Evaluating a trainee’s progress in surgical dexterity

The local cardiac surgical training program is modelled on a one-to-one apprenticeship encompassing a number of years. Trainee progress is regularly audited and work of increasing complexity is provided, commensurate with the trainee's ability. Speed and accuracy are desirable surgical goals and reflect a high level of decision-making and dexterity. The trainee's surgical speed over a period of time was monitored as one measure of progress. The mean time required to complete a coronary anastomosis (graft time) decreased from 12.8±1.9minutes in the first year of training to 9.0±1.9minutes in year four, inter-group variance (ANOVA) was highly significant from year two to year three and from year three to year four (p<0.001). Risk stratification was utilised in the selection of patients for the trainee. Parsonnet score increased from 5.1±3.5 in year one to 6.0±5.0 in year four. Similarly, EuroSCORE increased from 2.1±1.8 to 2.4±2.1. Additionally, variable life-adjusted display (VLAD) plots were constructed in order to provide a visual representation of performance against predicted outcome by EuroSCORE. Successive VLAD plots demonstrate the changing practice of the trainee as it came to resemble more closely that of his instructor and this was achieved without jeopardising patient outcome.peer-reviewe

The dignity and rights of migrants in Catholic canon law

This study investigates the role of canonical norms in the mission of the Catholic Church to promote, protect and ensure respect for the dignity and rights of refugees and migrants.peer-reviewe

Recurrent chest infections in two young non-smoker men

Pulmonary mucinous cystic carcinomas are rare salivary gland type carcinomas of the lung. They form part of a wide spectrum of mucin secreting glandular mixed type tumours. They comprise 0.1 – 0.2% of all lung tumours. They occur more frequently in young patients and present with cough or recurrent chest infections and therefore may be easily misdiagnosed. Since treatment depends fully on complete surgical resection early diagnosis is essential. Even with treatment the 10-year survival is quoted at 53%. We describe two cases of such rare tumours both of who underwent curative surgical resection. Both patients were younger than 35 years old and presented with recurrent chest infections. The patients were followed for up to eight years and the outcome recorded. A literature search confirms the occurrence in younger patients, who often present with pneumonias and that surgery is the only hope for cure.peer-reviewe

Atypical presentation of a rib chondrosarcoma

Background: This case report represents a variation from the typical characteristics of an uncommon cardiothoracic pathology, i.e rib chondrosarcomas. Usually this pathology is seen in patients over 40 years of age and grows relatively slowly, taking around 2 years to present clinically. Case Presentation: Our patient was an asymptomatic and healthy 27 year old male who presented with a large right sided thoracic mass. CT scaning revealed an inhomogeneous lesion around 6cm in diameter, arising from the 8th right rib, with no obvious signs of aggressive type of growth and no evidence of metastatic spread. The decision was taken to excise the lesion based on clinical and radiological evidence. Histopathological analysis was carried out at two centres and reported a Grade II 55mm x 48mm x 43mm show with a variably cellular tumour consistent with chondrosarcoma. The case was discussed with the oncological team who advised no need for further treatment given histology and radiological report, except clinical and radiological surveillance. Conclusions: Chondrosarcomas are the 3rd commonest type of bone tumour however it is considered rare for them to originate from the ribcage in a young individual over a relatively short time span. CT scanning is considered the gold standard image and surgery as the main form of management.peer-reviewe

Laparoscopic omentoplasty and split skin graft for deep sternal wound infection and dehiscence patient

Treatment of sternotomy dehiscence secondary to infection is complex. We describe a case where following debridement and negative pressure therapy the greater omentum was harvested laparoscopically, pedicled on the right gastroepiploic artery and transposed through a subxiphoid window and laid into the chest wound. The omentum was covered with a split skin graft. The omental transposition provided a healthy vascular bed for the skin graft to be laid on top of. This technique allows for larger defects to be closed when due to the amount of bone loss the sternum cannot be brought together. Such procedures are normally performed when all other measures have failed and myocutaneous flaps cover the omentoplasty. Our case is novel in that the laparoscopic harvest and the use of direct skin grafting make this an option to be considered earlier as a single definitive procedure.peer-reviewe

