"Trade-off" between medical cost controls and quality of care? Maybe, maybe not! Part II.

In Part I of this article, published in the last issue of the JQA (February/March 1990, Vol. 12, No. 1), Majors Varney and Schroeder reviewed the issues surrounding the impact of the Medicare prospective pricing system (PPS). After defining "quality health care" and discussing indicators of quality, the authors presented several arguments by anti-cost containment advocates. In Part II, research is presented on the effects of cost containment on access to health care, substance abuse programs, improved care, severity indexing, alternative care, and utilization review programs.

A wire-sheath system for MR-guided biopsy and drainage: laboratory studies and experience in 10 patients.

On the basis of laboratory experiments, we devised a wire-sheath system for MR-guided biopsy and drainage and then evaluated that system in 10 patients. The localizing system consisted of a 20-gauge plastic sheath into which a stainless-steel alloy wire had been inserted. In laboratory studies, we compared this wire-sheath assembly with other materials to determine its optimal visualization on MR images. We then used the same wire-sheath system to perform 16 procedures (in 10 patients), including six biopsies, five diagnostic fluid aspirations, and five catheter drainages of infected and noninfected fluid collections. The laboratory results showed that the wire-sheath assembly cast a 7-mm artifact, was visualized well on all pulse sequences, and was safe within the magnet (minimal attraction). The assembly was visualized well in each patient and provided adequate localization. MR-guided biopsy and drainage can be performed with high-resolution detail by using this wire-sheath system. Potential uses of this system include (1) treatment of lesions that can be seen on MR images only (or that can be seen to significantly better advantage on MR images than on sonograms or CT scans), and (2) treatment of patients in whom avoidance of the radiation delivered by CT is imperative.

Balloon techniques for percutaneous gastrostomy in a patient with partial gastrectomy.

Intragastric balloon techniques were used to achieve direct gastric distention and efferent loop obstruction in order to perform percutaneous gastrostomy on two occasions in a patient with a partial gastrectomy and Billroth II anastomosis. Previous attempts at percutaneous endoscopic gastrostomy and conventional radiologic percutaneous gastrostomy had been unsuccessful. Although a history of partial gastrectomy has been considered an impediment to both percutaneous gastrostomy and percutaneous endoscopic gastrostomy, this experience demonstrates that percutaneous gastrostomy can be performed safely in this setting with balloon assistance.