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At least 991 records · Page 55Linked to original sources
PubMed2006

Endoscopic management of radiation-induced complete upper esophageal obstruction with an antegrade-retrograde rendezvous technique.

BACKGROUND: Esophageal strictures occur in 3% to 4% of patients with head and neck cancer who undergo radiation therapy. Some patients develop complete obstruction of the upper esophagus. Antegrade dilatation is often unsuccessful and many of these patients require surgery. OBJECTIVE: To describe the outcomes and complications of an endoscopic antegrade-retrograde rendezvous procedure to restore esophageal patency. DESIGN: Retrospective review of 8 cases treated with an endoscopic rendezvous procedure between August 2001 and April 2005. Medical records of consenting patients were abstracted for clinical history, procedural success, complications, and follow-up. SETTING: A large tertiary referral center. PATIENTS: Eight patients with head and neck or upper esophageal cancer and complete upper esophageal obstruction from radiation stricturing who underwent an attempted rendezvous procedure. MAIN OUTCOME MEASUREMENTS: Clinical procedural success, reported adverse events. RESULTS: Seven patients were men, and median age was 65 years. The median interval between radiation and the rendezvous procedure was 11 months. In 7 of 8 cases esophageal patency was restored and no major complications occurred. Two esophageal microperforations resolved without intervention. Most patients responded well to subsequent serial dilations and many discontinued gastrostomy tube use. LIMITATIONS: Retrospective, selection bias. CONCLUSIONS: An antegrade-retrograde rendezvous technique with subsequent dilation appears to be safe and effective for endoscopic management of complete upper esophageal obstruction induced by radiotherapy and can obviate the need for esophageal resection.

Aged↗
PubMed2004

Early percutaneous endoscopic gastrostomy nutrition in head and neck cancer patients.

OBJECTIVE: Many head and neck cancer patients suffer from poor nutrition. Nutrition is a problem during and after therapy, especially when it consists of extensive surgery, intensive (chemo)radiotherapy or their combination. Additional enteral nutrition has been provided by means of either nasogastric tube feeding, surgical gastrostomy, radiologic percutaneous gastrostomy or percutaneous endoscopic gastrostomy (PEG). Because of the straightforward, easy technique involved and its low complication rate, PEG has become established as the primary route of nutrition in these patients. Previously, the aim of assisted enteral nutrition was to compensate for already existing malnutrition; nowadays, an additional purpose is to diminish or prevent the development of malnutrition. The main objective of this study was to evaluate the safety of pre-treatment PEG in a sample of patients with an upper aerodigestive tract area malignancy treated in a tertiary referral centre. MATERIAL AND METHODS: A total of 79 patients with an upper aerodigestive tract area malignancy were treated with a total of 80 PEGs during the period 1997-2001. RESULTS: Most of the PEGs (62/80; 77.5%) were performed by an otolaryngologist. An open gastrostomy was needed in five cases because of unsuccessful gastroscopy due to oesophageal stricture (n=4) or severe trismus (n=1). Both acute and late complications were minor and the respective complication rates (1/80; 1.3% and 12/80; 15%) were low. In addition, all complications were easily managed and did not seriously affect the actual treatment. CONCLUSIONS: A major advantage of having the PEG performed by the otorhinolaryngologist was the possibility to combine it easily with other necessary procedures, such as panendoscopy, tracheostomy and additional biopsy. In addition, the timing of the procedure was easy to schedule.

Adult↗
PubMed2000

[CT enteroclysis for detection of small bowel tumors].

