Traumatic cysts of the spleen--the role of cystectomy and splenic preservation: experience with seven consecutive patients.

Nonparasitic secondary cysts (pseudocysts) of the spleen are uncommon and usually result from blunt abdominal trauma. A 3-year experience with 7 consecutive cases of posttraumatic splenic pseudocysts suggests an increased prevalence of this clinical entity. This report describes 7 adult patients (5 men and 2 women) with a mean age of 32 years, all of whom sustained relatively minor trauma within 5 years of admission. Persistent epigastric or left upper quadrant pain led to a CT scan diagnosis of splenic cysts that varied in size from 7 cm to 15 cm. Each patient underwent resection of the cyst-bearing portion of the spleen with preservation of the remaining normal splenic parenchyma. There were no deaths or complications in the entire group. Because posttraumatic splenic cysts are rare, the accumulation of a significant data base leading to firm conclusions is lacking.(ABSTRACT TRUNCATED AT 250 WORDS)

Various methods of breast reconstruction after mastectomy: an economic comparison.

This study is an economic comparison of various methods of breast reconstruction after mastectomy. The hospital bills of 287 patients undergoing breast reconstruction at three institutions from June of 1988 to March of 1991 were analyzed. The procedures examined included mastectomy, implant and tissue-expander reconstruction, and TRAM and latissimus pedicle flaps, as well as free TRAM and free gluteal flaps. These procedures were subdivided into those which were performed at the time of mastectomy and those performed at a later admission. In addition, auxiliary procedures (i.e., revision, nipple reconstruction, tissue-expander exchange, and contralateral mastopexy/reduction) also were examined. Where appropriate, these procedures were subdivided into those performed under general or local anesthesia and by inpatient or outpatient status. Data from the three institutions were converted to N.Y.U. Medical Center costs for standardization. A table is presented that summarizes the costs of each individual procedure with all the pertinent variations. In addition, a unique and novel method of analyzing the data was developed. This paper describes a menu system whereby other data regarding morbidity, mortality, and revision rates may be superimposed. With this information, the final cost of reconstruction can be extrapolated and the various methods of reconstruction can be compared. This method can be applied to almost any complex series of multiple procedures. The most salient points elucidated by this study are as follows: The savings generated by performing immediate reconstruction varies between $5092 (p < 0.05) for free gluteal flaps and $10,616 (p < 0.05) for pedicled TRAM flaps.(ABSTRACT TRUNCATED AT 250 WORDS)

Physicians at the bedside: thoughts and actions with regard to health care allocation.

In the past the study of the allocation of scarce medical resources centered around "high-tech" forms of health care, such as the use of the artificial heart and hemodialysis. The use of nonbiomedical criteria (ie, should the social worth or financial status of a particular patient dictate preferential treatment over another patient in times of shortage) in the allocation decision-making process may be at times highly controversial.The study of allocation need not only lie in the dramatic realm of high technology, but should also be directed to the less dramatic, everyday situations. Decisions concerning treatment based upon social worth and financial status are made almost daily by practitioners. A thorough understanding of this phenomenon is tantamount to the ethical and proper practice of medicine.

Physicians at the bedside: practitioners' thoughts and actions regarding bedside allocation of resources.

In the past, the study of the allocation of scarce medical resources centered around high-technology forms of health care such as the artificial heart, haemodialysis, etcetera. A major controversy considered in this study concerns the use of non-biomedical criteria (i.e., whether the social worth or financial status of a particular patient should dictate preferential medical treatment over another patient in times of shortage) in the allocation decision-making process. This article suggests that the study of allocation need not only focus on the dramatic realm of the high-tech, but should also concern itself with less dramatic everyday situations. Decisions concerning treatment based upon social worth and financial status are made almost daily by most practitioners; a thorough awareness of this phenomenon is prerequisite to the proper practice of medicine. Interviews with physicians disclose that most of these everyday allocation decisions are made tacitly, with non-biomedical criteria playing a role even in decisions that appear to have been prompted only by benign (even-guided) intentions.

KIE: A medical student doing a research project at the Hastings Center addressed the issue of how socioeconomic considerations influence physician decision making in routine patient care. He interviewed 15 people, including cardiothoracic surgeons, medical educators, private practitioners, medical students and educators, and two dentists. His questions focused on the subjective or extra-clinical criteria used in the respondents' clinical allocation decisions, the concern for and priority of society in their daily practice, and the concerns and priority of their medical practice in their daily life. He concluded that most everyday allocation decisions are made tacitly, with nonbiomedical criteria playing a role even in decisions that appear to have been intended to be impartial.

Transient temperature profiles in tissues with nonuniform blood flow distributions.

Numerical methods and the bio-heat transfer equation are employed to calculate temperature profiles in tissues subjected to nonuniform blood flow distribution for initial and boundary conditions which simulate experimental physiological situations. Results indicate that one can infer, from sudden changes in temperature distribution, the occurrence of sudden changes in tissue blood flow. However, prediction of blood flow distribution from near equilibrium or steady-state temperature profiles is of poor resolution, and does not appear useful as a practical technique. The methods and results are useful for predictions of temperature profiles in the absence of significant endogenous or exogenous heating; they can be extended to such applications by straightforward methods.