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At least 775 records · Page 43Linked to original sources
PubMed1999

Repeat vasectomy reversal after initial failure: overall results and predictors for success.

PURPOSE: We review the treatment outcomes for microsurgical reconstruction following failed vasectomy reversal and identify predictors for success. MATERIALS AND METHODS: We performed a retrospective review of our experience with microsurgical reconstruction in 41 men who underwent 1 or more prior unsuccessful vasectomy reversal procedures. Of these patients 20 underwent bilateral (16) or unilateral (4) vasoepididymostomy, 11 underwent bilateral (7) or unilateral (4) vasovasostomy and 10 underwent unilateral vasoepididymostomy with contralateral vasovasostomy. Postoperative followup consisted of serial semen analyses and telephone interviews. RESULTS: Patency and pregnancy followup data were available in 33 and 31 patients, respectively. Five couples had ongoing uncorrected female factor infertility problems and were not included in pregnancy rate calculations. Mean obstructive interval was 10.6 years. Overall patency and pregnancy rates were 79 and 31%, respectively. Mean total motile sperm count for patients demonstrating patency at followup was 38.0 million. History of conception with the current partner was predictive of future conception with 4 of 5 nonremarried couples (80%) initiating a pregnancy versus 3 of 18 remarried couples (17%) (p = 0.006). Other factors, including smoking history and obstructive interval, did not correlate with postoperative success. Reconstruction with vasovasostomy on at least 1 side trended toward improved patency (p = 0.17) and pregnancy rates (p = 0.15), although they did not assume statistical significance. CONCLUSIONS: Microsurgical reconstruction following failed vasectomy reversal is associated with high patency and moderate pregnancy rates at short-term followup. In our series previous conception with the current partner was predictive of future conception after reconstruction. Urologists performing repeat vasectomy reversal must be familiar with microsurgical techniques, since almost three-quarters of patients will require at least unilateral vasoepididymostomy.

Adult↗
PubMed1992

Pilot study to evaluate impact of a policy of adjuvant chemotherapy for high risk stage 1 malignant teratoma on overall relapse rate of stage 1 cancer patients.

A total of 41 patients with stage 1 malignant teratoma of the testis treated from January 1986 to June 1990 was entered into a pilot study of 2 courses of adjuvant cisplatin-based combination chemotherapy. Of the patients 22 had a high or intermediate risk of relapse according to the Medical Research Council (United Kingdom) prognostic factor analysis and surveillance was instituted for 19 patients with a low relapse risk. The overall relapse rate in this group of patients (median followup 2 years) was 9.7% (5% in the adjuvant group and 16% in the surveillance group), which was significantly better than the 35% rate in the historical series treated by surveillance from 1980 to 1985 and equaled or was possibly better than that reported from adjuvant retroperitoneal lymph node dissection. Justification for consideration of 1 course of adjuvant treatment for such cases is reviewed, and the need for examination of such an approach in a neoadjuvant setting with either lymph node dissection or surveillance is examined.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Adaptation-dependent changes of bipolar cell terminals in fish retina: effects on overall morphology and spinule formation in Ma and Mb cells.

We have investigated the effects of light and dark adaptation on the overall morphology of bipolar cell (BC) terminals in sublaminae a and b of the inner plexiform layer after labelling with Lucifer Yellow (LY) and PKC immunostaining using confocal laser scanning microscopy and serially sectioned material for electron microscopy. Three-dimensional reconstructed terminals showed marked adaptation-dependent changes of their morphology. Terminals of mixed rod-cone BCs in sublamina a (Ma BC) were irregular and scalloped in light adapted, but smooth and regular in dark-adapted specimens. Terminals from mixed rod-cone BCs in sublamina b (Mb BCs) exhibited an opposite behaviour. At the ultrastructural level, bipolar terminals in both sublaminae showed fingerlike extensions (spinules) invaginating presynaptic amacrine cell (AC) processes. Sixty-two percent of the dark-adapted Mb terminals in sublamina b showed spinules, whereas 21% of the light-adapted terminals had spinules. By contrast, 50.6% of the light-adapted Ma terminals in sublamina a formed spinules, compared to 17.8% of the dark-adapted Ma terminals in this sublamina. These observations reflect the functional subdivision of the inner plexiform layer in an inner ON-and an outer OFF-centre lamina. Our findings suggest that the synaptic plasticity of BC axon terminals may be due to differences of BC membrane potential, or the activity of AC input onto bipolar terminals. They may contribute to processes of fine tuning regulating the efficiency of AC-BC interaction under varying adaptation conditions.

