scholarly journals Long Term Monitoring of Patients with Positive Lupus Anticoagulant and Antiphospholipid Antibodies. Are All Cases Persistently Positive?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1452-1452
Author(s):  
Matthew R. Kovacs ◽  
Alejandro Lazo-Langner ◽  
Martha L Louzada ◽  
Michael J. Kovacs
Keyword(s):  
Anticoagulant Therapy ◽  
Antiphospholipid Antibodies ◽  
Research Funding ◽  
Positive Test ◽  
Confirmatory Test ◽  
Repeat Testing ◽  
Repeat Test ◽  
The Mean ◽  
Mean Time

Abstract Background. Lupus Anticoagulants (LA) and Antiphospholipid Antibodies (APLA) are known to be associated with both arterial and venous thromboembolism (VTE). The implications of positive test results often include indefinite anticoagulant therapy and thus accurately identifying these patients is important. Current guidelines for laboratory testing of both LA and APLA, require that initial positive results are confirmed by repeat testing at least 12 weeks after initial positivity to be considered diagnostic. Repeat testing is not routinely performed once a patient is deemed to be positive. If repeat testing is performed years after initial confirmation and is negative, the clinical implications of this are not certain and there are no criteria to determine which patients can safely be considered negative. We aimed to determine the proportion of patients with positive LA or APLA who remained positive at least 2 years after initial confirmation. Methods. We retrospectively reviewed a cohort of patients with positive LA and APLA evaluated at the Thrombosis Clinic of the London Health Sciences Centre (London, Ontario, Canada) between 1998 and 2016 and who had repeat LA/APLA tests done at least 2 years after the initial LA/APLA positive confirmation. LA testing was done as per the International Society on Thrombosis and Haemostasis criteria available at the time of testing, using dilute Russell viper venom time screening and confirmatory tests in all cases. APLA testing was done using commercial enzyme-linked immunosorbent assays (Louisville APL Diagnostics Inc. or Inova Diagnostics Inc.), according to the manufacturers' instructions. Results. We included 73 patients (39 [53.4%] female). The average age at diagnosis of LA or APLA was 49.3 years. The average follow-up was 103.1 months (range 24 to 218 months). At diagnosis, 57 (78%) patients had a VTE (26 deep vein thrombosis [DVT], 16 pulmonary embolism [PE], 17 both DVT and PE), 10 had a stroke or transient ischemic attack (TIA) and 3 myocardial infarction (MI). Warfarin was the most common long-term anticoagulant used (66 of 73 patients). Nine patients were treated with rivaroxaban, 5 with LMWH, and 1 patient was treated with edoxaban. A total of 4 patients did not require anticoagulant therapy. Eleven (15.1%) patients suffered a recurrent thrombotic event while on anticoagulant therapy, (5 DVT, 5 PE, 1 DVT and PE). Nine of the recurrent events occurred while the patient was being treated with warfarin. Four of the 40 female patients suffered at least one miscarriage. One patient died while being followed due to complications from renal failure. The mean time between the first positive test and the first confirmatory test was 8.9 months (range 3 to 132), whereas the mean time between the first confirmatory test and the first repeat test was 68.9 months (range 24 to 207). Thirty-seven (50.6%) patients were negative on the second repeat test. All of them remained on anticoagulants. Conclusion. Our results suggest that up to 50% of patients became negative for LA and/or APLA at least 2 years after initial positivity, particularly if only one type of test was positive at diagnosis. The clinical relevance of this result is not certain including implications about discontinuing anticoagulant therapy. Further research in this relevant matter is warranted. Table Table. Disclosures Lazo-Langner: Pfizer: Honoraria; Bayer: Honoraria; Daiichi Sankyo: Research Funding. Louzada:Pfizer: Honoraria; Janssen: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Bayer: Honoraria. Kovacs:Daiichi Sankyo Pharma: Research Funding; LEO Pharma: Honoraria; Bayer: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding.

scholarly journals Surveillance System in Smart Cities: A Dependability Evaluation Based on Stochastic Models

Electronics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 876
Author(s):  
Igor Gonçalves ◽  
Laécio Rodrigues ◽  
Francisco Airton Silva ◽  
Tuan Anh Nguyen ◽  
Dugki Min ◽  
...  
Keyword(s):  
Surveillance System ◽  
Smart Cities ◽  
Heterogeneous Data ◽  
Time To Failure ◽  
Video Streams ◽  
Dependability Evaluation ◽  
The Mean ◽  
Mean Time ◽  
The Internet Of Things

