Gastrostomy Tube Placement Without Nasogastric Tube: A Retrospective Evaluation in 85 Patients

Purpose

Our study evaluated techniques for percutaneous gastrostomy (G)-tube placement without the use of a nasogastric (NG) tube. Instead, direct puncture of a physiologic air bubble or effervescent-enhanced gastric bubble distention was performed in patients with upper digestive tract obstruction (UDTO) or psychological objections to NG tubes.

Materials and Methods

A total of 886 patients underwent G-tube placement in our department during a period of 7?years. We present our series of 85 (9.6%) consecutive patients who underwent percutaneous G-tube placement without use of an NG tube.

Results

Of these 85 patients, fluoroscopic guided access was attempted by direct puncture of a physiologically present gastric air bubble in 24 (28%) cases. Puncture of an effervescent-induced large gastric air bubble was performed in 61 (72%) patients. Altogether, 82 (97%) of 85 G tubes were successfully placed in this fashion. The three failures comprised refusal of effervescent, vomiting of effervescent, and one initial tube misplacement when a deviation from our standard technique occurred.

Conclusion

The described techniques compare favorably with published large series on G-tube placement with an NG tube in place. The techniques are especially suited for patients with UDTO due to head, neck, or esophageal malignancies, but they should be considered as an alternative in all patients. Direct puncture of effervescent-enhanced gastric bubble distention is a safe, patient-friendly and effective technique.     

Pattern of varicocele vein blood gases in patients undergoing microsurgical Varicocelectomy

Background

Varicocele is known to be associated with infertility and sperm disorders. The exact cause of this ailment is not fully understood. There are limited numbers of studies where venous blood gases (VBGs) of varicocele veins were determined with conflicting results. Therefore, we have investigated the pattern of VBGs in both internal spermatic and external spermatic varicocele veins and correlation with semen quality parameters in infertile individuals who underwent left microsurgical varicocelectomy.

Methods

Patients (n?=?27) undergoing left microsurgical varicocelectomy at a tertiary care hospital, were included in the study. Before surgery, semen parameters and scrotal color Doppler ultrasonography was performed. During surgery, blood sample was drawn from varicocele veins (internal spermatic and external spermatic veins) and a peripheral arm vein of the same patient as a control. The VBGs of all veins under study were estimated and compared with each other. The VBGs were also correlated with various semen quality parameters. Data, expressed as Mean?±?SD, regarding VBGs in three veins were analyzed using one-way ANOVA. The correlation between VBGs and semen quality parameters was determined using Pearson’s correlation. Differences were considered significant at p?<?0.05.

Results

The pH was found to be higher (p?<?0.01) in the internal spermatic vein compared with the external spermatic and the peripheral veins. Partial pressure of oxygen (pO₂) and oxygen saturation (sO₂) were higher (p?<?0.01) in the internal spermatic vein compared with the peripheral vein. However, concentration of bicarbonate (HCO₃₎ was lower (p?<?0.01) in both veins compared with the peripheral vein. Partial pressure of carbon dioxide (pCO₂) was also lower (p?<?0.01) in the varicocele veins compared with the control vein.

Conclusion

The internal spermatic veins had higher pH and oxygen tension, but lower HCO₃ and pCO₂ levels compared with the control peripheral veins. External spermatic veins had lower pCO₂ and HCO₃ but other VBGs were similar to the peripheral veins. The shift of VBGs of internal spermatic vein toward arterial blood pattern may be a missing link to understand the pathophysiology of varicocele.

     

The nature of diversity of HLA-DRB1 exon 3

Exon 3 of DRB1 is known to be polymorphic, but thought to be conserved within allelic groups. This implies that exon 3 polymorphisms would not need to be considered in evolutionary studies or clinical settings when assessing immunogenicity of allelic mismatches in stem cell transplantation. To further assess this, we determined the sequences of DRB1 exon 3 by hemizygote amplification and direct sequencing on 55 selected DNA samples containing 42 DRB1 alleles for which no exon 3 sequence data were previously available. The data confirmed the high degree of overall sequence conservation. The DRB4- and DRB5-associated alleles were completely conserved within their DRB1 groups. However, it could be shown that exon 3 is more diverse than previously expected. Multiple allelic differences within each group of DRB3-associated DRB1 alleles were found, without identifying unique group-related sequence motifs differentiating between these groups. For DRB1*1402 and DRB1*1406, it could be shown that they originated from DRB1*0302. In several samples previously typed as DRB1*1401, a novel DRB1 allele was identified: DRB1*1454. Thus, from a clinical viewpoint, the availability of exon 3 sequence information may be useful for optimizing typing as well as matching strategies. Additionally, it will allow for more detailed evolutionary studies, further elucidating the origin of alleles and the mechanisms driving sequence diversification.     

