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Percutaneous endoscopic gastrostomy: a safe and effective bridge for enteral nutrition in neurological or non-neurological conditions
No full textPercutaneous endoscopic gastrostomy (PEG) is one of the most commonly used methods for nutritional support in patients who are unable to take food orally. Traditional surgical gastrostomy, percutaneous radiologic gastrostomy, and laparoscopic gastrostomy are the alternatives. The most common indication is neurogenic dysphagia followed by obstructive causes such as head and neck tumors. Ethically justified and clinically comprehensive guidelines should be followed during the decision-making process for PEG tube placement. A limited life expectancy; technical difficulties, such as the inability to bring the anterior gastric wall in apposition to the abdominal wall; or pharyngeal/esophageal obstruction, which compromise tube insertion, peritonitis, and uncorrectable coagulopathy are absolute contraindications. The "pull method" is the first described and still the most performed technique of PEG tube placement. The procedure is simple, safe, and effective and fulfills all requirements to provide an ideal route for nutritional support. This article summarizes the reported experience on PEG in the current literature and discusses its utility in patients with neurological conditions
Fistulotomy and drainage of deep postanal space abscess in the treatment of posterior horseshoe fistula
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Gastric polypoid lesions: Analysis of 150 endoscopic polypectomy specimens from 91 patients
No full textPenetrating Abdominal Gunshot Wounds Caused by High-Velocity Missiles: A Review of 51 Military Injuries Managed at a Level-3 Trauma Center
No full textThe aim of this study was to present the outcomes of military penetrating abdominal gunshot injuries, to identify factors that predict morbidity, and to compare the present results with those from two civilian trauma centers. Fifty-one consecutive patients who had suffered high-velocity gunshot wounds to the abdomen were assessed retrospectively. Penetrating abdominal trauma index, the number of injured organs, and the presence of colonic injury were significantly associated with high morbidity by univariate analysis. Multivariate analysis showed that only the number of organs injured and presence of colonic injury were independent predictors of morbidity. Our results showed that military rifle bullets do not cause greater tissue disruption than that found in wounds created by lower-velocity projectiles. The presence of colonic injury and the number of organs injured (more than three) seem to be important predictors of morbidity in penetrating abdominal gunshot wounds caused by high-velocity missiles
An unusual cause of small bowel obstruction: Gossypiboma – case report
No full textAbstract Background The term "gossypiboma" denotes a mass of cotton that is retained in the body following surgery. Gossypiboma is a medico-legal problem especially for surgeons. To the best of our knowledge, the patient presented herein is the second reported patient in whom the exact site of migration of a retained surgical textile material into the intestinal lumen could be demonstrated by preoperative imaging studies. Case presentation A 74-year-old woman presented with symptoms of small bowel obstruction due to incomplete intraluminal migration of a laparotomy towel 3 years after open cholecystectomy and umbilical hernia repair. Plain abdominal radiography did not show any sign of a radio-opaque marker in the abdomen. However, contrast enhanced abdominal computerized tomography revealed a round, well-defined soft-tissue mass with a dense, enhanced wall, containing an internal high-density area with air-bubbles in the mid-abdomen. A fistula between the abscess cavity containing the suspicious mass and gastrointestinal tract was identified by upper gastrointestinal series. The presence of a foreign body was considered. It was surgically removed with a partial small bowel resection followed by anastomosis. Conclusions Although gossypiboma is rarely seen in daily clinical practice, it should be considered in the differential diagnosis of acute mechanical intestinal obstruction in patients who underwent laparotomy previously. The best approach in the prevention of this condition can be achieved by meticulous count of surgical materials in addition to thorough exploration of surgical site at the conclusion of operations and also by routine use of surgical textile materials impregnated with a radio-opaque marker.</p
Breast cancer and immune thrombocytopenic purpura: Is there any association between these 2 distinct diseases?
No full textBackground: An association between breast cancer and immune thrombocytopenic purpura (ITP) is very rare; there are only 18 cases reported in the English literature so far. Patients and Methods: A 65-year-old woman who had been diagnosed with ITP 5 years ago presented with 2 palpable masses in her left breast. Following establishment of the histopathologic diagnosis of invasive ductal carcinoma by fine needle aspiration biopsy, the patient underwent left modified radical mastectomy. Results: Histopathologic examination confirmed invasive ductal carcinoma in the bigger mass, and in situ ductal carcinoma in the smaller. The case was T2NoMo, therefore exclusive anti-estrogen therapy was started for the next 5 years. However, thrombocytopenia recurred twice in the first postoperative year. Fluorodeoxyglucose positron emission tomography (FDG-PET) scanning showed no breast cancer metastases anywhere in the body. Following immunoglobulin infusion, the platelet count increased enough for surgery, and the patient underwent splenectomy for ITP in the 10th month after the previous breast cancer surgery. After an uneventful postoperative period, the patient has been symptom-free during the 1-year of follow-up with normal platelet levels. Conclusion: Although the relevant current data are conflicting, in the present case no direct relationship between ITP and breast cancer could be observed clinically
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