Adaptation, Ocular↗
PubMed2003

Multiple regression modelling of mineral base oil biodegradability based on their physical properties and overall chemical composition.

A set of 38 mineral base oils was characterized by a number of chemical (i.e., overall chemical composition) and physical parameters used routinely in industry. Their primary biodegradability was evaluated using the CEC L-33-A-93 test. Multiple (stepwise) linear regression (MLR) analyses were performed to describe the relationships between the biodegradability values and the chemical or physical properties of oils. Chemical, physical, and both types of parameters were successively used as independent variables. Using chemical descriptors as variables, a four-variable model equation was obtained that explained only 68.2% (adjusted R-squared statistic=68.2%) of the variability in biodegradability. The fitting was improved by using either the physical or the whole parameters as variables. MLR analyses led to three-descriptor model equations involving kinematic viscosity (as log), Noack volatility (as log) and either the viscosity index (pure physical model) or the paraffinic carbon percentage (mixed chemical-physical model). These two models displayed very similar adjusted R-squared statistics, of approximately 91%. Their predicting ability was verified using 25 additional base oils or oil blends. For 80% of oils on a total of 63, the absolute percentage error on biodegradability predicted by either model was lower than 20%. Kinematic viscosity was by far the most influential parameter in the two models.

Biodegradation, Environmental↗
PubMed1999

Quantification of the dissolved organic matter effect on the sorption of hydrophobic organic pollutant: application of an overall mechanistic sorption model

This study presents an overall sorption model to estimate the sorption equilibrium coefficients of hydrophobic organic pollutants for heterogeneous aquatic systems. This proposed model combines a series of sorption equilibrium relationships including the adsorption of dissolved organic matters on particulates, the binding between organic pollutants and dissolved organic matters, and the sorption of organic pollutants on particulates with or without the presence of dissolved organic matters. By using this model, variations among the sorption equilibrium coefficients with the concentrations of dissolved organic matters are obtained. Also discussed herein are case studies involving pollutants having a wide spectrum of K(ow)s, different types of dissolved organic matters, different pH values and ionic strengths. In most of the case studies, the sorption equilibrium coefficients initially increase with the-concentrations of dissolved organic matters and, then, decrease after reaching a maximum value. This study also addresses the relative errors of partition coefficients attributed to the negligence of the effect caused by the dissolved organic matter, the so-called third-phase effect.

Journal Article↗
PubMed2002

Sulfate dry deposition fluxes and overall deposition velocities measured with a surrogate surface.

Previous studies have shown that the dry deposition of particulate sulfate can account for a significant fraction of its total (wet + dry) deposition. However, there is no generally accepted method to directly measure dry deposition. In this study, the particulate sulfate dry deposition was measured using a smooth surrogate surface between September 2000 and June 2001 in Izmir, Turkey. Concurrently, ambient air samples were collected. Average particulate sulfate fluxes and ambient concentrations were 49.3 +/- 24.3 mg m(-2) d(-1) and 11.2 +/- 6.6 microg m(-3), respectively. The measured particulate dry deposition fluxes were higher than those measured in other urban and rural areas. The contribution of marine and terrestrial sources was also estimated and found to be insignificant. The particulate phase overall dry deposition velocities calculated using the dry deposition fluxes and corresponding ambient concentrations averaged 6.3 +/- 3.9 cm s(-1). This value is higher than values typically used to estimate particulate sulfate deposition; however, it is in good agreement with values determined using similar surrogate surface techniques.

Air Pollutants↗
PubMed1999

A laboratory method for determination of overall haemostatic potential in plasma. I. Method design and preliminary results.

