Paramedian incisional complications after prophylactic laparoscopy-assisted gastropexy in 411 dogs.

OBJECTIVE: To determine the frequency and types of paramedian incisional complications after prophylactic laparoscopy-assisted gastropexy (LAG) in dogs and to evaluate potential risk factors for complications. STUDY DESIGN: Multi-institutional retrospective study. ANIMALS: Client-owned dogs (N = 411). METHODS: Records for dogs that underwent single-incision-port laparoscopy-assisted gastropexy (SIPLAG) or multiple-port laparoscopy-assisted gastropexy (MPLAG) at five veterinary referral hospitals were reviewed. Information regarding signalment, surgical procedures, perioperative care, and incisional complications was collected. Follow-up information was obtained by review of medical records and/or communication with owners. Potential risk factors for complications were examined statistically. RESULTS: Paramedian incisional complications were observed in 78 of 411 (19%) dogs. The most common complication was seroma formation, which occurred in 51 (12.4%) dogs. Surgical site infections were observed in 16 (3.9%) dogs, and dehiscence or development of excessive scar tissue at the incision site were each observed in nine (2.2%) dogs. Complications resolved with conservative treatment in 75 of 78 (96.2%) dogs and with surgical treatment in three of 78 (3.8%) dogs. The odds of complications were approximately twice as high in dogs undergoing SIPLAG than in dogs undergoing MPLAG (odds ratio, 2.03; P = .006). CONCLUSION: Minor paramedian incisional complications, particularly seroma formation, were frequently observed after LAG. Most complications were successfully managed conservatively. Single-incision-port laparoscopy-assisted gastropexy was associated with a higher complication rate compared with MPLAG. CLINICAL SIGNIFICANCE: Owners should be informed that there is a relatively high rate of minor paramedian incisional complications after LAG. The risk of complications appears to be higher for SIPLAG than for MPLAG.

Charging of Oxide Nanoparticles in Media of Intermediate Dielectric Constant.

The use of surfactants to charge colloidal particles in solvents of intermediate dielectric constants (5 < ε < 40) is investigated. While particle charging mechanisms in aqueous (ε = 80) and apolar (ε < 5) media are well understood, the interplay of these different charging mechanisms, which can all occur in solvents of intermediate dielectric constants (sometimes referred to as "leaky dielectrics"), remains to be fully explored. Conductometric titrations determining the critical micelle concentration (CMC) of the surfactant (aerosol-OT) confirm the existence of reverse micelles in intermediate dielectrics and show that as the solvent dielectric constant decreases, the CMC decreases as well. Electrophoretic mobility measurements of three oxide particles (SiO2, TiO2, and MgO) highlight various charging mechanisms that arise from particle-solvent, particle-surfactant, and solvent-surfactant interactions in a solvent series of alcohols and ketones. The results show that a combination of donor-acceptor particle-solvent interactions, surfactant ion adsorption, and reverse micelle-mediated acid-base interactions can all charge oxide particles in intermediate dielectrics. Furthermore, the results show that the dielectric constant of the solvent affects the relative magnitudes of each charging mechanism.

Socioeconomic inequalities in health during the Great Recession: A scoping review of the research literature.

Aims: The so-called 'Great Recession' in Europe triggered widespread concerns about population health, as reflected by an upsurge in empirical research on the health impacts of the economic crisis. A growing body of empirical studies has also been devoted to socioeconomic inequalities in health during the Great Recession. The aim of the current study is to summarise this health inequality literature by means of a scoping review. Methods: We have performed a scoping review of the research literature (English language) published in the years 2012-2017. Only empirical papers with (a) health status measured on the individual level, (b) information on socioeconomic position (i.e. employment status, educational level, income/wealth, and/or occupational class), and (c) data from European countries in both pre- and post-crisis years were considered relevant. In total, 49 empirical studies fulfilled these inclusion criteria. Results: The empirical findings in the 49 included studies predominantly show that socioeconomic inequalities in health either increased or remained stable from pre- to post-crisis years. Two-thirds (65%) of the studies found evidence of either increasing or partially increasing health inequalities. Thus, people in lower socioeconomic strata fared worse overall in terms of health during the Great Recession, compared to people with higher socioeconomic status. Conclusions: The Great Recession in Europe tends to be followed by increasing socioeconomic inequalities in health. Policymakers should take note of this finding. Widening socioeconomic inequalities in health is a major cause of concern, in particular if health deterioration among 'vulnerable groups' is caused by accelerating cumulative disadvantages.

