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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. Am J Surg. 1998;175:236-239. [C] 1998 by Excerpta Medica, Inc.

Patients with Crohn's disease or regional enteritis (chronic inflammatory bowel disease) often have inflammation across the wall of the intestine. Deep fissures may occur and lead to fistulas (abnormal passages, often between two cavities). Fistulous tracts that end blindly result in intra-abdominal abscesses; these occur either within or behind (intraperitoneal or retroperitoneal) the peritoneal lining of the abdomen and its organs. The incidence of retroperitoneal abscess is much lower than that of intraperitoneal abscess in Crohn's disease patients. A review of the medical records of 610 patients with Crohn's disease limited to the small intestine was undertaken; 21.2 percent (129 patients) developed intra-abdominal abscess formation. The abscesses were more often located in the intraperitoneal area than in the retroperitoneal area (109 versus 20). All 129 patients underwent surgery. The ratio of male to female patients in the retroperitoneal fistula group was 18 to 2. Reoperation was undertaken for recurrent abscess in 13 (12 percent) of the patients with intraperitoneal abscess; an additional 9 patients (8.2 percent) underwent reoperation for other reasons. Twenty-four patients developed external fistulas following simple incision and drainage procedures. In the intraperitoneal abscess group, 4 deaths occurred (3.7 percent); 3 were due to postoperative sepsis (bacterial infection in the blood). In the retroperitoneal group, 2 patients (10 percent) underwent reoperation for recurrent abscess, and 4 (20 percent) did so for other reasons. Two patients (10 percent) developed external fistulas. No deaths occurred in the retroperitoneal group. Sixty-two of the 129 patients underwent primary en bloc resection with excellent results. The number of deaths due to postoperative sepsis is considerably lower than what would be expected in a group of Crohn's patients with disease of the ileum and colon. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gaucher's disease is an inherited metabolic condition that causes massive enlargement of the spleen. The accepted treatment is surgical removal of the entire spleen. Because of the risk of fatal infection and the potential for bone and liver disease after splenectomy, partial splenectomy is considered preferable by some surgeons. A retrospective study was undertaken of patients undergoing splenectomy for Gaucher's disease over the past 27 years. The records of 48 patients were reviewed to determine both the short and long-term results of treatment. Total splenectomy was performed on 35 patients (73 percent), and partial splenectomy on 13 patients (27 percent). There was one death following surgery; this patient had undergone total splenectomy. Thirteen patients had postoperative complications. Within an average follow-up period of 25 months, 11 patients (23 percent) who had undergone total splenectomy showed accelerated bone disease. None of the partial splenectomy patients had evidence of accelerated bone disease. Since surgery, eight patients have died; four deaths were from malignancies that occurred after total splenectomy. These findings indicate that both total and partial splenectomy can be performed safely with minimal increased illness. Total splenectomy is associated with more aggressive bone disease and a tendency to develop malignancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Twenty-five patients with ulcerative colitis were treated between 1959 and 1986 at The Mount Sinai Hospital, with severe gastrointestinal hemorrhage as their major complaint. Twenty-two patients required operation, while three patients were treated medically. Total proctocolectomy with ileostomy was carried out in 5 patients, and subtotal colectomy accompanied by mucous fistula (14), Hartmann closure (2), or ileosigmoidostomy (1) was performed in 17 patients. Eleven of the patients who underwent operation had emergency colectomies, while the remaining 11 had semielective procedures. Subtotal colectomy was performed in 10 of the 11 emergency cases. Indications for emergency surgery were massive hemorrhage alone in seven patients and severe hemorrhage complicated by toxic megacolon in four patients. One patient died postoperatively of a perforated duodenal ulcer following emergency subtotal colectomy. There were two late deaths from leukemia in one surgically treated patient and one medically treated patient at 9 and 18 months, respectively. All 4 of the 25 patients with remaining intact rectums were alive and well at 3- to 12-year follow-up. Subtotal colectomy can be undertaken in patients with massive hemorrhage from ulcerative colitis for whom subsequent ileoanal anastomosis is planned, provided that one recognizes and is prepared for the approximately 12% risk of continued rectal hemorrhage., Ulcerative colitis, a chronic, inflammatory condition affecting the colon, leads to bloody diarrhea in most cases, but hemorrhage is rare. When it does occur, emergency surgery is necessary, and total proctocolectomy (removal of the colon and rectum) is often necessary. Subtotal colectomy (removal of the colon, leaving the rectum) may also be an effective way to treat colitis patients with hemorrhage. This was evaluated by reviewing records from 26 patients, who were either admitted with hemorrhage or who developed one. The average age at the onset of colitis was 25.4 years, and at the time of hemorrhage, 28 years. One patient in the group died due to infection following a perforated duodenal (small intestine) ulcer, and three were managed without surgery. Of the remaining 22 patients, emergency surgery was performed for 11, and 11 underwent semi-elective procedures. Total proctocolectomy was performed on five patients, with ileostomy (surgical creation of an opening through which the intestinal contents drain) for four, and ileo-anal anastomosis (connection of the small intestine to the anus) for one. The remaining 17 patients had subtotal procedures, most of which were done on an emergency basis. Of the patients with subtotal colectomy, 14 required subsequent surgery; seven of these procedures were planned at the time of the first operation. The four patients with intact rectums were alive and well at follow-up. Overall, it appears that subtotal colectomy can be performed in ulcerative colitis patients with massive hemorrhage when subsequent ileo-anal anastomosis is planned. The risk of continued rectal hemorrhage, however, is approximately 12 percent. (Consumer Summary produced by Reliance Medical Information, Inc.)