The aim of this study was to design a simple laboratory method that can screen the overall haemostatic potential in plasma (OHPP) when a hyper- or hypocoagulable state is present. A fibrin time curve was made via spectrophotometric registration of fibrin generation and lysis in plasma, to which exogenous thrombin and tissue type plasminogen activator was added. The area under the curve, calculated by the sum of absorbance (ABS-sum), varied in correlation to the concentrations of platelets or purified pro-/anticoagulants: tissue factor, von Willebrand factor, fibrinogen, antithrombin, plasminogen, or plasminogen activator inhibitor type 1. The ABS-sums also changed in positive relation to the haemostatic function investigated in 16 menopausal women and 14 young healthy nonpregnant women (controls). The findings imply that the ABS-sums not only offer a general information about fibrin generation and lysis in vitro, but also reflect the OHPP (i.e., final combined effects of platelet activity, coagulation, and fibrinolysis in vivo). Preliminary results were satisfactory; the levels of OHPP, expressed as the ABS-sums, were higher in normal pregnant women than in the controls, and even higher in preeclamptic patients than in pregnant women with no complications, which corresponds to the different grades of hypercoagulability in the three groups. Moreover, the level of OHPP was considerably lower in an untreated infant with von Willebrand's disease type 3 and in factor VIII- or factor IX-deficient plasma samples.

Adult↗
PubMed2003

Number of metastatic sites rather than location dictates overall survival of patients with node-negative metastatic renal cell carcinoma.

OBJECTIVES: To perform a retrospective study to determine whether survival and immunotherapy response are related to the site of metastases (lung versus bone) and to the number of organ sites involved (one versus multiple). The most common sites of metastatic renal cell carcinoma (mRCC) are the lung and bone. METHODS: The records of 434 patients with mRCC were reviewed. Patients with pathologic evidence of nodal involvement were excluded, leaving 120 patients with mRCC to lung only, 33 patients to bone only, and 144 patients with multiple organ involvement. The response rates to immunotherapy and overall survival were compared. The variables evaluated in statistical analyses included Eastern Cooperative Oncology Group score, grade, 1997 tumor stage, and multiple organ involvement. RESULTS: The median survival for patients with lung only and bone only mRCC was 27 months; patients with multiple organ involvement had a median survival of 11 months. In patients who underwent nephrectomy followed by immunotherapy, the median survival time was 31, 31, and 13 months in the lung, bone, and multiple sites groups, respectively. The response rate to immunotherapy after nephrectomy was 44%, 20%, and 14% in the lung, bone, and multiple organ groups, respectively. Multivariate analysis confirmed that metastatic disease to more than one organ site was associated with poor prognosis (2.05 risk ratio, P <0.001). CONCLUSIONS: Patients with mRCC to only one organ site fared significantly better than patients who had evidence of disease in multiple organs. Survival in patients with disease limited to the lung was similar to that of patients whose disease was limited to bone.

Bone Neoplasms↗
PubMed2003

Evaluation of overall costs of currently available small flexible ureteroscopes.

OBJECTIVES: To perform a meta-analysis of the currently available data regarding the durability of flexible ureteroscopes to establish cost estimates for the purchase and use of five currently available, smaller than 9F, ureteroscopes. Healthcare costs have become increasingly germane to the determination of disease management strategies. Improved ureteroscope technology has expanded the role of these instruments. However, the initial purchase costs and high maintenance costs have become problematic with these fragile instruments. METHODS: Ureteroscope durability data on the Storz 11274AA, Olympus URF-P3, Wolf 7325.172, ACMI AUR-7, and ACMI DUR-8 were collected from three prior studies. Combining the durability data and cost data regarding the initial purchase price and maintenance costs of these instruments, we calculated the overall costs associated with the use of each of the ureteroscopes for 25, 50, 75, and 100 cases during the first year (warranties included) and with subsequent use. RESULTS: The variability in the costs associated with the use of the currently available smaller than 9F ureteroscopes was significant. The initial instrument purchase price, durability, repair costs, and associated warranties all contributed to large discrepancies in the cost of performing ureteroscopy. In this model, during the first year of ownership, the projected cost of performing 100 ureteroscopic cases varied by a difference of 95% depending on the ureteroscope used. CONCLUSIONS: Physicians and institutions that perform ureteroscopy should strongly consider the purchase price, durability, repair cost, and associated warranties before the purchase of small flexible ureteroscopes.

Costs and Cost Analysis↗
PubMed1993

Patients' good and bad surprises: how do they relate to overall patient satisfaction?

