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Bernard Cristalli MD
AIHP- ACCA
CNGOF - AMACOG
bcrist@club.fr
Le 30 janv. 07 à 21:38, William D. McIntosh, M.D a écrit :
> Where in the world can you have an AVERAGE length of stay
> post-hysterectomy of 5 days? My LSH'ers go home same day, vag
> hysts the
> next morning, and even abdominals go home on the second postop
> morning.
>
> WD McIntosh MD, FACOG
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dean
> Huffman .
> Sent: Tuesday, January 30, 2007 10:36 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Uterine-Artery Embolization versus Surgery for Symptomatic
> Uterine Fibroids
>
> .
>
> Uterine-Artery Embolization versus Surgery for Symptomatic Uterine
> Fibroids
>
> The REST Investigators
>
> ABSTRACT
>
> Background The efficacy and safety of uterine-artery embolization, as
> compared
> with standard surgical methods, for the treatment of symptomatic
> uterine
> fibroids remain uncertain.
>
> Methods We conducted a randomized trial comparing uterine-artery
> embolization
> and surgery in women with symptomatic uterine fibroids. The primary
> outcome was
> quality of life at 1 year of follow-up, as measured by the Medical
> Outcomes
> Study 36-Item Short-Form General Health Survey (SF-36).
>
> Results Patients were randomly assigned in a 2:1 ratio to undergo
> either
> uterine-artery embolization or surgery, with 106 patients undergoing
> embolization and 51 undergoing surgery (43 hysterectomies and 8
> myomectomies).
> There were no significant differences between groups in any of the
> eight
> components of the SF-36 scores at 1 year. The embolization group had a
> shorter
> median duration of hospitalization than the surgical group (1 day
> vs. 5
> days,
> P<0.001) and a shorter time before returning to work (P<0.001). At 1
> year,
> symptom scores were better in the surgical group (P=0.03). During the
> first
> year of follow-up, there were 13 major adverse events in the
> embolization group
> (12%) and 10 in the surgical group (20%) (P=0.22), mostly related
> to the
> intervention. Ten patients in the embolization group (9%) required
> repeated
> embolization or hysterectomy for inadequate symptom control. After the
> first
> year of follow-up, 14 women in the embolization group (13%) required
> hospitalization, 3 of them for major adverse events and 11 for
> reintervention
> for treatment failure.
>
> Conclusions In women with symptomatic fibroids, the faster recovery
> after
> embolization must be weighed against the need for further treatment
> in a
> minority of patients. (ISRCTN.org number, ISRCTN23023665
> [controlled-trials.com] .)
>
> N Engl J Med. 2007 Jan 25;356(4):360-70.
> PMID: 17251532
>
> http://content.nejm.org/content/vol356/issue4/index.shtml
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