Perioperative characteristics, histological diagnosis, and outcome in cats undergoing surgical treatment of primary hyperparathyroidism.

OBJECTIVE: To report perioperative characteristics, complications, histopathologic diagnosis and outcome in cats undergoing surgical treatment for primary hyperparathyroidism (PHPT). STUDY DESIGN: Multi-institutional, retrospective case series. ANIMALS: Thirty-two client-owned cats. METHODS: Medical records of cats treated with surgical removal of 1 or more parathyroid gland(s) with confirmed histopathologic evaluation were reviewed. Cats were divided into preoperative ionized calcium (iCa) groups corresponding to the 33rd, 67th, and 100th percentiles of the preoperative iCa results of the study population. Follow-up consisted of phone conversation with owners or primary veterinarian. RESULTS: Ionized calcium was above reference range in all cats (median 1.8 mmol/L [interquartile range, 1.5-1.9]). Abnormal tissue was excised after cervical exploration in all cats. The most common histopathologic diagnoses were parathyroid adenoma in 20 of 32 (62.5%) cats and parathyroid carcinoma in 7 of 32 (21.9%) cats. At discharge, 6 of 32 (18.8%) cats had hypercalcemia, 5 of 32 (15.6%) had hypocalcemia, and 21 of 32 (65.6%) were normocalcemic. Preoperative iCa did not correlate with postoperative iCa. The median follow-up time was 332 days (range, 7-3156). Overall median survival time was 1109 days (95% CI, 856-1332). Survival time was not associated with preoperative iCa group, hypocalcemia at discharge, hypercalcemia at discharge, or diagnosis of carcinoma. CONCLUSION: In this cohort of cats, parathyroid adenoma was the most common cause of PHPT, and surgical treatment resulted in very good median survival time. Preoperative iCa was not predictive of postoperative hypocalcemia. CLINICAL SIGNIFICANCE: Surgical parathyroidectomy for treatment of PHPT in cats provides a favorable prognosis.

Radiographic Differentiation of Cranial Mediastinal Lymphomas from Thymic Epithelial Tumors in Dogs and Cats.

In both dogs and cats, the most common cranial mediastinal masses (CMMs) are lymphoma and thymic epithelial tumors (TETs). Pretreatment differentiation of these tumors using fine needle aspiration or biopsy is essential because lymphomas are treated medically, whereas TETs are treated surgically. The purpose of this retrospective study was to determine whether thoracic radiographic findings can be used to aid clinicians in preliminarily differentiating the two tumor types before cytology or histopathology results become available. Medical records, available cytologic or histologic samples, and thoracic radiographs were evaluated for 62 dogs and 28 cats. Seventeen radiographic criteria were assessed by two examiners, and regression modeling was performed to test for significant predictors of tumor type. In dogs, CMMs with at least two well-defined radiographic margins on a lateral view and CMMs causing a rightward shift of the cardiac silhouette on a ventrodorsal or dorsoventral view were significantly more likely to be TETs than lymphomas (P < .001 and P < .01, respectively). No significant predictive variables were identified in cats. Radiographic findings do not eliminate the need for invasive sampling, but in dogs, they may guide the clinician in providing preliminary information to owners regarding the staging and therapeutic measures that may eventually be recommended.

