scholarly journals Functional outcome in patients following cartilage regenerative treatement: outcome at minimum follow-up of 12 months

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0031
Author(s):  
Thore Zantop ◽  
Christian Zantop ◽  
Anja Hönninger ◽  
Dominik Hauner ◽  
Przemyslaw Warminski ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Knee Flexion ◽  
Cartilage Regeneration ◽  
Lysholm Score ◽  
Cartilage Defects ◽  
Return To Sports ◽  
Male And Female ◽  
Female Patients ◽  
Male Patients

Aims and Objectives: Full thickness cartilage defects may be devastating for the patients. Even though, the surgical options have improved, only limited information for returning to sports. Aim of this study was therefore to compare the functional outcome and the return to sports rate of patients following cartilage regenerative treatment at a minimum follow up of 12 months. Materials and Methods: A total of 50 Patients (32 male, 18 female) undergoing cartilage regeneration using a Matrix-associated chondrocyte transplantation (MACT, Novocart, TETEC, Aesculap) (27 femorotibial, 23 patellofemoral) were evaluated at a minimum follow-up of 12 months. Follow-up was performed using a multifactorial functional analysis including isokinetic strength measurements (BTE-primus), proprioceptive tests (MTF tests), a tapping test and a 3d-motion analysis (myomotion, Noraxon) during single leg squats, bilateral drop jumps and single leg hop tests. Agility was assessed using a lateral speedchase (Globalspeed, Hemsbach). Clinical results were recorded using Tegner and Lysholm score. Results: Patients showed a Lysholm score of 86,3 +/-10,3 and 84,0 +/-13,9 for male and female, respectively. The tegner score was significantly reduced when compared to preoperatively (male 4,72 +/-1,6, female 4,75 +/-1,5). Thigh circumference was reduced by an average of 3,6 cm for male and 4,4 cm for female patients. The tapping test revealed no differences between male and female patients providing a leg symmetry index (LSI) of 102,0 (+/-8,4) with an overall average frequency of 10,14 (+/-1,27). During single leg squat male patients had a significantly lower knee flexion of 55,8 (+/-8,5) of the postoperative leg compared to the non-injured leg (62,2 +/-8,2) whereas the knee abduction was -6.8 (+/-15,1) and -11,8 -11,82 (+/-16,6) for the postoperatively and non-injured leg, respectively. Evaluating the single leg hop, the LSI of distance values was 90,8 (+/-11,9) and for height values 84,0 (+/-16,0) for the male patients. There was a trend towards reduced ROM with regard to knee flexion of the injured leg to the non-injured. Cutting time during lateral speedchase showed a LSI of 98,29 (+/-13,8) and 99,44 (+/-8,2) for male and female patients, respectively. Conclusion: This prospective analysis of patients following cartilage regeneration implicates that the use of a multifactorial “return-to-sports” analysis 12 months postoperatively provides a good correlation to the clinical outcome and scores. At this FU point, Patients following MACT show knee joint function that is close to normal.

scholarly journals Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: Does Gender Impact Outcomes?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0022
Author(s):  
Arianna L. Gianakos ◽  
Olasunmbo Okedele ◽  
Sean Flynn ◽  
John G. Kennedy ◽  
Christopher W. DiGiovanni
Keyword(s):  
Osteochondral Lesions ◽  
Symptom Duration ◽  
Osteochondral Transplantation ◽  
Autologous Osteochondral Transplantation ◽  
Duration Of Symptoms ◽  
Male And Female ◽  
Female Patients ◽  
Male Patients ◽  
The Mean

