Uterine artery embolization versus myomectomy: a multicenter comparative study.

OBJECTIVE: To determine whether there is significant quality of life score improvement after uterine artery embolization (UAE) and to compare UAE and myomectomy outcomes. DESIGN: Prospective cohort controlled study. SETTING: Sixteen medical centers in the United States. PATIENT(S): One hundred forty-nine UAE patients and 60 myomectomy patients. Patients were assigned to myomectomy or UAE on the basis of a best treatment decision made by the patient and her physician. All patients were observed for 6 months. The UAE patients also had follow-up examinations at 1 year. INTERVENTION(S): Myomectomy or UAE. MAIN OUTCOME MEASURE(S): Quality of life score changes, menstrual bleeding score changes, uterine size differences, time off, and adverse events. RESULT(S): Both groups experienced statistically significant improvements in the uterine fibroid quality of life score, menstrual bleeding, uterine volume, and overall postoperative quality of life. The mean hospital stay was 1 day for the UAE patients, compared with 2.5 days for the myomectomy patients. The UAE and myomectomy patients returned to their normal activities in 15 days and 44 days, respectively, and returned to work in 10 days and 37 days, respectively. At least one adverse event occurred in 40.1% of the myomectomy patients, compared with 22.1% in the UAE group. CONCLUSION(S): The uterine fibroid quality of life score was significantly improved in both groups. No significant differences were observed in bleeding improvement, uterine volume reduction, uterine fibroid quality of life score improvement, and overall quality of life score improvement between groups. Patients receiving UAE required fewer days off work, fewer hospital days, and experienced fewer adverse events.

Development of a human pancreatic islet-transplant program through a collaborative relationship with a remote islet-isolation center.

BACKGROUND: With the development of the Edmonton Protocol, pancreatic islet transplantation (PIT) now offers insulin-dependent diabetic patients metabolic stability. The PIT Food and Drug Administration (FDA) regulations, pancreatic islet isolation (PII) techniques, and clinical PIT protocols are challenging and make PIT program development daunting. PURPOSE: Review of the establishment of a PIT program through a collaborative relationship with a remote PIT/PII center. METHODS: Four key elements are required: (1) development of a collaborative relationship with an established PIT/PII center, (2) achievement of institutional review board and FDA approval at both centers, (3) generation of standard operating procedures, and (4) development of a multidisciplinary PIT team. RESULTS: Securing a collaborative relationship with an experienced PIT/PII center permitted our program to develop in less than 18 months. Twenty-two PITs were completed in the first clinical year. CONCLUSIONS: Collaboration with an experienced PIT/PII center allows developing programs to focus on patient safety and care, prudent use of pancreata, and consolidates PII expertise and experience.

Aortoduodenal fistula and associated rupture of abdominal aortic aneurysm after endoluminal stent graft repair.

The main complications of endovascular repair of abdominal aortic aneurysms are vascular leaks and rupture, although infection and aortoduodenal fistulas have also been reported rarely. We report a case of aortoduodenal fistula with separate retroperitoneal rupture of an abdominal aortic aneurysm after endovascular stent graft repair. The initial implantation was uneventful, without any leaks at 1 month. The patient underwent open repair and did well. To our knowledge, this is the first case report of aortoduodenal fistula and associated retroperitoneal rupture of the aneurysm after endovascular stent graft repair of an abdominal aortic aneurysm.