Surveillance monitoring systems are highly necessary, aiming to prevent many social problems in smart cities. The internet of things (IoT) nowadays offers a variety of technologies to capture and process massive and heterogeneous data. Due to the fact that (i) advanced analyses of video streams are performed on powerful recording devices; while (ii) surveillance monitoring services require high availability levels in the way that the service must remain connected, for example, to a connection network that offers higher speed than conventional connections; and that (iii) the trust-worthy dependability of a surveillance system depends on various factors, it is not easy to identify which components/devices in a system architecture have the most impact on the dependability for a specific surveillance system in smart cities. In this paper, we developed stochastic Petri net models for a surveillance monitoring system with regard to varying several parameters to obtain the highest dependability. Two main metrics of interest in the dependability of a surveillance system including reliability and availability were analyzed in a comprehensive manner. The analysis results show that the variation in the number of long-term evolution (LTE)-based stations contributes to a number of nines (#9s) increase in availability. The obtained results show that the variation of the mean time to failure (MTTF) of surveillance cameras exposes a high impact on the reliability of the system. The findings of this work have the potential of assisting system architects in planning more optimized systems in this field based on the proposed models.

P14.67 Long-term results of gamma knife radiosurgery for treatment of intracranial glomus jugulare tumors

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii50-ii51
Author(s):  
R M Emad Eldin ◽  
K M Abdel Karim ◽  
A M N El-Shehaby ◽  
W A Reda ◽  
A M Nabeel ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Long Term Results ◽  
Glomus Jugulare ◽  
The Mean ◽  
Mean Time

Abstract BACKGROUND Glomus Jugulare tumors are benign but locally aggressive ones that represent a therapeutic challenge. Previous studies about the use of Gamma Knife Radiosurgery (GRS) in those tumors have documented good results that needed larger number of patients and longer follow up periods to be confirmed. MATERIAL AND METHODS Between August 2001 and December 2017, 70 patients with glomus jugulare tumors were treated at the Gamma Knife Center, Cairo. They were 46 females and 24 males. The mean age was 48 years (16–71 years). Nineteen of these patients were previously operated, 5 were partially embolized, 3 underwent embolization and subsequent surgery and 43 had gamma knife as their primary treatment. Volume-staged gamma knife radiosurgery was used in 10 patients and single-session in 60 patients, with a total of 86 sessions. The mean target volume was 12.7 cm3 (range 0.2 to 34.5 cm3). The mean tumor volume was 15.5 cm3 (range 0.2 to 105 cm3). The mean prescription dose was 14.5 Gy (range 12 to 18 Gy). RESULTS The mean follow up period was 60 months (range 18 to 206 months), and by the time of the data analysis, two of the patients were dead (66 and 24 months after GK treatment). The tumor control was 98.6% (69/70). Thirty-two tumors became smaller and 37 were unchanged. The symptoms improved in 36 patients, were stable in 32 patients, and worsened in 2 patients who developed a transient facial palsy and worsened hearing. Symptomatic improvement began before any reduction in tumor volume could be detected, where the mean time to clinical improvement was 7 months whereas the mean time to tumor shrinkage was 18 months. CONCLUSION This study about the long term follow up of the GKR for the intracranial glomus jugulare tumors confirmed that this is a highly effective and safe treatment. This data shows that the clinical improvement is not correlated with the radiological volume reduction.

The use of deslorelin implants for the long-term contraception of lionesses and tigers

2008 ◽  
Vol 35 (6) ◽  
pp. 525 ◽  
Author(s):  
H. J. Bertschinger ◽  
M. A. de Barros Vaz Guimarães ◽  
T. E. Trigg ◽  
A. Human
Keyword(s):  
South Africa ◽  
Effective Means ◽  
Panthera Leo ◽  
Ovarian Activity ◽  
Panthera Tigris ◽  
Field Observations ◽  
The Mean ◽  
Free Ranging ◽  
Mean Time

