Feasibility of ultrafast computed tomography in the early evaluation of coronary bypass patency

Although ultrafast computed tomography (UFCT) is able to determine coronary artery bypass graft (CABG) patency, the clinical applicability in the early postoperative period has not been investigated. We prospectively studied 22 consecutive patients who developed angina-like chest pain, electrocardiogram (EKG) abnormalities, elevated creatine phosphokinase-MB fractions (CPK-MB fractions) (> 5%), or sudden cardiac death in the early post-CABG period. UFCT (flow mode) examinations from 4 to 28 days postoperatively were performed at six levels with 13 scans each. Indications for obtaining UFCT included chest pain (14), elevated CPK-MB (14), EKG abnormalities (10), and aborted sudden cardiac death (1). There were 78 grafts evaluated with 87 distal anastomoses. Sixty were saphenous vein grafts (SVG), 16 were left internal mammary artery (LIMA) grafts, 1 was a free right internal mammary artery (RIMA), and 1 was a right gastroepiploic artery. The 60 SVG included 9 sequential grafts with 18 distal anastomoses. UFCT identified 5 occluded nonsequential SVG and of these, 3 underwent coronary angiography confirming the UFCT findings. Visualization was inadequate to determine patency in 5/17 internal mammary artery (IMA) grafts, and all 5 were in the early part of this study and felt to be related to UFCT image protocol. All sequential grafts were determined to be patent on UFCT, although visualization was inadequate to determine if one or both of the outflow distal anastomoses were patent. Our series shows early nonsequential SVG occlusion at 5/51 (9.8%) in patients with postoperative clinical signs of possible graft occlusion. UFCT to determine the patency of proximal grafts is feasible in the early postoperative period. If UFCT is indeed a valid test for graft patency, then this study implies that most signs and symptoms of ischemia in the early postoperative period may not represent graft occlusion.

Female surgeons in the 1990s. Academic role models

As part of a larger survey of the membership of the Association of Women Surgeons, data were collected to characterize the participation of women in academic surgery and surgical education. Of the 1500 members, 676 (45%) responded, and 318 of these respondents held a faculty appointment. Two hundred thirty-nine of the respondents' practices were based in a university or university-affiliated hospital. This sample was biased toward more academically motivated, upwardly mobile surgeons. Two hundred thirty-six of the respondents believed policies relating to tenure are unfair to women. Four hundred fifty-three respondents reported having role models at some point in their career, half of whom were men. However, only 204 still had access to role models or mentors at the time of the survey. Six hundred thirty respondents believed that female medical students need successful female surgeons as role models.