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Chemotherapy or chemoradiotherapy (CRT) was performed in cases with distant metastasis, while surgery alone or surgery with chemotherapy or neoadjuvant chemoradiotherapy (NCRT) was performed in cases with no distant metastasis. This study confirmed the poor prognosis of these rare tumors [5]. The resection margin status is very important in the surgical treatment of anorectal carcinoma. For advanced rectal cancer, the resection margin affects survival, and pelvic exenteration can improve the resection margin status [6]. Extramammary Paget’s disease has been reported to require a 1-cm resection margin to make the margins negative [7]. Given these requirements, excision of PS lesions with sufficient margins may substantially widen the perineal defect. There were cases in which the perineal defect was left open [8]. Management of an open perineal defect takes a long time to heal, resulting in poor quality of life (QOL). In our case, the perineal healing period was shortened by reconstructive plastic surgery and sufficiently secured resection margins. In addition, due to the preoperative suspicion of infiltration of the prostate and the levator ani muscle, it was also considered important to ensure sufficient margin status of the urethra. Exposing the bulbar urethra from the perineum approach allowed dissection with a good visual field for securing the resection margin of the urethral. It has been hypothesized that NEC could originate from the differentiation of pluripotent stem cells, preceding adenocarcinoma or the mechanical stimulation [9]. In previous reports of anal canal NEC or adenocarcinoma with neuroendocrine features accompanying PS, the tumor cells of PS had NEC features [4, 10]. In our case, the tumor cells of the perianal lesions had no NEC features. It is possible that anal canal NEC and primary extramammary Paget’s disease were present at the same time. However, it is reasonable to regard them as a series of conditions in which anal canal NEC exhibited PS because the perianal lesions were positive for CK20 and CDX2. Gynecology & Obstetrics Dr. Betty Chou Phipps 227, JHH bchou1@jhmi.edu 410-955-6710 Ophthalmology Dr. Henry Jampel Woods 177 hjampel@jhmi.edu Orthopaedic Surgery Dr. Dawn LaPorte dlaport1@jhmi.edu Dr. Michael Ain JHOC 5253 main@jhmi.edu 410-955-9300 Otolaryngology Dr. Alexander Hillel ahillel@jhmi.edu Pathology Dr. Charles Steenbergen Csteenb1@jhmi.edu 410-502-5982 Pediatrics Dr. Nicole Shilkofski Bloomberg 8464 410-955-2727 7 DEPARTMENTAL RECOMMENDATIONS nshilko1@jhmi.edu Psychiatry Dr. Vinay Parekh Meyer 4-181, JHH vparekh1@jhmi.edu 410-955-5514 Radiology Dr. Lilija Solnes lsolnes1@jhmi.edu Surgery Dr. Pamela Lipsett Osler 603 plipsett@jhmi.edu 410-955-3739 Urology Dr. Marisa Clifton Marburg 144A mmeyer18@jhmi.edu 410-955-2139 Internship advisors are available to assist students seeking post-graduate appointments. Students applying in these areas should make appointments to see at least one of the departmental advisors. Students are encouraged to seek additional advice from a variety of faculty, house staff, college advisors and peers. A broad base of information is helpful. It may also be helpful to talk to some of our recent graduates who are at other institutions. The Office of Medical Student Affairs can provide names and addresses to assist you. There are some students who will be going into residencies in disciplines other than those listed. While the Associate Dean of Medical Student Affairs can advise students concerning that process, it is also important that students speak with the department or division director in the discipline in which they have interest. DEPARTMENTAL RECOMMENDATIONS The following statements, provided by the clinical departments, suggest curricular choices for students wishing to enter post graduate training in a particular specialty. ANESTHESIOLOGY The basic recommendations for entrance into a residency in Anesthesiology and Critical Care Medicine are: 1. An interest and demonstrated proficiency in basic physiological and pharmacological principles. 2. A solid background in internal medicine, surgery, and/or pediatrics. Anesthesiology requires a clinical base year (medicine, surgery, pediatrics, or transitional) which is either a separate preliminary year or twelve months of basic experience incorporated into the residency itself, depending upon the program. The preliminary year focus should be chosen based on your preferences and skills, although internal medicine is often considered most useful. Elective suggestions for medical students include cardiology, pulmonary medicine, emergency medicine, surgical intensive care, and a medicine or surgery sub-internship. 3. A four-week elective in anesthesiology will allow you to develop an informed specialty decision and permit us to support your application as best we can. Further advanced electives in anesthesiology or anesthesia sub-specialties can be helpful to assist in career decisions and can be tailored to your interests but are not necessary. It is typically not helpful to do away or “audition” rotations in anesthesia. 4. Research in any area (basic science, clinical, biomedical engineering, information management, health policy, etc.) can be relevant to anesthesiology and can greatly enhance an application, although it is not expected or required unless you anticipate an academic career. 8 DEPARTMENTAL RECOMMENDATIONS 5. Personal characteristics suggesting promise in anesthesiology, which include an inquisitive nature, dynamic decision-making skills utilizing multiple variables and hypothesis testing, the ability to maintain a high level of vigilance and detail-oriented approach to patient care, good procedural skills, the desire to work as part of a team, a willingness to be flexible and adapt to different work environments and new technology, and the ability to organize resources and maintain a demeanor of effective leadership in crisis situations. Dr. Colleen Koch Chair Department of Anesthesiology and Critical Care Medicine DERMATOLOGY We welcome students to take a dermatology clerkship regardless of the medical discipline they intend to pursue. However, this should take place towards the end of their third year after completing several core clerkships including Medicine, Surgery and Pediatrics. We believe students should receive as broad exposure to medicine as possible before taking our introductory clerkship (Clinical Clerkship in Dermatology) and making career decisions. If further experience/learning is desired, we also suggest taking our Advanced Clinical Clerkship in Dermatology. For those students with a career interest in Dermatology, taking electives in related sub-specialties such as Rheumatology, Immunology, and Plastic Surgery are encouraged. Dr. Daren Simkin Assistant Professor, Department of Dermatology Assistant Residency Program Director Director of Medical Student Education Medical Student Rotation Coordinator: Shanika Bennett sbenne17@jhmi.edu EMERGENCY MEDICINE The student interested in a career in Emergency Medicine is well advised to take advantage of the career counseling services available in the Department of Emergency Medicine to aid them in their decision-making process. Students can be advised in the following areas: 1. Personal life/goal
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