Ventral hernia repair is associated with overall financial losses. Inpatient synthetic mesh repairs are essentially budget neutral. Outpatient and inpatient repairs without mesh result in net financial losses. Inpatient biologic mesh repairs result in a negative contribution margin and striking net financial losses. Cost-effective strategies for managing ventral hernias in a tertiary care environment need to be developed in light of the financial implications of this patient population.

The results indicate a significant age-related decline in VIP-positive nerve fibers and vessel diameter in the submacular choroid in disease-free human donor eyes. These findings suggest that a decline in the neural control of ChBF and vessel diameter may explain the reductions in ChBF and its adaptive control observed clinically with aging.

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Elective ventral hernia repair in the functionally dependent patient population has significant morbidity and mortality. Increasing age, ascites, preoperative renal failure, and preoperative pulmonary compromise are independent predictors of 30-day mortality. Nonoperative management should be strongly considered in the presence of these risk factors. Further studies are needed to determine optimum management strategies for functionally dependent patients with ventral hernias.

Transcranial Doppler (TCD) monitoring of the intracranial vessels is useful for the detection of microembolic signals (MES), which can help with risk stratification and evaluation of therapies. The presence of any emboli during a TCD exam is concerning and treatment is controversial. In this case, an unusual high count of emboli were detected in all vessels, which prompted a change in clinical management. It is now believed that the injectable cardiovascular ultrasound contrast agent (Definity®) was the cause of the large number of MES. Ramanathan reported a similar case in which an unusual amount of MES were detected during emboli monitoring (EM) and were felt to be contamination from Definity® contrast injected 2 hours prior to the EM exam. When unexpectedly faced with numerous MES, practitioners should consider other factors that can influence the results of TCD with EM.