Objective To assess the long-term outcome of patients intermittent catheterization after the explantation of eroded AUS cuÂs. In seven patients the AUS was who had an artificial urinary sphincter (AUS) implanted between 10 and 15 years ago. abandoned; two of these patients reverted to condom drainage and five had continent or incontinent urinary Patients and methods Of 68 patients who had an AUS implanted more than 10 years ago, 61 were followed diversions fashioned. Thus, if those who died with a functioning AUS are included, 46 of 61 (75%) with suÃcient detail for analysis. Thirty-four had a neuropathic bladder with sphincter dysfunction, 15 achieved long-term continence with the AUS. Conclusions Despite the high complication and revision had post-prostatectomy sphincter weakness incontinence and 12 further patients had a variety of rate, these results show that acceptable continence rates can be achieved in the long-term, particularly in indications.Results The 61 patients experienced a total of 58 major the male neuropathic bladder and in those with postprostatectomy sphincter weakness. Many of the comcomplications and 49 have required at least one revision procedure. Currently eight (13%) patients are plications encountered may be less common with the current re-designed models of the AUS. However, it is satisfactorily continent with their original AUS in situ and 29 others have a satisfactory revised AUS. Thus essential that both surgeon and patient recognize and accept the likelihood of complications and revisions 37 of 61 (61%) are continent using an AUS at least 10 years after first implantation. Eleven patients died before using the AUS. The continued use of the AUS where simpler methods of obtaining continence are and of these two had a satisfactory original AUS in situ and seven had successful revisions. In two patients inappropriate remains justified. Keywords Artificial urinary sphincter, urinary contithe AUS failed but they were considered unfit for revision. Four female patients were continent and used nence, complications, outcome details the outcome in patients who had an AUS

Background Patient-reported outcome (PRO) data evaluating the physical and psychosocial impact of Cryolipolysis (CoolSculpting) treatment are limited. Objectives Assess multidimensional aspects of satisfaction following cryolipolysis treatment of the flanks and abdomen using a combination of PRO instruments. Methods This was a multi-national, prospective, single cohort, interventional study. The primary endpoint was the proportion of Satisfied or Very Satisfied participants with treatment at 12 weeks post final treatment. Secondary endpoints included satisfaction categorized by treatment area, total number of treatment cycles, baseline body mass index (BMI), and fat volume reduction measured by 3D photography at 12 weeks post final treatment. Exploratory endpoints assessed the physical and psychosocial impacts of treatment. Safety was monitored throughout the study. Results Of 112 participants who were treated, 74.1% were female. The mean age and BMI were 42.5 years and 24.9 kg/mg 2, respectively. Of the 106 evaluable participants, 89.6% were Satisfied or Very Satisfied with treatment results. Satisfaction was high regardless of body area(s), total number of treatment cycles, or baseline BMI. Mean (SD) fat volume reduction was 264.8 mL (411.4). Overall, 90.6% reported Noticeable or Very Noticeable fat reduction, 89.6% were Likely or Very Likely to treat additional areas, and 93.4% would recommend cryolipolysis to a friend. 24 (21.4%) participants reported treatment-emergent adverse events (AEs); 23 (20.5%) reported these as Adverse Device Effects (ADE). No serious device-related or unanticipated adverse effects occurred. Conclusions Cryolipolysis (CoolSculpting) for fat reduction of the flanks and/or abdomen was well-tolerated and associated with high levels of satisfaction across multidimensional PROs.

A t present in England and Wales just over 20% of all deaths are followed by a post mortem examination, almost all on the instructions of a coroner. In contrast, in Scotland and Northern Ireland the rates are below 10%. In a wider context overall post mortem rates in the provinces of Canada vary between 5-9% and are probably much lower in France and Germany. The reasons for this variation are unknown. Remarkably there has been no national audit of the indications for, or value of, autopsy examination. In this review we consider: c why autopsies should be performed after cardiac surgery c who should perform these autopsies and how they should be reported c what has been learnt from post mortem examinations performed on patients dying after cardiac surgery c what the role of these autopsies is in the future. POST MORTEM EXAMINATION AFTER SURGERY cPathologists frequently refer to the many published studies which have shown that important new information is detected in autopsies performed in patients dying in hospital.1 At least two have shown that the rate of unexpected findings has not altered significantly over several decades. Methods have been developed to categorise the degree of concordance between pre-mortem clinical diagnoses and post mortem findings.2 A recent meta-analysis identified discrepancies in 10-20.6% of post mortem examinations where the patient would potentially have survived if the correct diagnosis had been known in life. 4 Although most of these studies have included patients dying after surgery, there have been few that specifically studied the value of post mortem examination after surgery. A retrospective study from Connecticut studied the clinical records and post mortem reports of 150 patients who died in a surgical intensive care unit. There was full agreement in only 58% of cases. The longer the patient was in the unit the greater the chance was of an unexpected finding. Infection was the most common undiagnosed condition, especially in patients who had received a transplant. 6 Impressed by these findings, we made a similar audit of 92 patients dying in our hospital after surgery in 2002 who had an autopsy. We found full agreement in 65%, a major disagreement in 20% and less important discrepancies in 15% of cases. Infection, pulmonary thromboembolism and ischaemic heart disease were the most important conditions diagnosed at post mortem examination. Important discrepancies were identified in 33% of orthopaedic procedures, 31% of neurosurgical, 27% of general surgical operations, but only 5.7% of cardiac operations.

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