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BACKGROUND: Medical emergency situations and even cardiac arrest can occur during treatment of patients in therapeutic hyperbaric chambers just as in other clinical departments; therefore, high quality structured management should be implemented for dealing with emergencies in this special working area. To ensure this the emergency medical treatment should not only be performed according to the current state of medical knowledge but needs to take the special features of the hyperbaric environment including safety aspects into account. METHOD: This article presents a description of the implementation and effects of routine emergency and resuscitation training at a center for hyperbaric medicine. RESULTS: By simulation of emergencies in a hyperbaric chamber it rapidly became clear that the treatment of medical emergencies and cardiac arrest under hyperbaric conditions has some special features and due to safety aspects cannot always be performed according to current medical guidelines. At the time of this simulation in a real life working environment, previously unknown structural and logistic problems became obvious whereby the solutions contributed to a significant improvement of structural and process quality and could potentially also improve the outcome quality. Furthermore, a positive and lasting learning effect in the fields of quality of resuscitation measures, organization of the workplace, communication skills, logistics and safety aspects was detectable by analyzing participant performance over a period of 4 years. On the part of the participating staff a positive feedback and high acceptance of emergency simulator training was confirmed. CONCLUSION: Through annual compulsory emergency training of the complete staff of the hyperbaric unit at the actual workplace, a structural and confident approach to dealing with emergencies and resuscitation situations was observed. By the use of on-site simulator training even in specialized hospital units, deficits and tentativeness regarding logistics, course of action, organization and communication in emergency situations can be minimized to provide optimum patient care in a real life emergency situation by focusing on the medical measures.
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Reanimação Cardiopulmonar/educação , Oxigenoterapia Hiperbárica , Idoso , Idoso de 80 Anos ou mais , Intoxicação por Monóxido de Carbono/terapia , Competência Clínica , Comunicação , Serviços Médicos de Emergência , Feminino , Fraturas Ósseas/terapia , Parada Cardíaca/terapia , Humanos , Masculino , Manequins , Equipe de Assistência ao Paciente , Segurança do Paciente , Choque/terapia , Tentativa de Suicídio , Adulto JovemRESUMO
A measurement of beam helicity asymmetries in the reaction 3He[over â](e[over â],e'n)pp is performed at the Mainz Microtron in quasielastic kinematics to determine the electric to magnetic form factor ratio of the neutron GEn/GMn at a four-momentum transfer Q2=1.58 GeV2. Longitudinally polarized electrons are scattered on a highly polarized 3He gas target. The scattered electrons are detected with a high-resolution magnetic spectrometer, and the ejected neutrons are detected with a dedicated neutron detector composed of scintillator bars. To reduce systematic errors, data are taken for four different target polarization orientations allowing the determination of GEn/GMn from a double ratio. We find µnGEn/GMn=0.250±0.058(stat)±0.017(syst).
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In the past years intoxication with local anesthetics, damage to nerves, vessels and other accompanying structures as well as infectiological events have been discussed more and more as complications accompanying peripheral nerve blocks (PNB). The following case report highlights a complication which seems to rarely occur and deals with a sheared continuous PNB, where a fragment of the catheter remained in the patient. The possible causes for the damage are discussed and recommendations on the clinical management of such a case are made.
