Chairman Of Surgery Research Articles

Some pioneers in plastic surgery of the facial region.

Much of this complex history comes from Europe, with contributions and advances from dentists, otolaryngologists, and general surgeons. Prior to World War I there wasnospecificplasticsurgeryspecialty.For example, Sir Harold Gillies, an otolaryngologist, learned many dental skills and techniques from Charles Auguste Valadier, a rogue French practitioner of dentistry and maxillofacial surgery. (Valadier is said to have treated most of his patients in an automotive vehicle described as a “traveling dental parlour” around 1900.) Gillies,extraordinarilyinnovative,technically superb, and politically adept, was called by some the “father of plastic surgery,” although such a descriptor probablydoesnotpayproperhomageandcredit to his many European predecessors. Gillies drew heavily from these surgeons and teachers in Britain and continental Europe,astheythemselveshadadvancedtheir own training and expertise.

Reality, Teaching, and the Four Researchers

The 112th meeting of the Association of American Medical Colleges (AAMC) was held November 2–7, 2001, in Washington, DC. The theme for the meeting was “Facing the Future,” yet there appeared to be considerable time and concern devoted to the realities of the present. The first plenary session, “The Cost of Compliance: Dollars, Time, and Faculty Morale,” caught the mood of the gathering with a careful analysis of the current costs to academic medical centers of the unfunded mandates for compliance. Russel E. Kaufman, MD, vice dean for education and academic affairs at Duke University School of Medicine, Durham, NC, presented his overview of the cost of compliance in research. Kaufman noted that the cost of the institutional review board at Duke, including record keeping, personnel, and time for protocol development and review of protocols, exceeded $12 million in supporting the medical school–wide research endeavor. Kaufman outlined a study done at Duke in which compliance costs were shown to increase at a rate exceeding that of any other research costs. He warned specifically about the Federal False Claims Act and the unknown potential fiscal effects of the privacy protection rules now pending implementation. Mark E. Erath, a partner in Healthcare Consulting Practice at PricewaterhouseCoopers LLP, San Francisco, Calif, presented the results of a study done by that firm documenting the cost of compliance for clinical healthcare. Erath reported that the Center for Medicare and Medicaid Services (CMS) code is now larger than the Internal Revenue Service code. At one phase in reviewing the data from his study, he noted that the time spent documenting clinical activities equaled the time spent actually performing the clinical activities. Erath suggested that breakthrough changes are required if the system is to survive financially. Primary among these changes that Erath suggested are three initiatives: (a) Unfunded mandates must be carefully examined, (b) the workforce supply crisis must be solved, and (c) the CMS and American public must eventually deal with the demand crisis for medical services. Erath’s study of the cost of compliance to healthcare is available from PricewaterhouseCoopers. This sobering dose of reality was followed by a session about the physician payment situation. The CMS update on the physician payment resulted in a 5.4% decrease in payment per work relative value unit. The 2002 relative value unit payment has declined to $36.23 compared with the 2001 value of more than $38.00. Of equal concern is the decrease in the technical component payment for radiologists of about 5%. This makes the overall “hit” for radiology departments about 11% for the year 2002. The AAMC and other professional organizations are working diligently to mitigate the effect of the suggested reductions. The general impression was that the best we could ever come away with is to reinstate the 2001 payment scale. The most likely scenario was that the reductions recommended by the CMS would stand. George F. Sheldon, MD, the Zack D. Owens Distinguished Professor of Surgery and chairman of surgery at the University of North Carolina, Chapel Hill, delivered an analysis of the 21st century workforce in medicine. Sheldon predicted a major upcoming physician shortage. Sheldon showed demographic data for medical resource that suggested a crucial shortage of physicians and, in particular, specialty trained physicians, is likely to develop during the next 10 years. We in radiology can certainly resonate with that opinion. Sheldon suggested a workforce study group for graduate medical education (GME) whose tasks would include documentation of the need to increase class size in the nation’s medical schools and support of an increase in the size of GME training Acad Radiol 2002; 9:834–836

George J. Heuer: forgotten pioneer neurosurgeon at the Johns Hopkins Hospital.