Photophysical Dynamics and Relaxation Pathways of Ligand-to-Metal Charge-Transfer States in the 5f1 [Np(VI)O2Cl4]2- Anion.

Although several publications report on the electronic structure of the neptunyl ion, experimental measurements to detail the photophysical dynamics of this open-shell actinyl system are limited in number. Time-resolved photoluminescence has been a useful experimental approach for understanding photophysical dynamics and relaxation pathways of a variety of other molecular and ionic systems, including gaseous plutonium hexafluoride and solid-state uranyl compounds. Here, we investigate time-resolved photoluminescence emission of the 5f1 neptunyl tetrachloride ([Np(VI)O2Cl4]2-) dianion following visible excitation. Photoemission of the lowest energy neptunyl ligand-to-metal charge-transfer (LMCT) transitions to both the ground and first electronically excited states is observed. Analyses of the decay lifetimes of the excited states suggest different relaxation pathways as a function of excitation energy. Vibronic progressions associated with the Np-oxo symmetric stretching mode are measured in emission spectra, and the energies from these progressions are compared with energies of vibronic progressions associated with the excitation spectra of [Np(VI)O2Cl4]2-. This study expands our understanding of this open-shell actinyl system beyond identification of excited states, allowing characterization of photophysical properties and evidence for the electronic character of the ground state, and suggests that this approach may be applicable to more complex actinide systems.

Entropy Drives Calcium Carbonate Ion Association.

The understanding of the molecular mechanisms underlying the early stages of crystallisation is still incomplete. In the case of calcium carbonate, experimental and computational evidence suggests that phase separation relies on so-called pre-nucleation clusters (PNCs). A thorough thermodynamic analysis of the enthalpic and entropic contributions to the overall free energy of PNC formation derived from three independent methods demonstrates that solute clustering is driven by entropy. This can be quantitatively rationalised by the release of water molecules from ion hydration layers, explaining why ion association is not limited to simple ion pairing. The key role of water release in this process suggests that PNC formation should be a common phenomenon in aqueous solutions.

Effects of Reverse Micellar Structure on the Particle Charging Capabilities of the Span Surfactant Series.

This paper investigates the effects of reverse micellar core size on the particle charging behavior of a series of acidic surfactants in apolar media. A series of Span surfactants was dissolved in deuterated decane at concentrations above the critical micelle concentration. The structures of the reverse micelles were measured using small-angle neutron scattering. It was determined that as the tail length of the surfactant increased, the size of the polar reverse micellar core decreased. Tritailed surfactants formed reverse micelles with the smallest polar cores, with radii of ∼4 Å. The sizes of the polar cores were correlated with the particle charging behavior of the Span surfactant series, as measured in a previous study. It was found that reverse micelles with intermediate core sizes imparted the largest electrophoretic mobilities to the particles. Reverse micelles with very small cores did not offer a large enough polar environment to favor charge stabilization, while very large polar cores favored disproportionation reactions in the bulk, resulting in increased electrostatic screening.

A Novel Imaging System Distinguishes Neoplastic from Normal Tissue During Resection of Soft Tissue Sarcomas and Mast Cell Tumors in Dogs.

