Biomedical subjects
K D Anderson
Publications and source records attributed to K D Anderson.
Experience with in-service examinations of pediatric surgical trainees.
A formal examination is an effective device for assessing certain aspects of a resident's competence. Participation by outside examiners is advisable. Generalizations on the basis of 2 yr of experience may be premature, however, the oral examination, strengthened by outside examiners and complemented by a written clinical problem-solving test, has provided insight into the candidates' abilities and into their progress from the first to the second year. In addition, this process has identified strengths and weaknesses in the training program, which has led to modifications of the surgical curriculum. It is concluded that comprehensive oral and written examination of pediatric surgical trainees at the completion of their first year and again at the end of their second year yields information that is of importance to the trainee and to the faculty.
Evolution of surgical treatment of bilateral Wilms' tumor.
Bilateral Wilms' tumor (stage V) accounts for 10 to 15% of patients with nephroblastoma. Heretofore, surgical resection in many of these children presented insoluble technical problems. Ex vivo renal perfusion with "bench" surgical excision and revascularization has been applied in the management of a child with bilateral Wilms' tumor unresectable by conventional techniques. Complete extirpation of tumor was accomplished. Furthermore, the autotransplanted kidney was removed from the field of radiation therapy given after operation. By selective application of this technique, the child with bilateral Wilms's tumor can be approached with a greater expectation of cure.
Selective surgical management based upon clinical status in infants with esophageal atresia.
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Pneumothorax secondary to perforation of sequential bronchi by suction catheters.
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Selective resection of malignant tumors using bench surgical techniques.
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Split portal flow in heterotopic hepatic transplantation.
Heterotopic hepatic transplantation was carried out in 31 pigs using three different methods of homograft revascularization. In one experimental group the host portal inflow was split between the homograft and native liver so that the graft was provided with intestinal-pancreatic effluent; the host liver with gastric-splenic venous blood. The liver grafts flourished in this environment. A small and variable degree of atrophy took place in the host liver. In the other two experimental groups in which the grafts were supplied with different kinds of systemic inflow only, atrophy invariably followed. Long-term homograft analysis was prevented by the intensity of immunologic rejection regardless of the location of the ectopic liver. The implications for clinical auxiliary liver transplantation are (1) heterotopic liver homografts must be supplied with a portal inflow from the host splanchnic bed, but (2) the total host splanchnic effluent is unnecessary. (3) The portal inflow must contain the pancreatic venous blood. (4) There is a criticial recipient--donor size relationship for successful portal revascularization in this type of auxiliary hepatic graft.
Peptic ulcer in children with gastric tube interposition.
An infrequent, but potentially serious, complication of gastric tube interposition is ulceration within the conduit. It is important, therefore, to recognize ulcer formation in its early stages by serial radiographs throughout the childhood years. While redundancy and partial obstruction with impaired drainage of the tube appear to be etiologic factors, distension of the transposed antrum may lead to hyperacidity and may play a role in ulcerogenesis. A course of dietary and antacid therapy may heal the ulcer, but surgical revision of the tube may prove necessary.
Renal homotransplantation in childhood: with special reference to the infant recipient and the lymphocyte chalone.
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Surgical treatment of gastroesophageal reflux in infants.
Thirty-one infants less than a year of age underwent surgery for correction of pernicious gastroesophageal reflux. Severe growth retardation from persistent vomiting was the single most important indication for surgery (25 patients). Recurrent aspiration penumonitis was another serious sequella of reflux and necessitated surgery in six patients. The diagnosis of gastroesophageal reflux was confirmed by barium swallow in all children, and in 17 a concomitant hiatal hernia was demonstrated. Patients selected for surgery were first treated conservatively unless they showed significant esophagitis or had a major portion of stomach in the chest. Babies treated early in the series had Allison repairs (7 transabdominal, 2 thoracic). Twenty-two subsequent patients have had Nissen fundoplication, and two gastropexies were performed. In 15 patients, significant gastric outlet obstruction required a complementary pyloroplasty. Four infants required a second surgical procedure because of recurrence. Two of the four patients had Nissen procedures with good results, one following a Boerema gastropexy and one following an Allison repair. The other two patients needed revision after fundoplication. There was no mortality. Twenty-eight children have been followed 6 months-8(1/2) years. All have excellent nutritional status and are following normal growth curves. Study of these patients indicates the need for early diagnosis and medical or surgical therapy for all infants with major gastroesophageal reflux.
The gastric tube for esophageal replacement in children.
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Adrenocortical responses during tularemia in human subjects.
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Auxiliary liver transplantation in acute liver failure.
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The pig in pediatric surgical research.
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The patterns of neurotransmitter and neuropeptide co-occurrence among striatal projection neurons: conclusions based on recent findings.
The neurotransmitter organization of striatal projection neurons appears to be less complex than once thought. Only 4 major evolutionarily conserved populations appear to be present. The neurons of two of these populations contain SP, DYN and GABA, with one of these two populations consisting of striatonigral projection neurons and the other of striatopallidal projection neurons. The two additional major populations of striatal projection neurons consist of striatopallidal and striato-nigral neurons that both contain both ENK and GABA. Although these conclusions greatly simplify the understanding of the organization of striatal projection neurons by suggesting that only a few major populations are present, these conclusions complicate understanding of neurotransmission between these neurons and their target areas by suggesting that each neuron utilizes multiple neuroactive substances to influence target neurons. Further studies will therefore be required to explore the mechanisms of neurotransmission by which striatal neurons communicate with their target areas.
Feeling the stress: perceptions of burnout among general surgery program directors.
PURPOSE: To document the types and levels of stress experienced by general surgery program directors as they fulfill their education and administrative responsibilities. METHODS: This study consisted of a 3-part survey that incorporated 2 established instruments to help determine the presence of burnout in program directors. A personal projects analysis was used to help identify the tasks most relevant to the role of program director as well as to evaluate their perceptions of these tasks. The Maslach Burnout Inventory (MBI) was used to measure the degree of burnout among program directors. Demographic data were gathered to develop a picture of the background of the program directors and how they spent their time. RESULTS: A total of 71.8% of program directors responded. Of all tasks, teaching received the highest ratings for importance, enjoyment, and control, as well as the lowest ratings for stress. Emotional exhaustion was the most notable aspect of burnout in program directors on the MBI. Program directors scoring high in burnout were younger, had been in their current position fewer years, and had fewer years overall as a program director. CONCLUSIONS: Burnout is more related to age and experience of program director than to features of the program itself.
Surgical residents as teachers.
Surgical program directors have assumed that residents take on the role of teachers of medical students, and they have seldom questioned this assumption. The purpose of this study was to: determine the extent to which surgical residents teach and evaluate medical students; assess how surgical residents are prepared for and evaluated on their teaching responsibilities; and to identify surgical program directors' opinions about residents as teachers. Written surveys were sent to program directors of surgical residencies. A response rate of 79 percent was achieved. All programs taught medical students and involved residents in the process. Surgical residents taught medical students in a variety of settings and were responsible for student evaluation Approximately half of the programs, however, did not offer formal instruction in teaching skills to their residents and 60 percent of program directors did not believe it was important. In addition residents rarely received evaluations from medical students or program directors on their teaching.