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Biomedical subjects

Patrick G Brady

Publications and source records attributed to Patrick G Brady.

5 recordsLinked to original sources
PubMed2005

Incidence of abdominal wall metastasis complicating PEG tube placement in untreated head and neck cancer.

BACKGROUND: Abdominal wall metastasis after PEG tube placement has been reported in patients with head and neck cancer. The incidence of this occurrence is unknown. OBJECTIVE: Evaluation of the incidence of abdominal wall metastasis as a complication of PEG tube placement in patients with head and neck cancer. DESIGN: Retrospective chart review. SETTING: H. Lee Moffitt Cancer Center and Research Institute, Nutritional Support Services. SUBJECTS: Head and neck cancer patients requiring nutritional support with PEG tube placement. RESULTS: Of the 304 patients with head and neck cancer, 218 had active disease with a viable tumor in the oropharynx or hypopharynx at the time of PEG placement. Two of these patients, both with active disease (0.92%), developed a PEG site metastasis. CONCLUSION: There is a small but definite risk for tumor implantation in the gastrostomy site when using the pull technique in patients with active head and neck cancer. Careful assessment of the oropharynx and hypopharynx before PEG tube placement and the use of alternative techniques for enteral access in patients with untreated or residual malignancy are recommended to minimize this risk. Use of other percutaneous techniques that do not involve traversing the hypopharynx with the catheter may help to prevent tumor translocation. When head and neck cancers metastasize to the gastrostomy site, patient survival appears limited even with extensive resection.

Abdominal Wall↗
PubMed2003

Reduction in the incidence of pancreatitis in patients undergoing sphincter of Oddi manometry: a successful quality improvement project.

OBJECTIVE: Acute pancreatitis is a recognized complication of sphincter of Oddi manometry (SOM). Its frequency of occurrence has been reported in the range of 4 to 31%. In an earlier retrospective study performed at this institution, the incidence of pancreatitis was 9.3% in patients who only had SOM compared with 26.1% in those patients who had SOM and endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy at the same session. On the basis of these data, a quality-improvement project was initiated at two university-affiliated hospitals. This involved performance of SOM without ERCP. If ERCP was required, it was performed at a different session. The purpose of this project was to decrease the incidence of pancreatitis associated with SOM. METHODS: This study involved prospective patient identification and retrospective chart review of patients who underwent SOM without ERCP between May 1998 and December 2000. SOM was performed using a triple-lumen catheter with water perfusion at a rate of 0.25 ml/min using an Arndorfer pneumohydraulic capillary perfusion system. The data recorded included pancreatitis after SOM, pancreatitis after ERCP and sphincterotomy, average days in the hospital after pancreatitis, and time between SOM and ERCP. RESULTS: Forty-one patients were studied. Three (7.32%) patients had pancreatitis after SOM. Five patients subsequently underwent ERCP and sphincterotomy and one (20%) patient had pancreatitis. The overall frequency of pancreatitis after SOM and any subsequent ERCP or sphincterotomy was 4 (9.78%) of 41 (95% confidence interval, 3.9-22.5%). The odds ratio for pancreatitis with ERCP and SOM at the same time compared with the SOM-only strategy was 3.26 (P = 0.05). The average stay in the hospital after pancreatitis ranged from 2 to 4 days, with a mean length of stay of 2.75 days. The time between SOM and subsequent ERCP ranged from 6 to 20 days, with a mean of 10.4 days. CONCLUSION: By adopting a protocol to perform diagnostic SOM, separate from ERCP and sphincterotomy, we were able to decrease the incidence of pancreatitis considerably at our institutions.

Acute Disease↗