肌萎缩侧索硬化症患者经皮内镜下胃造瘘术研究

目的 探讨经皮内镜下胃造瘘术在肌萎缩侧索硬化症导致吞咽困难患者中的应用价值.方法 回顾性分析2005年4月至2010年7月65例住院经皮内镜下胃造瘘术的肌萎缩侧索硬化症患者的临床资料.结果 65例患者中共有63例操作成功,成功率96.9%(63/65).操作时间8～17 min.操作失败2例,均为操作过程中窒息.术后感染2例.术后3个月随访,63例患者体重均有所增加,体质指数由术前的(18.3±1.0)kg/m2增加到(19.7±1.2)kg/m2,两者比较差异有统计学意义(t=15.8,P＜0.01),无其他术后并发症.结论 经皮内镜下胃造瘘术可以明显改善肌萎缩侧索硬化症患者的营养状况,安全而且有效.窒息是导致操作失败的主要原因.

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Objective To evaluate the value of percutaneous endoscopic gastrostomy (PEG) in the treatment of amyotrophic lateral sclerosis (ALS) patients with dysphagia. Method Sixty-five ALS patients underwent PEG from April 2005 to July 2010 were analysed retrospectively. Results All the 65 patients underwent PEG,and 2 patients failed because of dyspnea. Totally 63 patients were intubated successfully,the successful rate was 96.9%(63/65). The operation time was 8-17 min. Two patients had local infection.After 3 months, the body mass index was increased from (18.3 ± 1.0) kg/m2 to (19.7 ± 1.2) kg/m2(t = 15.8,P ＜ 0.01), without peritonitis, migration of the gastrostomy tube and other complications. Conclusions PEG is a safe method with a low complication for ALS patients to get enteral nutrition. Dyspnea is the main reason of failure.     

蛋白磷酸酶2A诱导肠上皮细胞凋亡机制研究进展

蛋白磷酸酶2A是细胞内重要的丝氨酸/苏氨酸蛋白磷酸酶,通过可逆性磷酸化使已磷酸化的蛋白质脱磷酸,参与细胞内众多信号通路和生理生化过程的调节.其生理活性的改变与肠上皮细胞损伤后凋亡、再生的发生密切相关,可能是肠上皮细胞凋亡与再生达到平衡的一个调节因子.

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Protein phosphatase 2A(PP2A)is a major Ser/Thr phosphatase involved in sevelral cellular signal transduction pathways.The reversible phosphorylation of proteins is accomplished by opposing activities of kinases and phosphatases.PP2A controls the specific dephosphorylation of thousands of phosphoprotein substrates and thus regulates physiological and biochemical processes of organism.The changes of the physiological activities of PP2A closely relate to apoptosis and regeneration of injured intestinal epithelial cell,and PP2A may be a regulatory factor in balancing the apoptosis and regeneration of intestinal epithehal cell.     

内外源性β-葡萄糖醛酸酶与原发性胆总管结石的关系

目的 探讨内外源性β-葡萄糖醛酸酶(β-G)与原发性胆总管结石的关系.方法 应用改良Fishman法检测35例原发性胆总管结石患者(试验组)和11例胆囊息肉患者(对照组)胆总管内胆汁中内外源性β-G活性.结果 试验组和对照组手术当天胆汁中内源性β-G活性分别为(7859.1±738.5)、(2174.9±348.4)U/L(P＜0.01);外源性β-G活性分别为(6786.1±544.3)、(1504.7±655.7)U/L(P＜0.01);试验组中13例急性患者手术当天与术后第7天胆汁中外源性β-G活性分别为(8935.7±845.9)、(2176.1±956.7)U/L(P＜0.05);22例慢性患者分别为(5137.2±540.7)、(1838.8±733.3)U/L(P＜0.05);急性患者手术当天胆汁中外源性β-G活性明显高于慢性患者(P＜0.05).结论 内、外源性β-G参与原发性胆总管结石的形成.

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Objective To explore the role of endogenous and exogenous β-glucuronidase( β-G) in the development of primary common duct stones.Method Using modified Fishman method to test the activities of the endogenous and exogenous β -G in 35 patients with primary common duct stones(experimental group) and 11 patients with cystic polypus (control group) respectively.Results The activities of endogenous β -G in the bile of experimental group and control group were (7859.1 ± 738.5 ),(2174.9 ± 348.4 ) U/L(P ＜0.01).While the activities of exogenous β-G in experimental group and control group were (6786.1 ±544.3),(1504.7 ±655.7) U/L (P ＜0.01).In experimental group,there were significant statistical differences in the activities of the exogenous β -G in the sample obtained on the day of operation and 7 days after operation from 13 cases with the acute inflammation [(8935.7 ± 845.9),(2176.1 ± 956.7) U/L]and from 22 cases with the chronic inflammation [(5137.2 ±540.7),(1838.8 ±733.3) U/L],and there were significant higher in the activities of the exogenous β -G in the sample obtained on the day of operation from the acute inflammation compared to those from the chronic inflammation (P ＜ 0.05 ).Conclusions There is obvious correlation between either endogenous or exogenous β -G with primary common duct stones.And the endogenous β -G might be one of the fundamental cause in the development of primary common duct stones. c inflammation (P ＜     

