Cost-effectiveness of a pro-active approach of urinary incontinence in women.

OBJECTIVE: To estimate the cost-effectiveness and cost-utility of actively encouraging older community-dwelling women with urinary incontinence to be diagnosed and treated. DESIGN: The study was designed as cost-effectiveness and cost-utility analyses alongside a cluster randomised controlled trial. Analyses were performed from a societal perspective. Direct medical and nonmedical costs were taken into account and valued according to the standard Dutch guidelines for economic evaluations. SETTING: Primary care. POPULATION: Study participants were 350 community-dwelling women 55 years or older with urinary incontinence. METHODS: Women in the intervention group were invited for diagnostic testing and treatment. The control group received usual care according to the Dutch guideline on urinary incontinence. Follow-up period was 12 months. MAIN OUTCOME MEASURES: Incontinence Impact Adjusted Life Years (IIALY), Quality Adjusted Life Years (QALY) and incremental costs calculated per IIALY and per QALY gained. RESULTS: Costs per extra life year without impact on daily life from urinary incontinence amounted to €5179 (95% CI -17 323 to 36 260). Costs per QALY amounted to €23 907 (95% CI -124 849 to 121 849). Assuming a ceiling ratio of €20 000, the probability that the intervention was cost-effective based on IIALYs was 91% and 46% based on QALYs. CONCLUSIONS: Improvements in severity of incontinence in older community-dwelling women can be achieved against reasonable costs, with an improvement of symptom-specific QALYs. Findings support an active role of primary care physicians towards women who hesitate to ask for help for urinary incontinence. TWEETABLE ABSTRACT: Encouraging women with urinary incontinence to be treated, improves symptoms and QOL against reasonable costs.

[Two pregnant immigrant women with tuberculous peritonitis]. / Twee zwangere buitenlandse vrouwen met peritonitis tuberculosa.

Two primigravid immigrant women aged 20 and 24 years were diagnosed with tuberculous peritonitis. The cases showed a significant delay in diagnosis. This was probably the cause for the premature birth and death of one foetus. The other child was diagnosed with congenital tuberculosis several months after birth and was successfully treated. The women were treated with the usual combination ofisoniazid, rifampicin, ethambutol and pyrazinamide. The unfamiliarity with this clinical picture is a problem in countries with a low incidence of tuberculosis. In both cases the final diagnosis was made by the characteristic image seen during laparoscopy. An early diagnosis and also an early start with tuberculostatic drugs are important for a favourable outcome of pregnancy. Pregnancy and breast-feeding are no contraindications for treatment with tuberculostatic drugs.

Isolated lateral tarsometatarsal joint arthrodesis: a case report.

There are few references in the literature to an isolated lateral tarsometatarsal joint arthrodesis. Most references include it as a component of a Lisfranc's joint arthrodesis, which usually involves arthrodesis of at least the intermediate tarsometatarsal joint. A case report involving the treatment of an isolated lateral tarsometatarsal joint arthrosis is presented. Dowel grafting of the fourth and fifth metatarsocuboid joints was initially attempted but resulted in nonunion. Revisional inlay bone grafting afforded solid arthrodesis in this case. Although there are some detrimental biomechanical effects of the procedure, they do not outweigh the need to alleviate the debilitating symptoms that can be associated with degenerative arthritis of the lateral tarsometatarsal joint.

Presentation of a unique ganglionic cyst.

Ganglions, often referred to as ganglionic cysts or synovial cysts, are benign, fluid-filled, cystic swellings. Ganglions are often isolated in the wrist and hand, although they are not uncommon to the foot. Surprisingly, with a high rate of occurrence there has been little discussion in the literature. The authors briefly review ganglionic cysts and present an interesting case report of an unusually large ganglion in the foot.

Complete rupture of the Achilles tendon: a new modification for primary surgical repair.

Appropriate surgical repair of ruptured Achilles tendon will decrease the complications commonly associated with conservative therapy, this is particularly true with respect to rerupture. A literature review of complete ruptures of the Achilles tendon and a new modification of the Lindholm surgical procedure is presented.