Gastrostomy button: clinical appraisal.

We retrospectively studied all gastrostomy buttons inserted in the Royal Children's Hospital, Brisbane between 1988 and 1995. One hundred and thirty-two patients (M = 60, F = 72) and 388 buttons were analysed. Intellectual handicap and cystic fibrosis comprised the majority of patients. Thirty-three patients had gastrostomy buttons inserted primarily, whereas, 99 patients received gastrostomy buttons inserted into matured gastrostomy stoma. The average longevity of all determined buttons (n = 280) was 360.43 days (SD = 310.24). The first buttons inserted primarily (n = 25) had longer longevity than the first buttons inserted into matured gastrostomy stoma (n = 82) with statistical significance. The average longevity of subsequent buttons was significantly less than the first buttons. Valve incompetence and leakage of gastric content around the shaft were the most common causes of button removal. We concluded that the gastrostomy button is the method of choice for long term enteral feeding in children.

Comparison between mushroom-type and balloon-type gastrostomy buttons.

The gastrostomy button has been improved rapidly over the last ten years. The gastrostomy button was divided into two groups. The first group had a mushroom tip and, in this study, the Bard button represented this group. The other had a balloon as an internal stabilizer and the Mic-key button represented this group. The authors retrospectively studied all buttons inserted at the Royal Children's Hospital, Brisbane between 1988 and 1995. The average longevity of Bard and Mic-key buttons were 378.82 and 259.62 days respectively. Valve incompetence was the most common cause of removal of the Bard button (38%), whereas, balloon rupture was the major cause of removal of Mic-key button (44%). Each type of gastrostomy button had its own advantages and disadvantages and these special characteristics will be discussed.

Primary gastrostomy button: a means of long-term enteral feeding in children.

Between June 1992 and December 1997, forty-two patients (M 19, F 23) received 94 primary gastrostomy buttons due to 22 intellectual handicap, 7 cystic fibrosis, 4 severe gastrooesophageal reflux, 2 bronchopulmonary dysplasia, 2 tumours in the neck region and 5 miscellaneous causes. Open fundoplication concomitant with primary button, primary open button and laparoscopic fundoplication concomitant with primary button were performed in 20, 15 and 7 patients respectively. The average longevity +/- standard deviation of all buttons was 388.36 +/- 360.35 days. The average longevity of the buttons of the laparoscopic fundoplication group was significantly lower than the others. The major causes of removal of Bard buttons were valve incompetence and flap damage, whereas, balloon leakage was the major cause of removal of the Mic-key button. There were merely minor stomal complications and no gastric separation and peritonitis. Because of the acceptable longevity of the buttons and minimal complications, we concluded that the primary gastrostomy button was the preferable method of long term enteral feeding in children.

Acquired toxoplasmosis in Malaysia.

Two cases of acquired toxoplasmosis in asymptomatic Malaysian patients are described. In both instances the diagnosis was first made on the finding of the Piringer-Kuchinka reaction in excised lymph nodes from these patients and serological studies further confirmed the presence of hihg toxoplasmic antibody titres. The characteristic histological features of toxoplasmic lymphadenitis are discussed. Diagnosis and management of the disease are briefly reviewed with emphasis that the importance of diagnosing this disease goes beyond the establishment of a mostly self-limiting, clinically unimportant protozoan infection.