中老年男性雄激素部分缺乏患者骨密度测定的临床价值

目的 探讨中老年男性雄激素部分缺乏(PADAM)患者的骨密度(BMD)特点和骨质疏松的发生率.方法 采用双能X线骨密度仪对56例PADAM患者(PADAM组)和与之年龄、体重指数(BMI)相匹配的51例健康中老年人(对照组)进行腰椎及股骨颈等部位的BMD测定,采用MES-01S20肌肉功能分析仪测定肌肉分布和力学特性,并收集相关生化指标、激素水平及部分骨代谢指标进行多元逐步回归分析.结果 与对照组比较,PADAM组腰椎BMD无显著改变(P＞0.05),而股骨颈、Ward三角区和大转子的BMD显著降低(P＜0.01),且其抗骨折能力和下肢最大肌力显著降低(P＜0.01).PADAM组和对照组的骨量减少发生率分别为48.2%(27/56)和35.3%(18/51),骨质疏松患病率分别为30.4%(17/56)和21.6%(11/51),两组比较差异有统计学意义(P＜0.05).PADAM患者的腰椎BMD与BMI呈正相关,而股骨颈、Ward三角区、大转子的BMD与年龄呈负相关,与BMI、血清总睾酮呈正相关(P＜0.05).结论 PADAM患者的BMD及抗骨折能力明显降低,存在骨质疏松性骨折的潜在危险,加强PADAM患者骨折的预防和治疗有重要意义.

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Objective To explore the characteristics of bone mineral density (BMD) and the incidence of osteoporosis in partial androgen deficiency in aging male (PADAM) patients.Methods Fifty-six PADAM patients (PADAM group) and 51 healthy persons (control group) were selected according to their age and body mass index (BMI),and measured their BMD in the second to fourth lumber and the neck of femur with the dual-energy C X-ray BMD measuring instrument.MES-01S20 muscle function analyzer was used to determinate the distribution and mechanical properties of muscle.The biochemical and bone metabolic markers and sexual hormones were collected and observed by multivariate stepwise regression analysis.Results Compared with control group,BMD significantly decreased in the Ward triangle,femoral neck and big rotor (P ＜ 0.01 ) and no significant change in lumbar in PADAM group (P ＞ 0.05 ),and the fracture strength of femoral neck (FS) and the lower-limb muscular strength (MS) also significantly decreased (P ＜ 0.01 ).The incidence of osteopenia were 48.2% (27/56) and 35.3% ( 18/51 ),osteoporosis were 30.4% (17/56) and 21.6% ( 11/51 ) respectively in PADAM group and control group.There was significant difference between two groups (P＜0.05).The BMD was positively correlated to BMI at the first to fourth lumber and negatively correlated to age,positively correlated to BMI and serum level of andrusol at the proximal left femur in the patients with PADAM.Conclusion BMD and the resistance to fracture aresignificantly lower in PADAM patients,and aging lower BMI and androgen deficiency are the risk factors of low BMD in PADAM patients.There is the potential of osteoporotic fracture risk,and it is important to strengthening the prevention and treatment of fractures in elderly PADAM patients.     

拉米夫定联合阿德福韦酯治疗乙型肝炎失代偿期肝硬化的临床疗效及安全性分析

目的 研究拉米夫定联合阿德福韦酯治疗乙型肝炎失代偿期肝硬化的临床疗效及并发症.方法 将86例乙型肝炎失代偿期肝硬化患者采用随机数字表法分为对照组和观察组,每组43例,对照组在常规治疗的基础上加服拉米夫定,观察组在对照组的基础上加服阿德福韦酯,治疗12个月后对其临床疗效进行评价.结果 两组患者治疗前后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、白蛋白(ALB)及Child-Pugh评分比较差异均有统计学意义(P<0.05),观察组治疗后ALT、AST与对照组比较差异有统计学意义(P<0.05);观察组HBeAg/HBeAb血清转换率和HBV DNA转阴率高于对照组[86.05%(37/43)比65.12%(28/43),79.07%(34/43)比55.81%(24/43)],两组比较差异有统计学意义(P<0.05);对照组共发生7例次并发症,观察组共发生8例次并发症,两组比较差异无统计学意义(P>0.05).结论 拉米夫定联合阿德福韦酯治疗乙型肝炎失代偿期肝硬化安全、有效,且临床疗效优于单纯应用拉米夫定.

