INTRODUCTION The surgical management of symptomatic giant hiatus hernia (GHH) aims to improve quality of life (QoL) and reduce the risk of life threatening complications. Previous reports are predominantly those with small sample sizes and short follow-up periods. The present study sought to assess a large cohort of patients for recurrence and QoL over a longer time period. METHODS This was a follow-up study of a prospectively collected database of 455 consecutive patients. Primary repair of GHH was evaluated by endoscopy/barium meal for recurrence and a standardised symptom questionnaire for QoL. Recurrence was assessed for size, elapsed time, oesophagitis and symptoms. RESULTS Objective and subjective review was achieved in 91.9% and 68.6% of patients. The median age was 69 years (range: 15-93 years) and 64% were female. Laparoscopic repair was completed in 95% (mesh in 6% and Collis gastroplasty in 7%). The 30-day mortality rate was 0.9%. The proportion of patients alive at five and ten years were 90% and 75% respectively. Postoperative QoL scores improved from a mean of 95 to 111 (p<0.01) and were stable over time (112 at 10 years).The overall recurrence rate was 35.6% (149/418) at 42 months; this was 11.5% (48/418) for hernias >2cm and 24.2% (101/418) for <2cm. The rate of new recurrence at 0-1 years was 13.7% (>2cm = 3.4%, <2cm = 10.3%), at 1-5 years it was 30.8% (>2cm = 9.5%, <2cm = 21.3%), at 5-10 years it was 40.1% (>2cm = 13.8%, <2cm = 26.3%) and at over 10 years it was 50.0% (>2cm = 25.0%, <2cm = 25.0%). Recurrence was associated with oesophagitis but not decreased QoL. Revision surgery was required in 4.8% of cases (14.8% with recurrence). There were no interval major GHH complications. CONCLUSIONS Surgery has provided sustained QoL improvements irrespective of recurrence. Recurrence occurred progressively over ten years and may predispose to oesophagitis.
The results of the present study form a practical guide to aid prehospital and retrieval services in establishing or reviewing their medical agent formularies. Key practice points illuminated by the data provide insights into current practice in critical care. There remains a clear need for similar studies from other services worldwide.
We have established a nonhuman primate (NHP) model to test novel agents for their ability to mobilize hemopoietic progenitors and stem cells. Both recombinant thrombopoietin and the truncated form, MGDF, have been shown in Phase 1 trials to increase the number of hemopoietic progenitors in the peripheral blood. We have explored this further in our NHP model by using the combination of pegMGDF with G-CSF and performed comparisons with other cytokines including G-CSF alone, pegylated G-CSF (pegG-CSF) and the combination of G-CSF + Stem Cell Factor (SCF). Male baboons aged between 7 and 14 years of age received cytokines as follows: 1. G-CSF alone 100mcg/kg/day S/C for 5 days; 2. pegG-CSF, single dose 300mcg/kg S/C; 3. G-CSF 100mcg/kg/day S/C + SCF 50mcg/kg/day S/C for 5 days; and 4. pegMGDF 1mcg/kg S/C second daily for 10 days + G-CSF 100mcg/kg/day S/C for 5 days starting 5 days after the pegMGDF. To control for inter-individual variation and allow a direct comparison, animals receiving G-CSF+pegMGDF were also mobilized with G-CSF+SCF with a minimum period of 12 weeks between mobilisations. Blood counts, peripheral blood (PB) CD34 positive cells and colony forming cells (CFC) were quantified at baseline and at day 5 after G-CSF. NOD/SCID repopulating cell (SRC) frequency was quantified at baseline from PBMNCs and on day 5 using cells harvested by leucapheresis. Baseline PB CD34 and CFC counts were < 2/μL and <1.6/μL respectively in all animals.The median peak PB CD34 count was 12/μL, 12.5/μL, 52/μL and 48/μL for G-CSF (n=8), pegG-CSF (n=4), G-CSF+SCF (n=9) and G-CSF+pegMGDF (n=4) respectively. The peak CD34 +ve count after mobilization with G+pegMGDF was significantly higher than that after mobilization with G-CSF alone using the non-parametric Mann Whitney test (p=0.049). The median peak PB CFC count was 6.5/μL, 8/μL, 32/μL and 28.5/μL for G-CSF (n=4), Peg G-CSF (n=4), G-CSF+SCF (n=5) and G-CSF+pegMGDF (n=4) respectively. The median SRC frequency fold-increase from baseline was 12, 7.5, 42 and 53 for G-CSF (n=4), pegG-CSF (n=4), G-CSF+SCF (n=2), and G-CSF+pegMGDF (n=3) respectively. Although there was a trend for an increase in peak CFC and SRC using G+pegMGDF, the differences were not statistically significant due to smaller sample numbers (p=0.34 and p=0.4 respectively). In the 4 animals that received both G-CSF+SCF and G-CSF+pegMGDF the peak PB CD34 and CFC were similar in each animal. The mean CD34 count was 48.3 ± 3.7/μL and 51 ± 8.5 μL and the mean CFC count 32 ± 5.7/μL and 28.5 ± 3/μL for G-CSF+SCF and G-CSF+MGDF respectively. SRC data for this cohort is currently available for two animals. The mean SRC frequency fold-increase was 42 and 58.5 respectively for G-CSF+SCF and G-CSF+pegMGDF respectively. These data suggest that the addition of pegMGDF to G-CSF increases primitive hemopoietic cell numbers compared to G-CSF alone and to a degree comparable to G-CSF plus SCF. This is of relevance in light of the recent clinical development of novel thrombopoietic proteins.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.