George J. Heuer was a pioneer in neurosurgery at The Johns Hopkins Hospital in the early 20th century; he trained under Harvey Cushing and acted as a mentor to Walter Dandy. In his early career, Heuer focused on research and clinical work in the field of neurosurgery and temporarily led the neurosurgery section at Johns Hopkins. One of his most important contributions to neurosurgery was the modern frontotemporal craniotomy. This elegant craniotomy, which initially was used to approach chiasmal tumors, developed into the modern frontosphenotemporal craniotomy, which neurosurgeons use to approach numerous tumors as well as most aneurysms. Although Dandy is frequently credited with inventing this operation. his article detailing the new approach clearly attributes its origin to Heuer, who was serving in World War I when the new technique was presented. Although he had hoped to lead the neurosurgical section at Johns Hopkins permanently, he returned from military service to find that Dandy had been appointed to this position. Heuer subsequently advanced to a distinguished career in general surgery as the chairman of surgery at two institutions, and was known for his contributions to surgical education. Throughout his academic years, Heuer continued to operate on the nervous system and to perform spinal cord and peripheral nerve surgery. He played an important role along with Cushing and Dandy in the creation of neurosurgery as a specialty, but he is rarely given credit for this accomplishment. The authors describe Heuer's contributions to neurosurgery as well as his distinguished surgical career.

Spirituality in Surgical Practice1,2

The role of spirituality in surgical practice has long been recognized as important, but it is only now receiving detailed analysis. In 1910 the British Medical Journal invited Sir William Osler, the premier physician of his day, to editorialize about people who depended on faith and prayer rather than medical professionals for treatment and healing. Osler concluded this editorial with the comment, “. . . the whole subject is of intense interest to me. I feel that our attitude as a profession should not be hostile . . . A group of active, earnest, capable young men are at work on the problem, which is of their generation and for them to solve.” Four generations later the question remains unresolved. Unfortunately, until the last decade or so the academic medical community has expressed little interest in or support of physicians, and especially surgeons, who attempt to shed light on spiritual issues as related to medical outcomes. Arguably the most imaginative and productive surgeon scientist of the early 20th century was Alexis Carrel of France. In 1903 he witnessed and recounted a scientifically unexplainable (miraculous?) healing of a pilgrim in Lourdes. Subsequent to the resultant publicity, surgical superiors at the University of Lyon warned that he would likely fail his final examination; this threat possibly contributed to his leaving France for the United States, where he later received the 1912 Nobel Prize in physiology. His account of the Lourdes experience and a small volume on prayer were both published posthumously. Another surgeon who applied academic scrutiny to the study of spirituality as understood in psychologic terms was Barney Brooks, chairman of surgery at Vanderbilt University Hospital from 1925 to 1951. In the early 1940s Brooks secured funds from the Rockefeller Foundation to assess the psychologic makeup and needs of surgical patients. Brooks reported the findings in his 1943 presidential address, “Psychosomatic Medicine” at the Southern Surgical Association. His colleagues responded negatively when he asserted that mental preparation and the patient’s mindset were on par with surgical skill, so the surgeon was responsible in assisting with this mental preparation. Brooks also addressed the psychologic nature of the surgeon as vital to the patient-physician relationship, deeming some technically skilled but socially deficient people unworthy of the surgical profession. Although Brooks’s study design would never be approved by any institutional review board today, his conclusions asserting the importance of a surgeon’s social interactions with patients were far ahead of his time. Matthew Walker, chairman of surgery at Meharry Medical College from 1944 until 1973, insisted that medical students and physicians needed to be in touch with their own mortality if they were to assist patients and their families in dealing with end-of-life issues. Addressing the role for spirituality in surgical practice involves the historical perspective, definition clarification, public opinion, current practices, funding, communication skills, and even accreditation requirements. Spiritual issues daily influence academic medical centers. Chaplaincy services, while often underused, exist in most medical centers. Hospital food services accommodate Muslim, Jewish, vegetarian, and other dietary restrictions. Scheduling of clinics, procedures, and even staff vacations frequently takes into account religious holy days. Challenges to hospital regulations concerning clothing, hairstyles, and head coverings arise from cultural and faith traditions. Some surgeons have developed special techniques in caring for Jehovah’s Witnesses because of their aversion to blood products. Beliefs about after-death physical wholeness lead some patients and No competing interests declared.

