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https://www.readbyqxmd.com/read/29349584/-percutaneous-endoscopic-gastrostomy-in-geriatrics-indications-technique-and-complications
#1
Rainer Wirth
The technique of percutaneous endoscopic gastrostomy (PEG) was introduced in 1979 as a semi-invasive approach for children with the need for a gastric fistula in order to avoid an operative intervention. The suture pull-through method was rapidly established and is now omnipresent. Because scientific evidence is broadly missing, there is some uncertainty about the indications in geriatric medicine. Guidelines do not recommend the insertion of a PEG in patients with severe dementia and malnutrition. Tube feeding is mainly recommended as a temporary method for patients who cannot take oral nutrition for more than 3 days or for whom the energy intake for more than 10 days presumably covers less than 50% of their needs, assuming that the overall prognosis is reasonable...
January 18, 2018: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/29348280/marked-cachexia-in-probable-invasive-pulmonary-aspergillosis-with-bronchopleural-fistula
#2
Christiana Page, Laura Blazy, Melanie Jenkins, Rosalba Spiritoso
A 49-year-old man with a medical history of diabetes and heavy smoking was admitted to intensive care with severe bilateral pneumonia associated with marked cachexia. He developed a complex right-sided bronchopleural fistula and was transferred to our tertiary centre for consideration of surgical intervention.Despite escalation of antibiotic therapy, he did not improve and further investigations led to a diagnosis of invasive pulmonary aspergillosis. Definitive treatment plans required a right pneumonectomy; however, given the severity of cachexia, he remained unable to undergo such a large operation...
January 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29340295/usage-characteristics-and-adverse-event-rates-%C3%A2-of-the-direct-puncture-and-pull-techniques-for-percutaneous-endoscopic-gastrostomy-in-patients-with-malignant-tumors-of-the-upper-aerodigestive-tract
#3
Niels Teich, Lars Selig, Susanne Liese, Franziska Schiefke, Alexander Hemprich, Joachim Mössner, Ingolf Schiefke
Background and study aims:  Patients with malignant tumors of the upper gastrointestinal tract are at risk of weight loss. Early supportive nutrition therapy is therefore recommended and usually requires placement of a percutaneous endoscopic gastrostomy (PEG). The aim of this study was to compare adverse events and usage characteristics of the direct puncture technique with those of the traditional pull technique when used in patients with endoscopically passable tumors. The primary endpoint was the rate of inflammatory adverse events (AEs) at the gastrostomy fistula...
January 2018: Endoscopy International Open
https://www.readbyqxmd.com/read/29334556/decoding-grade-b-pancreatic-fistula-a-clinical-and-economical-analysis-and-subclassification-proposal
#4
Laura Maggino, Giuseppe Malleo, Claudio Bassi, Valentina Allegrini, Matthew T McMillan, Alex Borin, Bofeng Chen, Jeffrey A Drebin, Brett L Ecker, Douglas L Fraker, Major K Lee, Salvatore Paiella, Robert E Roses, Roberto Salvia, Charles M Vollmer
OBJECTIVE: The aim of this study was to describe characteristics and management approaches for grade B pancreatic fistula (B-POPF) and investigate whether it segregates into distinct subclasses. BACKGROUND: The 2016 ISGPS refined definition of B-POPF is predicated on various postoperative management approaches, ranging from prolonged drainage to interventional procedures, but the spectrum of clinical severity within this entity is yet undefined. METHODS: Pancreatectomies performed at 2 institutions from 2007 to 2016 were reviewed to identify B-POPFs and their treatment strategies...
January 12, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29285616/correlation-between-the-skeletal-muscle-index-and-surgical-outcomes-of-pancreaticoduodenectomy
#5
Kenta Sui, Takehiro Okabayshi, Jun Iwata, Sojiro Morita, Tatsuaki Sumiyoshi, Tatsuo Iiyama, Yasuhiro Shimada
PURPOSES: Sarcopenia is known to be associated with a worse prognosis following abdominal operations; however, the relationship between sarcopenia and the outcomes of pancreaticoduodenectomy remains unclear. MATERIALS: We measured body composition parameters, including total abdominal muscle area, using preoperative staging computed tomography (CT), in patients undergoing pancreaticoduodenectomy for periampullary cancer. The incidence of sarcopenia among these patients was evaluated and multivariable analysis was performed to identify independent predictors of postoperative pancreatic fistula...
