Acta neurochirurgica. Supplement
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Board certification and accreditation of training programs began as measures of quality in the United States. Both functions were done initially by the American Board of Neurological Surgery (ABNS). In 1954, certification of trainees and accreditation of programs became separate functions in order to eliminate potential conflicts of interest. ⋯ Accreditation of training programs is a separate function administered by the Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education. Individual programs are reviewed on a periodic basis for quality of the curriculum, facilities, faculty, and patient volume. The ABNS and the RRC are separate groups, both comprised of neurosurgeons with a strong commitment to the educational process.
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Acta Neurochir. Suppl. · Jan 1997
Cerebral vascular response to hypertonic fluid resuscitation in thermal injury.
The purpose of this project was to study the effects of various resuscitation fluid protocols in a systemically thermally injured rat sustaining 70% body surface area third degree burn using the pial window model in rats. The results show that there was a significant albumin leak in the cerebral vessels in both the experimental group which underwent no resuscitation fluid, as well as the experimental group that was resuscitated with Lactated Ringer's solution using the Parkland formula. When this was compared to the control group, as well as to the experimental group which received hypertonic hyperosmotic saline (HMS) boluses every hour, there was little if any leakage seen.
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Acta Neurochir. Suppl. · Jan 1997
Morphologic analysis of the cerebral microcirculation after thermal injury and the response to fluid resuscitation.
Using the pial window model, we have previously demonstrated that there is a disruption of the blood brain barrier with distal thermal injury [1-3]. Our laboratory has shown that treatment with Lactated Ringer's Solution did not improve labeled albumin leakage. ⋯ The results show that there was significant progressive arterial dilatation over six hours in the thermally injured animals treated with HHS. There was also a significant increase in leukocyte number if the animals were thermally injured and had no resuscitation fluid or if the animals were thermally injured and underwent resuscitation fluid with Lactated Ringer's compared to either the control group or the group that was treated with HHS after thermal injury.
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Over the past ten years, an average of 135 residents have entered neurosurgical training in the United States each year. These neurosurgeons-to-be come from about 250 applicants who annually enter the national matching program for neurosurgery. After completing training, they join a pool of practicing neurosurgeons that includes about 3,260 board certified neurosurgeons and an additional 390 practicing neurosurgeons who are still in the certification process. ⋯ We do need to restrict the number of trainees to that number we can train properly. The quality of our neurosurgeons needs to be maintained. Beyond that, the market place, however imperfect, is a better long-term regulator of numbers than any governmental or privately-based committee.
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Acta Neurochir. Suppl. · Jan 1997
Comparative StudyIntracranial pressure in a modified experimental model of closed head injury.
Intracranial pressure (ICP) was studied in a modified experimental model of closed head injury, in which the dynamic process of impact versus impulse loading was separately controlled. In this model, mortality of Wistar rats was considerably higher as compared to Sprague-Dawley rats subjected to similar traumatic conditions. Therefore Sprague-Dawley rats were used for all further experiments. ⋯ At the moment of impact there was a momentary blood pressure peak immediately followed by a transient period of hypotension. ICP measurements following directly to an impact-acceleration trauma, revealed an abrupt rise in ICP reaching pathological levels within 5 minutes. In conclusion, this modified model of closed head injury produces a predictable and reproducible pathologic ICP in Sprague-Dawley rats.