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The purpose of this study was to analyze hospital cost, resource utilization, and outcome by age for a large group of hospitalized plastic surgical patients using the DRG format. Hospital cost per patient for all plastic surgical admissions (both inpatient and potentially ambulatory patients) treated (N = 1632) at an academic medical center increased with age and peaked for plastic surgical patients 75 to 80 years of age ($11,585 per patient). Although DRG payment would have produced an aggregate profit of $2,404,854, older plastic surgical patients (65 years of age and above) generally produced losses. Older plastic surgical patients demonstrated a longer hospital length of stay, a greater severity of illness, a higher percent of outliers, and a greater mortality than younger plastic surgical patients. In addition, older plastic surgical patients had higher clinical resource utilization based on a number of clinical parameters such as emergency admission, SICU utilization, need for blood transfusions, and need for plasma product infusions. This study suggests that the current DRG reimbursement methodology may be inequitable vis-à-vis the older plastic surgical patient. As additional pressures encourage the performance of more ambulatory procedures (previously performed as inpatients), our profit margins may decline and possibly affect our ability to provide quality plastic surgical care. 相似文献
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C J Green 《Laboratory animals》1987,21(1):1-10
Laboratory animals have been crucial to the development of modern microsurgical techniques which are now routinely used in many clinical departments worldwide. In return, microsurgical techniques are important in biomedical research as they allow many surgical procedures to be performed on rodents instead of dogs, pigs or primates. This has obvious advantages in terms of low cost, the use statistically valid numbers for comparison and the availability of genetically defined animals which are more likely to give valid answers to immunological questions. Microsurgical reconstruction is important in plastic, orthopaedic, urogenital, vascular and peripheral nerve surgery in man and it is likely that it will become part of every surgeon's training in the near future. In this review, the instrumentation essential to any microsurgical enterprise and the sutures available are described. Basic microsurgical techniques for end-to-end and end-to-side anastomosis of small vessels and for joining peripheral nerves, oviducts and other tubular structures are given in outline. Techniques for transplanting kidney, heart, heart and lung, liver, spleen, pancreas, small bowel, stomach, testicle, ovary and whole joint are only outlined but key references are given. Finally, some of the clinical indications for microsurgical reconstruction are reviewed. 相似文献
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听神经瘤的显微外科现状 总被引:1,自引:0,他引:1
听神经瘤是主要起源于前庭神经的良性肿瘤,手术切除是其主要治疗方法之一,听神经瘤常用手术入路包括枕下乙状窦后入路(RSC)、经颅中窝入路(MFC)、经迷路入路(TLC)三种手术入路.非手术治疗包括放射治疗以及动态影像学观察.术中面神经监测应用为解决听神经瘤手术中面神经功能保留问题提供了一种很好的途径,使听神经瘤的并发症发生率已大大降低.本文就听神经瘤外科治疗做一综述. 相似文献
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目的:观察不同软通道微创手术方式治疗小脑出血的临床疗效。方法:高血压脑出血25例分成软通道微创血肿清除组(n=14)和侧脑室引流组(n=11)。以治疗后28天SSS和死亡率作为判断疗效的标准,比较两组的疗效。2组患者在入院时和入院后7 d行(格拉斯哥昏迷量表,Glasgow coma scale,GCS)评分,入院时和入院后14d及28d行(斯勘的纳维亚卒中量表,Scandinavianstroke scale,SSS)评分。结果:治疗组手术后SSS评分14d(t=3.65 P〈0.01)及30d(t=4.01,P〈0.01),治疗组明显优于对照组。两组总有效率比较有显著差异(P〈0.05)。结论:软通道微创血肿清除术疗效优于单纯侧脑室引流术,其作为治疗小脑出血的微创治疗技术总体上是安全、有效的,明显降低了患者死亡率,提高了患者生存质量。 相似文献
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The objective of this study is to investigate the operative methods and therapeutic effects of stereotactic-guided microsurgical resection of hypertensive cerebral hemorrhage lesions in functional region. 18 cases of intracranial lesions (diameter 1.5–3 cm) were studied using a Leksell-G stereotactic system. Guided by the CT or MR, a small incision was made and the skull was opened with an annular drill. Electrophysiological stimulation was applied along the non-functional areas. 100 patients with cerebral hemorrhage were randomized into two groups of 50 cases each. One of the groups was treated using microsurgery, while the other group was treated using stereotactic technique. A comparative study was carried out between the two treatment methods for hypertensive intracerebral hemorrhage using the recent (1 month) and long-term (6 months) treatment. Using a Leksell-G system for precise positioning of microsurgery, 100 % of the lesion was fully removed. Neurological function was well protected without mortality or neurological deficiency. The use of stereotactic microsurgery for hypertensive intracerebral hemorrhage is successful compared with traditional methods. There is a significant clinical effect on the recovery of neurological function in patients. Stereotactic microsurgical resection of the lesion along with Ribbon treatment of hypertensive cerebral hemorrhage is an accurate, minimally invasive, safe, and effective surgical method. 相似文献
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桥小脑角区脑膜瘤显微外科手术17例分析 总被引:1,自引:0,他引:1
目的:探讨桥小脑角脑膜瘤的临床表现及相应的手术治疗方案,提高显微外科手术治疗效果.方法:回顾分析我院近5年来收治的17例桥小脑角脑膜瘤患者,均采用枕下乙状窦后手术入路.结果:本组肿瘤全切率为88.3%面神经和位听神经功能大部分保留,无死亡病例.结论:术前详细的检查和完善的手术方案制订对桥小脑角区脑膜瘤的手术治疗至关重要,显微外科手术是治疗桥小脑角区脑膜瘤安全有效的方法 相似文献
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J W Smith 《Plastic and reconstructive surgery》1966,37(3):227-245