The literature documents little research regarding patients' good and bad surprises in the hospital. Such experiences may inform a patient's future decisions about recommending or returning to the hospital. Utilizing a database of survey respondents, the authors conducted qualitative and quantitative analyses of patients' self-reported surprises about their hospital stay and the relationship between those surprise experiences and their overall feelings of satisfaction. Analysis of these data shows that patients do experience surprises during their hospital stays, that specific events are associated with these surprises, and that these surprises influence patient satisfaction. These results suggest that in order for health care providers to continuously improve and meet patients' needs and expectations, providers must determine steps to take to delight their patients, to avoid patient disappointments, and to meet patients' basic expectations.

Adolescent↗
PubMed1998

Prediction of overall pulmonary function loss in relation to the 3-D dose distribution for patients with breast cancer and malignant lymphoma.

PURPOSE: To predict the changes in pulmonary function tests (PFTs) 3-4 months after radiotherapy based on the three-dimensional (3-D) dose distribution and taking into account patient- and treatment-related factors. METHODS: For 81 patients with malignant lymphoma and breast cancer, PFTs (VA, VC, FEV1 and TL,COc) were performed prior to and 3-4 months after irradiation and dose-effect relations for early changes in local perfusion, ventilation and air-filled fraction were determined using correlated CT and SPECT data. The 3-D dose distribution of each patient was converted into four different dose-volume parameters, i.e. the mean dose in the lung and three overall response parameters (ORPs, which represent the average local injury over the complete lung). ORPs were determined using the dose-effect relations for early changes in local perfusion, ventilation and air-filled fraction. Correlation coefficients were calculated between these dose-volume parameters and the changes in PFTs. In addition, the impact of the variables chemotherapy (MOPP/ABV and CMF), tamoxifen, smoking, age and gender on the relation between the mean lung dose and the relative changes in PFTs following radiotherapy was studied using multiple regression analysis. RESULTS: The mean lung dose proved to be the easiest parameter to predict the reduction in PFTs 3-4 months following radiotherapy. For all patients the relation between the mean lung dose and the changes in PFTs could be described with one regression line through the origin and a slope of 1% reduction in PFT for each increase of 1 Gy in mean lung dose. Smoking and CMF chemotherapy influenced the reduction in PFTs significantly for VA and TL,COc, respectively. Patients treated with MOPP/ABV prior to radiotherapy had lower pre-radiotherapy PFTs than other patient groups, but did not show further deterioration after radiotherapy (at 3-4 months). CONCLUSIONS: The relative reduction in VA, VC, FEV1 and TL,COc 3-4 months after radiotherapy for breast cancer and malignant lymphoma can be estimated before radiotherapy based on the mean lung dose of each individual patient and taking into account the use of chemotherapy and smoking habits of the patient.

Adolescent↗
PubMed1999

Modelling the overall effect of pH on the apparent heat resistance of Bacillus cereus spores.

A simple overall model is proposed to describe the effect of both the pH of the heating menstruum and the pH of the recovery medium on the apparent spore heat resistance of Bacillus cereus. Applied to foods making up both heating and recovery media, the model can be reduced to only two parameters. Its goodness of fit and its robustness enable it to be applied to the optimisation of heat treatments. However. further experiments should be undertaken to validate the model for other species and to determine the parameters related to reference species such as Clostridium botulinum.

Bacillus cereus↗
PubMed2001

Overall survival and local recurrence of 406 completely resected stage IIIa-N2 non-small cell lung cancer patients: questionnaire survey of the Japan Clinical Oncology Group to plan for clinical trials.

