Personality differences between internal medicine and surgical residents in an Asian population.

PURPOSE: Personality traits often have an impact on the way individuals relate to each other as colleagues and the patients we treat. It is often perceived that distinct personality exist between different specialties and may help predict success during one's training and career. METHODS: Objective of the study was to compare the personality between surgical and medical residents. Thirty-five medical residents and 35 surgical residents completed the Revised NEO Personality Inventory, a validated measure of personality traits. A score was generated for each of the 5 major character traits namely: neuroticism(N), extraversion(E), openness(O), conscientiousness(C), agreeableness(A). Each of these traits were subdivided into 6 component facets. This was compared with sociodemographic characteristics. RESULTS: Medical residents displayed higher scores in the area of overall Agreeableness, with a mean score of 47.4 vs 40.5. Within Agreeableness facets, medical residents also displayed higher scores of straightforwardness, altruism and modesty. Surgical residents displayed higher scores in terms of overall Extraversion (52.4 vs 45.4). Within the Extraversion facets, surgical residents were also more assertive and excitement-seeking. There was no difference in the overall neuroticism domain; however, within the neuroticism facets, surgical residents had statistically higher mean scores in angry hostility and impulsiveness. Gender stratification did not result in any statistically significant difference. CONCLUSION: There are fundamental differences between personalities of medical and surgical residents. Detailed analysis of each individual's data could be useful, with proper assistance and coaching, for residents in learning more about their personalities and how these impact their clinical practice. This can be beneficial in future career counselling and the development of a more holistic medical practitioner.

Postoperative risk of chronic kidney disease in radical nephrectomy and donor nephrectomy patients: a comparison and analysis of predictive factors.

INTRODUCTION: To compare baseline renal function and identify predictive factors in patients undergoing radical nephrectomy (RN) or donor nephrectomy (DN) and their risk of subsequent chronic kidney disease (CKD) after surgery. MATERIALS AND METHODS: A retrospective review of patients with no baseline CKD undergoing RN (n = 88) and DN (n = 58) from 2000 to 2008 was performed. Baseline and postoperative renal function (eGFR) was determined using the Modification of Diet in Renal Disease (MDRD) formula. CKD was defined as eGFR < 60 mL/min/1.73 m2 according to the National Kidney Foundation guidelines. RESULTS: Before surgery, patients undergoing RN and DN had a mean eGFR (+/- SD) of 83.5 +/- 17.4 and 92.9 +/- 17.0 mL/min/1.73 m2 respectively (p = 0.002). Patients with RN had significantly greater morbidities including hypertension (47.7%), diabetes (14.8%) and ischemic heart disease (12.5%) than DN (5.2%, 0% and 1.7% respectively) (all p < 0.05). Median follow up was 3.5 years. The relative hazard of developing CKD post RN compared with DN was 1.91 (95% CI 1.01 to 3.61, p = 0.040). The median time to CKD was 77 months (range 2-107) for RN and 100 months (range 11-105) for DN. Age, gender, comorbidities, radical nephrectomy and baseline kidney function were individual risk factors for CKD post nephrectomy. However, preoperative eGFR was the only independent prognostic factor on multi-variable analysis. CONCLUSIONS: Patients undergoing RN are distinctly different from kidney donors in terms of age, renal function and comorbidities. RN is not an independent predictive factor for CKD but the lower baseline renal function in RN patients significantly accelerates renal senescence in the uninephrectomy state.

Successful endourological management of the 'forgotten' stent in a transplanted kidney.

BACKGROUND: Ureteric stents are used to prevent urological complications like ureteric fistulas and obstruction in kidney transplants. Despite its advantages, complications arising from delayed removal of a double J (DJ) stent include urinary tract infections, stone encrustation, and migration of the DJ stent [Sansalone et al.: Transplant Proc 2005;37:2511-2515]. Encrustation of the stent makes removal difficult and risks injury to the transplanted kidney. CASE PRESENTATION: We report a case of retained DJ stent for 19 years presenting with recurrent urinary tract infections. A radiograph revealed a retained ureteric stent extending from the right iliac fossa transplant kidney to the urinary bladder with multiple foci of large calcification along its length. Two sessions of extracorporeal shockwave lithotripsy along the stent were performed after a percutaneous nephrostomy tube had been placed in the transplanted kidney. Subsequently, the retained DJ stent was removed endoscopically after laser lithotripsy to remnant calcifications. Remnant stone fragments were removed with another session of ureteroscopy and laser lithotripsy. The patient achieved complete stent and stone clearance with a functioning graft. CONCLUSION: This case illustrates that significant stone encrustation of the retained stent in a transplanted kidney can be treated successfully with a combination of endourological techniques.

Embryonal rhabdomyosarcoma of the adult urinary bladder: a rare case report of misclassification as inflammatory myofibroblastic tumor.

Embryonal rhabdomyosarcoma (ERMS) of the adult urinary bladder is a rare malignant tumour. Inflammatory myofibroblastic tumour (IMT) of the bladder is a benign genitourinary tumour that may appear variable histologically but usually lacks unequivocal malignant traits. Techniques like flow cytometry and immunohistochemistry may be used to differentiate these two tumours. Our patient, a 46-year-old male, had rapidly recurring lower urinary tract symptoms after two transurethral resections of the prostate. He subsequently underwent a transvesical prostatectomy which showed IMT on histology. However, his symptoms did not resolve and an open resection done at our institution revealed a 6 cm tumour arising from the right bladder neck. This time, histology was ERMS with diffuse anaplasia of the bladder. Rapid recurrence of urinary symptoms with prostate regrowth after surgery is unusual. Differential diagnoses of uncommon bladder malignancies should be considered if there is an inconsistent clinical course as treatment approaches are different.

Preoperative Renal Volume: A Surrogate Measure for Radical Nephrectomy-Induced Chronic Kidney Disease.

OBJECTIVES: Surgically induced chronic kidney disease (CKD) has been found to have less impact on survival as well as function when compared to medical causes for CKD. The aim of this study is to evaluate whether preoperative remaining kidney volume correlates with renal function after nephrectomy, which represents an individual's renal reserve before surgically induced CKD. METHODS: A retrospective review of 75 consecutive patients (29.3% females) who underwent radical nephrectomy (RN) (2000-2010) was performed. Normal side kidney parenchyma, excluding renal vessels and central sinus fat, was manually outlined in each transverse slice of CT image and multiplied by slice thickness to calculate volume. Estimated glomerular filtration rate (eGFR) was determined using the Modification of Diet in Renal Disease equation. CKD is defined as eGFR < 60 mL/min/1.73 m(2). RESULTS: Mean preoperative normal kidney parenchymal volume (mean age 55 [SD 13] years) is 150.7 (SD 36.4) mL. Over median follow-up of 36 months postsurgery, progression to CKD occurred in 42.6% (n = 32) of patients. On multivariable analysis, preoperative eGFR and preoperative renal volume <144 mL are independent predictors for postoperative CKD. On Kaplan-Meier analysis, median time to reach CKD postnephrectomy is 12.7 (range 0.03-43.66) months for renal volume <144 mL but not achieved if renal volume is >144 mL. CONCLUSIONS: Normal kidney parenchymal volume and preoperative eGFR are independent predictive factors for postoperative CKD after RN and may represent renal reserve for both surgically and medically induced CKD, respectively. Preoperative remaining kidney volume may be an adjunct representation of renal reserve postsurgery and predict later renal function decline due to perioperative loss of nephrons.