ABSTRACT
BACKGROUND: The use of prosthetic materials for the repair of paraesophageal hiatal hernia (PEH) may lead to esophageal stricture and perforation. High recurrence rates after primary repair have led surgeons to explore other options, including various bioprostheses. However, the long-term effects of these newer materials when placed at the esophageal hiatus are unknown. This study assessed the anatomic and histologic characteristics 1 year after PEH repair using a U-shaped configuration of commercially available small intestinal submucosa (SIS) mesh in a canine model. METHODS: Six dogs underwent laparoscopic PEH repair with SIS mesh 4 weeks after thoracoscopic creation of PEH. When the six dogs were sacrificed 12 months later, endoscopy and barium x-ray were performed, and biopsies of the esophagus and crura were obtained. RESULTS: The mean weight of the dogs 1 year after surgery was identical to their entry weight. No dog had gross dysphagia, evidence of esophageal stricture, or reherniation. At sacrifice, the biomaterial was not identifiable grossly. Biopsies of the hiatal region showed fibrosis as well as muscle fiber proliferation and regeneration. No dog had erosion of the mesh into the esophagus. CONCLUSIONS: This reproducible canine model of PEH formation and repair did not result in erosion of SIS mesh into the esophagus or in stricture formation. Native muscle ingrowth was noted 1 year after placement of the biomaterial. According to the findings, SIS may provide a scaffold for ingrowth of crural muscle and a durable repair of PEH over the long term.
Subject(s)
Hernia, Hiatal/pathology , Hernia, Hiatal/surgery , Intestine, Small/transplantation , Wound Healing , Animals , Biocompatible Materials , Digestive System Surgical Procedures , Disease Models, Animal , Dogs , Intestinal Mucosa/transplantationABSTRACT
A counsellor worked for 1 year in three practices in a rural area where there was previously no practice-based counselling. The service was evaluated, using a range of methods, in order to inform general practitioners and policy-makers about the demand for counselling, where it fits with other services, its potential value and how to organise and audit the service efficiently. Five kinds of information were collected: administrative data; patients' views; well-being scores; GPs' perceptions of individual patients; and interviews with the counsellor, GPs and other primary care staff by an independent researcher. All the GPs used the service, referring 131 people. The most common reason for referral was 'relationship difficulties'. There were improvements in patients' well-being, self-awareness and coping skills, and high satisfaction among GPs and patients. Communication with other services was seen to improve. The counselling service was found to fill a gap by addressing the needs of a substantial group of patients for whom psychiatric care was inappropriate.
Subject(s)
Counseling , Family Practice , Mental Health , Rural Health Services/standards , Attitude of Health Personnel , Counseling/standards , Counseling/statistics & numerical data , Humans , Interviews as Topic , Patient Satisfaction , Pilot Projects , Process Assessment, Health Care , Surveys and QuestionnairesABSTRACT
In a rural hospital in Malawi a protocol was developed for the treatment of severely anaemic children to improve the chances of survival of children with haemoglobin levels of 5 g/dl or less (referred to here as severe anaemia), and also to reduce the risks of transmission of human immunodeficiency virus (HIV) by blood transfusion in a unit where the routine screening of donated blood for HIV positivity is not available. Comparison of the results of applying the protocol (using digoxin, frusemide and selective delayed transfusion) with the results of using a widely accepted regimen of routine transfusion of all children with haemoglobin (Hb) of 5 g/dl or less suggests that stabilization of a severely anaemic child's cardiac state before transfusion improves the chances of survival. Many children with very low haemoglobin values do not then require transfusion, thus avoiding the dangers of transfusing blood that is potentially HIV positive. Those who do need transfusion withstand the procedure better.
Subject(s)
Anemia/therapy , Blood Transfusion , Anemia/drug therapy , Child, Preschool , Humans , Infant , Infant, Newborn , Malawi , Rural HealthABSTRACT
In a rural hospital in Malawi a protocol was developed for the treatment of severely anaemic children to improve the chances of survival of children with haemoglobin levels of 5 g/dl or less (referred to here as severe anaemia); and also to reduce the risks of transmission of human immunodeficiency virus (HIV) by blood transfusion in a unit where the routine screening of donated blood for HIV positivity is not available. Comparison of the results of applying the protocol (using digoxin; frusemide and selective delayed transfusion) with the results of using a widely accepted regimen of routine transfusion of all children with haemoglobin (Hb) of 5 g/dl or less suggests that stabilization of a severely anaemic child's cardiac state before transfusion improves the chances of survival. Many children with very low haemoglobin values do not then require transfusion; thus avoiding the dangers of transfusing blood that is potentially HIV positive. Those who do need transfusion withstand the procedure better
