ABSTRACT
<p><b>BACKGROUND</b>Percutaneous endoscopic gastrostomy (PEG) feeding is widely used in stroke patients suffering from persistent dysphagia; however, predicting the risks and benefits of PEG insertion in the individual patient is difficult. The aim of our study was to investigate if candidate risk factors could predict short-term mortality risk in poststroke patients who had PEG tube insertion for persistent dysphagia.</p><p><b>METHODS</b>This was a retrospective study of 3504 consecutive stroke patients admitted to two metropolitan hospitals during the period January 2005 to December 2013 and who also underwent PEG insertion for feeding due to persistent dysphagia.</p><p><b>RESULTS</b>A total of 102 patients were included in the study. There were 22 deaths in 6 months after insertion of PEG tubes and 20 deaths of those occurred within 3 months post PEG. Those who survived beyond 6 months showed significantly lower mean age (75.9 ± 9.0 years vs. 83.0 ± 4.9 years, P < 0.001), a lower mean American Society of Anesthesia (ASA) score (3.04 ± 0.63 vs. 3.64 ± 0.58, P < 0.001) compared to nonsurvivors. In multiple Logistic, age (P = 0.004, odds ratio [OR] = 1.144; 95% confidence interval [CI]: 1.044-1.255); ASA (P = 0.002, OR = 5.065; 95% CI: 1.815-14.133) and albumin level pre-PEG insertion (P = 0.033, OR = 0.869; 95% CI: 0.764-0.988) were the independent determinants of mortality respectively.</p><p><b>CONCLUSIONS</b>We propose that age, ASA score and albumin level pre-PEG insertion to be included as factors to assist in the selection of patients who are likely to survive more than 3 months post PEG insertion.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Deglutition Disorders , Mortality , General Surgery , Gastrostomy , Methods , Retrospective Studies , Stroke , Mortality , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To research the diagnosis and effective treatment of penetrating anorectal wounds.</p><p><b>METHODS</b>Retrospective analysis was done in 16 cases of penetrating anorectal wounds from 1985 to 2004. Debridement and suture of anorectal and vesical wounds, effective diversion of fecal and urinary stream and sufficient presacral drainage were performed in all cases.</p><p><b>RESULTS</b>All the 16 cases were cured. Among them, 2 cases with infection in presacral space were cured by sufficient drainage after operation, one case was cured by secondary repair after anal sphincter was repaired unsuccessfully and one case with rectovesical fistula was cured with conservative treatment. None of them suffered from complications such as anal stenosis, dysuria or impotence etc.</p><p><b>CONCLUSIONS</b>For penetrating anorectal wound, to master early recognition of concomitant injures, to select appropriate surgical intervention and to strengthen perioperative treatment are the keys to improve the curative effects.</p>