PURPOSE: To assess the feasibility and the usefulness of CT enteroclysis (helical CT with enteroclysis) in detecting small bowel tumors. MATERIALS AND METHODS: Fifty patients were referred for suspicion of small bowel tumor. CT enteroclysis is performed by injecting a large volume of water using a pomp through a nasojejunal tube followed by a thin section helical acquisition. RESULTS: Forty-eight helical CT enteroclysis were performed in order to detect 25 small bowel tumors. Among them 22 were confirmed by histological study. The mean size of tumors was 23 mm. In 12 of 17 cases, diagnosis was missed or incomplete at conventional barium study. Enteroscopy was performed in 12 of 22 cases, with discordant result in one case and incomplete result in 3 cases. In 8 cases, including 5 carcinoid tumors, patients had surgery after CT enteroclysis only, enteroscopy would probably have not made the diagnosis because the lesions were far from the duodenojejunal junction and ileocaecal valve. CONCLUSION: Helical CT enteroclysis is a new method for detecting small bowel tumors, easy to perform, well tolerated. It seems to be more sensitive than conventional barium studies and less invasive than enteroscopy. Tumor characterization and staging can be performed using a single examination. It seems to be justified to perform CT enteroclysis to detect small bowel tumors or in the evaluation of patients with polyposis.

Adult↗
PubMed1984

Partial small bowel obstruction.

From January 1976 through December 1980, 91 patients were admitted to Middlesex General Hospital in New Brunswick, N.J. with an initial diagnosis of partial small bowel obstruction. Postoperative adhesions accounted for 79% of the cases. Eighty of the 91 patients (88%) were managed successfully by tube decompression with 67 (74%) showing clinical or radiographic improvement within the first 24 hours. The mean duration of hospitalization for the nonoperative group was 6.9 days, 5.3 days for patients managed with nasogastric tubes versus 10.8 days for those managed with long tubes (P less than or equal to 0.008). Of the 11 patients who required operation, the mean preoperative hospital stay was 7.7 days, and four patients suffered nonfatal postoperative complications. None of the 91 patients developed strangulation. A barium upper gastrointestinal series was performed in 13 cases and was reliable in the determination of the need for operative intervention in each case. More efficient treatment of partial small bowel obstruction can be accomplished with a nasogastric tube as opposed to a long tube and by earlier use of barium upper gastrointestinal contrast studies in cases that do not resolve after 48 hours of tube decompression.

Female↗
PubMed2001

Stamm gastrostomy for postoperative gastric decompression in gynecologic oncology patients.

OBJECTIVE: The aim of this study was to report our experience with Stamm gastrostomy for postoperative gastric decompression on a gynecologic oncology service. METHODS: This was an observational study over the 9-year period ending in October 2000. A 24 French MIC gastrostomy with the Stamm technique was used. Criteria for a gastrostomy are outlined in the text and tubes placed for palliation were excluded. Patients were followed to determine length of open drainage, time to removal, related complications, and those who may have benefited. RESULTS: A total of 167 patients had 174 nonpalliative gastrostomy tubes placed. Nine percent of the patients had related complications with a major complication rate of 2%. Overall, approximately one-third of the patients appeared to benefit from the gastrostomy tube. CONCLUSION: The results support the safety and efficacy of the MIC gastric tube in patients undergoing extensive gynecologic cancer surgery which is likely to impact the function of the gastrointestinal tract.

Adult↗
PubMed2000

Duodenal vs. gastric administration of labeled leucine for the study of splanchnic metabolism in humans.

Low-rate (6 ml/h) intragastric infusion of stable, isotope-labeled amino acids is commonly used to assess the splanchnic handling of amino acids in humans. However, when used in the postabsorptive state, this method yields unreliable plasma isotopic enrichments, with a coefficient of variation >10%. In this metabolic condition, we confirmed in six subjects that an intragastric infusion of L-[(2)H(3)]leucine at 6 ml/h yields an unreliable isotopic steady state in plasma amino acids with a coefficient of variation of 43 +/- 12% (mean +/- SD). In five additional subjects, we assessed the effects of 1) increasing the rate of delivery of a leucine tracer in an isotonic plasmalike solution at 240 ml/h into the gastric site, and 2) changing the site of infusion from gastric to duodenal with this same high rate of delivery. In contrast to the gastric route, and regardless of the rate of delivery, only the intraduodenal route allowed 1) isotopic plasma steady state (i.e., coefficients of variation were <10%: 5 +/- 3%), and 2) reproducible leucine extraction coefficients (22 +/- 5%). We conclude that an infusion site that bypasses the gastric emptying process, i.e., the duodenal route, along with delivery of a plasmalike solution, is necessary to reach isotopic steady state in plasma when labeled leucine is infused into the gastrointestinal tract in the postabsorptive state.

