Creating innovative departments

'Creating an innovative department' as an objective implies further improvements in organization, function, and progression of a surgical unit active in patient care, research, and education. It is of prime importance to stress here the mutual benefits of patient care, research (the basis for future patient care) and education (the channel for training health care professionals in future patient care). Neither innovation (from latin innovare: to renew, revive) nor creation (from latin creare: to make, produce) is something that will fall from heaven without effort any time soon. Hence, a pro-active attitude towards progress is indicated. This requires searching for new ideas, allocation of resources, finding allies, getting focussed, and being persistent. One word says it all: WORK

Predictability of aortic dissection as a function of aortic diameter

The role of aortic diameter on the occurrence of type A dissection was investigated in 73 patients with dilated ascending aorta at the lime of pre-operative evaluation. Using transthoracic echocardiography for diagnosis and measurements, 54 patients were identified with type A dissection (group 1) and 19 without dissection (group 2). The true mean aortic diameters were identical (6·0±1·3 cm in group 1 and 6·4±1·4 cm in group 2; mean±SD; ns) as were the indexed aortic diameters (ratio of diameter/body surface area; 3·2±0·8 cm . m−12 and 3·4±0·7cm m−2 respectively; ns). However, the individual diameters showed a pronounced scatter in both groups (range from 3·6±11·0 cm). Of the 73 patients, 66 had surgery (47/54 with and 19/19 without dissection) and seven patients were treated medically. Emergency surgery was performed in 45/66 patients (all with acute type A dissection) andelective repair in 21/66 (19 without and two with chronic type A dissection). In-hospital mortality was 18% in the emergency group, 5% in the elective group and 57% in the medical group. It is concluded that patients with dilated ascending aorta have a substantial incidence of acute dissection. Their clinical course is unpredictable; acute dissection occurs in some, and in others the ascending aorta continues to enlarge without dissection. Because patients with dissection often arrive too late for elective repair andhave to be operated on as emergencies with a higher operative risk, we recommend elective surgery before the diameter of the ascending aorta has reached 6 c