OBJECTIVE: To assess the ability of a novel imaging system designed for intraoperative detection of residual cancer in tumor beds to distinguish neoplastic from normal tissue in dogs undergoing resection of soft tissue sarcoma (STS) and mast cell tumor (MCT). STUDY DESIGN: Non-randomized prospective clinical trial. ANIMALS: 12 dogs with STS and 7 dogs with MCT. METHODS: A fluorescent imaging agent that is activated by proteases in vivo was administered to the dogs 4-6 or 24-26 hours before tumor resection. During surgery, a handheld imaging device was used to measure fluorescence intensity within the cancerous portion of the resected specimen and determine an intensity threshold for subsequent identification of cancer. Selected areas within the resected specimen and tumor bed were then imaged, and biopsies (n=101) were obtained from areas that did or did not have a fluorescence intensity exceeding the threshold. Results of intraoperative fluorescence and histology were compared. RESULTS: The imaging system correctly distinguished cancer from normal tissue in 93/101 biopsies (92%). Using histology as the reference, the sensitivity and specificity of the imaging system for identification of cancer in biopsies were 92% and 92%, respectively. There were 10/19 (53%) dogs which exhibited transient facial erythema soon after injection of the imaging agent which responded to but was not consistently prevented by intravenous diphenhydramine. CONCLUSION: A fluorescence-based imaging system designed for intraoperative use can distinguish canine soft tissue sarcoma (STS) and mast cell tumor (MCT) tissue from normal tissue with a high degree of accuracy. The system has potential to assist surgeons in assessing the adequacy of tumor resections during surgery, potentially reducing the risk of local tumor recurrence. Although responsive to antihistamines, the risk of hypersensitivity needs to be considered in light of the potential benefits of this imaging system in dogs.

Temperature Effects on Micelle Formation and Particle Charging with Span Surfactants in Apolar Media.

This paper examines the effects of temperature on the micellization and particle charging behavior of the Span surfactant series in an apolar environment. The critical micelle concentrations of each of six surfactants at five temperatures were measured by conductometric techniques. The thermodynamic properties of micellization were calculated using Gibbs-Helmholtz analysis. Magnesia particles were then dispersed in solutions of these surfactants, and their electrophoretic mobilities were measured at three temperatures. Preliminary small-angle neutron scattering (SANS) experiments were conducted to measure the size of aggregates (referred to as reverse micelles) of three of the surfactants. It was found that for all but one of the surfactants the critical micelle concentration (CMC) increased by as much as an order of magnitude across a 40 °C range of temperature. One of the surfactants exhibited a decrease in CMC upon increasing temperature, likely due to a decrystallization of the tails upon reverse micelle formation. The maximum particle mobilities decreased upon increasing temperature due to the increased electrostatic screening by charged reverse micelles at higher temperatures.

Unexpected Actinyl Cation-Directed Structural Variation in Neptunyl(VI) A-Type Tri-lacunary Heteropolyoxotungstate Complexes.

A-type tri-lacunary heteropolyoxotungstate anions (e.g., [PW9O34](9-), [AsW9O34](9-), [SiW9O34](10-), and [GeW9O34](10-)) are multidentate oxygen donor ligands that readily form sandwich complexes with actinyl cations ({UO2}(2+), {NpO2}(+), {NpO2}(2+), and {PuO2}(2+)) in near-neutral/slightly alkaline aqueous solutions. Two or three actinyl cations are sandwiched between two tri-lacunary anions, with additional cations (Na(+), K(+), or NH4(+)) also often held within the cluster. Studies thus far have indicated that it is these additional +1 cations, rather than the specific actinyl cation, that direct the structural variation in the complexes formed. We now report the structural characterization of the neptunyl(VI) cluster complex (NH4)13[Na(NpO2)2(A-α-PW9O34)2]·12H2O. The anion in this complex, [Na(NpO2)2(PW9O34)2](13-), contains one Na(+) cation and two {NpO2}(2+) cations held between two [PW9O34](9-) anions, with an additional partial occupancy NH4(+) or {NpO2}(2+) cation also present. In the analogous uranium(VI) system, under similar reaction conditions that include an excess of NH4Cl in the parent solution, it was previously shown that [(NH4)2(U(VI)O2)2(A-PW9O34)2](12-) is the dominant species in both solution and the crystallized salt. Spectroscopic studies provide further proof of differences in the observed chemistry for the {NpO2}(2+)/[PW9O34](9-) and {UO2}(2+)/[PW9O34](9-) systems, both in solution and in solid state complexes crystallized from comparable salt solutions. This work reveals that varying the actinide element (Np vs U) can indeed measurably impact structure and complex stability in the cluster chemistry of actinyl(VI) cations with A-type tri-lacunary heteropolyoxotungstate anions.

