[Medical technology, a problem?].
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Cost Control↗
Biomedical subjects
P A van Gelder
Publications and source records attributed to P A van Gelder.
Algorithms in medicine.
The ever rising costs of health care in Western countries necessitate some form of cost control. Restrictions can be and will be imposed externally by, for instance, the government. These measures will probably lead to a decrease in quality of health care and the profession should therefore seek ways to prevent outside interference by developing an internal means of cost control. On short terms a form of internal control with preservation of the quality of care would be the introduction and widespread use of algorithms, restricting the use of useless and unnecessary tests and therapies. For long term results education must take on new tasks leading to a better understanding of costs an benefits of medical activities. The development of algorithms is hindered by the lack of common consensus of optimal care, the lack of relevant data and the inefficient way data are managed. When introduced the algorithm, especially when compulsory, will engender much resistance and unhappily, ways must be found to overcome them by sanctions. The profession must realise that if they do not do anything it will be done for them.
Cost Control↗
Microvascular surgery and diseased vessels.
Hardly any data exist concerning the effects of arterial vessel disease on the results of microvascular surgery. As the scope of microvascular surgery expands, diseased vessels will surely be encountered more frequently. Therefore an experiment was performed in rabbits who were fed a cholesterol-enriched diet for 3 months. Then an anastomosis was made in both carotid and femoral arteries (total of 65 arteries) with microsurgical techniques. The diet was continued until the animals were killed at fixed times from 1 day to 4 months. The overall patency rate at the time of death was 91.8%. At the time of the operation two situations were present: hypercholesterolemia without any macroscopic changes and hypercholesterolemia with evident macroscopic atherosclerotic lesions. Atherosclerotic lesions in these small arteries present technical surgical difficulties, and direct results will depend on the skill and experience of the surgeon. Hypercholesterolemia without any macroscopic changes, in combination with the trauma of the operation, will lead to an accelerated formation of atherosclerotic changes. Lesions already present will progress in size. Both events lead to narrowing of the lumen at a later stage.
Animals↗
Healing of microvascular arterial anastomoses, as seen on corrosion casts by scanning electron microscopy.
We made 44 microsurgical anastomoses in the femoral artery in rats. The healing was studied from one day to 4 months, by making an acrylic cast of the lumen of the femoral artery and the surrounding vessels, and examining the cast by scanning electron microscopy. The method proved to be easy and relatively quick, and it limited the possibility of artifacts. The high depth of focus permitted simultaneous study of the main lumen and of the perivascular structures after microvascular anastomoses.
Animals↗