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Anestesia por Condução/efeitos adversos , Anestesia por Condução/instrumentação , Catéteres/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/instrumentação , Acidentes por Quedas , Adolescente , Anestesia Geral , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Falha de Equipamento , Feminino , Corpos Estranhos/cirurgia , Fixação de Fratura , Humanos , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Optimizing the needle position using ultrasound (US) instead of electrical nerve stimulation (NSt) is increasingly common for perivascular brachial plexus block. These two methods were compared in a prospective, randomized, single-blinded controlled trial regarding effectiveness and time of onset of peripheral nerve blockade. METHODS: After puncture (penetration of neurovascular sheath and complete insertion of needle) 56 patients were randomly assigned to either the US group (finding the needle tip in transpectoral section, short axis, correction of needle position if local anesthetic spread was insufficient) or the NSt group (target impulse reaction in median, ulnar or radial nerve of 0.3 mA/0.1 ms, if necessary correction of position before injection of local anesthetic) to verify the needle position. All patients received 500 mg 1% mepivacaine. Sensory and motor blocks were tested by single nerve measurements (SNM) 5, 10 and 20 min after finishing the injection, where 0 represents minimal and 2 maximal success of the block. RESULTS: Single nerve measurements were analyzed using repeated measures ANOVA. The mean results of cumulative SNMs were significantly higher in the US group at all measurement times. Sensitivity US/NSt: 5 min: 3.36±2.32/2.63±1.87; 10 min: 5.45±2.41/4.21±2.45; 20 min: 7.30±2.02/6.43±2.43, p=0.015, motor function US/NSt: 5 min: 3.91±1.81/3.02±1.67; 10 min: 5.27±1.66/4.05±1.70; 20 min: 6.64±1.37/5.50±1.90, p<0.001. At the beginning of surgery complete nerve blockade was achieved in 89% in the US group and 68% in the NSt group (p=0.006), 3 (US) versus 7 (NSt) patients needed supplementation and 3 (US) versus 11 (NSt) patients needed general anesthesia (p=0.022). To achieve the nerve block took approximately 1 min more in the US group (p=0.003). CONCLUSION: The use of ultrasound in perivascular brachial plexus blocks leads to significantly higher success rates and shorter times of onset.
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Plexo Braquial/diagnóstico por imagem , Bloqueio Nervoso/métodos , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Método Duplo-Cego , Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Medição da Dor , Estudos Prospectivos , Resultado do Tratamento , UltrassonografiaRESUMO
Although active learning improves student outcomes in science, technology, engineering, and mathematics (STEM) programs, it may provoke anxiety in some students. We examined whether two psychological variables, social anxiety (psychological distress relating to the fear of negative evaluation by others) and academic self-efficacy (confidence in one's ability to overcome academic challenges), interact with student perceptions of evidence-based instructional practices (EBIPs) and associate with their final grades in a STEM-related course. Human anatomy and physiology students in community college courses rated various EBIPs for their perceived educational value and their capacity to elicit anxiety (N = 227). In general, practices causing students the most anxiety (e.g., cold calling) were reported by students as having the least educational value. When controlling for students' self-reported grade point averages, socially anxious students rated several EBIPs as more anxiety inducing, whereas high-efficacy students reported less anxiety surrounding other EBIPs. Furthermore, mediation analysis revealed that individual differences in academic self-efficacy at the beginning of the term explained some of the negative association between students' social anxiety levels and final grades in the course. Our results, obtained in a community college context, support a growing body of evidence that social anxiety and academic self-efficacy are linked with how students perceive and perform in an active-learning environment.
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Aprendizagem Baseada em Problemas , Autoeficácia , Ansiedade , Medo , Humanos , Percepção , EstudantesRESUMO
Collections of sponges by the late Dr. William C. Austin and the authors (N. McDaniel, R. Harbo and B. Ott) provided material for descriptions of new species from two genera of Poecilosclerida for shallow waters of Southern British Columbia, Canada and Northern Washington, USA: Lissodendoryx and Myxilla. There have been no new species of these two genera described for the Northeast Pacific since Laubenfels' work in central California (Laubenfels 1930, 1932) and Lambe's reports in 1893 to 1895 for Geological Survey of Canada sponge collections from British Columbia, Canada to the Bering Sea. We describe three new species of Lissodendoryx (Lissodendoryx) (Demospongiae, Poecilosclerida, Coelosphaeridae) and one new species of Myxilla (Myxilla) (Demospongiae, Poecilosclerida, Myxillidae): L. (L.) barkleyensis n. sp., L. (L.) littoralis n. sp., L. (L.) toxaraphida n. sp. and M. (M.) austini n. sp. Lissodendoryx (L.) barkleyensis n. sp. is cave-dwelling, has acanthostyles 112-260 µm, tornotes 107-177 µm, arcuate isochelas 8-28 µm and two sizes of sigmas 18-29, 26-55 µm. Lissodendoryx (L.) littoralis n. sp. fistulate habitus is adapted to muddy substrates similar to some Polymastia species also found commonly in the Northeast Pacific. It has subtylostyles 185-336 µm, tylotes 112-229 µm, arcuate isochelas 11-23 µm, and sigmas 30-75 µm. Lissodendoryx (L.) toxaraphida n. sp. is the only described Lissodendoryx species with raphides shaped like toxas. It has acanthostyles 140-286 µm, tornotes 143-195µm, arcuate isochelas 18-34 µm and toxiform raphides 65-156 µm. Myxilla (M.) austini n. sp. has a fistulate habitus and both tornote and tylote megascleres. It appears to be tolerant of low oxygen environments. Myxilla (M.) austini n. sp. has smooth to sparsely spined styles 193-353 µm, tylotes 153-221 µm, tornotes 174-260 µm, two sizes of anchorate isochelas 13-27, 42-81 µm, and two sizes of sigmas 13-47, 33-78 µm. All specimens were collected from shallow water (intertidal to 25 m).