December 28, 2017: Surgery Today
https://www.readbyqxmd.com/read/29280707/successful-conservative-treatment-of-enterocutaneous-fistula-with-cyanoacrylate-surgical-sealant-case-report
#6
N Musa, F Aquilino, P Panzera, G Martines
AIM: Enterocutaneous (EC) fistula is an abnormal communication between the gastrointestinal tract and the skin. The majority of EC fistulas result from surgery. Only 15-25% of EC fistulas are spontaneous and they often result from underlying diseases such as Crohn's disease, radiation and chemotherapy. CASE REPORT: A 62-year old woman who, in 2012, underwent Pylorus-preserving cephalic pancreaticoduodenectomy (PPPD sec. Traverso-Longmire), due to an advanced pancreatic ductal adenocarcinoma (pT3N1M1)...
September 2017: Il Giornale di Chirurgia
https://www.readbyqxmd.com/read/29276586/postoperative-enterocutaneous-fistula-principles-in-non-operative-approach
#7
E A Sule, M A Nzegwu, J C Okolo, R U Onyemekheia
Introduction: Postoperative enterocutaneous fistulae could constitute a challenge when they occur following an abdominal surgery. Astute application of correct principles in its management is essential for good outcomes. Methods: A retrospective review of records of patients with enterocutaneous fistulas managed non-operatively was done. Clinical assessment, anatomic and physiologic classification of fistula, fluid resuscitation, electrolyte correction, parenteral/enteral nutrition, antibiotic use and fistula effluent monitoring, formed the basis of management...
December 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/29273218/clinical-predictors-and-prevalence-of-receiving-special-preschool-school-support-in-children-with-repaired-esophageal-atresia
#8
Michaela Dellenmark-Blom, Linus Jönsson, Vladimir Gatzinsky, Kate Abrahamsson
BACKGROUND/PURPOSE: In a sparsely investigated field, we aimed to evaluate the use of special preschool/school support among children with repaired esophageal atresia (EA) and/or tracheoesophageal fistula (TEF), the predicting clinical factors for this support, and level of school absence. METHODS: Data on 119 EA/TEF children 2-17years old were collected through medical records and questionnaires (response rate 95%). Logistical regression analysis identified clinical predictors of special preschool/school support in the population without genetic disorders (n=105)...
November 28, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29245311/role-of-enteral-nutrition-in-pancreaticocolonic-fistulas-secondary-to-severe-acute-pancreatitis-a-case-report
#9
Binxin Cui, Lu Zhou, Samiullah Khan, Jianmin Cui, Wentian Liu
RATIONALE: Pancreaticocolonic fistula (PCF) is an exceedingly rare complication of severe acute pancreatitis (SAP) and has primarily been treated surgically, but a few reported cases are successfully treated with nonsurgical methods. PATIENT CONCERNS: A 32-year-old male presented to our hospital with chief complaints of sharp and persistent left upper quadrant abdominal pain radiating to the back. DIAGNOSES: Computed tomography showed a pancreatic pseudocyst replacing a majority of the pancreatic parenchyma and PCF that formed between the pancreas and the colon...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29216349/developing-a-standard-set-of-patient-centred-outcomes-for-inflammatory-bowel-disease-an-international-cross-disciplinary-consensus
#10
Andrew H Kim, Charlotte Roberts, Brian G Feagan, Rupa Banerjee, Willem Bemelman, Keith Bodger, Marc Derieppe, Axel Dignass, Richard Driscoll, Ray Fitzpatrick, Janette Gaarentstroom-Lunt, Peter D Higgins, Paulo Gustavo Kotze, Jillian Meissner, Marian O'Connor, Zhi-Hua Ran, Corey A Siegel, Helen Terry, Welmoed K van Deen, C Janneke van der Woude, Alandra Weaver, Suk-Kyun Yang, Bruce E Sands, Séverine Vermeire, Simon Pl Travis
Background and Aims: Success in delivering value-based healthcare involves measuring outcomes that matter most to patients. Our aim was to develop a minimum Standard Set of patient-centred outcome measures for inflammatory bowel disease (IBD), for use in different healthcare settings. Methods: An international working group (n=25) representing patients, patient associations, gastroenterologists, surgeons, specialist nurses, IBD registries and patient-reported outcome measure (PROM) methodologists participated in a series of teleconferences incorporating a modified Delphi process...