History of the department of surgery in Cincinnati

This narrative reviews the foundations and development of surgery in Cincinnati beginning with the surgical pioneers and the founding of the first medical institutions by Dr. Daniel Drake. The amalgamation of multiple medical schools resulted in university affiliation and a “full-time” chairman of surgery. The arrival of Dr. George Heuer and his Johns Hopkins group caused great turmoil but resulted in a strong department of surgery and residency program. Drs. Reid, Carter, and Altemeier succeeded Dr. Heuer and each contributed to the department’s growth and success. Dr. Josef E. Fischer became chairman of surgery in 1978 and led the department through difficult times to its greatest expansion and development—bringing to a department with an outstanding history and tradition the reforms and modernizations needed to take it into the 21st century. Dr. Fischer has now returned to Boston and Harvard and was succeeded by Dr. Jeffrey Matthews in 2001. Under his capable leadership the department of surgery at the University of Cincinnati seems assured of a bright future.

Henry K. Beecher, M.D.: an historical perspective?

Associate Professor of Anesthesiology; State University of New York at Buffalo; Chief; Anesthesiology Services; Veterans Affairs Western New York Healthcare System; Buffalo, New York; Bacon.Douglas_R@Buffalo.VA.GOVTo the Editor: - I read with fascination the article by Gravenstein [1]about Henry K. Beecher. The author is to be commended for including so many interesting, personal antidotes about Dr. Beecher. This paper humanizes a historic person in a unique way, making Dr. Beecher's personality available to those who never had the chance to meet him.However, the historic record does not support Dr. Gravenstein's thesis. Dr. Beecher did not, as Gravenstein wrote, make anesthesiology a university specialty. In fact, despite the author's comments to the contrary, Beecher's contributions to the academic practice of the specialty are modest when compared to his contemporaries. The man who did more to make anesthesiology an equal in the university setting was Ralph Milton Waters of the University of Wisconsin. His teaching and departmental organization are used in more than 60% of the academic departments in the United States. [2]Richard Kitz, Beecher's successor, is from this lineage, and no doubt, even at the Massachusetts General Hospital (MGH), the influence of Ralph Waters prevails.It is interesting to compare the appointments of the chief of anesthesia at the MGH in 1936 with the same position at Baseline Hospital in New York City a year previously. Beecher, after completing 3 yr of training as a surgical house officer and a year working with August Krogh, the Danish Noble Laureate, [3]was appointed assistant anesthetist at MGH and instructor in anesthesia at Harvard. Five months later, with the departure of Howard H. Bradshaw, Beecher became anesthetist in chief at MGH, backed by the chairman of surgery, Edward D. Churchill. [4]By contrast, at Bellevue, the chairman of surgery, Arthur Wright, searched for the best-trained physician possible to head the anesthesia section. His choice was a junior faculty member of Ralph Waters' department in Madison, Wisconsin who had completed an internship, practiced as an internist for several years, and completed 3 yr of residency training in anesthesiology! Emery Andrew Rovenstine brought innovative anesthetic techniques and agents to Bellevue because he had been formally trained to do so; he also began to develop an extensive collaborative research relationship with the basic scientists at New York University. Within 2 yr of his arrival in New York, the Bellevue program rivaled any other program in the country. Over the next 20 yr, Rovenstine's program was the most successful and influential in the country, training more departmental chairs than any other university program. [2]In must admit that I am somewhat perplexed by Dr. Gravenstein's statement that Beecher's relationship with organized anesthesia began with some difficulties. [1]Dr. Beecher was admitted to membership in the American Society of Anesthetists (ASA) on September 2, 1939. [5]However, Beecher would not have initially qualified for an advanced category of ASA membership called

Managing information technology in academic medical centers: a "multicultural" experience.

