Local and national trends in general surgery residents\u27 operative experience: do work hour limitations negatively affect case volume in small community-based programs?

The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was -1.20 (P = 0.52) vs 1.78 (P = 0.07) for the national program average with statistically significant difference on comparison (P = 0.027). We also found significant difference in case volume changes at the national level compared with our institution for the following ACGME defined subcategories: alimentary tract [8.19 (P \u3c 0.01) vs -1.08 (P = 0.54)], abdomen [8.48 (P \u3c 0.01) vs -6.29 (P \u3c 0.01)], breast [1.91 (P = 0.89) vs -3.6 (P = 0.02)], and vascular [4.03 (P = 0.02) vs -3.98 (P = 0.01)]. Comparing the national trend to the community hospital we see that there is total increase in cases at the national level whereas there is a decrease in case volume at the community hospital. These trends can also be followed in ACGME defined subcategories which form the major case load for a general surgical training such as alimentary tract, abdominal, breast, and vascular procedures. We hypothesize that work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule, and implement institutional modifications which are too resource demanding for smaller training programs

Stercoral Perforation Requiring Subtotal Colectomy in a Patient on Methadone Maintenance Therapy

Stercoral perforation of the colon is a rare but serious complication of chronic constipation. We present a case of stercoral perforation requiring subtotal colectomy in a 41-year-old female who had been on methadone maintenance for a history of long-term intravenous heroin use. Our case highlights the importance of prompt and thorough surgical intervention in the successful treatment of this rare condition

The First Reported Case of Ureteral Perforation in a Patient withSevere Toxic Epidermal Necrolysis Syndrome.

The aim of this study was to briefly review toxic epidermal necrolysis syndrome (TENS) and Steven Johnson Syndrome (SJS), as well as describe the unique complication of ureteral perforation. A case of ureteral perforation in an 18-year old woman with TENS was documented and reviewed. In addition to studying this unusual presentation the authors have also provided a brief review of TENS and SJS along with several common complications of this disease process. The patient in question suffered a severe case of TENS with extensive mucocutaneous involvement. After 2 weeks of intensive therapy, she suddenly became anuric. She developed obstructive uropathy and bilateral hydronephrosis from mucosal debris and sludge. A left forniceal rupture was visualized on pyelography. SJS and TENS are two different presentations in the spectrum of the same disease process. There have been descriptions of gastrointestinal, respiratory, vaginal, and ocular mucosal involvement, including cases of corneal and colonic perforation. However, acute renal failure secondary to ureteral obstruction and perforation has never been described. Although rare, one must entertain every possibility when attempting to diagnose complications of the disease

Epithelioid Sarcoma and Unclassified Sarcoma with Epithelioid Features: Clinicopathological Variables, Molecular Markers, and a New Experimental Model

This study aims to address the current knowledge gap in the diagnosis and treatment of epithelioid sarcoma (ES) and unclassified sarcoma with epithelioid features (USEF) by: (a) characterizing and comparing the clinical behavior and outcome of ES and USEF patients treated at a single institution, (b) evaluating the expression of a panel of differentiation and other tumor-related molecular markers in human ES and USEF specimens, and (c) developing an ES experimental model for future studies to enhance our understanding of ES molecular determinants while developing more effective therapeutic strategies

The genomic landscape of epithelioid sarcoma cell lines and tumours

We carried out whole genome and transcriptome sequencing on four tumor/normal pairs of epithelioid sarcoma. These index cases were supplemented with whole transcriptome sequencing of three additional tumors and three cell lines. Unlike in rhabdoid tumors (the other major group of SMARCB1-negative cancers), epithelioid sarcoma shows a complex genome with a higher mutational rate, comparable to that of ovarian carcinomas. Despite this mutational burden, SMARCB1 mutations remain the most recurrent event and are likely critical drivers of tumor formation. Several cases show SMARCB1 alleles that do not go through biallelic inactivation and we explore this further in vitro. Finding CDKN2A deletions in our discovery cohort, we evaluated CDKN2A protein expression in a tissue microarray. 37% (6/16) of cases had lost CDKN2A in greater than or equal to 90% of cells while the remaining cases had maintained the protein. RNAseq based expression analysis of epithelioid sarcoma cell lines shows a unique profile that does not cluster with any particular tissue type nor with other SWI/SNF aberrant lines. The maintenance of expression of most SWI/SNF members other than SMARCB1 prompted us to evaluate protein level expression of other complex members. In vitro studies show that other SWI/SNF proteins are expressed as part of a residual complex, similar to previous observations in rhabdoid tumor lines. This residual SWI/SNF is susceptible to synthetic lethality and may therefore indicate a therapeutic opportunity.Medicine, Faculty ofNon UBCPathology and Laboratory Medicine, Department ofReviewedFacultyResearcherOthe