Obesity can predispose women to pelvic organ prolapse and can also affect the success of pelvic organ prolapse surgery. The purpose of this study was to compare the postoperative anatomical outcomes ...following sacral colpopexy (SC) and transvaginal mesh colpopexy in a group of obese women with pelvic organ prolapse.
We conducted a retrospective cohort study of obese women who underwent SC (n = 56) or transvaginal mesh colpopexy (n = 35). Follow-up ranged from 6 to 12 months. Preoperative, perioperative, and postoperative variables were compared using Student t, Mann-Whitney U, and Fisher exact tests, and by analysis of covariance.
The women in the SC group had significantly higher mean apical vaginal measurements (P < 0.05), and significantly fewer stage II recurrences than women in the transvaginal mesh colpopexy group. There were no significant differences between the groups for other postoperative outcomes, including mesh erosion, recurrent prolapse symptoms, dyspareunia, and surgical satisfaction (P > 0.05).
In these 91 obese patients with pelvic organ prolapse, SC resulted in better anatomical outcomes than transvaginal mesh colpopexy. However, the two procedures had similar outcomes with regard to recurrent symptoms and surgical satisfaction.
Our practice policy has been to provide intraoperative radiotherapy (IORT) at resection to patients with head-and-neck malignancies considered to be at high risk of recurrence. The purpose of the ...present study was to review our experience with the use of IORT for primary or recurrent cancer of the parotid gland.
Between 1982 and 2007, 96 patients were treated with gross total resection and IORT for primary or recurrent cancer of the parotid gland. The median age was 62.9 years (range, 14.3-88.1). Of the 96 patients, 33 had previously undergone external beam radiotherapy as a component of definitive therapy. Also, 34 patients had positive margins after surgery, and 40 had perineural invasion. IORT was administered as a single fraction of 15 or 20 Gy with 4-6-MeV electrons. The median follow-up period was 5.6 years.
Only 1 patient experienced local recurrence, 19 developed regional recurrence, and 12 distant recurrence. The recurrence-free survival rate at 1, 3, and 5 years was 82.0%, 68.5%, and 65.2%, respectively. The 1-, 3-, and 5-year overall survival rate after surgery and IORT was 88.4%, 66.1%, and 56.2%, respectively. No perioperative fatalities occurred. Complications developed in 26 patients and included vascular complications in 7, trismus in 6, fistulas in 4, radiation osteonecrosis in 4, flap necrosis in 2, wound dehiscence in 2, and neuropathy in 1. Of these 26 patients, 12 had recurrent disease, and 8 had undergone external beam radiotherapy before IORT.
IORT results in effective local disease control at acceptable levels of toxicity and should be considered for patients with primary or recurrent cancer of the parotid gland.
Introduction and hypothesis
The aim of this study was to determine the reoperation rate for sling placement or revision in patients who had primary continence procedures based on prolapse reduction ...stress testing (RST) prior to laparoscopic sacral colpoperineopexy (LSCP).
Methods
This was a retrospective cohort study of women who had RST prior to LSCP for symptomatic pelvic organ prolapse. Patients with positive test (Pos RST) had a concomitant midurethral sling procedure and those with negative test (Neg RST) did not. Variables were compared with either Student’s
t
test or Fisher’s exact test.
Results
In Neg RST group (
n
= 70), the rate of surgery for de novo urodynamic stress incontinence was 18.6%. In Pos RST group (
n
= 82), the rate of sling revision for bladder outlet obstruction was 7.3%. Overall, 88% of patients did not require a second surgery.
Conclusions
The use of RST to recommend concomitant continence procedures during LSCP results in a single surgery for the majority of our patients.
Obesity can predispose women to pelvic organ prolapse and can also affect the success of prolapse surgery. Sacral colpopexy is a common surgical approach used to treat significant prolapse, and may ...be performed by laparotomy or laparoscopy. The objective of this study was to determine whether surgical outcomes following abdominal sacral colpopexy (ASC) and laparoscopic sacral colpopexy (LSC) varied according to BMI.
We conducted a retrospective cohort study of women who had undergone ASC (n = 90) and LSC (n = 150). Preoperative, perioperative, and postoperative information was collected from patient charts and entered into a database according to BMI category (normal weight 18.5 to 24.9 kg/m², overweight = 25 to 29.9 kg/m², obese ≥ 30 kg/m²). Within each BMI group, outcomes were compared between ASC and LSC patients using Student t, Mann-Whitney U, and Fisher exact tests, and analyses of covariance.
In normal weight patients, postoperative apical measurements were worse in ASC patients (P = 0.01). In overweight patients, the ASC group had worse posterior measurements (P = 0.05) and fewer mesh/suture erosions (P = 0.03) but more recurrent prolapse symptoms (P = 0.007). In obese patients, the ASC group had better anterior measurements (P = 0.008). There were no differences in any BMI category for prolapse stage, surgical satisfaction, or classification of surgical success or failure (P > 0.05).
Differences between ASC and LSC were identified when patients were categorized according to BMI. These findings may be useful in counselling patients and planning the appropriate surgical approach for sacral colpopexy based on BMI.
