Would Surgeons Opt for Polypropylene Mesh if They Hypothetically Had Stress Urinary Incontinence or Pelvic Organ Prolapse?

Introduction • Controversy surrounding vaginal mesh kits • Many patients have negative connotations regarding mesh • If patients were shown that their surgeons would opt for mesh –maybe this would help lessen the negativity?https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1057/thumbnail.jp

Contemporary multicenter outcomes of continent cutaneous ileocecocystoplasty in the adult population over a 10-year period: A Neurogenic Bladder Research Group study

AIMS: Evidence is sparse on the long-term outcomes of continent cutaneous ileocecocystoplasty (CCIC). We hypothesized that obesity, laparoscopic/robotic approach, and concomitant surgeries would affect morbidity after CCIC and aimed to evaluate the outcomes of CCIC in adults in a multicenter contemporary study. METHODS: We retrospectively reviewed the charts of adult patients from sites in the Neurogenic Bladder Research Group undergoing CCIC (2007-2017) who had at least 6 months of follow-up. We evaluated patient demographics, surgical details, 90-day complications, and follow-up surgeries. the Mann-Whitney U test was used to compare continuous variables and χ² and Fisher\u27s Exact tests were used to compare categorical variables. RESULTS: We included 114 patients with a median age of 41 years. The median postoperative length of stay was 8 days. At 3 months postoperatively, major complications occurred in 18 (15.8%), and 24 patients (21.1%) were readmitted. During a median follow-up of 40 months, 48 patients (42.1%) underwent 80 additional related surgeries. Twenty-three patients (20.2%) underwent at least one channel revision, most often due to obstruction (15, 13.2%) or incontinence (4, 3.5%). Of the channel revisions, 10 (8.8%) were major and 14 (12.3%) were minor. Eleven patients (9.6%) abandoned the catheterizable channel during the follow-up period. Obesity and laparoscopic/robotic surgical approach did not affect outcomes, though concomitant surgery was associated with a higher rate of follow-up surgeries. CONCLUSIONS: In this contemporary multicenter series evaluating CCIC, we found that the short-term major complication rate was low, but many patients require follow-up surgeries, mostly related to the catheterizable channel

Sanctuary Cities? Asylum? Dreamers? When a House is Not a Home: The Legal and Socioeconomic Implications of National Populism on Local Governance and Individual Liberties

Since the 1950s, the U.S. has proudly boasted itself as a nation of immigrants, However, immigration reform is amongst the most intensely confusing, divisive, and polarizing issues in America\u27s public square. Immigration remains front and center in the public debate across the U.S., especially since the September 11th terrorist attacks. The fear and turmoil, which ebbed and flowed since the 9/11 tragedy, reached a boiling point during the 2016 general election cycle, and ultimately the election of the 45th president, Donald J. Trump. This article examines the impact and implications of a broken federal government on America\u27s cities which are increasingly at odds with the White House, a divided Congress, and an overwhelmed federal judiciary. There is much work to do in shaping our immigration policies an our nation\u27s leaders must be ready, able, and willing to do it. This Article is organized into five parts. Part I (this section) provides the reader with an overview of legal issues arising from the Constitution in the immigration context. Part II provides background information on so-called Sanctuary Cities as a modem-day Underground Railroad, including the origins of the movement, the anatomy of Sanctuary Cities, and some key socioeconomic opportunities and challenges that occur in Sanctuary Cities. Part III addresses the special relationship between the District of Columbia and the Federal Government, while also examining the delicate balance of a Federal City asserting Sanctuary City status. Part IV covers the Separation of Powers, including an in-depth analysis of Executive Order 13768, Enhancing Public Safety in the Interior of the United States, and uses key precedent to evaluate the constitutionality of the Executive Order principally City of Chicago v. Sessions, City and County of San Francisco v. Trump, and City of San Antonio v. Texas, challenging 2017 Texas Senate Bill-4, which outlaws Sanctuary Cities in Texas, and California\u27s 2017 Senate Bill 54 that confers Sanctuary State status in that jurisdiction this year. 16 The fact that two of America\u27s largest and most politically influential states have adopted such divergent views on immigration is a clarion call for immigration reform. Finally, Part V looks at socioeconomic implications for Sanctuary Cities as they look to set policies and regulations, as well as administer health, education, and other social service programs for their residents. Moreover, this section examines how local immigrant residents are being negatively affected by emerging federal and state laws which are contrary to local municipality regulations. Part V concludes by offering some reasonable, commonsense reforms to solve this American nightmare

