Health-related quality-of-life treatments for severe haemophilia: utility measurements using the Standard Gamble technique

Prophylaxis for haemophilia improves outcomes, but at a substantial cost. Cost-utility analysis balances improvements seen in health-related quality of life (HRQoL) against costs, with the purpose of aiding healthcare decision-making. This analysis uses a measure of HRQoL known as utility. The objective of this study was to measure HRQoL (utility) values for states of health that result from on-demand therapy or prophylaxis. The HRQoL for different health states (including target joint bleeding, different intensities of prophylaxis, and indwelling intravenous catheters [ports]) was measured for healthy adults (n=30), parents of haemophilic children (n=30), and adults with haemophilia (n=28). Parents and patients rated health states similarly. Healthy adults gave the lowest ratings. The following rank, in order of HRQoL, was obtained: prophylaxis (low > medium > high) > on-demand therapy > prophylaxis with port> prophylaxis with infected port > on-demand therapy with development of a target joint. We conclude that: (1) haemophilia and its treatment reduce HRQoL; (2) prophylaxis is preferred to on-demand therapy; (3) intravenous ports substantially reduce HRQoL; (4) and an intravenous port to provide prophylaxis is preferable to on-demand therapy if a target joint develops.     

Systemic chemotherapy in patients with indwelling ureteral stenting

BACKGROUND: We investigated whether systemic chemotherapy increased episodes of acute pyelonephritis (APN) in patients with an indwelling double-J stent due to non-urological malignant ureteral obstruction. METHODS: A retrospective study was performed on a total of 74 patients (16 men and 58 women; median age, 53.0; range, 34-84 years) with non-urological malignant ureteral obstruction, who were managed by double-J stenting between October 1997 and December 2001. The patients were divided into those who received (33 patients, group I) and those who did not receive systemic chemotherapy (41 patients, group II) during the stent indwelling period (median, 7.0; range, 1-44 month). Routine antibiotic prophylaxis was not administered to any patient. Median follow-up was 10.5 (range, 1-45) months. Clinical features, including the incidence of febrility and APN, were compared between the two groups. RESULTS: Of the 74 patients, 18 patients (24.3%) experienced acute febrile episodes during ureteral stenting, but only five (6.8%) patients were diagnosed as having APN. No significant difference in the incidence of fever or APN was found between the two groups (P = 1.000 and P = 0.651, respectively). Univariate logistic analysis indicated that only the duration of follow-up was a risk factor for an episode of fever. Other parameters had no clinical significance. CONCLUSION: Our findings suggest that systemic chemotherapy may not predispose the risk of acute pyelonephritis in patients with an indwelling ureteral stent due to non-urological malignant ureteral obstruction.     

CARDIOVASCULAR EFFECTS OF I.V. INDUCTION IN CHILDREN: COMPARISON BETWEEN PROPOFOL AND THIOPENTONE

We have compared the haemodynamic responses to i.v. propofol2.5 mg kg^-1 with those to thio-pentone 5.0 mg kg^-1 in 41 healthyChinese children at induction of anaesthesia. They were allocatedto four groups according to their age and induction agent received:group 1 <2yr, propofol, n = 9; group II < 2 yr, thiopentone,n = 9; group III 2–12 yr. propofol, n = 12; group IV 2–12yr, thiopentone, n = 11. Anaesthesia was maintained by spontaneousventilation with 70% nitrous oxide and 0.5% halothane in oxygen.Arterial pressure and heart rate were monitored by automaticoscillo -tonometer. Stroke volume was measured by two-dimensionalechocardiography and pulse Dopper. Measurements were made beforeinduction and at 1-min intervals for 5 min after induction.The reduction in mean arterial pressure was significantly greaterafter propofol (28–31%) than after thiopentone (14–21%)(P = 0.001). The reduction in cardiac index (10–15%) afterinduction was not significantly different between the two agents(P = 0.122). Baroref/ex mediated increases in heart rate andsystemic vascular resistance were less after propofol than afterthiopentone. The baroreceptor reflex was more attenuated inchildren aged less than 2 yr than in older children. (Br. J.Anaesth. 1993; 70: 647–653) ^*Present address: Department of Anaesthesia, Addenbrookes Hospital,Hills Road, Cambridge     

Vecuronium: an anthropometric comparison

This study set out to determine if there was any resistance to vecuronium in Nepalese studied in Nepal compared with Nepalese, Chinese and European patients studied in Hong Kong. The four groups, each of 10 male and 10 female patients, were intubated 60 s after administration of 0.1 mg.kg-1 vecuronium. The Nepalese patients in Nepal had significantly less satisfactory intubating conditions (p = 0.002). Similarly, male patients had significantly less satisfactory conditions than female patients (p = 0.004). Some anthropometric measurements were significantly different between the patients in Nepal and those in Hong Kong. There were also sex-related anthropometric differences. It is suggested that differences in response to vecuronium could be explained by differences in distribution volume and muscle mass.     

Outpatient therapy of intra-abdominal abscesses following early discharge from the hospital

Although percutaneous aspiration and drainage of abdominal abscesses will frequently avert an open surgical procedure, patients remain hospitalized during drainage. The authors treated 9 patients for abscesses using percutaneous drainage catheters and sent them home with the catheter in place. All had an uneventful recovery. An average of $12,050 was saved in each case. The authors suggest that outpatient drainage of abdominal abscesses is significantly less expensive than inpatient treatment, yet does not jeopardize patient care.