Selection of patients for ambulatory lumbar discectomy: results from four US states

Background contextThere is a persistent trend for more outpatient lumbar discectomies in the United States.PurposeTo investigate the characteristics of the patients selected for ambulatory procedures.Study designRetrospective cohort study.Patient sampleForty-seven thousand one hundred twenty-five patients who underwent outpatient and 102,592 patients undergoing inpatient lumbar discectomies and were were registered in the State Ambulatory Surgery Database (SASD) and State Inpatient Database (SID), respectively, for New York, California, Florida, and North Carolina from 2005 to 2008.Outcome measuresRate of outpatient procedures, 30-day readmissions, and hospital charges.MethodsWe performed a retrospective cohort study involving patients who underwent outpatient and inpatient lumbar discectomies and were registered in SASD and SID, respectively, for New York, California, Florida, and North Carolina from 2005 to 2008. Logistic regression models were used to demonstrate the association of socioeconomic factors with the odds of undergoing an outpatient procedure.ResultsMale gender (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03–1.08), private insurance (OR, 1.93; 95% CI, 1.86–2.01), lower Charlson Comorbidity Index (OR, 4.04; 95% CI, 3.17–5.16), and higher volume hospitals (OR, 1.06; 95% CI, 1.04–1.08) were significantly associated with outpatient procedures. Higher income (OR, 0.83; 95% CI, 0.81–0.85), older age (OR, 0.996; 95% CI, 0.995–0.997), coverage by Medicaid (OR, 0.89; 95% CI, 0.83–0.96), African Americans (OR, 0.65; 95% CI, 0.60–0.70), and other minority races were associated with decreased odds of outpatient procedures. The rate of 30-day postoperative readmissions was higher among inpatients. Institutional charges were significantly lower for outpatient lumbar discectomies. The median charge for inpatient surgery was $24,273 as compared with $11,339 for the outpatient setting (p<.0001).ConclusionsAccess to ambulatory lumbar discectomies appears to be more common for younger, white, male patients, with private insurance and less comorbidities, in the setting of higher volume hospitals. Further investigation is needed in the direction of mapping these disparities for appropriate resource utilization.     

Cardiovascular magnetic resonance of cardiac tumors and masses

Cardiac masses diagnosis and treatment are a true challenge, although they are infrequently encountered in clinical practice. They encompass a broad set of lesions that include neoplastic (primary and secondary), non-neoplastic masses and pseudomasses. The clinical presentation of cardiac tumors is highly variable and depends on several factors such as size, location, relation with other structures and mobility. The presumptive diagnosis is made based on a preliminary non-invasive diagnostic work-up due to technical difficulties and risks associated with biopsy, which is still the diagnostic gold standard. The findings should always be interpreted in the clinical context to avoid misdiagnosis, particularly in specific conditions (e.g., infective endocarditis or thrombi). The modern multi-modality imaging techniques has a key role not only for the initial assessment and differential diagnosis but also for management and surveillance of the cardiac masses. Cardiovascular magnetic resonance (CMR) allows an optimal non-invasive localization of the lesion, providing multiplanar information on its relation to surrounding structures. Moreover, with the additional feature of tissue characterization, CMR can be highly effective to distinguish pseudomasses from masses, as well as benign from malignant lesions, with further differential diagnosis of the latter. Although histopathological assessment is important to make a definitive diagnosis, CMR plays a key role in the diagnosis of suspected cardiac masses with a great impact on patient management. This literature review aims to provide a comprehensive overview of cardiac masses, from clinical and imaging protocol to pathological findings.     

Ruptured inferior vena cava aneurysm in the setting of mural vascular malformation: A case report

Aneurysm of the inferior vena cava is a rare anomaly with a very few reported cases worldwide. We report the case of a 26-years-old man with acute severe abdominal pain and hypovolemic shock following an episode of syncope. Ultrasonography showed a fusiform aneurysmal dilation of the infra-hepatic inferior vena cava (IVC), with a large saccular portion at its posterolateral wall and mural thrombosis. Abdominal computed tomography scan revealed extension to the right renal vein and adhesion to the right kidney. The saccular aneurysm and the right kidney were resected, and anatomopathological examination revealed a cavernous hemangioma. All symptoms disappeared after surgery. This is the first reported case of symptomatic congenital saccular aneurysm of the IVC due to mural vascular malformation and with involvement of the right kidney leading to nephrectomy.     

Effect of purslane seed supplementation on inflammatory cytokines,oxidative stress and muscle damage in response to high-intensity intermittent exercise in national athlete runners

Sport Sciences for Health - Purslane supplementation has anti-oxidative, anti-inflammatory, skeletal muscle-relaxant activities. However, it is unknown if the ingestion of purslane will affect the...