Modified Trendelenburg Procedure for Varicose Vein

Varicose veins of lower limbs is very common in clinical practice with its associated complications like venous ulcer, edema and pigmentation. Sapheno-femoral in competence and perforator incompetence are the principal cause of varicose veins. Trendlenburg operation of sapheno-femoral ligation and perforator ligation is standard procedure for its treatment. But for a beginner surgeon the procedure has some potential risks like injury to saphenous vein, injury to femoral vein and tributaries during dissection and ligation producing complications like bleeding, haematoma and long operative time. We have modified this Trendlenburg operation by a simple technique of canulating the saphenous vein from mid thigh end to easily identify the T-junction and tributaries. This Modified Trendlenburg Operation reduces the intra-operative complications and decreases the operation time.

The study of auscultation-assisted bedside blind placement of the nasojejunal feeding tube in oldest-old patients / 中国实用护理杂志

Objective:To evaluate the success rate and influencing factors of auscultation-assisted bedside blind placement of the spiral nasojejunal feeding tube in oldest-old patients.Methods:A case series study was conducted in those elderly hospitalized patients who met the indications for naso intestinal intubation from January 2019 to May 2021 in China-Japan Friendship Hospital. Auscultation-assisted bedside blind placement of the spiral nasojejunal feeding tube was implemented. In addition, abdominal X-ray imaging was performed to confirm the location of the catheter tip. The primary indicators included were the success rate and the first attempt success rate of nasojejunal tube placement;, while the secondary indicators included were the number of attempts and the time of insertion. The rate of operational-related adverse events was ustreated as to evaluate the indicator of safety. Logistic regression analysis was used to conduct multi factor analysis.Results:The total success rate and the first-attempt success rate of tube implantation reached were 90.1%(73/81) and 85.2%(69/81), respectively. The mean attempt per individual patient was (1.2 ± 0.2) times for each patient. The median length of operation time was 40.0(27.0, 45.0) minutes, more specifically, among which the median length time of nasogastric and gastrojejunal placement was 20.0(15.0, 25.0) and 18.0(12.5, 20.0) minutes, respectively; while the median lengthtime of nasogastric placement was greaterhigher than that of gastrojejunal placement ( Z = -2.78, P<0.05). As suggested by multivariate analysis, indicated that the conscious conditions of patients had a signific antlyimpact affect on the success rate of for tube implantation ( OR = 19.25, 95% CI 1.24-299.63, P<0.05). In addition, the incidence rate of operational-related adverse events was 37.0%(30/81). By contrast, there were no serious adverse events occurring during the study period. Conclusions:The auscultation-assisted bedside blind placement of the nasojejunal feeding tube technique is effective and safe for early nutrition support in oldest-old patients in terms of early nutritionsupport, the success rate of which is significant largely affected by the patients′ conscious conditions of patients.

The role of tourniquet in myomectomy: an observational study

Background: Leimymoma is one of the commonest benign tumours encountered in women during the reproductive age. One quarter of these women may be symptomatic. When surgical management is indicated, myomectomy may be considered as the procedure of choice. Myomectomy can be complicated by severe intraoperative haemorrhage. One of the methods to reduce blood loss during myomectomy is the mechanical application of tourniquet.Methods: A prospective observational single arm study was done with 24 women who underwent open myomectomy to determine the utility of tourniquet in reducing blood loss during the procedure.  Women of reproductive age group, having symptomatic fibroid, not responding to medical therapy, not completed their family and with total uterine size not exceeding 20 weeks were included in the study while those with pregnancy, concomitant adenomyosis, cervical or broad ligament fibroid, bleeding diathesis were excluded. The 7-French pediatric feeding tube was used as tourniquet. Our primary end point was intra-operative blood loss. Secondary outcome measures included operative morbidity and blood transfusion rates.Results: It was seen that application of the tourniquet considerably reduced the amount of blood loss and made resection of the myoma much easier. 83.3% patients had a blood loss less than 200ml and the rest between 200ml and 400ml. For majority of the patients (75%) the postoperative change of PCV was between 1 and 2%.Conclusions: The infant feeding tube form of tourniquet is cheap, safe, readily available, effectively reduces blood loss during myomectomy while not adding to the complications due to the operation.

