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This study shows that non-cytotoxic Fc receptor blocking antibodies occurred more frequently in pre-transplant sera when the recipient had been transfused over five units of blood. Moreover 7/12 previously untransfused patients developed Fc receptor blocking antibodies during an elective blood transfusion regime. Erythrocyte antibody-rosette-inhibiting antibodies were also found at significantly higher values in the sera of women during the first trimester of a normal first pregnancy than in women studied at the time of spontaneous abortion. Family studies showed that this activity was linked to the HLA gene complex. These results indicate that EA inhibiting antibodies directed against MHC linked antigens are associated with specific abrogation of the immune response.
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The effect of applying an energy pulse to the heart during ventricular fibrillation is described by the probability of successful defibrillation or success rate. Seven to ten (8.60 +/- 0.84: mean +/- standard deviation) defibrillation trials per energy were randomly attempted at energies which span the defibrillation success rate versus energy curve. We obtained 70.0 +/- 8.4 episodes per dog. We fit the defibrillation success rate versus energy relationship from ten dogs (20.5 +/- 1.5 kg) to four types of curves: linear, exponential, probit transformed linear, and logit transformed linear. The correlation coefficients for each fit are 0.917 +/- 0.057, 0.944 +/- 0.014, 0.926 +/- 0.51, and 0.889 +/- 0.098, respectively. We therefore conclude that the exponential curve best describes the DSRE relationship. This suggests the existence of an energy below which defibrillation does not occur. At higher energies, the exponential curve asymptotically approaches a 100% success rate, which indicates that increasing the energy produces a diminishing benefit to defibrillation success rate. The estimated energies with a 0% defibrillation success rate are surprisingly consistent among dogs, with 2.072 +/- 0.553 J. The estimated energy with an 80% defibrillation success rate is 5.217 +/- 1.091 J. The estimated defibrillation success rate corresponding to the defibrillation threshold of 3.59 +/- 1.06 J is consistent with 0.516 +/- 0.144. The estimated energies with a 0% success rate correlate well with the defibrillation thresholds with R = 0.772; P = 0.0088. Since implantable defibrillators have a limited energy supply, we determined energy efficiency by dividing defibrillation success rate by the applied energy and energy consumption by dividing the applied energy by the defibrillation success rate. The most efficient defibrillation energy occurs at the maximum energy efficiency and the minimum energy consumption. The most efficient defibrillation energy of 4.34 +/- 0.97 J determined from the exponential fit has a success rate of 0.70 +/- 0.06. The most efficient defibrillation energy can be predicted from the defibrillation threshold. Clinically, a 70% success rate may not be adequate. We, therefore, compared the energy efficiency and consumption of energies with 90% and 95% success rates to the most efficient defibrillation energy. About a 50% increase in energy from the most efficient defibrillation energy is necessary for a 90% success rate which results in about a 13% loss in energy efficiency and about a 16% increase in energy consumption. About an 84% energy increase is necessary for a 95% success rate which results in about a 24% loss in energy efficiency and about a 33% increase in energy consumption.(ABSTRACT TRUNCATED AT 400 WORDS)
OBJECTIVE: To estimate whether a history of a previous successful vaginal birth after cesarean delivery (VBAC) has an effect on a subsequent VBAC attempt. METHODS: A chart review of cases identified from the International Classification of Diseases, 9th Revision (ICD-9) codes and cases identified in the logbooks on Labor and Delivery yielded 1,216 cases of attempted VBAC from 1996 to 2000. Data gathered from these cases included history of previous successful VBAC. Variables of interest included previous successful normal spontaneous vaginal delivery, history of diabetes, labor induction, and recurrent indication for cesarean delivery. RESULTS: Of the 336 patients with a history of one or more previous successful VBAC attempts, 94.6% had a subsequent successful VBAC, whereas 70.5% of the remaining 880 patients were successful (P <.001). For those patients with one or more previous successful normal spontaneous vaginal deliveries, 87.8% had a successful VBAC, whereas 75.6% were successful without this history (P =.001). The presence of diabetes and a recurrent indication for cesarean delivery both decreased VBAC success and were independently associated with poor outcome (P <.001). Patients with a history of previous VBAC were 7 times more likely to have a subsequent VBAC success (odds ratio 7.40, 95% confidence interval 4.51-12.16; P <.001). Those with a history of previous normal spontaneous vaginal delivery were not more likely to have a successful VBAC when the other variables were controlled. Induction did not affect VBAC outcome. CONCLUSION: A history of a previous successful VBAC increases the likelihood for success with future attempts. Maternal diabetes and history of a recurrent indication for cesarean delivery are poor prognosticators for successful trial of labor. LEVEL OF EVIDENCE: II-2