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Objective To study the clinical effect and complication of the combination treatment of lamivudine and adeforvir dipivoxil in decompeasated hepatitis B cirrhosis. Methods Eighty-six cases of decompensated hepatitis B cirrhosis were divided into the observation group and the control group with 43 eases each by random digits table. The control group was treated with routine treatment and lamivudine, and the observation group was added with adefovir dipivoxil on the base of the treatment in the control group. The clinical effect after 12 months' treatment was evaluated. Results After 12 months'treatment, the level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), albumin ( ALB ) and Child-Pugh grade had significant improvement than that before the treatment in two groups(P < 0.05 ), and in the observation group they improved more obvious (P <0.05). The frequence of seroconversion of HBeAg/HBeAb and HBV DNA in the observation group was higher than that in the control group [86.05%(37/43) vs. 65.12%(28/43),79.07% (34/43) vs. 55.81%(24/43)], and the difference between the two groups was significant (P < 0.05 ). Seven cases of times complications happened in the control group and 8 cases of times complications happened in the observation group and the difference between the two groups was not significant (P > 0.05 ). Conclusion The effect of lamivudine and adefovir dipivoxil in the treatment of decompensated hepatitis B cirrhosis is superior to the only lamivudine.     

锐劲特在环境中的降解及其毒理学研究进展

该文综述了锐劲特在环境中的应用,并结合国内外在农药降解领域的研究,对锐劲特及其代谢产物在环境中的降解行为、锐劲特的作用机制及其毒理学研究进展进行论述.锐劲特在水体中以光解和水解为主,在土壤中除了光解和水解作用,还存在氧化作用.研究表明,锐劲特及其代谢产物对非标靶类动物(蜜蜂、淡水脊椎动物、鸟类等)具有毒性.但对人类的健康影响还有待进一步研究.

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This article reviewed the application of Regent (fipronil),emphasizing its current research advance in the degradation in environment and toxicity of Regent(fipronil)and its metabolite,and its degradation action.The main degradation approach is photolysis and hydrolysis in water,and simultaneously occurring oxidation in the soil.Fipronil is toxic for bee.freshwater verebrate and birds,but the effect of fipronil on human being should be researched further.More atllention should be paid to the safety for human in application of fipronil.     

广西农村肺结核病防治管理新模式的效果评价

目的 探索有效的农村肺结核病防治管理新模式,为农村社区肺结核病防治策略的制定提供科学依据.方法 于总人口为67.9万人的广西兴业县,在县级结核病防治机构肺结核诊疗服务可及性差的农村乡镇中,选择人口数合计为152 518人的交通不便的4个乡镇作为实验组,开展以乡镇卫生院为诊疗管理中心、按社区服务可及性设服务点、聘请家庭督导员协助督导的农村肺结核病防治管理新模式的项目研究,项目基线及终期肺结核病例数分别为44例和117例;同时在该县选择条件类似、人口数合计为133 303人的大平山镇、龙安乡和高峰镇作为对照组.对照组开展现行国家结核病防治规划规定的县级结核病诊疗管理模式,基线及终期肺结核病例数分别为56例和110例.采用双向比较方法从肺结核患者发现情况、患者治疗转归情况和结核病控制工作管理情况等方面评价新模式的效果.采用SPSS 13.0统计软件进行统计分析,计数资料的组间比较采用x2检验.结果 经过2年的项目实施,项目实施前后实验组肺结核患者涂阳新登记率从16.39/10万(25/152 518)提高到51.14/10万(78/152 518)(x2=27.281,P<0.01);初治涂阳患者治愈率从71.4%(15/21)提高到91.1%(51/56)(x2=4.812,P<0.05);初治涂阴患者完成疗程率从23.5%(4/17)提高到71.4%(15/21)(x2=8.622,P<0.01);初治涂阳患者丢失率从23.8%(5/21)下降为0.0%(0/56)(x2=10.608,P<0.01);初治涂阴患者丢失率从64.7%(11/17)下降为4.8%(1/21)(x2=15.624,P<0.01).项目终期,实验组的初治涂阳患者治愈率[91.1%(51/56)]高于对照组的治愈率[72.0%(36/50)](x2=6.531,P<0.05),而初治涂阳病例丢失率[0.0%(0/56)]低于对照组[16.0%(8/50)](x2=7.534,P<0.01);项目实施期间实验组患者的按时服药率[91.5%(107/117)]、按时领药率[100.0%(117/117)]、按时复查痰率[83.6%(98/117)]均高于对照组[分别为81.8%(90/110)、92.7%(102/110)、64.5%(71/110)],差异均有统计学意义(x2=4.589、8.820、11.005,P值均<0.05).结论 农村肺结核病防治管理新模式在提高肺结核患者发现率和治愈率,减少患者丢失率,以及改善患者治疗管理状况等方面都有明显效果.

