RESUMO
The monocyte-macrophage system has long been recognized as a necessary accessory to the immune response. Recently, however, monocyte-macrophages have been shown to be important effectors of cell-mediated cellular cytotoxicity (both antibody dependent and antibody independent). In this study, monocyte-mediated cellular cytotoxicity of both types was assessed on 51Cr-labeled human erythrocytes (type B+) using autologous and standardized AB serum, and monocytes from 57 normal controls, 16 women with benign breast disease, and 175 patients with cancers of the breast (44 patients), colorectum (46 patients), head and neck (33 patients), lung (13 patients), and melanoma (39 patients). Although results were variable, many of the patients had depressed antibody-dependent cellular cytotoxicity suggesting decreased ability of their monocyte-macrophage to lyse the sensitized erythrocytes. Enhanced antibody-dependent cellular cytotoxicity was observed in patients with localized colorectal cancer, but this effect was reversed in patients with advanced disease. Serum factors did not significantly affect responses in most cases. The clinical relevance of this assay remains to be determined.
Assuntos
Citotoxicidade Celular Dependente de Anticorpos , Citotoxicidade Imunológica , Hemólise , Monócitos/imunologia , Neoplasias da Mama/imunologia , Adesão Celular , Eritrócitos/imunologia , Feminino , Neoplasias de Cabeça e Pescoço/imunologia , Humanos , Neoplasias Intestinais/imunologia , Neoplasias Pulmonares/imunologia , Macrófagos/imunologia , Melanoma/imunologia , Neoplasias/imunologia , Valores de ReferênciaRESUMO
The 1H nuclear magnetic resonance spectral characteristics of the cyano-Met form of Chironomus thummi thummi monomeric hemoglobins I, III and IV in 1H2O solvent are reported. A set of four exchangeable hyperfine-shifted resonances is found for each of the two heme-insertion isomers in the hyperfine-shifted region downfield of ten parts per million. An analysis of relaxation, exchange rates and nuclear Overhauser effects leads to assignments for all these resonances to histidine F8 and the side-chains of histidine E7 and arginine FG3. It is evident that in aqueous solution, the side-chain from histidine E7 does not occupy two orientations, as found for the solid state, rather the histidine E7 side-chain adopts a conformation similar to that of sperm whale myoglobin or hemoglobin A, oriented into the heme pocket and in contact with the bound ligand. Evidence is presented to show that the allosteric transition in the Chironomus thummi thummi hemoglobins arises from the "trans effect". An analysis of the exchange with bulk solvent of the assigned histidine E7 labile proton confirms that the group is completely buried within the heme pocket in a manner similar to that found for sperm whale cyano-Met myoglobin, and that the transient exposure to solvent is no more likely than in mammalian myoglobins with the "normal" distal histidine orientation. Finally, a comparison of solvent access to the heme pocket of the three monomeric C. thummi thummi hemoglobins, as measured from proton exchange rates of heme pocket protons, is made and correlated to binding studies with the diffusible small molecules such as O2.
Assuntos
Chironomidae/química , Histidina/química , Metemoglobina/análogos & derivados , Animais , Heme/química , Concentração de Íons de Hidrogênio , Espectroscopia de Ressonância Magnética , Metemoglobina/química , Conformação Proteica , Prótons , Soluções , Temperatura , Termodinâmica , ÁguaRESUMO
Chylous ascites in infants and children has been the subject of 35 articles in the English language literature during the past 30 years. Analysis of the cases of 58 patients reveals that chylous ascites has been reported twice as frequently in infants as in older children, but that the clinical presentations, essentials of diagnosis, treatment alternatives, and mortality rates have been otherwise remarkably similar. Two thirds of patients treated without operation were cured, half of them within the first month of therapy. Even though the documented experience with total parenteral nutrition in infants and children with chylous ascites is remarkably scant, parenteral nutritional support appears to have decreased the hazard of medical therapy by maintaining an adequate nutritional intake while eliminating obligate losses consequent to repeated paracentesis. Patients in whom chylous ascites recurs, after resumption of a regular diet, should undergo surgical exploration, according to a defined strategy that includes visualization of the retroperitoneal origin of the superior mesenteric artery.