Category: Ankle; Arthroscopy Introduction/Purpose: Autologous osteochondral transplantation (AOT) is commonly used in the treatment of osteochondral lesions (OCL) of the talus. There is limited data comparing gender differences in the incidence, presentation, and outcomes following AOT. The purpose of this study is to compare these differences between male and female patients. Methods: Eighty-five consecutive patients who underwent AOT were retrospectively reviewed. Patients were divided into two groups based on gender. Demographic data and OCL defect characteristic data were recorded. Functional outcomes were assessed pre- and post-operatively using the Foot and Ankle Outcome Score (FAOS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was used to assess cartilage incorporation. The mean clinical follow-up was 47.2 months, with mean MRI follow-up of 24.8 months. Results: Fifty-five (65%) males and 30 (35%) females were included. OCL defect size was significantly larger in men (112.8mm2) when compared with women (88.7mm2) (p<0.0001). Male patients had a significantly longer duration of symptoms (p<0.001) and OCLs were more likely traumatic in nature (p=0.0006) when compared with female patients. Mean FAOS improved pre- to postoperatively from 50 to 81(P < .001) with a statistically significant increase in men (p<0.0001). The mean MOCART score was 82.1 and 86.7 in male and female patients, respectively (p<0.0001). Lesion size was negatively correlated with MOCART score (r = -0.36,P = .004). No differences were found in knee donor site morbidity, complication rate, or revision surgery. Conclusion: Our study demonstrates that male patients typically present with talar OCLs that are larger in size, traumatic in nature, and with longer symptom duration when compared with female patients. In addition, male patients had greater improvement in FAOS scores following AOT. Therefore, understanding these differences may influence the management and treatment of talar OCLs in male and female patients.

Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR) Registry XI: gender impact on long-term outcomes

Lupus ◽  
2019 ◽  
Vol 28 (5) ◽  
pp. 635-641
Author(s):  
S Zhang ◽  
Z Ye ◽  
C Li ◽  
Z Li ◽  
X Li ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Causes Of Death ◽  
Survival Rates ◽  
Systemic Lupus ◽  
Male And Female ◽  
Female Patients ◽  
American College Of Rheumatology ◽  
Male Patients

Objective The objective of this paper is to assess the role of gender on survival rate and causes of death and organ damage in systemic lupus erythematosus (SLE) patients in China from 2009 to 2015. Methods We conducted a multicenter cohort study to analyze the differences in outcome data between male and female SLE patients. A group of 1494 SLE patients who fulfilled the 1997 American College of Rheumatology SLE classification criteria were enrolled in the Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR) registry from April 2009 to February 2010. All enrolled patients were followed up at least once per year from 2009 to 2015. For patients who could not attend the outpatient clinic, follow-up was conducted by telephone interview. We collected demographic data, clinical manifestations and damage scores (System Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)). Survival rates were evaluated using the Kaplan-Meier method. Results This study included 1352 women and 142 men. The five-year survival rates were 92.0% for men and 97.6% for women. The survival rates of males were significant lower than for females ( p = 0.019). Male patients received methylprednisolone pulse therapy and cyclophosphamide significantly more than female patients ( p = 0.010). During follow-up, 12 male patients and 66 female patients died. The most common cause of death was infection (41.7%) for men and active SLE disease (27.3%) for women. At the end of the study, the major accumulated organ damages included renal (8.5%) and musculoskeletal (7.7%), and nervous system (5.6%) for men and renal (8.8%) and musculoskeletal (6.7%) for women. There were no significant differences in SDI scores between the two groups at baseline and at the end of the study. Conclusions Male SLE patients had lower survival rates than female patients. Male patients received more methylprednisolone pulse and cyclophosphamide therapy. The most common causes of death were infection for male patients and active SLE disease for female patients. The major accumulated organ damages were renal, musculoskeletal, and nervous system both for male and female SLE patients in China.

Do Outcomes of Osteochondral Allograft Transplantation Differ Based on Age and Sex? A Comparative Matched Group Analysis

2017 ◽  
Vol 46 (1) ◽  
pp. 181-191 ◽  
Author(s):  
Rachel M. Frank ◽  
Eric J. Cotter ◽  
Simon Lee ◽  
Sarah Poland ◽  
Brian J. Cole
Keyword(s):  
Failure Rate ◽  
Older Patients ◽  
Reoperation Rate ◽  
Osteochondral Allograft ◽  
Male And Female ◽  
Female Patients ◽  
Allograft Transplantation ◽  
Outcome Scores ◽  
Male Patients