Paciente idoso desospitalizado: a continuidade da terapia nutricional enteral domiciliar / Dehospitalized Elderly Patient: The Continuity of Home Enteral Nutritional Therapy

Introdução: o aumento do uso de Terapia Nutricional Enteral em pacientes internados e que muitas vezes necessitam dar continuidade da terapêutica no domicílio, faz com que a alta hospitalar seja estimulada como parte da oferta de cuidados em rede pelo Sistema Único de Saúde, nos diferentes pontos da Rede de Atenção à Saúde. Objetivo: verificar o uso e a continuidade da Terapia Nutricional Enteral Domiciliar do paciente idoso desospitalizado. Metodologia: pesquisa exploratória, prospectiva e descritiva sob os pressupostos da pesquisa quantitativa e qualitativa, para melhor compreensão da situação da Terapia Nutricional Enteral Domiciliar, dos pacientes idosos desospitalizados. A coleta de dados foi realizada entre agosto a outubro de 2018, através de entrevistas individuais, previamente agendadas, com idosos de 60 anos e mais, de ambos os sexos, que tiveram alta do Centro Hospitalar do Município de Santo André. Atendendo a Resolução 466/12, o estudo foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem da USP e da Instituição Pública, Todos os participantes assinaram o Termo de Consentimento Livre e Esclarecido. Foi utilizado um instrumento com questões para captar os dados Sociodemográficos e questões norteadoras para captar a realidade do uso da Terapia de Nutrição Enteral Domiciliar. Resultados: participaram do estudo 67 pacientes, sendo 55,2% do sexo masculino e 44,8% feminino, do total 40,3% ficaram internados até 20 dias. Os principais diagnósticos na admissão para internação foram acidente vascular encefálico com 62,7% e 19,4% com câncer. Das co-morbidades destacaram-se a hipertensão arterial com 61,2% dos pacientes e 29,9% que possuíam hipertensão arterial e diabetes melittus. Dos participantes 76,1% eram acamados, em relação aos cuidadores 73,1% eram familiares e 19,4% formais, 47,8% dos participantes informaram que receberam orientações sobre os cuidados pós-alta por Enfermeiro e Nutricionista. Quanto à Terapia Nutricional Enteral Domiciliar 100% dos participantes faziam uso regular da dieta, 46,3% estavam em uso entre um a três meses e 23,9% no período de seis a 11 meses, a dieta industrializada liquida era utilizada por 74,6% dos pacientes de forma exclusiva. Em relatos 89,6% dos pacientes recebiam as dietas e insumos fornecidos pelo programa de SAD. Ao buscar conhecer a experiência do uso da Terapia no Domicílio emergiram as categorias: processo educativo em saúde, as falas expressaram muitas informações ao mesmo tempo. Na vivência com a TNED, observou-se expressões de discernimento da necessidade da nova fase pela qual passavam com o despertar na pluralidade de sentimentos dos novos desafios; enfrentamento das complicações com a TNED, mesmo com as orientações fornecidas no pré alta hospitalar as complicações não deixaram de ocorrer. Quanto ao sistema de referência e contrarreferência, verificou-se que apesar das dificuldades os pacientes estão sendo acolhidos pela Rede. Conclusão: Considerando que todos os pacientes com indicação da Terapia Nutricional Enteral Domiciliar receberam as orientações para o cuidado no domicílio, observou-se da importância do acolhimento e suporte assistencial na Rede para a continuidade da Terapia ao paciente desospitalizado, que mesmo com as dificuldades os pacientes fazem uso da TNED, sem relatos de reinternações.

