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Background In a previous article (10.1007/s00701-019-03888-3), preliminary results of a survey, aiming to shed light on the number of surgical procedures performed and assisted during neurosurgery residency in Europe were reported. We here present the final results and extend the analyses. Methods Board-certified neurosurgeons of European Association of Neurosurgical Societies (EANS) member countries were asked to review their residency case logs and participate in a 31-question electronic survey (SurveyMonkey Inc., San Mateo, CA). The responses received between April 25, 2018, and April 25, 2020, were considered. We excluded responses that were incomplete, from non-EANS member countries, or from respondents that have not yet completed their residency. Results Of 430 responses, 168 were considered for analysis after checking in- and exclusion criteria. Survey responders had a mean age of 42.7 ± 8.8 years, and 88.8% were male. Responses mainly came from surgeons employed at university/teaching hospitals (85.1%) in Germany (22.0%), France (12.5%), the United Kingdom (UK; 8.3%), Switzerland (7.7%), and Greece (7.1%). Most responders graduated in the years between 2011 and 2019 (57.7%). Thirty-eight responders (22.6%) graduated before and 130 responders (77.4%) after the European WTD 2003/88/EC came into effect. The mean number of surgical procedures performed independently, supervised or assisted throughout residency was 540 (95% CI 424–657), 482 (95% CI 398–568), and 579 (95% CI 441–717), respectively. Detailed numbers for cranial, spinal, adult, and pediatric subgroups are presented in the article. There was an annual decrease of about 33 cases in total caseload between 1976 and 2019 (coeff. − 33, 95% CI − 62 to − 4, p = 0.025). Variables associated with lesser total caseload during residency were training abroad (1210 vs. 1747, p = 0.083) and female sex by trend (947 vs. 1671, p = 0.111), whereas case numbers were comparable across the EANS countries (p = 0.443). Conclusion The final results of this survey largely confirm the previously reported numbers. They provide an opportunity for current trainees to compare their own case logs with. Again, we confirm a significant decline in surgical exposure during training between 1976 and 2019. In addition, the current analysis reveals that female sex and training abroad may be variables associated with lesser case numbers during residency.

Summary Electrical anesthesia was induced in 75 mongrel dogs using direct current combined with an alternating rectangular wave applied in the midsagittal plane between the chin and the posterior parietal area with platinum-sponge electrodes. Duration of the wave was varied from 0.1 to 1. millisecond: the frequency from 100 to 1000 cps. The electrodes were applied by a simple technique of gluing with Eastman 910 adhesive and tape. Systolic and diastolic blood pressure increased during induction and with any subsequent increases in current or with any sudden decrease in current. Gradual decreases in current did not have this effect. Bradycardia (sometimes alternating with tachycardia) occurred at the same time as the hypertension. During steady states of anesthesia, arterial blood pressure and rhythm returned to normal. the blood pressure more slowly. Upon cessation of current, blood pressure (if still elevated) immediately returned to normal. Prior sedation reduced these pressor reactions. Electric current applied to an extremity resulted in similar cardiovascular changes, which were ablated by denervation of the extremity. Placing of electrodes on the cranial bones did not decrease cardiovascular changes, nor did prefrontal lobotomy. All combinations of durations and frequencies produced hypertension and bradycardia. These changes were greater with lower frequencies and shorter durations. However, less satisfactory anesthesia resulted with the higher frequencies. Gradual or abrupt application of an anesthetic level had similar cardiovascular effects. An instantaneous application of an anesthetic level using 100 cps with a 1 millisecond pulse was adopted for routine use. A table of peak voltages was obtained with various combinations of wave frequency and duration. The peak voltage increased with decreasing percentage of time of passage of current (pulse duration/period ratio). It is suggested that this may be the dosage measurement related to anesthetic level. Respiratory and pressor reactions to intravenous sodium cyanide and to inhaled carbon dioxide were present during and after electrical anesthesia. The occasional increases in body temperature which occur during electrical anesthesia appear to be the result of muscular activity combined with failure of the panting mechanism and can be avoided by paralyzing drugs or adequate pulmonary ventilation. Skin (paw) temperature reactions to electrical anesthesia were not consistent. Skin temperature increases were observed after barbiturates (prolonged increase) and succinylcholine (brief increase). Electrical anesthesia would appear to be a suitable method for the surgical preparation of experimental animals for awake experiments.

The filling pressure in the minute vessels of the skin of the foot has been estimated by a method of elevation and reactive hyperemia. A series of 90 observations was made on 78 patients. This test has been found helpful in evaluating the degree of arterial insufficiency, permitting a more accurate selection of patients to be treated by conservative methods, local amputation or more radical procedures.

The nutrient arteries of eleven tibiae and eight humeri were ligated. In every instance there was an immediate and usually a large decrease in intramedullary pressure. In nine bones the pressure rose to preocclusion levels within less than three hours. In an additional eight the pressure returned to normal within from four to twenty-two days. In only two instances did the postligation pressure not recover during the period of observation (sixteen to twenty-five days). Post mortem injection of the subclavian or femoral artery resulted in filling of the nutrient arterial system via collateral channels in all specimens.

Osteomalacia is a metabolic disease of bone in which there is a deficient mineralization of the bony matrix. The amount of matrix present is normal or slightly increased. The defective deposition of calcium salts is due to the lowered concentration of calcium or phosphorus, or both, in the body fluids, as a result either of impaired absorption from the gastrointestinal tract or increased renal excretion. Because of their decreased mineral content, the bones are weakened, becoming soft and bending readily. Deformities of the extremities, pelvis, vertebrae, and skull may occur. As a result of the weakening of the bones, the osteoblasts are stimulated to lay down new bone matrix and elaborate alkaline phosphatase, which is usually present in abnormal concentration in the blood serum (1). In some cases of osteomalacia, multiple, almost symmetrical, radiolucent bands of diminished density, resembling fractures, occur in the cortex of the bone. These pseudofractures are seen most frequently in the axillary bord...

