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Preliminary Medicine: this track offers a 1-year rigorous experience in internal medicine. In most hospitals, the differences between preliminary and categorical (3-year track) interns on the medicine wards are minimal. They have similar clinical responsibilities, share the same call schedule, and admit the same number of patients. The only distinction is that preliminary interns sometimes are able to secure a few more elective months. Both community hospitals and academic medical centers offer preliminary medicine positions. You will learn a great deal of general medicine and how to take care of sick patients, both on the floors and in the intensive care unit. Choose a competitive specialty having earned mediocre grades in the corresponding rotation. Avoid doing an audition rotation or away elective because you are scared that they will think less highly of you. Never send a letter of intent to your top program stating that you plan on ranking them as your #1 choice. Shorten your rank list because you received a flattering recruitment letter making you believe that the residency program was going to rank you at the top of their list. Preliminary Surgery: Similar to its medicine counterpart, a position in preliminary surgery offers the exact same experience as that of an intern in general surgery. You will have the honor of rounding very early in the morning, managing postoperative patients on the surgical floors, taking call every third or fourth night, and rarely scrubbing in for cases in the operating room. The remaining positions are sometimes chosen by students who believe that a pseudosurgical internship would best prepare them for residency, such as those in ophthalmology, emergency medicine, and anesthesiology. Realistically, most preliminary surgery positions are last-minute choices picked by scrambling students who failed to match into preliminary medicine or transitional year internships. Transitional Year: Many medical students are confused by the role of transitional year programs. Usually offered by community hospitals, transitional programs are cosponsored by two departments. The curriculum of a typical transitional year requires 4 months (minimum) of internal medicine, 1 month of emergency medicine, and 1 month of ambulatory medicine. Some programs also mandate months of surgery or obstetrics; others require critical care rotations. Regardless, all transitional year internships allow for 2 to 6 flexible months of electives.

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A variety of techniques have been described, but one method involves creating an ulnarly based flap of the extensor retinaculum elevated from over the fourth extensor compartment. Care must be taken when injecting because the radial artery or its branches lie in close proximity to the tendon. In addition, injection can precipitate tendon rupture, although tendon rupture typically results in resolution of symptoms with little functional deficit. If the radiographs suggest substantial bony impingement of the canal, early release may be considered before the tendon ruptures. Blunt dissection should be used to identify any cutaneous branches of the superficial radial nerve or the palmar cutaneous branch of the median nerve, and these nerve branches should be protected to avoid injury and neuroma formation. The fascia over the tendon is decompressed from the volar wrist crease distal to the trapezium. A high rate of symptomatic improvement and a low rate of recurrence are seen following surgical release. Koh S, Nakamura S, Hattori T, Hirata H: Trigger digits in diabetes: Their incidence and characteristics. Strategies include nonsurgical treatments, such as splinting, injection, or therapy, and surgical techniques, such as tendon release. Valdes K: A retrospective review to determine the long-term efficacy of orthotic devices for trigger finger. References References printed in bold type are those published within the past 5 years. Colbourn J, Heath N, Manary S, Pacifico D: Effectiveness of splinting for the treatment of trigger finger. Le Viet D, Tsionos I, Boulouednine M, Hannouche D: Trigger finger treatment by ulnar superficialis slip resection (U. Calleja H, Tanchuling A, Alagar D, Tapia C, Macalalad A: Anatomic outcome of percutaneous release among patients with trigger finger. Zyluk A, Jagielski G: Percutaneous A1 pulley release vs steroid injection for trigger digit: the results of a prospective, randomized trial. Jirarattanaphochai K, Saengnipanthkul S, Vipulakorn K, Jianmongkol S, Chatuparisute P, Jung S: Treatment of de Quervain disease with triamcinolone injection with or without nimesulide: A randomized, double-blind, placebocontrolled trial. Engkvist O, Lundborg G: Rupture of the extensor pollicis longus tendon after fracture of the lower end of the radius: A clinical and microangiographic study. Hirasawa Y, Katsumi Y, Akiyoshi T, Tamai K, Tokioka T: Clinical and microangiographic studies on rupture of the E. No difference Jirarattanaphochai K, Saengnipanthkul S, Vipulakorn K, et al: Treatment of de Quervain disease with triamcinolone injection with or without nimesulide: A randomized, double-blind, placebo-controlled trial.

