A technique for evaluating competitive flow for intraoperative decision making in coronary artery surgery

The effect of native coronary competitive flow on the patency of arterial and saphenous vein grafts is controversial. We use a simple intraoperative technique to evaluate competitive flow that allows us to make informed intraoperative decisions regarding anastomotic quality, vessel runoff, and competing native coronary blood flow.     

Building Our Future: A Plea for Leadership

In recent years the spastic nature of the health care marketplace has continued to increase, which has greatly escalated the demands of leadership in academic medical centers. The expectations of leaders, including surgery chairs, have increased considerably, whereas their capacity for independent action has undeniably diminished. In such a predicament, it is useful to revisit fundamentals, using them as a guide to build a sound future. Five leadership principles are critical to building a better future: (1) recognizing that the work of leadership involves an inward journey of self-discovery and self-development; (2) establishing clarity around a set of core values that guide the organization as it pursues its goals; (3) communicating a clear sense of purpose and vision that inspires widespread commitment to a shared sense of destiny; (4) building a culture of excellence and accountability throughout the entire organization; and (5) creating a culture that emphasizes the development of leaders and leadership as an organizational capacity. Leadership and learning are inextricably linked. We must change the perception that learning in academic surgery is about correcting a deficit rather than a natural part of human growth and development. Our ability to learn, grow, and contribute to an organization is what provides each of us with meaning and identity. This feeling of being part of something special that is larger than ourselves is a powerful force and an important dividend of great leadership.     

Human immunodeficiency virus infection of the brain: pitfalls in evaluating infected/affected cell populations

Monocyte/macrophages and CD4 T-cells are the primary hematopoietic targets of productive HIV infection. In the brain, potential cellular targets for HIV infection include perivascular and parenchymal macrophages/microglia, oligodendrocytes, endothelia, neurons, and astrocytes. We examine evidence of productive and non-productive infection for each cell type in the brains of HIV-infected patients with and without HIV encephalitis. Despite the voluminous literature and substantial experimental effort over the past two decades, evidence for productive infection of any brain cell other than macrophages is left wanting.     

Pediatricians’ views of postpartum depression: A self-administered survey

Summary Objective: To assess pediatricians knowledge and views about postpartum depression (PPD).Method: Self-administered survey of a nationwide random sample of general pediatricians.Results: Of 1200 eligible pediatricians sampled, 389 responded (32%). Half of pediatricians (49%) reported little or no education about PPD. Many respondents (51%) underestimated the overall incidence of PPD. Most pediatricians (80%) estimated the incidence in their practice as less than the published incidence. Few pediatricians felt confident they would recognize PPD (31%). Pediatricians were rarely familiar with available screening tools (7%). Many pediatricians (51%) felt screening was feasible in their practices. In logistic regression analysis, intent to begin screening was independently associated with <6 years in practice, positive view of feasibility and greater awareness of PPD.Conclusions: Pediatricians sampled have limited awareness of PPD and are unfamiliar with screening tools. Efforts to involve pediatricians in screening should address these knowledge barriers.Nancy E. Law deceased November 9, 2003.     

Prediction of breast cancer size by ultrasound, mammography and core biopsy

Neoadjuvant chemotherapy and non-surgical tumor ablation rely upon imaging studies to determine tumor size. In this study the accuracy of ultrasound (US) mammography and core biopsy in determining tumor size was examined in 202 patients with Stages I and II breast cancer. The most accurate single modality for determining tumor size was mammography with a correlation coefficient of 0.66, followed by US (r = 0.48) and core biopsy (r = 0.28). Size measurements were less accurate in lobular than ductal cancers. The combination of the three modalities understaged 25% of the tumors > 1cm in size, and overstaged 10% of those < 1cm. The inability to accurately determine tumor size has important implications for the use of non-surgical ablation.     

Immunotoxins and neuropeptide-toxin conjugates experimental applications

The use of targeted toxins in research applications has recently grown considerably. The ability to remove a few specific cells, even when surrounded by different populations, has given scientists a powerful tool for the understanding of systems biology. The use of targeted toxins in research is rich and varied; here we limit ourselves to describe some of those exciting results that researchers have made in the neurosciences.     

Genome-wide screen for prostate cancer susceptibility genes in men with clinically significant disease

BACKGROUND: One of the difficulties confronting genetic studies of prostate cancer is the complex and heterogeneous etiology. Given the high population frequency of lesions meeting the histological definition of prostate cancer, a significant portion of men with a positive family history may be diagnosed due to increased surveillance and associated higher likelihood of biopsy. Over diagnosis decreases power to detect genes that increase susceptibility to a clinically significant prostate cancer. METHODS: We re-evaluated all 623 men with prostate cancer in our 188 hereditary prostate cancer families and identified a subset of 244 men with more aggressive disease based upon meeting at least one of the following clinical and/or pathologic criteria: tumor grade Gleason score > or = 7, tumor stage T2c or higher, pretreatment PSA > or = 20 ng/ml, rising PSA after treatment, evidence of metastasis, or death from prostate cancer. RESULTS: Genome-wide screens were re-performed by defining men as affected only if they met the criteria for clinically significant disease. The new analyses identified stronger evidence for linkage in Xq27-28 and 22q, as well as several novel loci, including 3p and 9p. CONCLUSIONS: Although, these results need to be confirmed in independent studies, our approach represents an important step to overcome the impact of over diagnosis in genetic studies of prostate cancer. Larger studies that incorporate this approach are needed.