This review of microsurgery considers the current status of both experimental and clinical uses of microsurgery in the fields of otolaryngology, ophthalmology, gynecology, the central and peripheral nervous systems, the vascular system and transplantation. A report of studies on the microcirculation of blood vessels and nerves demonstrated the usefulness of mignification for research studies and emphasized certain factors which could be significant in selecting the best techniques for repairing nerves and blood vessels. Techniques of repair are included, for they have been changed on the basis of experimental studies. Consideration has been given to the advantages of magnification in identification and removal of tumors and vascular anomalies. A report on the use of microtechniques for repairing fallopian tubes is included. It provides a basis for reviewing the problems associated with the repair of small tubes and ducts. The need for microtechniques should increase as medical progress calls for greater precision for the fields of reparative, reimplantation and transplantation surgery. 相似文献
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S N Fedorov A I Ivashina S I Anisimov L N Prokopenko A L Moskvichev 《Vestnik rentgenologii i radiologii》1989,(1):57-59
The paper is devoted to analysis of the results of CT in 1000 patients examined in the Multibranch Research and Technology Complex Eye Microsurgery. The specific feature of CT in this institution is that 52% of all investigations of ophthalmological patients fall to the share of eyeball abnormality and 40%--to a study of the other parts of the organ of vision. CT indications are extended for low tension glaucoma, complicated high myopia, and for monitoring the position of microsurgical implants. The use of CT in such a highly specialized medical institution as the MRTC Eye Microsurgery is considered indispensable. 相似文献
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Decision makers are interested in measuring the costs and benefits of various interventions, and sometimes they are presented with the average costs and benefits of alternative interventions and asked to compare these. Usually a newer intervention is being compared with an existing one, and the most appropriate comparison is not of average costs (and benefits) but of the extra--or marginal--costs (and benefits) of the new intervention. Reanalysis of the cost effectiveness ratio of biochemical screening of all women for Down''s syndrome compared with age based screening shows that the marginal cost effectiveness of biochemical screening is 47,786 pounds, compared with an average cost effectiveness of 37,591 pounds. It may sometimes be difficult or costly to calculate marginal costs and benefits, but this should be done whenever possible. 相似文献
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Huseyin C. Yalcin Akshay Shekhar Ajinkya A. Rane Jonathan T. Butcher 《Journal of visualized experiments : JoVE》2010,(44)
Understanding the relationships between genetic and microenvironmental factors that drive normal and malformed embryonic development is fundamental for discovering new therapeutic strategies. Advancements in imaging technology have enabled quantitative investigation of the organization and maturing of the body plan, but later stage embryonic morphogenesis is less clear. Chicken embryos are an attractive vertebrate animal model system for this application because of its ease of culture and surgical manipulation. Early embryos can be cultured for a short time on filter paper rings, which enables complete optical access for cell patterning and fate studies1,2. Studying advanced developmental processes such as cardiac morphogenesis are traditionally performed through a window of the eggshell3-5, but this technique limits optical access due to window size. We previously developed a simple method to culture whole embryos ex-ovo on hexagonal weigh boats for up to 10 days, which enabled high resolution imaging via ultrasonography6,7. These cultures were difficult to transport, limiting the types of imaging tools available for live experiments. We here present an improved shell-less culture system with a cost-effective, portable environmental chamber. Eggs were cracked onto a hammock created by a polyurethane membrane (cling wrap) affixed circumferentially to a plastic cup partially filled with sterile water. The dimensions of the circumference and depth of the hammock were both critical to maintain surface tension, while the mechanics of the hammock and water beneath helped dampen vibrations induced by transportation. A small footprint circulating water bath was also developed to enable continuous temperature control during experimentation. We demonstrate the ability to culture embryos in this way for at least 14 days without morphogenic defect or delay and employ this system in several microsurgical and imaging applications.Download video file.(67M, mov) 相似文献
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M. Shane Hutson J. Veldhuis Holley E. Lynch G. Wayne Brodland 《Biophysical journal》2009,97(12):3075-3085
Laser microsurgery and finite element modeling are used to determine the cell-level mechanics of the amnioserosa—a morphogenetically crucial epithelium on the dorsal surface of fruit fly embryos (Drosophila melanogaster). In the experiments, a tightly focused laser ablates a subcellular hole (1 μm in diameter) that passes clean through the epithelium. The surrounding cells recoil from the wound site with a large range of initial recoil velocities. These depend on the embryo's developmental stage and the subcellular wound site. The initial recoil (up to 0.1 s) is well reproduced by a base finite element model, which assumes a uniform effective viscosity inside the cells, a constant tension along each cell-cell boundary, and a large, potentially anisotropic, far-field stress—one that far exceeds the stress equivalent of the cell-edge tensions. After 0.1 s, the experimental recoils slow dramatically. This observation can be reproduced by adding viscoelastic rods along cell edges or as a fine prestressed mesh parallel to the apical and basal membranes of the cell. The mesh also reproduces a number of double-wounding experiments in which successive holes are drilled in a single cell. 相似文献
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