Adult↗
PubMed1992

The site of gastrointestinal absorption of gepirone in humans.

This study was conducted in seven healthy male subjects and was performed over four sessions with a 1-week washout between sessions. It was designed to compare the bioavailability of an oral 20-mg gepirone dose (treatment 1) with that obtained after application of the same dose by gastric intubation to the distal (treatment 2) and proximal (treatment 3) regions of the small intestine, and after 4 consecutive 5-mg gepirone doses given orally at hourly intervals (treatment 4). Serial blood samples were taken over 24 hours after dose after each treatment. Plasma concentrations of gepirone and 1-(2-pyrimidinyl)-piperazine (1-PP), a metabolite of gepirone, were quantitated by gas chromatography-mass spectrometry. Mean gepirone time to reach peak concentration (tmax) after treatments 1, 2, and 3 ranged between 0.57 and 1.07 hours. There were no significant differences between sites and treatments for gepirone t1/2, which ranged between 2.8 and 3.3 hours. The mean gepirone maximum peak plasma concentration (Cmax) was significantly higher (P less than .05) after treatment 2 (12.92 +/- 7.24 ng/mL) compared with treatment 1 (6.79 +/- 3.54 ng/mL) or treatment 3 (6.33 +/- 2.26 ng/mL). Gepirone area under the curve (AUCinf) was also significantly higher (P less than .05) after treatment 2 (29.83 +/- 17.42 ng.h/mL) compared with treatment 1 (18.07 +/- 6.10 ng.h/mL) or treatment 3 (17.74 +/- 7.69 ng.h/mL). There were no significant differences in gepirone AUCinf between treatments 1 and 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed2002

[Three-luminal nasojejunal tube in digestive surgery: preliminary feasibility study].

STUDY AIM: The benefit of enteral nutrition is an established fact for severely burned or multiple injured patients with a reduction of septic morbidity. Enteral nutrition is now possible in upper gastrointestinal tract surgery with the development of nasojejunal triple lumen tube and we report a new application with an operative placement. The aim of the study was to evaluate the nasojejunal triple lumen tube in digestive surgery. MATERIAL AND METHODS: From November 1999 to August 2001, a nasojejunal triple lumen tube was placed during surgery for high surgical risk patients (n = 17) or under radioscopic control for the treatment of post operative complications (n = 6). RESULTS: The surgical placement was possible in all cases. The radioscopic placement failed in two cases, one of which being solved with endoscopic procedure. There was no morbidity during the tube placement. Four patients were excluded because of early post operative death (n = 3) or premature removal of the tube by the patient (n = 1). The enteral nutrition was early in 18 patients and its mean duration was 18.2 days (range 3-75). Technical problems occurred in 9 patients and the replacement of the tube was necessary in 8 cases. CONCLUSION: The nasojejunal triple lumen tube is a feasible, safe and relatively well-tolerated procedure in upper gastrointestinal tract surgery.

Adult↗
PubMed1989

Relationship between the first-order intestinal absorption rate constant in vivo and the membrane permeability clearance in a perfusion system: an intragastric administration method in vivo.