PURPOSE: We evaluate variables affecting the success of repairs of urethrocutaneous fistula after hypospadias surgery. MATERIALS AND METHODS: The records of 123 boys who underwent fistula repair at Primary Children's Medical Center were reviewed. Of these patients 100 underwent initial fistula repair at our center (surgery was performed at our center in 82 and elsewhere in 18) and 23 were referred from elsewhere after unsuccessful fistula repairs. Patient age was 6 months to 34 years (median 3.21 years) and interval between surgeries was 3.7 months to 12 years (median 12.6 months). Several variables potentially affecting the success of fistula closure were retrospectively assessed. RESULTS: Including those patients referred from outside hospitals, fistulas were successfully closed in 71%, 72%, 77%, 100% and 100% of these patients after fistula repairs 1 to 5, respectively. Variables studied yielded stent 67.7% (36 of 54 cases) versus no stent 76.1% (35 of 46) and operating microscope 70.4% (59 of 71) versus loupes 72.4% (21 of 29) in terms of success. Success based on patient age yielded 65.5% for younger than 2 years (n = 29 patients), 71.7% for 2 to 5 (46), 64.7% for 6 to 12 (17) and 87.5% for older than 12 (8). When considering the type of original hypospadias repair and its affect on fistula closure success, a significantly lower success was noted with Yoke and King procedures (p = 0.007 and 0.037, respectively). In patients who underwent hypospadias surgery and all subsequent fistula closure attempts at our center, fistulas were successfully repaired in 72%, 67% and 100% of patients after attempts 1 to 3, respectively. Initial fistula repair was successful in 72% (59 of 82) of patients who underwent original hypospadias surgery at our center and in 67% (12 of 18) of those referred after hypospadias surgery at an outside hospital. CONCLUSIONS: Regarding urethrocutaneous fistula closure, the data from this study suggest that there is no clear difference in stent versus no stent and microscope versus loupes, age at fistula closure does not affect success, type of original hypospadias procedure may influence success (King and Yoke procedures were least successful), success rate is not negatively impacted in recurrent fistula cases, given a diverse group of fistulas, success of fistula repair for attempts 1 to 5 was 71%, 72%, 77%, 100% and 100%, respectively, and success rate in a tertiary pediatric urology setting is not influenced by whether the original hypospadias procedure or initial fistula closure was performed in the pediatric urology setting versus outside hospital.
PURPOSE: This research evaluated initial treatment of deep dental caries with caries control (CC) procedure and the effect of other factors on the success of indirect pulp therapy (IPT) and formocresol pulpotomy (FP). METHODS: Retrospective chart audits were performed on 226 primary molars with deep caries approaching the pulp that were treated using IPT and FP. Mean follow-up was 3.4 years. CC with glass ionomer cement (GIC) was performed on 50 of the 226 teeth 1 to 3 months before pulp therapy. RESULTS: IPT therapy was successful 94% of the time, whereas FP was successful 70% of the time. The initial use of CC increased the IPT/FP success rate to 92% vs a 79% success rate in teeth without CC. Primary molar FP success on primary first molars was 61% vs 83% in second molars. IPT therapy was successful 92% of the time for first molars vs 98% of the time for second molars. Thirty-six percent of the FP-treated teeth exfoliated early vs 2% of the IPT-treated teeth. Primary first molars with reversible pulpitis had a higher success with IPT (85%) vs FP (53%). The type of final restoration did not affect IPT or FP success, except that FPs restored with an immediate IRM (Dentsply/Caulk, Milford, Del) restoration decreased success to 39%. CONCLUSIONS: IPT for the treatment of deep dental caries lesions produced greater long-term success than FP. FP success in primary first molars was lower compared to IPT success, especially in teeth with reversible pulpitis. Also FP-treated teeth showed significantly earlier exfoliation patterns. The prior treatment of deep dental caries lesions with CC procedures improved the subsequent IPT or FP success.
