Changing relationship of pediatric surgical workforce to patient demographics.

Background: Physician workforce studies indicate that more specialists contribute to higher average costs. The closely monitored pediatric surgery specialty may reflect what is occurring in other specialties.

Methods: This report reviews the number of complex operations performed on infants and children in 1970, with <225 trained US pediatric surgeons, and in 2010, when there were 1,130.

Cardiovascular magnetic resonance in patients with pectus excavatum compared with normal controls.

Purpose: To assess cardiothoracic structure and function in patients with pectus excavatum compared with control subjects using cardiovascular magnetic resonance imaging (CMR).

Method: Thirty patients with pectus excavatum deformity (23 men, 7 women, age range: 14-67 years) underwent CMR using 1.5-Tesla scanner (Siemens) and were compared to 25 healthy controls (18 men, 7 women, age range 18-50 years).

912 open pectus excavatum repairs: changing trends, lessons learned: one surgeon's experience.

Background: Severe pectus excavatum (PE) is common, often causing physiologic impairment. Inconsistent results have been reported using a variety of open surgical techniques with extensive subperiosteal costal cartilage resection.

Methods: Since 1969, 912 (80% men) symptomatic PE patients (mean severity index 4.

Surgical correction of pectus carinatum: lessons learned from 260 patients.

Background: Patients with pectus carinatum (PC) frequently experience physiologic symptoms, which are often overlooked by physicians. Sparse data have been published regarding the indications for correction of PC and the newer techniques of surgical repair.

Methods: Since 1970, 260 (89% males) symptomatic patients with PC with a mean severity index of 1.

Repair of pectus chest deformities in 320 adult patients: 21 year experience.

Background: Severe pectus chest deformities are common, often causing physiologic impairment. Patients who do not undergo repair during childhood often experience progressive worsening of symptoms during adulthood. There are few published reports regarding pectus repair in adults.

Recent experience with open repair of pectus excavatum with minimal cartilage resection.

Hypothesis: Inconsistent results have been reported using a variety of open surgical techniques to correct pectus excavatum (PE) deformities with subperiosteal resection of deformed costal cartilages.

Design: Retrospective 6-year review of 450 consecutive patients undergoing PE repair.

Setting: Tertiary care academic medical center.

Open repair of pectus excavatum and carinatum deformities with minimal cartilage resection.

Background: Numerous modifications of the Ravitch open repair of pectus excavatum (PE) and carinatum (PC) have been used by surgeons with inconsistent results.

Methods: During a 3-year period, 275 consecutive patients underwent open repair of PE and PC using a new less invasive technique. A small chip of costal cartilage was resected medially and laterally from each deformed cartilage, allowing it to barely touch the sternum and rib (laterally) after the sternum had been elevated or depressed, and twisted to the desired position.

Open repair of pectus excavatum with minimal cartilage resection.

Objective: To summarize the clinical experience with a new open repair for pectus excavatum (PE), with minimal cartilage resection.

Summary Background Data: A wide variety of modified techniques of the Ravitch repair for PE have been used over the past 5 decades, with the complications and results being inconsistent. Extensive subperiosteal costal cartilage resection and perichondrial sheath detachment from the sternum may not be necessary for optimal repair.

Less extensive techniques for repair of pectus carinatum: the undertreated chest deformity.

Background: Although patients with pectus carinatum (PC) often experience moderate to severe symptoms, there are sparse published data about the indications for correction, the newer techniques of surgical repair, and the results. This study reviews clinical experience with new, less extensive, open operative techniques for repair of PC.

Study Design: Since 1970, 154 patients (119 men and 35 women) with symptomatic PC (mean severity index 1.

Mucosal regeneration of a duodenal defect using small intestine submucosa.

Intestinal tissue engineering has the potential of developing new treatment strategies for patients with a deficit in intestinal surface area. The purpose of this study was to investigate the capacity of small intestine submucosa (SIS) to regenerate intestinal epithelia in a rodent model for a duodenal defect. A duodenotomy was created in 20 Sprague-Dawley rats and was repaired with a circular patch of SIS.

Management of pectus chest deformities in female patients.

Background: There is sparse published information regarding surgical management of females with pectus excavatum (PE) or carinatum (PC) deformities.

Methods: During the past 33 years 104 females with PE, and 21 with PC underwent surgical repair using extensive modifications of the Ravitch technique. Seven had previous right breast implants, 3 had prostheses placed in the PE deformity.

Cardiorespiratory outcome after corrective surgery for pectus excavatum: a case study.

Purpose: The purpose of this case study was to examine the effect of pectus excavatum before and after surgical correction on ventilatory and cardiorespiratory responses to submaximal and maximal exercise.