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Objective To explore the effect of new model for tuberculosis (TB) control and management, and provide a scientific basis and justification for making TB control strategies in rural communities. Methods Among those townships with low TB service accessibility by the county TB control institute in Guangxi Xingye county (population of 679 thousands), four townships with total population of 152 518 and inconvenient transportation, were selected as the experimental group to conduct a new model research project. Based on the accessibility for community services, setting diagnosis and treatment management centers in township hospitals, employing family treatment supporters to supervise the treatment process. The TB cases of the base-line and the project expiration of the experimental group were 44 and 117. Meanwhile,three townships including Dapingshan, Longan and Gaofeng in the county with the similar condition and total population of 133 303 were selected as the control group. The control group conducted the provisions of national TB control program in the county TB clinic management. The TB cases of the base-line and the project expiration of the control group were 56 and 110. By double-direction comparison method ,the effect of the new model was evaluated through TB patients detection, treatment outcomes and TB control management data. SPSS 13.0 statistical software was adopted and Chi-square test was used for analyzing technical data. Results After two-year project research implementation, in the experimental group the detection rate of new smear-positive TB patients increased from 16. 39/100 000 (25/152 518) to 51.14/100 000 (78/152 518) (x2 = 27.281, P < 0. 01), the cure rate of new smear-positive cases increased from 71.4% (15/21) to 91.1% (51/56) (x2 = 4. 812, P < 0. 05), and the completing treatment rate in newly diagnosed smear-negative cases improved from 23.5% (4/17) to 71.4% (15/21) (x2 = 8. 622, P <0. 01) ;the loss rate of newly diagnosed smear-positive cases dropped from 23.8% (5/21) to 0. 0% (0/56)(x2 = 10. 608 ,P <0. 01) ,and the loss rate of newly diagnosed smear-negative cases decreased from 64. 7%(11/17)to 4. 8% (1/21) (x2 = 15. 624 ,P <0. 01). Meanwhile ,the cure rate of new smear-positive cases in the experimental group,91. 1% (51/56) ,was higher than the control group,72.0% (36/50) (x2 = 6. 531,P <0. 05). The loss rate of newly diagnosed smear-positive cases in the experimental group(0. 0% (0/56))was lower than the control group (16.0% (8/50)) (x2= 7.534, P< 0.01) . During the project implementation,in the experimental group the on time rate of taking medicine,91.5% (107/117) and receiving medicine, 100. 0% (117/117), the reexamining sputum ratio, 83.6% (98/117) were higher than that in the control group: 81.8% (90/110) ,92. 7% (102/110) and 64. 5% (71/110). The differences were statistically significant (x2 = 4. 589,8. 820 and 11. 005, P < 0. 05). Conclusion The new management model had been proved effective. It can improve TB case detection and cure rates, reduce the loss rate of patients, and improve patient treatment and management conditions as well.     

舍曲林治疗儿童情绪障碍的临床观察

目的 了解舍曲林在儿童情绪障碍治疗中的有效性、安全性、起效时间及有效剂量.方法 对147例应用舍曲林治疗的儿童情绪障碍患儿进行回顾性分析,项目包括有效率、舍曲林用量、起效时间及不良反应.结果 137例患儿遵医嘱定期复诊.治疗后2个月,有效率为80.3%(110/137),不良反应发生率为5.8%(8/137).舍曲林有效剂量为(47.9±19.0)mg/d,起效时间为(20.4±13.2)d;儿童强迫症舍曲林有效剂量[(58.7±26.2)mg/d)]显著高于抑郁障碍[(43.6±14.0)mg/d]、广泛性焦虑障碍[(44.4±10.6)mg/d]及恐怖性焦虑障碍[(43.5±15.5)mg/d](P值均<0.01);抑郁障碍起效时间[(14.0±6.1)d]较儿童强迫症[(26.6±16.3)d]、广泛性焦虑障碍[(22.3±13.9)d]和恐怖性焦虑障碍[(21.4±12.8)d]短(P值均<0.01).结论 舍曲林是治疗儿童情绪障碍的有效药物,起效时间在2～3周,不良反应轻,多数患儿能耐受.对抑郁障碍起效较快,对儿童强迫症有效剂量较大.

