ABSTRACT
A massive shift of patients to relatively specialized types of care has occurred. Until recently these patients had been treated in local centers with good results and at much less expense. The issue of the loss of moral authority at the local level is not insignificant. One cause for optimism has been the good relationship with neurosurgeons at several local trauma centers. This has allowed for most head injury patients to be treated locally, though this is not reflected in these data, as these patients were not transferred.
Subject(s)
Hospitals, Rural/organization & administration , Quality of Health Care , Trauma Centers/organization & administration , Aged , Aged, 80 and over , Health Services Misuse , Hip Prosthesis/statistics & numerical data , Humans , Kentucky , Medical Audit , Patient TransferSubject(s)
Health Care Costs , Medicaid/economics , Medicare/economics , Cost Control , Humans , Kentucky , United StatesABSTRACT
Laparoscopy and the availability of procedures which can be easily performed through the laparoscope, including appendectomy, alter the surgeon's approach towards the management of right lower quadrant pain, both acute and chronic. Laparoscopy can be utilized in a variety of clinical settings, a number far greater than those patients which would otherwise be considered proper subjects for open appendectomy. Laparoscopy can be diagnostic, therapeutic, and also prophylactic. A two year experience of managing right lower quadrant pain in a rural hospital setting was reviewed; the procedure naturally lent itself to a variety of patients because of its ease, safety, and diagnostic accuracy. Chart review indicates an extraordinary degree of success in alleviating both acute and chronic symptoms; only one patient appears to have recurrent right lower quadrant pain out of our entire group. The use of laparoscopy in this manner creates a paradigm for a type of medical practice that is problem-oriented instead of specialty-oriented. The pathological status of the appendix was not the only factor that predicted patients' clinical response to the procedure.
Subject(s)
Abdomen, Acute/etiology , Abdominal Pain/etiology , Appendectomy , Laparoscopy , Abdomen, Acute/surgery , Abdominal Pain/surgery , Adolescent , Adult , Aged , Child , Child, Preschool , Chronic Disease , Diagnosis, Differential , Female , Humans , Male , Middle AgedABSTRACT
Bilateral ectopic pregnancy is a rare phenomenon. It has been 76 years since the first published report of a case of bilateral ectopic pregnancy. Since then about 200 cases have been reported in the literature; we report a case here.
