection of the treatment method that takes into account the anatomy of the fistula, state of the anal sphincters and patient's preference is central in the successful management of fistula-in-ano

Abdominal wall sinus as a result of spilled gallstone post laparoscopic cholecystectomy: a case report

This is a case report of a 73 year old male patient who presented with a chronic discharging sinus from the right side of his abdominal wall almost three years after he underwent laparoscopic cholecystectomy CAT scan showed a sinus tract leading to a radio-opaque foreign body located in a cavity just lateral to the right edge of the right lobe of the liver, highly suggestive of a gallstone being slipped during cholecystectomy .The patient underwent surgery where the sinus tract was excised and a gallstone was removed from a cavity sinus in the peritoneurn just lateral to the right edge of the right lobe of the liver. Both the laparotomy wound and sinus tract wound were completely healed three weeks post operatively. Gallstone abscess and sinus formation post laparoscopic cholecystectomy are becoming more common than expected due to the underestimation of many surgeons of the hazards that may result from gallbladder perforation and stone spillage intraperitonially during the procedure. This a rare and new complication post laparoscopic cholecystectomy and can be prevented by several simple precautions and manoeuvres. Increase of awareness about this type of complication will facilitate it prevention

Attenuation of cardiovascular responses to laryngoscopy and tracheal intubation with verapamil

To evaluate the efficacy of verapamil in controlling hemodynamic responses to tracheal intubation under general anesthesia. We studied eighty normotensive patients [American Society of Anesthesiologists physical status [I]] undergoing elective surgery. They were randomly assigned to two main groups. Group I included 20 patients randomly allocated into two equal subgroups [1a and 1b]. Group II were divided into three subgroups with 20 patients each [IIc, IId and IIe] to receive saline [control], verapamil 0.05 milli grams/kilogram body weight, verapamil 0.1 milligrams /kilogram body weight. Patients with anticipated difficult tracheal intubation, hypertension, renal or hepatic diseases were excluded. The drugs were administered 60 seconds before commencing laryngoscopy. Anesthesia was induced with thiopentone 5 milligrams/kilogram body weight intravenously and fentanyl 2mcmicro g/kg intravenously, vecuronium 0.15 milligrams/kilogram body weight. During anesthesia, ventilation was assisted or controlled with 1% halothane and 50% nitrous oxide in oxygen. Laryngoscopy lasting 30sec. was attempted 2 minutes after administration of thiopentone and vecuronium. Patients receiving saline exhibited significant increase in systolic, diastolic arterial pressures mean arterial pressure, and heart rate associated with tracheal intubation. The increases in mean arterial pressure and heart rate were attenuated in patients treated with verapamil. These findings suggest that bolus injection of verapamil was an effective method of controlling hypertension and tachycardia associated with intubation. This technique may be useful in hypertensive patients and it may protect them from serious complications. Further studies in hypertensive patients might be helpful