Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Load bearing analysis has been performed in cadaver knees after different types of inner meniscus resection in extension and in 30 degrees and 60 degrees flexion. Contact areas, mean and maximum pressure differences and load flow changes were measured in the medial and lateral compartment of the knee. The investigation led to following findings: After posterior meniscal tear the resection of the tear with marginal smoothing is followed by a minimum of parameter deviation. ⋯ At the medial site a decrease of the load bearing area and the pressure can be registered. In contrast to that there is an increase of these parameters at the lateral site. Consecutive osteoarthritis after medial meniscectomy is therefore interpreted not as a result of increased pressure but of a floating load bearing.
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Over the last twenty years, the most dramatic change in American surgical care has been the shift from inpatient to outpatient surgical care. Ambulatory surgery in the 1990s, with its demonstrated ability to lower individual patient and overall societal surgical care costs, while maintaining quality equal to inpatient services, has been embraced by all segments of the American health care delivery system. ⋯ It also appears likely that ever increasing numbers of surgical operations will be completed on an outpatient basis. Ambulatory surgery is one of those rare socioeconomic-political movements in which all participants have benefitted as demonstrated by public interest and demand, surgeon satisfaction, patient participation, and, most importantly, payer encouragement and mandate.
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Day surgery has been practised in Great Britain for many years. However, only in the last few years there has been a great surge of interest in the practice of day surgery. This has taken place despite many obstacles such as clinician's preference for more traditional approaches and initial lack of facilities and resources. ⋯ However, there is a wide variation in relation to performance of day surgery throughout the country between hospitals. This is true both for total number of surgical patients treated on a day care basis and for individual surgical procedures. Day surgery is now generally accepted as best option of treatment for over 50% of all elective surgical procedures and it is expected that by the end of this decade this figure is likely to be over 60%.