Introduction: the increase in the use of Enteral Nutritional Therapy in inpatients, who often need to continue their treatment at home, means that hospital discharge is encouraged as part of the network of care provided by the Unique Health System at the various points of the Health Care Network. Objective: To evaluate the use and continuity of Home Enteral Nutritional Therapy in dehospitalized elderly patients. Methodology: Exploratory, prospective and descriptive research under the assumptions of quantitative and qualitative research, to better understand the situation of Home Enteral Nutritional Therapy, with dehospitalized elderly patients. Data collection was carried out from August to October 2018, through previously scheduled individual interviews with elderly individuals aged 60 years and older, of both genders, who were discharged from the Hospital Center of the Municipality of Santo André. In compliance with Resolution 466/12, the study was approved by the Research Ethics Committee of the School of Nursing of USP and the Private Institution. All the participants signed the Free and Informed Consent Form. An instrument was used with questions to capture the sociodemographic data and guiding questions to capture the reality of the use of Home Enteral Nutrition Therapy. Results: 67 patients participated in the study, 55,2% male and 44,8% female, of which 40,3% were hospitalized for 20 days. The main diagnoses at admission for hospitalization were cerebral vascular accident with 62,7% and 19,4% with cancer. Among the comorbidities, arterial hypertension stood out with 61,2% of the patients and 29,9% who had arterial hypertension and diabetes melittus. Of the participants, 76,1% were bedridden, in relation to the caregivers 73.1% were family members and 19.4% were formal caregivers, 47,8% of the participants reported that they received guidance on post-discharge care from Nurse and Nutritionist. As for Home Enteral Nutritional Therapy, 100% of the participants made regular use of the diet, 46,3% were in use between one and three months and 23,9% over a period of six to 11 months, and the liquid industrialized diet was used by 74,6% of the patients exclusively. In reports 89,6% of patients received the diets and inputs provided by the SAD program. When seeking to know the experience of the use of Therapy at Home, the following categories emerged: educational process in health, the speeches expressed a lot of information at the same time. In the experience with HENT, there were expressions of discernment of the needs of the new phase they went through with the awakening in the plurality of feelings of the new challenges; facing complications with HENT, even with the guidance provided in the pre-hospital discharge the complications did not fail to occur. As for the system of reference and counter-reference, it was found that despite the difficulties the patients are being welcomed by the Network. Conclusion: Considering that all patients with indication of Home Enteral Nutritional Therapy received the guidelines for home care, it was observed the importance of the reception and assistance support in the Network for the continuity of Therapy to the dehospitalized patient, that even with the difficulties the patients make use of HENT, without reports of readmissions.

Establishment of a visualized of prediction model for postpyloric placement of spiral nasoenteral feeding tube in neurocritical care patients / 中国实用内科杂志

OBJECTIVE: To analyze the factors influencing postpyloric placement of spiral nasoenteral feeding tube(NET) in neurocritical care patients and establish a visualized prediction model. METHODS: Patients in Neurological Intensive Care Unit(NICU)who undertook postpyloric placement of NET after receiving prokinetics from Apr 2012 to Mar 2018 were included for retrospective analysis. The patients were divided into the success and failure group base on whether the tube tip entered into duodenum(or beyond)or not confirmed by bedside X-ray 24 hours later. The baseline data, APACHE Ⅱ score(acute physiology and chronic health evaluation Ⅱ), AGI grade(acute gastrointestinal injury), therapeutic measures and agents administered were recorded. Univariate and multivariate Logistic regression analysis was used to identify the potential factors affecting the postpyloric placement of NET. Based on those factors, a predicting model was established and visualized into an easy-to-use nomogram. RESULTS: A total of 241 patients including146 male and 95 female were enrolled for the study, with an median age of 58 years, median APACHEⅡscore of 20, median AGI of Ⅰ.The placement succeeded in 119(49.4%) of 241 patients. Logistic regression analysis demonstrated that APACHE Ⅱ score, sedatives and analgesics, vasopressors and AGI grade were among the influencing factors. A prediction model with a ROC-AUC of 0.8002 were established and visualized into a nomogram. CONCLUSION: APACHE Ⅱ score, sedatives and analgesics, vasopressors and AGI grade are the factors influencing success of postpyloric NET placement in neurocritical care patients, which incorporate a predicting model that can be visualized into a nomogram. The nomogram provided intensivists an easy-to-use decision support tool in NET placements.

