Specialty choices of medical students and house officers in Karachi, Pakistan

Unerstanding patterns of career choices inmedicine is importnat for educators and policy-makers to plan the supply of specialists. This study analysed the career choices made by medical students and house officers in 2 private and 2 public medical schools in Karachi, Pakistan. An anonymous, self-administered and gynaecology were the 4 highest ranked specialties, with internal medicine ranked top as both the 1st and 2nd choice. Internal medicine was the 1st choice for significantly more students in public than private medical colleges (22.2% versus 1l4.9%). Students from private medical institutions chose a wider range of specialties than those from publicly-funded colleges. A high proportion of medical students and graduates in Karachi favour the same medical specialties, which may lead to saturation in those areas of specialization.

Acute dyspnea and a new murmur in a team physician

A 61-year-old physician for a professional sports team experienced transient palpitations and dyspnea while playing in an over-50 basketball scrimmage. He had been physically active for many years, had no known cardiopulmonary disorders, and had never been told of a heart murmur. He had not been febrile, nor had he experienced any chest pain. There was no history of recent dental work.

Easy cardioplegia delivery, aortic venting, and reperfusion technique

Myocardial preservation is an essential aspect of coronary revascularization as well as of other open heart procedures. As these procedures are becoming more complex, specifically myocardial revascularization, impeccable myocardial protection becomes imperative. Described is a technique that enables one to easily accomplish good myocardial preservation with minimal clutter using readily available materials.

Revascularization after thrombolytic therapy for acute myocardial infarction: an analysis of 573 patients

From October, 1981, to January, 1987, at our center, 891 patients received streptokinase within 6 hours of acute myocardial infarction. A total of 318 patients were treated medically, while 388 patients (43.5%) underwent coronary artery bypass grafting (CABG) alone and 185 (20.7%) were treated with percutaneous coronary angioplasty (PTCA). Subsequent CABG was performed in 37 of 185 PTCA patients after unsuccessful angioplasty. Group characteristics were similar. However, multiple-vessel coronary artery disease was present in 70.3% of CABG patients compared with 24.1% in the PTCA groups. Procedure mortality was 3.6% for CABG alone, 5.4% for PTCA alone, and 13.5% for the combined angioplasty and operation group (p less than 0.05 compared with CABG). All deaths in the PTCA group with subsequent CABG occurred in those patients taken emergently to CABG (5 of 20 patients). We conclude that with proper patient selection both forms of revascularization are safe and effective. However, emergency coronary bypass surgery in the event of failed angioplasty has a high risk.

Complications of the Angelchik prosthesis in the management of gastroesophageal reflux

There have been a number of reports on the complications of the Angelchik silicone prosthesis since Angelchik and Cohen first reported the use of the device in 46 patients with gastroesophageal reflux. The exact incidence of complications is difficult to estimate; however, the company estimates 0.81 per cent for migration and 0.15 per cent for erosion of the prosthesis. The purpose of this paper is to review our experience with 13 complications related to the Angelchik prosthesis in eight patients referred to Emory University Hospital. These complications consisted of recurrent reflux esophagitis in six patients, intractable dysphagia in two, esophageal stricture in two, displacement of the prosthesis in two, disruption of the prosthesis in one patient, and gastric erosion in two patients. The management of these complications required removal of the prosthesis and performance of a Nissen fundoplication in six patients. Distal esophagectomy with esophagogastrostomy was performed in one patient, and colon interposition was performed in another patient. In summary, serious complications of the Angelchik prosthesis implanted for gastroesophageal reflux and their management are presented.

Management of the infected pacemaker: explantation, sterilization, and reimplantation

From January, 1970, through December, 1984, nineteen infected or eroded pacemaker units were reimplanted in 17 patients. Characteristics of the patients, types of infecting organisms, surgical management, and complications are described. Optimal treatment of the infected generator pocket requires explantation of the generator unit with utilization of the in situ leads for pacing by an external-demand pacemaker unit. The generator unit is sterilized, and new leads are placed with relocation of the pocket. The old leads are then removed. This technique has been used safely and with excellent results for the past fourteen years.

Laryngotracheoesophageal cleft in a newborn

A case of laryngotracheoesophageal cleft in a newborn is presented. A newborn presenting with respiratory distress underwent contrast radiographic studies, direct laryngoscopy, bronchoscopy, and esophagoscopy, demonstrating a complete laryngotracheoesophageal cleft, esophageal diverticulum and microgastria. Attempts to maintain an adequate airway by ligation of the salivary ducts and ligation of the distal esophagus were unsuccessful. Continued biliary drainage per endotracheal tube postoperatively afforded a presumptive diagnosis of bronchobiliary fistula. The child expired on its fourth day of life. A review of the literature and modalities of therapy for these rare and unusual combinations of foregut anomalies is discussed. This is the first reported case of a newborn with the combination of laryngotracheoesophageal cleft, bronchobiliary fistula, microgastria and esophageal diverticulum.

Surgical management of familial benign chronic pemphigus by excision and primary closure

A case describing primary closure after full-thickness excision of long-standing familial benign chronic pemphigus (Hailey-Hailey disease) in a 54-year-old man is presented. The involved axillary, inguinoscrotal, and perineal skin was excised and closed primarily without difficulty. Eradication of the disease in the excised areas was accomplished with minimal hospitalization and morbidity. Familial benign chronic pemphigus and its differential diagnosis are discussed and the literature on surgical management of this rare disease is reviewed.

Congenital intradural neuroblastoma

A case of congenital intradural neuroblastoma with paraspinous involvement in a newborn is reported. A newborn presenting with paraplegia was treated with decompressive laminectomy and an attempt to debulk the tumor followed by postoperative radiation and chemotherapy. Literature review and treatment of the intraspinal neuroblastoma is presented along with the differential diagnosis of infantile intraspinal tumors. This is the first reported case describing congenital intradural neuroblastoma with no extradural component in a newborn.