December 5, 2017: Journal of Crohn's & Colitis
https://www.readbyqxmd.com/read/29187086/nutrition-management-of-home-parenteral-nutrition-among-patients-with-enterocutaneous-fistula-in-the-sustain-registry
#11
Charlene Compher, Marion F Winkler, Peggi Guenter, Ezra Steiger
BACKGROUND: Home parenteral nutrition (HPN) is a vital therapy for patients who have the diagnosis of enterocutaneous fistula (ECF), yet little is known about how these patients are managed. This research compares nutrition management of adults with ECF as the indication for HPN therapy to those with other indications. METHODS: This is an analysis of data from adult HPN patients in the Sustain registry enrolled between August 2011 and February 2014 who have the diagnosis of ECF or other indication for HPN who served as the control group...
February 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/29150418/immune-enhancing-formulas-for-patients-with-cancer-undergoing-esophagectomy-systematic-review-protocol
#12
Astrid Naranjo, Elizabeth Isenring, Laisa Teleni
BACKGROUND: Adult patients with an esophageal cancer can potentially be compromised with postoperative leaks or fistulae if patients' nutritional status is in a vulnerable stage. Currently in Australia, there is a growing need for clinicians to know whether use of immune-enhancing formulas (IEFs) containing Arg, omega-3, and RNA are a cost-effective approach compared with isonitrogenous-isocaloric formulas to reduce postoperative infectious complications in esophagectomy patients. Since IEFs may carry higher costs, this has led to inconsistencies in practice among clinicians and hospitals...
November 17, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/29150368/the-utility-of-ercp-in-pediatric-pancreatic-trauma
#13
Eric H Rosenfeld, Adam M Vogel, Denise B Klinkner, Mauricio Escobar, Barbara Gaines, Robert Russell, Brendan Campbell, Hale Wills, Anthony Stallion, David Juang, Rajan K Thakkar, Jeffrey Upperman, Mubeen Jafri, Randall Burd, Bindi J Naik-Mathuria
BACKGROUND/PURPOSE: Endoscopic retrograde cholangiopancreatography (ERCP) is an adjunct for pediatric pancreatic injury management, but its use and utility in pediatric patients are unclear. We set out to evaluate the use of ERCP and its effects on outcomes. METHODS: A retrospective review was performed for children who had pancreatic injuries at 22 pediatric trauma centers between 2010 and 2015. ERCP details and outcomes were collected. Analysis was performed using descriptive statistics and Wilcoxon rank-sum tests...
October 13, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29148005/microsurgery-for-wrist-arteriovenous-fistula-creation-in-children-a-retrospective-cohort-study
#14
Afram Akturk, Roel Bakx, Michiel J S Oosterveld, Jim C H Wilde, Mirza M Idu
INTRODUCTION: Creating functional arteriovenous fistulae (AVF) at the wrist is challenging in paediatric patients because of the small calibre of the blood vessels. METHODS: We report our experience with AVF surgery in children younger than 15 years of age using microsurgical techniques. Twenty-five patients underwent AVF surgery between 2003 and 2015 (20 for haemodialysis, 4 for plasmapheresis and 1 for parenteral nutrition). Median (range) age was 9 (2-15) years and median weight was 24 (8-61) kg...
