APDS Task Force on Resident Transfers: Guidelines for Program Directors.

OBJECTIVE: Resident attrition from the field of General Surgery has been extensively studied. Attrition from one General Surgery program to the benefit of another has not. General Surgery programs can be negatively affected when a resident decides to leave the program for another. When a resident in a general surgery residency program decides to attempt transfer to another program several decisions must be made. The resident applies for the open position, interviews and then may be offered a position in that program. If an offer is made and the resident accepts, at what point is the resident's current Program Director notified? At what point in the process does the resident leave his/her current program to begin the new program? At what point does the new Program Director obtain a summative evaluation of the resident? Does the resident experience retribution as a result of informing his/her fellow residents and faculty that s/he is leaving? These are all questions that Program Directors struggle with when they find themselves with an unexpected opening to fill. The APDS Task Force on Resident Transfers attempted to answer these and other questions. DESIGN: A 19-question survey was distributed via the APDS to all General Surgery Program Directors who utilize the list serve. The survey asked questions related to the following: acceptable reasons for transfer; timeline for the application, interview and transfer process; retaliation against residents who chose to transfer; and transparency in the transfer process. SETTING: The survey was distributed via e-mail nationwide. PARTICIPANTS: General Surgery Residency Program Directors are participated in the survey. RESULTS: The majority of the 99 respondents agreed to the following guidelines: (1) Program Directors must promote transparency in the transfer process; (2) Program Directors must make a statement against retaliation; (3) personal or family preference is the most acceptable reason for transfer; (4) an established transfer date must be agreeable to both programs; and, (5) a recruitment timeline should be established for both programs. All data are included below. CONCLUSIONS: The reasons that a resident chooses to leave a program and the effect this has on the program and the other residents requires further study. Program Directors should educate residents about the transfer process and that procedure should be available as a written policy. When a resident desires transfer to another program, following these guidelines may make the transition easier for all involved. The APDS supports putting them into practice.

Malignant mucosal melanoma of the paranasal sinuses: Two case presentations.

Primary mucosal melanoma of the paranasal sinuses is a rare tumor of the head and neck which can be a devastating disease. Cancers arising in the sinonasal cavity are extremely rare, with a poor survival rate. There is inherent difficulty in diagnosing these lesions due to their complex anatomic locations and symptoms which are often confused with more common benign processes. The primary treatment of this rare disease process is resection, except in advanced stages where surgical resection is not an option. Diagnostic accuracy in consideration of size, location, and presence of metastatic disease of these malignant tumors tailors individual patients to different management in order to achieve the longest possible survival.

Hepatic artery aneurysm erosion into the stomach: an unusual cause of gastrointestinal bleeding.

BACKGROUND: Hepatic artery aneurysms are the second most common visceral aneurysms. The natural history of hepatic artery aneurysms typically results in enlargement, rupture, and life-threatening hemorrhage. Atherosclerosis, traditionally, has been the most common cause of hepatic artery aneurysm. OBJECTIVE: A case of a hepatic artery aneurysm invading the stomach is presented to draw attention to the clinical presentation of this potentially catastrophic entity. CASE REPORT: A 74-year-old man presented to the Emergency Department (ED) with hematemesis. He was hemodynamically stable with a hemoglobin of 10.5. Abdominal CT imaging revealed a hepatic artery aneurysm that eroded into the stomach. The erosion was successfully repaired operatively and the aneurysm was embolized. CONCLUSION: The most common symptom is epigastric pain. The clinical and radiological findings of a hepatic artery aneurysm eroding into the stomach with subsequent upper and lower gastrointestinal hemorrhage, as highlighted in the case reported, have received little prior attention in the medical literature.