Background: The effect of patient age or sex on outcomes after osteochondral allograft transplantation (OCA) has not been assessed. Purpose: To determine clinical outcomes for male and female patients aged ≥40 years undergoing OCA compared with a group of patients aged <40 years. Study Design: Cohort study; Level of evidence, 3. Methods: A review of prospectively collected data of consecutive patients who underwent OCA by a single surgeon with a minimum follow-up of 2 years was conducted. The reoperation rate, failure rate, and patient-reported outcome scores were reviewed. All outcomes were compared between patients aged <40 or ≥40 years, with subgroup analyses conducted based on patient sex. Failure was defined as revision OCA, conversion to knee arthroplasty, or gross appearance of graft failure at second-look arthroscopic surgery. Descriptive statistics, Fisher exact or chi-square testing, and Mann-Whitney U testing were performed, with P < .05 set as significant. Results: A total of 170 patients (of 212 eligible patients; 80.2% follow-up) who underwent OCA with a mean follow-up of 5.0 ± 2.7 years (range, 2.0-15.1 years) were included, with 115 patients aged <40 years (mean age, 27.6 ± 7.3 years; 58 male, 57 female) and 55 patients aged ≥40 years (mean age, 44.9 ± 4.0 years; 33 male, 22 female). There were no differences in the number of pre-OCA procedures between the groups ( P = .085). There were no differences in the reoperation rate (<40 years: 38%; ≥40 years: 36%; P = .867), time to reoperation (<40 years: 2.12 ± 1.90 years; ≥40 years: 3.43 ± 3.43 years; P = .126), or failure rate (<40 years: 13%; ≥40 years: 16%; P = .639) between the older and younger groups. Patients in both groups demonstrated significant improvement in Lysholm (both: P < .001), International Knee Documentation Committee (IKDC) (both: P < .001), Knee Injury and Osteoarthritis Outcome Score (KOOS) (both: P < .001), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (both: P < .001), and Short Form–12 (SF-12) physical (both: P < .001) scores compared with preoperative values. Patients aged ≥40 years demonstrated significantly higher KOOS symptom ( P = .015) subscores compared with patients aged <40 years. There were no significant differences in the number of complications, outcome scores, or time to failure between the sexes. In patients aged <40 years, female patients experienced failure significantly more quickly than male patients ( P = .039). In contrast, in patients aged ≥40 years, male patients experienced failure significantly more quickly than female patients ( P = .046). Conclusion: This study provides evidence that OCA is a safe and reliable treatment option for osteochondral defects in patients aged ≥40 years. Male and female patients had similar outcomes. Patients aged <40 years demonstrated lower KOOS symptom subscores postoperatively compared with older patients, potentially attributable to higher expectations of return to function postoperatively as compared with older patients.

scholarly journals Autologous Matrix-Induced Chondrogenesis for Treatment of Focal Cartilage Defects in the Knee: A Follow-up Study

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098187
Author(s):  
Justus Gille ◽  
Ellen Reiss ◽  
Moritz Freitag ◽  
Jan Schagemann ◽  
Matthias Steinwachs ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Demographic Data ◽  
Case Series ◽  
Defect Size ◽  
Lysholm Score ◽  
Outcome Analysis ◽  
Cartilage Defects ◽  
Chondral Defects ◽  
The Mean

Background: Autologous matrix-induced chondrogenesis (AMIC) is a well-established treatment for full-thickness cartilage defects. Purpose: To evaluate the long-term clinical outcomes of AMIC for the treatment of chondral lesions of the knee. Study Design: Case series; Level of evidence, 4. Methods: A multisite prospective registry recorded demographic data and outcomes for patients who underwent repair of chondral defects. In total, 131 patients were included in the study. Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) score for pain were used for outcome analysis. Across all patients, the mean ± SD age of patients was 36.6 ± 11.7 years. The mean body weight was 80.0 ± 16.8 kg, mean height was 176.3 ± 7.9 cm, and mean defect size was 3.3 ± 1.8 cm2. Defects were classified as Outerbridge grade III or IV. A repeated-measures analysis of variance was used to compare outcomes across all time points. Results: The median follow-up time for the patients in this cohort was 4.56 ± 2.92 years. Significant improvement ( P < .001) in all scores was observed at 1 to 2 years after AMIC, and improved values were noted up to 7 years postoperatively. Among all patients, the mean preoperative Lysholm score was 46.9 ± 19.6. At the 1-year follow-up, a significantly higher mean Lysholm score was noted, with maintenance of the favorable outcomes at 7-year follow-up. The KOOS also showed a significant improvement of postoperative values compared with preoperative data. The mean VAS had significantly decreased during the 7-year follow-up. Age, sex, and defect size did not have a significant effect on the outcomes. Conclusion: AMIC is an effective method of treating chondral defects of the knee and leads to reliably favorable results up to 7 years postoperatively.

Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment

2018 ◽  
Vol 46 (6) ◽  
pp. 1362-1370 ◽  
Author(s):  
Philipp Schuster ◽  
Markus Geßlein ◽  
Michael Schlumberger ◽  
Philipp Mayer ◽  
Raul Mayr ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Cartilage Regeneration ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Varus Malalignment ◽  
Medial Osteoarthritis ◽  
Ikdc Score ◽  
Chondral Resurfacing

Background: High tibial osteotomy (HTO) is a widely used treatment option for medial osteoarthritis and varus malalignment, especially in young patients with early osteoarthritis. Limited outcome data are available for this procedure in severe osteoarthritis, and no long-term data are available using newer implants. Purpose: To determine survivorship and functional results of medial open-wedge HTO combined with a chondral resurfacing (CR) procedure (abrasion plus microfracture) in severe medial osteoarthritis (Kellgren-Lawrence grade 3 and 4) and varus malalignment. Furthermore, factors that potentially influence the outcome were analyzed. Study Design: Case series; Level of evidence, 4. Methods: From September 2005 to December 2008, all cases of HTO (fixation with an angular-stable internal fixator) combined with CR were prospectively surveyed with regard to survival (Kaplan-Meier-method, not requiring arthroplasty) and functional outcome (subjective International Knee Documentation Committee [IKDC] score). Cartilage regeneration at the time of hardware removal, tibial bone varus angle (TBVA), pre- and postoperative mechanical medial proximal tibial angle (MPTA), and postoperative alignment were analyzed with regard to the result. Results: Seventy-nine knees were included (73 patients; mean age 50.9 ± 7.6 years). The follow-up rate was 90% at 10.0 ± 1.2 years (range, 8.3-12.1 years). Pre- and postoperative mechanical tibiofemoral axis were 9.6° ± 3.0° of varus and 0.6° ± 2.7° of valgus, respectively. Survival rate was 81.7% (95% CI, 72.5%-90.9%) at 10 years. Subjective IKDC score significantly improved from 44 ± 11 preoperatively to 70 ± 13 at one, 66 ± 15 at three, 66 ± 15 at five, and 65 ± 17 at ten years ( P < .001 at any point of follow-up). Poor cartilage regeneration and low preoperative IKDC score (<40) were associated with decreased survival. High preoperative TBVA was associated with better and an overcorrected MPTA (>95°) with inferior functional outcome at final follow-up, respectively. Conclusion: Even in cases of severe medial osteoarthritis and varus malalignment, HTO in combination with a CR procedure is a good to excellent treatment option. The role of the CR procedure remains unclear. Although good results are obtained with overcorrected MPTA, long-term functional outcome is inferior.

scholarly journals Sex-Disaggregated Data on Clinical Characteristics and Outcomes of Hospitalized Patients With COVID-19: A Retrospective Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Mengdie Wang ◽  
Nan Jiang ◽  
Changjun Li ◽  
Jing Wang ◽  
Heping Yang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Clinical Characteristics ◽  
Random Effect ◽  
Hospitalized Patients ◽  
Male And Female ◽  
Female Patients ◽  
Disease Outcomes ◽  
Male Patients

