Comparison of cardiothoracic surgery training in usa and germany

Background  

Training of cardiothoracic surgeons in Europe and the United States has expanded to incorporate new operative techniques and requirements. The purpose of this study was to compare the current structure of training programs in the United States and Germany.     

To posture or not to posture after macular hole surgery

OBJECTIVE: To evaluate the anatomic and functional success of phacovitrectomy and intraocular gas tamponade for macular hole surgery with only first night face down posturing. METHODS: This was a nonrandomized observational prospective trial over 9 months, with data collection on 28 eyes of 26 consecutive patients who underwent phacovitrectomy, internal limiting membrane peel, and intraocular gas tamponade (C2F6) for stage 2, 3, and 4 macular holes. Data included sex, age, hole latency and Gass stage, preoperative and postoperative visual acuity and ocular coherence tomography, refractive outcome, ocular comorbidity, first postoperative day gas fill, and intraocular pressure. Postoperatively, all patients were postured face down overnight. Thereafter, patients with more than 70% gas fill (beyond the inferior retinal vascular arcade) were asked to stop posturing, although they were advised not to lie flat on their backs at night for 10 days. RESULTS: The sample was divided into patients who did and did not need to posture postoperatively, depending on first day gas fill. Twenty patients did not need posturing and 8 patients needed postoperative posturing for 10 days. The mean macular hole duration was 10.5 months. A total of 87.5% compared to 100% achieved hole closure in the posture and nonposture group, respectively. The mean postoperative visual acuity was 0.5 +/- 0.25 LogMAR. Statistical analysis revealed no significant difference in age, hole duration, preoperative and postoperative visual acuities, intraocular pressure measured 24 hours postoperatively, or refractive error between the two samples. CONCLUSION: Phacovitrectomy for macular hole surgery without postoperative face down posture is a reasonable approach, as long as the eye has more than 70% gas fill (beyond the inferior retinal vascular arcade) on the first postoperative day. This study showed no statistically significant difference between patients who postured and those who did not posture. The combination of phacoemulsification, pars plana vitrectomy, internal limiting membrane, and gas tamponade in macular hole surgery reduces the difficulty of posturing in elderly patients. This technique saves the patient from exposure to a second intraocular intervention to remove a cataract which will commonly develop after vitrectomy and gas tamponade alone.     

Anterior Cruciate Ligament Reconstruction with Bone Patellar Tendon Bone Graft through a Mini Arthrotomy

Instability after rupture of anterior cruciate ligament (ACL) may lead to recurrent episodes of giving way, an increased risk of meniscal injury and premature degenerative changes. A total of 25 cases with ACL injuries were evaluated after reconstruction with bone patellar tendon bone graft through a mini-arthrotomy. All patients were male. Maximum number of patients were between 25-30 years of age (40%). The most common modality of injury was contact sports (44%). Most common complaint was instability of knee (100%). Average Lysholm score increased from pre-operative of 47 (27-75) to post-operative of 87 (68-95). Two patients (8%) had retropatellar pain. Moderate to severe graft site tenderness was present in 4 (21%). After an average follow up of one year three months, the results were comparable with the results of arthroscopic reconstruction.Key Words: Anterior cruciate ligament reconstruction, Mini arthrotomy     

Percutaneous angioplasty in clinical management of renovascular hypertension: initial and long-term results

Between January 1980 and July 1983, percutaneous transluminal angioplasty was attempted on 137 stenotic renal arteries in 100 patients. At termination of follow-up studies (3-39 months, mean of 16 months), 70% of those treated for hypertension had benefited from the procedure. Stenosis secondary to fibromuscular dysplasia responded better than stenosis from arteriosclerosis (85% and 65% of the patients, respectively). Benefit was minimal for those with stenosis of the renal artery ostium or renal insufficiency. Determining levels of renal vein renin before angioplasty is helpful in selecting patients; following angioplasty, this has considerable significance in predicting the success of the procedure.     

Suppression of glomus cell K conductance by 4-aminopyridine is not related to [Ca]i, dopamine release and chemosensory discharge from carotid body

The hypothesis that suppression of O₂-sensitive K⁺ current is the initial event in hypoxic chemotransduction in the carotid body glomus cells was tested by using 4-aminopyridine (4-AP), a known suppressant of K⁺ current, on intracellular [Ca²⁺]_i, dopamine secretion and chemosensory discharge in cat carotid body (CB). In vitro experiments were performed with superfused–perfused cat CBs, measuring chemosensory discharge, monitoring dopamine release by microsensors without and with 4-AP (0.2, 1.0 and 2.0 mM in CO₂-HCO₃^- buffer) and recording [Ca²⁺]_i by ratio fluorometry in isolated cat and rat glomus cells. 4-AP decreased the chemosensory activities in normoxia but remained the same in hypoxia and in flow interruption. It decreased the tissue dopamine release in normoxia, and showed an additional inhibition with hypoxia. Also, 4-AP did not evoke any rise in [Ca²⁺]_i in glomus cells either during normoxia and hypoxia, although hypoxia stimulated it. Thus, the lack of stimulatory effect on chemosensory discharge, inhibition of dopamine release and unaltered [Ca²⁺]_i by 4-AP are not consistent with the implied meaning of the suppressant effect on K⁺ current of glomus cells.     

Indications for breast imaging in women under age 35 years

To determine appropriate indications for breast imaging in young women, the authors correlated patient histories with mammographic and/or sonographic findings and biopsy or follow-up results for 625 patients aged 13-34 years. The only important indications were a palpable mass and suspicion of an abscess. Of the 335 studies performed for evaluation of a palpable mass, 184 (55%) were normal, 28 (8%) were compatible with benign disease, and 123 (37%) were suggestive of malignancy. Biopsies were performed in 73 patients; the findings were benign in 67 cases, and carcinoma was found in six. Imaging studies were considered helpful in four of the 15 cases of suspected abscess, in that the studies established the presence and extent of an abscess. Studies in 275 women were performed for a variety of other indications. The findings were normal in 239 (87%) studies, benign in 21 (8%), and suggestive of malignancy in 15 (5%); there were no known carcinomas in any of the patients. Women with the "low-yield" indications identified in this study should be followed up clinically rather than referred for imaging studies.     

Changes in BiSpecteral Index (BiS) values during cardiopulmonary bypass (CPB)

Background: BiSpecteral Index (BiS) monitoring is standard monitoring regimen in anaesthesia practice. It has also been used in cardiac surgery. It is especially important due to the high incidence of neurological injury or dysfunction that occurs following CPB. This is a retrospective study of 33 cases that were monitored with BiS during the course of coronary artery or valvular surgery, including the period of CPB.Methods: Thirty three cases monitored with BiS were studied retrospectively. Result: From the recordings it was determined that the value of BiS which was ranging between 40 to 60 after induction, dropped below 25 at the onset of CPB. This change was statistically significant (p<0.05).Conclusion: This decrease in the BiS value is probably a result of hypo-perfusion and due to clear, oxygen - poor priming fluid reaching the brain. Other periods of hypotension also correlated with the low values of BiS. This cerebral hypoxia which would occur at this time could be the cause of the incidence of neurological dysfunction that is known to occur following CPB.