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Poríferos , Animais , Oceano PacíficoRESUMO
While repairing a biplane cardiovascular X-ray system in a hospital, a service technician accidentally activated the system's floor pedal. He continued his work under unnoticed exposure for about 5 min until the system alarm was automatically activated. About 2 h after the exposure, the technician developed an erythema on parts of his left face and neck. The next day, he reported his incident to the competent authorities and was hospitalised in a unit specialised in treating heavily irradiated patients. Frequent blood analysis did not show any signs for a significant exposure to radiation. The Federal Office of Public Health then conducted extensive dose estimations. It could be shown that the dismounted collimator was always in front of the lateral X-ray tube, shielding the technician from the direct beam. The dose estimations came to the following conservative results: an effective dose of 5 mSv, a skin dose of 200 mSv, an eye lens dose of 100 mSv and an extremity dose (arm) of 700 mSv. The cause of the erythema remains unclear since the estimated doses are thought to be too low to induce any visible effect on the skin.
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Eritema/etiologia , Cristalino/efeitos da radiação , Exposição Ocupacional/efeitos adversos , Imagens de Fantasmas , Proteção Radiológica/normas , Pele/efeitos da radiação , Raios X/efeitos adversos , Humanos , Exposição Ocupacional/análise , Recursos Humanos em Hospital , Doses de Radiação , Liberação Nociva de RadioativosRESUMO
The impact of excessive daytime sleepiness (EDS) on road test performance was examined in patients with Parkinson's disease (PD). Twenty-one patients with PD completed the Epworth Sleepiness Scale (ESS) and an on-road driving test. Five participants had EDS according to their self-report on the ESS. Neither EDS nor PD medications were associated with on-road driving performance. These findings suggest that in this pilot study EDS did not impair PD patients' driving skills on a formal driving evaluation.
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Condução de Veículo , Distúrbios do Sono por Sonolência Excessiva/fisiopatologia , Doença de Parkinson/fisiopatologia , Desempenho Psicomotor/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Índice de Gravidade de DoençaRESUMO
This study assessed the clinical utility of contrast sensitivity (CS) relative to attention, executive function, and visuospatial abilities for predicting driving safety in participants with Parkinson's disease (PD). Twenty-five, non-demented PD patients completed measures of contrast sensitivity, visuospatial skills, executive functions, and attention. All PD participants also underwent a formal on-road driving evaluation. Of the 25 participants, 11 received a marginal or unsafe rating on the road test. Poorer driving performance was associated with worse performance on measures of CS, visuospatial constructions, set shifting, and attention. While impaired driving was associated with a range of cognitive and visual abilities, only a composite measure of executive functioning and visuospatial abilities, and not CS or attentional skills, predicted driving performance. These findings suggest that neuropsychological tests, which are multifactorial in nature and require visual perception and visual spatial judgments are the most useful screening measures for hazardous driving in PD patients.