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Objective To explore the efficacy, safety,time of drug taking effect and therapeutic dosage of sertraline in treatment of child emotional disorder. Method One hundred and forty-seven patientswith child emotional disorder were treated by sertraline and the efficacy rate, therapeutic dosage, the time of drug taking effect and adverse reaction was analyzed retrospectively. Results One hundred and thirty-seven patients were regular visited under supervision of a physician. Two months after treatment, the efficacy rate was 80.3%(110/137) and the rate of adverse reaction was 5.8%(8/137). The therapeutic dosage of sertraline was (47.9 + 19.0) mg/d. The time of drug taking effect was (20.4±13.2) d. The therapeutic dosage of sertraline in obsessive-compulsive disorder [(58.7±26.2) mg/d] was significantly higher than that in depression[(43.6±14.0) mg/d],anxiety disorder[(44.4±10.6) mg/d] and phobia[(43.5±15.5) mg/d](P < 0.01 ). The time of drug taking effect in depression[( 14.0±6.1 ) d] was significantly shorter than that in obsessive-compulsive disorder[(26.6±16.3) d,anxiety disorder [(22.3±13.9) d] and phobia [(21.4±12.8) d] (P <0.01). Conclusions Sertraline is an efficient and safe medicine in treatment of child emotional disorder. Its adverse reaction is slight and most patients can tolerate. But it takes higher therapeutic dosage in obsessive-compulsive disorder and the time of drug taking effect is earlier in depression than in other disorder.     

腹腔镜胆囊切除术与内窥镜逆行胰胆管造影术/内窥镜下Oddi括约肌切开取石术联合治疗胆囊结石合并胆总管结石

目的 探讨腹腔镜胆囊切除术(LC)与内窥镜逆行胰胆管造影术(ERCP)/内窥镜下Oddi括约肌切开取石术(EST)联合治疗胆囊结石合并胆总管结石的临床价值.方法 回顾性分析2005年1月至2010年8月应用LC和ERCP/EST联合治疗胆囊结石合并胆总管结石48例患者的临床资料.结果 48例患者中ERCP成功46例,LC完成45例,术后恢复快,住院时间短,46例随访3～12个月无结石残留及严重并发症发生.结论 联合LC与ERCP/EST的优势,治疗胆囊结石合并胆总管结石符合微创外科理念,具有住院时间短、创伤小、患者恢复快等优点,是目前治疗胆囊结石合并胆总管结石较为理想的选择.

Abstract：

Objective To discuss the clinical value of laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic Oddi sphincterotomy (EST) on treating choledocholithiasis with cholecystolithiasis. Method The clinical data of 48 patients with choledocholithiasis complicated by cholecystolithiasis treated with LC combined with ERCP/EST from January 2005 to August 2010 was collected and analyzed retrospectively. Results Forty-six patients achieyed success by ERCP,and 45 patients finished LC,all patients underwent LC combined with ERCP/EST were recovered more rapidly,with shorter hospital stays. No severe complications or residual stone and refluent cholangitis in the follow-up of 3-12 months of 46 patients. Conclusions Combining the advantages of LC with ERCP/EST treating patients with choledocholithiasis complicated by cholecystolithiasis,according to the theoretics of minimally invasive surgery, with less invasive and the advantages of shorter hospital stays and rapid recovery. It is the comparatively ideal choice for the treatment of choledocholithiasis complicated by cholecystolithiasis at present.     

脓毒症休克患者血管外肺水的监测及其对预后的预测价值

目的 分析脓毒症休克患者血管外肺水(EVLW)的变化特点,探讨其与脓毒症休克预后的关系.方法 采用回顾性分析的方法,将21例脓毒症休克患者根据最终临床转归分为存活组(10例)与死亡组(11例),观察两组患者的临床特征,利用脉波指示剂连续心排血量(PiCCO)监护仪进行血流动力学监测,测定EVLW,分析其与患者预后的关系.结果 存活组入院第1、2、3天EVLW分别为(12.7±1.8)、(11 3±1.3)、(10.1±1.3)ml/kg,死亡组分别为(14.4±1.0)、(14.6±1.4)、(14.6±1.3)ml/kg,两组比较差异有统计学意义(P＜0.05);存活组随入院时间延长EVLW均明显下降(P＜0.05),死亡组无明显变化(P＞0.05).结论 脓毒症休克患者EVLW均有明显增加;EVLW的动态变化可预测患者的预后.

