ABSTRACT
Advances in medicine, including diagnostic techniques and therapeutic procedures, have resulted in the ambulatory management of many diseases. A number of surgical procedures previously considered to require hospitalization now are offered on a routine basis as an outpatient or short-stay admission. Although the use of microdiscectomy for the treatment of virgin herniated disc in ambulatory patients has been reported in very limited numbers, it has not been applied to other problems, such as recurrent herniated disc, far lateral disc, or foramenal stenosis. In addition, it only has been used in optimal patients. The authors analyzed a diverse group of patients who underwent outpatient microdiscectomy and found, for most patients studied, hospitalization was not necessary. Seventy-four patients were prospectively studied to determine whether unilateral root decompression for disc or stenosis could be accomplished on an ambulatory basis. Ninety percent of the patients were able to be discharged on the day of surgery. There was no significant morbidity related to the ambulatory approach. The authors also found a significant cost savings for third party reimbursers.
Subject(s)
Ambulatory Surgical Procedures , Diskectomy , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Adult , Diskectomy/economics , Diskectomy/methods , Female , Humans , Male , Microsurgery/economics , Microsurgery/methods , Middle Aged , Prospective Studies , RecurrenceABSTRACT
A case of postoperative dissemination of fat particles into the cerebrospinal fluid pathways is reported. Following removal of a foramen magnum meningioma, a postoperative MR scan showed fat droplets in the basal cisterns and in the frontal horns of the lateral ventricles. The patient was asymptomatic and a repeat MR scan 7 months later was normal, with resolution and clearing of the previously noted cerebrospinal fluid fat.
Subject(s)
Foramen Magnum , Lipids , Meningeal Neoplasms/surgery , Meningioma/surgery , Postoperative Complications/diagnosis , Skull Neoplasms/surgery , Subarachnoid Space , Aged , Female , Humans , Magnetic Resonance ImagingABSTRACT
In a review of 38 glioblastoma patients for whom fresh tissue kinetic data were available before any therapy was instituted, no correlation between the labeling index and survival time could be statistically determined. This relationship seems entirely consistent with the published theoretical determinants of tumor behavior: that is, altered ability for growth arrest and differentiation, constantly evolving mutant sublines, genetic instability, and an ever-changing metabolic and vascular environment.
