World Neurosurg
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Neurological surgery is historically among one of the most competitive residency matches, but data suggest a downward trend in neurosurgical residency applicants in the United States. In 2002, our department, in conjunction with our institution, began an initiative to increase exposure to and interest in neurological surgery, targeting both undergraduate and medical students. This study outlines and assesses the factors used by our institution to successfully prepare and recruit medical students for residency in the field of neurological surgery. ⋯ An earlier, organized involvement of the neurosurgical department in medical student education can result in an improved understanding of the role of neurosurgeons among other practitioners as well as a greater number of well-qualified residency applicants into neurological surgery.
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To evaluate the use of intraaortic balloon pump (IABP) placement to counter severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage (SAH). ⋯ In select patients, particularly young women with poor-grade SAH, balloon-pump counterpulsation may serve as a useful adjunct in the management of severe cardiac dysfunction after SAH. Further investigation is necessary to define the optimal patient population for this technique.
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With the development of edema and the possible enlargement of the hemorrhagic contusion, patients with a bifrontal contusion may deteriorate rapidly or even die as the result of central brain herniation. Therefore, close monitoring and in time treatment may be important to these patients. ⋯ ICP is one of the most important intensive types of monitoring for patients with moderate-to-severe bifrontal contusions and may be beneficial in creating a better prognosis. Intensive care and proper management are necessary to reduce stays in ICU, hospitalization, and mannitol osmolar therapy, and to improve GOS.
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The term trepanation describes the removal of sections of bone from the cranium. Although others may have made earlier reference to trepanation, in 1995, Chinese archeologists discovered a skull at the Neolithic site Fujia from approximately 3000 bc (the Dawenkou Cultural Period), Guangrao, Dongying, Shandong, China, and after careful examination of the specimen, the archeologists suggested that the procedure had been performed on a living patient who subsequently survived. Archeological evidence supports that the practice of trepanation was widespread.
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Contributing to medical practice in developing countries has become increasingly prevalent. Primary care and preventative health initiatives have been most visible, although attention has recently shifted to surgical disease, which represents a large burden in resource-poor settings. Typically dominated by individual efforts, there is now a more concerted approach, with surgical care being included in the comprehensive primary health care plan set by the World Health Organization. Although ethical dilemmas in international surgery have been discussed sporadically in the context of specific missions from the visiting surgeon/team perspective, we are missing a comprehensive evaluation of these issues in the literature. Here we have chosen to systematically categorize ethical issues confronted while teaching and operating in a developing country into 2 broad categories: venue (i.e., host) and visitor related. ⋯ This article provides a discussion written from visiting and host surgeon perspectives on diverse ethical challenges for which there is limited literature, including location selection, unmet needs at home, role of sponsors, and personal gain. In addition to candid discussion and a solutions-focused approach, the reader is provided with an "ethical checklist" for international surgical education, akin to the World Health Organization surgical safety checklist, to serve as a framework for the design of surgical missions that avoid ethical pitfalls.