Assuntos
Ascite Quilosa/terapia , Pré-Escolar , Ascite Quilosa/etiologia , Ascite Quilosa/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Ligadura , Masculino , Artérias Mesentéricas/cirurgia , Nutrição Parenteral , RecidivaRESUMO
Crohn's disease limited to the appendix is uncommon. The disease may mimic acute appendicitis with fever, leukocytosis, right lower quadrant pain, and occasionally a palpable mass. When Crohn's disease affects the appendix, it typically has a longer clinical period in which the patient has symptoms than do most cases of acute appendicitis. The most common preoperative diagnoses are acute appendicitis and appendiceal abscess. A review of the literature is presented along with our experience in three additional cases of Crohn's disease limited to the appendix. We suggest that Crohn's disease be included in the preoperative differential diagnosis and that extensive intraoperative examination of the gastrointestinal tract be made in any case of suspected appendicitis that has had a protracted preoperative course.
Assuntos
Doenças do Ceco/cirurgia , Doença de Crohn/cirurgia , Adolescente , Adulto , Apendicectomia , Apêndice/patologia , Doenças do Ceco/diagnóstico , Doenças do Ceco/patologia , Doença de Crohn/diagnóstico , Doença de Crohn/patologia , Granuloma/patologia , Humanos , Inflamação , MasculinoRESUMO
The English-language literature, from 1952 to 1979, was surveyed for all papers concerned with vascular trauma penetrating wounds of the neck, or carotid injuries in particular, and all valid, first-hand, adequately detailed cases of carotid arterial trauma were abstracted. The valid, first-hand, adequately detailed cases of carotid arterial trauma were abstracted. The current status of all our own hospital survivors who had been treated for carotid artery injuries was also established to add needed longitudinal perspective. In all, 722 cases were available for analysis. The mean age was 28 years, and the overall mortality rate was 21%. One hundred and eighty-six patients presented with severe neurological deficits. If they underwent arterial repair, 34% were better; if they had a carotid ligated, or were not treated surgically, only 14% improved (P = 0.01). Shock or coma, independently, were significantly ominous (P less than 0.001), but there was no evidence to support coma as a contraindication to restoring arterial continuity. Similarly, in the patients with preoperative neurological deficits, no data could be found to substantiate the contention that prompt arterial repair would yield better results than delayed repair. Follow-up status at 1 year was available for only 40 cases from the results than delayed repair. Follow-up status at 1 year was available for only 40 cases from the entire literature. Assessment of our own patients, at a mean of 4.6 years after injury, uncovered multiple, persistent neurological defects, one stenotic arterial repair, two aneurysms, and an arteriovenous fistula.
Assuntos
Lesões das Artérias Carótidas , Adulto , Artérias Carótidas/cirurgia , Circulação Cerebrovascular , Coma/complicações , Feminino , Humanos , Masculino , Doenças do Sistema Nervoso/etiologia , Prognóstico , Estudos Retrospectivos , Choque/complicações , Fatores SocioeconômicosRESUMO
A pilot study was undertaken to determine the usefulness of colonoscopy in the postoperative follow-up of patients with colorectal cancer. Of 56 patients, 9 (17 percent) had positive intraluminal examinations, including one recurrent cancer and three large polyps (greater than 1 cm) despite normal barium enema films. Twenty percent had negative colonoscopic findings which ruled out suspicious lesions on roentgenograms. More than one third had alterations in therapy as a result of colonoscopic examination. Colonoscopy is a useful and fruitful diagnostic aid in the follow-up of colon cancer. It should be used early in the postoperative period and added at rational intervals in long-term surveillance. It appears to complement other accepted methods of detecting recurrence.
