Outcome of conservative treatment of primary vesicoureteral reflux in 87 Thai children in a single center

AIM: To evaluate the outcome of primary vesicoureteral reflux (VUR) using conservative treatment. METHODS: Eighty-seven children with primary VUR who had been treated with a conservative medical regimen and monitored through a yearly cystogram were recruited for the study. The study was conducted at the Pediatric Nephrology Clinic in Songklanagarind Hospital, the major tertiary care center in southern Thailand. Statistical analyses using Kaplan-Meier survival curves, chi-squared test, Fisher's exact test and multivariate analysis with Cox regression were performed. RESULTS: The study group consisted of 41 boys and 46 girls, with a total of 133 VUR. The age of the boys was significantly lower than that of the girls (P < 0.001). Resolution of the low grades (grades I-III) of VUR was significantly more frequent than that of the high grades (grades IV-V) (68/95, 72%vs 14/38, 37%; P < 0.001). Using the Kaplan-Meier survival analysis and log-rank test, the resolutions of VUR in boys versus girls, and age <1 years versus >or=1 years were not significantly different (P = 0.2252 and 0.4756, respectively). Low-grade VUR and unilateral VUR had significantly higher probabilities of resolution than high-grade VUR and bilateral VUR, respectively (P = 0.0041 and 0.0467, respectively). Multivariate Cox regression analysis indicated that among low-grade VUR, boys and unilateral VUR had significantly higher probabilities of resolution. Among the high-grade VUR, neither sex nor laterality had a significant effect on the probabilities of VUR resolution. CONCLUSION: This study offers more evidence that children with low-grade VUR have a higher chance of reflux resolution if they are boys and have only unilateral VUR. There is still no good guide for resolution of reflux in children with high-grade VUR.     

Variation in Mortality from Ischaemic Heart Disease between England and Scotland

A Comparison of mortality from ischaemic heart disease underthe age of 60 for 1980 to 1981 between the Grampian Health Boardand the North Staffordshire Health Authority has been made.A total of 993 deaths was notified by death certificate fromthe two areas of similar population of which 434 were from Grampianand 559 from North Staffordshire. After examination of generalpractitioner and hospital case notes, autopsy reports and deathcertificates, nearly all (532) of the North Staffordshire deathswere accepted as being due to ischaemic heart disease but onlythree-fifths (263) of the Grampian deaths could be begin besubstantiated as there was inadequate information for the remainder.Deaths from ischaemic heart disease seem apparently to be twofoldgreater in North Staffordshire than Grampian but much of thisdiscrepancy could be attributed to a widely different autopsyrate and to unavailability of case notes. Experience of thissurvey suggests that the results of other epidemiological investigationsmay be equally or even more unreliable.     

Do Electrode and Lead Design Differences for Permanent Cardiac Pacing Translate into Clinically Demonstrable Differences? (Comparison of Sintered Platinum and Activated Vitreous and Porous Carbon Electrodes)

A randomized prospective study was undertaken to compare the electrical performances of three permanent, endocardial, tined pacing leads with different electrode designs--sintered platinum, vitreous carbon, and porous carbon. Ninety-nine patients received one of the leads (S80 31; 423S 32; S100 36). Acute R wave amplitude and ST elevation of the native endocardial electrogram, voltage threshold, impedance, and current flow at four pulse durations (0.25-1.0 msec) were measured. Voltage thresholds were measured noninvasively at each of four pulse durations at 2 days and 1, 3, and 6 months after implantation. No significant differences were found in sensing properties, or current flow at threshold at 0.5 msec pulse duration. The 423S lead had a significantly higher impedance at threshold and both a higher impedance and lower current flow at 5 V. No significant differences in threshold voltages were found between the three leads at any pulse duration, at any of the assessed times after implantation. Six-month thresholds for the S80, 423S, and S100 leads were 1.18 +/- 0.35, 1.17 +/- 0.29, and 1.06 +/- 0.38 V respectively at 0.5 msec pulse duration. Differences between 'high performance' pacing leads need to be of a greater order of magnitude before they can be exploited to give any real clinical advantage to patients.     

Satisfaction and Job Stress in General Practice

This paper investigates sources of job satisfaction and dissatisfactionin general practice and identifies pressures and difficultiesexperienced by general practitioners in their work. The studyrevealed wide spread job satisfaction based on three separate(but independent) aspects of general practice: clinical, psychosocialor managerial. Despite this, significant pressures were experiencedand, in common with previous studies over the last 20 years,this research found continuing problems affecting young generalpractitioners in particular. The main pressures currently experiencedwere uncertainty and insecurity about work, isolation, poorrelationships with other doctors, disillusion with the roleof the general practitioner, and an awareness of changing demands.These pressures were related to experience in general practice,amount of study leave and practice organization. Like previousstudies, it also appears from this research that continuingeducation could play an important role in attenuating thesediffi culties. It is argued that the emphasis should be on developingsupport, confidence and better contacts between general practitioners,as well as teaching knowledge and skills.     

Ten-year stability of cardiovascular responses to laboratory stressors

In this study we examined test-retest stability of cardiovascular stress responses over a decade of the life span. Participants were 55 male college undergraduates. 19 years of age at initial testing, and 29 years of age at follow-up testing Stressors were a foot cold pressor and an aversive reaction time task. Cardiovascular measures included systolic and diastolic blood pressure, heart rate, and preejection period. For cold pressor, the magnitude and pattern of cardiovascular responses remained unchanged at the 10-year follow-up. For the reaction time task, the characteristic cardiovascular response patterns was preserved but with significant attenuation of magnitude. The present findings are consistent with previous observations of temporal stability but over a substantially longer test-retest interval. The long-term stability of stress responses is discussed in the context of stress test methodology, behavioral response demands, and maturation of the physiological systems involved in cardiovascular response expression.