Thoracic Surgery Workforce: Report of STS/AATS Thoracic Surgery Practice and Access Task Force—Snapshot 2010

BackgroundThe Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS) have intermittently surveyed their combined membership. These manpower surveys have provided snapshots of thoracic surgery, documenting practice changes over time. At this critical time in US health care reform the physician workforce is of critical importance. This survey updates the data obtained from the 2000 and 2005 surveys.MethodsThe survey instrument was updated from the 2005 survey. It was received by 5265 surgeon members of the STS/AATS during November and December 2009. There was a superb 50% return rate. The data were entered into a comprehensive database. Perception Solutions, Inc, independently performed the analysis.ResultsThe median age of the active US thoracic surgeons is 52.9 years. Women comprise 3.4% of adult cardiac, 5.2% of congenital heart, and 7.9% of general thoracic surgeons. The decision to pursue a career in thoracic surgery was made before or in medical school by 45.3% of surgeons. The majority of survey respondents had a mean of 8.7 years of residency training after medical school graduation. The cumulative average educational debt was $56,000. Overall career satisfaction was 46$55,947 to $59,673. The number of additional years the currently active US cardiothoracic surgeon plans to practice is 12.6 years. Therefore, the projected retirement age of the thoracic surgery workforce will be 65. This is consistent among all surgeons: adult cardiac, 66 years; congenital heart, 65 years; and general thoracic, 67 years.ConclusionsThese data give a clear profile of the specialty at this time. The major challenges remain length of training and educational debt of the thoracic surgeon. Case volume, scope of practice, malpractice costs, and career satisfaction remain major elements to provide a positive environment to recruit new surgeons in to the specialty. The resident pool has contracted while the workforce ages and retirement looms. Significant shortages may develop as the US population ages in the environment of health care reform

Primary meningioma of the middle ear: case report

Abstract Objective: To report a rare case of primary meningioma of the middle ear. Method: We describe the case of a 55-year-old woman who presented with decreased hearing and fullness in the left ear, with a middle-ear mass. We also review the world literature regarding primary extracranial meningioma of the middle ear and its management. Results: Primary middle-ear meningioma, a rare clinical entity, was diagnosed in this patient based on an initial transmastoid biopsy. Magnetic resonance imaging with gadolinium enhancement excluded the presence of an intracranial component. Complete excision of the tumour was achieved using a combined approach tympanoplasty. The patient had an uneventful post-operative course. Conclusion: Meningiomas, although rare in the middle ear, need to be included in the differential diagnosis of middle-ear lesions presenting to the otolaryngologist. This case emphasises the management strategy required when dealing with a middle-ear mas

Partial cricotracheal resection for paediatric subglottic stenosis: update of the Lausanne experience with 129 cases

OBJECTIVES Partial cricotracheal resection (PCTR) is widely accepted for treating severe paediatric laryngotracheal stenosis (LTS). However, it remains limited to a few experienced centres. Here we report an update of the Lausanne experience in paediatric PCTR performed or supervised by a senior surgeon (Philippe Monnier). METHODS An ongoing database of 129 paediatric patients who underwent PCTR for benign LTS between March 1978 and July 2012 at our hospital was retrospectively reviewed. Demographic characteristics and information on preoperative status, stenosis and surgery were collected. Primary outcomes were measured as overall and operation-specific decannulation rates (ODR and OSDR, respectively), and secondary outcomes as morbidity, mortality and postoperative functional results. RESULTS A total of 129 paediatric patients [79 males and 50 females; mean age, 4.1 years (1 month-16 years, median age of 2 years old)] underwent PCTR during the study period. ODR and OSDR were 90 and 81%, respectively. The decannulation rates were significantly superior for single-stage PCTR compared with double-stage PCTR in both ODR and OSDR. Eight patients died postoperatively for reasons unrelated to surgery. Partial anastomotic dehiscence was seen in 13 patients, 9 of whom were successfully treated by revision surgery. Respiratory, voice and swallowing functions were near normal or only minimally impaired in 86, 65 and 81% of patients, respectively. CONCLUSIONS PCTR is effective and feasible with good ODR and OSDR for highgrade / severe LTS. Glottic involvement and the presence of comorbidities were negative predictive factors of decannulation. Early detection and reintervention of postoperative incipient dehiscence contribute to avoiding the progress to late restenosis; however, voice improvement remains a challeng

Choosing the Most Suitable Technology of Involute Gearing

Import 02/11/2016Bakalářská práce se zabývá výběrem vhodné technologie výroby evolventního ozubení. V úvodu jsou uvedeny základní informace o ozubení a ozubených kolech. Dále jsou popsány nejpoužívanější metody výroby ozubení. Hlavní část bakalářské práce se zabývá popisem způsobu výroby evolventního ozubení pro konkrétní zakázku. Na začátku je vybrán vhodný obráběcí stroj. Následuje návrh a popis výroby upínacího přípravku a výběr obráběcích nástrojů. Dále je stručně popsán způsob tvorby programu pro CNC stroj pomocí softwaru SolidCAM. Na závěr je provedeno zhodnocení vybraného způsobu výroby po technické i ekonomické stránce.This thesis deals with the selection and evolution of suitable involute gearing production technology. The introduction provides basic information about gears and sprockets. Further the most widely used methods for the production of toothing are described. The main part of the thesis describes a method of producing involute gearing for a specific contract. The beginning deals with the selection of a suitable machine tool followed by a description of design and manufacturing fixtures and the selection of cutting tools. The following work briefly describes the formation of a program for CNC machining using SolidCAM software. At the end is a technical and economical appreciation of the chosen method of production.346 - Katedra obrábění, montáže a strojírenské metrologievýborn