BACKGROUND: the group of completely resected stage IIIA-N2 non-small cell lung cancer patients (NSCLC) is considered to be heterogeneous in various aspects including survival and the recurrent pattern. In the present study, we attempted to clarify the factors which separate these patients into high and low risk groups based on the survival and local recurrence. METHODS: a questionnaire survey on the survival and local recurrence of non-small cell lung cancer patients with pathological stage IIIA-N2 disease who underwent a complete resection from January 1992 to December 1993 was performed by the Japan Clinical Oncology Group as of July 1999. The information on the survival of 406 patients and that of local recurrence in 332 of them was available. RESULTS: the 5-year survival of the 406 patients was 31.0%. In a univariate analysis, the age, clinical and pathological T status, number of N2 stations, pathological N1 disease, operative modality and postoperative radiotherapy were all found to be important prognostic factors. Clinical N2 disease marginally influenced the survival (P=0.07). In a multivariate analysis of these variables including clinical N2 disease, the survival was significantly worse in the case of multiple N2 stations (hazard ratio=1.741), the presence of pathological N1 disease (1.403), pathological T2 or 3 disease (1.399) and an age older than 65 (1.327). The rate of freedom from any local recurrence at the bronchial stump, or in the hilar, mediastinal or supraclavicular lymph nodes at 5 years was 64%. In a univariate analysis of the freedom from local recurrence, the clinical N status, pathological T status, pathological N1 disease and number of N2 stations were all found to be important prognostic factors. A multivariate analysis revealed the freedom from local recurrence to be adversely influenced by multiple N2 stations (hazard ratio=2.05), and the presence of either clinical N1 or 2 (1.733) disease. The 5-year survival and the rate of freedom from local recurrence at 5 years were 43 and 75% in patients with a single N2 station and 17 and 48% in those with multiple N2 stations, respectively. CONCLUSIONS: the number of N2 stations (single vs. multiple N2 stations) was found to be a useful prognostic factor, which can separate completely resected stage IIIA-N2 patients into high and low risk groups regarding both the overall survival and local recurrence.

Adult↗
PubMed2000

The impact of overall treatment time on outcomes in radiation therapy for non-small cell lung cancer.

PURPOSE: A retrospective study was carried out to evaluate the impact of overall treatment time (OTT) on the results of radiation therapy for non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: From Jan. 1990 to Dec. 1996, 256 patients with stages I-IIIb NSCLC entered this analysis. All patients received definitive radiotherapy. Biologically effective dose (BED) was used to standardize the irradiation effects. The correlation between OTT and local progression-free survival was analyzed by linear-regression and Cox proportional hazard models. The prognostic variables for survival and distant metastasis were also briefly studied. RESULTS: OTT had been shortened in 64 patients because of an accelerated hyperfractioned irradiation, while OTT was prolonged i n 114 patients due to interruptions of irradiation courses. The main ca uses of interruption were machine breakdown or delayed preparations of c errobend block for boost fields (55%), holidays (11%) and treatment toxi city and side effects (34%). Patients tre ated with prolonged OTT (> 45 days) had significant poorer local progression-free survival than whom with OTT of </=45 days, 1, 3 and 5 year actuarial local progression-free survivals being 49, 17 and 15% for the former, and 74, 35 and 25% for the latter, respectively (P<0.001). BED-T that contained the factor of OTT correlated directly to local controls, which implied that BED-T represented radiobiological effects accurately, in other words, OTT had played a role in determining the radiobiological effects. Linear-regression on 103 cases treated with BED of 80-85 Gy(10) showed that 3 year local progression-free survival decreased by 9% per week with prolongation of OTT, or vice versa it increased by 9% per week with shortening OTT in an OTT range of 30-76 days. Cox multivariate analyses confirmed that OTT was an independent prognostic factor for local controls. CONCLUSION: OTT may have played an important role in determining local controls in radiotherapy for NSCLC. One should always keep in mind to make the OTT as short as possible, provided the patients can tolerate it, and to reduce irradiation interruptions for whatever reasons to a minimum.

Adult↗
PubMed1996

The second national survey of infection in hospitals: methods of data collection and overall impressions.

The Hospital Infection Society, in association with the Public Health Laboratory Service and the Infection Control Nurses Association, launched the Second National Prevalence Survey of Infection in Hospitals in 1993. On completion of the survey, 157 hospitals throughout the British Isles had taken part with approximately 37 000 patients surveyed. The survey in the Royal Hospitals Trust, Belfast, included all inpatients who were present in the wards on the survey day. Infection control nurses (ICNs) from a selected number of the other participating hospitals were sent questionnaires and asked about their methods of data collection, and their overall impression of the Second National Survey. All respondents received help in performing the survey, but only 10% provided prior training to ward staff before the survey visit. Sixty-five percent of respondents supplied information to the wards prior to the survey visit. In comparison with the questionnaire respondents, it was found that using a 'link' nurse to assist in data collection was much more efficient in relation to the time involved. Many ICNs expressed concern over the amount of time spent on this survey, although in general the value of such a survey was appreciated. Twenty-six percent of respondents indicated that they would not be willing to undertake a future survey.

Cross Infection↗
PubMed1998

Outcome from out-of-hospital cardiac arrest caused by nonventricular arrhythmias: contribution of successful resuscitation to overall survivorship supports the current practice of initiating out-of-hospital ACLS.

