scholarly journals Laparoscopic Jejunostomy as the standard procedure of Jejunostomy tube placement in upper GI and laryngeal cancers: A case series

2021 ◽  
Keyword(s):  
Standard Procedure ◽  
Pancreatic Enzyme ◽  
Case Series ◽  
Tube Placement ◽  
Jejunostomy Tube ◽  
Upper Gi ◽  
Increased Risk ◽  
Catheter Obstruction ◽  
Laparoscopic Jejunostomy

Background: Laparoscopic enteral-feeding access is the best option for patients with advanced upper gastrointestinal, oropharyngeal, and laryngeal cancers needing to maintain their caloric intake before surgery or during chemoradiotherapy. Methods: During a laparoscopic procedure by a cystostomy catheter system, a jejunostomy tube was placed for 14 patients. All the patients had a 2-month follow-up for complications and performance of the feeding system. Results: Based on the obtained results, there was no internal leak and peritonitis among the subjects. One patient converted to an open procedure due to perforation during the procedure. In three patients, the extraction of the catheter was encountered during the follow-up period and a replacement was required. One case of wound infection and one case of catheter obstruction occurred among the subjects. Catheter obstruction was easily resolved using warm water and pancreatic enzyme irrigation. There was one patient with partial intestinal obstruction who was managed through nonoperative means. No significant bleeding was encountered during the surgery. Conclusion: Laparoscopic jejunostomy with this method is simple and cost-effective and can be performed within an acceptable timeframe with minimum complications. It is the procedure of choice for upper GI and laryngeal cancer patients, those at increased risk of aspiration, and subjects not candidates of percutaneous endoscopic gastrostomy. Reference

scholarly journals Postoperative Complications Following Ankle Fractures in the Geriatric Population: A Case Series

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0009
Author(s):  
Matthew Anderson ◽  
Aaradhana J. Jha ◽  
Sameer M. Naranje ◽  
Gean C. Viner ◽  
Haley McKissack ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Internal Fixation ◽  
Revision Surgery ◽  
Open Reduction ◽  
Illicit Drugs ◽  
Standard Procedure ◽  
Case Series ◽  
Ankle Fractures ◽  
Increased Risk

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures are among the most common orthopedic injuries. While open reduction and internal fixation (ORIF) is the standard treatment for displaced ankle fractures in younger patients, there is controversy regarding the optimal management of these injuries among geriatric patients due to the high prevalence of comorbidities. Closed manipulation leads to poor long-term functional outcomes, with high rates of malunion and non-union in all populations as well as higher mortality in patients over 65 years of age. However, surgical management in the elderly carries rates of complications as high as 20-40%. The purpose of this study was to investigate risk factors for healing complications following ORIF of ankle fractures in patients greater than 75 years of age. Methods: All patients 75 years of age and older undergoing open reduction and internal fixation of ankle fractures at a single institution from 2008 to 2018 were identified. Patients with polytrauma and/or pilon fractures were excluded. Patient medical records were reviewed to obtain information regarding details about the injury, surgery, and follow-up as well as patient demographics and comorbidities. Radiographs from post-operative clinic visits were examined by a foot and ankle certified orthopedic fellow for each patient and the time for complete union was recorded as well as any delayed union or malunion. Fisher’s exact tests were used to compare post-operative complications (wound infection, wound dehiscence, sepsis, deep vein thrombosis, revision surgery, and malunion/nonunion) among those with and without specific comorbidities. Results: Patients with other comorbidities had a statistically significant increased risk of revision surgery (p<0.0001). Additionally, those who used illicit drugs had statistically significant increased risk of sepsis (0.0213). Revision surgeries included syndesmotic screw removal, a standard procedure which does not necessarily imply presence of complication. Conclusion: Elderly patients are susceptible to various postoperative complications. Substance abuse is associated with revision surgery, while the presence of other comorbidities collectively is associated with sepsis. To optimize postoperative management, surgeons should be aware of patient comorbidities and exceptionally attentive at follow-up examinations for these patients.

scholarly journals Combined pars plana glaucoma drainage device placement and vitrectomy using a vitrectomy sclerotomy site for tube placement: a case series

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Enchi Kristina Chang ◽  
Sanchay Gupta ◽  
Marika Chachanidze ◽  
John B. Miller ◽  
Ta Chen Chang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Tube Placement ◽  
Glaucoma Drainage Device ◽  
Drainage Device ◽  
Glaucoma Drainage Devices ◽  
Pars Plana ◽  
Sclerotomy Site

