A case of isolated splenic tuberculosis.

There are few cases of isolated splenic tuberculosis reported in the literature internationally, and nearly none from western medical centers. The incidence of tuberculosis has declined in the United States since the 1950s, with 11,585 reported cases in 2009, 21% of which were exclusively extrapulmonary. Splenic tuberculosis occurs mostly as part of miliary tuberculosis in immunocompromised patients. Isolated splenic tuberculosis is extremely rare, particularly in the immunocompetent patient. Patients susceptible to acquiring splenic tuberculosis usually have one of the following risk factors: immunosuppression, preceding pyogenic infections, splenic abnormalities, prior trauma to the spleen, sickle cell disease and other hemopathies, and in the immunocompetent patient another body site infected by M. tuberculosis. In this report we present the case of a young immunocompetent male with no other significant past medical history with isolated splenic tuberculosis.

Follicular cell-derived thyroid cancer.

Follicular cell-derived thyroid cancers are derived from the follicular cells in the thyroid gland, which secrete the iodine-containing thyroid hormones. Follicular cell-derived thyroid cancers can be classified into papillary thyroid cancer (80-85%), follicular thyroid cancer (10-15%), poorly differentiated thyroid cancer (<2%) and undifferentiated (anaplastic) thyroid cancer (<2%), and these have an excellent prognosis with the exception of undifferentiated thyroid cancer. The advent and expansion of advanced diagnostic techniques has driven and continues to drive the epidemic of occult papillary thyroid cancer, owing to overdiagnosis of clinically irrelevant nodules. This transformation of the thyroid cancer landscape at molecular and clinical levels calls for the modification of management strategies towards personalized medicine based on individual risk assessment to deliver the most effective but least aggressive treatment. In thyroid cancer surgery, for instance, injuries to structures outside the thyroid gland, such as the recurrent laryngeal nerve in 2-5% of surgeries or the parathyroid glands in 5-10% of surgeries, negatively affect quality of life more than loss of the expendable thyroid gland. Furthermore, the risks associated with radioiodine ablation may outweigh the risks of persistent or recurrent disease and disease-specific mortality. Improvement in the health-related quality of life of survivors of follicular cell-derived thyroid cancer, which is decreased despite the generally favourable outcome, hinges on early tumour detection and minimization of treatment-related sequelae. Future opportunities include more widespread adoption of molecular and clinical risk stratification and identification of actionable targets for individualized therapies.

Study habits centered on completing review questions result in quantitatively higher American Board of Surgery In-Training Exam scores.

PURPOSE: The American Board of Surgery In-Training Exam (ABSITE) is administered to all general surgery residents annually. Given the recent changes in the format of the examination and in the material being tested, it has become increasingly difficult for residents to prepare for the ABSITE. This is especially true for incoming postgraduate year (PGY) 1 residents because of the respective variability of the surgical clerkship experience. There have been many studies in the past that support the use of weekly assigned readings and examinations to improve ABSITE scores. Other studies have investigated the study habits of residents to determine those that would correlate with higher ABSITE scores. However, there is a lack of information on whether completing review questions plays an integral role in preparing for the ABSITE. We hypothesize that those residents who completed more review questions performed better on the ABSITE. METHODS: ABSITE scores of current and past general surgery residents at SUNY Downstate Medical Center, a university hospital, were reviewed (2009-2013). These residents were then polled to determine how they prepared for their first in-training examination. RESULTS: Average ABSITE percentile was 46.4. Mean number of review questions completed by residents was 516.7. Regression analysis showed that completion of more review questions was associated with a significantly higher percentile score on the ABSITE (p < 0.0027). Further analysis showed that for every 100 review questions completed by a PGY 1 resident taking the ABSITE for the first time, the ABSITE percentile score should improve by 3.117 ± 0.969. Average reported study time in hours/week was 9.26. Increased study time was also significantly correlated with higher ABSITE percentile scores (p < 0.007). Again, further analysis showed that for every 1h/wk spent studying, ABSITE percentile score should increase by 1.76 ± 0.62. The Kruskal-Wallis H test showed that studying in group vs individual settings had no effect on ABSITE performance (p = 0.20). It was also used to analyze primary study resource, which demonstrated that there was no significant difference in residents' performance based on their primary study source (p = 0.516). CONCLUSION: Recent changes in the format of the ABSITE to a 2-tiered examination in 2006 and subsequent plan to return to a unified test for all PGY levels has made preparation difficult. With a more focused, question-based approach to studying, residents may see a demonstrable improvement in their scores. Our study supports this hypothesis-showing that residents who complete more review questions had higher ABSITE percentile scores. In the past, it has been demonstrated that strong ABSITE scores are associated with higher written board scores. With the widespread adoption of the Surgical Council on Resident Education curriculum, we postulate that residency programs that rely on this review question-based curriculum will report improved ABSITE percentile scores and written board pass rates.

Progression of malrotation into volvulus in an adult after appendectomy.

Among the pediatric population malrotation is the most common cause of volvulus. This paper describes a case of adult malrotation, which progressed to volvulus shortly after appendectomy. It also reviews clinical presentations and diagnostic tools, discusses the recommended management, and considerations when addressing of this rare malady.