Diversity in medical school: perceptions of first-year students at four southeastern U.S. medical schools.

PURPOSE: To assess students' perceptions of the extent of diversity in their classes, the role of diversity in their first-year curriculum, and their predictions of the amount of diversity in their future patient populations. METHOD: In 1998, students at four southeastern U.S. medical schools that had distinct demographics and differing institutional missions completed a questionnaire on diversity at the end of the first year. In the instrument, diversity was defined according to nine population characteristics: age, sex, race, ethnic background, physical disability, religious affiliation, sexual orientation, socioeconomic status, and rural background (growing up in a community of less than 5,000). Responses were compared according to students' institution, sex, and race. RESULTS: Questionnaires were returned by 349 of 474 students (74%). Students at the school with the most diverse first-year class placed the greatest value on the contributions of diversity to the learning environment. Women students placed more value on the inclusion of diversity issues in the curriculum than did men students, and they placed greater value on understanding diversity issues in their future medical practices than did men. Compared with Asian American, Hispanic, and white students, African American students were the least likely to think that the curriculum contained adequate information about diversity. CONCLUSIONS: The results indicate that perceptions of diversity were influenced by the students' own demographic characteristics and those of their medical school. The more diverse the class, the more comfortable the students were with diversity and the more they valued its contribution to their medical education.

Positive identification by post-surgical defects from unilateral lambdoid synostectomy: a case report.

The comparison of pre- and postmortem radiographs as a method of identification of unknown human remains is well established in the forensic and radiologic literature. Identification can be based on a single bony feature when there is evidence of prior surgery, trauma or unusual anatomic variation. We present a case in which a positive identification was made using bony changes in the skull secondary to prior surgery for correction of unilateral lambdoid craniosynostosis. The unusual radiographic appearance of the bony defect initially raised the question of trauma and foul play.

Radiographic identification of unknown human remains and interpreter experience level.

The use of radiographs as a means of identification of unknown remains is a well-established method as performed by radiologists, forensic anthropologists, or pathologists. We devised a test to determine whether the degree of radiographic and medical knowledge of a film interpreter correlates with the degree of accuracy in making comparisons of radiographic unknowns. Three groups considered to be distinctly different in their level of medical knowledge and radiographic interpretive skills were chosen to evaluate forensic identification cases. Although all three groups identified a majority of cases correctly, none were completely accurate. The group with training in radiographic interpretation performed significantly better. Our study supports the need for trained interpreters in cases of forensic identification.

Adult Hirschsprung's disease.

Two cases of adult Hirschsprung's disease are reported along with a review of 47 cases reported in the literature. Chronic constipation is present in almost all cases. The barium enema examination may suggest the diagnosis if an area of smooth narrowing with proximal dilatation is seen (83%), but biopsy proof of absence of ganglion cells is necessary. Fourteen per cent of patients had a dilated colon without a narrowed segment. Anal manometry is helpful if it demonstrates absence of normal anorectal inhibitory reflex. Total colonic aganglionosis in the adult has been reported, but is exceptionally unusual. The diagnosis of adult Hirschsprung's disease should be suspected in patients with a history of chronic constipation and appropriate radiographic findings.

Development of an effective short introductory course in diagnostic radiology.

As part of a general medical curriculum renewal, a new one-week course in diagnostic radiology was given to students at the beginning of their third year. The course format consisted of didactic presentations to the entire class, a single afternoon session of small group discussions of unknowns, and three daily case-of-the-day unknowns with prizes for correct responses. One hundred fifty-eight students were tested on the first and last days of the course; testing consisted of two parallel 46-item multiple choice questions given in a crossed design. Questions covered radiographic anatomy and pathology as well as proper test ordering. Differences in achievement before and after the course as measured by the pre- and post-tests were highly significant. The class achieved a mean of 27 (59%) correct responses on the pre-test and a mean of 37 (80%) on the post-test (F(1156) = 15.79; P less than .001). The reliability coefficient of the pre- and post-tests was about .30. A course critique was returned by 88 students. There was anticipated variation in the evaluations of the different didactic lecturers. Instructors receiving the highest scores were cited for their enthusiasm, clarity, and the relevance of their presentation. Conversely, those receiving low marks were cited as being unenthusiastic and boring, merely presenting example after example of radiographic abnormalities with little explanation. The afternoon small group discussions were perceived as the best part of the course. Despite the fact that moderator experience ranged from second year resident to full professor, the seminars received uniformly positive comments.

Treatment of biliary obstruction caused by metastatic cancer.

Over an 8-year period, among 41 patients with obstructive jaundice caused by metastases to the liver or lymph nodes adjacent to the porta hepatis, palliative biliary decompression was established surgically in 11, by percutaneous transhepatic biliary drainage (PTBD) in 25, and by both methods in 2. Three patients had no drainage procedure performed. Early mortality after drainage occurred in 6 of 38 patients, and the median survivals (actuarial) for the remaining 32 patients were 4.5 months for the surgical group (range 2 to 21 months) and 4 months for the PTBD group (range 2 to 14 months). Although there were trends toward more frequent hospital readmissions and episodes of cholangitis in the PTBD group, the only statistically significant difference was in the number of catheter manipulations required. We concluded that when patients develop obstructive jaundice as a manifestation of metastatic cancer, useful palliation can be achieved by either surgical or percutaneous decompression.

Pitfalls in cholangiographic interpretation.