Abstract Purpose The purpose of this study is to report the safety and efficacy of pars plana glaucoma drainage devices with pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma. Methods Retrospective case series of 28 eyes of 28 patients who underwent combined pars plana glaucoma drainage device and pars plana vitrectomy between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity, and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests. Results Mean IOP decreased from 22.8 mmHg to 11.8 mmHg at 1.5 years (p = 0.002), and mean medication burden decreased from 4.3 to 2.1 at 1.5 years (p = 0.004). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 < IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 86.4% at 1 year and 59.8% at 1.5 years. At their last visit, three eyes (10.7%) achieved complete success with IOP reduction as above without medications, and 14 eyes (50.0%) achieved qualified success with medications. Hypotony was observed in 1 eye (3.6%) prior to 3 months postoperatively and 0 eyes after 3 months. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of > 2 lines. Two eyes required subsequent pars plana vitrectomies for tube obstruction, and one eye had transient hypotony. Conclusions The results of pars plana glaucoma drainage device and pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting glaucoma drainage devices into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

scholarly journals Combined Pars Plana Glaucoma Drainage Device Placement and Vitrectomy Using a Vitrectomy Sclerotomy Site for Tube Placement: A Case Series

2020 ◽  
Author(s):  
Enchi Kristina Chang ◽  
Sanchay Gupta ◽  
Marika Chachanidze ◽  
John B. Miller ◽  
Ta Chen Chang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Statistical Tests ◽  
Case Series ◽  
Tube Placement ◽  
Glaucoma Drainage Device ◽  
Retrospective Case ◽  
Tube Obstruction ◽  
Pars Plana ◽  
Sclerotomy Site

Abstract Background: The purpose of this study is to report the safety and efficacy of pars plana (PP) glaucoma drainage devices (GDDs) with pars plana vitrectomy (PPV) using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma.Methods: Retrospective case series of 28 eyes of 28 patients who underwent combined PP GDD and PPV between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity (BCVA), and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests.Results: Mean IOP decreased from 22.8 mmHg to 11.4 mmHg at 1.5 years (p = 0.009), and mean medication burden decreased from 4.3 to 1.7 at 1.5 years (p = 0.009). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 ≤ IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 77.7% at 1 year and 45.8% at 1.5 years. At their last visit, four eyes (14.3%) achieved complete success with IOP reduction as above without medications, and 13 eyes (46.2%) achieved qualified success with medications. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of >2 lines. Two eyes required subsequent PPV for tube obstruction, and one eye had transient hypotony.Conclusions: The results of pars plana GDD and vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting GDDs into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

PS02.152: DEVELOPMENT OF INTESTINAL PNEUMATOSIS AND PORTAL VENOUS GAS AFTER ESOPHAGECTOMY IS NOT INDICATIVE OF ISCHEMIC BOWEL AND CAN BE SUCCESSFULLY MANAGED NON-OPERATIVELY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 164-164
Author(s):  
Erin Gillaspie ◽  
Micheal Moynagh ◽  
Sameh Said ◽  
Mark Allen ◽  
Shanda Blackmon ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Case Series ◽  
Pneumatosis Intestinalis ◽  
Bowel Ischemia ◽  
Tube Placement ◽  
Jejunostomy Tube ◽  
Radiographic Findings ◽  
Intestinal Pneumatosis ◽  
Ischemic Bowel ◽  
Portal Venous Gas

Abstract Background Pneumatosis intestinalis has long been a marker of advanced bowel ischemia and prompts urgent laparotomy. In post-operative settings, the presence of pneumatosis represents a significant management dilemma. We share a case-series of post-esophagectomy patients with pneumatosis intestinalis and no corollary intra-abdominal pathologic findings on re-exploration. Methods January 2000 to December 2017, 1760 patients underwent Ivor-Lewis esophagectomy or gastrectomy with jejunostomy-tube placement. Charts were reviewed retrospectively to identify patients with pneumatosis intestinalis discovered in the post-operative period. Demographic data, operative details and postoperative course were reviewed including incidence and details of re-exploration. Results Eleven patients met inclusion criteria. Nine were male (81.8%) and mean age was 69 years. All patients had radiographic confirmation of pneumatosis intestinalis and in many cases portal venous gas (Figure 1). Clinical course was variable without discernable trends in vitals or laboratory values. Development of significant postoperative ileus along with delivery of enteral tube feeds through a jejunostomy tube preceded development of the pneumatosis in all patients. Nine patients were re-explored and none had evidence of bowel ischemia. Conclusion The finding of pneumatosis intestinalis in the post-operative setting can be alarming and pose a management dilemma. With the advent of improved and readily available imaging, there has been an increase in findings that have no corollary physical symptomatology. In this series of patients, despite dramatic radiographic findings, none had ischemic bowel. Pneumatosis intestinalis alone in patients who have undergone esophagectomy should not be considered an indication for emergency re-exploration. Disclosure All authors have declared no conflicts of interest.

scholarly journals Increased risk of brain cancer incidence in stroke patients: a clinical case series, population-based and longitudinal follow-up study