Assuntos
Adenoma/cirurgia , Neoplasias do Colo/diagnóstico , Colonoscopia , Pólipos Intestinais/cirurgia , Neoplasias Retais/diagnóstico , Adenoma/diagnóstico por imagem , Adulto , Idoso , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/cirurgia , Estudos de Avaliação como Assunto , Seguimentos , Humanos , Pólipos Intestinais/diagnóstico por imagem , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Projetos Piloto , Radiografia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgiaRESUMO
BACKGROUND: We set out to compare a prospective evaluation of microlaparoscopic cholesystectomy (MLC) using 5-mm ports for the scope and operating ports and two 2-mm ports for retracting to the historic results of standard laparoscopic cholecystectomy (SLC). METHODS: Fifty-six consecutive patients were operated electively for symptomatic gallstones between June 1997 and July 1998. Demographics, history of prior abdominal surgery, operative time, resident level, need to convert, length of stay, and postoperative analgesia were recorded for each case. In all, 43 women and 13 men aged 21 to 89 (average, 51 years) underwent MLC. Average weight was 78 kg (range, 48-119) and average height was 163 cm. RESULTS: Operative time for MLC was 72+/-25 min (range, 35-140), somewhat less than the referenced standard of 79+/-27 min (p = 0.1). The skin-to-trocar time (6+/-2 vs. 13+/-77 min) and intraoperative cholangiogram time (9+/-8 vs. 11+/-6 min) were significantly shorter (p<0.01 and p<0.05, respectively) for MLC. Other partial times were not significantly different. PGY2 residents averaged 74+/-21 min (range, 44-118) compared to 75+/-27 min (range, 35-140) for PGY3 and 53+/-5 (range, 43-59) for PGY5. Patient weight influenced time. Patients <65 kg averaged 56 +/-12 min; 66-80 kg, 72+/-24 min; 81-95 kg, 78+/-26 min; and >95 kg, 85+/-22 min. Previous abdominal surgery did not affect operative time. Nine patients (16%) required conversion from 2- to 5-mm ports because of adhesions, wall thickening, or need for better retraction. Time in these patients was 95+/-26 min vs. 68+/-21 min in other patients (p<0.01). No patient was converted to an open procedure. Three patients (5%) had a positive cholangiogram and common bile duct exploration that required placement of an extra 5-mm trocar. Five patients (9%) required insertion of an additional 2-mm port. All patients received patient-controlled analgesia (PCA). Morphine use was 0.21+/-0.19 mg/kg (range, 0-0.8). Hospital stay was 1.31 days (range, 0.5-4). Subjective satisfaction was excellent because of smaller incisions. No additional morbidity was seen with MLC. CONCLUSION: MLC is a feasible and safe approach that provides similar times to SLC with better cosmesis, a less painful recovery, and possibly an earlier return to normal activity.
Assuntos
Colecistectomia Laparoscópica/métodos , Colelitíase/cirurgia , Microcirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiografia , Colelitíase/diagnóstico por imagem , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Estudos Prospectivos , Resultado do TratamentoRESUMO
One hundred patients underwent upper endoscopy for the placement of percutaneous endoscopic gastrostomies (PEGS) during a four year period from 1984 to 1988. These cases were retrospectively reviewed to document the need for total endoscopy during PEG. Ninety-seven per cent of the procedures were successful. In 89 per cent, a complete exam of the esophagus, stomach, and duodenum was performed, revealing pathologic findings in 59 per cent. The most common abnormalities were in the esophagus (23%) and the stomach (27%); however, a portion of the findings were also present in the duodenum (12%) and the pylorus (11%). Additional findings present in the complete esophagogastroduodenoscopy (EGD) done at the time of PEG included a five per cent incidence of gastric outlet obstruction and antral ulcers or polyps in six per cent. The breakdown of findings in the duodenum included eight per cent incidence of duodenal ulcers and four per cent incidence of duodenitis. A total of 22 per cent of the patients had some evidence of peptic ulcer disease. Many of the cases in which pathology was found required a change in medications and, when postoperative bleeding occurred after PEG, the other pathologic entity was much more likely to be the cause of the complication than the PEG. A careful and complete EGD is mandated every time a patient is scheduled for PEG.