Contraception is an essential tool for controlling reproduction in captive and free-ranging lions. This paper describes the treatment and contraception of 23 captive and 40 free-ranging lionesses (Panthera leo) and four captive tigers (Panthera tigris) in South Africa using 3 × 4.7 mg, 2 × 4.7 mg, 9.4 mg or 4.7 + 9.4 mg deslorelin implants. Thirty-one lionesses were treated more than once at 11- to 60-month intervals. In Brazil, two lionesses were treated with 9.4-mg implants and faecal progesterone and oestradiol concentrations were monitored for 920 days. All combinations of deslorelin showed the length of contraception to be around 30 months with one 3 × 4.7 mg treatment lasting 40 months in one captive lioness. The mean time taken to reconception was 30.1 months for the 3 × 4.7 mg combination. The faecal analyses of the lionesses in Brazil reflected quiescent ovarian activity for periods of 17 and 30 months, respectively, when small oestradiol peaks but no progesterone peaks started to appear. This confirmed the field observations in South Africa. No side effects occurred although several of the lionesses were treated repeatedly for up to 8 years. Deslorelin (Suprelorin) is a safe and effective means of controlling reproduction in captive or free-ranging populations of lions. Where contraception is to be maintained, the implementation of implants at 24-month intervals is recommended.

Percutaneous Fasciotomy for Dupuytren’s Contracture

1997 ◽  
Vol 22 (4) ◽  
pp. 521-522 ◽  
Author(s):  
R. A. DUTHIE ◽  
R. B. CHESNEY
Keyword(s):  
Long Term Results ◽  
Dupuytren’S Contracture ◽  
Dupuytren's Contracture ◽  
The Mean ◽  
Mean Time ◽  
Palmar Skin

Percutaneous fasciotomy has long been established as a treatment for Dupuytren’s contracture. There have been no studies to date of the long-term results of this procedure. We followed up a group of 82 patients 10 years after operation in 1981 and 1982. Thirty-four per cent had had no further surgery. The mean time to further surgery in the rest was 60.4 months. Splitting of the palmar skin which healed with regular dressings occurred in three cases. No other complications were noted. Percutaneous fasciotomy can produce lasting improvement in patients with Dupuytren’s contracture and still has an important role in their overall management.

scholarly journals The Majority of Inpatient Short Synacthen Tests Are Performed Incorrectly, Due to Imprecise Timing, Incorrect Sampling and Failure to Interrupt Steroid Administration

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A98-A99
Author(s):  
Aonghus McCarthy ◽  
Susan McKenna ◽  
Keira Hall ◽  
Aileen Niland ◽  
Gerard P Boran ◽  
...  
Keyword(s):  
Hospital Staff ◽  
Repeat Testing ◽  
Steroid Administration ◽  
Synacthen Test ◽  
The Mean ◽  
Short Synacthen Test ◽  
Mean Time ◽  
Sample Window ◽  
Serum Acth ◽  
Interpretation Of Results

Abstract Introduction: The short synacthen test (SST) is commonly used to assess adrenal function. Accurate timing and appropriate holding of exogenous steroids are essential to ensure correct interpretation of results. Aims & Methods: We reviewed all SSTs performed on inpatients in our hospital over a 1-year period, in order to determine accuracy of testing. Results: 42 patients (Male 15, Female 27), with mean age 68 years (range 43–90), underwent SST. The majority (39/42; 93%) of tests were requested by internal medicine physicians. The indications for testing were; suspected adrenal insufficiency (18), HPA axis suppression (9), fatigue (7), hyponatremia (5), suspected pituitary disease (2) and vomiting (1). 7 (44%) of the 16 patients taking steroids did not have medication appropriately held. 31 (74%) patients did not have serum ACTH measured prior to the test. 28 (66%) tests were not started at the correct time. Only 10 (24%) of the 30 minute samples were completed within the 25-35min sample window. The mean time between the 0min and 30min samples was 42mins (median 62mins; range 0-209mins). 12 (29%) tests involved an unnecessary 60min sample. 8 (19%) tests had no interpretation of results documented in the medical notes. 4 (10%) patients underwent repeat testing, necessitated by an incorrect first test. Discussion: The vast majority of inpatient SSTs (33/42;79%) were performed suboptimally, with the most common errors pertaining to incorrect timing of the test, inaccurate sampling and inappropriate pre-test steroid administration. Considering these errors, some results may have been interpreted incorrectly. Repeat tests were recognised as required in 10% of patients, with associated inconvenience, cost and discomfort. Improved training and guidelines for performing SSTs should be available to hospital staff to ensure more accurate application of the test.

scholarly journals Meta-Analysis of Long-Term Risk of Recurrent Venous Thromboembolism after Stopping Anticoagulation in Men and Women with First Unprovoked Venous Thromboembolism