BackgroundSex and gender are crucial variables in coronavirus disease 2019 (COVID-19). We sought to provide information on differences in clinical characteristics and outcomes between male and female patients and to explore the effect of estrogen in disease outcomes in patients with COVID-19.MethodIn this retrospective, multi-center study, we included all confirmed cases of COVID-19 admitted to four hospitals in Hubei province, China from Dec 31, 2019 to Mar 31, 2020. Cases were confirmed by real-time RT-PCR and were analyzed for demographic, clinical, laboratory and radiographic parameters. Random-effect logistic regression analysis was used to assess the association between sex and disease outcomes.ResultsA total of 2501 hospitalized patients with COVID-19 were included in the present study. The clinical manifestations of male and female patients with COVID-19 were similar, while male patients have more comorbidities than female patients. In terms of laboratory findings, compared with female patients, male patients were more likely to have lymphopenia, thrombocytopenia, inflammatory response, hypoproteinemia, and extrapulmonary organ damage. Random-effect logistic regression analysis indicated that male patients were more likely to progress into severe type, and prone to ARDS, secondary bacterial infection, and death than females. However, there was no significant difference in disease outcomes between postmenopausal and premenopausal females after propensity score matching (PSM) by age.ConclusionsMale patients, especially those age-matched with postmenopausal females, are more likely to have poor outcomes. Sex-specific differences in clinical characteristics and outcomes do exist in patients with COVID-19, but estrogen may not be the primary cause. Further studies are needed to explore the causes of the differences in disease outcomes between the sexes.

Midterm Results after Implant-Free Patellar Fixation Technique for Medial Patellofemoral Ligament Reconstruction

2019 ◽  
Vol 33 (11) ◽  
pp. 1140-1146
Author(s):  
Philipp Mayer ◽  
Philipp Schuster ◽  
Michael Schlumberger ◽  
Martin Eichinger ◽  
Michael Pfaff ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Surgical Technique ◽  
Functional Outcome ◽  
Revision Surgery ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Return To Sports ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Preoperative Level

AbstractProblems and complications concerning the patellar fixation in medial patellofemoral ligament reconstruction (MPFLR) have been reported. The purpose of this retrospective study was to systematically analyze the surgical technique for MPFLR with a V-shaped patellar bonetunnel for implant-free fixation of an autologous gracilis tendon, allowing early functional rehabilitation, regarding restoration of the patellofemoral stability, patient satisfaction, return to sports, and technique-specific complications. In 2010, 128 cases of consecutive isolated MPFLR were performed. All these cases were included. After a minimum follow-up of 3 years, 104 cases were retrospectively analyzed (follow-up: 81.3%) with regard to redislocation, subjective functional outcome (Tegner's score and sports level compared with preoperative level), patient satisfaction, revision surgery, and technique-specific complications. After a follow-up of 45.7 ± 3.2 months, 101 of 104 cases (97.1%) showed no redislocation. Mean Tegner's score was 5.1 ± 1.8 (range, 2–9). A total of 61.5% patients reported about a higher sports level compared with their preoperative level. The patient satisfaction was high with 94.2%. In two cases (1.9%), technique-specific problems occurred as the bone bridge of the V-shaped tunnel was insufficient due to a malpositioning of the aiming device. No further technique-specific problems occurred and no revision surgery was necessary during the observational period. The presented surgical technique is safe and it reliably restores the patellofemoral stability, with a low rate of redislocations, an excellent subjective functional outcome, and a high-patient-reported satisfaction. No major technique-specific complications occurred.

A Novel DNA/RNA FISH X Inactivation Assay Reveals a Nonrandom, Ploidy-Dependent Acquisition of the Active and Inactive X Chromosomes in Childhood Hyperdiploid Acute Lymphoblastic Leukemia (ALL) and Non-Hodgkin Lymphoma (NHL).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1080-1080
Author(s):  
Oskar A. Haas ◽  
Petra Zeitlhofer ◽  
Sabine Strehl ◽  
Michael Pfeilstoecker ◽  
Margit Koenig ◽  
...  
Keyword(s):  
Acetic Acid ◽  
X Chromosome ◽  
Dna Sequences ◽  
X Chromosomes ◽  
Childhood All ◽  
Male And Female ◽  
Female Patients ◽  
Rna Fish ◽  
Random Fashion ◽  
Male Patients