Sarcomatoid lung carcinomas: a case series

We report on three Caucasian Greeks 2 males and 1 female (67, 54 and 62 years old) that were operated with sarcomatoid carcinoma of the lung, an uncommon tumor that sometimes is referred as pleomorphic carcinoma (spindle and giant cell carcinomas). These tumors are encountered in the thorax far more often than true sarcomas. There are many erroneous reports of pulmonary sarcomas made before the advent of adjunctive pathologic screening, including immunohistochemical studies. Pulmonary Sarcomatoid Carcinomas represent 0.2-1% of all lung cancers in different series and they are considered that they are not significantly aggressive than ordinary lung carcinoma

Adaptive reuse and the museum : installing a museum in a preexisting shell

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Architecture, 1990.Includes bibliographical references (leaves 123-132).The thesis deals with the complexities involved within the conversion of an old building to an art museum. The restoration of a building is by itself a complicated problem, conjuring up questions about the relationship between the old and new parts of the structure. The reuse of the old building as a museum of art adds a new set of relationships, multiplying the interactions and enhancing the complexity. The analysis of the problems is st:rUctured in two parts: The first is a theoretical discussion of generic questions and issues linked with the museum as an institution on the one hand, and with the preservation of the built environment on the other. The second joins the two fields of the above discussion together, by referring to the particular kind of building: the museum within an old structure. This is done by means of analysis of selected examples. An artificial separation of the two fields is again used as a tool for the analysis. The discussion focuses on the concrete expression of specific choices in both of the fields, from which, in conclusion, general deductions are drawn.by Agis Ikonomidis-Doumbas.M.S

Stricture prevention after extended circumferential endoscopic mucosal resection by injecting autologous keratinocytes in the sheep esophagus

Background: During the past decades, endoscopic mucosal resection (EMR) has been developed to treat early intramucosal esophageal cancers and dysplastic Barrett's esophagus. The primary drawback of this method is severe postsurgical esophageal stricture formation. The purpose of this preclinical study was to assess strategies for prevention of this major complication by injecting autologous keratinocytes in the EMR mucosal defect in the sheep model. Methods: Circumferential, 6-cm-long EMRs were performed in the esophagus of nine sheep. Autologous keratinocytes were harvested 2weeks before EMR and cultured. Circumferential resection consisted of two opposite hemicircumferential mucosectomies allowing a widespread resection of 24cm2. Immediately after EMR, autologous keratinocytes were endoscopically injected in the mucosal defect. Animals were sacrificed after 6months. Results: Circumferential EMRs were successfully performed in all animals. There were no intra- or postoperative complications. None of the animals developed strictures. All animals were sacrificed at 6months as planned. Histological examinations showed fibrotic changes in 10% (range 0-25%) of the circumferential muscularis propria interna layer and 7.2% (range 0-25%) in the muscularis propria externa layer at the midportion of the EMR. No circumferential transmural fibrosis was identified. Conclusions: Prevention of stricture formation after extensive (6-cm long) circumferential EMR of the sheep esophagus can be achieved by injecting autologous keratinocytes into the wound of the resected mucosal segmen

Comparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm

ObjectiveValve sparing root replacement (VSRR) is an attractive option for the management of aortic root aneurysms with a normal native aortic valve. Therefore, we reviewed our experience with a modification of the David V VSRR and compared it with stented pericardial bioprosthetic valve conduit (BVC) root replacement in an age-matched cohort of older patients.MethodsA total of 48 VSRRs were performed at our institution, excluding those on bicuspid aortic valves. We compared these cases with 15 aortic root replacements performed using a BVC during the same period. Subgroup analysis was performed comparing 16 VSRR cases and 15 age-matched BVC cases.ResultsThe greatest disparity between the VSRR and BVC groups was age (53 vs 69 years, respectively; P < .0005). The matched patients were similar in terms of baseline demographics and differed only in concomitant coronary artery bypass grafting (2 VSRR vs 7 BVC patients; P = .036). None of the VSRR and 3 of the BVC procedures were performed for associated dissection (P = .101). Postoperative aortic insufficiency grade was significantly different between the 2 groups (P = .004). The cardiopulmonary bypass, crossclamp, and circulatory arrest times were not different between the VSRR and BVC groups (174 vs 187 minutes, P = .205; 128 vs 133 minutes, P = .376; and 10 vs 13 minutes, respectively; P = .175). No differences were found between the 2 groups with respect to postoperative complications. One postoperative death occurred in the BVC group and none in the VSRR group. The postoperative length of stay and aortic valve gradients were less in the VSRR group (6 vs 8 days, P = .038; 6 vs 11.4 mm Hg, P = .001). The intensive care unit length of stay was significantly less in the VSRR group (54 vs 110 hours, P = .001).ConclusionsVSRR is an effective alternative to the BVC for aortic root aneurysm