STUDY OBJECTIVE: Studies indicate that ventricular tachycardia (VT) and ventricular fibrillation (VF) are no longer the most common rhythms initially documented in out-of-hospital sudden cardiac death. Although the outcome from asystole and rhythms designated as pulseless electrical activity (PEA) is reported as poor (approximately 1% survival), resuscitative efforts for these patients are still encouraged. The purpose of this study was to determine the potential contribution that this patient group makes to overall survivorship. METHODS: During this 2-year prospective study, all patients in cardiopulmonary arrest who were transported to the study institution after out-of-hospital Advanced Cardiac Life Support (ACLS) interventions were considered eligible for inclusion. Patients younger than 18 years of age and those in posttraumatic arrest were excluded. Age, sex, first-documented arrest rhythm, presence of a witness to the arrest, performance of bystander CPR, survival to hospital discharge, and functional status at discharge were recorded. RESULTS: A total of 197 patients met the inclusion criteria. The initial rhythm was VF/VT in 59 (30%; 95% confidence interval [CI], 24% to 37%) and asystole/PEA in 138 (70%; 95% CI, 64% to 76%). There was 1 hospital survivor in the VT/VF group; 9 patients (7%; 95% CI, 4% to 13%) in the asystole/PEA group survived to hospital discharge. Of the asystole/PEA survivors, 100% (95% CI, 66% to 100%) had a witnessed arrest and 56% (95% CI, 21% to 86%) received bystander CPR. Fifty-six percent (95% CI, 21% to 86%) of the asystole/PEA survivors were discharged at a functional level equivalent to that preceding arrest. CONCLUSION: In this study, patients in asystole/PEA comprised 90% of the survivors. The outcome for patients with asystole/PEA whose arrest was witnessed and who received bystander CPR may be greater than previously estimated and supports the current practice of initiating aggressive out-of-hospital ACLS in this patient group.

Adult↗
PubMed2001

Prognostic significance of factors affecting disease free interval and overall survival for Stage II breast cancer in Greece. A multivariate cohort study.

BACKGROUND: Univariate analysis evaluates the impact of a prognostic factor on survival rates, either disease free (DFI) or overall (OS). Since many of the factors are interrelated, it is difficult to predict the prognosis of an individual patient. Multivariate analysis is therefore required in order to allow factors act together thus ending in the best possible combined predicting result. METHODS: A step-up procedure (Cox's Proportional Hazards Regression model) was used to include various prognostic parameters, relating to patients themselves, to the pathology of their tumours and to the treatment schedule followed. Two hundred and sixty-nine Stage II breast cancer Greek patients, treated from 1981 until 1991 and with a median 12-year of follow-up are studied. RESULTS: Five factors were found to be significant for patients DFI. In order of relevant importance, these were the number of infiltrated nodes, tumour size, postoperative radiotherapy, adjuvant chemotherapy and patients age. Regarding patients OS, tumour size, number of positive nodes, patients' age at entry and ER/PR status were the most important ones. CONCLUSION: Our long-term (12-year), single institution, single area results, suggest that, the prognostic factors for patients DFI and OS are the same with those of series from Europe and USA. Additionally, they remain unchanged after long-term follow-up, compared to a previously reported short-term national-wide study from this country.

Adult↗
PubMed2001

Vaginal birth after caesarean section in a population with a low overall caesarean section rate.

OBJECTIVE: To determine the clinical outcome of vaginal birth after caesarean section (VBAC) in a Dutch population with a low overall caesarean section (CS) rate of 6.5%. STUDY DESIGN: Prospective population based cohort study of 252 patients with a previous caesarean section (CS). Outcome parameters were trial of labour (TOL), success rate and VBAC rate. RESULTS: The TOL rate in the study cohort was 73%, success rate 77%, VBAC rate 56%. The reason for the previous CS influenced success rate. Complications, morbidity and mortality were not different between elective, emergency CS and TOL group, except for a higher incidence of haemorrhage more than 500 ml in the elective CS compared to the TOL group (29% versus 17%, relative risk (RR) 1.74 (1.15--2.34)). CONCLUSIONS: In this Dutch study the success rate is comparable to rate in US study reports. Increase of the VBAC rate can mainly be achieved by increasing the number of women attempting TOL.

Breech Presentation↗