Can preoperative computed tomography of the chest predict completeness of the major pulmonary fissure at surgery?

BACKGROUND: An incomplete major pulmonary fissure can make anatomic lung resection technically more difficult and may increase the risk of complications, such as prolonged postoperative air leak. The objective of this study was to determine if preoperative computed tomography (CT) of the chest could accurately predict the completeness of the major pulmonary fissure observed at the time of surgery. METHODS: From October 2008 to June 2009, patients at a single university institution were enrolled if they underwent surgery for a pulmonary nodule, mass or known cancer. At the time of surgery, completeness of the major pulmonary fissure was graded 1 if pulmonary lobes were entirely separate, 2 if the visceral cleft was complete with an exposed pulmonary artery at the base with some parenchyma fusion, 3 if the visceral cleft was only evident for part of the fissure without a visible pulmonary artery and 4 if the fissure was absent. The preoperative CT scan of each patient was graded by a single, blinded chest radiologist using the same scale. We used the Pearson χ2 test with 2-tailed significance to test the independence of the operative and radiologic grading. RESULTS: In 48% (29 of 61) of patients, the radiologic and operative grading were the same. Of those graded differently, 94% (30 of 32) were within 1 grade. Despite this agreement, we observed no statistically significant correlation between the operative and radiologic grading (p = 0.24). CONCLUSION: The major fissure can often be well-visualized on a preoperative CT scan, but preoperative CT cannot accurately predict the completeness of the major pulmonary fissure discovered at surgery.

Thoracic surgery training in Canada according to the residents: the thoracic surgery resident survey, of the Canadian thoracic manpower and education study (T-Med).

OBJECTIVE: The resident component of the Canadian Thoracic Manpower and Education Study (T-MED) was conducted to understand the basic demographic of Canadian thoracic surgery residents, the factors influencing their selection of training programs, current work conditions, training and competencies, and opinions in regard to the manpower needs for the specialty. DESIGN: A modified Delphi process was used to develop a survey applicable to thoracic surgery residents. In May and June 2009, residents completed the voluntary anonymous Internet-based survey. All Canadian residents participated in the survey, providing a 100% response rate. RESULTS: Most respondents were male (11/12), and the average age was 34 years old with an anticipated debt greater than $50,000 on graduation. All residents worked more than 70 hours per week, with most doing 1 : 3 or 1 : 4 on-call. Two-thirds of respondents reported being satisfied or very satisfied with their training program. Rates of anticipated competence in performing various thoracic surgeries on graduation differed between residents and program directors. Two-thirds (8/12) of residents planned to practice thoracic surgery exclusively, and hoped to practice in an academic setting. Most residents (10/12) agreed or strongly agreed that not enough jobs are available in Canada for graduating trainees and that the number of residency positions should reflect the predicted availability of jobs. CONCLUSIONS: This study has provided detailed information on thoracic surgery resident demographics and training programs. Most thoracic surgery residents are satisfied with their current training program but have concerns about their job prospects on graduation, and they believe that the number of training positions should reflect potential job opportunities. This survey represents the first attempt to characterize the current state of thoracic surgery training in Canada from the resident's perspective and may help in directing educational and manpower planning.

Weather and chinook winds in relation to spontaneous pneumothoraces.

BACKGROUND: Spontaneous pneumothorax (SP) results from the rupture of blebs or emphysematous bullae. Rapid changes in weather may precipitate this process. The city of Calgary is well suited to examine the effects of weather and specifically the rapid changes in weather associated with a chinook event and the occurrence of SP. METHODS: We performed a retrospective chart review of all cases of SP in the Calgary Health Region from 2001 to 2005. We obtained local hourly weather data over the same period from Environment Canada. We then compared the rates of SP on chinook and nonchinook days. Further, we compared mean daily temperature, humidity, wind speed and atmospheric pressure on chinook and nonchinook days. RESULTS: In all, 220 SP events from 149 patients occurred during the 4.5-year study period. There was no significant difference in the rate of SP on chinook days versus nonchinook days (p = 0.80). Similarly, there was no significant difference in the rate of SP in each of the 4 seasons (p = 0.30). We observed significantly higher average wind speed and lower mean atmospheric pressure on days with SP versus days without (p = 0.009, p = 0.020, respectively). There was no difference in mean temperature or mean relative humidity when comparing days with SP versus days without. CONCLUSION: We found no association between SP and chinook events. We observed significantly higher wind speeds and lower atmospheric pressures on days with SP versus days without.