Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal.

The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce density as one of 6 core indicators for monitoring universal access to safe, affordable surgical and anaesthesia care. Using Nepal as a case study, we explored the capacity of a generalist workforce (led by a family physician or MD general practitioner and non-physician anaesthetist) to enable effective surgical delivery through task-shifting. Using a multiple-methods approach, we retrospectively mapped essential surgical care and the enabling environment for surgery in 39 hospitals in 25 remote districts in Nepal and compared it with LCoGS indicators.

Maternity Waiting Home Interventions as a Strategy for Improving Birth Outcomes: A Scoping Review and Meta-Analysis.

Background And Objective: Over 300 000 women worldwide die due to pregnancy-related complications annually, with most occurring in developing countries where access to skilled obstetric care is limited. Maternity waiting homes (MWHs) are one intervention designed to increase access to skilled prenatal care in resource-limited settings. MWHs are defined as accommodations at or near a health facility where pregnant women can stay in the final weeks of their pregnancy so they can be easily transferred to the health facility to give birth.

Search for neutrino oscillations at the palo verde nuclear reactors.

We report on the initial results from a measurement of the antineutrino flux and spectrum at a distance of about 800 m from the three reactors of the Palo Verde Nuclear Generating Station using a segmented gadolinium-loaded scintillation detector. We find that the antineutrino flux agrees with that predicted in the absence of oscillations excluding at 90% C.L.

Anaesthetics for general anaesthesia in growing pigs.

A comparison was made between different anaesthetics for general anaesthesia in growing pigs, with focus on minor surgery under field conditions and for experiments in clinical research. Healthy cross-breed pigs (Hampshire x Yorkshire x Swedish Landrace) weighing 20-45 kg were used. The anaesthetics combinations compared were 1) azaperone plus metomidate (AM), 2) Zoletil (zolazepam + tiletamine) plus xylazine (ZX), and 3) Zoletil plus xylazine plus ketamine (ZXK).

Lithotripsy of urinary bladder stones with a mechanical lithotriptor inserted through a narrow introducer. An experimental study in pigs.

Mechanical lithotripsy of urinary bladder stones was performed with the RotoLith lithotriptor in 8 pigs with implanted human stones or artificial stones after open cystotomy. The effect of the treatment on the urinary bladder was investigated macro- and microscopically immediately after the lithotripsy in 4 animals and 4 weeks after the lithotripsy in the other 4 animals. The stones were fragmented into very small pieces which would have been possible to pass with the urine.

Cytogenetic analysis of 57 primary prostatic adenocarcinomas.

Cytogenetic analysis after short-term culture in vitro of primary tumor samples was attempted in 82 patients with prostatic cancer. Tumor material was obtained by radical prostatectomy or transurethral resection. Successful cytogenetic studies were performed on 57 tumors of which five were well, 30 moderately, and 22 poorly differentiated adenocarcinomas.

AgNOR staining in benign hyperplasia and carcinoma of the prostate.

We have modified existing techniques for silver staining of nucleolar organizer regions of intact interphase cells by hypotonic swelling and by formic acid treatment to reduce background staining. This allowed the microscopic identification and counting of individual AgNORs in the nucleoli. The method was used on nine adenomatous prostatic samples (including one of normal prostate tissue outside a localized tumor) and on seven prostatic adenocarcinomas.

Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. Swedish-Norwegian Testicular Cancer Group.

Between 1981 and 1986, 279 consecutive patients with clinical stage I (CS1) nonseminomatous germ cell tumors (NSGCT) of the testis underwent pathological staging (PS) with retroperitoneal lymphadenectomy (RPLND). Patients with retroperitoneal metastases (PS2) received adjuvant chemotherapy. The median follow-up time after RPLND was 50 months (range, 30 to 90).

Intravesical mitomycin C for carcinoma in situ of the urinary bladder.

Mitomycin C was given intravesically over periods of 2-32 months to 34 patients with carcinoma in situ of the urinary bladder. Initial complete response was obtained in 17 patients, 14 of whom remained without evidence of disease during follow-up averaging 28 months from cessation of mitomycin therapy. In three responding patients malignant cells reappeared in the urine during follow-up, although no recurrence of carcinoma could be proven in bladder biopsy specimens.

Malignant lymphoma of the testis.

Lymphoma presenting in the testis was evaluated in 24 patients. The tumours were classified according to both the Rappaport and the Kiel classification. The Rappaport classification yielded only two tumour types--15 diffuse histiocytic and 9 diffuse mixed histiocytic-lymphocytic, with no pure lymphocytic lymphoma.

Intravesical adriamycin therapy in carcinoma in situ of the urinary bladder.

Intravesical Adriamycin treatment was given to 22 patients with carcinoma in situ of the urinary bladder. The treatment schedule consisted of monthly Adriamycin instillations in a dose related to bladder capacity. Endoscopic inspection with multiple bladder biopsies and cytoanalysis of urine was performed after every third instillation.

Occlusion of renal arterial tumor supply with absolute ethanol. Experience with 20 cases.

Absolute ethanol was used for renal ablation in 20 patients with carcinoma of the kidney. The procedure was followed by nephrectomy in 6 patients without metastases, all of whom are alive without evidence of recurrence 4 to 20 months after treatment. Fourteen patients with metastatic or locally advanced disease were embolized to palliate pain or hematuria without subsequent nephrectomy.

Staging of bladder carcinoma with computed tomography.

In a series of 24 patients with bladder carcinoma. 17 of whom underwent cystourethrectomy, the discriminatory power of computer tomography (CT) in staging of the tumours was compared with the clinical evaluation. In low-stage tumours the accuracy of staging was not increased by CT.

Spontaneous hemothorax from bronchopulmonary sequestration. Unusual angiographic and pathologic-anatomic findings.

An eight year old girl with acute glomerulonephritis developed a massive hemothorax without previous trauma. Angiography demonstrated a bronchopulmonary sequestration with multiple arterial aneurysms. Surgical treatment was succussful.

Histological grading and treatment failures in carcinoma of the uterine body.

In a material of 777 patients with carcinoma of the uterine body, Stages I and II, 115 (15%) had poorly differentiated tumours, and 662 (85%) moderately-to-well differentiated tumours. The five-year tumour death rate was 34% and 12%, respectively. No differences in local recurrences and metastases in the pelvis were recorded in the two tumour groups.