Use of Endoscopic Suturing for the Treatment of Malignant Gastric Ulcer-Related Hemorrhage.

Gastrointestinal bleeding secondary to malignancy can be difficult to manage with traditional endoscopic therapies. Endoscopic suturing is a relatively new technology with limited data available regarding its use for bleeding related to peptic ulcer disease. We describe a case where endoscopic suturing was successfully used to control gastrointestinal hemorrhage from a previously known malignant ulceration that was refractory to traditional interventions.

The Residency Match in South Dakota: A National Comparison of Specialty and Geographic Trends.

BACKGROUND: Current estimates suggest progressively increasing need for rural family medicine and primary care providers in the near future. Predominantly rural states such as South Dakota have even greater difficulty in attracting these providers. Since its founding, the Sanford School of Medicine (SSOM) at the University of South Dakota has designed its curriculum to encourage students to choose these specialties and practice within the state upon completing residency. The objective of this paper was to evaluate trends in specialty choice and geographic location of residency programs for SSOM graduates compared with national means. METHODS: A retrospective observational analysis of residency match data including specialty and geographic location of the program was performed for matched seniors of SSOM from the years 2000-2020 and compared to national data over the same period. RESULTS: The proportions of students matching with primary care, surgical, or medical specialties at SSOM was not significantly different from national means. Proportionally, SSOM had almost twice the national average of students matching into family medicine (17.5 percent vs 9.0 percent). A significantly greater proportion of SSOM graduates matched into general surgery (8.1 percent vs 6.0 percent). SSOM students were significantly more likely (71.5 percent) than national (63.0 percent) and Midwest (58 percent) averages to match within their home region. CONCLUSIONS: SSOM's curriculum has led to a greater proportion of graduates matching with family medicine programs and at the national average for primary care overall. SSOM students are also significantly more likely than the national average to match within the same region of their medical school.

Cushing's Syndrome in a Pregnant Patient Secondary to Adrenal Adenoma: Treatment With Unilateral Adrenalectomy.

BACKGROUND: A pregnant woman presented with Cushing's syndrome (CS) secondary to adrenal adenoma and was treated with laparoscopic-assisted right adrenalectomy during the second trimester of pregnancy. SUMMARY: Our patient is a 33-year-old woman who presented with hypertension and cushingoid appearance at 21 weeks gestational age. Laboratory evidence indicated CS was likely, and imaging found a 2.3 x 3.0 cm right adrenal nodule as a suggested cause. Laparoscopic-assisted right adrenalectomy was performed at 23 weeks 4 days gestation without complication. Pathology of the removed specimen revealed an adrenal gland containing a 3.0 x 3.0 x 2.0 cm well-circumscribed proliferation of adrenal cortical cells without significant atypia. This report describes the rare occurrence of CS during pregnancy and subsequent successful surgical management. We review the diagnosis of CS during pregnancy and surgical considerations. CONCLUSION: CS, while a rare entity in the general population, is even more unique in the setting of pregnancy due to the negative effects of hypercortisolism on fertility. CS during pregnancy presents a diagnostically complicated scenario, along with specific considerations necessary for successful surgical management.