Annals of surgery
-
To answer the controversial question of whether or not vascular fellowships detract from general surgical training, questionnaires were sent to directors of 41 approved vascular fellowship programs, 41 residency directors in the same institutions, and 40 residency directors in university programs without approved fellowships. Overall response rate was 74% (93% of vascular fellowship directors, 63% of same-institution residency directors, and 65% of residency directors without vascular fellowships). Thirty-four per cent of fellowship directors and 38% of same-institution residency directors indicated that the fellowship has reduced the vascular surgery case load of residents. ⋯ Fifteen per cent of institutions without approved fellowships have now initiated vascular fellowship programs, and an additional 23% plan to begin such fellowships. No fellowship directors plan to abolish their programs, although 8% plan to decrease the number of fellows in order to increase general surgery resident participation. Among the majority of institutions studied, vascular fellowships have not adversely affected general surgical training, and often enhanced it.
-
While Type III dissecting aneurysms of the aorta in patients with renal transplants have been described, this report appears to represent the first successful replacement of the ascending aorta with correction of valvar aortic insufficiency in a patient with a Type I aortic dissection. The operative result and subsequent clinical course have been gratifying. On the basis of these findings an aggressive surgical approach is recommended for patients with this combination of conditions.
-
Renal artery dissections are stenotic or occlusive lesions most often observed in hypertensive patients with underlying atherosclerosis or fibromuscular disease. Acute dissections may present spontaneously, as a complication of diagnostic or therapeutic angiography or as an agonal event associated with overwhelming systemic illness. Chronic dissections may produce renovascular hypertension or be entirely asymptomatic. ⋯ In addition, renal failure was associated with 59% of the deaths. The lethality of renal artery dissections and the ease and success of revascularization, which preserves renal function and ameliorates associated renovascular hypertension, emphasize the need for an aggressive approach to the recognition and treatment of this entity. Therapy should be directed toward arterial reconstructions and the preservation of functioning renal tissue.
-
Case Reports
Cricothyroidotomy for long-term tracheal access. A prospective analysis of morbidity and mortality in 76 patients.
Cricothyroidotomy for long-term tracheal access was prospectively studied in 76 critically ill patients. Thirty patients (39%) survived and 46 (61%) died. Mean duration of follow-up computed in all survivors was 8.5 months. ⋯ There were no significant differences in any of the parameters studied between the group with and the group without airway pathology. The morbidity and mortality of cricothyroidotomy in adults are similar to that reported for tracheostomy. However, cricothyroidotomy should be avoided in children and adolescents because of the risk of subglottic stenosis.