Observations from the AAMC advisory panel on biomedical research.

The author gives a brief history of the events that led to the establishment of the Association of American Medical Colleges (AAMC) Advisory Panel on Biomedical Research, describes some of its early activities, and discusses some of the issues that the biomedical research community is facing. Specifically, he describes how the competition for research funding that became particularly intense in 1989-90 eroded the well-orchestrated coalition approach to appropriations that had been the norm. Another disturbing development was a growing tension between research faculty and the administrators of their institutions. To address these problems, the author, under the aegis of the AAMC, convened a series of workshops during the summer of 1990 to provide a forum for airing concerns and allowing different groups to become aware of each other's positions and perceptions. These workshops were quite useful and helped in framing some important issues. Also deriving from the workshops was the recognition that a continuing advisory group on research policy was needed; thus the AAMC advisory panel was created. The author describes its unusual characteristics and its importance. Subcommittees were later established to facilitate the effectiveness of the panel. Early in the panel's deliberations it became clear that it was important to bring into the meeting various knowledgeable individuals to educate and interact with panel members. The author concludes by surveying the larger picture of the public's eroding confidence in research universities and higher education in general, the punitive environment that this has created in Congress, the increasingly harsh economic situation, and what these conditions may portend for future research funding.

Gastric tube oesophagoplasty--a long-term assessment.

The first gastric tube oesophagoplasty at the Royal Alexandra Hospital for Children was performed in 1968. Over the next 15 years, until 1982, a total of 46 operations were performed. This represents the largest series of gastric tube oesophagoplasty in children yet reported in the literature. Two techniques have been in use and are compared. The main aim of the paper is to present the long-term results of gastric tube oesophagoplasty. In our 15 years' experience with the gastric tube for oesophageal replacement, we have found it to be a very satisfactory procedure, with a very low mortality and failure rate. The vascularity of the stomach gives rise to less anxiety than with colon. Early postoperative complications are readily identified and treated. There is a higher risk of serious chest complications in bringing the gastric tube through the chest with primary anastomosis in the neck. This also predisposes to diaphragmatic herniation and obstruction, complications not seen when the gastric tube is brought up substernally. The long-term results are very encouraging, with virtually all the children leading active and normal lives. The gastric tube functions satisfactorily with no evidence of the late complications often reported with colonic tubes. There is no significant difference in the long-term results of the two techniques of gastric tube oesophagoplasty used in this hospital.