Oncotarget ◽  
2017 ◽  
Vol 8 (65) ◽  
pp. 108989-108999 ◽  
Author(s):  
Chih-Wei Chen ◽  
Tain-Junn Cheng ◽  
Chung-Han Ho ◽  
Jhi-Joung Wang ◽  
Shih-Feng Weng ◽  
...  
Keyword(s):  
Cancer Incidence ◽  
Brain Cancer ◽  
Clinical Case ◽  
Case Series ◽  
Population Based ◽  
Stroke Patients ◽  
Follow Up Study ◽  
Increased Risk

scholarly journals Unilateral Levator Aponeurosis Excision for Marcus Gunn Syndrome and Risk Factors of Residual Jaw Winking

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Qingyao Ning ◽  
Jing Cao ◽  
Jiajun Xie ◽  
Qi Gao ◽  
Changjun Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Strong Association ◽  
Case Series ◽  
Increased Risk ◽  
Frontalis Suspension ◽  
Silicone Rod ◽  
Independent Risk Factors ◽  
Levator Aponeurosis

Purpose. To investigate the association of ptosis, levator, and jaw winking in Marcus Gunn jaw-winking synkinesis (MGJWS), and the risk factor of preservation and outcomes of the unilateral levator excision and frontalis suspension.Methods. Clinical features of MGJWS case series from 2011 to 2018 were retrospectively reviewed. Association between jaw winking and ptosis/levator function was statistically analyzed. The patients underwent unilateral levator excision and frontalis suspension using silicone rod or autogenous fascia lata. Clinical outcomes were evaluated in operated patients and the independent risk factors of residual jaw winking were investigated after a long follow-up.Results. There were 42 MGJWS patients in 2011 to 2018, accounting for 2.87% of all congenital blepharoptosis. 80% of mild jaw winking was accompanied with mild ptosis and fair levator function, and moderate-to-severe jaw winking was often accompanied with moderate-to-severe ptosis and poor levator function (P<0.05). Ptosis showed a strong association with excursion of jaw winking (R = 0.785,P<0.01). Jaw winking was resolved in all 34 operated patients with good correction of ptosis. Severity of jaw winking is an independent risk factor for the residual synkinesis after surgery. Severe preoperative jaw winking had an 18.05 times increased risk of postoperative residual synkinesis compared with moderate jaw winking (P<0.05).Conclusions. In MGJWS eyelid excursion of jaw winking has a direct correlation with ptosis and dysfunction of levator muscle. Unilateral levator aponeurosis excision and frontalis suspension is an efficient approach for MGJWS. Severe jaw winking is a risk factor of residual eyelid synkinesis after surgery.

scholarly journals Persistent Peristomal Leakage from Percutaneous Endoscopic Gastrostomy Successfully Treated with Argon Plasma Coagulation

2020 ◽  
pp. 1-5
Author(s):  
Cláudia Macedo ◽  
Nuno Almeida ◽  
Ana Rita Alves ◽  
Ana Margarida Ferreira ◽  
Pedro Figueiredo
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Low Cost ◽  
Argon Plasma Coagulation ◽  
Case Series ◽  
Argon Plasma ◽  
Tube Placement ◽  
Plasma Coagulation ◽  
Endoscopic Gastrostomy ◽  
Gastrostomy Tube Placement

<b><i>Introduction:</i></b> Percutaneous endoscopic gastrostomy is a safe and effective technique and its use is widely spread. Peristomal leakage may occur within the first few days after gastrostomy tube placement and also in the mature gastrostomy tract. The initial treatment involves conservative measures. If the leakage does not resolve, different endoscopic interventions could be necessary with consequent impairing of enteral nutrition and, in some cases, the need of creating a new gastro-cutaneous fistula. <b><i>Case Report:</i></b> We present 4 consecutive cases complicated with late peristomal leakage and medical treatment failure. These patients underwent upper digestive endoscopy, and circumferential fulguration of the mucosa surrounding the tube with pulsed argon plasma coagulation (APC) at 50 W and 1 L/min flow rate was performed. Additional long through-the-scope clips were applied in 2 cases, since the inner orifice remained enlarged, in order to obtain a better closure. Complete leakage and skin changes resolution occurred between 2 and 6 weeks after the procedure (mean 3.5 weeks). The overall mean follow-up was 19 months after the endoscopic procedure (maximum 30 months, minimum 10 months). There was no recurrence of leakage. <b><i>Conclusion:</i></b> The use of APC alone or combined with long through-the-scope clips in large internal stoma orifice resolved persistent leakage from percutaneous endoscopic gastrostomy in all 4 presented cases without complications. In our case series, this technique appeared to be an effective, safe, and relatively low-cost alternative to the treatment of persistent peristomal leakage of the mature gastrostomy tract.