Survey on Accumulated Drug Information by Pharmaceutical Companies about Crushed or Simply Suspended Internal Medicines / 医薬品情報学

Objective: We conducted a survey on drug information accumulated by pharmaceutical companies about the adequacy of administration of crushed or simply suspended internal medicines through enteral feeding tube, examination methods to confirm adequacy and inquiries from medical institutions to pharmaceutical companies about the adequacy of these methods.Methods: We sent a questionnaire to 162 pharmaceutical companies that sell internal medicines to collect information. The survey was conducted from May 1, 2016 to March 31, 2017.Results: The questionnaire response rate was 61% (99 companies responded). Eighty and 90 percent of the companies possessed information about the drug crushing methods and simple suspension methods used for administration of internal medicines,respectively. The type of information and examination methods used varied among the companies, was very limited, and was often limited to new drugs. The information acquisition rate about crushing methods was 69.3% in original examination methods of pharmaceutical companies. On the other hand, 90.3% of the information about simple suspension methods was obtained by the unified method of Hand Book of Simple Suspension Method.Conclusions: In the future, medical practice and patients will benefit if examination methods to confirm the adequacy of crushing and administration through feeding tubes are commonly and consistently obtained by pharmaceutical companies. Furthermore, it would be very useful for information of crushing methods and simple suspension methods to be included in package inserts and interview forms.

Application of nasogastric feeding tube placed by endoscopy to give enteral nutrient solution in the pediatric intensive diseases / 中华临床营养杂志

Objective To investigate the efficacy and safety of nasogastric feeding tube placed by endoscopy to give enteral nutrient solution in the pediatric intensive diseases.Methods A retrospective analysis of 30 children with serious illness who were given enteral nutrient solution through the nasogastric feeding tube placed by endoscopy from January 2013 to May 2016 in our hospital was conducted including 12 boys and 18 girls aging from 2 months to 14 years with the mean as (6.86±3.44) years old.Catheterization condition including catheter insertion time after hospitalization,catheter maintenance time,hospital stay and retention time after discharge,postoperative complications after catheterization,prognostic indications including anal exhaust and defecation time,blood urine amylase and returning to normal time,and changes of the indicators for nutrition including total protein,albumin,prealbumin,retinol binding protein were analyzed.Results Catheter insertion time after hospitalization was (16.13 ± 10.51) days,catheter maintenance time (21.35± 9.62) days,hospitalization time after catheterization (20.10±8.96) days and hospital stay (36.23± 14.20) days.10 cases (33.3％) maintained the catheter for (11.10±4.65) days after the discharge.The anal exhaust time was (2.84±3.32) days and the defecation time (4.55±3.35) days;The urinary amylase significantly deceased three days after catheterization compared with that of one day before catheterization (P =0.047);Serum total protein,albumin,prealbumin and retinol binding protein increased three days after catheterization compared with that of one day before catheterization,but the difference was not statistically significant (P＞0.05).5 children (17％) had complications including 3 children of abdominal distension and 2 children of vomiting.Conclusions Nasogastric feeding tube placed by endoscopy to give enteral nutrient solution in the pediatric intensive diseases can improve the intestinal and pancreatic function,recover their nutritional status to some extent and be controlled safely.However,the waiting time for catheterization and the hospital stay after catheterization are relatively long.The implementation of this technology and the awareness of its safety need be strengthened.