Abstract：

Objective To analyze the alterative characteristics of the extravascular lung water (EVLW ) in the patients with septic shock and clarify its value on the prognosis of these patients.Methods By the methods of retrospective analysis,according to the ultimate survival,21 patients with septic shock were divided into survivor group (10 cases) and non-survivor group (11 cases).The clinical features of the patients were observed and hemodynamic monitoring was made with PiCCO monitor.The EVLW was measured and the relationship between the EVLW and the prognosis of patients was analyzed.Results On the first,second and third day,EVLW was (12.7 ±1.8),(11.3 ±1.3),(10.1 ±1.3) ml/kg in survivor group,and (14.4 ± 1.0),(14.6 ± 1.4),(14.6 ±1.3) ml/kg in non-survivor group respectively,and there were statistical differences between two groups (P <0.05).However,on the second day after the intensive therapy,EVLW in survivor group dropped significantly(P＜0.05),but the non-survivor group only declined slightly,and compared with the result of the first day,there was no obvious difference (P >0.05).Conclusions The EVLW in the patients with septic shock increases significantly.The dynamic changes of the EVLW may be one of the factors for predicting the prognosis of patients with septic shock.     

Percutaneous endoscopic gastrostomy evaluation of device materials: are we "failsafe"?

The development of the percutaneous endoscopic gastrostomy (PEG) tube for enteral access was a revolutionary technological advance. This device has undergone some minor modification over the past 30 years but remains very similar to the original PEG tube design. Use of the PEG tube for gastric enteral feeding access continues to increase yearly both in pediatric and adult populations. One of the difficulties noted with PEG tube use in daily clinical practice is the ultimate degradation of the PEG tube wall material, leading to tube cracking, tearing, and leaking, requiring replacement of the gastrostomy tube. Historically, the predominant polymer material used for PEG tube composition was silicone. More recently, polyurethane has been examined as a potential, more durable material for PEG tube composition. Copolymers, or combinations of silicone and polyurethane and other polymer materials, are currently under investigation as the answer for the development of a bioinert, tissue-friendly, durable, PEG tube composition material.     

Outcome of percutaneous endoscopic gastrostomy (PEG): comparison of two policies in a 4-year experience

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is the technique of choice for long-term enteral nutrition. Though safe and technically simple, PEG has been associated with significant morbidity and mortality. AIM: We compared the outcome of strategies applied in two different periods; the original approach of PEG insertion during hospitalization (upon request), and PEG insertion 30 days after hospital discharge. METHODS: A cohort of 127 patients scheduled for PEG insertion from 1.1.1997 to 31.12.2000, was evaluated. In 61 consecutive patients admitted from 1.1.1997 to 31.12.1998 the PEG insertion was planned during hospitalization, as close to the time of the physician's request (period 1). Sixty-six consecutive patients admitted from 1.1.1999 to 31.12.2000 were scheduled for the PEG insertion 30 days after discharge (period 2). The 30-day mortality rate was calculated from the time of the request. Univariate and multivariate analyses were used to find predictive factors for 30-day mortality. RESULTS: There were 61 patients with a mean age of 78+/-13 in period 1, and 66 patients with a mean age of 77.8+/-15.5 in period 2. There was no significant difference between patients of the two periods in regard to age, sex, underlying disease, nutritional and mental status. Patients received PEG 30 days after hospital discharge had a 40% lower 30-day mortality rate than patients who received PEG during hospitalization from the time of request for PEG (P=0.01) and a 87.5% lower rate when calculated from the time of insertion (P<0.0001). In-hospital PEG insertion, bed-ridden and disorientation were found to be independent factors predictive of 30-day mortality after PEG insertion (P=0.016,P=0.001, and P=0.0005, respectively). CONCLUSION: PEG insertion during hospitalization increases mortality and should be avoided. A grace period of 30 days with nasogastric tube feeding before PEG insertion may prevent mortality and achieve a long-term enteral nutrition.     

PEG--管饲肠内营养的新方法

目的 旨在探讨经皮胃镜下胃造口术（ＰＥＧ）在神经科应用的临床价值。方法 对３０例神经内，外科病人，需肠道内营养而又无法经口进食者，行经皮胃镜下胃造口术，方法 经造口管喂养后营养不良状况明显改善，使肺部感染得到了控制，其中能经口进食而拔管者７例，术后带管出院者１０例，因原发疾病加重而死亡者３例，除２例出现局部皮肤炎症反应外，并无其他严重并发症。结论 对需要长期营养支持的神经内，外科病人，ＰＥＧ是一种     

The safety of percutaneous endoscopic gastrostomy tube placement in patients with existing ventriculoperitoneal shunts