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Once the computer runs through all applicants, the temporary matches are finalized. Your destiny is printed out on a piece of paper, stuffed into an envelope, and then given to you exactly 1 month later. Program directors desperately want to fill their programs with the best students, and medical students anxiously pine for their number one choice. Because medicine has traditionally been a competitive profession, we can assume that both groups have the potential to behave unprofessionally in an attempt to achieve their goals. Both program directors and applicants must honor the binding commitment of the final Match result. The listing of a program or applicant on a rank-order list indicates a commitment to accept the appointment (provided that a match is made). Residency programs will release students from their Match agreements only in individual cases of serious hardship. Residency programs could lose their accreditation for repeated offenses, and medical students may acquire a mark on their permanent licensure record. The Match system can only be fair and ethical when everyone-students and directors alike-abide by the rules like true professionals. The sparks of love and lasting bonds could happen at any time, whether during first-year orientation or surgery clerkship. Today, nearly every graduating class has its share of student couples, and marriages in which both partners are practicing physicians are on the rise. But, for graduating seniors involved in a relationship, an additional hurdle awaits: the Couples Match. In this process, every couple has the same two goals: (1) to secure a residency position in the desired specialty of choice; and (2) to match at a program in the same hospital, city, or general geographic region. The Couples Match is a special arrangement within the main residency matching system. It eliminated the chaotic behind-the-scenes negotiations couples used to secure residency appointments. The Match system now easily accommodates the additional flexibility medical student couples require to achieve their goals. However, there are also couples-such as those who participated in an early match-who coordinated a successful outcome without entering the Couples Match. However, all types of couples can enter the Couples Match- boyfriends, girlfriends, newlyweds, gays, lesbians, or even close friends simply wishing to remain together during residency.

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Source: American Medical Association Fortunately, life does get better after completing the arduous neurosurgical residency. According to this same report, the average attending neurosurgeon works 60 hours per week in the United States. Neurosurgeons affiliated with Level I trauma centers find themselves, on occasion, coming in to the hospital to operate in the middle of the night. Overall, it appears that schedules vary among practicing physicians and can often be adapted to a certain extent on desired lifestyle. However, it is clear that the specialty is expanding and becoming increasingly specialized. As a result, the demand for neurosurgeons will likely remain stable for years to come. Currently, the two notable erage 34 applications and reexceptions to this rule are pediatric neuceived 10. The three top reasons cited for pursuing additional subspecialty training were personal interest for knowledge, job market demand, and academic prestige. Inadequate training during residency was cited by less then one third of those residents contemplating fellowship training. Most neurosurgeons in the academic community agree that it depends on the medical center at which the resident completed his or her training. If a resident graduates from a program known to be extremely strong in a particular subspecialty, fellowship training in that specialty is not required. Many academic departments boast of the lack of need for fellowship training in areas in which their institution is particularly strong. The neurosurgery community is sufficiently small so that the relative strength of any given program for a subspecialty is actually accepted as common knowledge. The first year (internship) is spent strictly in rotations through general surgery and other surgical subspecialties. Most neurosurgical programs are small and spread the residents across several hospitals. In most programs, a q3 schedule (overnight call every third night) is very common, but it is not unusual to be on a q2 call schedule for several months at a time. One resident described the arduous training as "the only residency in which the internship year is the easy year. When not operating, they see patients in the outpatient clinic, neurologic intensive care unit, and hospital floors.