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Condução de Veículo , Cognição/fisiologia , Doença de Parkinson/fisiopatologia , Desempenho Psicomotor/fisiologia , Percepção Visual/fisiologia , Idoso , Atenção , Exame para Habilitação de Motoristas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valor Preditivo dos TestesRESUMO
BACKGROUND: Colonoscopy is an operator-dependent procedure. The medical literature describes disparity in colonoscopy performance with respect to polyp detection, caecal intubation rates and procedural times. AIM: To assess prospectively the impact of feedback among a large cohort of colonoscopists on three performance parameters: caecal intubation rate, insertion time and withdrawal time. METHOD: In a prospective clinical study, procedural data from all out-patient colonoscopies performed by attending gastroenterologists at our institution were recorded routinely in a computerized database. Enhanced serial feedback was provided on a quarterly basis for three procedure parameters: intubation to caecum, insertion time and withdrawal time. Feedback (absolute value, % rank and group distribution) was sent by email every 3 months beginning with January 2005 feedback for all of 2004, and subsequently quarterly in April 2005 (for January-March 2005), July 2005 (for April-June 2005) and October 2005 (for July-September 2005). RESULTS: Feedback was provided to 58 endoscopists with a median experience level of 8 years. There was a relative decline of 19% in incomplete procedures, with median caecal non-intubation rates decreasing from 4.7% to 3.8% following the introduction of feedback while median insertion times declined from 10.6 to 9.5 mins, P = 0.02. Median withdrawal times did not change significantly, 9.1-8.9 mins, P = 0.6. CONCLUSIONS: Feedback by email appears to improve colonoscopy performance, enhancing completion rates and shortening insertion times without compromising withdrawal times.
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Competência Clínica/normas , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Cirurgia Colorretal/normas , Retroalimentação , Colonoscopia/métodos , Remoção de Dispositivo , Humanos , Intubação Gastrointestinal , Estudos Prospectivos , Fatores de TempoRESUMO
BACKGROUND: In 2002, a U.S. Multi-Society Task Force on Colorectal Cancer recommended that the withdrawal phase for colonoscopy should average at least 6-10 min. This was based on 10 consecutive colonoscopies by two endoscopists with different adenoma miss rates. AIMS: To characterize the relationship between endoscopist withdrawal time and polyp detection at colonoscopy, and to determine the withdrawal time that corresponds to the median polyp detection rate. DESIGN: Procedural data from out-patient colonoscopies performed at the Mayo Clinic, Rochester during 2003 were reviewed. Endoscopists were characterized by their mean withdrawal time for a negative procedure and individual polyp detection rate. RESULTS: A total of 10 955 colonoscopies performed by 43 endoscopists were analysed. Median withdrawal time was 6.3 min (range: 4.2-11.9); polyp detection rate was 44.0% (all polyps), 29.8% (< or = 5 mm), 5.9% (6-9 mm), 6.7% (10-19 mm), 2.1% (> or = 20 mm). Longer withdrawal time was associated with higher polyp detection rate (r = 0.76; P < 0.0001); this relationship weakened for larger polyps (r = 0.19 for polyps 6-9 mm, r = 0.28 for polyps 10-19 mm, r = 0.02 for polyps > or = 20 mm). Overall median polyp detection rate corresponded to a withdrawal time of 6.7 min. CONCLUSION: Our findings support a colonoscopy withdrawal time of at least 7 min, which correlates with higher colon polyp detection rates.
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Pólipos do Colo/diagnóstico , Colonoscopia/métodos , Adenoma/diagnóstico , Competência Clínica , Estudos de Coortes , Neoplasias do Colo/diagnóstico , Pólipos do Colo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
INTRODUCTION: This survey characterizes viewpoints of cognitively intact at-risk participants in an Alzheimer prevention registry if given the opportunity to learn their genetic and amyloid PET status. METHODS: 207 participants were offered a 25-item survey. They were asked if they wished to know their ApoE and amyloid PET status, and if so, reasons for wanting to know, or not, and the effects of such information on life plans. RESULTS: 164 (79.2%) of registrants completed the survey. Among those who were unaware of their ApoE or amyloid PET results, 80% desired to know this information. The most common reasons for wanting disclosure were to participate in research, to arrange personal affairs, to prepare family for illness, and to move life plans closer into the future. When asked if disclosure would help with making plans to end one's life when starting to lose their memory, 12.7% vs. 11.5% responded yes for ApoE and amyloid PET disclosures, respectively. Disclosure of these test results, if required for participation in a clinical trial, would make 15% of people less likely to participate. Likelihood of participation in prevention research and the desire to know test results were not related to scores on brief tests of knowledge about the tests. DISCUSSION: These results suggest that stakeholders in AD prevention research generally wish to know biological test information about their risk for developing AD to assist in making life plans.