The purpose of this study is to review our experience with the use of IORT for patients with advanced cervical metastasis.
Between August 1982 and July 2007, 231 patients underwent neck dissections ...as part of initial therapy or as salvage treatment for advanced cervical node metastases resulting from head and neck malignancies. IORT was administered as a single fraction to a dose of 15 Gy or 20 Gy in most pts. The majority was treated with 5 MeV electrons (112 pts, 50.5%).
1, 3, and 5 years overall survival (OS) after surgery + IORT was 58%, 34%, and 26%, respectively. Recurrence-free survival (RFS) at 1, 3, and 5 years was 66%, 55%, and 49%, respectively. Disease recurrence was documented in 83 (42.8%) pts. The majority of recurrences were regional (38 pts), as compared to local recurrence in 20 pts and distant failures in 25 pts. There were no perioperative fatalities.
IORT results in effective local disease control at acceptable levels of toxicity. Our results support the initiation of a phase III trial comparing outcomes for patients with cervical metastasis treated with or without IORT.
Research by hospitalists may aid the evolution of hospital medicine into an academic specialty.
To describe the factors associated with research and publication activities among hospitalists and ...describe trends in hospitalist-led publications.
We surveyed members of the Society of Hospital Medicine in June 2012 and conducted univariate analyses on their responses to determine predictors of successful authorship and to describe factors associated with research engagement. We searched PubMed from the database inception to October 2013 for publications with "hospitalist" or "hospital medicine" affiliated authors. Original research articles were reviewed for methodology and funding sources.
Of the 645 respondents (5.8% response rate), 277 (43%) had authored peer-reviewed publications, 126 (19%) had access to mentorship, and 68 (11%) reported funding support. There were 213 (33%) who were engaged in research, with the majority conducting quality improvement (QI) research (n = 152, 24%). Completion of a fellowship, pediatrics training, the presence of a mentor, funding, and >25% protected time for research were each individually associated with an increased likelihood of authoring publications. Hospitalist-led publications in PubMed have been increasing from 36 in 2006 to 179 in the first 10 months of 2013. Of the original research publications (n = 317), the majority were clinical (n = 129, 41%), and 58 (18%) were QI. Thirty-nine (22%) authors reported funding support.
Peer-reviewed publications by hospitalists are increasing, suggesting the academic maturation of hospital medicine. Provision of mentorship for hospitalists specifically in QI and guidance toward funding resources may assist in supporting this trend.
Introduction and hypothesis
Laparoscopic sacral colpoperineopexy (LSCP) involves posterior graft extension to the perineum for improved posterior support. The objective of this study was to determine ...whether posterior measurements differed between those that had graft extension done abdominally (A-LSCP) or abdomino-vaginally (AV-LSCP).
Methods
This was a retrospective cohort study of patients that underwent A-LSCP (
n
= 17) and AV-LSCP (
n
= 51). Pre-, peri-, and postoperative variables were compared using Student’s
t
, Fisher’s exact, and analysis of covariance tests.
Results
Follow-up was 6 to 12 months. There were no differences between A-LSCP and AV-LSCP for any vaginal measurements or stage of prolapse (
P
> 0.05). Although not statistically different, A-LSCP patients had lower rates of mesh erosion and dyspareunia (
P
> 0.05). AV-LSCP patients had fewer prolapse symptoms (
P
= 0.01), but both groups had similar surgical satisfaction (
P
= 0.8).
Conclusions
A-LSCP and AV-LSCP had comparable effects on posterior vaginal measurements; however, mesh erosion and subjective outcomes differed between the two approaches.
Background: Total Prolift® is a pelvic floor repair system that is performed transvaginally and can be carried out with or without the uterus in situ.
Aim: To compare surgical outcomes following ...total Prolift colpopexy (TPC) and total Prolift hysteropexy (TPH).
Methods: This was a retrospective cohort study of women that underwent TPC (n = 65) or TPH (n = 24). Outcomes were compared between groups using Student’s t‐test, ANCOVA and Fisher’s exact tests (P ≤ 0.05).
Results: There were no significant differences between TPC and TPH for all peri‐operative variables. Patients were followed 6–12 months after surgery. Post‐operatively, TPC patients had significantly higher pelvic organ prolapse – quantification (POP‐Q) point C measurements (P = 0.05); however, all other POP‐Q measurements were similar, including POP‐Q apical stage of prolapse, with 99% in the TPC group and 92% in the TPH group at stage I or less. Post‐operative mesh erosion, prolapse symptoms, surgical satisfaction, sexual activity and dyspareunia rates did not significantly differ between groups.
Conclusions: This study showed that TPC and TPH have similar surgical outcomes, except for vaginal vault measurements reflected by POP‐Q point C.
This study tested whether two 1-day retreats focused on spiritual self-care would positively change nurse participants' spirituality. A total of 199 critical care nurses were accepted into this ...study; 87 were randomized to receive the retreat intervention. All 199 nurses were tested preretreat, 1 month and 6 months postretreat. Retreat participants demonstrated increased spirituality.
PDF
