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  • 1
    ISSN: 1530-0358
    Keywords: Cost-effectiveness ; Costs ; Dynamic graciloplasty ; Fecal incontinence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study evaluates the cost-effectiveness of dynamic graciloplasty for intractable fecal incontinence. PATIENTS AND METHODS: The costs and effects of dynamic graciloplasty were measured in a prospective, longitudinal study and in a clinical trial. Forty-three patients with intractable fecal incontinence were evaluated before and after dynamic graciloplasty. Costs were obtained from the hospital information system and from patient-oriented questionnaires. We compared the costs of a dynamic graciloplasty with the costs of a colostomy. Colostomy costs were evaluated using a group of seven patients who had a stoma in place for incontinence for several years. Sensitivity analyses were included. RESULTS: Total direct costs of lifelong dynamic graciloplasty were $31,733 (United States dollars), costs of lifelong conventional treatment were $12,180 (United States), and costs of colostomy, including lifelong stoma care, were $71,576 (United States). The clinical success rate of dynamic graciloplasty was 74 percent. Quality of life after successful dynamic graciloplasty was better than with conventional treatment. CONCLUSION: We found that dynamic graciloplasty was more expensive than conventional treatment but resulted in a significantly higher quality of life. Stoma treatment was the least attractive alternative regarding both costs and effects. The Dutch Health Insurance Executive Board recommended reimbursement for the dynamic graciloplasty procedure.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1912
    Keywords: α2-Adrenoceptors ; 3H-Clonidine binding sites ; 3H-Rauwolscine binding sites ; Noradrenergic neurons ; Serotoninergic neurons
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary α2-adrenoceptors located presynaptically on nerve terminals are known to modulate the release of neurotransmitters from noradrenergic and serotoninergic neurons. The pre- and/or postsynaptic localization of binding sites for α2-adrenergic radioligands, the agonist 3H-clonidine and the antagonist 3H-rauwolscine, was investigated in the rat cerebral cortex by the use of specific neurotoxins. Intracerebroventricular ijections of 6-hydroxydopamine (6-OH-DA) and 5,7-dihydroxytryptamine (5,7-DHT) were used to destroy the noradrenergic and serotoninergic neurons, respectively, and the success of the treatment was controlled by measurement of tritium accumulation in cortex slices incubated with 3H-noradrenaline or 3H-serotonin. In cortical membranes, 3H-rauwolscine bound to a single site (K D about 5 nmol/l; B max 217–247 fmoles/mg protein), whereas 3H-clonidine bound to a high affinity site (K D 0.6–1.4 nmol/l) and a low affinity site (K D 6–10 nmol/l). The total number of high plus low affinity 3H-clonidine binding sites was about two thirds of the number of 3H-rauwolscine binding sites. 6-OH-DA treatment significantly increased the number of high affintiy 3H-clonidine binding sites without reducing the number of high plus low affinity binding sites, indicating a denervation supersensitivity. K D- as well as B max-values for 3H-rauwolscine remained unaltered after 6-OH-DA-treatment. Since an increase in postsynaptic α2-adrenoceptors due to 6-OH-DA-administration might have masked a loss of presynaptic α2-adrenergic binding sites, rats were chronically treated with high doses of clonidine in order to prevent a possible supersensitivity of postsynaptic receptors. Even under these conditions 6-OH-DA did not reduce the number of 3H-clonidine and 3H-rauwolscine binding sites. Injection of 5,7-DHT had no influence on binding parameters of 3H-clonidine and 3H-rauwolscine. It is concluded that in the cerebral cortex the number of postsynaptic α2-adrenoceptors is much greater than that of presynaptic α2-adrenoceptors. Therefore, the changes in the number of presynaptic α2-adrenoceptors due to destruction of noradrenergic or/and serotoninergic neurons cannot be detected by equilibrium binding studies with 3H-clonidine or 3H-rauwolscine.
    Type of Medium: Electronic Resource
    Library Location Call Number Volume/Issue/Year Availability
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