Percutaneous endoscopic gastrostomy in patients undergoing resection for oral tumors: a retrospective review of complications and outcomes.

PURPOSE: The use of a percutaneous endoscopic gastrostomy (PEG) in patients undergoing resection for oral tumors is not universal, and varying complication rates have been reported. This study reviews our experience with the use of a PEG as an adjunct in this setting. MATERIALS AND METHODS: The records of patients treated for oral tumors by oral and maxillofacial surgery were reviewed retrospectively. All patients undergoing resection for oral tumors and having a PEG were included. Patient age, gender, disease type, and stage, as well as type of operation, were recorded. Data obtained included the timing of PEG placement, duration of PEG use, and PEG complications. Patient weight and body mass index (BMI) were abstracted when recorded preoperatively and about 2 weeks and between 4 and 8 weeks postoperatively. Weight and BMI results were subjected to statistical analysis. RESULTS: Fifty PEGs were placed in 49 patients with oral tumors. The mean age of the patients was 61 years. More than 90% of tumors were squamous cell carcinomas. Most PEG tubes were placed at the time of resection by 1 surgeon and were retained for a mean duration of 114 days. A minor complication rate of 10% and a major complication rate of 8% were noted. Weight decreased significantly by 2.9% from preoperative level to week 2, but there was no other significant difference found between any other weight or BMI measurement. Incidental findings on PEG placement included Barrett's metaplasia in one patient and gastric adenocarcinoma in another. CONCLUSIONS: The use of PEG in patients with oral tumors at our institution was found to be effective in maintaining adequate nutrition, as assessed by weight and BMI, during recovery and convalescence. There is an acceptable low complication rate. Use of an experienced endoscopist and PEG placement at the time of resection are advocated.     

Structure of the schistosome eggshell: amino acid analysis and incorporation of labelled amino acids.

Preparations of eggshells of Schistosoma mansoni and S. japonicum were hydrolyzed and analyzed for amino acid composition. Both species showed great similarities in the proportions of each residue found. The predominant amino acid in shell hydrolysates was found to be glycine, which accounted for 37% of S. mansoni and 45% of S. japonicum amino acids. Four components (glycine, aspartic acid, lysine, and serine) totalled 68--75% of amino acids in the eggshells. Other individual amino acids were present in relatively small proportions ranging from 5.2--0.01%. Less than 1% of the amino acid residues were identified as tyrosine, and bityrosine was detected at a level not exceeding 1 in 1,600 residues. Carbohydrates were estimated to comprise 7.5--10% of the eggshell weight, based on hexose assay, and glucosamine was identified as the principal amino sugar in shell hydrolysates. In vivo labelling of the S. mansoni eggshell was demonstrated following injection of C14-glycine and C14-tyrosine into infected mice and subsequent purification of the shells of eggs recovered from their liver.     

A primer for physical examination of the elbow

The elbow is a complex joint consisting of 3 separate but important articulations: the ulnohumeral, radiohumeral, and proximal radioulnar joints. The elbow assists in positioning the hand in space through 2 important motions, flexion-extension and pronation-supination. Although the elbow is not a weightbearing joint, it is subjected to significant loads, especially in overhead and throwing athletes. An accurate knowledge of the anatomy and physiology of the elbow joint is critical for conducting a focused physical examination and arriving at an accurate diagnosis. The goal of this article is to review general and focused physical examination of the elbow in a systematic manner based on medial, lateral, anterior, and posterior aspects.     

Schistosoma mansoni infections in T-cell deprived mice, and the ameliorating effect of administering homologous chronic infection serum. II. Pathology.

Liver changes occurring in mice deprived of their T-cells by a combination of thymectomy and anti-mouse thymocyte serum, and in immunologically intact control mice, were followed during the early stages of heavy Schistosoma mansoni infections. Lesions in both groups began developing by day 38 and were maximal by day 48. Hepatic changes in control mice culminated in large hypersensitivity granulomas, tissue eosinophilia, portal periphlebitis, fibrosis, vascular obstruction, and infarction leading to arterialization and preferential sinusoidal channeling. Deprived mice showed greatly reduced egg reactions composed principally of macrophages, monocytes, and occasional neutrophils, and only minimal alteration of liver architecture; however, focal and disseminated hepatocellular lesions became prominent as the infections progressed, and by day 48 virtually every hepatocyte was affected. Typically, hepatocytes showed microvesicular cytoplasmic damage (steatosis) or ballooning degeneration with accompanying nuclear pyknosis or karyorrhexis. This cellular pathology may be attributed to the direct or indirect effect of eggs or egg products on liver cells. The administration of chronic infection serum obtained from immunocompetent mice to T-cell deprived mice dramatically eliminated the hepatocellular lesions. It also increased eosinophil participation and fibrosis in the egg reactions but did not restore the size and other cellular features typical of egg hypersensitivity granulomas. Serum from uninfected normal mice was found to lack these effects.     

Median Sternotomy or Right Thoracotomy Techniques for Total Artificial Heart Implantation in Calves

The choice of optimal operative access technique for mechanical circulatory support device implantation ensures successful postoperative outcomes. In this study, we retrospectively evaluated the median sternotomy and lateral thoracotomy incisions for placement of the Cleveland Clinic continuous‐flow total artificial heart (CFTAH) in a bovine model. The CFTAH was implanted in 17 calves (Jersey calves; weight range, 77.0–93.9 kg) through a median sternotomy (n = 9) or right thoracotomy (n = 8) for elective chronic implantation periods of 14, 30, or 90 days. Similar preoperative preparation, surgical techniques, and postoperative care were employed. Implantation of the CFTAH was successfully performed in all cases. Both methods provided excellent surgical field visualization. After device connection, however, the median sternotomy approach provided better visualization of the anastomoses and surgical lines for hemostasis confirmation and repair due to easier device displacement, which is severely limited following right thoracotomy. All four animals sacrificed after completion of the planned durations (up to 90 days) were operated through full median sternotomy. Our data demonstrate that both approaches provide excellent initial field visualization. Full median sternotomy provides larger viewing angles at the anastomotic suture line after device connection to inflow and outflow ports.     

The effect of mango and neem extract on four organisms causing dental caries: Streptococcus mutans, Streptococcus salivavius, Streptococcus mitis, and Streptococcus sanguis: an in vitro study.

BACKGROUND AND OBJECTIVES: Chewing twigs of the mango or neem tree is a common way of cleaning the teeth in the rural and semi-urban population. These twigs are also believed to possess medicinal properties. The present study was conducted to evaluate the antimicrobial effects of these chewing sticks on the microorganisms Streptococcus mutans , Streptococcus salivarius , Streptococcus mitis , and Streptococcus sanguis which are involved in the development of dental caries. An additional objective was to identify an inexpensive, simple, and effective method of preventing and controlling dental caries. MATERIALS AND METHODS: The sticks were sun dried, ground into a coarse powder, and weighed into 5 gm, 10 gm, and 50 gm amounts. These were added to 100 ml of deionized distilled water. After soaking for 48 h at 4 degrees C, the water was filtered. The filtrate was inoculated onto blood agar plates containing individual species of microorganisms and incubated at 37 degrees C for 48 h. Results: Mango extract, at 50% concentration, showed maximum zone of inhibition on Streptococcus mitis . Neem extract produced the maximum zone of inhibition on Streptococcus mutans at 50% concentration. Even at 5% concentration neem extract showed some inhibition of growth for all the four species of organisms. INTERPRETATION AND CONCLUSION: A combination of neem and mango chewing sticks may provide the maximum benefit. We recommend the use of both the chewing sticks.