S MALL BOWEL reversal was first studied by Mall [1}, Miihsam [2] and McClure [3]. The conclusion of these early investigators was that small intestine reversal was fatal to dogs. Within the last ten years interest has been reawakened in surgical procedures designed to delay intestinal transit time [4,5]. Reversal of a small se~nent of terminal ilcmn by these recent investigators has demonstrated that this procedure is compatible with prolonged survival. Protracted survival with maintenance of nutritional balance after massive small bowel resection and end to end anastomosis is frequently difficult or impossible to achieve [6]. The exact length of small bowel necessary to preserve adequate nutrition is variable and depends on several factors, i.e., adequacy of the blood supply, whether the residual segqnent is proxinml jejunum or terminal ileum, the activity and age of the individttal and even perhaps the efficiency of his metabolic processes. Infarction of small bowel may be due to underlying cardiovascular disease, producing thrombosis or embolism in tim superior mesenteric artery (or one of its main branches), intestinal atresia, cardiac decompensation, injury, volvulus, internal herniation or strangulation obstruction clue to adhesions or tmnors. The literature on the subject of small bowel resection, as well as our own experience with $5 per cent small bowel resection in eighty. three mongrel dogs in the experimental surgery laboratories of Presbyterian Medical Center and Children's Hospital, San Francisco, indicate the creation of the following metabolic abnormalities: (1) hypowflemia, (2) metabolic acidosis, (3) megaloblastic anemia, (4) markedly reduced absorption of vitamin Br.,, fats and fat ty acids (Pz~-tagged oleie acid, Dxylose cholesterol) [7]. A considerable portion of neutral fat is absorbed undigested and this process is largely localized in the proximal small bowel. When this area is removed, absorption is slower, but eventually takes place from lower se~nents after enzymatic digestion. The jejunum absorbs all of the carbohydrate and most of the fat and protein before these substances reach the ilemn. Upon resection of the ileum and ile~ecal valve, absorption by the jejunmn is greatly decreased due to "jejunal hurry," i.e., decreased intestinal transit time because of loss of the ileocecal valve. (5) Hypoproteinemia with relative increase in globulins and decrease in albumin. This situation frequently will cause partial anastomotic obstruction and compound the state of malnutrition [8,9]. (6) Hypocalcemia.

In the literature the nutrient artery to the diaphysis of the canine femur has been described as arising from the medial circumflex femoral artery which is a branch of the deep femoral artery. However in 19% to 100 canine hind extremities dissected after injection with colored media, the femoral nutrient artery arose from a large muscular branch (the proximal posterior femoral) of the superficial femoral artery. In 17% of 42 dogs one femur only was supplied by this variant. In three additional femurs other variations occurred.

A method of obviating the carotid and aortic body chemoreceptor response has been presented consisting of excision of the carotid bodies and denervation of the aortic body or bodies. The physiological responses of these animals to high altitude acclimatization are characterized by a marked increase in erythrocyte volume, a decrease in plasma volume, and a minimal increase in total blood volume. The respiratory response to anoxia is markedly decreased and the sensitivity to inspired CO 2 at high altitude is unchanged from that at sea level.

Blood flows in the external iliac artery measured with noncannulating square wave electromagnetic flow probes are reported in 15 unmedicated rhesus monkeys. Blood flows up to 22 months after unilateral lumbar sympathectomy increased 5–200% when compared to simultaneous contralateral flows or ipsilateral flows prior to sympathectomy. Central (aortic) blood pressures in 13 old monkeys were 80–130 mm. Hg diastolic and 105–185 mm. Hg systolic. Cardiac output in two monkeys was 80–200 ml./kg./minute.

The vast majority of dissecting aneurysms originate in the aorta, with the main branches involved only by extension from the aortic source. Edwards, however, expressed the opinion that local dissecting aneurysm superimposed on atheromatous changes may be associated with thrombosis of peripheral arteries and cites a case of local dissection in the popliteal artery.1Lovitt and Corzine also report the occurrence of dissecting aneurysm in the coronary arteries.2Most dissecting aneurysms are found in relation to atherosclerotic or medial necrotic vascular changes. Careful perusal of the literature failed to reveal a case of local dissection of the renal artery without evidence of aortic involvement. Report of a Case A 47-year-old man was in apparent good health until eight hours prior to hospitalization (April 26, 1952), at which time there was the sudden onset of deep, nauseating, nonradiating, intense left flank pain. A moderate degree of shock was present

INTRODUCTION THE PRONOUNCED cutaneous hyperemia upon release of a tourniquet has long been familiar to surgeons. This reaction, which is called reactive hyperemia, has been studied in detail by a number of workers, starting with Lister and including many of the outstanding names in vascular physiology. The period of hyperemia bears a definite relationship to the length of the circulatory arrest. Provided occlusion is not prolonged for more than a few minutes, the duration of the hyperemia is usually one-half to threefourths that of the arrest. 1 It has been shown that the hyperemia represents the repayment of a blood flow debt which is built up during the period of arrest in the limb distal to the cuff.* The reaction is dependent upon accumulation of local metabolites during the period of arrest and upon the arterial pressure within the limb. 4 The intense cutaneous hyperemia is the result of dilatation