Clinical presentation, natural history and outcomes of intramedullary spinal cord cavernous malformations

2019 ◽  
Vol 90 (6) ◽  
pp. 695-703 ◽  
Author(s):  
Anshit Goyal ◽  
Lorenzo Rinaldo ◽  
Redab Alkhataybeh ◽  
Panagiotis Kerezoudis ◽  
Mohammed Ali Alvi ◽  
...  
Keyword(s):  
Natural History ◽  
Surgical Resection ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Univariate Analysis ◽  
Case Series ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Increased Risk

ObjectiveThere is a paucity of literature investigating the clinical course of patients with spinal intramedullary cavernous malformations (ISCMs). We present a large case series of ISCMs to describe clinical presentation, natural history and outcomes of both surgical and conservative management.MethodsWe retrospectively reviewed the clinical course of patients diagnosed with ISCMs at our institution between 1995 and 2016. Haemorrhage was defined as clinical worsening in tandem with imaging changes visualised on follow-up MRI. Outcomes assessed included neurological status and annual haemorrhage rates.ResultsA total of 107 patients met inclusion criteria. Follow-up data were available for 85 patients. While 21 (24.7%) patients underwent immediate surgical resection, 64 (75.3%) were initially managed conservatively. Among this latter group, 16 (25.0%) suffered a haemorrhage during follow-up and 11 (17.2%) required surgical resection due to interval bleeding or neurological worsening. The overall annual risk of haemorrhage was 5.5% per person year. The rate among patients who were symptomatic and asymptomatic on presentation was 9.5% and 0.8%, respectively. Median time to haemorrhage was 2.3 years (0.1–12.3). Univariate analysis identified higher ISCM size (p=0.024), history of prior haemorrhage (p=0.013) and presence of symptoms (p=0.003) as risk factors for subsequent haemorrhage. Multivariable proportional hazards analysis revealed presence of symptoms to be independently associated with haemorrhage during follow-up (HR 9.39, CI 1.86 to 170.8, p=0.013).ConclusionLarge, symptomatic ISCMs appear to be at increased risk for subsequent haemorrhage. Surgery may be considered in such lesions to prevent rebleeding and subsequent neurological worsening.

Laparoscopic jejunostomy tube placement

ASVIDE ◽  
2019 ◽  
Vol 6 ◽  
pp. 88-88
Author(s):  
Shrey Patel ◽  
Charles Bakhos
Keyword(s):  
Tube Placement ◽  
Jejunostomy Tube ◽  
Laparoscopic Jejunostomy

scholarly journals Feasibility and safety of a novel electromagnetic device for small-bore feeding tube placement

2019 ◽  
Vol 4 (1) ◽  
pp. e000330 ◽  
Author(s):  
Lewis E Jacobson ◽  
May Olayan ◽  
Jamie M Williams ◽  
Jacqueline F Schultz ◽  
Hannah M Wise ◽  
...  
Keyword(s):  
Tracking System ◽  
Case Series ◽  
Feeding Tube ◽  
Tube Placement ◽  
Level Of Evidence ◽  
Electromagnetic System ◽  
Initial Location ◽  
Effective Delivery ◽  
Intent To Treat

BackgroundMisplacement of enteral feeding tubes (EFT) in the lungs is a serious and potentially fatal event. A recent Food and Drug Administration Patient Safety Alert emphasized the need for improved technology for the safe and effective delivery of EFTs.ObjectiveWe investigated the feasibility and safety of ENvue, a novel electromagnetic tracking system (EMTS) to aid qualified operators in the placement of EFT.MethodsThis is a prospective, single-arm study of patients in intensive care units at two US hospitals who required EFTs. The primary outcome was appropriate placement of EFTs without occurrence of guidance-related adverse events (AEs), as confirmed by both EMTS and radiography. Secondary outcomes were reconfirmation of the EFT tip location at a follow-up visit using the EMTS compared with radiography, tube retrograde migration from initial location and AEs.ResultsSixty-five patients were included in the intent-to-treat analysis. EFTs were successfully placed in 57 patients. In eight patients, placement was unsuccessful due to anatomic abnormalities. According to both the EMTS and radiography, no lung placements occurred. No pneumothoraces were reported, nor any guidance-related AEs. Precise agreement of tube tip location was achieved between the EMTS evaluations and radiographs for 56 of the 58 (96.5%) successful placements (one patient had two placements). Tube tip location was re-confirmed 12–49 hours after EFT insertion by the EMTS and radiographs in 48 patients (84%). For 43/48 patients (89.5%), full agreement between the EMTS and radiography evaluations was observed. For the five remaining patients, the misalignment between the evaluations was within the gastrointestinal tract. Retrograde migration from the initial location was observed in 4/49 patients (8%).ConclusionA novel electromagnetic system demonstrated feasibility and safety of real-time and follow-up tracking of EFT placement into the stomach and small intestine, as confirmed by radiographs. No inadvertent placements into the lungs were documented.Level of evidenceLevel V (large case series).

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