Based on a session at the 1997 conference on Information Resources and Academic Medicine sponsored by the Association of American Medical Colleges, this article illustrates how the beliefs and concerns of academic medicine's diverse professional cultures affect the management of information technology. Two scenarios--one dealing with the standardization of desktop PCs, the other with publication of syllabi on an institutional intranet--form the basis of this exercise. Four prototypical members of a hypothetical medical center community--the chairman of surgery, a senior basic scientist, the chief information officer of an affiliated hospital, and the chief administrative officer--offer their perspectives on each scenario. Their statements illustrate many of the challenges of planning, deploying, and maintaining effective information technology in the "multicultural" environment of academic medical centers.

Kidney Transplantation: Principles and Practice

This is the fourth edition of a text that has become a standard in the field. The author, Peter Morris, MD, PhD, is an Australian whose early career included training in the United Kingdom and the United States. Since 1974, he has been chairman of Surgery at Oxford University, England. He is a versatile transplantation surgeon and immunobiologist whose distinguished career has spanned much of clinical surgery and basic science. Since Dr Morris is one of the world's experts not only in transplantation but also in histocompatibility testing, in elucidating the mechanisms of rejection, and in inducing transplantation tolerance, the book is authoritative in all respects. An interesting resume of the changes in transplantation that have occurred over the last century is provided by the preface of the first edition (a concise review of the entire history of transplantation from the late 1800s up to 1978) and of the other

Neurological Surgery in the Nineteenth Century

Born in Latvia in 1836, Ernst von Bergmann received his medical education and first academic position at the University of Dorpat in Russia. In 1866, he served as a military surgeon in the Prusso-Austrian War, followed by duty in the Franco-Prussian War of 1870. He was appointed to the faculty of the University of Würzburg in 1878 and 4 years later moved to the University Clinic in Berlin. As a professor and chairman of surgery, he taught until his death in 1907. Von Bergmann practiced general surgery but devoted a large part of his career to the treatment of neurological diseases. Known for his development of aseptic technique, his early military experiences directed his attention to cranial trauma and, ultimately, neurosurgery. In 1880, he authored his first textbook, which described missile ballistics and animal experiments first demonstrating the physiological response later known as "the Cushing reflex" and advocated meticulous intracranial debridement with thorough closure after trauma. Twenty years later, as senior editor of the massive System of Practical Surgery, his contributions included pediatric neurosurgery, successful treatment of abscesses and tumors, diagnostic radiography, and cerebral localization using external landmarks and the neurological examination. Revered by his students and honored by his colleagues, von Bergmann became a proponent for aggressive neurosurgical treatment. His skilled techniques, developed in parallel with accurate experimental physiology, advanced 19th century surgical progression and formed a solid framework for the advances of neurosurgical specialists.

W. Dean Warren, MD

On May 10, 1989, one of the best and brightest men in this noble profession died. W. Dean Warren, MD, the Joseph Brown Whitehead Professor and Chairman of Surgery at Emory University School of Medicine, Atlanta, Ga, succumbed to an illness that he had fought for 4 years with uncommon bravery, strength of character, and infinite grace. Those of us who knew and loved him will miss him greatly; but it is our profession, which is now bereft of one of its strongest leaders, that will suffer without his guidance and moral strength. He was blessed with great intelligence and sparkling wit, but of greater importance was his dedication to truth and candor. This dedication was like a beacon for all of us in surgery. He could never, and did not, abide pomposity, deceit, and cant. You well might ask about the forces that shaped this consummate academic surgeon. Certainly,