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Clinical manifestations and evaluation of adults with suspected native valve endocarditis. Prevention of Infective Endocarditis: Guidelines from the American Heart Association. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Diagnosis, Treatment and Long-Term Management of Kawasaki Disease: A statement for health professional from the committee on rheumatic fever, endocarditis and Kawasaki disease, Council on Cardiovascular Disease in the Young, American Heart Association. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. For more information, please contact George Hoare, Special Sales, at george hoare@mcgraw-hill. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. You are my inspiration-each and every day-for all that I do and all that I hope to achieve. Thank you for your love, for your never-ending support and devotion, and for always being there with a soft "pet" whenever I need one. Coller Research Fellow, Department of Surgery; Plastic Surgery Resident, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Michigan borschel@umich. Deciding on a career in medicine was easy; choosing a specialty, on the other hand, was agonizing. I imagined myself as a future surgeon or emergency medicine physician, but after extensive research and clinical experiences, I soon discovered that anesthesiology was the perfect fit. I realized at the time that medical students need a good written resource to guide them through this difficult career-defining decision. This is when the idea for the Ultimate Guide to Choosing a Medical Specialty was born. A single comprehensive resource, this book provides detailed insight into each field and allows students to quickly and easily compare specialties under consideration. These 12 chapters provide everything you need to begin making this major decision-how to research each specialty, what to do if you remain undecided, how to apply for a residency position, and much more. In Part 2, "Specialty Profiles," a chapter is devoted to each of the 20 major medical disciplines, all following a similar format and exploring common themes. Interspersed throughout the text are special inserts-"Vital Signs" and "The Inside Scoop"-that provide easy-to-read factoids like salary information and match statistics. But you do not have to be a medical student in order to get something out of this book.

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Stem cells for regeneration is still nascent, but might lead to breakthrough medical advances. Thus, the discovery of stem cells led us to predict that their use might impact health care more than the discovery of anaesthesia and antibiotics. These are currently derived from fertilised eggs in excess of in vitro fertilisation clinics. Nuclear cloning (also known as nuclear transfer) involves the introduction of a nucleus from donor cell into an enucleated oocyte to generate an embryo with a genetic makeup 99. Nuclear transfer was first reported by Briggs and King in 1952 (20), the first vertebrate (frog) derived from nuclear transfer was reported in 1962 by Gurdon with nuclei derived from non-adult sources (21). The cloning of Dolly in 1997 was remarkable since she was the first mammal derived from an adult somatic cell (22). Two types of nuclear cloning are described; this includes the controversial reproductive cloning where the generation of an infant with an equal genetic makeup to the donor cell is Topics in Tissue Engineering, Vol. Thus, this stem cell source has an unlimited capability for different immunocompatible tissue transplants. Amniotic fluid contains several cell types derived from the developing foetus (23). In addition, these undifferentiated cells express some embryonic stem cell markers. Amniotic fluid derived cells expand extensively without a feeder layer, doubling every 36 hours, retaining long telomeres for over 250 population doublings. They showed the ability to differentiate into functional cells corresponding to each of the three embryonic germ layers (ectoderm, endoderm and mesoderm) giving rise to adipogenic, osteogenic, myogenic, endothelial, neuronal and hepatic cells (24). The ability to isolate genetically and phenotypically stable, pluripotent cells from such a widely and easily available source will positively have an impact on regenerative medicine. However, they are closer to the embryo and they possibly retain some pluripotent characteristics. When transplanted, these cells show low immunogenicity and can even have localised immunosuppressive functions. This source of stem cells has the advantage of being normally discarded, with no morbidity to both mother and newborn. This leads to a limitless supply with the possibility of isolation of huge numbers of cells with no or few ethical considerations. The word "stroma" is derived from Greek and the Oxford dictionary defines it as "anything spread or laid out for sitting on" (27). The bone marrow stroma supports haemopoiesis and is made up of a network of fibroblast like cells. Bone marrow derived stem cells were isolated for the first time by Friedenstein and colleagues. They took bone marrow and incubated it in plastic culture dishes and after 4 hours they removed non-adherent cells.