Tri-nucleotide consortium of androgen receptor is associated with low serum FSH and testosterone in asthenospermic men

Androgen mediating signaling is implicated in regulating the expression of reproductive related genes. Any deviation in the gene expression might be the ignitable precursor for genomic instability that inflames the genomic rearrangements and a leading cause of cancer. The main goal of this study was to determine the relationships between trinucleotide repeats of androgen receptor (AR), sex steroids, and sexual function in men presenting with reduced sperm motility. We investigated the singleton or combinatorial effects of the length of trinucleotide repeats of AR on reproductive hormones, clinical parameters, semen analyses, as well as sexual assessment function of 210 asthenospermic outpatients along with 125 normal subjects. Sexual assessment was executed using the International Index of Erectile Function (IIEF-15 score) which measures erectile function (EF), orgasmic function (OR), sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction. Our findings suggest that long (>26 CAG)n repeats have an inverse correlation with circulatory FSH and T, whereas long (>25 GGC)n repeats have moderated affiliation with reduced sperm concentration. The study revealed a novel finding by exploring the negative correlation between elongated (CAG)n repeats and the cumulative IIEF-15 score, orgasm function (OR), and erectile function (EF) in asthenospermic men. This study examines the tri-nucleotide correlation with sexual function in Punjabi men enhancing our understanding of the regulatory mechanisms of sexual performance.

Abbreviations: AR: androgen receptor; IIEF-15 score: International Index of Erectile Function; EF: erectile function; OR: orgasmic function; SD: sexual desire; IS: intercourse satisfaction; FSH: follicular stimulating hormone; T: testosterone; NTD: N-terminal transactivation domain; DBD: DNA-binding domain; LBD: ligand binding domain; TNR: tri-nucleotide repeat     

INPP5K variant causes autosomal recessive congenital cataract in a Pakistani family

Congenital cataract (CC) is clinically and genetically highly heterogeneous. Here, we enrolled a consanguineous kindred (LUCC15) from Pakistan, with 3 affected individuals suffering with CC. Exome sequencing revealed a transition mutation [c.149 T > C; p.(Ile50Thr)] in INPP5K. Inositol polyphosphate‐5‐phosphatase K, encoded by INPP5K, is involved in dephosphorylation of phosphatidylinositol (PtdIns) 4,5‐bisphosphate, and PtdIns 3,4,5‐trisphosphate. Recently, pathogenic variants in INPP5K have been reported in families with congenital muscular dystrophies, intellectual disability, and cataract. In our family LUCC15, mild to moderate intellectual disability along with speech impairment was observed in 2 affected individuals. Magnetic resonance imaging of brain and muscles tissues did not reveal any cerebellar or muscular atrophy. However, electromyography of both upper and lower limbs revealed irritable myopathy. Comparison of clinical phenotype of all the known affected individuals, including LUCC15 family, homozygous for INPP5K alleles revealed reduced penetrance of muscular dystrophy and intellectual disability. Similarly, skeletal muscle abnormalities were highly variable among inpp5ka zebrafish mutants analyzed in this study. These phenotypic variabilities may be due to epigenetic factors and/or genetic modifiers.     

Extensive uterovaginal prolapse during labor

Uterovaginal prolapse complicating pregnancy is an extremely rare event. Obstetricians should be familiar with the condition as early recognition and close follow up is essential in order to avoid possible fetomaternal risks. We report a case of 35-year-old lady who presented to the emergency with complaints of labor pains, absent fetal movements and huge uterine cervical prolapse in active phase of labor. She was conservatively treated with bedrest, blood transfusions and irrigation of prolapsed cervix. A dead female fetus was delivered vaginally. Ring pessary was placed postnatally. We believe that an extensive uterovaginal prolapse needs close surveillance and can be managed conservatively.     

Effect of Pb toxicity on the growth and physiology of two ecotypes of Elsholtzia argyi and its alleviation by Zn

Hydroponics experiments were conducted to underpin the nature of interactions between Zn, an essential micronutrient and Pb, a nonessential element on plant growth and root morphology, as well as antioxidant adaptation in mined ecotype (ME) and nonmined ecotype (NME) of Elsholtzia argyi. Plants were exposed to 50 μM Pb having normal Zn (0.5 μM), and two other treatments of the same Pb with low (0.05 μM) and high (20 μM) Zn, respectively for 12 days. Application of Pb with normal Zn caused adverse effects on the overall growth and antioxidant capacity of both ecotypes, however; effects were more pronounced in NME. The addition of high Zn along with Pb improved the growth and antioxidant capacity of both the ecotypes, while low Zn failed to show significant changes in NME plants; however slightly aggravated the Pb toxicity in the plants of ME. Zinc antagonized Pb concentrations in root and stem of both ecotypes and leaf of ME, while no significant differences were noted in Pb concentrations of NME leaf. It is suggested that in E. argyi, mechanisms of Pb and Zn uptake and translocation as well as their interactions within the plant cell may be different for both ecotypes and need to be further investigated. © 2010 Wiley Periodicals, Inc. Environ Toxicol, 2011.