Eagle Syndrome Presenting after Blunt Trauma.

As classically described, Eagle syndrome is an entity where patients develop pain or neurologic manifestations arising from an elongated styloid process and/or an ossified stylohyoid ligament irritating or compressing adjacent cranial nerves or the carotid arteries. Over the past few years, there have been reports of actual injury to the internal carotid artery with dissection, occlusion, and strokes. We present 3 cases identified after blunt trauma: 1 due to carotid compression and 2 due to actual injury to the internal carotid artery.

β-Blockade and Operative Mortality in Noncardiac Surgery: Harmful or Helpful?

Importance: The use of perioperative pharmacologic β-blockade in patients at low risk of myocardial ischemic events undergoing noncardiac surgery (NCS) is controversial because of the risk of stroke and hypotension. Published studies have not found a consistent benefit in this cohort.

Objective: To determine the effect of perioperative β-blockade on patients undergoing NCS, particularly those with no risk factors.

The role of a preliminary PGY-3 in general surgery training.

Introduction: Even before the preliminary postgraduate year (PGY)-3 was eliminated from surgical residency, it had become increasingly difficult to fill general surgery PGY-4 vacancies. This ongoing need prompted the Association of Program Directors in Surgery (APDS) leadership to form a task force to study the possibility of requesting the restoration of the preliminary PGY-3 to Accreditation Council for Graduate Medical Education-approved general surgery residency programs.

Methods: The task force conducted a 10-year review of the APDS list serve to ascertain the number of advertised PGY-4 open positions.

Perceptions of graduating general surgery chief residents: are they confident in their training?

Background: Debate exists within the surgical education community about whether 5 years is sufficient time to train a general surgeon, whether graduating chief residents are confident in their skills, why residents choose to do fellowships, and the scope of general surgery practice today.

Study Design: In May 2013, a 16-question online survey was sent to every general surgery program director in the United States for dissemination to each graduating chief resident (CR).

Results: Of the 297 surveys returned, 76% of CRs trained at university programs, 81% trained at 5-year programs, and 28% were going directly into general surgery practice.

Percutaneous femoral vein access for inferior vena cava filter placement does not cause insertion-site thrombosis.

Background: The efficacy of inferior vena cava (IVC) filters in the prevention of pulmonary embolism in patients with lower extremity deep venous thrombosis (DVT) has been well described. What remains uncertain is the risk of insertion-site thrombosis of the femoral vein after filter placement. Historically, the risk was relatively high, most likely due to large delivery systems and therefore a need for longer compression at the insertion site to provide hemostasis.

General surgery vs fellowship: the role of the Independent Academic Medical Center.

Objectives: To compare career choices of residency graduates from Independent Academic Medical Center (IAMC) and University Academic Medical Center (UAMC) programs and evaluate program directors' perceptions of residents' motivations for pursuing general surgery or fellowships.

Design: From May to August 2011, an electronic survey collected information on program characteristics, graduates' career pursuits, and career motivations. Fisher's exact tests were calculated to compare responses by program type.

Vena cava filter practices of a regional vascular surgery society.

Background: Vena cava filter (VCF) use in the United States has increased dramatically with prophylactic indications for placement and the availability of low-profile retrievable devices, which are overtaking the filter market. We surveyed the practice patterns of a large group of vascular surgeons from a regional vascular surgery society to see whether they mirrored current national trends.

Methods: A 17-question online VCF survey was offered to all members of the Southern Association of Vascular Surgery.

Retrospective evaluation of residents' American Board of Surgery In-Service Training Examination (ABSITE) scores as a tool to evaluate changes made in a basic science curriculum.

Objective: To evaluate the effectiveness of a new basic science curriculum at a university-affiliated general surgery residency program.

Design: A retrospective evaluation of general surgery residents' American Board of Surgery (ABS) In-Training Examination (ABSITE) scores before and after the implementation of a new basic science curriculum.

Setting: Not-for-profit tertiary referral center with a university-affiliated Accreditation Council for Graduate Medical Education (ACGME) accredited community general surgery residency program.

Cerebral oximetry does not correlate with electroencephalography and somatosensory evoked potentials in determining the need for shunting during carotid endarterectomy.

Objective: Several reports in the literature have described the value of regional cerebral oximetry (rSO(2)) as a neuromonitoring device during carotid endarterectomy (CEA). The use of rSO(2) is enticing because it is simpler and less expensive than other neuromonitoring modalities. This study was performed to compare the efficacy of rSO(2) with electroencephalography (EEG) and median nerve somatosensory evoked potentials (SSEP) in determining when to place a shunt during CEA.

Carotid angioplasty and stenting is a safe and durable procedure in a community hospital.

Carotid angioplasty and stenting (CAS) has been touted as a reasonable alternative to carotid endarterectomy (CEA) for high-risk surgical candidates. Several published CAS series, primarily from academic centers, show immediate results approaching those of CEA. However, very little is known about long-term results with CAS, particularly in the community hospital setting.

A pitfall of protracted surgery in the lithotomy Position: lower extremity compartment syndrome.

Although the lithotomy position is frequently used in urologic, gynecologic, and colorectal surgery, the potentially devastating complication of lower extremity compartment syndrome is not widely recognized. The authors report a 50-year-old woman who underwent 8 hours of colorectal surgery in the lithotomy position. After surgery she complained of bilateral calf pain and was noted to have episodes of ventricular tachycardia.