Assuntos
Endoscopia , Gastrostomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Duodenoscopia , Esofagoscopia , Feminino , Gastroenteropatias/diagnóstico , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Estudos RetrospectivosRESUMO
Under the auspices of the Resident Education Committee of the Society of American Gastrointestinal Endoscopic Surgeons, 158 of 298 (53%) of surgical training program directors responded to a survey on the current status of endoscopy in residency programs. Although 100 per cent claim that gastrointestinal endoscopy is provided by their program, only 76 per cent have formal endoscopy training, usually centered around the PGY 3 level, with only 23 per cent having didactic lectures in endoscopy. Directors claim to have trained nearly all of their residents by the completion of residency, averaging 44 esophagogastroscopies, 37 colonoscopies, and 46 flexible sigmoidoscopies per resident. However, they feel only 71 per cent of trainees are able to perform esophagogastroscopies and 67 per cent to perform colonoscopies in clinical practice. Ninety-seven per cent of directors feel endoscopy is important to surgical residency training, and 87 per cent have full-time faculty doing endoscopy. Only 44 per cent have a director of endoscopy; endoscopy is supervised by surgeons exclusively in only 48 per cent. Only 35 per cent have ongoing endoscopy research. When surgeons are not performing endoscopy, 66 per cent feel that the gastrointestinal (GI) service provides adequate service or training. Gastroenterology has a monopoly in endoscopy at 28 per cent of institutions, and 67 per cent of program directors feel there would be resistance to the formation of a separate surgical endoscopy service. Surgeons work in their own surgical endoscopy suite in only 15 per cent of institutions; in a GI suite in 13 per cent; and in a combined suite in the remainder.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Endoscopia Gastrointestinal , Cirurgia Geral/educação , Internato e Residência , Atitude do Pessoal de Saúde , California , Competência Clínica , Internato e Residência/estatística & dados numéricos , Avaliação de Programas e Projetos de SaúdeRESUMO
To compare techniques of gastrostomy in elderly patients, the records of 100 patients age 70 and older who underwent gastrostomy tube placement as a primary procedure were reviewed. Two separate unmatched groups of 50 patients each were identified: those that underwent operative gastrostomy tube (OGT) placement and those that underwent percutaneous endoscopic gastrostomy tube (PEG) placement. The groups were studied for demographic similarities and for differences in morbidity, mortality, and ease of feeding. Comparison showed that PEGs had a lower mortality (0%) and morbidity (10%) than did OGTs where mortality was 4 per cent and morbidity was 22 per cent. PEGs began feeding sooner (1.0 day vs. 2.8 days) than OGTs. In addition, almost 60 per cent of the PEG patients underwent complete upper endoscopy at the time of the PEG, which revealed pathology that either altered the type of tube placed or the eventual medical management. PEG offers a less morbid, safer, and easier to use method of gastrostomy tube placement than OGT in the majority of elderly patients.
Assuntos
Gastroscopia , Gastrostomia/métodos , Laparotomia , Idoso , Idoso de 80 Anos ou mais , Nutrição Enteral , Feminino , Gastroscopia/efeitos adversos , Gastrostomia/efeitos adversos , Gastrostomia/mortalidade , Humanos , Laparotomia/efeitos adversos , Masculino , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Establishment of a percutaneous endoscopic jejunostomy via direct jejunal puncture was accomplished in a 45-year-old woman five years after a partial esophagectomy with cervical esophagogastrostomy for adenocarcinoma of the esophagus. The patient had recurrence of the cancer at the anastomotic site with subsequent inability to eat, necessitating a feeding tube for prolonged enteral nutrition. Although percutaneous puncture of the jejunum has been previously described, it has been limited to patients who had undergone partial or complete gastrectomies with Bilroth II anastomoses. This case report of direct endoscopic jejunal tube placement in a patient after esophagectomy further establishes this procedure as a viable alternative to surgically placed feeding tubes in patients with altered gastric anatomy.