Plucked human hair shafts and biomolecular medical research

The hair follicle is a skin integument at the boundary between an organism and its immediate environment. The biological role of the human hair follicle has lost some of its ancestral importance. However, an indepth investigation of this miniorgan reveals hidden complexity with huge research potential. An essential consideration when dealing with human research is the awareness of potential harm and thus the absolute need not to harm—a rule aptly qualified by the Latin term “primum non nocere” (first do no harm). The plucked hair shaft offers such advantages. The use of stem cells found in hair follicles cells is gaining momentum in the field of regenerative medicine. Furthermore, current diagnostic and clinical applications of plucked hair follicles include their use as autologous and/or three-dimensional epidermal equivalents, together with their utilization as surrogate tissue in harmacokinetic and pharmacodynamics studies. Consequently, the use of noninvasive diagnostic procedures on hair follicle shafts, posing as a surrogate molecular model for internal organs in the individual patient for a spectrum of human disease conditions, can possibly become a reality in the near future.peer-reviewe

The Orthodox tradition on divorced and remarried faithful : what can the Catholic Church learn?

This study investigates the question “The Orthodox Tradition on Divorced and Remarried Faithful: What can the Catholic Church Learn?” in three steps: first, it outlines the progress of Catholic interest in the Orthodox approach to divorce and remarriage over the last few decades; secondly, it presents the main features of this approach against the broader context of the Orthodox world; and thirdly, it points out five aspects of the Orthodox tradition that can shed new light and instigate the Catholic Church in her ongoing reflection on marriage and the pastoral challenges of the family.peer-reviewe

Improving myocardial protection : the key variables which affect troponin release after CABG

Background: Myocardial cell ischaemic injury during cardiopulmonary bypass and aortic crossclamp remains a key limiting factor to patient outcomes in coronary artery bypass grafting. Troponin I has been shown to be an effective indicator of myocardial ischaemic injury and achieves peak levels early post-operatively. Methods: All consenting CABG patients from one centre, during a one year period, were recruited. All surgeries were performed using identical techniques besides the cardioplegia volume and number of doses. Troponin I levels were checked regularly post-operatively until a peak troponin I level was ascertained. All the patient demographics, crossclamp times, bypass times and cardioplegia dosing were analysed using multiple combinations of statistical tools. Results: 172 patients were included in the study and cardiopulmonary bypass (CPB) time was found to be significant as a single variable (p=0.033). The combination of CBP time and ischaemia time (p=0.002) and the combination of CPB time and multidose cardioplegia (p=0.009), were both found to significantly affect peak troponin I levels. Another analysis was performed on the volume of cardioplegia used. While this was not significant as an individual variable it did become significant when combined with ischaemia time at a threshold total cardioplegia volume of 750mls (p=0.026).Conclusions: The conclusion therefore is that using over 750mls of cardioplegia in multiple doses will safely protect against an ischaemia time of up to 62min. However there is no protection against the CPB time, which proved to have the most impact on myocardial cell damage in our practice.peer-reviewe

Complex factors in preconditioning a microarray gene

Preconditioning is complex, strong, evolutionary conserved cellular survival mechanism that is exhibited by different species as well as in different organs. A focused approach on microarray evaluation of preconditioning will be used to highlight the lack of clarity in investigating this complex phenomenon, exacerbated by the absence of a standardised terminology. This paper is an extensive review of the scientific literature on the investigation of preconditioning by means of a microarray approach. It dissects the design of the experiments used to investigate such phenomenon and classifies the complex factors in investigating preconditioning. It presents an attention to detail to the lexicon with a suggested classification and terminology that describes preconditioning that may help stratify and clarify research in this field.peer-reviewe