On the Cover
Backlit Aspens Near Monitor Pass, California 2012
by Stuart Hahn, MD
This photograph of a beautifully lit aspen grove in autumn was taken in the Sierra Nevada Mountains near the border of California and Nevada.
Dr Hahn retired from The Permanente Medical Group in 2010. He has been seriously exploring photography since 2000 and has an interest in both wildlife and landscape photography. For further information about his artwork, Dr Hahn can be contacted at: .
Vasal Injury During Inguinal Herniorrhaphy: A Case Report and Review of the Literature
Lawrence Flechner, MD, PhD; James Smith, MD, MS; Patrick Treseler, MD, PhD; John Maa, MD
An injury to the vas deferens during inguinal herniorrhaphy from possible tethering of the vas has not, to our knowledge, previously been described in the surgical literature. We report a case of iatrogenic injury of the vas deferens that occurred during elective hernia repair in a 28-year-old man who had previously sustained blunt trauma to the abdomen and pelvis.
A Business Case for Tele-Intensive Care Units
Alberto Coustasse, DrPh, MD, MBA, MPH; Stacie Deslich, MA, MS; Deanna Bailey, MS; Alesia Hairston, MS; David Paul, DDS, PhD
A tele-intensive care unit (tele-ICU) uses telemedicine, in an intensive care unit (ICU) setting, to care for critically ill patients by off-site clinical resources. This literature review examined a large number of studies of implementation in hospitals. The evidence supporting cost savings was mixed. Implementation of a tele-ICU system was associated with cost savings, shorter lengths of stay, and decreased mortality. However, two studies suggested increased hospital cost after implementation. Intensivists working these systems are able to more effectively treat ICU patients, providing better clinical outcomes for patients at lower costs compared with hospitals without a tele-ICU.