Thrombogenicity and Reoperation of the St. Jude Medical Silzone (R) valve:A comparison with the conventional St. Jude medical valve

Background and aim of the study: The St. Jude Medical Silzone(R) valve was withdrawn from the market after an interim analysis of the AVERT study revealed a 2.76% incidence of paravalvar leakage leading to valve re-replacement, compared with only 1.02% in the control group. Additionally, an increased risk for thromboembolic complications was reported in different series of patients. Methods: To monitor the consistency of these reports, the incidence of thromboembolic complications and paravalvar leakage was investigated in 113 patients who received a Silzone valve at the authors' institution, compared with 101 patients who, immediately prior to the Silzone group, received a conventional valve. Results: No difference was found in the incidence of either thromboembolism or paravalvar leakage after either Silzone or conventional valve replacement. Conclusion: Differences between the AVERT study and the present study might reflect differences in operative technique or in patient groups, but this as yet is unknown. To clarify the prospects of the estimated 36,000 patients with Silzone valves world wide, further research should aim at identifying possible unique features of patient groups with a higher risk of paravalvar leakage leading to valve explantation. In brief, an increased rate of paravalvar leakage and/or thromboembolism does not apply to either valve replacement groups

Новатор. 2016. № 39

In this paper I defend Judith Jarvis Thomson's 'Good Samaritan Argument' (otherwise known as the 'feminist argument') for the permissibility of abortion, first advanced in her important, ground-breaking article 'A Defense of Abortion' (1971), against objections from Joseph Mahon (1979, 1984). I also highlight two problems with Thomson's argument as presented, and offer remedies for both of these problems. The article begins with a short history of the importance of the article to the development of practical ethics. Not alone did it put the topic of the abortion on the philosophical map, but it made 'practical ethics' in the late 1960s feminist, also

Clamp ablation of the testes compared to bilateral orchiectomy as androgen deprivation therapy for advanced prostate cancer

PURPOSE: Burdizzo clamp ablation of the testes (CAT) may provide an incisionless, cost-effective form of androgen deprivation therapy (ADT) in men with adenocarcinoma of the prostate (ACP) who find bilateral orchiectomy (BO) unacceptable or can not afford medical ADT. The aim of this study was to compare CAT with BO as primary ADT in men with ACP. MATERIALS AND METHODS: Written, informed consent was obtained from men with locally advanced or metastatic ACP. Patients were prospectively randomized to BO (n = 9) or CAT (n = 10) under local anaesthesia, and were evaluated 3 and 7 days, 6 weeks and 3 months post-procedure. The protocol was approved by the local institutional ethics committee. Statistical analysis was performed using Student's, Mann-Whitney's and Fisher's tests. RESULTS: Mean duration of the procedure was significantly longer for BO than CAT (16.9 vs. 10.9 minutes). Mean pain scores during and after the procedure did not differ significantly. Serum testosterone decreased significantly on days 3 and 7 after CAT, but increased at 6 weeks, and was significantly higher than after BO. Serum luteinizing hormone increased significantly from day 3 after BO and from day 7 after CAT. Serum prostate specific antigen decreased significantly after BO, but not after CAT. Minor complications were more common after BO (89%) than CAT (40%). In the 9 men who did not achieve castrate levels of testosterone after CAT, BO was performed. CONCLUSIONS: CAT was quicker to perform and had a lower complication rate, but was not as effective as BO in achieving castrate serum testosterone levels