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2527-2527 ◽  
Author(s):  
Faizan Khan ◽  
Alvi Rahman ◽  
Marc Carrier ◽  
Clive Kearon ◽  
Jeffrey I. Weitz ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Anticoagulant Therapy ◽  
Research Funding ◽  
Meta Analysis ◽  
First Year ◽  
Advisory Committees ◽  
Men And Women ◽  
Second Year ◽  
Recurrent Vte

Abstract Background: The optimal duration of anticoagulation after a first unprovoked venous thromboembolism (VTE) is uncertain. Anticoagulant therapy is highly effective at reducing the risk of recurrent VTE, but this clinical benefit is not maintained once anticoagulation is stopped. Current guidelines suggest considering indefinite anticoagulation in all patients with unprovoked who have a non-high bleeding risk. However, this is a weak recommendation based on limited evidence. Deciding whether patients with a first unprovoked VTE should be considered for indefinite anticoagulant therapy requires estimation of the long-term risk of recurrent VTE after stopping anticoagulation. This risk however, is poorly established, hindering decision making. Methods: We performed a systematic review and meta-analysis of randomized clinical trials and prospective observational studies to determine the rate of recurrent VTE in the first year, in the second year, between years 2 and 5, and years 5 and 10; and the cumulative incidence for recurrent VTE at 2, 5 and 10 years after stopping anticoagulation in men and women with first unprovoked VTE, who had completed at least 3 months of initial treatment. Studies were identified through a comprehensive literature search using MEDLINE, EMBASE and the Cochrane CENTRAL databases. Data clarifications were requested from authors of eligible studies. Rates of recurrent VTE were calculated for each study from the total number of recurrent VTE events divided by the person-years of follow-up, and then pooled using random-effects meta-analysis. Results: Fourteen studies involving 6, 446 patients were included in the analysis. Among men with a first unprovoked VTE, the pooled rate of recurrent VTE per 100 person-years after stopping anticoagulation was 11.2 events (95% CI, 9.0-13.6) in the first year; 7.4 events (95% CI, 5.5-9.5) in the second year; 4.4 events/year (95% CI, 3.2-5.7) between years 2 and 5, and 3.8 events/year (95% CI, 1.6-6.9) between years 5 and 10 [Table 1]. Among women with a first unprovoked VTE, the pooled rate of recurrent VTE per 100 person-years after stopping anticoagulation was 8.6 events (95% CI, 6.5-11.0) within the first year; 5.2 events (95% CI, 3.5-7.2) in the second year; 3.0 events/year (95% CI, 1.6-4.7) between years 2 and 5, and 2.0 events/year (95% CI, 1.3-2.9) between years 5 and 10 [Table 1]. In men and women respectively, the cumulative incidence for recurrent VTE was 17.8% (95% CI, 14.0%-21.9%) and 13.4% (95% CI, 9.8%-17.4%) at 2 years, 28.2% (95% CI, 22.0%-34.4%) and 20.9% (95% CI, 14.0%-28.5%) at 5 years, and 40.8% (95% CI, 28.0%-53.9%) and 28.5% (95% CI, 19.5%-38.3%) at 10 years after stopping anticoagulant therapy [Table 2]. Conclusions: Among patients with a first unprovoked VTE who have completed at least 3 months of initial treatment, men have a higher long-term risk of recurrent VTE after stopping anticoagulation, and may be given greater consideration for indefinite anticoagulant therapy. Our findings affirm the importance of considering patient's sex in deciding the optimal duration of anticoagulation, and as such, emphasize the need for individualized, patient-centered approach for the long-term management of unprovoked VTE. Disclosures Carrier: BMS: Honoraria, Research Funding; Leo Pharma: Research Funding; Pfizer: Honoraria; Bayer: Honoraria. Weitz:Bristol-Myers Squibb: Honoraria; Daiichi-Sankyo: Honoraria; Ionis: Consultancy, Honoraria; Janssen: Honoraria; Servier: Honoraria; Novartis: Honoraria; Bayer: Honoraria; Boehringer Ingelheim: Honoraria, Research Funding. Schulman:Boehringer-Ingelheim: Honoraria, Research Funding; Daiichi-Sankyo: Honoraria; Sanofi: Honoraria; Bayer: Honoraria. Couturaud:Pfizer: Research Funding; Bayer: Honoraria, Other: Travel Support; AstraZeneca: Honoraria; Actelion: Other: Travel Support; Intermune: Other: Travel Support; Leo Pharma: Other: Travel Support; Daiichi Sankyo: Other: Travel Support. Becattini:Bayer HealthCare: Other: Lecture Fees; Boehringer Ingelheim: Other: Lecture Fees; Bristol Meyer Squibb: Other: Lecture Fees. Agnelli:Daiichi Sankyo: Other: Personal Fees; Boehringer Ingelheim: Other: Personal Fees; Bayer Healthcare: Other: Personal Fees; Pfizer: Other: Personal Fees; Bristol-Myers-Squibb: Other: Personal Fees. Brighton:Glaxo Smith Klein: Other: Personal Fees; Novo Nordisk: Other: Personal Fees; Bayer: Other: Personal Fees. Lensing:Bayer: Employment. Prins:Pfizer: Consultancy; Daiichi Sankyo: Consultancy. Hutton:Cornerstone Research Group: Honoraria. Palareti:Roche: Membership on an entity's Board of Directors or advisory committees; Werfen: Speakers Bureau; Alfa-Wassermann: Membership on an entity's Board of Directors or advisory committees; Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees. Prandoni:Pfizer: Consultancy; Daiichi-Sankyo: Consultancy; Sanofi: Consultancy; Bayer: Consultancy. Büller:Pfizer: Consultancy, Research Funding; Daiichi-Sankyo: Consultancy, Research Funding; Roche: Consultancy, Research Funding; Sanofi-Aventis: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Bayer: Consultancy, Research Funding; Boehringer Ingelheim: Consultancy, Research Funding; Thrombogenics: Consultancy, Research Funding; Isis: Consultancy, Research Funding; GlaxoSmithKline: Consultancy, Research Funding. Rodger:Biomerieux: Research Funding.