Holmium laser for the surgical treatment of benign prostatic hyperplasia.

INTRODUCTION: Holmium laser ablation of the prostate (HoLAP) is a surgical approach for treatment of benign prostatic hyperplasia (BPH). Limited evidence suggests laser ablation/vaporization is inferior to enucleation with respect to reoperation rates. Our objective was to determine if properly performed laser ablation results in outcomes similar to enucleation. MATERIALS AND METHODS: A total of 198 patients with moderate to severe lower urinary tract symptoms and/or acute urinary retention had holmium laser enucleation of the prostate (HoLEP) or HoLAP between 2008 and 2014. Patients with metastatic prostate cancer, prior pelvic radiation, or bladder cancer involving the bladder neck or prostatic urethra were excluded. All procedures involved residents and were supervised by one experienced surgeon. The decision to perform HoLAP versus HoLEP was made intraoperatively. Demographics, pre, peri and postoperative data were collected. RESULTS: A total of 169 men were analyzed: 54 had HoLAP and 115 had HoLEP. Mean follow up was 27.16 months for HoLAP, and 38.18 months for HoLEP. As expected, the HoLEP group had larger prostates, longer mean operative times, and greater reduction in total PSA. There was no difference in the net change of flow rate between groups. CONCLUSION: Both HoLEP and HoLAP are appropriate surgical interventions for the management of BPH, when properly performed. Our findings suggest that adequate ablation of prostatic adenoma results in similar 2 year outcomes as enucleation

Diagnosis and Management of Hematuria.

Microscopic and gross hematuria present unique and difficult diagnostic and management challenges in the already complex general surgery patient. This article provides the general surgeon with relevant knowledge in the pathophysiology, anatomy, etiologies, workup, and treatments of hematuria. In addition common causes of hematuria that may be encountered by the general surgeon (including trauma, urinary tract infection, urolithiasis, and malignancy), the difficult to manage clinical situation of clot urinary retention is presented. This article provides a urologic framework of thinking for the clinician to best manage a general surgery patient who has hematuria

Doubly chloro bridged dimeric copper(II) complex: magneto-structural correlation and anticancer activity

We have synthesized and structurally characterized a new doubly chloro bridged dimeric copper(II) complex, [Cu2(μ-Cl)2(HL)2Cl2] (1) based on a Schiff base ligand, 5-[(pyridin-2-ylmethylene)-amino]-pentan-1-ol). Single crystal X-ray diffraction shows the presence of dinuclear copper(II) centres in a square pyramidal geometry linked by obtuse double chloro bridge. The magnetic study illustrated that weak antiferromagnetic interactions (J = −0.47 cm−1) prevail in complex 1 which is well supported by magneto-structural correlation. This compound adds to the library of doubly chloro bridged copper(II) complexes in the regime of spin state cross over. DFT calculations have been conducted within a brokensymmetry(BS) framework to investigate the exchange interaction further which depicts that the approximate spin projection technique yields the best corroboration of the experimental J value. Spin density plots show the presence of an ∼0.52e charge residing on the copper atom along with a substantial charge on bridging and peripheral chlorine atoms. The potential of complex 1 to act as an anticancer agent is thoroughly examined on a series of liver cancer cell lines and screening shows the HepG2 cell line exhibits maximum cytotoxicity by phosphatidyl serine exposure in the outer cell membrane associated with ROS generation and mitochondrial depolarization with increasing time in the in vitro model system