Decompressive percutaneous endoscopic gastrostomy in nonmalignant disease

BACKGROUND: Percutaneous endoscopic gastrostomy is the standard for long-term enteral access. It can provide enteral nutrition or gastrointestinal decompression. Utilization of the gastrostomy for decompression has traditionally been reported in the setting of malignant obstruction. However, decompressive gastrostomy can play a role in the treatment of nonmalignant bowel dysfunction as well. METHODS: Over a 2-year period, 20 of 121 percutaneous endoscopic gastrostomies attempted by this surgical endoscopist were for gastrointestinal decompression. RESULTS: Eleven of 18 gastrostomies successfully placed for decompression were for benign conditions. In 5 patients with fistulous disease, the purpose of decompression was to divert the gastrointestinal tract until operative repair. Four of these patients have since undergone definitive surgery. CONCLUSIONS: This series presents the successful use of the percutaneous endoscopic gastrostomy for decompression of nonmalignant conditions. In such scenarios, the drainage gastrostomy can be employed as a bridge to future surgery, or as a means of long-term decompression for bowel dysfunction.     

A complex caliceal-cutaneous and caliceal-peritoneal fistula in a renal transplant patient: a case for conservative management

Caliceal fistula is a rare complication after renal transplant and may lead to graft failure. We present a case of complex caliceal-cutaneous and caliceal-peritoneal fistula in a renal transplant patient who was successfully managed conservatively.     

Analysis of factors affecting the spontaneous closure of a gastrocutaneous fistula

Background/purpose

Few reports have documented the rate of persistence of a gastrocutaneous fistula (GCF) after gastrostomy removal or the reason for the persistence of a GCF. The purpose of this report was to analyze a large group of pediatric patients with a persistent GCF to determine the rate of persistence and any factors that correlate with the persistence of a GCF.

Methods

This was a retrospective review of 1,042 children from The Children’s Hospital, Denver, Colorado who had a gastrostomy constructed between 1992 and 2002. The charts of all children with a persistent GCF after gastrostomy catheter removal were analyzed for correlation between 13 clinical parameters and the persistence of a GCF.

Results

There were 150 children with a persistent GCF for an incidence of 34%. Time elapsed between the creation of the GCF and removal of the gastrostomy appliance (≤8 months versus >8 months) was the only parameter that showed any correlation with persistence of a GCF (P < .05). None of the other parameters studied showed any conclusive correlation with persistence of a GCF.

Conclusions

Time was the only factor that determined whether a surgically created GCF would persist after removal of a gastrostomy appliance.     

Bouveret's Syndrome as a Rare Complication of Cholecystolithiasis: Report of a Case

Bouveret's syndrome, which is gastric outlet obstruction caused by a gallstone in the duodenum or pylorus, is a very rare complication of gallstone disease. It occurs most commonly in women (65%), with a median age of 68.6 years. This disorder is usually treated by surgery, but it has also been successfully treated by endoscopy, with or without extracorporeal shock wave lithotripsy. The mortality rate has improved to 12% in recent years. Herein we report the case of a 76-year-old woman with Bouveret's syndrome, and review the literature on this unusual entity. Received: January 7, 2002 / Accepted: May 7, 2002 Reprint requests to: E. Shiloni     

Uterovaginal fistula after laparoscopic excision of uterosacral endometriotic nodule

A uterovaginal fistula was reported after an uneventful laparoscopic excision of a left uterosacral endometriotic nodule in a young woman. Indirect thermal injury to the left ureter by the bipolar grasping forceps was the main cause of the injury. Contributing factors are analyzed and preventive measures pertinent to this case are discussed.     

Vertical and horizontal motion perception in congenital nystagmus

We investigated whether individuals with congenital nystagmus (CN) have abnormalities in motion perception and whether any such abnormality could be due to their nystagmus or to adaptive mechanisms to avoid oscillopsia. CN and control subjects performed motion detection and discrimination tasks. In the detection tasks, subjects reported the onset of motion and drift direction in either a vertical or horizontal direction. In the discrimination task, the stimulus was a high-contrast grating and moved vertically. Subjects judged whether successively presented reference and test velocities were the same or different, using a forced choice instruction. Vertical velocity detection was normal in the patient group. The vertical velocity discrimination task showed that the patients were less accurate than the controls, especially when velocities were slow. Horizontal velocity detection thresholds were raised in the patient group regardless of the direction of the slow phase velocity (spv) of the nystagmus. Evaluation of eye movement recordings performed during the task demonstrated that detection velocity was highest when stimulus motion and spv were in the same direction. When nystagmus was absent due to a prolonged neutral zone, thresholds did not reduce to normal values. The findings show that the image motion caused by the nystagmus cannot account for all the abnormalities found. Deficits occurred in the absence of nystagmus and when motion was orthogonal to the meridian of the nystagmus suggesting that the suppression of motion perception is, in part, due to adaptive mechanisms used to avoid oscillopsia.     

泌尿生殖瘘的防治

本文报告了由妇科和产科疾病导致尿瘘108例,各占13.9%和86.1%。通过对尿痿形成的原因、类型和部位的临床分析,提出了防治泌尿生殖痿的有效措施及妇产科诊治与手术的注意事项,强调了成功地进行痿孔修补手术的要点。     

Right-sided vegetation unmasks aortic endocarditis.

Echocardiography is a key tool in the diagnosis of infective endocarditis. Although transthoracic echocardiography is the first step in the work-up, transoesophageal echocardiography is mandatory for the evaluation of the exact extent of the infectious process. Indeed, perivalvular abscess can fistulate towards different heart chambers, leading sometimes to critical clinical situations.     

胰体尾部肿瘤的手术切除

摘要：目的 探讨胰体尾部肿瘤的外科治疗方法。方法 近18年来，采用手术治疗胰体尾部肿瘤45例，其中恶性肿瘤33例，良性肿瘤12例；行远端胰腺切除17例，联合脏器切除24例，肿瘤局部切除4例。结果 病理类型：胰体尾癌33例，胰岛细胞瘤8例，囊腺瘤2例，上皮样纤维瘤1例，囊性畸胎瘤1例。切除肿瘤最大径：胰体尾癌平均为（8.0±2.6）cm；胰岛细胞瘤平均为（6.5±2.4）cm。无手术死亡病例。术后并发症：胰瘘2例，膈下脓肿2例，胰腺假性囊肿1例，上消化道出血 1例，切口感染或愈合不良3例，均经非手术疗法治愈。结论 远端胰腺切除术是治疗胰体尾部肿瘤的有效方法；术前需常规做好联合脏器切除的准备；胰腺残端的处理选用主胰管结扎加褥式缝合法可有效避免胰瘘的发生。