scholarly journals Clinical features and outcomes of bowel perforation in primary pediatric gastrointestinal lymphoma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiayu Yan ◽  
Yanlong Duan ◽  
Tingting Liu ◽  
Jianlin Guo ◽  
Chunhui Peng ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Bowel Perforation ◽  
Outpatient Department ◽  
Gastrointestinal Lymphoma ◽  
Long Term Follow Up ◽  
The Mean ◽  
Mean Time ◽  
Prompt Diagnosis

Abstract Background Whether surgery can improve the prognosis of patients with primary pediatric gastrointestinal lymphoma (PPGL) who experienced bowel perforation remains controversial. This study aimed to evaluate the prognosis of such patients. Methods Nine patients pathologically diagnosed with PPGL who experienced perforation at our center between January 2010 and December 2020 were enrolled and divided into two groups: those with perforation during (n = 4) and before (n = 5) chemotherapy. Their medical records were reviewed, and long-term follow-up was conducted by telephone in February 2021. Results All patients with perforation during chemotherapy were diagnosed with PPGL in the outpatient department. The mean time from outpatient visit to chemotherapy was 17.3 ± 6.1 days. Two patients experienced perforation during the first chemotherapy regimen and received conservative treatment, while the others developed perforation after multiple chemotherapy regimens and underwent surgery. All of the patients received regular chemotherapy and survived for a mean follow-up time of 3.8 ± 1.9 years. No patient with perforation before chemotherapy had a definite diagnosis in the outpatient department. Among these patients, 4 experienced perforation and underwent surgery, of whom 3 developed perforation-related complications and died; the other recurred after chemotherapy. Only the patient who received conservative treatment was diagnosed with PPGL before chemotherapy, received regular chemotherapy, and survived without a recurrence for 1.0 year. Conclusion Prompt diagnosis and chemotherapy improve the prognosis of PPGL. Surgery does not affect the prognosis of patients with perforation during chemotherapy but may accelerate disease progression in patients with perforation before chemotherapy.