Cholangiography is a well established method of evaluating the biliary tract, and the typical appearances of the more commonly encountered biliary tract disorders have been well described. There are many pitfalls, however, in the interpretation of cholangiograms that become apparent as large numbers of patients are examined. These pitfalls may be secondary to: congenital anatomic alteration, failure to appreciate normal biliary ductal anatomy, technical errors, and interpretative confusion. Awareness of these pitfalls is emphasized to avoid serious cholangiographic misdiagnosis.

Incomplete small bowel obstruction by the Garren-Edwards gastric bubble necessitating surgical intervention.

A 39-yr-old woman was treated with Garren-Edwards gastric bubble, a new nonsurgical device for the treatment of obesity. The patient did well for 31/2 months before presenting with a partial small bowel obstruction caused by a spontaneously deflated bubble. After several days of observation and therapeutic maneuvers, a partially deflated bubble was removed surgically. Although the patient had had previous abdominal surgery, she had no adhesions that were considered contributory to the obstructive process at surgery; the deflated bubble did not deflate enough to traverse the distal ileum. This case represents the first case of bowel obstruction by this device in a patient with a "normal" intestinal tract. Patients considering placement of a Garren-Edwards gastric bubble must be fully informed of this potential complication even when there has been no prior abdominal surgery.

Undigested vegetable matter identified on barium-enema examination.

Undigested vegetable matter may reach the colon intact and be discovered on barium-enema examination. The authors demonstrate several examples of filling defects in the colon caused by vegetable matter. The characteristic shape and corresponding dietary history should allow for an appropriate diagnosis.

Exposure to magnetic resonance imaging does not produce taste aversion in rats.

A taste aversion test was used to evaluate possible toxic effects of magnetic resonance imaging (MRI). Thirty male Sprague-Dawley rats were randomly assigned to four groups: Group One (n = 10) received 30 minutes exposure inside the MRI scanner; Group Two (n = 10) received a sham exposure to the MRI scanner; Group Three (n = 5) was injected with 0.15 M lithium chloride; and Group Four (n = 5) was injected with vehicle. All groups were given 10 minutes access to a 0.1% saccharin solution immediately prior to their respective treatment. The rats treated with lithium chloride displayed a taste aversion to the saccharin solution upon subsequent testing over an eight day period. The two control groups (Two and Four) and the rats exposed to MRI did not display any aversion to the saccharin solution. These results are compared to other studies that have shown that magnetic fields can influence biological systems.

Personal identification by radiographic comparison of vascular groove patterns of the calvarium.

A case of forensic identification utilizing the vascular grooves within the skull is presented. The case is unique in that the antemortem radiographs were from childhood, rendering useless the more standard points of comparison. Calvarial vascular grooves represent unique points of comparison when the only available premortem radiographs were obtained during childhood, especially when one is attempting to identify children (living or dead).

Radiologic forensic investigation of fatal gunshot wounds.

The interested radiologist can be a valuable consultant in the investigation of fatal gunshot wounds as well as in the identification of human remains.

Greenfield caval filters: long-term radiographic follow-up study.

Sixty-nine patients with a Greenfield inferior vena cava (IVC) filter in place for 1-9 years were evaluated with supine abdominal radiographs. In 22 patients (32%) the filter span diameter had increased by 3-11 mm, and in six patients (9%) it had decreased by 3-18 mm. Twenty patients (29%) had caudad migration of 3-18 mm, and four (6%) had cephalad migration. In five patients (7%) the filter was at an angle of more than 16 degrees from the vertical. A decrease in filter span of 7 mm or more may result in IVC occlusion, whereas an increase of 6 mm or more may result in caval wall penetration. Caudad migration may be caused by a fibrous reaction around the struts which slowly draws the filter caudally. A change in filter angle may result from displacement of a strut into the right renal vein as well as from physiologic changes. The abdominal radiograph is a valuable method for follow-up study of patients with Greenfield filters if the filter position, span, migration, and angle are noted in the report.

Uterine carcinoma metastatic to the larynx.

Involvement of the larynx with metastatic disease is a rare occurrence. Batson's plexus was first proposed to explain metastatic disease to the head and neck from distant primaries, but more recent studies suggest that tumor cells in the thoracic duct may spread to the cervical region by way of retrograde flow through afferent cervical lymphatic vessels.

Diffuse mesenteric amyloidosis: CT, sonographic, and pathologic findings.

We report an unusual case of diffuse infiltration of the mesentery by amyloidosis. The CT, sonographic, and operative findings mimicked abdominal carcinomatosis.

Percutaneous transhepatic biliary drainage.

Percutaneous transhepatic biliary drainage is performed for the relief of biliary obstruction, usually on a malignant basis. The basic pathology and indications for the procedure are discussed, and the technical materials and methods are detailed. The role of the radiologic technologist in performing this procedure is emphasized.

Stomal disruption in gastric partition in morbid obesity (comparison of radiographic and endoscopic diagnosis).

Twenty-two patients who had gastric partition surgery for morbid obesity and subsequently developed stomal dilatation were evaluated with both upper gastrointestinal barium examinations and upper endoscopy. Both examinations were positive in eight patients. Endoscopy alone was positive in 14, but retrospective view of the upper gastrointestinal series was positive in nine of the patients. The authors stress the importance of a dedicated radiologist in performing these difficult examinations and the need for specific measurements of the stomal diameter.