Experience With the Cardiac Surgery Simulation Curriculum: Results of the Resident and Faculty Survey.

Background: The Cardiac Surgery Simulation Curriculum was developed at 8 institutions from 2010 to 2013. A total of 27 residents were trained by 18 faculty members. A survey was conducted to gain insight into the initial experience.

Simulation-Based Training in Cardiac Surgery.

Background: Operating room surgical training has significant limitations. This study hypothesized that some skills could be learned efficiently and safely by using simulation with component task training, deliberate practice, progressive complexity, and experienced coaching to produce safer cardiac surgeons.

Methods: Training modules included cardiopulmonary bypass, coronary artery bypass grafting, aortic valve replacement, massive air embolism, acute intraoperative aortic dissection, and sudden deterioration in cardiac function.

Cardiopulmonary bypass simulation at the Boot Camp.

Objective: At Boot Camp, we evaluated a modular approach to skills mastery related to cardiopulmonary bypass and crisis scenarios.

Methods: With 32 first-year cardiothoracic surgery residents divided into 4 groups, 4 consecutive hours were devoted to cardiopulmonary bypass skills by using a perfused nonbeating heart model, computer-controlled CPB simulator, and perfused beating heart simulator. Based on the cardiopulmonary bypass simulator, each resident was assessed by using a checklist rating score on cardiopulmonary bypass management and 1 crisis scenario.

Simultaneous spontaneous bilateral pneumothoraces in an asthmatic.

The occurrence of simultaneous spontaneous bilateral pneumothoraces is a very rare event. We present a case of a 14-year old asthmatic female patient who presented to the emergency room for routine treatment. While receiving nebulizations, she suddenly developed supraclavicular fullness with crepitus.

Acute renal failure post coronary artery bypass grafting at the University Hospital of the West Indies.

Objectives: The purpose of the study was to determine the period prevalence of acute renal failure (ARF) after coronary bypass surgery (CABG) at the University Hospital of the West Indies and to identify risk factors.

Method: A retrospective analysis of patients who underwent CABG during the period 1994-2004 was done. Data collected included; age, gender, weight, the presence of hypertension (HTN), diabetes mellitus (DM), hypercholesterolaemia, previous myocardial infarction (MI), blood pressure on admission, urea and creatinine one year prior to surgery, on admission for surgery and post-surgery, duration of intra-operative hypotension, duration of cardiopulmonary bypass, perfusion pressure and the perioperative medications.

Struma cordis in a Jamaican woman.

A case of ectopic thyroid within the right ventricle (struma cordis) occurring in a middle-aged Jamaican woman is described. This rare and fascinating condition is curable utilizing standard open-heart surgical techniques. Investigations to rule out primary thyroid or ovarian malignancy, as well as the presence of remaining normal thyroid tissue or other ectopic thyroid rests are important in the management of these patients.

Thal-Hatafuku oesophagogastroplasty: an effective option in the palliation of non-chagasic megaesophagus.

The palliation of patients with megaesophagus secondary to achalasia of the cardia presents significant challenges to the surgeon. Experience with palliation of megaesophagus secondary to Chagas' disease suggests that options other than cardiomyotomy or oesophagectomy can result in satisfactory outcomes. A small series of patients with non-chagasic megaesophagus who were treated with a gastroesophagoplasty procedure is discussed.

Pancreaticopleural fistula: a rare thoracic complication of pancreatic duct disruption.

Pancreaticopleural fistula resulting in a chronic pleural effusion is a rare complication of pancreatic duct disruption. We describe the presentation and management of 2 children with pancreaticopleural fistulas. Pleural fluid amylase concentration and contrast computed tomography were sufficient to establish the diagnosis in both cases.

A high fidelity tissue-based cardiac surgical simulator.

Objective: Issues concerning the training and certification of surgical specialists have taken on great significance in the last decade. A realistic computer-assisted, tissue-based simulator developed for use in the training of cardiac surgical residents in the conduct of a variety of cardiac surgical procedures in a low-volume cardiothoracic surgery unit of a typical developing country is described. The simulator can also be used to demonstrate the function of technology specific to cardiac surgical procedures in a way that previously has only been possible via the conduct of a procedure on a live animal or human being.

Thirty-five years of cardiac surgery in Jamaica.

A retrospective review of the files of all patients who underwent cardiac surgery at the University Hospital of the West Indies (UHWI) and the Bustamante Hospital for Children (BHC), during the period April 1968 to June 2003 was undertaken. Data collected included age, gender New York Heart Association risk score, type and date of cardiac surgery. The mortality rate of patients who underwent surgery during the period January 1994 to June 2003 was also analyzed A total of 2202 patients had undergone cardiac surgery (CS) in Jamaica during the study period of 35 years and two months.

