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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
    Electronic Resource
    Electronic Resource
    Springer
    Naunyn-Schmiedeberg's archives of pharmacology 333 (1986), S. 335-341 
    ISSN: 1432-1912
    Keywords: Postsynaptic 5-HT1 receptors ; Adenylate cyclase ; Rat hippocampus ; 5-HT1A, 5-HT1B, 5-HT1C, 5-HT2 receptor subtypes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 1. Serotonin (5-HT) stimulated adenylate cyclase activity in homogenates of rat hippocampus. This effect was pharmacologically characterised with a series of agonists and antagonists of various structural classes. 2. These compounds where also tested in radioligand binding studies using selective ligands for the various subtypes of 5-HT1 and 5-HT2 receptors. 5-HT1A, 5-HT1B and 5-HT1C recognition sites were labelled with [3H]8-OH-DPAT ([3H]8-hydroxy-2-(di-n-propylamino)-tetralin) in pig cortex membranes, [125I]CYP([125I]iodocyanopindolol) in rat cortex and [3H]mesulergine in pig choroid plexus membranes, respectively. 3. The rank order of potency of 13 agonists stimulating adenylate cyclase activity in homogenates of rat hippocampus was in good agreement with the rank order of affinity of these agonists for the 5-HT1A binding site: N,N-dipropyl-5-carboxamidotryptamine (DP-5-CT)〉5-carboxamidotryptamine (5-CT)〉8-OH-DPAT〉5-HT〉 5-methoxytryptamine (5-OCH3T)〉d-LSD〉5-methoxy-3-(1,2,3,6-tetrahydro-4-pyridinyl)-1H-indole (RU 24969)〉α-methylserotonin (α-CH3-5-HT)〉dopamine〉2-methylserotonin (2-CH3-5-HT). The correlation between the respective potencies and affinities of these agonists was r=0.934, P〈0.001. 4. There was no correlation between stimulation of adenylate cyclase activity by these agonists and their affinity for 5-HT1B, 5-HT1C or 5-HT2 binding sites. r=0.381–0.108, P〈0.20–0.73. 5. Potent antagonists at D-1 receptors (SCH 23390), 5-HTM receptors (ICS 205-930), 5-HT2-receptors (ketanserin) and 5-HT1C-receptors (mesulergine) antagonised the 5-HT stimulated adenylate cyclase activity only at very high concentrations. In contrast, spiperone and metitepin were potent antagonists of the effect of 5-CT and 5-HT on adenylate cyclase. The use of these selective antagonists allowed to exclude the possibility that 5-HT stimulates adenylate cyclase activity in rat hippocampus through D-1, 5-HTM, 5-HT2 or 5-HT1C receptors. 6. These data support the concept that 5-HT stimulated adenylate cyclase activity in rat hippocampus is mediated by a 5-HT1A receptor.
    Type of Medium: Electronic Resource
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