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Sarcoidosis
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
The diagnosis of sarcoidosis rests on finding noncaseating granuloma in a biopsy specimen and proving that this is not due to a known granuloma producing infection. Less invasive biopsies should be done whenever possible. Biopsies of skin lesions and subcutaneous nodules are nearly always positive. Specimens from less obviously diseased tissue such as from the lower lip for minor salivary glands often have a significant yield.26 The conjunctival biopsy is nearly always positive if a small millet-seed nodule can be biopsied, but even in the absence of this, granulomas can be obtained 70% of the time if bilateral biopsies are taken.27 All of these can be performed on an ambulatory basis. The most frequently biopsied site in children has been a peripheral lymph node, including the scalene fat pad biopsy. This a low risk procedure but usually requires anesthesia and admission to the hospital or ambulatory surgery. Other biopsy sites in children have been liver, lung parenchyma, parotid gland, bone, striated muscle and testes.4,8,11Figure 2 shows the microscopic features of sarcoidosis.
Health care and cost containment in Denmark
Published in Elias Mossialos, Julian Le Grand, Health Care and Cost Containment in the European Union, 2019
Terkel Christiansen, Ulrika Enemark, Jørgen Clausen, Peter Bo Poulsen
Registrations of ambulatory and day care activity have frequently been incomplete and the two labels often used for the same activities. As of 1995, the counties have had to report on ambulatory activities. Two-thirds of these concern surgical patients.12 Among almost 500,000 ambulatory cases in the first half of 1995,10 per cent required surgery. Ambulatory surgery is used for smaller ex-post treatment and for some acute care. However, operations like eye cataract surgery, knee surgery, sterilization and hernia operations are also undertaken in ambulatory or day care.12
Outpatient thoracic surgery
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Laureano Molins, Juan J. Fibla, Jorge HernÁNdez
The term “ambulatory surgery” was coined by J. E. Davis in 1986. Outpatient surgery, also called “major ambulatory surgery” or “day surgery,” can be defined as a surgical or diagnostic procedure performed under general, locoregional, or local anesthesia with or without sedation, requiring post-operative care and returning home the same day of surgery. It must be distinguished from “short-stay surgery” in which a major surgical procedure stay lasts between 1 and 3 days. Other terms such as “early discharge surgery” have been discarded for being inaccurate or confusing terms.
vNOTES for adnexal procedures
Published in Journal of Obstetrics and Gynaecology, 2021
Pedro Brandão, Amélia Almeida, Paula Ramôa
All procedures were completed without converting to conventional surgery, except for one patient who did not tolerate pneumoperitoneum due to obesity and other major comorbidities. The maximum surgery length was 210 minutes, but if only procedures without frozen section are considered, the maximum length was 138 minutes. The estimated blood loss was minimal. The anaesthetic protocols were similar to conventional laparoscopy with no unexpected events or extra needs. Post-operative analgesic requirements were minimal. Patients were discharged the day after, a 23–hours stay in accordance to the ambulatory surgery current practices. There were no complications during or after the procedures and no sexual dysfunction. Overall patient satisfaction was excellent. Both patients who tried to conceive after vNOTES were able to do it successfully.
Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: experience of a single institution
Published in International Journal of Hyperthermia, 2021
J. Rodríguez, J. Isern, N. Pons, A. Carmona, E. Vallejo, J. Cassadó, J. A. De Marcos, M. Paraira, N. Giménez, A. Pessarrodona
Regarding the clinical outcomes, HIFU ablation was followed by substantial shrinkage of the ablated myomas with significant symptom improvement. We must highlight that these results were achieved in women with a median maximum diameter of treated fibroids of 6.4 cm, which is higher than that reported in most series of HIFU treatment [37–39]. Minor complications (9%) and major complications (0%) rate was much lower compared with series of patients undergoing UAE (52%, 3%), hysterectomy (28%, 6%) or myomectomy (14%, 5%) [24]. Additionally, in our series all patients underwent ambulatory surgery while the mean length of hospital stay reported for UAE, hysterectomy and myomectomy is 2, 5 and 6 days respectively. In short, HIFU allowed us to treat uterine fibroids with good clinical results and without the surgical morbidity of myomectomy and minimally invasive procedures.
Determining future capacity for an Ambulatory Surgical Center with discrete event simulation
Published in International Journal of Healthcare Management, 2021
Kayla Reece, Jeff Avansino, Maria Brumm, Lynn Martin, Theodore Eugene Day
Ambulatory surgery centers (ASCs) are modern health care facilities focused on providing surgical care with patients arriving from and returning to home after their procedures. This practice emerged in the 1970s in the United States, principally in adults, but has rapidly increased in volume and spread into the pediatric population. The rapid growth of ASCs has transformed the outpatient experience for millions of Americans each year by providing them with a more convenient and typically more cost-effective alternative to hospital-based procedures [2]. The National Survey of Ambulatory Surgery reported that 3.2 million children under the age of 15 received care for outpatient surgery in 2006 [3]. Between 1996 and 2006 the number of surgical visits to ASCs increased by almost 300% [4]. Due to continued medical advances and technological innovations, similar increases in ASC utilization were realized over the last decade, as more surgeries can be safely conducted in an ambulatory setting.