OBJECTIVES: To determine whether the skill performance and psychomotor agility, as measured by the endotracheal intubation success rate, of air ambulance medical personnel would be affected by the potential fatigue incurred when increasing the length of their shifts from 12 to 24 hours. METHODS: This was a retrospective review of all flight and intubation records from a large air medical transport system from 1997, when 24-hour shifts were in place, and six months (March-August) of 1996, during which 12-hour shifts were scheduled. Records of all intubation efforts during both periods, including multiple attempts per patient, and outcomes of all attempts, were recorded. Results of successes and failures were tabulated for both ultimate intubation outcome per patient and all attempts per patient for each calendar day and for the 12 hours between 19:00 and 07:00 when fatigue might play a role. Results from the two study periods were compared using Fisher's exact test. RESULTS: During the six months of 1996, 190 of 199 (95.5%) patients were ultimately successfully intubated. These patients required 237 attempts (80.1% successful). During 1997, 362 of 376 (96.3%) patients were successfully intubated, and required 438 attempts (82.6% successful). There was no statistically significant difference in the number of ultimately successful intubations (p = 0.66) or total intubation attempts (p = 0.37) between 1996 and 1997. Analysis of intubations between 19:00 and 07:00 revealed 81 of 84 (96.4%) patients successfully intubated in 1996, with 81 of 103 (78.6%) attempts successful. During 1997, 173 of 180 (96.1%) patients were ultimately successfully intubated, with 173 of 212 (81.6%) attempts successful. Again, there was no significant difference in the number of successful intubations (p = 0.99) or intubation attempts (p = 0.55) between 1996 and 1997. CONCLUSION: Psychomotor agility of air ambulance medical personnel, as measured by the success rate of endotracheal intubation, was not affected by the potential additional fatigue incurred as a result of increasing shift length from 12 to 24 hours.
BACKGROUND: There is limited population-based data on behavioral factors found to be important for successful weight loss maintenance among adults. METHODS: Data from the 2004 Styles surveys, mailed to U.S. adults aged > or = 18 years were used to examine the difference in selected weight loss strategies and attitudes among persons who reported successful weight loss attempts (lost weight and able to keep it off) and persons who were not successful (previous attempts to lose weight were unsuccessful or they could not keep the lost weight off). Behaviors examined included modification of diet, leisure-time and sports activities, and self-monitoring, and barriers to weight management. RESULTS: Among adults who reported losing weight or trying to lose weight, 31.0% had been successful at both losing weight and maintenance after weight loss. Successful weight loss status differed by sex, age, and current weight status. Assessment of reported weight loss strategies, found that exercising > or = 30 minutes/day and adding physical activity to daily life were significantly higher among successful versus unsuccessful weight losers. Individuals who were successful at weight loss and maintenance were less likely to use over-the-counter diet products than those who were unsuccessful at weight loss. Significantly more successful versus unsuccessful weight losers reported that on most days of the week they planned meals (35.9% vs. 24.9%), tracked calories (17.7% vs. 8.8%), tracked fat (16.4% vs. 6.6%), and measured food on plate (15.9% vs. 6.7%). Successful losers were also more likely to weigh themselves daily (20.3% vs. 11.0%). There were a significantly higher proportion of successful losers who reported lifting weights (19.0%) versus unsuccessful (10.9%). The odds of being a successful weight loser were 48%-76% lower for those reporting exercise weight control barriers were influencing factors (e.g., no time, too tired to exercise, no one to exercise with, too hard to maintain exercise routine) compared to those who reported little or no influence of exercise; similarly, the odds were 48-64% lower for those who found certain dietary barriers to be influential (e.g., eat away from home too often, diet/health food costs too much). CONCLUSION: Self-monitoring strategies such as weighing oneself, planning meals, tracking fat and calories, exercising 30 or more minutes daily, and/or adding physical activity to daily routine may be important in successful weight loss maintenance. Leisure-time activities such as lifting weights or cooking/baking for fun are common strategies reported by those who were successful weight losers.
OBJECTIVE: To determine the success of resuscitations performed by Queensland surf lifesavers and the factors associated with successful resuscitation. DESIGN: Retrospective case survey, using data from Surf Life Saving Association of Australia resuscitation report forms. SETTING: 54 Queensland beaches patrolled by surf lifesavers, and nearby areas, between 1973 and 1992. OUTCOME MEASURES: Reasons and success rates for resuscitation, distance from surf clubhouse, whether inside patrolled area, victim's age, sex, facial colour on presentation, occurrence of vomiting, airway difficulties and involvement of alcohol. RESULTS: 171 resuscitations were reported (80% involving males and 20% females), with a success rate of 67%. Seventy-two per cent were performed during patrol hours, 17% within patrolled areas (95% successful) and 55% outside patrolled areas (only 62% successful) (P = 0.004 for difference in success rates); resuscitation success rates fell with increasing distance from the surf clubhouse (P = 0.009). Reasons for resuscitation were: immersion, 70% (success rate, 68%); collapse, 22% (success rate, 47%); and surf or beach injury, 7% and 1%, respectively (success rate, 100% for each). Resuscitation was more likely to be successful if the victim's facial colour on presentation was normal, pale or blue, but not if grey, and if the victim did not vomit or regurgitate. CONCLUSIONS: Resuscitation by surf lifesavers was highly successful when the victim was close to the surf patrol, indicating a need for funding to expand patrol areas. Public awareness of the greater safety of "bathing between the flags" (in the delineated patrol area) should be increased.