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This multicenter, randomized clinical trial compared two surgical procedures — the Burch colposuspension and the autologous fascial pubovaginal sling — in women with urinary stress incontinence. Success rates (in terms of overall urinary-incontinence measures and stress-incontinence measures specifically) were higher at 2 years for the sling group, but this group also had greater morbidity. These findings inform decision making with respect to surgical treatment of stress incontinence and underscore the importance of surgical randomized trials.
Patients with out-of-hospital respiratory distress who received treatment from emergency medical services personnel with advanced-life-support training had a lower in-hospital mortality than those who received treatment from providers without this training. The difference may be in part attributable to advanced-life-support interventions. Whether the data are sufficient to justify broad implementation of such training is unclear.
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As compared with mortality in hospitals with high-level, high-volume neonatal intensive care units (NICUs), the mortality among very-low-birth-weight infants was higher at NICUs with lower levels of care and lower patient volumes. Although these data cannot prove cause and effect, the results suggest that increased regional consolidation of perinatal care is feasible and might reduce mortality among very-low-birth-weight infants.
A 44-year-old morbidly obese woman inquires about bariatric surgery, a treatment option for patients with a body-mass index of 40 or more (or of 35 or more when there are coexisting medical conditions). Bariatric surgery has been shown to result in substantial weight loss and resolution of associated conditions. A successful clinical outcome requires an experienced multidisciplinary management team and an informed patient who will follow a plan of long-term management and self-care.
A 61-year-old man was referred to the thoracic oncology service for management of a thymoma. Six weeks earlier, a mediastinal mass, 4 cm in diameter, had been detected on a computed tomographic scan obtained because of chest pain. A positron-emission tomographic scan showed increased tracer uptake in the area of the lesion. Biopsy specimens showed a World Health Organization type B1 thymoma. Physical examination was normal. A decision on management was made.
In Gonzales v. Carhart, the Supreme Court ruled 5 to 4 that a physician can be prohibited from performing a particular medical procedure to abort a fetus, even if the physician believes the procedure is necessary to protect a woman's health. The author discusses the important implications of this decision for patients and physicians.
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