Policy makers in all countries are searching for cost-effective, quality health care. In the realm of surgical care, one response to modern cost and quality pressures is same-day surgery. This article discusses three aspects of same-day surgery programs: key management issues; analysis of competitiveness; and, the growth potential of same-day surgery. Today's managers of same-day surgery programs are most concerned with issues related to their customers, be they physicians, insurers, or patients. Indeed, program managers identify market research, program development, and patient, physician, and facility management as areas critical to success. An exploratory survey carried out of ten same-day centers indicates that programs must excel in two areas to succeed. First, they must develop efficient and appropriate operations. Second, they must communicate aspects of these operations to different customers, realizing that each customer type is interested in different aspects of the program. This article provides a framework for the analysis of customer interests. It also suggests that surgery centers satisfy customer preferences rather better than do hospital outpatient programs. Same-day surgery will increase. Uncertainty lies in how quickly and in what form such activities in hospitals and centers will develop. Countries will likely experience different growth patterns, according to the relative power of factors affecting both the supply and demand of same-day surgery.

Ambulatory Surgical Procedures↗

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Ultrastructure of monolayer cultures of pancreatic islet cells.

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Animals↗

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Hyaline cytoplasmic inclusions in human hepatoma. A case report.

A case of hepatoma in a 79-year old woman is reported. The patient had an enlarged liver and a pathological liver scintigram. Percutaneous liver biopsies were performed both with Menghini-and fine needles. The most prominent feature was the presence of hyaline cytoplasmic PAS-negative inclusions in liver parenchymal cells. There was no nuclear atypia. Electron microscopy disclosed two types of cytoplasmic changes. One consisted of a lamellar ultrastructure and was interpreted as a hyperplasia of smooth-surfaced endoplasmic reticulum. The other change consisted of smooth globular non-membrane limited regions containing amorphous or finely fibrillar material. This was interpreted as corresponding to the hyaline inclusions visible in the light microscope. The presence of PAS-negative hyaline cytoplasmic inclusions may thus be a sign of hepatoma. This may be of relevance for the diagnostic considerations of material obtained by fine needle biopsy.

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Chronic subarachnoid midazolam (Dormicum) in the rat. Morphologic evidence of spinal cord neurotoxicity.

BACKGROUND AND OBJECTIVES: In humans, the benzodiazepine midazolam has been reported to exert an antinociceptive action after subarachnoid injections. It has been shown that subarachnoid midazolam given to rabbits produces significant pathology in spinal cord morphology, as detected with light microscopy. In order to further characterize these changes, this study was performed, using a more sensitive histologic technique, including electron microscopy as well as unbiased morphometry. METHODS: The histopathology of the rat lumbar spinal cord was investigated after chronic subarachnoid administration of a commercially available preparation of midazolam. After daily injections of 100 micrograms of midazolam, the animals were transcardially perfused on the twentieth day with a mixture of formaldehyde and glutaraldehyde. RESULTS: Morphometric evaluation of cell number and mean cell volume (MCV) by the disector method revealed a significant lower (P < .05) cell number and a tendency toward higher MCV in the midazolam-injected group (n = 6), compared to the rats injected with saline (n = 6). The higher MCV, in combination with a reduced number of nerve cells, indicated a loss of small neurons. The electron microscopic findings confirmed that midazolam caused neuronal death, since degenerated cell somata, fibers, and terminals were observed in most of the rats. Furthermore, an increased number of microglial cells phagocytosing nerve structures were also seen mainly in the dorsal horn. CONCLUSIONS: The authors found that chronic subarachnoid administration of midazolam gives objective signs of neurotoxicity in the rat spinal cord. The authors' findings are in contrast to those of an earlier light microscopic study in the rat. The present results emphasize both the necessity of morphometric and ultrastructural studies before spinal administration of novel drugs to humans and the neurotoxic potential of midazolam. Since neurotoxicity of midazolam now has been demonstrated in both rats and rabbits, there may be reason to be sceptical of the use of subarachnoid midazolam in humans.

Adjuvants, Anesthesia↗