Main Determinant Of Outcome Research Articles

Long-term faecal continence in infants born with anorectal malformations.

In a retrospective study of 92 patients admitted between 1975 and 1986 with anorectal malformations, we reviewed the faecal continence according to the level of their anomaly using a scoring system taken from Pescatori et al. The results of the different operative procedures were compared. Forty-seven of the 50 patients in the low anomaly group had complete faecal continence. Two died from associated anomalies and one infant had incomplete continence. This child had an associated neural tube defect. Of eight patients in the intermediate group, three had good results while two were incontinent: three patients died from associated anomalies. There were 34 patients with high anomalies, 27 of whom showed a wide range of faecal control from complete continence to different degrees of incontinence. Seven infants died from septicaemia and/or associated anomalies. The anatomical level of the lesion and the presence or absence of any associated neurological defect were the main determinants of outcome. The sex of the child and the operative procedure employed to correct the anomaly appeared to be less important.

Cost Comparison of Immediat Angioplasty Versus Thrombolysis Followed by Conservative Therapy for Acute Myocardial Infarction: A Randomized Prospective Trial

Immediate angioplasty and thrombolysis followed by conservative therapy are treatment strategies for acute myocardial infarction. The objective of this study was to compare the costs of these two strategies during a 12-month period. Of 103 patients with acute myocardial infarction who sought medical assistance within 12 hours after onset of symptoms, 4 were excluded from analysis for various reasons, 51 received tissue plasminogen activator, and 48 underwent immediate angioplasty as the initial revascularization strategy. The main outcome determinants were direct monetary costs and indirect measures of costs, including duration of hospital stay and return to work. No significant difference in monetary costs between the two initial treatment strategies could be demonstrated. A trend was noted toward a briefer hospital stay and fewer late in-hospital procedures for patients treated initially with immediate angioplasty. Other measures of indirect costs were not statistically different. The hypothesis that thrombolysis followed by conservative therapy would be more cost-effective than immediate angioplasty in the treatment of patients with acute myocardial infarction could not be substantiated. The two strategies seem to have similar cost-effectiveness.

Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis.

Of 46 patients who had Nissen fundoplication for proved gastro-oesophageal reflux, 25 were available for follow up after a median of 20 years, 15 had died of unrelated causes, and six could not be traced. All 25 patients in the follow up study were personally interviewed: 21 consented to an endoscopy, 14 to 24 hour recording of oesophageal pH and manometry, and 15 to radionuclide transit test. Repeat fundoplication for recurrent reflux was performed in two cases during the study. Heartburn and regurgitation were significantly lessened (p < 0.005), but the incidence of dysphagia was slightly increased. Endoscopy showed six of 21 fundic wraps to be defective. Erosive oesophagitis was seen in two patients, and Barrett's oesophagus (histologically confirmed) in one of them and six other patients. Total reflux time was abnormal in four of 14 patients. No patient with an intact fundic wrap seen on endoscopy, only two of seven with Barrett's oesophagus, and one of four with abnormal reflux had oesophagitis. Fundoplication in itself did not affect oesophageal motility or transit, provided that the wrap was intact. It is concluded that Nissen fundoplication gave a reasonably good longterm effect in chronic reflux disease, with the stage of the fundic wrap as the main determinant of outcome.

Outcome and complications of assisted reproduction

This review discusses studies documenting an increase in birth rate associated with in vitro fertilization and gamete intrafallopian transfer. The results of zygote intrafallopian transfer are also encouraging. The rates of chromosomal and congenital abnormalities in assisted reproduction are similar to the rates at which these problems occur in normal pregnancies. Multiple pregnancy is the main determinant of outcome. Singleton pregnancies have higher rates of pregnancy complications. Factors affecting outcome of assisted reproduction include age of the mother, level of basal follicle-stimulating hormone, the number of embryos or gametes transferred, response to ovarian stimulation, and the quality of gametes and eventually of the embryo. Complications of these procedures relate to the technique used. Recent reports have highlighted the effects of multiple gestation in terms of perinatal morbidity, the effect on the family, and the demand for neonatal resources, as well as ethical issues surrounding selective reduction. The use of gonadotropin-releasing hormone agonist has led to an increase in the incidence of severe ovarian hyperstimulation. Other reports document the incidence of ectopic pregnancy in in vitro fertilization with embryo transfer.

Spinal epidural abscess: presentation and treatment: A report of 21 cases

To examine the presentation, investigative findings, treatment and outcome in patients with spinal epidural abscess. The study was a retrospective analysis of all patients with this condition presenting to the Neurosurgical Units at the Royal Prince Alfred Hospital and Westmead Hospital, Sydney, during the period September 1984 to September 1987. There was a total of 21 patients with an age range from 7-87 years (mean 47 years). Eleven cases were acute and ten chronic. The causative organism was Staphylococcus aureus in 15 of the 21 cases, the other organisms involved were Mycobacterium tuberculosis, Escherichia coli, Streptococcus and Pseudomonas aeruginosa. All patients were treated with a combination of surgery (decompression with or without fusion) and prolonged antibiotic administration. Of the 21 patients 11 had a good to excellent outcome while 10 had a poor outcome. The main determinant of outcome was the neurological state at presentation emphasising the importance of early diagnosis and prompt treatment.