Effect of high up front charges on access to surgery for poor patients at a public hospital in New Mexico

Background  

A public hospital in New Mexico required collection of 50% of estimated costs prior to elective surgeries for self-pay patients. This study assesses the impact of this policy on access to elective surgical procedures.     

New options for central venous access in cancer chemotherapy. Multiple lumen catheters

New technology has allowed the creation of single catheters with up to four separate luminal channels for access to the central venous system. Since cancer chemotherapy may be associated with local complications specifically related to the mode of intravenous administration, temporary central venous access with a multiple lumen catheter (MLC) offers distinct theoretical advantages over previously used peripheral venous sites. As part of a prospective study to evaluate the clinical efficacy of MLC, the authors have separately studied the usefulness of these catheters in providing venous access to patients receiving chemotherapy.     

Intraocular lens removal during penetrating keratoplasty for pseudophakic bullous keratopathy

Pseudophakic bullous keratopathy is now the most common reason for penetrating keratoplasty. In previous reports, the type of intraocular lens (IOL) most frequently encountered in these eyes was the iris plane IOL. The authors reviewed 27 cases of IOL removal during penetrating keratoplasty. Lenses were removed if they were dislocated or associated with iritis, recurrent hyphema, glaucoma, or persistent cystoid macular edema. The IOL encountered most often was the anterior chamber lens (in 22 eyes); closed thin loop, semiflexible or flexible anterior chamber lenses accounted for 19 of these. Iris plane lenses were removed from five eyes. No posterior chamber lenses were removed. Clear grafts were obtained in 24 of 27 cases (89%); visual acuity improved or remained the same in 24 cases, to 20/60 in 11 cases. The most common causes of poor postoperative vision were retinal disease (6/27 cases) and glaucoma (6/27 cases). The association between anterior chamber lenses and pseudophakic bullous keratopathy is probably the result of both the increase in use of these lenses and the documented propensity of the closed loop semiflexible anterior chamber lenses to cause complications.     

Benign scrotal tumors masquerading as expanding varicoceles

Vascular lesions of the scrotum though most often varicoceles, can occasionally represent either benign or malignant tumors containing vascular elements. Two pediatric patients presenting with vascular scrotal masses resembling varicoceles are reported. Histologic interpretation of the operative specimens demonstrated benign tumors of the scrotum. Hemangiomas, hamartomas, or mesenchymal tumors should be especially suspect in the presence of any vascular right scrotal lesion. Because of the infrequency of prepubertal varicoceles, any vascular lesion of the scrotum in this age group should undergo biopsy before simple excision is performed to rule out the presence of malignancy. Early excision of benign mesenchymal tumors is especially important if, as some believe, they eventually dedifferentiate to more malignant tumors later in the lifetime of an individual.