Women in academic surgery: the pipeline is busted.

PURPOSE: This investigation examined the trends for gender-based advancement in academic surgery by performing a comparative analysis of the rate of change in the percentage of medical students, surgery residents, and full professors of surgery who are women. METHODS: All available Women in Medicine Annual Reports were obtained from the American Association of Medical Colleges (AAMC). The gender compositions of medical graduates, surgery residents, and full professors were plotted. Binomial and linear trendlines were calculated to estimate the year when 50% of surgery full professors would be women. Additionally, the percentage distribution of men and women at each professorial rank was determined from 1995 to 2009 using these reports to demonstrate the rate of academic advancement of each gender. RESULTS: The slope of the line of increase for women full professors is significantly less than for female medical students and for female general surgery residents (0.36, compared with 0.75 and 0.99, respectively). This predicts that the earliest time that females will account for 50% of full professors in surgery is the year 2096. When comparing women and men in academic ranks, we find that women are much less likely than men to be full professors. CONCLUSIONS: The percentage of full professors in surgery who are women is increasing at a rate disproportionately slower than the increases in female medical students and surgery residents. The rates of increase in female medical students and surgery residents are similar. The disproportionately slow rate of increase in the number of female full professors suggests that multiple factors may be responsible for this discrepancy.

Carotid artery stenting for stenosis following cervical radiotherapy: report of early failure with associated stent fracture.

Experience with carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CE) for management of carotid stenosis continues to evolve. We report the case of a 64-year-old man who was treated with bilateral CAS for stenoses, which developed 7 years following thyroidectomy, neck dissection, and radiotherapy. Although long considered an ideal alternative to CE in this clinical setting, CAS in this case was complicated by multiple episodes of recurrent stenosis in his left carotid, managed by balloon angioplasty. Severe, early recurrence in his right carotid associated with a type III stent fracture was managed by CE. Close surveillance and intervention prevented neurologic morbidity. This case, combined with emerging published experience, argues for reappraisal of the general consensus that CAS is an ideal alternative to CE for radiotherapy-associated carotid stenoses.

Common femoral vein aneurysm simulating an inguinal hernia.

Common femoral vein aneurysms are rare, yet knowledge of this entity is important for the surgeon who performs hernia repairs. This is because common femoral vein aneurysms can simulate inguinal or femoral hernias, and misdiagnosis can lead to significant morbidity if treated incorrectly. To our knowledge, only five other cases of femoral aneurysms simulating inguinal or femoral hernias have been reported. We present the case of a 50-year-old male with inguinal pain and swelling who was found to have a common femoral vein aneurysm at surgical exploration for hernia repair. The etiology, diagnostic strategy, and management options for common femoral vein aneurysm are presented and are followed by recommendations for operative management. In the case of an unanticipated femoral aneurysm found during hernia repair, we recommend termination of the procedure followed by elective repair to be performed after appropriate diagnostic testing has been completed.