Short-term clinical outcomes in extremely/very low birth weight infants with individual nutritional support / 肠外与肠内营养

Objective: To explore the application value of bedside nasojejunal feeding tube placement using four steps of ultrasonic-assisted method in critical ill patients. Method: Thirty-three critical ill patients receiving enteral nutrition were enrolled. We adopt four steps of ultrasonic guidance to conduct nasojejunal feeding tube placement. The details were as followed: nasojejunal feeding tube placement within the esophagus, within Gastric body, within After the pylorus, at last the location of nasojejunal feeding tube. Results: The placement of nasojejunal feeding tube was successful in 28 patients, failed in 2 patients. The failure reason include that the false appearance of pylorus through and the lost gastrointestinal motility led to the sticking of nasojejunal feeding tube on arcus major ventriculi and it couldn't enter into gastric antrum and pylorus. Conclusion: The application of nasojejunal feeding tube placement by four steps of ultrasonic-assisted is a novel feeding technique, and it's simple, effective, noninvasive and repeatability procedure with a high success rate and low complications.

Placement of a Jejunal Feeding Tube via an Ultrasound-Guided Antral Progressive Water Injection Method / 中华医学杂志(英文版)

<p><b>Background</b>Jejunal feeding tube allows the nutrition of critical care patients more easy and safe. However, its placement remains a challenge. This study aimed to introduce a jejunal feeding tube through an ultrasound-guided antral progressive water injection method and subsequently to examine its efficacy.</p><p><b>Methods</b>Between April 2016 and April 2017, 54 patients hospitalized in the Department of Critical Care Medicine, Peking Union Medical College Hospital, China who needed nutritional support through a jejunal feeding tube were recruited for this study. Patients who applied ultrasound-guided antral progressive water injection method were classified into the experimental group. Patients who applied conventional method were registered as control group.</p><p><b>Results</b>No significant differences were found in age, body mass index, and Acute Physiology and Chronic Health Evaluation score, but a significant difference in operation time was found between the experimental group and the control group. Of the 24 individuals in the control group, 17 displayed clear catheter sound shadows once the tube entered the esophagus. In comparison, of the 30 individuals in the experimental group, all harbored catheter sound shadows through the esophageal gas injection method. Subsequent observation revealed that in the control group (via ultrasonographic observation), 15 individuals underwent successful antral tube entry, for a success rate of 63%. In the experimental group (via antral progressive water injection), 27 individuals underwent successful antral tube entry, for a success rate of 90%. There was a significant difference between the success rates of the two groups (χ = 5.834, P = 0.022).</p><p><b>Conclusion</b>The antral progressive water injection method for the placement of a jejunal feeding tube is more effective than the traditional ultrasonic placement method.</p>

Management of Intramural Esophageal Dissection with Gastric Feeding Tube in an Alcoholic-hepatitis Patient / 대한소화기학회지

Intramural esophageal dissection is a rare but clinically important condition in the field of gastroenterology. Classically, intramural esophageal dissection rarely occurs in patients who are anticoagulated or have poor medical condition, and its clinical presentation may include chest pain, dysphagia and hematemesis. Herein, we present a case of intramural esophageal dissection in an alcoholic hepatitis patient that was diagnosed by endoscopy and successfully treated with conservative management.

Role of nasojejunal feeding tube nutrition in patients with severe traumatic brain injury / 中国脑血管病杂志

