scholarly journals Rare case of dual gastrointestinal perforations

2020 ◽  
Vol 13 (3) ◽  
pp. e233658
Author(s):  
David Hudson ◽  
Jonathan Foo ◽  
Jason Robertson
Keyword(s):  
Adjuvant Radiotherapy ◽  
Inflammatory Markers ◽  
Rare Case ◽  
Neck Surgery ◽  
Oesophageal Perforation ◽  
Invasive Squamous Cell Carcinoma ◽  
Percutaneous Gastrostomy ◽  
Floor Of Mouth ◽  
Prior Surgery ◽  
Percutaneous Gastrostomy Tube

A 49-year-old man presented to the nearest emergency department profoundly septic with significantly raised inflammatory markers. He had a background of floor of mouth invasive squamous cell carcinoma for which he underwent complex head and neck surgery followed by adjuvant radiotherapy and insertion of a percutaneous gastrostomy tube for feeding. He experienced 3 weeks of retching, cough and malaise. Imaging revealed both an oesophageal perforation and perforated duodenal ulcer, presumed secondary to oesophageal stricturing from his prior surgery and radiotherapy.

scholarly journals Communication surrounding initiation and withdrawal of non-invasive ventilation in adults with Motor Neuron(e) Disease: clinicians’ and family members’ perspectives

2021 ◽  
pp. 205343452110101
Author(s):  
Charlotte Chapman ◽  
Sara Bayes ◽  
Moira Sim
Keyword(s):  
Family Members ◽  
Interpretive Description ◽  
Invasive Ventilation ◽  
Percutaneous Gastrostomy ◽  
International Guidelines ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Percutaneous Gastrostomy Tube ◽  
Depth Interviews ◽  
Deceased People

Introduction International guidelines recommend that health care clinicians communicate with people with MND and their family members about non-invasive ventilation (NIV) and percutaneous gastrostomy tube (PEG) prior to or at the onset of respiratory symptoms. This study sought to discover the degree to which these recommendations are followed in practice. Methods Interpretive Description methodology was employed. Nineteen clinicians experienced in caring for people with MND, six relatives of recently deceased people with MND and one person with MND participated in semi-structured in-depth interviews. Clinicians’ accounts of NIV and PEG related communications were compared to family member participants’ recollections of their own discussions with clinicians. Data were analysed thematically. Results Six major themes emerged that together capture the factors that impact practitioner-patient-family communications about NIV and PEG. Some clinicians were unaware of MND guidelines particularly communicating the burdens or possible withdrawal of NIV or found them challenging to implement. Consequently, family participants reported that they and their relatives with MND found clinicians’ communication on these topics inadequate. This led to them ‘topping up’ their knowledge from less authoritative sources, predominantly the internet. Discussion Clinicians’ lack of awareness of the international guidelines and discomfort about discussing the benefits and burdens of NIV and PEGs means some people with MND and their families may be unprepared for the consequences of using and ceasing NIV.

scholarly journals Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status

Nutrients ◽  
2020 ◽  
Vol 13 (1) ◽  
pp. 57
Author(s):  
Adam Brewczyński ◽  
Beata Jabłońska ◽  
Sławomir Mrowiec ◽  
Krzysztof Składowski ◽  
Tomasz Rutkowski
Keyword(s):  
Head And Neck ◽  
Nutritional Support ◽  
Nutritional Intervention ◽  
Nutritional Risk ◽  
Percutaneous Gastrostomy ◽  
Critical Weight ◽  
Oncological Treatment ◽  
Feeding Tubes ◽  
Hpv Status ◽  
Percutaneous Gastrostomy Tube

Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.

scholarly journals Primary maxillofacial chordoma: a rare case report and literature review

2019 ◽  
Vol 47 (9) ◽  
pp. 4575-4579
Author(s):  
Yu Cui ◽  
Xiang-yan Cui ◽  
Tingting Yu ◽  
Zhan-peng Zhu ◽  
Xin Wang
Keyword(s):  
Adjuvant Radiotherapy ◽  
Rare Case ◽  
Postoperative Radiotherapy ◽  
Eastern Cooperative Oncology Group ◽  
Treatment Strategies ◽  
Comprehensive Treatment ◽  
Neck Lymph Node ◽  
Group Score ◽  
Rare Case Report

Primary maxillofacial chordoma is extremely rare. We herein report a very rare case of a recurrent maxillofacial chordate tumor that was diagnosed in a 56-year-old woman who underwent three tumor resections. After surgical treatment, the patient healed well with an Eastern Cooperative Oncology Group score of 1. She was discharged to a local hospital for adjuvant radiotherapy. Close follow-up was ongoing at the time of this writing. Radical surgery and adjuvant radiotherapy remain the main treatment strategies for chordoma. Postoperative radiotherapy is particularly important. Our experience is to administer a total dose of 50 Gy to a clearly delineated target. If appropriate comprehensive treatment is available, distant metastasis of primary chordoma is rare, and neck dissection is therefore not generally recommended. Neck lymph node dissection is generally not recommended.

