ABSTRACT
Gastrostomy tubes are used for primary and supplemental feeding and gastric decompression. The purpose of the study was to compare the complication rate of gastrostomy tube placement by either endoscopic or fluoroscopic technique. Between 1996 and 2004, the surgical and radiological services at a Level I trauma hospital placed gastrostomy tubes in 378 patients (endoscopy=268, fluoroscopy=110). The percutaneous gastrostomy group comprised 71% of the cohort with a mean age of 51+/-21 (range: 1-93 years of age), and the percutaneous radiographic gastrostomy group comprised the remaining cohort (29%) with a mean age of 57+/-19 (range: 17-95 years of age). Fifty-eight percent of the percutaneous gastrostomy group were female (n=155) and 42% were male (n=113), whereas the gender distribution for the percutaneous radiographic gastrostomy group was 33% female (n=36) and 67% male (n=74). There was an overall complication rate of 36% (22% and 70% for the endoscopic and fluoroscopic methods, respectively). The most frequent complication in both types of techniques was tube dislodgement (endoscopic=32% [19/268]; fluoroscopic=27% [21/110]). There were very few serious complications. Women had a higher rate of postprocedure complications than did men, at 35% versus 27%. We conclude that gastrostomy tube placement by either endoscopic or fluoroscopic methods results in a number of complications, though most of them are minor. Patients must therefore be informed that this is not a complication-free procedure.
Subject(s)
Fluoroscopy/adverse effects , Gastroscopy/adverse effects , Gastrostomy/adverse effects , Intubation, Gastrointestinal/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cross Infection/etiology , Equipment Failure/statistics & numerical data , Female , Fluoroscopy/statistics & numerical data , Gastroscopy/statistics & numerical data , Gastrostomy/statistics & numerical data , Hematoma/etiology , Humans , Infant , Intubation, Gastrointestinal/statistics & numerical data , Male , Middle Aged , Patient Education as Topic , Patient Selection , Peritonitis/etiology , Pneumoperitoneum/etiology , Retrospective Studies , Trauma CentersABSTRACT
Gestational choriocarcinoma is a highly metastatic neoplasm derived from placental tissue, occurring in approximately 1:20,000 - 40,000 pregnancies. Although gestational choriocarcinoma may follow any gestational event, it most commonly follows molar pregnancies. We report a case of a 24-year-old Hispanic woman with persistent trophoblastic disease who, after failing to respond to chemotherapy, was found to have metastasis to the liver and pancreas. The patient underwent successful distal pancreatectomy and splenectomy to be followed by salvage chemotherapy. Strong risk factors for choriocarcinoma include previous molar pregnancy or spontaneous abortion and increased maternal age. Gestational choriocarcinoma is classically responsive to chemotherapy; surgical excision is reserved for acute emergencies and is an acceptable option for patients with persistent disease in need of palliative treatment and tissue diagnosis.
Subject(s)
Choriocarcinoma/secondary , Liver Neoplasms/secondary , Pancreatic Neoplasms/secondary , Uterine Neoplasms/pathology , Adult , Biomarkers, Tumor/blood , Choriocarcinoma/diagnosis , Choriocarcinoma/therapy , Chorionic Gonadotropin, beta Subunit, Human/blood , Combined Modality Therapy , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/therapy , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/therapy , Pregnancy , Tomography, X-Ray Computed , Uterine Neoplasms/diagnostic imaging , Uterine Neoplasms/therapyABSTRACT
Androgen insensitivity syndrome (AIS) is an X-linked recessive disorder characterized by varying degrees of feminization secondary to androgen receptor insensitivity. We report a case of a 34-year-old female with complete androgen insensitivity who presented with a history of primary amenorrhea and two intra-abdominal gonads found on CT scan. The patient underwent successful laparoscopic bilateral gonadectomy without complications. AIS is present in 1:20,000 to 64,000 males; complete androgen insensitivity is seen in 2-5:100,000 phenotypic females and should therefore be considered in any otherwise healthy female with abnormal pubertal development and infertility. Although controversial, most endocrinologists agree that gonadectomy may be performed after puberty with minimal risk of testicular neoplasm.