The neurosurgeon as chairman of surgery

Greeley’s opinion about departmental stewardship may ring a note of truth for some. However, the opportunity to serve for the past 2 years as acting chairman and, subsequently, as Chairman of the Department of Surgery at Albany Medical College has left me with an optimistic view of this challenging responsibility. Presently, only a handful of neurosurgeons in the United States serve as chairmen of university-based multispecialty surgical departments. This article examines this infrequent phenomenon and shares my perception of the generic responsibilities and problems faced not only by neurosurgeons but by anyone assuming this position. Dr. Eben Alexander, Jr., the editor of this journal, asked me to prepare this topic nearly a year ago. The assignment was completed promptly, but the manuscript was filed to allow aging-for both the text and the author. The intervening period, as expected, has produced an evolution of my initial view of departmental leadership, but the changes were not as significant as 1 had anticipated.

Men I syndrome and islet cell lesions of the pancreas.

S INCE Dr Edward Ellison’s reign as Chairman of Surgery at the Medical College of Wisconsin from 1958 to 1970, a deep interest has existed at our institution in hyperfunctioning islet cell lesions of the pancreas, Our charge in this report is to discuss the salient features of multiple endocrine neoplasia, Type 1 (MEN I) syndrome, which includes islet cell pancreatic lesions as a major component, and to review the different types of isolated sporadic islet cell pancreatic tumors. Although the MEN I syndrome and isolated pancreatic islet cell tumor are relatively rare, patients with these conditions are being recognized with increasing frequency due to the current general availability of hormone radioimmunoassays. Most radiologists who practice at major hospitals will likely encounter one or more patients with the clinical features of the MEN I syndrome or of a sporadic islet cell tumor. A high index of suspicion is essential to make an accurate diagnosis of the condition, leading to appropriate management of the patient and screening of his family. Since 1960, we have evaluated 66 individuals from among 200 kindred of two families with the MEN I syndrome. Data from the larger of the two families spans five generations.’ Evidence collected to date indicates that 21 individuals in this family have the syndrome (Fig 1). Of these individuals, 12 exhibited biochemical or morphologic evidence, or both, of islet cell neoplasm or hyperplasia. During the past two decades, we have also evaluated 50 isolated patients with sporadic nonfamilial islet cell lesions. Of these, 48 had a functioning neoplasm or hyperplasia while two had a nonfunctioning tumor.

A Tribute to Sam Powers, MD

This issue is dedicated to the memory of Sam Powers. It is also a tribute to his family, with whom we share their great loss. Sam was a valuable member of the Editorial Board of theArchivesfor nearly ten years. For us he was a friend and colleague, teacher, and mentor throughout his career in Albany, NY, on the Surgery Study Section, the Surgical Biology Club, National Institutes of Health site visits, the Surgical Forum, and many other activities. No one knew Sam Powers better than Charles Eckert, who preceded him as chairman of Surgery at the Albany Medical College. We are indebted to Dr Eckert for providing the foregoing memorial. Of Sam's many contributions to our understanding of surgical problems, he will particularly be remembered for his clear, incisive thinking and expression. He was sought as a teacher for programs and postgraduate courses because he could help surgeons

Current Management of Acute Gastrointestinal Hemorrhage

Dr Teruo Matsumoto, chairman of surgery, and 11 of his colleagues at the Hahnemann Medical College, collaborated on this monograph that is aimed at providing "practical yet adequate basic knowledge for the first line practicing physicians on how to handle massive GI hemorrhage." Chapters on pathophysiology and pathology are followed by chapters on the diagnostic techniques of endoscopy, arteriography, and roentgenography. The lesions that cause gastrointestinal (GI) hemorrhage are discussed in chapters on peptic ulcer disease, varices, and gastric mucosal hemorrhage and all other sources. Finally, there is a chapter on lower GI bleeding. Granted, there is a real need for a concise monograph to update the management of acute GI hemorrhage. As Dinoso points out in the first chapter, advances have been made in the following three areas: diagnosis, eg, fiberoptic endoscopy and selective angiography; pathophysiology, new information on acute mucosal lesions; and treatment, selective infusion of vasoconstrictors. The