scholarly journals Percutaneous gastrostomy tube placement in a patient with prior sleeve gastrectomy

2021 ◽  
Vol 5 ◽  
pp. 23
Author(s):  
Taylor Alexander Pate ◽  
Daniel William O’Neal ◽  
Chris Dobzyniak
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Weight Loss Surgery ◽  
The United States ◽  
Tube Placement ◽  
Percutaneous Gastrostomy ◽  
Number Of Patients ◽  
Gastrostomy Tube Placement ◽  
Gastrostomy Tubes ◽  
Percutaneous Gastrostomy Tube

Sleeve gastrectomies have quickly become the most common bariatric weight loss surgery performed in the United States (U.S.). Given that hundreds of thousands of gastrostomy tubes (G tubes) are also placed each year, the number of patients with prior sleeve gastrectomies requiring a G tube will surely rise in the coming years. The case presented herein is a patient with prior sleeve gastrectomy who underwent percutaneous G tube placement.

Abstract TMP84: Percutaneous Gastrostomy Tube, but not Tracheostomy, Predicts 30-Day Readmissions in Spontaneous Intracerebral Hemorrhage: An Analysis of the 2013 Nationwide Readmissions Database

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Angela Hays Shapshak ◽  
John P Donnelly ◽  
Farhaan Vahidy ◽  
Karen C Albright
Keyword(s):  
Intracerebral Hemorrhage ◽  
Survey Design ◽  
Tube Placement ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Post Discharge ◽  
Percutaneous Gastrostomy ◽  
Design Variables ◽  
Nationally Representative ◽  
Percutaneous Gastrostomy Tube ◽  
Peg Tube

Background: Spontaneous intracerebral hemorrhage (sICH) is associated with substantial disability, accounting for considerable resource utilization among stroke survivors. Debate exists about the timing and utilization of tracheostomy (Trach) and percutaneous gastrostomy (PEG) tube placement in sICH patients. We hypothesized that sICH survivors with PEG and/or Trach would have higher odds of 30-day readmission. Methods: We analyzed the 2013 Nationwide Readmissions Database, a nationally representative sample of hospital discharges. Patients with a primary discharge diagnosis of sICH (ICD-9 code 431) were included in the analysis. Repeat, pediatric, same-day events, head trauma, AVM/fistula, and discharges occurring in December were excluded. Patients who received PEG and/or Trach were identified using published algorithms. We defined readmission as any admission within 30-days of index hospitalization discharge. Odds ratios for 30-day readmission comparing exposed versus unexposed were estimated with adjustment for demographics, risk factors, and concurrent illness. All analyses were performed using survey design variables. Results: Among the 32,715 sICH index hospitalizations, 3,480 (10.6%) received a PEG and 1806 (5.5%) received a Trach. Overall 4,320 (13.2%) were readmitted within 30 days (PEG 20.5%, trach 18.9%). In the fully adjusted models, sICH patients with PEG had higher odds of readmission (OR 1.43, 95% CI 1.14-1.80), while patients with trach did not (OR 0.77, 95% CI 0.54-1.11). Predictors of readmission among individuals with and without PEG and Trach will be presented. Conclusions: sICH patients who underwent PEG placement had higher odds of 30-day readmission while patients receiving Trach did not. This finding suggests that heightened post-discharge surveillance of individuals receiving PEG may be warranted.

Balloon-Assisted, Fluoroscopically Guided Percutaneous Gastrostomy Tube Placement

2018 ◽  
Author(s):  
Joseph Farnam ◽  
Jason Iannuccilli ◽  
Gregory Soares
Keyword(s):  
Balloon Catheter ◽  
Gastrostomy Tube ◽  
Tube Placement ◽  
Percutaneous Gastrostomy ◽  
Patient Discomfort ◽  
Clinical Scenarios ◽  
Tract Dilation ◽  
Gastrostomy Tube Placement ◽  
Gastrostomy Tubes ◽  
Percutaneous Gastrostomy Tube

Fluoroscopic placement of gastrostomy tubes requires creation and dilation of a percutaneous tract through which the tube is placed. Given the relatively large caliber of these tubes, aggressive dilation of the percutaneous tract is necessary prior to their insertion. Tract dilation is most commonly performed via the use of several sequential dilators or a single telescoping serial dilator. These methods are cumbersome and relatively time-consuming, and as a result this portion of the procedure can result in considerable patient discomfort as well as technical complications. This chapter describes the use of a balloon catheter for gastrostomy creation. It describes clinical scenarios that would benefit from gastrostomy tube placement. The procedure is described in a step-by-step manner with a focus on gastrostomy tract dilatation.

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