Massive Retroperitoneal Hematoma Caused by Retroperitoneal Ectopic Pregnancy

A massive retroperitoneal hematoma caused by a retroperitoneal ectopic pregnancy is managed successfully utilizing multidisciplinary cooperation and transfusion of blood products. The authors report an unusual case of a retroperitoneal ectopic pregnancy presenting as a massive retroperitoneal hematoma in a hemodynamically unstable patient. © 2007 Quadrant HealthCom, Inc

Surgical management of adrenal cysts.

Adrenal cysts are rare and are often found incidentally during abdominal imaging for another reason. We describe two cases of adrenal cysts, one of which was found to be a cystic pheochromocytoma. Most cystic pheochromocytomas are not diagnosed by urinary screening studies, and the first indication of a pheochromocytoma may be hemodynamic instability during resection. We review the literature on adrenal cysts and make recommendations for the management of cystic adrenal masses

Applying “Expectancy Theory” to Surgical Residency Training

Expectancy Theory is a well known theory in work motivation literature. It was first proposed by Victor Vroom in 1964 after studying the motivations behind individuals’ decision making. Expectancy Theory holds that a person’s choice to behave in a certain way reflects the belief that chosen actions will result in desired outcomes. Expectancy Theory is parsed of three components: Expectancy (E), Instrumentality (I) and Valence (V). Expectancy (E) is the belief that performance goals will be met if appropriate efforts are applied. Instrumentality (I) denotes an expectation that rewards will follow if defined performance outcomes are met. Valence (V) refers to the value an individual places on the reward being given. Expectancy Theory involves an interaction between these components, summing in a Motivational Force (MF). Namely, E x I x V = MF. Thus, as viewed by Expectancy Theory, MF will be affected by changes in performance expectations, recognition of goal achievements, and valuations of declared rewards. Interestingly, the traditional work-place organizational structure is in many ways analogous to contemporary surgical residency training in theUnited States. Examples include varied work assignments in the workplace being similar to varied clinical rotation assignments during residency; promotions offered in the workplace likened to training year advancement in residency; and the work-place hierarchy (e.g. employee to manager) akin to the hospital hierarchy (e.g. intern to department head). Many other similarities exist as well. These analogies between work-place organizational structure and surgical residency are significant as we propose the application of Expectancy Theory to surgical residency training. What follows are opportunities for greater insight into surgical resident MF, as well as the potential to enhance surgical residency training and performance. Learning Objectives: 1. To understand Expectancy Theory and its relevance to adult learning 2. To understand the application of Expectancy Theory to surgical residency education 3. To understand factors affecting motivation in adult learners 4. To understand Expectancy Theory, and Motivational Force in enhancing surgical resident trainin

Are roadside pedestrian injury patterns predictable in a densely populated, urban setting?

BACKGROUND: Roadside pedestrian injuries represent a significant portion of trauma team activations, especially at urban trauma centers. Patient demographics and severity of injury vary greatly in this patient population. Herein, we hypothesize that injury patterns may be predictable, especially with respect to age. MATERIALS AND METHODS: All patients with roadside pedestrian injuries evaluated at our urban, level one trauma center from January 2006 through December 2008 were retrospectively reviewed. Data were collected from the institutional trauma registry. Age was used as an independent variable and compared with injury type, substance abuse, discharge setting, and mortality. RESULTS: There were 226 roadside pedestrian injuries during the study period. Patients were divided into groups according to age, under 20 y, 21-40 y, 41-65 y, and over 65 y. Head injuries were more prevalent in patients over age 65, 30.4% versus 14.0% (P = 0.05). There was a trend for increasing alcohol use in the younger population. The likelihood of discharge to a rehab facility increased with age, 0%, 11.8%, 38.2%, 50.0%, respectively (P \u3c 0.001). Mortality was significantly higher in patients older than 65 y, 15.2% versus 3.3% (P = 0.049). CONCLUSIONS: Roadside pedestrian injuries have predictable injury patterns based on age. Older patients are more likely to have a head injury, longer length of stay, need for a rehab stay, and have a higher mortality. Further studies are needed to correlate precise injuries with collision mechanism and evaluate specific risk factors in this high risk population