The nature and fate of categorical surgical residents who "drop out".

BACKGROUND: Little is known about the fate of categorical surgical residents who leave a program or if they differ from those who successfully complete a program. METHODS: Matching into separate categorical and preliminary categories with elimination of the pyramid began in 1982. The files of all categorical residents matched between 1982 and 1995 were reviewed for demographic and scholastic data. Drop-outs were compared with the residents who completed the program and with the current house staff. All residents have been followed up to the present. RESULTS: Between 1982 and 1996, 19 of 88 (22%) categorical residents who matched into the program left voluntarily. Eleven of 63 (17%) were male and 8 of 25 (32%) female (P = 0.12; test of proportions-Z = -1.55). They entered both surgical and nonsurgical fields. The major reasons for leaving were related to life-style issues. Their academic credentials are very similar to those who remained. CONCLUSIONS: The drop-out rate of categorical surgical residents is significant, and replacing them is not easy. We have not identified any characteristics that might predict attrition.

A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction.

BACKGROUND: Many cases of acute adhesive small-bowel obstruction (SBO) can be successfully treated with intestinal tube decompression. There is considerable controversy, however, regarding whether a short nasogastric tube (NGT) or a long nasointestinal tube (LT) is the best method of intestinal tube decompression. PATIENTS AND METHODS: A prospective, randomized trial was conducted to compare NGT and LT decompression with respect to the success of nonoperative treatment and morbidity of surgical intervention in 55 patients with acute adhesive SBO. RESULTS: Twenty-eight patients were managed with NGT and 27 with LT. There were 44 cases of partial SBO (23 NGT, 21 LT) and 11 cases of complete SBO (5 NGT, 6 LT). Twenty-one patients ultimately required operation, including 13 managed with NGT (46%) and 8 with LT (30%) (P = 0.16). The mean period between admission and operation was 60 hours in the NGT group versus 65 hours in the LT group. At operation, 3 patients in the NGT group had ischemic bowel that required resection. Postoperative complications occurred in 23% of patients treated with NGT versus 38% of patients treated with LT (P = 0.89). Postoperative ileus averaged 6.1 days for NGT patients versus 4.6 days for LT patients (P = 0.44). There were no deaths. CONCLUSIONS: Patients with adhesive SBO can safely be given a trial of tube decompression upon hospital admission. There was no advantage of one type of tube over the other in patients with adhesive SBO.

Changing distribution of carcinoma of the colon and rectum.

The anatomic distribution of carcinoma of the colon and rectum in patients operated upon at this institution over a 30 year period was studied. All patients with recently diagnosed adenocarcinoma of the colon and rectum were placed into one of three groups: right colon, left colon or transverse colon. An analysis of the distribution of tumors over four time periods--1945 to 1949, 1956 to 1957, 1966 to 1969 and 1976 to 1978--revealed an increase in the percentage of tumors of the right colon with time that was most significant in the last time period studied. Various explanations for the recent increased incidence of tumors of the right colon found were discussed.

Inhibition of DNA synthesis by carcinogens in human colon mucosa in organ culture.

The capability of carcinogens with different modes of action to affect replicative DNA synthesis in the human colon was tested with the use of organ culture of histologically normal mucosae from patients undergoing colectomy for colon cancer or diverticulosis. 1,2-Dimethylhydrazine, an organotropic carcinogen for the colon in rodents, inhibited DNA synthesis of mucosa at a concentration of 3.0 mM but not at 1.5 mM. Methylazoxymethanol acetate, a proximate carcinogen, inhibited DNA synthesis at a concentration of 1.5 mM. N-Methyl-N'-nitro-N-nitrosoguanidine (MNNG), a direct-acting carcinogen, inhibited DNA synthesis at a concentration of 0.5 mM. No tissue toxicity was observed at the doses of these carcinogens used. The procarcinogen benzo[a]pyrene, which is not organotropic for the colon, caused no inhibition of DNA synthesis in colon explants at concentrations of 0.01--0.05 mM. These data indicate that replicative DNA synthesis in the human colon is most sensitive to the inhibitory effect of the direct-acting carcinogen MNNG.

Peripheral lymphocytes in carcinoma of the colon and rectum.

Changes in peripheral lymphocyte counts have been reported in many different malignant conditions. We have studied 202 patients with carcinoma of the colon and rectum and have evaluated the relationship between peripheral lymphocytes and stage of disease as well as sex, location of tumor and carcinoembryonic antigen levels. We found a correlation between advancing stage of disease and lower levels of peripheral lymphocytes. An inverse relationship for carcinoembryonic antigen levels and lymphocyte values was also noted for the entire group as well as for individual Stages B anc C. It was suggested that the combination of both lymphocyte levels and carcinoembryonic antigen determinations might be useful as a prognostic indicator.