Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) - The Importance of Nutritonal Support in Patients with Head and Neck Cancers (HNCs) or Neurogenic Dysphagia (ND).

BACKGROUND: We evaluated the effectiveness and safety of prophylactic PEG performed for the enteral nutrition support during the oncological treatment of patients with HNCs and as a part of the management of neurological patients experiencing neurogenic dysphagia. METHODS: In 2013 we followed up on a group of 23 HNC patients subjected to prophylactic PEG. We assessed the duration of the procedure, intraprocedural incidents and their causes, time to tube-refeeding and discharge after intervention, post interventional analgesia, early and late complications,toleration, costs and postoperative course of these patients after radical surgery maintaining PEG in place. In parallel we followed up on a group of 10 neurological patients who have undergone a PEG placement to improve the nutrional status and to prevent recurrent chest infections due to ND related silent aspiration. RESULTS: The procedures were performed under sedation with Midazolam and the mean duration was about 7 minutes.Postoperative analgesia was minimal. Refeeding through the tube was initiated 2-4h hours later and the patients were discharged 12-24h after the procedure. Early complications were not observed and later we noted 2 cases of peristomal infections, succesfully managed conservatively. After oncologic surgery we noted 2 (8.69%) pharyngocutaneous fistulas.Conservative care obliterated the fistulas at 6 weeks, maintaining the feeding tube in place. We also compared the results with a group of 27 patients fed through the naso-gastric tube and a group of 20 cases with open gastrotomy-tube prophylactically inserted. The 10 neurological patients had varied conditions but degenerative diseases like motor neuron disease (3 cases" 30%) and multiple sclerosis (2 cases -20%) took the lead we encountered one case of peristomal infection and one case of tube blockage resolved by replacement. We evaluated the nutritional status by controling the weight of these patients before and after PEG placement. A mean weight gain of 3.1 kg(range 1.2 â€" 7) was documented. CONCLUSIONS: PEG is a simple minimmaly invasive procedure performed safely under sedation. It takes a very short time and is virtually free of major complications. The requirements of analgesics are minimal. The refeeding is started early and the tube is well tolerated by the patient. PEG has an important role in the conservative healing of pharyngocutaneous fistula.PEG is the procedure of choice for the neurological patients.It prevents weight loss and aspiration pneumonia in patients with neurogenic dysphagia with a low rate of complications.

Laparoscopic treatment of a hepatic subcapsular abscess secondary to gallbladder perforation: case report.

We present a rare case of type II Niemeier gallbladder perforation(GBP) developed as a complication of acute calculous cholecystitis. A 76-year-old man was admitted to our surgical unit with the presumptive diagnosis of acute cholecystitis. CT scan revealed a subcapsular collection developed on the visceral surface of the right hepatic lobe. It was communicating through a thin hypodense band with the cystic duct, distal to an impacted stone. Through laparoscopy the collection was confirmed to be a subcapsular liver abscess secondary to GBP.The cholecystectomy and the abscess cavity treatment were completely handled via laparoscopic approach. The paper demonstrates that laparoscopic approach can be a safe and feasible method in order to treat both the cause and the complication in this situation. Early diagnosis and appropriate minimally invasive approach are the key to manage this rarity.

Localisation and preservation of the autonomic nerves in rectal cancer surgery - technical details.

Iatrogenic surgical injury to pelvic autonomic nerves followed by genitourinary dysfunctions are well known problems after total partial mesorectal excision for rectal cancer. The purpose of our paper is to present the useful anatomical landmarks for a safe nerve-sparing surgery in rectal oncology. Over the course of a total mesorectal excision we describe and illustrate the key risk zones of autonomic nerve injury based on our experience in rectal surgery and on the revised literature.

Temporary protective loop ileostomy in open low rectal resection -- an alternative technique.

The paper presents a simplified method for performing a temporary protective loop ileostomy as a result of our experience in 33 cases of low rectal resections for cancer.The particularities of this technique are: the skin incision is smaller than the muscle one, the seromuscular layer of the loop is fixed at the skin level only by marking a small portion of the antimesenteric wall, with no mucosal eversion. No supporting rod is used. The reversal requires resection of the thickened freemargins and enterorrhaphy. It involves a direct approach and avoids median laparotomy and segmental bowel resection.There was no case of peristomal abscess, bleeding, prolapse,retraction of the loop after the stoma was formed. Four patients(12.12%) had peristomal dermatitis. Five patients (15.62%) had high output fluid losses with electrolyte disorders, one of them(3.12%) with acute renal failure. Closure was performed after 6 weeks on average for the colorectal anastomoses and 10 weeks for the coloanal ones. We recorded a case (3.12%) of enterocutaneous fistula that was managed conservatively and 4 cases(12.12%) of incisional hernia, all of them surgically treated. No mortality was attributed to either creation or closure of the temporary loop ileostomy. It is a simple and fast technique in accordance with the temporary character of its indication.

[Historic review of minimally invasive surgery in Romania--a new surgical era]. / Scurt istoric al chirurgiei miniminvazive in România--o noua era chirurgicala.

The minimally-invasive surgery developed during the last decades, having an important place within the operating techniques of many surgical specialities once high-performing instruments and devices were created. It is represented by laparoscopic, thoracoscopic, arthroscopic and endoscopic techniques (diagnostical and therapeutical). The introduction and development of such techniques at the global level allowed for them to be introduced in our country in a rather short period of time after their usage abroad. This article consists of a brief description of the minimally-invasive surgery both at the global and national level.

Coping behavior and risk and resilience stress factors in French regional emergency medicine unit workers: a cross-sectional survey.

The Emergency Department (ED) has the highest workload in a hospital, offering care to patients in their most acute state of illness, as well as comforting their families and tending to stressful situations of the physical and psychological areal. Method. A cross-sectional survey of 366 Emergency Unit staff members including medical doctors, medical residents, medical nurses and ward aids, was undergone. Study participants came from four periphery hospitals in the Moselle Department of Eastern France with similar workforce and daily patient loads statistics. The instruments used were the Perceived Stress Scale PSS-10 and the Brief COPE questionnaire. Conclusions. Perceived work overload and overall stress is strongly related to work hours and tend to have a stronger influence on doctors than on the nursing staff. Substance use is a common coping method for medical interns, consistent with prior research. The regular assessment of the ED staff perception of stress and stress related factors is essential to support organizational decisions in order to promote a better work environment and better patient care.