In an attempt to explore the quantitative relation in the intestinal absorption between in vivo and a perfusion system, time courses of the remaining fraction in the stomach and that in the small intestine following the intragastric administration of drug solution to rats were simultaneously analyzed by a linear compartment model, using L-glucose and 3-O-methyl-D-glucose (3-O-MG) as model compounds. Derived first-order gastric emptying rate constant (kg) and first-order intestinal absorption rate constant (ka) were 0.025 and 0.018 min-1, respectively, for L-glucose and 0.033 and 0.275 min-1, respectively, for 3-O-MG. Values of the membrane permeability clearance (CLa,m) estimated in the perfusion system were 0.71 and 3.00 microliters/min/cm, respectively, for L-glucose and 3-O-MG. The operational luminal volume (Vo), given as CLa,m/Ka, of 39 microliters/cm for L-glucose was in agreement with the actual luminal volume in vivo estimated by a inulin dilution method and ranging from 20 to 60 microliters/cm, supporting the idea that CLa,m quantitatively reflects the intestinal membrane permeability in vivo and that the luminal volume in vivo is the primary factor which correlates CLa,m and Ka. The Vo of 11 microliters/cm for 3-O-MG was smaller, though still in the same order. It was also shown that the gastrointestinal absorption of 3-O-MG was gastric emptying limited.

3-O-Methylglucose↗
PubMed1995

Octreotide versus pyloric exclusion in reducing gastrointestinal secretions entering the duodenum in a canine model.

Pyloric exclusion is advocated in the treatment of duodenal injury. The beneficial effect is thought to be due to diversion of gastric secretions and resultant reduction of biliary and pancreatic secretions. The long-acting somatostatin analog, Octreotide, makes the inhibitory actions of somatostatin on gastric, biliary, and pancreatic secretions a potential alternative to pyloric exclusion. We compared the effect of pyloric exclusion to the effect of Octreotide on the volume of gastrointestinal secretions entering the duodenum by creating a duodenal fistula using a canine model. Five animals had modified Thomas cannulas placed in the duodenum. Two animals had staple closure of the pylorus with a gastrojejunostomy in addition to the cannula. Gastrointestinal secretions were measured in 2- or 3-hour collection periods performed every third or fourth day. Animals were administered saline or Octreotide (100 micrograms/hour) intravenously during each collection. Up to 9 hours of collections under both saline and Octreotide (18 hours total) were done on each dog. Octreotide alone reduces gastrointestinal secretions entering the duodenum more than pyloric exclusion alone. Pyloric exclusion and Octreotide together offered no additional reduction in gastrointestinal secretions entering the duodenum over Octreotide alone.

Animals↗
PubMed2006

Nonnutritive sucking: one of the major determinants of filial love.

The present study investigated the rewarding effects of nonnutritive sucking on the development of a filial preference. Two experiments were conducted to test whether nonnutritive visceral and oral stimuli have reinforcing properties independent from each other or act in synergy. Lambs could interact freely with their dam but were deprived of suckling by covering the udder for the first 12 hr. In Experiment 1, suckling was prevented and replaced by human giving, in the presence of the mother, either a bottle of water (B5 and B2.5: 5% or 2.5% birth weight, BW, divided into seven portions over 12 hr) or water via tube-feeding (I5 and I2.5: 5% or 2.5% BW, also divided into seven portions over 12 hr). During a two-choice test performed at 12 hr after birth, only B5 and I5 lambs preferred their mother to an alien ewe however, B5 were faster at choosing their mother at the beginning of the test. B2.5 and I2.5 lambs made a random choice. In Experiment 2, suckling was prevented and replaced by human giving, in the presence of the mother, either a bottle of water (B2.5: 2.5% BW, divided into seven portions over 12 hr) or water via tube-feeding (I10 and I2.5: 10% or 2.5% BW, also divided into seven portions over 12 hr). During a two-choice test at 12 hr, tube-fed lambs (I10 and I2.5) preferred their mother to a human. B2.5 lambs were equally attracted to both partners and spent more time near the human than lambs from the other groups. In a test of reactivity to a human performed on neonates isolated from their mother, B2.5 lambs explored the human much more than the other lambs. The presence of the human had soothing properties in B2.5 lambs and once the human left, they were the only lambs displaying enhanced vocal and locomotor activity. In these experiments, nonnutritive gastrointestinal stimuli induced a preference for the mother whereas nonnutritive sucking led to a strong positive relationship with the human. These results suggest that when lambs suckle their dam, the development of filial bonding is facilitated through the combined effects of oral and gastrointestinal stimuli.