BACKGROUND: Because the insertion of percutaneous endoscopic gastrostomy tubes (PEG) involves disruption of the gastrointestinal tract with potential peritoneal contamination, patients with indwelling ventriculoperitoneal (VP) shunts could be at increased risk of meningitis, a potentially devastating infection. The safety of PEG placement in the presence of a VP shunt is unclear. METHODS: A retrospective chart review was performed that included all adult patients with existing VP shunts requiring PEG placement at a single university medical center over an approximate 9-year period from July 1995 to March 2004. RESULTS: Thirty-nine patients who underwent PEG placement 2-564 days after shunt placement were identified. Two patients (5%) subsequently developed meningitis. Cerebrospinal fluid cultures demonstrated Staphylococcus aureus and Enterococcus faecalis. These infections occurred 2 and 15 months after PEG placement, respectively. At the time of PEG placement, 17 patients (44%) were receiving antibiotics for reasons other than operative prophylaxis, and 11 patients (28%) received prophylactic antibiotics. Both infected patients had received antibiotics at the time of PEG placement. CONCLUSIONS: These data constitute the largest series of patients with existing VP shunts undergoing PEG placement reported to date. When compared with the published 2%-5% infection rate for patients with VP shunts alone, our data do not suggest an increased risk of infection for patients after PEG placement. As the total number of adult patients requiring a PEG after VP shunt placement is low, multicenter studies should be carried out to better stratify this risk.     

Impact of Percutaneous Endoscopic Gastrostomy (PEG) on the Evolution of Disease in Patients with Amyotrophic Lateral Sclerosis (ALS)

Dysphagia is a highly prevalent symptom in Amyotrophic Lateral Sclerosis (ALS), and the implantation of a percutaneous endoscopic gastrostomy (PEG) is a very frequent event. The aim of this study was to evaluate the influence of PEG implantation on survival and complications in ALS. An interhospital registry of patients with ALS of six hospitals in the Castilla-León region (Spain) was created between January 2015 and December 2017. The data were compared for those in whom a PEG was implanted and those who it was not. A total of 93 patients were analyzed. The mean age of the patients was 64.63 (17.67) years. A total of 38 patients (38.8%) had a PEG implantation. An improvement in the anthropometric parameters was observed among patients who had a PEG from the beginning of nutritional follow-up compared to those who did not, both in BMI (kg/m²) (PEG: 0 months, 22.06; 6 months, 23.04; p < 0.01; NoPEG: 0 months, 24.59–23.87; p > 0.05). Among the deceased patients, 38 (40.4%) those who had an implanted PEG (20 patients (52.6%) had a longer survival time (PEG: 23 (15–35.5) months; NoPEG 11 (4.75–18.5) months; p = 0.01). A PEG showed a survival benefit among ALS patients. Early implantation of a PEG produced a reduction in admissions associated with complications derived from it.     

经皮内镜下胃/空肠造口术并发症的预防与治疗

目的:重点探讨经皮内镜下胃肠造口术并发症的预防及治疗. 方法:对2002年10月至2003年12月间85例恶性肿瘤病人共行88例次经皮内镜下胃造口(PEG)和经皮内镜下空肠造口(PEJ),回顾性统计并发症的发生情况.所有PEG/J均采用拉出法. 结果:85例病人PEG/J术后无操作相关死亡,无严重并发症,但微小并发症发生率为8.2%(7/85).7例病人发生8次微小并发症,分别为切口感染2例、导管断裂2例、导管尖端移位2例、导管缠绕1例、导管渗漏1例,均通过非手术治疗后治愈. 结论:经皮内镜下胃/空肠造口术操作简便、安全,加强围手术期的处理是控制并发症的关键.     

Percutaneous endoscopic gastrostomy: experience of three years]

Patients who are not able to eat do need tube feeding. The most preferred way of artificial enteral nutritional support is feeding via percutaneous endoscopic gastrostomy (PEG) tubes. Head and neck cancer patients do represent a special group of patients needing a PEG. On the one hand at the time of admission to the hospital they are mainly undernourished. On the other hand the failure rate of placing a PEG is the highest among them. Furthermore in the perioperative period nasogastric tubes do cause a lot of complications in these settings. 188 PEG placements were carried out from July 1995 till November 1998. Indications: head and neck cancer (n = 171), neurologic disorders (n = 17). PEG tubes were placed 76 times during intratracheal narcosis and 112 times following local anaesthesia. 39 times there was a prior abdominal surgery in our patients medical history. The pull-through, the push-wire and the introducer techniques were used. Beside the usual oro-gastric way of endoscopying (n = 163), 25 times the following alternative ways of entering the upper gastrointestinal tract were used: transnasal route (n = 4), through a Kleinsasser type direct laryngoscope (n = 7) and via the opened pharynx (n = 14). No immediate or late onset procedure related complications occurred. During a follow-up of 22,480 tubedays 26 minor (dermatitis n = 24, ulcer n = 2) and 8 major (abscess n = 4, perforation/peritonitis n = 3, stomach and bowel wall necrosis n = 1) complications occurred. The success rate of placing a PEG was 98.9%. In head and neck cancer patients placing a PEG is suggested when there is a need for at least a 7 days time tube-feeding. Using the described alternative ways, a PEG tube can be placed almost always. Because of the uncertain outcome, nutritional support via PEG tubes is suggested also in cachectic patients and in vegetative state as well.     