Methods: The patient was a 30-yr-old longshoreman who had mild pectus excavatum since infancy that became worse during his adolescent growth years. The deformity persisted into adulthood with increasing symptoms.

Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum.

Purpose: Uncertainty exists as to whether pectus excavatum causes true physiologic impairments to exercise performance as opposed to lack of fitness due to reluctance to exercise. The purpose of this study was to examine the effect of pectus excavatum on ventilatory and cardiovascular responses to incremental exercise in physically active patients.

Methods: Twenty-one patients with pectus excavatum (age range, 13 to 50 years; mean [+/- SD] age, 23.

Surgisis patch tracheoplasty in a rodent model for tracheal stenosis.

Background: Tracheal stenosis is a challenging surgical problem that can require reconstruction using autologous grafts or artificial stents. In this study, we evaluate the efficacy of Surgisis, a commercially available, biocompatible, acellular matrix, in the repair of a critical-size tracheal defect.

Methods: A full-thickness defect (2 mm x 6 mm) was created in tracheal rings 4 through 6 in adult rats.

Management of ovarian cysts in women undergoing restorative proctocolectomy for ulcerative colitis.

More than half of all patients undergoing restorative proctocolectomy (RP) for ulcerative colitis (UC) are women, yet there is a paucity of information regarding the frequency, management, and outcome of ovarian cysts. A single surgeon's (E.W.

Current management of pectus excavatum.

Pectus excavatum (PE) is one of the most common anomalies of childhood. It occurs in approximately 1 in every 400 births, with males afflicted 5 times more often than females. PE is usually recognized in infancy, becomes much more severe during adolescent growth years, and remains constant throughout adult life.

Repair of recurrent pectus deformities.

A paucity of information is available regarding the surgical repair of recurrent pectus deformities (RPD). From 1993 through 2001 35 patients ranging in age from 6 to 51 years (mean, 23 years) underwent repair of RPD a mean of 11 years after the original repair: modified Ravitch repair (31), prosthetic implantation (three), and Nuss procedure (one). All patients had accompanying symptoms including decreased stamina (76%), chest discomfort (53%), asthma (33%).

Morbidity and mortality of short-bowel syndrome in infants with abdominal wall defects.

Total parenteral nutrition (TPN) has made survival beyond infancy possible for many infants who have sustained small intestinal loss as a result of gastroschisis or omphalocele. The length and quality of life in these patients have often been limited by the development of late sequelae secondary both to the protracted use of TPN and the long-term complications of a shortened gut. This study was undertaken to determine what factors influence the morbidity and mortality of short-bowel syndrome (SBS) due to gastroschisis or omphalocele.

Increasing social capital via local networks: analysis in the context of a surgical practice.

The relationship between social capital (support, trust, patient awareness, and increased practice revenue) and local networks (university hospital) in communities has received little attention. The development of computer-based communication networks (social networks) has added a new dimension to the argument, posing the question of whether local networks can (re-)create social capital in local communities. This relationship is examined through a review of the literature on local networks and social capital and a surgeon's practice management from 1990 to 2001 with respect to repair of pectus chest deformities.

Repair of pectus excavatum and carinatum deformities in 116 adults.

Objective: To determine the feasibility of surgically correcting pectus excavatum and carinatum deformities in adult patients.

Summary Background Data: Although pectus chest deformities are common, many patients progress to adulthood without surgical repair and experience increasing symptoms. There are sparse published data regarding repair of pectus deformities in adults.

Comparison of minimally invasive and modified Ravitch pectus excavatum repair.

Background/purpose: Minimally invasive repair of pectus excavatum (MIRPE) has gained wide acceptance during the last 4 years. This study compares, retrospectively, the experience at 2 large hospitals, 1 using MIRPE and the other a modified Ravitch repair (MRR).

Methods: From 1996 to 2000, 68 PE patients underwent MIRPE at one hospital, and 139 underwent MRR at another hospital.

Diagnosis of obstructive jaundice.

The diagnosis of obstructive jaundice remains difficult yet vital, since operative decompression may relieve extrahepatic blockage, but operation can only harm patients with intrahepatic block or parenchymal cell inflammation or necrosis. Three new diagnostic methods (liver scanning, angiography, and transjugular transhepatic cholangiography) are reviewed, as is bilirubin metabolism, so important in the diagnosis of jaundice. Three clinical problems are discussed: extrahepatic obstruction due to cancer of the pancreas, biliary atresia causing jaundice in the newborn, and the diffuse ductal obstruction known as sclerosing cholangitis.