ABSTRACT
BACKGROUND: Various gastrostomy tube placement techniques have been reported in the literature. The endoscopic U-stitch technique allows for primary button placement without the need for laparoscopy. The purpose of this study was to quantify the completion rate and the occurrence of complications with this procedure at one academic teaching hospital. METHODS: All gastrostomy procedures between February 2001 and September 2008 were reviewed. Data were collected from paper and electronic records for endoscopic U-stitch procedures. RESULTS: Endoscopic U-stitch gastrostomies were attempted in 121 patients, with primary button placement in 115 (95%) and conversion to an open procedure in 6. No procedure-related deaths occurred, and 7% of patients experienced postoperative complications that included hematemesis, cellulitis, colonic perforation, granulation tissue requiring operative excision, and surgical fistula closure. Average operative time was 18 min. CONCLUSION: The endoscopic U-stitch technique is safe and allows for primary button placement in infants and children. Its complication rate compares favorably with other laparoscopic and open techniques described in the literature.
Subject(s)
Endoscopy, Gastrointestinal/methods , Gastrostomy/methods , Hospitals, Teaching , Suture Techniques , Adolescent , Child , Child, Preschool , Follow-Up Studies , Humans , Infant , Ohio , Retrospective Studies , Treatment Outcome , Video RecordingABSTRACT
We present a case of methicillin-sensitive Staphylococcus aureus metastatic endophthalmitis (SAME) that developed from a bacteremia. We compare this to a literature review of similar cases and report unique characteristics of SAME. We discuss important considerations in the work-up and treatment of endogenous endophthalmitis.
Subject(s)
Bacteremia/microbiology , Diabetic Foot/microbiology , Endophthalmitis/microbiology , Staphylococcal Infections/diagnosis , Aged , Humans , Male , Staphylococcal Infections/drug therapy , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purificationABSTRACT
The objective of this study was to examine the prevalence of potentially inappropriate medications (PIMs) and potential adverse drug effects (ADEs) in older adults presenting to the emergency department (ED). This was a prospective observational study of a convenience sample of adults 65 years and older presenting to the ED at an urban, tertiary care hospital. Potentially inappropriate medications were defined according to 2003 Beers criteria. Potential ADEs were defined as either (1) a potential drug-drug interaction, (2) alternative medication likely to cause toxicity or drug interactions, or (3) toxic doses of vitamins or minerals. Of 174 eligible patients, 124 were enrolled. The mean number of medications used per patient was 8.6 (range, 0-20). Thirty six patients (29%, 95% confidence interval, 27%-37%) presented to the ED with at least one PIM. Eight PIMs were prescribed in the ED, representing 16% of all prescriptions in the ED. Potential ADEs meeting the defined criteria were found in 26.6% of patients. A subanalysis of a random sample of charts revealed significant discordance between medication lists obtained by the research assistants and that of the health care providers. Older ED patients are at high risk for use of potentially inappropriate medications and ADEs. This problem may be magnified by inaccurate medication lists obtained by ED providers. A larger multicenter study may help to better define the scope of this problem.