Assuntos
Esôfago/cirurgia , Jejunostomia , Punções , Anastomose Cirúrgica , Nutrição Enteral , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Jejunostomia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estômago/cirurgiaRESUMO
In order to gain a longitudinal perspective of the benefits, complications, and role of the neodymium yttrium aluminum garnet (Nd-YAG) laser in the treatment of colorectal neoplasms, we performed a review of endoscopies using the laser during a 53-month period ending in January 1989. We reviewed the records of 100 patients for details of the endoscopic procedure and demographic data. Performance status and survival were critically assessed. We performed 275 procedures on 57 men and 43 women with an average age of 76.5 years. An average of 2.75 procedures, each lasting an average of 45 minutes, were performed per patient. Half of the patients had fulgurations of rectal tumors with the common indication being bleeding. Thirteen morbid events and no deaths occurred. Ninety-six per cent of the procedures were performed with the patient under intravenous sedation. The Karnofsky performance scale applied to surviving patients revealed that 90 per cent were able to care for themselves and scored greater than 70. Average survival was 5.58 months. Our results indicate that the Nd-YAG is a safe and effective tool in the treatment of colorectal neoplasms offering palliation as well as maintenance of quality of life.
Assuntos
Neoplasias Colorretais/cirurgia , Terapia a Laser , Adulto , Idoso , Colonoscopia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , ReoperaçãoRESUMO
To assess the indications and yield of single session panendoscopy (SSPE), patients who underwent colonoscopy and esophagogastroduodenoscopy (EGD) at the same time were retrospectively reviewed. Endoscopy records and patient charts of 101 patients who underwent SSPE during a 45-month period were analyzed for demography, indication, and results. Average age was 72.9 years. Common indications were positive occult blood tests (74%), anemia (28%), altered bowel habits (15%), and iron deficiency (13%). Most frequent findings at colonoscopy included diverticulosis (47%), polyps (37%), hemorrhoids (28%), and arteriovenous (AV) malformations (13%). Nine cases of cancer were found, seven of which were right-sided. Colonoscopy was normal in 12 per cent. EGD findings include esophagitis (55%), hiatal hernia (47%), and gastritis (33%). Eleven per cent were normal. Occult blood loss is not predictive of either a positive or negative study. SSPE is a safe and specific approach; however, based on this study, colonoscopy is recommended as the initial study for occult blood loss with plans to proceed to EGD when the lower endoscopy is normal. Even when the colonoscopy suggests the etiology for occult blood loss, EGD will yield a significant number of treatable and unsuspected lesions.
Assuntos
Colonoscopia/métodos , Gastroenteropatias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Divertículo/diagnóstico , Duodenoscopia , Esofagoscopia , Feminino , Gastroenteropatias/economia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Sangue Oculto , Estudos RetrospectivosRESUMO
A review of patients undergoing elective tracheostomy (TRACH) and percutaneous endoscopic gastrostomy (PEG) was undertaken to decide whether addition of PEG to a planned tracheostomy was safe and indicated by conditions mandating the tracheostomy. Charts were reviewed for demographic data, details of operation, outcome, and disposition. Sixteen patients with an average age of 61 years were studied. Primary diagnosis included CNS disease (7), trauma (6), and multisystem failure (3). These patients had 35 associated diseases. Indications for tracheostomy were respiratory failure (9) and prolonged intubation (7). The average time from admission to procedure was 23.7 days. Average operative time was 50 minutes. There were three postoperative complications. Ten patients were discharged (5 home, 5 skilled facility) and six expired. All patients had functioning tracheostomies and PEGs at the time of disposition. Percutaneous endoscopic gastrostomy is a logical adjunct to planned tracheostomy, adding little morbidity but with potential benefit to long-term management in this special group of chronic care patients.
