Looking after well siblings of adolescent girls with anorexia: an important parental role.

BACKGROUND: Research has suggested that well siblings of children with chronic and life-threatening illnesses are at risk for negative outcomes and that parents' responses to the illnesses can influence the adaptation of well siblings. Yet, parents' efforts to look after well siblings in the context of illness are rarely considered in literature about sibling adaptation. The importance of attending to the needs of well siblings was a major theme to emerge from a qualitative analysis of the experiences of parents of adolescent girls with anorexia nervosa. METHODS: In-depth interviews were conducted with 24 parents of adolescent girls with anorexia and analysed using grounded theory method. RESULTS: The data indicated that parents viewed caring for well siblings in the context of anorexia as an important role and responsibility. Parents reported making conscious and active efforts to look after well siblings by: maintaining normality; compensating for changes to routines; protecting siblings; providing emotional support; and managing the consequences. CONCLUSIONS: This paper provides a picture of the actions parents take to help well siblings adapt to anorexia in the family. Further research is needed to develop and expand this understanding to families experiencing a wide range of chronic and life-threatening illnesses. The findings underline the importance of clinical attention and further research into the critical parental role of caring for well siblings.

Transversalis fascia-Cooper ligament vs. ileopubic tract repair for medial inguinal hernia.

In a prospective randomized study of 171 patients, transversalis fascia-Cooper ligament (McVay) repair of medial inguinal hernia was compared with transversalis fascia-ileopubic tract (Ottsen) repair. After median follow-up of 5 years, the total recurrence rate was 9% (95% confidence interval 4-17) following McVay repair and 15% (9-25) following the Ottsen operation. The difference was not statistically significant, but the analysis showed that, whereas the recurrence rate associated with McVay herniorrhaphy was almost constant after 2 years, recurrences continued to appear after Ottsen repair.

Direct inguinal herniorrhaphy. A long-term follow-up study.

The cumulated recurrence rates following repair of 365 primary medial inguinal hernias in 297 patients were 13% after 5 years of observation, 19% after 10 years and 23% after 15 years (median observation times). Re-recurrence after repeat herniorrhaphy occurred in 45% of patients over a 10-year period. A more restrictive approach to surgery of direct inguinal hernia is advocated, especially to repair of recurrent hernia.

The effect of cysteamine on the Brunner gland secretion in the rat.

Cysteamine in a single subcutaneous administration induces release of gastrin, acid hypersecretion, and duodenal ulcer in rats. Pentagastrin-induced acid hypersecretion has no ulcerogenic effect. The Brunner glands in the proximal duodenum have previously been shown to be an important factor in the natural defence of the duodenal mucosa, and this study has been performed to determine the effect of cysteamine and pentagastrin on the Brunner glands in the rat. The proximal duodenum was isolated in situ and drained by a polyethylene tube. The secretion was studied for two 5-h periods after administration of cysteamine or pentagastrin, and then the Brunner glands were studied histologically. Pentagastrin did not affect spontaneous Brunner gland secretion, whereas cysteamine inhibited the output approximately 50%. After cysteamine the secretory cells were low and depleted of mucus, suggesting that cysteamine interferes with the synthesis of the secretory product. The depression of the Brunner gland secretion may be an important factor in the pathogenesis of cysteamine-induced duodenal ulceration.

Long-term results of surgery for carcinoid tumours of the gastro-intestinal tract.

54 patients were followed-up 1-22 years (median 11 years) after histological verification of a carcinoid tumour. four patients died before operation; 41 patients had their lesion in the appendix, 13 in different extra appendiceal sites in the gastrointestinal tract. There was a significant difference between the median ages and the mortality rates in the two groups. Only one patient with an appendiceal tumour died of his disease. Appendiceal carcinoid, even with local spreading to the serosa and local lymph nodes, seemed to be adequately treated by a simple appendectomy. Extensive surgery, following the principles of treatment for malignant tumours, should be undertaken, when spread to the caecum or ascending colon is present or when the tumour is of extra-appendiceal origin.

Cysteamine-induced duodenal ulcer and acid secretion in the rat.

Duodenal ulcers can be produced in rats within 24 h by a single subcutaneous administration of cysteamine. To determine the role of gastric acid secretion in the pathogenesis of these ulcers, secretory and pathoanatomic studies were performed in chronic fistula rats ater an ulcerogenic dose of cysteamine. A prolonged increase of acid secretion was seen after cysteamine, reaching fourfold the basal level after 5 h. The acid response lasted for 10 to 11 h. After vagotomy cysteamine-induced acid secretion was markedly reduced. Ulcer formation was prevented by vagotomy and by drainage of the gastric juice before it entered the duodenum. When a gastric acid output equivalent to that produced by the ulcerogenic dose of cysteamine was induced by repeated injections of pentagastrin, no mucosal changes were seen in the duodenum. These results indicate that, although some acid in the duodenum is required for ulcer formation, the hypersecretion of acid induced by cysteamine is not the only factor responsible for the development of duodenal ulcer.