Objective To investigate the application effect of nasojejunal feeding tube nutrition in patients with severe traumatic brain injury. Methods The clinical data of 54 patients with severe traumatic brain injury admitted to the Department of Surgical Critical Care Medicine,the Third Affiliated Hospital,Sun Yatsen University between June 2012 and December 2014 were analyzed retrospectively. They were divided into either a nasojejunal feeding tube nutrition support group (nasojejunal group,n = 26)or an asogastric feeding tube nutrition support group (asogastric group,n = 28)according to the different ways of enteral nutrition. All patients began to receive nasal feeding whole protein preparations (enteral nutritional emulsion,TPF-D)from the second day after admission to intensive care unit (ICU). The time to reach the enteral nutrition support target,the time of parenteral nutritional support,nutritional index (albumin and hemoglobin),the time admission to ICU,and the incidences of infection and gastrointestinal complications in both groups were observed. Results (1)According to the body weight to calculate calorie demand, the nasojejunal group reaching the time of enteral nutrition support target was faster than that of the asogastric group (3. 0 ± 0. 8 d vs. 7. 7 ± 2. 5 d). There was significant difference between the 2 groups (P 0. 05). Conclusion Nasojejunal feeding tube nutrition support may be faster to achieve the target of enteral nutrition supports and shorten the time in ICU.

Solution of difficult nasojejunal feeding tube intubation under digital subtraction angiography system / 实用放射学杂志

Objective To solve the difficulty of intubation of nasojejunal feeding tube under digital subtraction angiography (DSA) system when conventional methods were failed.Methods Seventy-one patients who failed to place the nasojejunal feeding tube by single guide wire under DSA conventional methods.With the methods of decreasing the stomach volume,changing the body posi-tion,and using a catheter or gastrointestinal motility,the nasojejunal feeding tube was placed into the proper position (more than 30cm far away from Treitz or gastrointestinal anastomosis).Results All the procedures were successfully accomplished.No compli-cations,such as throat damage,abdominal pain,perforation and hemorrhage of digestive tract were found.The mean duration under DSA was four minutes (2-7min).Conclusion With the help of various methods above,we can improve the success rate of intuba-tion and reduce the duration of the nasojejunal feeding tube placement,when conventional methods were failed.

Respiratory Complications Associated with Insertion of Small-Bore Feeding Tube in Critically Ill Patients / 대한구급학회지

Small-bore flexible feeding tubes decrease the risk of ulceration of the nose, pharynx, and stomach compared with large-bore and more rigid tubes. However, small-bore feeding tubes have more respiratory system complications, such as pneumothorax, hydropneumothorax, bronchopleural fistula, and pneumonia, which are associated with significant morbidity and mortality. Thus, it is important to confirm the correct position of feeding tubes. Chest X-ray is the gold standard to detect tracheal malpositioning of the feeding tube. We present three cases in which intubated patients exhibited an altered mental state. An assistant guide wire was used at the insertion of small-bore feeding tubes. These conditions are thought to be potential risk factors for tracheobronchial malpositioning of feeding tubes.

Non-invasive closed placement of nasojejunal feeding tube during Ivor-Lewis esophagectomy for esophageal carcinoma / 中国肿瘤临床

Objectives:To improve the surgical procedures and investigate the feasibility of the closed placement of nasojejunal tube during Ivor-Lewis esophagectomy. Methods:From January 2010 to December 2013, 85 patients (72 males and 13 females) with esophageal or gastric cardiac carcinoma underwent Ivor-Lewis esophagectomy in our department. Briefly, the general surgical proce-dures were performed as follows:1) stomach mobilization and enlargement of esophageal hiatus and pyloric sphincter digital fracture via laparotomy; 2) tubular stomach reconstruction, esophageal carcinoma resection, and intra-thoracic esophagogatrostomy via right posterolateral thoracotomy;and 3) forward closed placement of feeding tube through the nostrils and jejunum of patients under the guid-ance of a surgeon, who palpates the pylorus through the hiatus with the use of fingers. Results:No operative death or feeding tube-asso-ciated adverse event was observed. Among the 85 patients who have undergone Ivor-Lewis esophagectomy, feeding tube placement in-to the jejunum during surgery failed in 33 cases. The success rate of nasojejunal feeding tube placement was 61.2%(52/85). Twelve pa-tients with successful tube placement did not receive enteral feeding for several reasons and were thereby transferred to parenteral group. Significant differences were observed in terms of the nutritional cost and proportion between enteral feeding and parenteral groups (?1,469 ± 741 vs.?3,223 ± 917, P0.05). Conclusion:The novel forward closed placement of nasojejunal feeding tube dur-ing Ivor-Lewis esophagectomy provides a non-invasive, feasible, simple, and economical method for postoperative nutritional support. Surgeons could perform this novel technique successfully in practice.

