Opportunity Costs in Paediatric Training: The Specialist Registrars Experience.

In the training process, there is a tension between the work life and home life of trainees. This study explored both the personal impact and the opportunity costs of training from the Specialist Paediatric Registrar (SPR) perspective. The survey explored 1) career progression, 2) perceived functional effectiveness at work, 3) psychological impact of hospital based training, and 4) the personal and social cost of training. Fifty-three (71%) SPRs responded of whom 47 (89%)were married or in long term relationships. Seventy-five percent of trainees had a definite career plan with 86% intending to undertake fellowship training. Seventy percent believed they were efficient time managers but 53% had difficulty in making time for academic pursuits and fifty percent experienced negative feelings, which lingered after work and interfered with their relationships at home. Seventy-four percent stated training was undertaken at significant personal cost with only 21% achieving a very satisfactory work/life balance. To address these difficulties trainee wellbeing should be addressed at the Basic Specialist Training (BST) level and the career path clearly explained outlining the challenges that are likely to be encountered.

Extended rethymectomy in the treatment of refractory myasthenia gravis: original video-assisted technique of resternotomy and results of the treatment in 21 patients.

UNLABELLED: The aim of the study was to analyze the impact of extended rethymectomy in patients with myasthenia gravis. Additionally, an original technique of resternotomy is described. Extended rethymectomy was performed on 21 patients with refractory myastenic symptoms after a previous transsternal thymectomy. In 8 patients the original video-assisted technique of complete longitudinal resternotomy with the aid of a special sternal retractor elevating the sternum from above and below was used. Severe intraoperative haemorrhage from the lacerated left innominate vein occurred in 3/13 patients operated on before the video-assisted technique of resternotomy had been introduced. In none of the 8 patients operated on with video-assisted resternotomy such a complication was noted. PATHOLOGICAL FINDINGS: retained thymic lobe (4/21 patients), ectopic foci of thymic tissue (13/21 patients) no thymic tissue (4/21 patients). Results of follow-up: complete remission (11.8%), improvement (64.7%); no improvement (35.3%) during the follow-up period (mean 3.4 years). There was neither deterioration of myasthenia nor mortality during follow-up in this group. We conclude that described technique of video-assisted resternotomy reliably prevents the laceration of the heart and great vessels, and that complete remission and improvement rates in patients operated on with the extended rethymectomy are relatively low but deterioration of myasthenia is prevented.

[Analysis of indications and results of surgical treatment for patients with pulmonary metastasis]. / Analiza wskazan i wyników leczenia operacyjnego chorych z prezerzutami nowotworów do pluc.

Ninety-three patients with pulmonary metastases (PM) were operated on between 1983 and 1997. Surgical complications occurred in 8 (9%) of patients. Two (3%) of patients died in hospital, 7 were operated on again due to further PM. An average survival after lung metastasis surgery was 40 months, median 22 months. 44% and 35% of patients survived respectively 3 and 5 years. Thanks to lung metastasis surgery the overall survival was longer; an average overall survival was 87 months (median 58 months). 58% and 38% of patients survived respectively 5 and 10 years. Time between treatment of primary tumour (PT) and lung metastasis surgery (disease free interval DFI) was on average 4 years, median 41 months. The patients who showed DFI-longer than 2 years had tendency to live longer (p = 0.086). Patients with PM are recommended to be operated on, even if further PM occur.