Articles: surgery.
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Am. J. Obstet. Gynecol. · Jun 2016
Midurethral slings: evidence-based medicine vs the medicolegal system.
Midurethral sling procedures are minimally invasive surgeries for stress urinary incontinence that use a trocar system to place a narrow ribbon of polypropylene mesh under the midurethra. The peer-reviewed scientific literature on these procedures is abundant and midurethral slings are the most well-studied incontinence procedure ever. Systematic reviews of the literature demonstrate that midurethral slings are safer and more (or equally) effective as traditional procedures. ⋯ It is not inconceivable that midurethral slings could become absent from the US market. If that happens, then US women with stress urinary incontinence will be harmed because they will not have access in this country to the best and safest stress urinary incontinence surgical procedure ever developed. It may be time for the Institute of Medicine or another comparable national agency to provide evidence-based recommendations on the midurethral sling.
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There is ongoing debate about nonpalliative primary tumor surgery in metastatic breast cancer patients. This issue has become even more relevant with the introduction of increasingly sensitive imaging modalities. ⋯ The present study-the first population-based analysis using propensity score methods-provides evidence of a favorable impact of primary tumor surgery on mortality in metastatic breast cancer patients. Most importantly, the benefit of primary tumor surgery increased over time from 1998 to 2009. Although the final results of ongoing randomized studies are awaited, currently available evidence should be discussed with metastatic breast cancer patients.
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Journal of neurosurgery · Jun 2016
Case ReportsArteriovenous malformation of the filum terminale: an exceptional case.
Arteriovenous malformations (AVMs) of the spine display a variety of different locations, angioarchitectures, and clinical presentations. The authors describe an exceptional case of a filum terminale AVM that is not described in any classification and discuss the origin and management of this malformation. A 59-year-old woman was admitted in June 2012 for cauda equina syndrome. ⋯ At 20 months after surgery, the patient was fully independent and radiological images confirmed the exclusion of the malformation. AVMs that originate from the filum terminale are exceptional. According to updated classifications, AVMs of the filum terminale should be categorized as a separate entity.
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J. Thorac. Cardiovasc. Surg. · Jun 2016
Observational StudyCharacteristics and long-term outcomes of contemporary patients with bicuspid aortic valves.
We sought to study the impact of surgical intervention on long-term outcomes in bicuspid aortic valve (BAV) patients who develop aortic valvular complications and/or have a concomitant aortopathy. ⋯ Patients with BAV have a high prevalence of AV dysfunction and concomitant aortopathy. Undergoing surgery (AV replacement and/or repair ± AAR) was associated with a significantly lower incidence of death and/or dissection.
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The clinical impact of the coexistence of compressive cervical myelopathy (CM) and/or lumbar spinal canal stenosis (LCS) with compressive thoracic myelopathy (TM) remains unknown. The purpose of this study was to examine the incidence, clinical pictures, and surgical outcomes of patients with compressive TM and the coexistence of compressive CM and/or LCS. ⋯ About 70 % of patients who underwent surgery for TM had concurrent CM and/or LCS, and they were initially diagnosed with CM or LCS. Single-stage multilevel decompression surgery for TM with concurrent CM and/or LCS is comparable to thoracic only surgery with regard to complications and surgical results, and it is well tolerated in elderly patients.