Objective The objective of the study was to examine the effect of selective fetoscopic laser photocoagulation (SFLP) vs serial amnioreduction (AR) on perinatal mortality in severe twin-twin ...transfusion syndrome (TTTS). Study Design This was a 5 year multicenter, prospective, randomized controlled trial. The primary outcome variable was 30 day postnatal survival of donors and recipients. Results There was no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11 of 20) vs 55% (11 of 20) ( P = 1.0, odds ratio OR 1, 95% confidence interval CI 0.242 to 4.14) or recipients at 30% (6 of 20) vs 45% (9 of 20) ( P = .51, OR 1.88, 95% CI 0.44 to 8.64). There was no difference in 30 day survival of 1 or both twins on a per-pregnancy basis between AR at 75% (15 of 20) and SFLP at 65% (13 of 20) ( P = .73, OR 1.62, 95% CI 0.34 to 8.09). Overall survival (newborns divided by the number of fetuses treated) was not statistically significant for AR at 60% (24 of 40) vs SFLP 45% (18 of 40) ( P = .18, OR 2.01, 95% CI 0.76 to 5.44). There was a statistically significant increase in fetal recipient mortality in the SFLP arm at 70% (14 of 20) vs the AR arm at 35% (7 of 20) ( P = .25, OR 5.31, 95% CI 1.19 to 27.6). This was offset by increased recipient neonatal mortality of 30% (6 of 20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality ( P = .055, OR 3.025/point) by logistic regression analysis. Conclusion The outcome of the trial did not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.
Retirement and issues associated with the initiation of retirement have undergone extensive change in the past decade. Multiple factors, including economic conditions, have resulted in a delay in the ...initiation of retirement. Delayed retirement of senior radiologists is a factor contributing to a diminished job market for entering radiology graduates. These senior radiologists have extensive experience in operational issues and understanding complex relationships with other health professionals, hospitals, and often medical schools. In addition, although they may not be as facile with MRI or PET/CT, senior radiologists have a tremendous command of traditional imaging, which is lacking in recently trained radiologists. The authors examine many of the issues related to delayed retirement and propose some possible solutions.
The employment of part-time radiologists (PTRs) has both advantages and disadvantages in various practice settings. The authors examine the pros and cons of PTRs and review the literature regarding ...PTRs both within and outside the specialty of radiology. The complexity of this issue is manifested in our inability to reach consensus on many policy issues for PTRs. Nevertheless, this article should be helpful in offering an objective, nonbiased background to initiating a discussion on employing PTRs in various radiology practices.
There are many retirement and preretirement issues facing individual radiology groups and practices. The discussion of the numerous options available for radiologists contemplating retirement ...sometimes becomes contentious within a practice and may pit younger radiologists against the more senior members of the group. The potential exists for the process to degenerate into personality clashes. The purpose of this article is to offer some objective guidance on retirement issues.
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