RESUMEN
BACKGROUND & AIMS: Eating and swallowing impairments often get worse as patients with severe cerebral palsy (CP) get older, creating increased demand for percutaneous endoscopic gastrostomy (PEG) tube placement. Here we investigated the feasibility, safety, adverse events (AEs) and outcomes of PEG in adult CP. METHODS: We performed a retrospective study of 26 consecutive severe adult (age: 28 [19-48] yrs) CP patients who underwent pull-PEG tube placement under general anesthesia between 2005 and 2012 (median follow-up: 23 [6-64] months) at the same tertiary hospital centre. RESULTS: The procedure was a technical success for 19 patients (BMI: 13.8 [10.7-21.4]) with (n = 11) or without (n = 8) previous respiratory disorder. Indications were mainly swallowing disorders (n = 14) and inadequate oral intake (n = 8). Early AEs were 7 transient oxygen needs, 3 local wound infections and 2 transient ileus. Long-term AEs were 9 non-severe gastrostomy incidents. There was no significant improvement in neurological status but respiratory function was improved in 6 patients and enteral nutrition enabled a significant median weight gain of 4.2 [1-8.8] kg (P < 0.01). Quality-of-life assessed by relatives and the healthcare team was improved in 13/16 and 13/15 cases respectively. AEs and outcomes did not differ significantly with previous respiratory disorder or nutritional status. CONCLUSIONS: PEG tube placement is feasible in adult CP, although the risk of failure is increased by anatomical specificities. Previous respiratory disorders and undernourishment did not increase AE rates or modify outcomes. There were positive changes over time for nutritional status and perceived quality-of-life, but no neurological improvement.
Asunto(s)
Parálisis Cerebral/terapia , Endoscopía Gastrointestinal , Nutrición Enteral/métodos , Gastrostomía , Intubación Gastrointestinal , Adulto , Trastornos de Deglución/terapia , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional , Estudios Retrospectivos , Centros de Atención Terciaria , Resultado del Tratamiento , Adulto JovenRESUMEN
Radical surgery remains the only potentially curative treatment for colorectal cancer. Major changes in the principles of rectal cancer resection have been recently described (total mesorectum excision) whereas there have been few changes in the principles of colonic cancer resection. This chapter presents surgical procedures for curative treatment of colorectal cancer in both the elective and emergency settings.
Asunto(s)
Neoplasias del Colon/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Neoplasias del Recto/cirugía , Neoplasias del Colon/patología , Medicina Basada en la Evidencia , Humanos , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Pronóstico , Neoplasias del Recto/patología , Factores de Riesgo , Resultado del TratamientoRESUMEN
A case of an Ascaris infection of the gallbladder is reported in a 29 years old female. The biological check-up was normal. The diagnosis was confirmed by ultrasonography and the patient was cured by albendazole. Such a localization is uncommon (2.1% of the hepatobiliary ascariasis), and the abdominal ultrasonography is the best way to confirm the diagnosis. Albendazole is the current treatment, but cholecystectomy is sometimes a must.