Perioperative Mortality and Long-Term Survival in 80 Dogs and 32 Cats Undergoing Excision of Thymic Epithelial Tumors.

OBJECTIVE: To examine perioperative mortality, long-term survival, causes of death, and prognostic factors for dogs and cats undergoing surgical excision of thymic epithelial tumors (TETs). STUDY DESIGN: Multi-institutional case series. ANIMALS: Eighty dogs and 32 cats. METHODS: Follow-up information was obtained for dogs and cats that underwent surgical excision of a TET between 2001 and 2012. RESULTS: Perioperative mortality was 20% in dogs and 22% in cats. No independent risk factors for perioperative mortality were identified. The estimated median survival time for all dogs was 1.69 years (95% CI 0.56-4.32) and the 1- and 4-year survival rates were 55% (95% CI 44-67) and 44% (95% CI 32-56). The estimated median survival time for all cats was 3.71 years (95% CI 0.56-unestimatable) and the 1- and 4-year survival rates were 70% (95% CI 53-87) and 47% (95% CI 0-100). Of animals that survived to discharge, 42% of dogs and 20% of cats eventually died of TET-related causes. The presence of paraneoplastic syndromes (hazard ratio [HR] 5.78, 95% CI 1.64-20.45, P = .007) or incomplete histologic margins (HR 6.09, 95% CI 1.50-24.72, P = .01) were independently associated with decreased survival in dogs. No significant predictors of survival were identified in cats. Conclusions regarding the effect of chemotherapy or radiation therapy could not be made. CONCLUSIONS: While there is substantial risk of perioperative death in dogs and cats undergoing surgery for TETs, many animals that survive to discharge have prolonged survival. Survival is significantly decreased in dogs with paraneoplastic syndromes or incomplete histologic margins.

Lateral caudal axial pattern flap in 13 dogs.

OBJECTIVE: To describe the frequency and extent of complications associated with lateral caudal axial pattern flaps used to cover large traumatic or excision skin defects on the dorsum, gluteal, and perineal region in 13 dogs. STUDY DESIGN: Case series. ANIMALS: Thirteen client-owned dogs. METHODS: Medical records from 8 institutions were reviewed for dogs treated with a lateral caudal axial pattern flap, including cases in which the procedure was combined with other reconstructive techniques. The flap length relative to the tail length, location of tail skin incision, size and cause of the defect, and short- and long-term complications were recorded. RESULTS: Thirteen dogs were included, 11 with tumors and 2 with traumatic skin loss. The mean estimated length of the flap relative to tail length was 51% (range 33-70%). Four dogs had wound complications. This included 2 dogs with minor postoperative wound complications (mild distal dehiscence) that did not require surgical revision and 2 dogs with major complications that required surgical revision. Two of these 4 dogs had distal flap necrosis, one was revised surgically and one was managed conservatively. In these 2 dogs, the flap length was estimated as 80% and 65% of the tail length, respectively. At 30 days, flaps in all dogs were completely healed. No long-term complications were recorded in any dog. For some dogs, the reconstruction was not obvious, with only the change in hair direction and color noticeable. CONCLUSION: Lateral caudal axial pattern flap is a reconstructive option for gluteal, dorsal, and perineal skin defects in dogs. Distal flap necrosis and dehiscence due to wound infection occurred in 4 dogs that required additional wound care but not always surgical revision.

Effect of synergists on organic pigment particle charging in apolar media.