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A patient with membranoproliferative glomerulonephritis and renal dysfunction caused by Schistosoma mansoni was treated with oxamniquine. High levels of circulating immuno-complexes returned to normal following treatment, although renal function for the long term was unchanged. Specific antischistosomal therapy may be of partial benefit to patients with this disease.
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Glomerulonefrite/etiologia , Esquistossomose , Adulto , Glomerulonefrite/tratamento farmacológico , Humanos , Masculino , Oxamniquine/uso terapêutico , Schistosoma mansoni , Esquistossomose/tratamento farmacológico , Esquistossomose/patologiaRESUMO
BACKGROUND: Recognizing that many Americans draw on religious or spiritual beliefs when confronted by serious illness, some medical educators have recommended that physicians routinely ask about spirituality or religion when conducting a medical history. The most appropriate wording for such an inquiry remains unknown. OBJECTIVE: To examine patient acceptance of including the following question in the medical history of ambulatory outpatients: "Do you have spiritual or religious beliefs that would influence your medical decisions if you become gravely ill?" METHODS: Self-administered questionnaires were completed by 177 ambulatory adult patients visiting a pulmonary faculty office practice at a university teaching hospital in 1997 (83% response rate). RESULTS: Fifty-one percent of the study patients described themselves as religious and 90% believe that prayer may sometimes influence recovery from an illness. Forty-five percent reported that religious beliefs would influence their medical decisions if they become gravely ill. Ninety-four percent of individuals with such beliefs agreed or strongly agreed that physicians should ask them whether they have such beliefs if they become gravely ill. Forty-five percent of the respondents who denied having such beliefs also agreed that physicians should ask about them. Altogether, two thirds of the respondents indicated that they would welcome the study question in a medical history, whereas 16% reported that they would not. Only 15% of the study group recalled having been asked whether spiritual or religious beliefs would influence their medical decisions. CONCLUSION: Many but not all patients surveyed in a pulmonary outpatient practice welcome a carefully worded inquiry about their spiritual or religious beliefs in the event that they become gravely ill.
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Atitude Frente a Morte , Comunicação , Saúde Holística , Pacientes/psicologia , Relações Médico-Paciente , Religião e Medicina , Espiritualidade , Assistência Terminal/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores Sociais , Inquéritos e Questionários , Confiança , Estados UnidosRESUMO
OBJECTIVE: To define gender differences in noncognitive behavioral problems of patients with AD and differences in the associated treatment of those problems. DESIGN/METHODS: We performed an observational study using the Systematic Assessment and Geriatric drug use via Epidemiology (SAGE) database, which contains data collected with the Minimum Data Set on a cross-section of nursing home residents in five US states. Behavior problems were documented at the first assessment of 28,367 residents with AD. We evaluated the role of gender differences in behavior as predictors of differences in nonpharmacologic versus specific pharmacologic therapies with psychoactive medications using logistic regression. RESULTS: Men were more likely than women to exhibit behavior problems such as wandering, abusiveness, and social impropriety (59% versus 50% for any behavior problem). Hallucinations and delusions as well as depression were equally prevalent in men and women. Nevertheless, men were more likely to receive psychoactive medications. Among the specific drug categories examined, and controlling for age and degree of cognitive impairment, men were more likely to receive antipsychotic drugs and less likely to be receiving antidepressants. CONCLUSION: Gender appears to play an important role in determining the frequency of behavioral problems in nursing home residents with AD, which may influence choice of treatments as well as the decision whether to treat. The use of more potent tranquilizers in men with problem behaviors has potential implications for morbidity, deserving further investigation.