Abstract The most common numerical chromosome aberration in childhood ALL and NHL is the gain of an extra X chromosome in both male and female patients. We were therefore interested to investigate whether this non-disjunction event affects the active and inactive X chromosomes in a random or non-random fashion. In female cases both the active or inactive X may be duplicated randomly or non-randomly, whereas in male patients only the solitary active homologue can be copied. However, in theory a duplicated active X might subsequently also be subjected to de novo inactivation in both sexes. The inactivation status of acquired X chromosomes is usually evaluated by methylation-specific PCR (MS-PCR), which allows the simultaneous quantification of various differentially methylated polymorphic DNA sequences on the X chromosome, such as those contained in the HUMARA or FMR1 genes. Previous evidence from such analyses suggested that in NHL patients the acquired X chromosomes are and remain always active in male patients, whereas in females both the active and inactive X are duplicated in a random fashion (McDonald et al, Genes, Chromosomes & Cancer 28:246;2000). In childhood ALL this issue has not yet been investigated. However, quantification with MS-PCR has its limitations, especially in cases with low blast cells numbers. To overcome this problem, we have therefore developed a simultaneous dual-color DNA/RNA FISH assay that enables the enumeration of active and inactive X chromosomes on a single cell level. FISH was performed with probes specific for the X centromere and the XIST RNA, which is exclusively expressed from and covers vast parts of the inactive X in human interphase cells. Following the successful evaluation of the assay on methanol/acetic acid-fixed cells that were obtained from 10 healthy individuals and 23 cases with various constitutional X chromosome aneuploidies, we analyzed 54 methanol/acetic acid-fixed samples from hyperdiploid cases of childhood ALL and 29 from NHL. The ALL cases comprised 24 males with two X, 23 females with three X and seven females with four X. The NHL cases consisted of 18 male (9 in the hypo- to hyperdiploid and 9 in the pseudotriploid to pseudotetraploid range) and 11 female patients (7 with three X and 4 with four X chromosomes). In contrast to all constitutional control samples, which as expected contained only one active X, two of the three X in leukemic cell samples from both male and female patients were active. The only exception was a male patient, who most likely was a Klinefelter syndrome with a constitutional XXY. In contrast, all female patients with four X had duplicated both the active and inactive X chromosome. These findings prove that irrespective of the sex of the patient, the active X is exclusively duplicated in cases with three X chromosomes. The consistent gain of both the active and inactive X in female cases with four X, on the other hand, further corroborates previously established evidence that in all instances a single non-discjunction event leads to the maldistribution of chromosomes irrespective of the ploidy range. Moreover, the exclusive presence of duplicated active X chromosomes in hyperdiploid ALL concurs with and explains the results of gene expression profiling studies, which have shown a corresponding over-expression of X-encoded genes.

The Effect of Treatment on the Melancholias (Depressions)

1982 ◽  
Vol 140 (3) ◽  
pp. 223-230 ◽  
Author(s):  
Max Hamilton
Keyword(s):  
Depressive Illness ◽  
Open Trial ◽  
Female Patients ◽  
Effect Of Treatment ◽  
Male Patients ◽  
Better Than

SummaryThe results described are based on data from 47 male and 83 female patients randomly assigned to treatment with imipramine or phenelzine in an open trial. All were fresh (untreated) cases diagnosed as suffering from depressive illness (melancholia). They were rated before treatment and 2 and four months later. Imipramine did not give results which were significantly better than phenelzine. With both drugs it was found that patients had done either very well or very poorly at follow-up, i.e. the distribution of scores was U-shaped (or bimodal at the least).The 55 men and 90 women who were unsuitable for treatment with drugs or who had failed to respond to such treatment were given a course of ECT and followed-up at corresponding intervals. The improvement after ECT was better than with drugs and the distribution of scores is quite different. An earlier series of male patients treated with ECT in the pre-drug days did not show as good a response to the treatment.

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