Initial experience with beating-heart single valve replacement surgery at the University Hospital of the West Indies, Kingston, Jamaica.

The objective of this study was to examine the consequences of performing single cardiac valve replacement procedures utilizing a beating-heart technique on typical patients presenting to the cardiothoracic surgery service for aortic or mitral valve replacement. Beating heart aortic (4) or mitral valve (1) replacement was performed on patients from July 2000 to November 2002. A stratified sample of five patients who underwent standard arrested-heart single valve replacement procedures between April 1997 and November 2002 was selected for retrospective comparison with the beating-heart group.

A simple, inexpensive simulation exercise in the construction of sutured intra-thoracic oesophageal anastomoses.

The ability to perform a hand-sutured intra-thoracic oesophago-gastric anastomosis remains an important skill for surgeons in the developing world to master. In the developed world, this skill is no longer widely practiced due to the prevalent use of surgical staplers in most centres. A simple preparation for teaching aspects of hand-sutured anastomotic techniques is described.

A simple preparation for introductory training in the construction of distal coronary anastomoses.

A simple laboratory preparation for use in training of junior level residents in the construction of distal coronary anastomoses is described. The preparation is easily stored and rapidly set-up, and provides a realistic substrate upon which basic anastomotic technical skills can be taught and the trainee's effort can be immediately assessed.

Transcriptional profiling of epidermal keratinocytes: comparison of genes expressed in skin, cultured keratinocytes, and reconstituted epidermis, using large DNA microarrays.

Epidermal keratinocytes are complex cells that create a unique three-dimensional (3-D) structure, differentiate through a multistage process, and respond to extracellular stimuli from nearby cells. Consequently, keratinocytes express many genes, i.e.

A case of pulmonary lymphangioleiomyomatosis.

A case of pulmonary lymphangioleiomyomatosis (PLAM) occurring in a 48-year-old Jamaican female is presented. The clinical, radiological, and pathological findings are typical of this rare condition, and serve to emphasize the need for a high index of suspicion in order to make the diagnosis and commence therapy early in the course of the disease. The outlook for patients with PLAM continues to be poor.

Thymic surgery in Jamaica 1992-2000.

The treatment for thymic tumours and/or myaesthenia gravis (MG) includes thymectomy. Controversy exists as to the optimal timing and operative approach to thymectomy. At the University Hospital of the West Indies, Kingston, Jamaica, the results of thymic surgery during the period 1992 to 2000 were studied retrospectively.

Thoracic endometriosis syndrome in Jamaica.

Thoracic endometriosis syndrome (TES) is a rare presentation of systemic endometriosis. An unusual cluster of patients from the Caribbean who were treated at a single hospital during the year 2001 is presented. All patients were managed surgically in the acute phase, with satisfactory results.

The role of stem cells in the evolution of longevity and its application to tissue therapy.

The role of stem cells in a multi-tiered organization of tissue structure extends the potential of longevity in multicelled organisms. This role can be responsible for the mechanism of evolution of the stem cells themselves. The principles involved in this mechanism can aid research for the development and management of successful tissue therapies.

Scleroderma with cardiac tamponade, hyperthyroidism and incidental papillary thyroid carcinoma.

Cardiac tamponade and malignancy are associated with a poor prognosis in Progressive Systemic Sclerosis (PSS). We present the case of a 31-year-old African-Jamaican woman with PSS and a thyroid neoplasm who presented with cardiac tamponade requiring pericardiocentesis. Despite the presence of two poor prognostic markers, she has had a favourable postoperative course.

Surgery for patent ductus arteriosus. Still the gold standard.

The surgical treatment of Patent Ductus Arteriosus (PDA) at the University Hospital of the West Indies, Kingston, Jamaica, was examined over an eight-year period. The results of standard surgical modalities were comparable to large published series. A review of the literature regarding the treatment options for PDA does not support a change in management strategy in favour of non-surgical methods.

Penetrating injury to the great vessels. Case reviews and management approaches for West Indian surgeons.

Penetrating injury to the great vessels in the thorax is an increasingly common and alarming clinical scenario in the West Indies, and in Jamaica in particular. The management of these often life-threatening injuries involves careful surgical planning and prompt operation, with close adherence to the principles of adequate pre-operative stabilization and investigations, and intra-operative exposure and repair. While this may be more easily accomplished in tertiary care centres, the geographical realities of the West Indies require that every surgeon be familiar with these techniques.