The current work investigates the apolar charging behavior of organic pigment particles and the role that synergists play in regard to particle charging. Organic pigments are often used in apolar paints, inks, and most recently electrostatic lithography. For electrolithography to work, the particles must be both stable and possess the correct polarity and magnitude of charge. It is therefore important to better understand the charging behavior and potential charging mechanisms of these particles that have received little or no attention in the literature. Unfortunately, these already complex systems are further complicated by the fact that the stability of organic pigments is often improved through the use of synergists. Synergists are designed to enhance the adsorption of steric stabilizers to the particles. However, their effect on particle charging has not been previously published. In this study, the particle zeta potential is determined for apolar dispersions of magenta and cyan particles in heptane (with and without synergist present). The particles are dispersed with three different surfactants commonly used in apolar charging studies: Span 80, Aerosol-OT, and OLOA 11000. Acid-base interactions appear to play an important role, particularly for cyan. However, due to the complexity of these systems, any general rule must be applied with caution as the particle, surfactant, and synergist chemistry all determine the nature of the particle charge.

Micellization behavior of Aerosol OT in alcohol/water systems.

This paper examines the effects of solvent composition on the micellization behavior of the surfactant Aerosol OT (AOT). The critical micelle concentrations of AOT in the pure solvents methanol, ethanol, propanol, and isopropanol were measured using conductiometric techniques. These solvents were then mixed with water to create solvent spectra from pure alcohol to pure water in 12 increments. Critical micelle concentrations were measured at each solvent composition. Dynamic light scattering was used to verify the presence or absence of micelles in the solvent mixtures. It was found that inverse micelles exist over a range of solvent compositions where εeff < 48 with CMCs increasing with increasing solvent polarity. Micellization was found not to occur when 48 < εeff < 80. Regular micelles formed in pure water, with the measured CMC agreeing with the literature value of 2.25 mM.

Traumatic pericardial rupture with secondary cardiac herniation in a dog.

OBJECTIVE: To describe the unique finding and treatment of a dog with cardiac herniation due to traumatic pericardial rupture. CASE SUMMARY: A 6.5-year-old entire male Yorkshire Terrier was presented for further management after being hit by a car. Despite suspected significant intrathoracic trauma at that time, the patient regained hemodynamic stability and had orthopedic surgery to correct a right iliac fracture. The patient was readmitted to the hospital 12 days following the initial visit due to considerable respiratory difficulty after accidentally being dropped several feet. Thoracic radiographs revealed an unusual severe mediastinal shift to the left with an atypical position of the cardiac silhouette against the left lateral thoracic wall. Due to the severe respiratory compromise of the patient and newly developed pneumothorax, an exploratory thoracotomy was recommended, where a complete rupture of the pericardium was identified, with secondary left-sided prolapse of the heart. Other more common intrathoracic injuries (ie, lung perforation, rib fractures) were also identified and partially repaired. The patient recovered successfully and was discharged 4 days postoperatively. NEW OR UNIQUE INFORMATION PROVIDED: This is the first case report in the veterinary literature of traumatic pericardial rupture and cardiac herniation. According to human case descriptions, this is a rare and often fatal occurrence, which can be significantly challenging to diagnose preoperatively or antemortem. Emergency veterinary clinicians should be aware of this rare but important complication of blunt thoracic trauma. Surgical intervention may be necessary in cases with suspected or confirmed entrapment of great vessels or cardiac chambers, although these abnormalities were not present in this case.

Roles of larval sea urchin spicule SM50 domains in organic matrix self-assembly and calcium carbonate mineralization.

The larval spicule matrix protein SM50 is the most abundant occluded matrix protein present in the mineralized larval sea urchin spicule. Recent evidence implicates SM50 in the stabilization of amorphous calcium carbonate (ACC). Here, we investigate the molecular interactions of SM50 and CaCO3 by investigating the function of three major domains of SM50 as small ubiquitin-like modifier (SUMO) fusion proteins - a C-type lectin domain (CTL), a glycine rich region (GRR) and a proline rich region (PRR). Under various mineralization conditions, we find that SUMO-CTL is monomeric and influences CaCO3 mineralization, SUMO-GRR aggregates into large protein superstructures and SUMO-PRR modifies the early CaCO3 mineralization stages as well as growth. The combination of these mineralization and self-assembly properties of the major domains synergistically enable the full-length SM50 to fulfill functions of constructing the organic spicule matrix as well as performing necessary mineralization activities such as Ca(2+) ion recruitment and organization to allow for proper growth and development of the mineralized larval sea urchin spicule.

