Background: Women compose half of all medical students but are underrepresented in the field of general surgery. Concerns about childbirth and pregnancy during training and practice are factors that may dissuade women from electing a career in surgery. Objective: To assess experiences related to childbirth and pregnancy among women general surgeons. Design: Survey questionnaire. Setting: Self-administered survey sent individually to women surgeons in training and practice. Participants: Women members of the Association for Women Surgeons or the American College of Surgeons who graduated from medical school and practice general surgery or a general surgery subspecialty. Main Outcome Measures: Descriptive data on the timing of pregnancy and perception of stigma attending childbirth and pregnancy as experienced by women surgeons, according to date of medical school graduation (0-9 years since graduation, 10-19 years, 20-29 years, and Ն30 years). The survey response rate was 49.6%. Trends over time were evaluated using comparisons of proportions and the Cochrane-Armitage trend tests across age cohorts. Results: The perception of stigma associated with pregnancy during training remained large but decreased from 76% in the most remote cohort to 67% in the most recent graduation cohort (PϽ .001). External influences, even women resident colleagues, were perceived as evincing negative instead of encouraging attitudes toward childbearing during residency, though less so than men, both resident colleagues and faculty. Frequency of pregnancy and pregnancies earlier in training increased over the time cohorts. Conclusions: The number of women general surgeons becoming pregnant during training has increased in recent years; however, substantial negative bias persists. Although the overall magnitude of perceived negative attitudes is greater among male peers than female peers and among faculty than peers, even women residents hold negative views of pregnancy among their colleagues during training. More than half of all women surgeons delay childbearing until they are in independent practice, post-training. Surgical residents and faculty of both sexes exerted negative influences with regard to consideration of childbearing. There was also a trend toward increased childbearing in more recent graduates.

The evolution of encephalization requires that energetic challenges be met. Several hypotheses, such as the maternal energy and expensive tissue hypotheses, have been proposed to explain how some species are able to provide adequate energetic resources for large brains. The former incorporates maternal investment strategies, such as extended life history and elevated resting metabolic rate, which contribute to the growth of a large brain. The latter incorporates the reduction of gut size, which increases available energy for the maintenance of adult brain size. This study examines a sample of strepsirrhines, testing the hypothesis that encephalized species utilize some combination of the above-mentioned strategies. Infants and juveniles from three species at the Duke Lemur Center (DLC) were measured periodically to arrive at head and body growth trajectories. These data were used to determine the energetic tradeoff among the offspring. The examination of gestation length, weaning age, intestinal size and resting metabolic rate was used to assess adult brain maintenance and maternal energetic contribution. The results reveal that Daubentonia, the most encephalized and thus human-like of the lemurs, does not experience an energetic trade-off between brain and body during ontogeny, but does exhibit a trade-off between extensive brain growth and possibly reduced intestinal growth. Also, maternal energy is utilized. Encephalized lemurs, such as Daubentonia, have higher resting metabolic rate, while encephalized lorisiforms have a longer period of gestation. These results demonstrate that there are several strategies for meeting the energetic demands of encephalization, and they can be manifested differentially across taxa.

No abstract

Pericardiocentesis (PC) is both a diagnostic and a potentially life-saving therapeutic procedure. Currently echocardiography-guided pericardiocentesis is considered the standard clinical practice in the treatment of large pericardial effusions and cardiac tamponade. Although considered relatively safe, this invasive procedure may be associated with certain risks and potentially serious complications. This review provides a summary of pericardiocentesis and a focused overview of the potential complications of this procedure.

The introduction of laparoscopy has provided trauma surgeons with a valuable diagnostic and, at times, therapeutic option. The minimally invasive nature of laparoscopic surgery, combined with potentially quicker postoperative recovery, simplified wound care, as well as a growing number of viable intraoperative therapeutic modalities, presents an attractive alternative for many traumatologists when managing hemodynamically stable patients with selected penetrating and blunt traumatic abdominal injuries. At the same time, laparoscopy has its own unique complication profile. This article provides an overview of potential complications associated with diagnostic and therapeutic laparoscopy in trauma, focusing on practical aspects of identification and management of laparoscopy-related adverse events.