Gastrostomy tube placement outcomes: comparison of surgical, endoscopic, and laparoscopic methods.

BACKGROUND: Advances in percutaneous endoscopic gastrostomy (PEG) and laparoscopic (LAP) techniques now allow for less invasive placement of gastrostomy tubes. This study compared morbidities and feeding outcomes of these procedures with standard surgical (OPEN) insertion. METHODS: Gastrostomy tubes placed in the operating room by the PEG, LAP, and OPEN methods were compared for insertion times, tube insertion and maintenance complications, enteral feeding complications, and feeding start days. Patients with concomitant intra-abdominal procedures were excluded. Patients were followed for 6 days after tube placement. RESULTS: A total of 91 catheters (PEG = 23, LAP = 39, OPEN = 29) were inserted in the operating room for indications of ventilator-dependent respiratory failure (45), dysphagia (30), head and neck cancer (9), and decreased mental status (7). No patients were fed on the day of the procedure. Insertion times were significantly longer (p < .05) in the OPEN technique (68 minutes) vs LAP (48 minutes) and PEG (30 minutes). Insertion complications occurred in the LAP and PEG cohorts (3 failed LAP, 1 failed PEG), and maintenance complications were higher in the LAP group, including 1 episode each of cellulitis, bleeding, and serous drainage. Twenty enteral feeding complications in 17 patients occurred in all groups (9 in LAP vs 6 in PEG and 5 in OPEN), and included emesis (6), high residual (5), diarrhea (3), ileus (3), nausea (2), and pain after feeding (1). Overall complications were significantly lower in the PEG (7) and OPEN (5) groups compared with the LAP group (15). Feeding start day was significantly delayed in the OPEN technique (2.1 days vs 1.7 in PEG and 1.5 in LAP); however, no difference was found in days to goal among groups (4.4-4.8 days). CONCLUSIONS: PEG should be the procedure of choice for placement of gastrostomy tubes. If PEG is contraindicated, then OPEN technique may be best due to fewer complications, although insertion time is longer than the LAP technique.     

Management of a traumatic gastric ulcer with a low-profile gastrostomy tube.

Since the advent of percutaneous endoscopic gastrostomy (PEG) tubes in 1980, they have become the device of choice for providing long-term enteral nutrition. Despite their overall safety, a number of complications can occur after PEG placement. Bleeding is usually a minor complication associated with PEG placement that occurs soon after the procedure and is most often caused by puncture of an abdominal wall vessel. More severe bleeding can occur when a branch of one of the gastric arteries is punctured. There are only a few case reports of traumatic gastric ulceration secondary to the internal bolster of a PEG. The internal bolsters are either balloons or dome shaped, and are 1.5-2.0 cm in height. We report a case in which a patient developed hemorrhage from a gastric ulcer induced by a balloon-type PEG tube that was resolved only after replacement with a tube manufactured with a low-profile internal bolster that was only 0.3 mm in height. The protruding tip of a balloon-type gastrostomy tube was believed to have caused traumatic injury to the gastric mucosa in our patient, causing ulceration. Usually, removal of the tube and placement in a different location may solve the problem. However, we believe that the PEG tube fashioned with a low-profile internal bumper is a safer option.     

External Bolster Placement After Percutaneous Endoscopic Gastrostomy Tube Insertion: Is Looser Better?

BACKGROUND: Abdominal and gastric wall inflammation, infection, and necrosis after percutaneous endoscopic gastrostomy (PEG) placement is a topic of importance but of limited study. Healing of the abdominal wound after PEG placement is thought to be dependent on a number of factors, including the patient's nutrition status, comorbid disease status, and postprocedural PEG wound care. Another important factor that may influence wound healing is tissue tension and compression. This requires special attention to the correct placement of the external bolster of the PEG tube against the abdominal wall. METHODS: We performed a study in mongrel dogs to determine the relevance of tissue compression on PEG-tube wound healing; 8 mongrel dogs each received 3 separate 24 Fr PEG tubes at 1 endoscopic setting. After PEG placement, the external bolster was placed at 0 cm, 1 cm, or 4 cm from the abdominal wall. Post-PEG care and enteral feedings were standardized. The dogs were killed at 3 weeks. RESULTS: Partial migration of the PEG internal bolster into the gastric wall occurred in 1 of 8 of the PEG tubes with the external bolster at 0 cm. PEG-tube-tract tissue inflammation was worse in the dogs with the external bolster placed at 0 cm. CONCLUSIONS: The position of the external bolster in relation to the abdominal wall may be an important factor in the healing of a post-PEG-tube-placement tissue tract.