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Biomedical subjects

R G Fosburg

Publications and source records attributed to R G Fosburg.

At least 19 recordsLinked to original sources
PubMed1997

Single-anastomosis femoral arteriovenous shunt as recipient vessels for free-flap reconstruction of a massive lumbosacral wound.

In any reconstructive microsurgical procedure, an adequate recipient circulation is required. None is readily available when reconstructing problem wounds of the lumbosacral spine, leading in some cases to the use of long vein grafts to the axilla to provide vascular access. A case of a massive back wound that was reconstructed microsurgically with a prefabricated preliminary arteriovenous shunt, based on the femoral vessels, is presented. This method takes advantage of the normal anatomic arrangement of the saphenous venous system, requires only one anastomosis, and provides an accessible vascular supply. The technical advantages of the procedure are discussed.

Adult↗
PubMed1995

Thoracic Surgery Workforce Report. The fourth report of the Thoracic Surgery Workforce Committee of The American Association for Thoracic Surgery and The Society of Thoracic Surgeons.

To determine demographics, practice patterns, and work volume of North American thoracic surgeons, we sent a detailed survey to all members of The American Association for Thoracic Surgery and The Society of Thoracic Surgeons between January and May 1993 to determine data for 1992; 3049 of 3487 (87%) thoracic surgeons responded and 2677 (88%) were in active practice. Ninety-seven percent were male and 3% female, with a mean age of 52 years. Sixty-five percent considered fee-for-service as their primary compensation mode. Only 24% do isolated subspecialty work: 2% pediatric cardiac surgery. 10% general thoracic surgery, and 12% adult cardiac surgery. Seventy-six percent of respondents do both cardiac and thoracic operations. Workload data for adult cardiac, pediatric cardiac, general thoracic, peripheral vascular, and pacemaker operations were requested. Volume data were cross-correlated with age, 10 geographic regions including Canada, type of practice, and type of compensation and were cross-checked by hospital discharge data for 1992. These data were compared with data from similar surveys performed in 1976, 1980, and 1985, under the auspices of the same two societies; these latter surveys used diplomates of the American Board of Thoracic Surgery as their database. Workloads have increased over previous surveys. Most surgeons do a wide variety of thoracic operations, and exclusive designations are in the minority.

Aged↗
PubMed1987

Thoracic surgery manpower: the fourth manpower study of thoracic surgery: 1985 report of the Ad Hoc Committee on Manpower of The American Association for Thoracic Surgery and The Society of Thoracic Surgeons.

Responding to a survey about their practice in 1985, 2,969 (70%) Board-certified thoracic surgeons provided data that were compared with data from manpower surveys in 1980 and 1976. (table; see text) Thoracic surgeons were most active between ages 35 and 54 years when they accomplished 61% of all general thoracic and 85% of cardiac operations. Surgeons older than 50 years performed significantly more general thoracic operations than younger surgeons, and the younger group performed significantly more cardiac operations than their older counterparts. Solo practice continued to decline. In smaller referral areas, the number of general thoracic procedures per surgeon increased, but the number of cardiac operations have decreased compared with 1980. Overall, general thoracic and cardiac operations increased, but peripheral vascular procedures and pacemaker insertions decreased in almost all nine census regions. Fewer general thoracic and cardiac operations were performed per thoracic surgeon in the western United States than in central and eastern regions. In response to questions about work load, 55% believed that their clinical activity was satisfactory, 42% operated too little, and 3% operated too much. The 363 non-Thoracic Board-certified surgeons who responded performed 14% of general thoracic and 8% of cardiac surgery in 1985. During the first half of the 1980s, our specialty certified an average of 134 thoracic surgeons annually, which is higher than the 120 surgeons per year estimated to meet the projected demand.

Adult↗
PubMed1979

Evaluation of the mediastinum by gallium-67 scintigraphy in lung cancer.

