Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

Objective

Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE).

Materials and Methods

We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG.

Results

The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE.

Conclusion

We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.     

Monitoring Therapeutic Response in a Case of Extrapulmonary Tuberculosis by Serial F-18 FDG PET/CT

Due to the low yield of AFB smear and culture in extrapulmonary tuberculosis, therapeutic responses of patients with extrapulmonary tuberculosis are usually monitored clinically and/or radiographically. Such monitoring techniques, however, are not enough to provide effective diagnosis if a remnant lesion exists after treatment. Tuberculosis presents hypermetabolic activity on F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) scanning. Reported herein is a case of extrapulmonary tuberculosis where the therapeutic response was assessed via serial F-18 FDG PET/CT scanning, which was useful for detecting the extent of extrapulmonary tuberculosis and for estimating the patient’s therapeutic response.     

Pediatric liver transplantation for hepatoblastoma: a single center experience

The objective of this study was to review our experience with liver transplantation (OLT) for hepatoblastoma (HB) patients. We evaluated retrospectively clinical features of seven pediatric patients with HB who underwent OLT at our institute from 2007 to February 2011. We investigated pretreatment extent of disease (PRETEXT) stage at diagnosis, type of procedure, complications, changes in serum alpha-fetoprotein (AFP) level, recurrences and metastases. The median age at surgery was 47 months (range, 11 months to 10.3 years). OLT was performed for PRETEXT stage III with a central location (n = 2) and for PRETEXT stage IV cases (n = 5). Five children underwent live donor OLT (LDLT) and two deceased donor OLT including one split deceased donor OLT. One patient received a hepatic vein stent insertion due to stenosis and another experienced biliary leakage which was treated with percutaneous drainage and conservative management. Postoperative serum AFP level remained below 20 ng/mL during follow-up period in six patients who were free of recurrences or metastases. Postoperative serum AFP levels in one patient with pulmonary metastasis were never below 20 ng/mL and increased gradually thereafter. A Pulmonary metastasis was discovered in the 2^nd month post-operative. The other 6 patients are free of tumor recurrences with 29.9 month median follow-up.Although the number of cases is small without long term follow-up data, OLT for unresectable HB confined to the liver following chemotherapy seemed to show good clinical results. The role of post transplantation serum AFP levels needs further investigation.     

Obstructive uropathy by total uterine prolapse leading to end-stage renal disease

A 74-year-old woman was admitted to our emergency room complaining of general weakness and anorexia that started 20 days earlier. She denied other underlying diseases that might have provoked chronic renal disease. Her serum creatinine was 12.35 mg/dL. A pelvic examination and computed tomography revealed severe bilateral hydroureteronephrosis with marked cortical thinning induced by total uterine prolapse. She was started on emergency hemodialysis due to her uremic symptoms and severe metabolic acidosis. Despite Foley catheter insertion and manual reduction of uterus for 1 month, renal function was not recovered. The department of gynecology was strongly opposed to performing a procedure to reverse the hydroureteronephrosis due to the irreversibility of her renal function. She is undergoing chronic maintenance hemodialysis. This is a case report of rare end-stage renal disease (ESRD) caused by obstructive uropathy due to pelvic organ prolapse (POP). We should consider POP as a cause of ESRD.     

Reliability of a PowerPoint Method for Wear Measurement After Total Hip Arthroplasty: A Retrieval Study Using 3-Dimensional Laser Scanning

The purpose of this study was to evaluate the reliability of the PowerPoint (PP) (2007 Version; Microsoft, Redmond, Wash) method for measuring polyethylene liner wear after total hip arthroplasty. Seventeen retrieved polyethylene liners were included in this study. Wear volumes were calculated using the PP, the Dorr and Wan, and 3-dimensional (3D) laser scanning methods. Spearman correlation coefficients for wear volume results indicated strong correlations between the PP and 3D laser scanning methods (range, 0.89-0.93). On the other hand, Spearman correlation analysis revealed only moderate correlations between the Dorr and Wan and 3D laser scanning methods (range, 0.67-0.77). The PP method can be used to monitor linear wear after total hip arthroplasty and could serve as an alternative method when computerized methods are not available.