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At least 955 records · Page 53Linked to original sources
PubMed1999

Timing of percutaneous endoscopic gastrostomy tube placement in head and neck cancer patients.

Percutaneous endoscopic gastrostomy (PEG) is an effective method for providing alimentation in patients with upper aerodigestive tract carcinoma. Multiple complications of this procedure have been reported, ranging from leakage around the tube to tumor seeding of the abdominal cavity. This study was undertaken to determine whether the timing of PEG tube placement with respect to primary tumor extirpation led to a difference in the number and severity of observed complications. The medical records of 43 patients with head and neck carcinoma who had PEG tubes placed from 1995 to 1996 were retrospectively reviewed. Comparisons of timing of PEG tube placement, complication, location, and stage of the primary tumor were performed. In addition, the use of adjuvant therapy with respect to the time of PEG tube placement and complications was evaluated. Of these, 23% were done before and 30% during surgery at the time of primary tumor resection (9 of 13 were after primary removal). One patient had an intraabdominal abscess. Minor complications occurred in 15 of 43 patients (35%) and included granulation tissue at the PEG site, leakage, and tube displacement. Eight of the 9 patients who underwent intraoperative PEG after tumor resection had no complications. Patients who underwent PEG during or after surgery had significantly fewer complications than those who underwent preoperative PEG or had unresectable tumors (P = 0.038). The largest number of complications occurred in patients who underwent preoperative PEG (57%) followed by patients whose tumors were unresectable (31%). There was no statistical difference with regard to tumor location or postoperative x-ray therapy in PEG complications. This study demonstrates that PEG tube placement after tumor resection has the lowest incidence of postoperative complications. Performing PEGs intraoperatively after tumor resection can prevent the need for additional anesthesia to provide alimentation in patients with upper aerodigestive tract carcinoma.

Endoscopy, Gastrointestinal↗
PubMed2003

The percutaneous endoscopic gastrostomy tube. medical and ethical issues in placement.

OBJECTIVE: Offering and recommending PEG tube placement to patients has been a topic of considerable interest in the medical literature. The role of individual health care professionals in the decision making process is poorly defined. PEG tubes are often placed inappropriately because of unrealistic and inaccurate expectations of what they can accomplish in patients unable to tolerate adequate oral intake. We have developed an algorithm for PEG placement for the geriatric, oncology, and neurology patients based on a critical review of current literature. METHODS: An extensive review of the literature was performed focusing on PEG tube placement in oncology, neurology, and geriatric patients. This algorithm was developed to provide both the primary care provider and the specialist with appropriate indications for PEG placement in these patient populations. RESULTS: Appropriate indications for PEG placement are 1) Esophageal obstruction (e.g., esophageal cancer), 2) Neurologic etiology of dysphagia without obstruction (e.g., status post cerebrovascular accident, pseudobulbar palsy), 3) Prolonged refusal to swallow without evidence of concomitant terminal illness (e.g., protracted pseudodementia due to severe depression), 4) Supplemental nutrition for patients undergoing chemotherapy or radiation therapy. CONCLUSIONS: If no physiologic benefit is expected with PEG placement (anorexia-cachexia syndrome), the health care team has no obligation to offer or perform an intervention. This same principle would apply if intervention improves physiologic states but has no effect on quality of life (e.g., permanent vegetative state). Small-bore feeding tubes are cost effective and relatively safe for enteral feedings of up to 6-8 weeks. This is especially pertinent in the population with acute neurological deficits, in which prognostication on extent of impairment is best estimated by communication with neurologist. In the geriatric population there is no proved benefit in weight gain or markers of nutrition (albumin, prealbumin) in patients with malnutrition due to impaired oral intake.

Aged↗
PubMed1982

Assessing small intestinal function in health and disease in vivo and in vitro.

Diet, dysfunction and disease induce primary and secondary changes in intestinal structure and function. The major techniques used to assess such changes in human and animal intestinal absorption and secretion in situ, in vivo and in vitro are reviewed concisely but critically and the problems of normalisation of the data explored. Exploitation of the various electrical potential differences generated by and across the intestinal epithelium allows the kinetic characterisation of the electrogenic glucose absorption mechanism, the measurement of functional lactase activity, the assessment of the thickness of the unstirred layer, the estimation of intestinal tonic (diffusive permeability and the recording of electrogenic secretion coupled with motility changes in the jejunum, in situ, of conscious man in health and disease. The use of animal intestine has allowed direct and indirect evidence of multiple hexose carriers to be obtained and a new technique allowing corrected kinetic parameters of Km and Jm to be estimated in vivo. Application of the technique to experimental conditions will allow a better assessment of the adaptive capabilities of the enterocytes absorptive functions.

Animals↗
PubMed2006

Cyclodextrin (CD) complexes of cholesterol--their potential use in reducing dietary cholesterol intake.

The main objective of this investigation was to test and see if cyclodextrins, a type of molecule which form inclusion complexes, could effectively prevent the absorption of food derived cholesterol. Cyclodextrins are nontoxic and easily tolerated, having only a slight sweet taste. alpha,beta,gamma-Cyclodextrins, 2-Hydroxypropyl-beta-cyclodextrin (2-HPCD), and heptakis-O,O-dimethyl-beta-cyclodextrin (DMCD) were tested in solutions of different concentrations. These solutions were then saturated with cholesterol and the excess cholesterol was removed. The clear solutions left were then analyzed by HPLC to assess the amount of cholesterol in the solutions, and compared to a standard. DMCD gave the best results in successfully dissolving (complexing) most of the cholesterol followed by HPCD and alpha-cyclodextrin. Beta- and gamma-CD showed nearly insignificant complex formation. After administration of 10 mg of cholesterol to mice through a gastric tube, the cholesterol level increased about 125-130%, and only 15-20%, if the cholesterol was administered together with 20 mg of DMCD. That means, the DMCD formed complexes with approximately 80-85% of the cholesterol administered in the mice gastrointestinal tract.

Animals↗
PubMed1977

Abdominal decompression: increased efficency by esophageal aspiration utilizing a new nasogastric tube.

Gastric aspiration alone utilizing either a Levin-type nasogastric tube or a gastrostomy tube is inefficient. The esophagus proved to be a more efficient supplemental site for aspiration of a swallowed bolus. For thirty-one patients, esophagogastric aspiration proved to be approximately twelve times as efficient as aspiration via a Levin-type tube for twenty-four patients or a gastrostomy tube in five patients (residual activity, of 3,35, and 42 per cent, respectively). Radiographic studies of a volunteer swallowing barium with each type of nasogastric tube in place showed efficient removal of the contrast agent by esophageal aspiration. With the Levin-type tube, the bolus promptly traversed the stomach and entered the duodenum along parallel channels remote from the x-ray -visualized gastric tube. Efficient postoperative exclusion of swallowed air clinically and experimentally by esophageal aspiration permits more rapid return of gastrointestinal function and full nutrition and perhaps shortened hospitalization.

Decompression↗