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Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/psicologia , Violência , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/administração & dosagem , Antipsicóticos/administração & dosagem , Transtornos Cognitivos/tratamento farmacológico , Transtornos Cognitivos/psicologia , Confusão/tratamento farmacológico , Confusão/psicologia , Feminino , Alucinações/tratamento farmacológico , Alucinações/psicologia , Humanos , Masculino , Casas de Saúde , Padrões de Prática Médica , Fatores SexuaisRESUMO
We studied two patients who were given high-dose intravenous steroid therapy and were intubated for status asthmaticus. Both became quadriplegic and wasted within 2 weeks. EMG had myopathic abnormalities. Muscle biopsy revealed severe atrophy of most muscle fibers, with disorganization of myofibrils and selective loss of thick (myosin) filaments. Immunohistologic stains for myosin isoforms confirmed the decrease or absence of this protein. Both patients clinically improved over several months.
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Corticosteroides/efeitos adversos , Doenças Musculares/induzido quimicamente , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , Quadriplegia/induzido quimicamente , Doença Aguda , Adolescente , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Doenças Musculares/patologia , Doenças Musculares/fisiopatologia , Condução Nervosa/fisiologia , Quadriplegia/patologia , Quadriplegia/fisiopatologiaRESUMO
A patient is presented who developed an acute gastrointestinal and neurologic syndrome progressing to coma after ingestion of a fish soup made in Rhode Island. Laboratory studies confirmed the clinical diagnosis of ciguatera poisoning. Physicians should be aware of the diagnostic features of this disease even in non-endemic areas.
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Ciguatera , Coma/induzido quimicamente , Peixes , Animais , Ciguatoxinas/análise , Coma/diagnóstico , Coma/terapia , Cobaias , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Rhode IslandRESUMO
PURPOSE: To evaluate the effect of Er;YAG laser on pig retina using a perfluorodecaline/retina interphase with the goal of precisely determining the extent of retinal tissue ablation. METHODS: Free running (tau = 250 microsec) Er:YAG laser pulses were transmitted through a zirconium fluoride (ZrF4) fiber guarded by quartz rod (d = 1000 microm). Laser pulses were applied to the retinal surface of enucleated pig eyes. Eyes were mounted in a specially designed rotating sample holder. The fiber probe was elevated 1.0 +/- 0.3 mm above the retinal surface with perfluorodecaline serving as transmitting medium. The laser energy was applied in a circular pattern with a radius of 3.0 mm. Radiant exposures were set to 1, 3, 5, and 10 J/cm2. RESULTS: Tissue ablation linearly increased with radiant exposure from 3.2 +/- 3.7 microm at 1 J/cm2 up to 40.9 +/- 12.9 microm at 10 J/cm2. Thermal tissue changes extended 70 +/- 10 microm vertically into the retina and 25 +/- 5 microm horizontally. Distortion of outer photoreceptor segments was noticed when the retina was exposed to radiant exposures of 3 J/cm2 or higher. CONCLUSIONS: The Er:YAG laser in combination with perfluorodecaline produced precise ablation of the pig retina, which suggests the feasibility of this technique for safe ablation of epiretinal membranes.
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Fluorocarbonos , Terapia a Laser/métodos , Procedimentos Cirúrgicos Oftalmológicos , Retina/cirurgia , Corpo Vítreo , Animais , Membrana Epirretiniana/cirurgia , Retina/patologia , SuínosRESUMO
The additional information obtained by gastroscopy in patients already examined by upper gastrointestinal roentgenography was assessed. For this purpose, a data sheet for computer analysis was filled in at the time of gastroscopy and again at patient dismissal. Overall, gastroscopy resulted in an altered diagnosis in 18 percent of 1, 368 examinations, and in another 7 percent of cases there were findings of possible clinical significance. Gastroscopic findings differed significantly from x-ray findings in 7 to 35 percent of cases, depending on the indication for the procedure.
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Gastroenteropatias/diagnóstico , Gastroscopia , Computadores , Erros de Diagnóstico , Sistema Digestório/diagnóstico por imagem , Estudos de Avaliação como Assunto , Gastroscopia/métodos , Humanos , RadiografiaRESUMO
The recently described technique of endoscopic placement of a permanent feeding gastrostomy is reviewed with several modifications. Our experience in 23 adults has led us to conclude that this nonsurgical technique is the procedure of choice in achieving long-term enteral nutrition in patients who have an intact, nonobstructed gut and in whom the stomach can be directly apposed to the anterior abdominal wall.