Mg2+ tunes the wettability of liquid precursors of CaCO3: toward controlling mineralization sites in hybrid materials.

Amorphous and liquid precursors of calcium carbonate are believed to be central species of biomineralization, which serves as an important inspiration for materials chemists in the quest for new and improved organic-inorganic hybrid materials. It has become increasingly clear that magnesium ions exhibit an important function through kinetic stabilization of the metastable precursors. We show that they additionally tune the wettability of liquid precursors of CaCO3, which is a crucial requirement for successful mineralization of proteinaceous organic matrices. Moreover, tunable wettability offers straightforward means to control mineralization sites in organic-inorganic hybrids.

Doctor-certified sickness absence in first and second trimesters of pregnancy among native and immigrant women in Norway.

AIMS: The authors sought to estimate differences in doctor-certified sickness absence during pregnancy among immigrant and native women. METHODS: Population-based cohort study of pregnant women attending three Child Health Clinics in Groruddalen, Oslo, and their offspring. Questionnaire data were collected at gestational weeks 10-20 and 28. The participation rate was 74%. A multivariate Poisson regression was used to analyse differences in sickness absence in pregnancy between immigrant and native women. RESULTS: A total of 573 women who were employed prior to their pregnancies were included, 51% were immigrants. After adjusting for age, years of education, marital status, number of children, occupation, part-time/full-time work, health status, severe pregnancy-induced emesis and language proficiency, the immigrant/native differences in number of weeks with sickness absence decreased from 2.0 to 1.2 weeks. Part-time/full-time work, health status, severe pregnancy-induced emesis and language proficiency were significant predictors of sickness absence. CONCLUSION: Immigrant women had higher sickness absence than native women during pregnancy. The difference in average number of weeks between native and immigrant women was partly explained by poorer health status prior to pregnancy, severe pregnancy-induced emesis and poorer proficiency in the Norwegian language among the immigrant women.

Benefits of Returning to Work After ECT.

BACKGROUND: Severe unipolar or bipolar depression is often not helped by pharmacotherapy and/or psychotherapeutic treatment alone, whereas more than 80% of these patients remit after sessions of electroconvulsive treatment (ECT). Getting patients back to work after a severe depression may be important for maintaining the effect of ECT. METHODS: Twenty consecutive patients remitted to an acute psychiatric hospital for depression underwent ECT. None of the patients had been working before the inpatient stay. Four patients were living on a permanent sickness allowance from the State (invalidity pension) before ECT, and thus were not expected to start work thereafter. RESULTS: Ten of the patients returned to work. Hospital treatment in Norway (including ECT) is provided free of charge with no copayments from the patient. The mean length of sick leave before ECT was 14.7 months. The 10 patients who returned to work had accrued public costs before their inpatient stays totalling NOK (Norwegian krone) 2,994,635 or a mean of NOK 299,463 per patient (&OV0556;1 = 9 NOK or $1 = 6 NOK ). The total public cost of their inpatient stays was NOK 1,680,000. During the first year after ECT, these 10 patients received NOK 2,680,000 in wages (NOK 3,238,300 during the mean number of months they were observed). CONCLUSION: Most of the patients (10 of 16) receiving ECT returned to work and within 2 years had earned more than the total cost both of their sick leave before admittance to hospital and the public cost of their 4 weeks' inpatient treatment. It is a pity that many countries, including Norway, only allow ECT as a treatment of last resort after failed psychotherapy or pharmacotherapy. Higher public spending is an inadvertent result of such a policy toward ECT.