Analysis of Variance↗
PubMed1998

Gastrostomy using a "Gastrofix" as an alternative for nasogastric tubes in ovarian cancer surgery.

OBJECTIVE: The aim of this study was to evaluate the use of a gastrostomy instead of a nasogastric tube following surgery for advanced ovarian cancer. DESIGN: This was a retrospective observational study. SETTING: The study was performed in a university teaching hospital. PARTICIPANTS: Thirty-four women undergoing debulking surgery for ovarian carcinoma participated. METHODS: In order to increase patients' comfort during the first postoperative days we inserted for gastric decompression a transcutaneous instead of a transnasal tube following debulking surgery. Only patients with bowel involvement and/or extensive tumor load in the upper abdomen were included in the study. In this study we report on the use of a gastrostomy using a Cystofix drainage catheter, resulting in what we call a "Gastrofix." The Gastrofix was placed in 34 patients with ovarian cancer. In 32 (94%) patients an extraperitoneal hysterectomy and bilateral salpingo-oophorectomy was performed, in 16 (47%) a resection of the diaphragmatic peritoneum, in 14 (41%) patients a paraaortic lymphadenectomy, and in 12 (35%) patients part of the bowel was resected. RESULTS: Free oral liquid intake and poor fiber diet were started after 5.5 days (median, range from 3-8 days) and 8 days (median, range from 4-12 days), respectively. The catheter was clamped off after 5 days (median, range from 2-8 days) and removed after 7 days (median, range from 3-11 days). Of the 34 patients only 12 (35%) received antiemetics (median of 4 days, range from 1-7 days). In 1 patient (3%) pain at the insertion site was observed on the third and fourth postoperative days. In 3 patients (9%) some fluid leakage at the insertion site was noted. In 4 patients (12%) the catheter fell out prematurely on days 0, 4, 6, and 9, respectively. In none of the patients were infection or fistulas at the insertion site noted. In all patients there was a satisfactory drainage of gastric content. CONCLUSION: After debulking surgery, the use of a Gastrofix resulted in an adequate gastrointestinal decompression without major complications. This technique may increase the comfort of the patient during the postoperative phase considerably.

Equipment Design↗
PubMedDate not supplied

Combination of midazolam and flumazenil in upper gastrointestinal endoscopy, a doubleblind randomized study.

We evaluated the clinical usefulness of flumazenil (formerly Ro15-1788), a benzodiazepine antagonist, in combination with midazolam in upper gastrointestinal endoscopy. Thirty outpatients were randomized into two groups: those receiving flumazenil and those receiving placebo after endoscopy. For sedation, only midazolam was used. Performances pre-sedation and post-sedation (at 30 and 60 min) were analyzed using the Trieger test, Number Connection test, and Digit Symbol test. Patients receiving flumazenil were fully alert and able to ambulate 5 min after injection with this medication. Performances at 30 min in the Trieger, Number Connection, and Digit Symbol tests were significantly better in the group receiving flumazenil, p less than 0.005, p less than 0.025, and p less than 0.01, respectively. No phlebitis, nausea, vomiting, or anxiety were noted. No resedation events were documented. We conclude that flumazenil can dramatically shorten the recovery period following sedation with midazolam in upper gastrointestinal endoscopy, and its use is not associated with major side effects.

Adult↗
PubMed1989

Tube feeding. Providing the most nutrition with the least discomfort.

In patients who cannot or will not eat, nutrition can be provided by enteral feeding through a gastrostomy or jejunostomy tube (or a nasogastric tube if use is to be brief). Endoscopic placement of tubes is increasing in popularity. Numerous enteral formulas have been devised to provide complete nutrition in a variety of circumstances, and special formulas are available for patients with malabsorption or hepatic, renal, or lung disease. Mechanical, metabolic, and gastrointestinal complications of enteral feeding are possible, but taking precautions by ordering specific techniques can reduce the risk.

Dietary Carbohydrates↗