Portal hypertensive biliopathy is described as abnormalities of the walls of the biliary tree secondary to portal hypertension. In literature it has also been named as "Cholangiopathy associated with portal hypertension", "Portal biliopathy" and "Portal cavernoma associated cholangiopathy". It is usually asymptomatic and found incidentally, but rarely patients do present with symptoms of abdominal pain, jaundice, asthenia and fever. Treatment is warranted in symptomatic cases only, and is dictated by the clinical manifestations and complications of the disease process. Due to presence of underlying severe portal hypertension, endoscopic biliary intervention is usually the first line of management, and is relatively safe and often sufficient. When surgery is resorted to, a porto-systemic shunt prior to biliary bypass procedure provides early relief of obstructive biliary symptoms and often precludes the need for a biliary bypass surgery. This review describes the pathophysiology, presentation, progression and management approaches to portal biliopathy.
ObjectiveTo determine the rate and trend of attrition from a surgical residency programme and to identify the reasons for attrition.MethodsA questionnaire-based survey was conducted at a university hospital. Separate questionnaires were designed for residents and programme directors (PDs). The residents who left the training voluntarily from one of the five surgical residency programmes (i.e., general surgery, orthopaedics, neurosurgery, otorhinolaryngology and urology) during the academic years 2005–2011 were identified from a departmental database. The residents who did not respond after three attempts at contact, or those who refused to participate, were excluded.ResultsDuring the last 6 years, 106 residents were recruited; 84 (78%) were men, of whom 34.5% left the programme voluntarily. Of 22 women, half (54%) left the programme voluntarily (P = 0.07). The overall 6-year attrition rate was 39%. The reasons identified for attrition, in descending order, were personal reasons, attitude of senior residents or faculty, and change of specialty. None of the residents cited an excess workload as a reason for their leaving the programme. About 40% rejoined the same specialty after leaving, while 35% chose a different specialty (80% chose a different surgical subspecialty and 20% chose medicine). There was a significant discrepancy in the perspective of residents and PDs about the reasons for attrition.ConclusionAttrition among surgical residents, in particular woman residents, is high. Personal reasons and interpersonal relations were the most commonly cited reasons. Programme managers and residents have significantly different perspectives, again an indication of a communication gap.
A mass casualty incident (MCI) is a challenging scenario in any healthcare setting. It puts to test the potential of a healthcare facility to perform under stress and manage utilisation of all available resources in a limited time. Over the last few years, Pakistan has been the site for many MCI secondary to terrorist bombings. The Aga Khan University Hospital having evolved as a major trauma centre of Karachi has dealt with a few of such MCI. We have reviewed four MCI over the last few years in which our hospital received patients. These incidents involved the . Some of these events were a result of suicide bombing. We attempt to look at the injury patterns of each event and the way these incidents were dealt at our institution and in doing so examine our evolution in the management of MCI. Recommendations based on defi ciencies in management and limitations felt are addressed. We infer that comparison of the four events will help our institution formulate a better plan to deal with future MCI and suggest a similar review for such incidents. on 11 May 2018 by guest. Protected by copyright.
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