November 13, 2017: Journal of Vascular Access
https://www.readbyqxmd.com/read/29137063/gallstone-ileus-displaying-the-typical-rigler-triad-and-an-occult-second-ectopic-stone-a-case-report
#15
Li Wang, Ping Dong, Yi Zhang, Bole Tian
RATIONALE: Gallstone ileus is a rare complication of cholecystolithiasis. It has a female predominance and can result in high mortality rates. PATIENT CONCERNS: A 71-year-old woman complaining of recurrent vomiting and vague epigastralgia for > 2 weeks presented to our department. DIAGNOSIS: Based on her physical examination, laboratory test results and radiographic findings (the typical Rigler's triad), she was diagnosed with gallstone ileus caused by multiple ectopic stones...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29130231/-effect-of-postoperative-hyperglycemia-on-clinical-outcome-of-gastrointestinal-fistula-patients-undergoing-gastrointestinal-reconstruction
#16
Qiongyuan Hu, Jian'an Ren, Wenhao Tang, Jieshou Li
OBJECTIVE: To investigate the effect of hyperglycemia within postoperative 48 hours on gastrointestinal (GI) fistula patients without preoperative diagnosis of diabetes undergoing selective GI reconstruction. METHODS: Clinical data of GI fistula patients with age of 18 to 70 years and without diffuse peritonitis and systemic infection undergoing definitive GI reconstruction at Intestinal Fistula Center of Jinling Hospital from September 2012 to December 2015 were retrospectively analyzed...
October 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/29106286/duodenal-lengthening-in-an-adult-with-ultra-short-bowel-syndrome-a-case-report
#17
Javier Bueno, Rosa Burgos, Susana Redecillas, Manuel López, Joaquin Balsells
BACKGROUND: We have recently demonstrated the feasibility of lengthening the duodenum in children with short bowel syndrome and a dilated duodenum. This procedure gains additional intestinal length in a challenging area of autologous gut reconstruction. Herein, we report the successful application of this technique in an adult with ultra-short bowel syndrome. METHODS: A 25-year-old man with a history of mid-gut volvulus was referred to our center for intestinal transplant evaluation...
November 6, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/29047047/impact-of-bariatric-surgery-on-outcomes-of-patients-with-inflammatory-bowel-disease-a-nationwide-inpatient-sample-analysis-2004-2014
#18
Prabin Sharma, Thomas R McCarty, Basile Njei
PURPOSE: There is a paucity of data regarding the benefits of bariatric surgery in patients with inflammatory bowel disease (IBD). The primary aim of this study was to evaluate the role of bariatric surgery on clinical outcomes among hospitalized patients with IBD. MATERIALS AND METHODS: The United States (US) National Inpatient Sample database was queried between 2004 and 2014 for discharges with co-diagnoses of morbid obesity and IBD. Hospitalizations with a history of prior-bariatric surgery were also identified...
October 18, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/29034041/successful-endovascular-repair-of-mycotic-aortic-pseudoaneurysm-followed-by-aortoesophageal-fistula
#19
Seiichi Yamaguchi, Hideki Ueda, Hisanori Fujita, Shigeyasu Takeuchi
Mycotic aneurysm of the aorta is a rare, but life-threatening pathology. In recent years, endovascular stent graft placement has been introduced as an effective alternative for treating infected aortic aneurysms. A 64-year-old woman with a history of paraplegia due to spinal cord injury was referred to our institute with fever and blood-tinged sputum. Computed tomography (CT) scan showed an 11-cm pseudoaneurysm arising from the proximal descending aorta, which was normal 1 month ago at the previous CT scan...
June 25, 2017: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/28992343/serum-to-dialysate-potassium-gradient-and-its-association-with-short-term-outcomes-in-hemodialysis-patients
#20
Steven M Brunelli, David M Spiegel, Charles Du Mond, Nina Oestreicher, Wolfgang C Winkelmayer, Csaba P Kovesdy
Background: A high serum-to-dialysate potassium (K + ) gradient at the start of dialysis leads to rapid lowering of serum K + and may confer a greater risk of adverse events. Here, we examined the near-term association of K + gradient with clinical outcomes. Methods: This retrospective (2010-11) event-based study considered 830 741 patient-intervals, each defined by a pre-dialysis measurement of serum K + made among adult Medicare Parts A and B enrollees who received in-center hemodialysis on a Monday/Wednesday/Friday schedule at a large US dialysis organization...
August 19, 2017: Nephrology, Dialysis, Transplantation
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