Assuntos
Gastrostomia , Traqueostomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Nutrição Enteral , Feminino , Gastrostomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Respiração Artificial , Estudos RetrospectivosRESUMO
A retrospective review of endoscopic procedures using the Nd-YAG laser was carried out for patients treated between September 1984 and November 1986. Two hundred twenty two procedures were performed on 104 patients (58M:46W) during this 26 month period. The study encompasses a unique period of time in this center, as it includes the initial use of the endoscopic laser technique, the learning curves associated with its application, and finally, the time when its use became routine. Treatment of tumors was the indication in 47 per cent of the cases. Gastrointestinal bleeding of benign cause was the indication in nearly half of the patients; arteriovenous malformations were the most common causes of bleeding. Laser photocoagulation of hemorrhoids was performed in 11 cases. Upper endoscopy was the route in 33 per cent of procedures. Anoscopy, flexible sigmoidoscopy, and colonoscopy were the routes in the remainder. The time spent on the procedure and the energy delivered were found to be variables of the type of lesion and the endoscopic route. Nd-YAG laser endoscopy can be used safely and effectively for a variety of bleeding and obstructive gastrointestinal conditions. Appropriate certification for granting of privileges to laser endoscopists is of utmost importance.
Assuntos
Endoscopia/métodos , Hemorragia Gastrointestinal/cirurgia , Neoplasias Gastrointestinais/cirurgia , Terapia a Laser/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia/efeitos adversos , Feminino , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-IdadeRESUMO
The rare condition of neonatal uterine prolapse is usually associated with congenital spinal defects and is often resistant to simple reduction. Previously, treatment has been primarily surgical and often deforming. In this case report a silastic-ensheathed pessary fashioned from a rubber Penrose drain allowed a nonoperative, simple and permanent correction, permitting the more important, yet less obvious, associated defects to take therapeutic precedence.
Assuntos
Prolapso Uterino/congênito , Feminino , Humanos , Recém-Nascido , Pessários , Prolapso Uterino/terapiaAssuntos
Colecistectomia Laparoscópica , Colecistite/cirurgia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica/efeitos adversos , Colecistite/diagnóstico , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Cross sections, including serial sections, of myocardial zonal lesions in right vetricular papillary muscles of cats subjected to hypovolemic shock were examined by electron microscopy. It was determined that the basic structure of A and I bands was retained even in severe zonal lesions with herniation of A and I bands through the intercalated disc into adjacent myocytes. The herniated A and I bands, together with accompanying mitochondria, were enclosed in membranes, apparently the unspecialized portion of the intercalated disc. Since the longitudinal orientation of myofilaments is retained in zonal lesions, this study indicates that intact A and I bands must slide past one another during the supercontraction of sarcomeres which is characteristic of zonal lesions. This study also presents evidence that the nexus may become involved in zonal lesions.
Assuntos
Miocárdio/ultraestrutura , Miofibrilas/ultraestrutura , Choque/patologia , Actinas/fisiologia , Animais , Gatos , Contração Miocárdica , Miocárdio/patologia , Miosinas/fisiologiaRESUMO
Right ventricular papillary muscles from control cats and from cats subjected to hypovolemic shock were studied in cross-section, including serial sections, by electron microscopy. Loops of nexus and a redundant right angle nexus were followed through serial cross-sections in papillary muscles from the shock cats. These unusual nexus configurations were interpreted as a possible means of connecting perpendicular sheets of nexus, of interdigitating adjacent cells, and of providing slack to be taken up during the radial swelling of myocardial contraction. The flexibility of the intercalated disc which is implicit in this interpretation may explain the ability of cardiac myocytes to recover from the severe distortions adjacent to the intercalated disc which occur in myocardial zonal lesions, and perhaps, if they are reversible, in other lesions which occur in proximity to the intercalated disc.
Assuntos
Miocárdio/ultraestrutura , Músculos Papilares/ultraestrutura , Choque/patologia , Animais , GatosRESUMO
Laparoscopic gastrostomy (LG) and laparoscopic jejunostomy (LJ) were performed successfully on 22 consecutive patients after development of the procedure on a porcine model. Patients did not undergo percutaneous endoscopic gastrostomies (PEG) due to obstruction from head and neck, esophageal cancer, gastropexy for gastric volvulus, perforated esophagus, failed PEGs, or surgeon's preference. Operative time averaged < 20.5 min. Five patients underwent the procedure under local anesthesia with intravenous sedation and three patients were operated on in a strictly outpatient setting. There was one postoperative death. LG and LJ are safe alternatives to open enterostomy in patients who cannot undergo PEG.