Canal wall planning by engine-driven nickel-titanium instruments, compared with stainless-steel hand instrumentation.

Twenty-two mesial roots of extracted human mandibular molars were divided into two groups based on root curvature and length. The mesiolingual canals were instrumented using either Flexofiles in a step-back anticurvature filing method, or they were instrumented with engine-driven 0.02 taper nickel-titanium files. Ground sections were prepared at 1-, 2.5-, and 5-mm levels from the working length. The mesiobuccal canal was used as an uninstrumented control for predentin character. Digitizing software was used to calculate the instrumented portion as a percentage of the total canal perimeter. The results indicated no significant difference in overall canal wall planning between the two groups and no significant difference at each of the three levels.

Outpatient parotidectomy at the Fallon Clinic. The first 2 years.

OBJECTIVES: To determine whether outpatient parotidectomy can be performed safely with high patient satisfaction and to compare the cost of outpatient and inpatient parotidectomy. DESIGN: A retrospective review of hospital and office charts of patients admitted for elective outpatient and inpatient parotidectomy from 1992 to 1994. SETTING: A community teaching hospital and a multispecialty group practice that are part of an integrated health care system. PATIENTS: Nineteen consecutive outpatients and 13 concurrent inpatients admitted electively for parotidectomy. INTERVENTION: Outpatient and inpatient parotidectomies performed as a sole procedure. MAIN OUTCOME MEASURES: Duration of surgery and anesthesia, length of stay after surgery, complications, hospital and office charges, and a patient satisfaction survey. RESULTS: Twenty patients were admitted for outpatient parotidectomy; 19 (95%) went home the same day. Outpatients were discharged an average of 4 hours after surgery. No complications were specifically attributable to outpatient status. The mean savings on hospital-based charges compared with a 1-night stay was $196 per case. The outpatients had 2 more postoperative visits in the first 90 days after surgery; their postoperative care cost $72 per case more than for the inpatient group. Patient satisfaction was high, but it was higher in the inpatient group. CONCLUSIONS: Parotidectomy can be performed safely on outpatients. Outpatient satisfaction was high, but inpatient satisfaction was higher. The savings per case depends on the particular cost structure of the institution and may be modest compared with that of a 1-night inpatient stay. Savings are higher when compared with the diagnosis-related group allowable stay of 4.0 days.

Hamartoma of the hypopharynx.

Hamartomas of the hypopharynx are rare. Detailed microscopic study is necessary to differentiate these tumors from the adult-type rhabdomyoma, pleomorphic rhabdomyosarcoma, and granular cell tumor. To our knowledge, our case of a hypopharyngeal rhabdomyomatous hamartoma removed by a lateral pharyngotomy is the only verified hypopharyngeal case in the literature, although a lesion reported by H. W. Smith in 1959 as a laryngeal rhabdomyoma most probably represents a rhabdomyomatous hamartoma, similar to that of the present case.

A comparison of surgical assisting in a prepaid group practice and a community hospital.

Previous studies of the work loads and time utilization of general surgeons in two different practice settings suggested that paraprofessional surgical assistants (SAs) could reduce surgeon assisting time and perhaps increase productivity. In order to further assess the potential advantage of using SAs as surgical assistants, the present study examines assisting patterns in a prepaid group practice where SAs are used and in a community hospital where only physicians are available to assist. In the prepaid group practice, 87 per cent of general surgical procedures were performed with an assistant; in the c ommunity hospital, 67 per cent of general surgical procedures were performed with an assistant. General practitioners also were found to assist in the community hospital; family practice residents, medical students and "others" also assisted in prepaid group. In both settings, the propensity to use an assistant was positively correlated with operative complexity. On operations of greatest complexity, surgeons were most likely to act as first assistants. The use of SAs was not usually associated with operative sessions longer than when surgeons assisted, except on operations of high complexity. In the prepaid group, SAs also frequently assisted on orthopedic surgery, neurosurgery and obstetrics-gynecology, only occasionally on otolaryngology and plastic surgery, and never on ophthalmology. It appears that in organizations such as a prepaid group practice, where mechanisms for sharing resources exist and incentives are provided to minimize the total cost of surgery, the utilization of SAs might be associated with cost savings. At present, organizational and financial barriers exist to the introduction of paraprofessionals as surgical assistants. It is difficult to advocate the modification of these barriers to facilitate the training and large-scale introduction of this new group of paraprofessionals in the current surgical market where there may already be an excess supply of surgeons.