Achilleas Lazopoulos

Burnout syndrome and job satisfaction in Greek residents: exploring differences between trainees inside and outside the country

BACKGROUND The purpose of this study is to investigate the levels of burnout among Greek residents, highlighting potential differences between those practicing at home and abroad, as well as to investigate correlations with demographic, individual and labor factors. METHODS The research was conducted on a sample of 131 residents, using an anonymous questionnaire which included demographic, individual and labor characteristics, Maslachs Burnout Inventory, questions regarding job and life satisfaction levels, working conditions and the impacts of the economic recession. RESULTS Fifty two point seven percent of the sample were training in the Greek National Health Service (N.H.S.), 27.5% in Germany and 19.8% in the United Kingdom. One out of three residents in the Greek system showed high levels of burnout in all three dimensions of the syndrome, while 51.1%, 72.2% and 30.8% of the Greek, British and German team, respectively, appeared burnt out simultaneously in two dimensions. Levels of job and life satisfactions ranged on average, while workload appeared heavy. CONCLUSIONS The occurrence of burnout was associated with gender, specialty, employment characteristics (working hours, autonomy, support etc.), proneness to accidents, country, job satisfaction and quality of life, but was not associated with age or marital status. No correlation was found with susceptibility to medical errors.

Late Postpneumonectomy Death From Stump Thrombus

64-year-old patient underwent right pneumonecAtomy for stage IIB lung adenocarcinoma. Routine follow-up was uneventful. Five years later, the patient was admitted urgently to our institution because of severe dyspnea and clinical findings consistent with acute right heart failure. The echocardiogram confirmed right ventricle pressure overload. Computed tomography (CT) of the chest revealed right pulmonary artery stump convex thrombus expanding to the left main pulmonary artery (Figs 1, 2). True pulmonary emboli were not demonstrated in the CT. Despite immediate thrombolysis, the patient was intubated and died 7 days later. The reported prevalence of pulmonary artery stump thrombosis after pneumonectomy is 12% [1]. It is usually identified incidentally during follow-up CT scans and

Video-assisted thoracic surgery reduces early postoperative stress. A single-institutional prospective randomized study

Background Video-assisted thoracic surgery (VATS) has been shown to effectively reduce postoperative pain, enhance mobilization of the patients, shorten in-hospital length of stay, and minimize postoperative morbidity rates. The aim of this prospective study is to evaluate neuroendocrine and respiratory parameters as stress markers in cancer patients who underwent lung wedge resections, using both mini muscle-sparing thoracotomy and VATS approach. Methods The patients were randomly allocated into two groups: Group A (n=30) involved patients who were operated on using the VATS approach, while in group B (n=30), the mini muscle-sparing thoracotomy approach was used. Neuroendocrine and biological variables assessed included blood glucose levels, C-reactive protein (CRP) levels, cortisol, epinephrine, and adrenocorticotropic hormone (ACTH) levels. Arterial oxygen (PaO2) and carbon dioxide (PaCO2) partial pressure were also evaluated. All parameters were measured at the following time points: 24 hours preoperatively (T1), 4 hours (T2), 24 hours (T3), 48 hours (T4), and 72 hours (T5), after the procedure. Results PaO2 levels were significantly higher 4 and 24 hours postoperatively in group A vs group B, respectively (T2: 94.3 vs 77.9 mmHg, P=0.015, T3: 96.4 vs 88.7 mmHg, P=0.034). Blood glucose (T2: 148 vs 163 mg/dL, P=0.045, T3: 133 vs 159 mg/dL, P=0.009) and CRP values (T2: 1.6 vs 2.5 mg/dL, P=0.024, T3: 1.5 vs 2.1 mg/dL, P=0.044) were found increased in both groups 4 and 24 hours after the procedure. However, their levels were significantly lower in the VATS group of patients. ACTH and cortisol values were elevated immediately after the operation and became normal after 48 hours in both groups, without significant difference. Postoperative epinephrine levels measured in group A vs group B, respectively, (T2: 78.9 vs 115.6 ng/L, P=0.007, T3: 83.4 vs 122.5 ng/L, P=0.012, T4: 67.4 vs 102.6 ng/L, P=0.021). The levels were significantly higher in group B. Conclusion This study confirmed that minimally invasive thoracic surgery, by means of VATS, significantly reduces the acute-phase response and surgical stress, while enables better postoperative oxygenation.

Percutaneous tracheostomy—beware of the thyroidea-ima artery

Percutaneous tracheostomy is a minimally invasive operation performed in patients, in order to provide an air passage through the windpipe. A rare cause of severe bleeding during such operation is the injury of the thyroidea-ima artery. This case report presents a patient with hemorrhage after thyroidea-ima injury during percutaneous dilatational tracheostomy. Surgeons should always be aware of such anatomic variation, in order to prevent urgent sternotomy.

Open thoracotomy for pneumothorax.

A thoracotomy is an incision into the pleural space of the chest. It is performed by surgeons (or emergency physicians under certain circumstances) to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine. This surgical procedure is a major surgical maneuver it is the first step in many thoracic surgeries including lobectomy or pneumonectomy for lung cancer and as such requires general anesthesia with endotracheal tube insertion and mechanical ventilation, rigid bronchoscope can be also used if necessary. Thoracotomies are thought to be one of the most difficult surgical incisions to deal with post-operatively, because they are extremely painful and the pain can prevent the patient from breathing effectively, leading to atelectasis or pneumonia. In the current review we will present the steps of this procedure.