Nutritional support with nasogastric feeding tube after transcatheter arterial chemoembolization in hepatic carcinomas / 实用放射学杂志

Objective To discuss interventional procedures before feeding tube placed in the DSA guidance,influence postoperative enteral nutrition support for the presence of nutritional risk of clinical outcomes in elderly patients with hepatocellular carcinoma. Methods 33 patients acquired with interventional therapy of hepatic carcinoma were selected as the study group.All of patients un-derwent preoperatively the nutritional risk screening and insertion of nasogastric feeding tube under DSA.Enteral nutritional support by the nasogastric feeding tube was used after interventional therapy.33 similar patients underwent parenteral nutritional support af-ter international therapy were selected as the control group.The change of the nutritional indexes,the incidence of the systemic in-flammatory response syndrome,the incidence of infection,and the length of hospital stay after operation were compared between the two groups.Results There were no significant differences in the plasma albumin levels and body weight changes compared between the two groups (P >0.05).However,the incidence of infection and the length of hospital stay were lower significantly in the study group than in the control group (P >0.05).Conclusion The nutritional risk screening before interventional treatment is necessary for the elder patients with hepatic carcinoma.The patients with nutritional risk can be placed the nasogastric feeding tube preopera-tively under DSA,and perform combined nutritional support to promote the recovery of nutritional state after operation.

Early Postoperative Retrograde Jejunojejunal Intussusception after Total Gastrectomy with Roux-en-Y Esophagojejunostomy: A Case Report

Intussusception is a rare cause of postoperative intestinal obstruction in adults. Many retrograde intussusceptions occur during the period following gastrectomy. A 77-year-old woman visited our hospital because of detected gastric adenocarcinoma. She received radical total gastrectomy with Roux-en-Y esophagojejunostomy. On the fifth postoperative day, she complained of abdominal pain, and we found leakage at the esophagojejunostomy site and dilatation of the Roux limb and the afferent limb of the jejunojejunostomy. Emergency surgery was performed. Retrograde jejunojejunal intussusception accompanied with a nasojejunal feeding tube was found at the efferent loop of the jejunojejunostomy. No ischemic change was found; therefore, manual reduction and primary repair of esophagojejunostomy was performed. She was discharged without complications on the 23rd re-postoperativeday. We suggest that the nasojejunal feeding tube acted as a trigger of intussusception because there was no definitive small bowel mass or postoperative adhesion. We present our findings here along with a brief review of the literature.

Urethral catheter knotting: an avoidable complication

Abstract: Urethral catheterisation is a common and safe procedure performed routinely. The small size of the urethra in a child necessitates the use of an infant feeding tube (Size 5 to 8 F) for catheterisation. Knotting within the bladder is a rare complication with significant morbidity often necessitating surgical or endoscopic removal. Insertion of an excessive length of tube contributes to coiling and knotting. We report an instance of knotting of an infant feeding tube in the proximal penile urethra of a 4 year-old male child requiring urethrotomy to remove it. Awareness of the risk and proper technique can reduce this complication

Effects of enteral nutrition by gastroscope-guided naso-jejunal feeding tube placement on acute severe pancreatitis endotoxemia / 中国综合临床