Delineation of the metastatic spread of lung cancer has been attempted by a variety of means. Controversy as to the indications for organ surveys, mediastinoscopy, scintillation scanning, and biopsy techniques still exists. Since definition of the micrometastatic state is yet unachieved, the staging of disease for therapy continues to be predicted on documented spread beyond the site of the origin. The records of 75 patients in whom the presence or absence of mediastinal metastases was known were retrospectively reviewed to establish the sensitivity, specificity, predictive values, and accuracy of 67Ga scintigrams. Comparisons were made with chest roentgenograms, mediastinal tomograms, and endoscopic findings. Five patients had 67Ga-negative studies. In the 70 patients having 67Ga-positive lung lesions, mediastinal 67Ga uptake had a sensitivity of 88%, a specificity of 86%, predictive values of 93% for a positive test and 76% for a negative test, and a test accuracy of 87%. These studies, plus those of others, permit selectivity of choosing candidates for mediastinoscopy. If the primary is 67Ga positive, a negative mediastinal scan obviates mediastinoscopy. If the mediastinum is 67Ga positive, mediastinal exploration is indicated. The level of involvement dictates whether resection is undertaken in suitable surgical candidates. This approach, employed since 1976, has lowered the costs of staging, and 67Ga has become our scintigram of choice.

Evaluation Studies as Topic↗
PubMed1976

An analysis of direct and indirect measurements of left atrial filling pressure.

Left ventricular function may be assessed by direct catheter measurements of left atrial pressure or by indirect measurements of pulmonary artery wedge pressure or pulmonary artery end-diastolic pressure. Controversy exists as to how closely the indirect measurements correlate with true left atrial pressure and to which is the most accurate. To clarify this probelm, we studied 43 patients undergoing cardiac surgical procedures with cardiopulmonary bypass. Both left atrial catheters for direct measurement and Swan-Ganz catheters were placed at the time of surgery. All patients were monitored continuously for 48 hours and hourly measurements were recorded. The resultant 1,620 left atrial pressure and pulmonary artery wedge pressure figures and 1,860 left atrial pressure and pulmonary artery end-diastolic wedge pressure measurements were subjected to computer analysis. The following conclusions have been found: (1) Pulmonary artery wedge pressure is a better indirect measure of left atrial pressure than is pulmonary artery end-diastolic wedge pressure (pooled correlation coefficient 0.629); (2) direct left atrial pressure measurement is more reliable and has fewer complications than indirect measurements; (3) there is no consistent correlation between left atrial pressure and central venous pressure (pooled correlation coefficient 0.3). A discussion of our results and the problems associated with left atrial catheters and Swan-Ganz catheters is presented.

Atrial Function↗
PubMed1975

Effect of deep hypothermia, limited cardiopulmonary bypass, and total arrest on growing puppies.

The advantages of a bloodless field and total cardiac relaxation have popularized the technique of deep hypothermia and total circulatory arrest for the correction of complex congenital cardiac defects in infancy. There is, however, a significant potential for cerebral and pulmonary complications. Presently, the most common technique is that of using a combination of surface cooling and cardiopulmonary bypass cooling and rewarming. Normal neurological development has been claimed with the present technique of hypothermia at 20 degrees C and total circulatory arrest for periods up to an hour; however, there are reports of seizure activity in the early postoperative period. There is also a disturbing incidence of respiratory insufficiency and, occasionally, hemorrhagic pulmonary edema. This study, using growing puppies and subjecting them to deep hypothermia and total circulatory arrest for varying periods of time, disclosed that animals subjected to 60 min of circulatory arrest recovered neurologically; however, there were histological changes of anoxia in the brain. Animals subjected to 30 min of total circulatory arrest were normal neurologically and there was no histological evidence of anoxic damage to brain tissue. Puppies that were continuously on cardiopulmonary bypass had no significant pulmonary changes caused by increasing the inspired oxygen tension in the ventilator; however, striking changes were noted when limited cardiopulmonary bypass was employed for core cooling and total circulatory arrest combined with pulmonary ventilation with 100% oxygen. We conclude from this experimental study that the use of surface cooling and core cooling with subsequent total circulatory arrest at 20 degrees C is a safe procedure, providing the period of time of cardiac arrest is kept around 30 min. We also conclude that the alveolar oxygen tension should be maintained at the lowest level possible during the interval of circulatory arrest to avoid the apparent rapid onset of post-traumatic pulmonary insufficiency.

Animals↗