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At least 19 recordsLinked to original sources
PubMed2005

Experience from "double-insurance bypass." Surgical results and additional techniques to achieve complex aneurysm surgery in a safer manner.

BACKGROUND: "Double-insurance bypass" was recently advocated to avoid the risk of cerebral ischemia during prolonged temporary occlusion of the carotid artery. For large aneurysms needing temporary but prolonged obliteration of the internal carotid artery (ICA). We have attempted the double-insurance bypass in 15 patients and, herein, report the efficacies and limitations of the procedure, and surgical techniques to make this procedure safer. METHODS: We treated 15 patients with complex internal carotid aneurysms by clipping surgery with the aid of radial artery (RA) to proximal middle cerebral artery (MCA) bypass, so-called double-insurance bypass. We analyzed surgical results of the procedure. RESULTS: In 11 patients, the duration of temporary occlusion of the ICA could be prolonged for as long as 110 minutes (mean, 45 minutes) without any ischemic complications. One patient in the earlier period of our experience suffered extended cerebral infarction due to possible restricted blood flow through the RA, because the brachial artery was compressed by the firm shoulder joint and neighboring structures. Thereafter, we routinely monitored the blood pressure of MCA (MCABP) and never experienced such cortical infarctions. Another 3 patients, however, experienced ischemia in the territory of perforating arteries that originated from a segment that could not be perfused by the RA-MCA bypass. CONCLUSIONS: In combination with monitoring of MCABP, the double-insurance bypass can be a safer and more potent adjunctive procedure for the treatment of complex internal carotid aneurysms which require prolonged temporary occlusion of the ICA.

Aged↗
PubMed1978

Private health insurance plans in 1976: an evaluation.

Private health insures collected a record $39.4 billion in premiums and returned $35 billion in benefits to their subscribers in 1976--a reflection of the steadily rising cost of health care, higher utilization, and the demand for expanded services. The industry experienced a net underwriting loss of $611 million, mainly because claims and operating expenses under insurance-company group business ran 3 percent above premium income. About 77 percent of the civilian population had some form of private hospital insurance, and about the same percentage had some form of surgical insurance. Lesser proportions were covered for other types of care. An estimated 12--13 percent of the population under age 65 had no economic protection against the costs of illness or health-related care--under either a private insurance plan or public program. Although virtually all of the aged were covered by Medicare, some 13--15 million bought private insurance, most of it under plans that covered some or all of the gaps in the Federal program.

Age Factors↗
PubMed2000

[Problems concerning the prices of surgical operations in Japan. Union of Social Medical Insurance Committee Members of Surgical Societies in Japan].

The Union of Social Medical Insurance Committee Members of Surgical Societies in Japan was established in 1967. The union has tried to develop scientific methods to assess the price of surgical operations in Japan and proposed a tentative plan for the assessment of the price of operations. The price of an operation includes personnel expenses and other costs such as the prime costs to repay loans for land and buildings, and taxes. Personnel expenses are calculated by the grade of technical difficulties, the number of doctors and nurses and the duration of the operation. A more precise method to judge the difficulties of the operation seems to be necessary. To examine the recent increase in expenses for surgical materials, the cooperation of main hospitals authorized by surgical societies will be necessary. The prices of surgical operations presented by the Ministry of Health and Welfare of Japan correlated well with the prices proposed by the Union.

Fee-for-Service Plans↗
PubMed2001

Technique of transmyocardial revascularization: avoiding complications in high-risk patients.

BACKGROUND: Transmyocardial revascularization (TMR) is an emerging therapy for coronary artery disease, with 7 years of published clinical research and nearly three years of clinical application. Every report thus far has confirmed that TMR relieves severe angina pectoris. It is primarily an alternative therapy for angina which has been refractory to conventional medical and surgical treatment. Operative mortality of 3% to 10% has been reported. METHODS: Seventy-seven patients were treated with TMR using a Holmium: YAG laser. Admission criteria included severe angina despite high doses of at least two anti-angina medications and nitroglycerin, reversible ischemia by thallium scan, and unsuitability for CABG or angioplasty. Patients had end-stage ischemic heart disease and multiple previous conventional procedures. TMR was performed through small left anterior thoracotomies using a 10.16 cm or less incision. RESULTS: Seventy-five patients recovered from surgery without major complications. One patient (1.3%) died of an autopsy-proven myocardial infarction in the treated region, and two additional patients had a myocardial infarction (4.3%). Four patients had paresis of the left phrenic nerve, as determined by an elevated left hemi-diaphragm on chest X-ray, from which three recovered fully. Patients had no bleeding or wound infections. Patients were intubated for an average of 1.5 hours and remained in ICU an average 0.8 days. Mean hospitalization was 3.4 days. CONCLUSIONS: Technically well-done TMR through a small anterior thoracotomy can have good therapeutic results and low morbidity and mortality. We will describe operative techniques which minimize pain and stress and help to insure surgical success.

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