Use of circular external skeletal fixator constructs to stabilize tarsometatarsal arthrodeses in three dogs

2004 ◽  
Vol 17 (04) ◽  
pp. 204-209 ◽  
Author(s):  
D. D. Lewis ◽  
R. W. Jones ◽  
R. C. Hill ◽  
G. M. Anderson ◽  
K. B. Halling
Keyword(s):  
Functional Outcome ◽  
Weight Bearing ◽  
Antibiotic Administration ◽  
Systemic Antibiotic ◽  
The Mean ◽  
Mean Time

SummaryThis report describes the use of circular external skeletal fixator (CESF) constructs for the stabilization of unilateral tarsometatarsal arthrodeses in three dogs with traumatic intertarsal or tarsometatarsal fracture/luxation injuries. The application of the CESF was performed following a limited approach to the intertarsal and tarsometatarsal joints. All three of the dogs developed post-operative wire tract inflammation with drainage and two dogs developed osteomyelitis. These complications resolved with systemic antibiotic administration, debridement, and/or wire removal, after which all of the dogs tolerated the CESF well and resumed weight-bearing on the affected limb. The mean time to CESF removal was 16 weeks. The CESF construct provided sufficient stabilization for progressive union of the tarsometatarsal arthrodeses with a good long-term functional outcome in all three of the dogs.

Antiphospholipid Syndrome On Cloud (APSOnCloud): web-based monitoring of oral anticoagulation

Lupus ◽  
2016 ◽  
Vol 26 (2) ◽  
pp. 179-185
Author(s):  
F Nogueira ◽  
F Signorelli ◽  
R A Levy
Keyword(s):  
Antiphospholipid Syndrome ◽  
Oral Anticoagulation ◽  
Antiphospholipid Antibodies ◽  
International Normalized Ratio ◽  
Testing Procedure ◽  
Vitamin K Antagonist ◽  
Web Based ◽  
Frequent Monitoring ◽  
The Mean ◽  
Mean Time

Antiphospholipid Syndrome (APS) is an autoimmune disease characterized by recurrent thromboses and fetal losses with the presence of antiphospholipid antibodies. The main treatment to prevent recurrent thrombotic events is oral anticoagulation with vitamin K antagonist (VKA), which requires frequent monitoring and dosage adjustments. Outpatient anticoagulation monitoring has its limitations, such as patients spending long hours between the testing procedure and waiting for the results to be adjusted. To optimize this adjustment and to improve APS patients-doctors relationship, we developed a website to help monitor APS patients, called Antiphospholipid Syndrome On Cloud or APSOnCloud. To test it, since March 2014 to March 2016, we registered 20 patients with APS that have inserted 132 international normalized ratio (INR) values. Sixty two percent were out of range and it took on average 7 hours for the doctor in charge to adjust these values. The mean time in therapeutic range was 58.1%. Our preliminary experience in monitoring VKA oral anticoagulation on APSOnCloud suggests that patients with APS might benefit from this web-based monitoring.

The Pharyngostomy Tube: Indications, Technique, Efficacy, and Safety in Modern Surgical Practice

2016 ◽  
Vol 66 (05) ◽  
pp. 390-395
Author(s):  
Jonathan Berger ◽  
Rafael Andrade ◽  
Eitan Podgaetz ◽  
Rafael Garza-Castillon
Keyword(s):  
Tube Placement ◽  
Nasogastric Tubes ◽  
Tube Removal ◽  
Gastric Decompression ◽  
Enteral Access ◽  
The Mean ◽  
Nasogastric Tube Placement ◽  
Mean Time ◽  
Straightforward Approach

Background Long-term nasogastric tubes are uncomfortable and associated with complications such as impairment with speech and swallowing, septum trauma, epistaxis, alar necrosis, and intubation of the trachea among others. Pharyngostomy tubes (PTs) are an alternative for prolonged enteral feeding, transluminal drainage of collections, and gastric decompression in patients with an intestinal obstruction and an inoperable abdomen. Patients and Methods This is a retrospective analysis of patients who had a PT placed at our institution from May 2005 to March 2015. The primary end point of the study was to establish the type and rate of complications and aspiration events related to PT use. Results During the specified period, a total of 84 PTs were placed. The most common indication for PT placement was enteric decompression in 65 (77.4%), followed by transluminal collection drainage in 12 (14.3%), and enteral access for nutrition in 7 (8.3%) patients. The mean time to tube removal was 17.8 days ± 17.1 (range, 2–119). We encountered 10 (11.2%) complications related to PT placement, including 7 cases of cellulitis, 2 superficial abscesses, and 1 patient with pharyngeal hemorrhage. Conclusion PTs are a relatively simple, safe, and straightforward approach to achieve long-term enteral decompression, access for feeding or transluminal drainage, avoiding the complications associated with prolonged nasogastric tube placement. The complication rate is low and patient satisfaction and compliance appear to be higher than with nasogastric tubes. Modern surgeons should be familiar with the procedure and technique. PTs should be part of every surgeon's armamentarium.

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