Art & craft: Creative fiction and Las Vegas.

This article provides a review of the contrasting ways in which modern essayists and novelists have reflected their experience of Las Vegas. The author suggests that while Las Vegas may serve as a convenient symbol for depression and alienation, contemporary fiction also celebrates Las Vegas for its life-enhancing impact. These themes are fused with surreal imagination in the novelKeno Runner by David Kranes.

Delayed postoperative epidural hematoma formation after heparinization in lumbar spinal surgery.

Treatment of thromboembolic disease in the postoperative lumbar spine patient is controversial. This case report describes an epidural hematoma with neurologic sequelae in an elderly patient who received intravenous heparin therapy over 2 weeks after lumbar decompression. Implications for treatment of thromboembolic disease in the postoperative lumbar spine is reviewed.

Functional outcome of inpatient rehabilitation in persons with brain tumors.

OBJECTIVE: To document functional outcome in persons with brain tumors undergoing inpatient rehabilitation and to compare outcomes with a group of traumatically brain injured patients. DESIGN: Retrospective, descriptive, and case-matched. SETTING: A free-standing inpatient brain injury rehabilitation unit. PARTICIPANTS: Forty consecutive patients with a variety of tumor types (40% were either glioblastoma multiforme or meningioma) and a mean age of 53.1 (SD 15.4) years. Sixty percent were men, 25% had recurrent tumors, and 15% had metastatic disease. Also, 40 patients with traumatic brain injury (TBI) matched for age, gender, and admission functional status. MAIN OUTCOME MEASURES: Change in Functional Independence Measure (FIM) scores, length of rehabilitation stay (LOS), and discharge disposition. RESULTS: The mean LOS for the tumor group was 17.8 (SD 9.9) days, mean FIM gain was 25.4 (SD 20.1) points, and 82.5% were discharged home. No demographic or tumor characteristic was statistically significant in predicting functional outcome at discharge, but greater gains were seen for persons with the diagnosis of meningioma, those with left-sided cerebral lesions, and those not receiving radiation therapy. TBI patients made statistically significant greater gains in total FIM change (34.6 vs 25.4), self-care (12.3 vs 8.5), and social cognition (5.2 vs 3.6). However, FIM efficiency and LOS were not statistically different between the TBI and tumor groups (1.9 vs 1.5 FIM points/day and 22.1 vs 17.8 days, respectively). CONCLUSIONS: Daily functional gains made by persons with brain tumor undergoing rehabilitation were similar to those made by a group of persons with TBI matched by age, gender, and admission functional status. Further research should use larger samples and address the impact of psychosocial and team factors on LOS and discharge disposition.