A macroscopic analysis of the epidemiology of thoracic aorta atherosclerosis: An autopsy study

Background: Atherosclerosis is the most important cardiovascular disease across the globe with a large proportion of associated morbidity and mortality. The aim of this study is to detect the presence of atherosclerosis-like lesions in the three segments of the thoracic aorta (ascending aorta, aortic arch and descending aorta) of 50 unselected adult cadavers of all ages. Methods: An autopsy analysis was performed using 50 unselected adult cadavers (37 male, 13 female – mean age 64.2 years; age range 19-90 years). Macroscopic dissection of the three segments of the thoracic aorta was performed and the presence of atherosclerosis-like lesions was evaluated according to the subjects’ demographic and clinical characteristics. Results: Atherosclerotic lesions in at least one of the three aortic segments were identified in 82% of cadavers, 83.78% of male and 76.92% of female. Of 50 subjects, 30% had an atherosclerotic lesion in the ascending aorta, 48% in the aortic arch and 44% in the descending aorta. No aneurysmal changes were detected. Smoking, hypertension, diabetes, hypercholesterolemia, obesity and coronary disease were the risk factors correlated most with the presence of atherosclerosis. Conclusions: Atherosclerosis-like lesions in the thoracic aorta are prevalent in adults of all ages. Obesity is a major risk factor regarding the development of atheromas. This cadaveric study comes to underline the necessity of further similar studies in order to evaluate the presence of atherosclerosis in the thoracic aorta, and also helps to assess the risk of major cardiovascular events in the general population.

Single sternal metastasis due to malignant melanoma with unexpected long-term survival: a case report.

Metastases from melanoma have a very poor prognosis for the patient. Single metastatic lesions in the sternum due to melanoma are extremely rare. A rare case of a presternal mass in a 56-year-old patient who had undergone excision for malignant melanoma is presented. Review of the patient’s history and surgical resection of a single metastatic soft tissue lesion offer the best chance of long-term survival.

eComment. Spontaneous regression of thymic tumours

It is with great interest that I have read the article by Fukui et al. [1]. Spontaneous regression of thymic epithelial tumours is rare according to the international bibliography and the three cases presented are really interesting. The regression of thymic epithelial tumours is not well explained but it looks that there is an important role of autoantibodies in such incidents, and in other autoimmune disorders related with thymomas [2]. There are cases reported in the literature related to thymic hyperplasia due to systemic chemotherapy and complete remission after finishing it. The thymus gland seems to be a part of the immunological mechanism not well understood until now [3]. The treatment for thymomas is surgical and, according to the type, radiotherapy or chemotherapy can follow [4]. In selective patients in whom absence of malignancy is proven by computed tomography (CT)-guided biopsy or else, repeated CT scanning can reveal such cases of spontaneous regression of thymic tumours, and lead to radiological and clinical monitoring rather than surgical treatment. High index of suspicion and supervision is mandatory in such cases [5]. Conflict of interest: none declared

eComment. Alveolar echinococcosis of the lung.

We read with great interest Karaman et al.s rare case concerning lung infection with Echinococcus alveolaris [1]. We would like to highlight two points concerning the conservative treatment and imaging characteristics of alveolar echinococcosis (AE). AE is a severe disease, with a mortality of over 90% in untreated patients. Radical surgery combined with chemotherapy for up to 2 years after surgery is recommended. Inoperable cases or patients who have undergone liver transplantation require continuous chemotherapy for many years. Long-term chemotherapy may significantly prolong survival [2]. Benzimidazoles, albendazole and mebendazole are presently used as chemotherapeutic agents. Failures in drug treatment as well as the occurrence of side effects have been reported, leading to the discontinuation of treatment or to progressive diseases [3]. Intravenous amphotericin B (preferably as a lipid emulsion) may be used as rescue chemotherapy in patients resistant or intolerant to benzimidazoles. Pilot trials with interferon-gamma and nitazoxanide were unsuccessful. Interferon-alpha has yet to be tested in a pilot trial. With regard to diagnosis, ultrasonography, computed tomography (CT) and magnetic resonance (MR) with standard and diffusion-weighted sequences all provide useful information and serve complementary roles in detecting and characterizing echinococcal lesions. Cross-sectional imaging is crucial for differentiating echinococcosis from malignant processes. CT is most useful for depicting the peripheral calcifications surrounding established echinococcal cysts, and MR imaging is most helpful for identifying echinococcosis of the central nervous system [4]. Conflict of interest: none declared

eComment. Primary mediastinal sarcomas

We have read with great interest the article by Luo et al. concerning the surgical outcomes for primary mediastinal sarcomas [1]. Sarcomas of the mediastinum and great vessels remain a rare subgroup of soft tissue sarcomas and prognosis remains poor with patients often presenting with advanced disease. Surgical resection represents the mainstay of therapy. The aim of this brief comment is to highlight the role of chemotherapy in a preoperative and postoperative setting. The key is to identify chemosensitive subtypes of mediastinal sarcomas (i.e. synovial sarcomas) and there is evidence of satisfactory results in the literature [2,3]. Conflict of interest: none declared.