Replacement of Percutaneous Endoscopic Gastrostomy Tube with Low Profile Button Percutaneous Endoscopic Gastrostomy: First Indian Experience

Background: Percutaneous endoscopic gastrostomy (PEG) is a common procedure employed for patients with swallowing disorders with a functioning gastrointestinal tract. Replacement of PEG with a conventional PEG tube by ‘pull technique’ is considered to be the standard of care. Low profile or button PEG, an alternative that obviates the need for endoscopy, is less explored in the Indian setting. Methods: Records of all the patients, who underwent PEG replacement with a low-profile PEG (MIC-KEY by Halyard, U.S.A.) for three years, were reviewed. Complications and other relevant details were recorded. Result: Twenty four low profile PEG tubes were placed in 16 patients; [male 12 (75%); median age(range) 67 (25-85) years]. The indications of PEG placement were stroke in 10 patients, other neurologic illnesses in 5 patients and laryngeal malignancy in 1 patient. Perforation peritonitis and skin induration developed in one patient each. None of the patients had any procedure-related fatal complication. Conclusion: Although PEG exchange with low profile PEG is considered safe, it has potential complications. Thus, utmost care is required to recognize and treat them early.

Imaging features of central nervous system fungal infections.

Fungal infections of the central nervous system (CNS) are rare in the general population and are invariably secondary to primary focus elsewhere, usually in the lung or intestine. Except for people with longstanding diabetes, they are most frequently encountered in immunocompromised patients such as those with acquired immunodeficiency syndrome or after organ transplantation. Due to the lack of inflammatory response, neuroradiological findings are often nonspecific and are frequently mistaken for tuberculous meningitis, pyogenic abscess or brain tumor. Intracranial fungal infections are being identified more frequently due to the increased incidence of AIDS patients, better radiological investigations, more sensitive microbiological techniques and better critical care of moribund patients. Although almost any fungus may cause encephalitis, cryptococcal meningoencephalitis is most frequently seen, followed by aspergillosis and candidiasis. The biology, epidemiology and imaging features of the common fungal infections of the CNS will be reviewed. The radiographic appearance alone is often not specific, but the combination of the appropriate clinical setting along with computed tomography or magnetic resonance may help to suggest the correct diagnosis.