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Human embryonic stem cells open new avenues for autologous cell-based therapy in degenerative diseases, bypassing the ethical and immunological problems [39]. Embryonic stem cells have huge potential in the field of tissue engineering and regenerative medicine [40]. Potency of Stem Cells the capacity to differentiate into specialized cell types and be able to give rise to any mature cell type is referred to as potency. The only totipotent cells are the fertilized egg and the cells produced by the first few divisions of the fertilized egg are also totipotent. Totipotent stem cells give rise to somatic stem/progenitor cells and primitive germ- line stem cells [26]. These pluripotent cells are characterized by self-renewal and a differentiation potential for all cell types of the adult organism [27]. These are true stem cells, with the potential to make any differentiated cell in the body. Human pluripotent stem cells would be invaluable for invitro studies of aspects of human embryogenesis [28]. These are true stem cells but can only differentiate into a limited number of types. For example, the bone marrow contains multipotent stem cells that give rise to all the cells of the blood but not to other types of cells. The corneal epithelium is a squamous epithelium [31] that is constantly renewing and is Oligopotent [32]. Most epithelial tissues self-renew throughout adult life due to the presence of unipotent progenitor cells [33]. Fetal stem cells can be isolated from fetal blood and bone marrow as well as from other fetal tissues, including liver and kidney [41]. The developing baby is referred to as a fetus from approximately 10 weeks of gestation. Most tissues in a fetus contain stem cells that are pluripotent and drive the rapid growth and development of the organs. Fetal blood is a rich source of haemopoietic stem cells, which proliferate more rapidly than those in cord blood or adult bone marrow [42]. Like adult stem cells, fetal stem cells are generally tissue-specific, and generate the mature cell types within the particular tissue or organ in which they are found. The classification of fetal stem cells remains unclear and this type of stem cell is currently grouped into an adult stem cell. Cord Blood Stem Cells Blood from the umbilical cord contains some stem cells that are genetically identical to the newborn. They are multipotent stem cells [43] that are able to differentiate into certain, but not all, cell types. The applications of cord blood are similar to those of adult bone marrow and are currently used to treat diseases and conditions of the blood or to restore the blood system after treatment for specific cancers. Like the stem cells in adult bone marrow, cord blood stem cells are tissue-specific.

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As advanced degree registered nurses, nurse midwives have completed an accredited midwifery program and passed the certification examination. Nurse midwives, however, attend only about 9% of vaginal births in the United States. As such, their professional relationship should always remain collegial and cooperative. It is one in which the obstetrician-the expert consultant-steps in whenever his or her services are necessary. Each of the following approved fellowships requires an additional 3 years of training. These specialists serve as consultants to general obstetricians for referrals involving pregnancies complicated by major disease or for diagnostic or therapeutic procedures. Instead, residents immediately begin surgical training in obstetrics and gynecology. The typical monthly rotations include labor and delivery, obstetric wards, general gynecology, reproductive endocrinology and infertility, gynecologic oncology, primary care, and neonatal intensive care unit. Due to the increasing emphasis on primary care within this specialty, most residency programs now require at least 6 months of outpatient rotations. Diagnostically, they perform genetic amniocentesis, fetal blood sampling, obstetrical ultrasound, chorionic villus sampling, and cordocentesis. Therapeutically, they are experts at high-risk deliveries, abortions, laparoscopy, fetal gene therapy, and fetal reduction. Gynecologic Oncology Roughly 15% of all cancers found in women involve tumors of the reproductive tract. This area of specialization focuses on the medical and surgical care of women with malignancies arising in the reproductive system: ovarian, uterine, cervical, vulvar, and vaginal cancer. These specialists receive extensive training in the biology and pathology of gynecologic cancer, particularly its diagnosis, treatment, and complications of oncologic care. Gynecologic oncologists comprise an elite group of surgeons who bring hope to thousands of afflicted women. They are skilled pelvic surgeons who use the latest techniques in radical surgery, chemotherapy, and radiation treatment. They manage the urinary and bowel complications resulting from cancer treatment, as well as pain, palliative care, and psychosocial issues. Gynecologic oncologists are supported by a multidisciplinary team of medical oncologists, radiation oncologists, and gynecologic pathologists who collaborate to provide optimal care. Gynecologic oncologists practice in a variety of clinical settings-academic medical centers, regional hospitals, and specialized cancer centers. Their practice also extends to the treatment of hormonal and reproductive disorders affecting women, children, men, and mature women.


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