Objective To investigate the therapeutic effects of early enteral nutrition by gastroscopeguided naso-jejunal feeding tube placement on the intestinal endotoxemia of patient with severe acute pancreatitis (SAP).Methods Fourty-three patients were randomized into two groups:patients receiving early enteral nutrition (EN) by gastroscope-guided naso-jejunal feeding tube placement (24 cases) and those receiving total parenteral nutrition (TPN) ( 19 cases).The serum endotoxin(ET),albumin (ALB) and amylase (AMY) levels were measured.Abdominal distension and other complications were observed in the two groups.Results The abdominal pain and distension relief time,intestinal bleeding,infectious complications of EN group were significantly improved compared with that of TPN group ( P ＜ 0.01 或 P ＜ 0.05 或 P ＜ 0.001 ).The serum ET levels of EN group was much lower ( [ 0.19 ± 0.11 ] EU/ml) than that of TPN group ( [ 0.85 ± 0.28 ] EU/ml)on day 14 post-treatment (t =10.456,P ＜ 0.001 ).The serum AMY levels were decreased significantly in two groups after treatment,and the difference between two groups was not significant (t =3.l17,t =1.889,P ＞0.05 ).The serum ALB recovery of two groups was not significantly different ( P ＞ 0.05 ).Conclusion Gastroscope-guided Naso-jejunal feeding tube placement for early enteral nutrition can protect intestinal mucosa,reduce complications,alleviate symptoms of patients with SAP,which are benefitial factors for the treatment of intestinal endotoxemia in patients with SAP.

Impact of enteral nutrition through jejunal feeding tube during chemotherapy on the nutritional status and immunologic function of patients after total gastrectomy / 中华临床营养杂志

Objective To investigate the impact of enteral nutrition (EN) through jejunal feeding tube on the nutritional status and immunologic function of patients during chemotherapy after total gastrectomy.Methods Totally 86 patients with gastric cancer who had undergone total gastrectomy with radical resection and jejunostomy received adjuvant venous chemotherapy in our department from January 2009 to June 2010.They were divided into EN group ( n =43 ) and control group ( n =43 ) according to the hospitalization number.The EN group maintained the jejunostomy tube until the end of 6 courses of chemotherapy,and was given EN support for 7 days through jejunal tube during each course of chemotherapy; the control group removed the tube before chemotherapy without further dietary restriction or nutrition support.The nutritional and immunologic indicators on the 1 st day before chemotherapy and the 1st day after 6 chemotherapy courses were measured.ResultsThree patients in the EN group withdrew from the study because of catheter blockage or catheter loss and 2 patients in the control group failed to complete the trial because of chemotherapy side effects or economic reasons; 81 patients entered the final analysis.After 6 courses of chemotherapy,both groups experienced body weight loss,but the percentage is significantly lower in EN group than in control group (6.9％ ± 0.95％ vs.11.2％ ± 1.32％,P =0.0000).Compared with the nutritional status before the first chemotherapy,the prognosis nutritional index (PNI) in both groups declined after the 6th chemotherapy.Such decline was not statistically significant in EN group ( P =0.1534) but was significant in control group (P =0.0000).The PNI in EN group after chemotherapy was significantly higher than that in control group (P =0.0040).The levels of IgG,NK,CD4 +,and CD4 +/CD8 + were significantly higher in EN group than in control group ( P =0.0083,0.0143,0.0000,and 0.0000,respectively) after chemotherapy.ConclusionEN during postoperative chemotherapy may improve the nutritional status and immunologic function in gastric cancer patients after total gastrectomy.

Application of naso-jejunal feeding tube in early enteral nutrition for patients with severe acute pancreatitis / 中国实用护理杂志

Objective To investigate the method and nursing care of early enteral nutrition through naso-jejunal feeding tube for patients with severe acute pancreatitis.Methods We retrospectively studied 37 patients with severe acute pancreatitis,who were given early enteral nutrition through naso-jejunum nutrition tube.Results Abdominal distention occurred in 5 patients,and 3 patients got mild diarrhea.No aspiration and SAP relapse occurred among 37 patients.All the patients were discharged from hospital after recovery.Conclusions Enteral nutrition through naso-jejunum nutrition tube is the main treatment and nutritional support measure for patients with severe acute pancreatitis.Daily care of the naso-jejunum nutrition tube,and prevention and treatment of complications are the critical work in SAP patients＇ nursing care.