Which G-Tube to Use in Pullers: Assessment of Pull Pressures on Skin Models to Determine Optimal Catheter Choice in Patients with Recurrent Pulled Gastrostomy Tubes.

INTRODUCTION: Pulled or dislodged gastrostomy catheters represent a common complication associated with percutaneous gastrostomy and are a common cause of recurrent visits in patients with altered mental status. We intended to perform an experiment to compare the pull forces required to dislodge different commonly used gastrostomy catheters. MATERIALS AND METHODS: We used a digital force gauge device to measure the pull forces required to dislodge three types of 20 French gastrostomy catheters in double-layer skin models. These included the Flow 20 Pull Method (Cook Medical, Bloomington, IN, USA), Entuit Gastrostomy BR Balloon Retention feeding tube (Cook Medical, Bloomington, IN, USA), and Ponsky Non-Balloon Replacement Gastrostomy Tube (CR Bard Inc, Salt Lake City, Utah, USA). The catheters were inserted into the skin model using the same technique as would be utilized in a patient. RESULTS: The mean forces measured to dislodge the per-oral Flow 20 Pull Method, Entuit Thrive Balloon Retention, and button-type retention Ponsky replacement catheters were 35.6, 22.8, and 20.6 Newtons, respectively. The pull method per-oral gastrostomy catheter required significantly more pull force to dislodge than both the Ponsky button-type retention catheter and the Entuit balloon retention catheters. There was no significant difference in the pull force required to dislodge the Ponsky replacement catheter and the Entuit balloon retention catheter. CONCLUSIONS: Per-oral image-guided gastrostomy with pull-method button-type retention catheters may be the ideal choice in patients at high risk of tube dislodgment.

Spectroscopic characterization of recently excavated archaeological potsherds from Tamilnadu, India with multi-analytical approach.

A combined analytical study of potsherds excavated from different archaeological sites of Tamilnadu (Kavalapatti, Nattapuraki and Thamaraikulam villages), India are analyzed by spectroscopic techniques such as FTIR, X-ray diffraction, thermogravimetric analysis (TGA) and Scanning Electron Microscope (SEM) coupled with Energy Dispersive Spectrometer (EDS). FTIR and XRD techniques have been attempted to characterize the mineralogical composition, firing temperature and firing conditions of the archaeological potsherds. Thermogravimetric analysis (TGA) is the complementary study to estimate the firing temperature from characteristic thermal reactions in potsherds under controlled firing in inert gas atmosphere. Further, Scanning Electron Microscopy (SEM) equipped and coupled with an Energy Dispersive Spectrometer (EDS) to analyze internal morphology and chemical composition of the potsherds was used. From the results of the above techniques, the firing temperatures of potsherds were found to be greater than 650°C.

Application of thermogravimetry-differential thermal analysis (TG-DTA) technique to study the ancient potteries from Vellore dist, Tamilnadu, India.

The characterization of archeological ceramic and pottery can be studied for the determination of firing temperature and the presence of raw materials by thermal analysis. Clay minerals are the main material for the production of ceramic and pottery and show some characteristic reactions such as dehydration, dehydroxylation and transformation. This is key point of criteria for the elucidation of firing temperature and raw material analysis. In the present work, DTA-TG, XRD and EDXRF technique are applied on representative potsherds from Vellore dist., Tamilnadu, India to derive the information about the production technology, raw materials and firing temperature. From the analysis, all the samples were considered to be fired from 800°C to 900°C and organic material might be added intestinally as a binder in the preparation of pottery.

The analytical investigations of ancient pottery from Kaveripakkam, Vellore dist, Tamilnadu by spectroscopic techniques.

Analytical investigations using Fourier Transform infrared spectroscopy (FT-IR), Powder X-ray Diffraction (PXRD), Thermal Analysis (TG-DTA), Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray Fluorescence Spectrometry (EDXRF) were carried out on ancient pottery fragments from Kaveripakkam, in order to outline manufacturing skills, technology information, firing condition and temperature of potteries. The whole set of data showed the firing temperature in the range of 800-900°C. The analytical characterization of the potsherds, by different complimentary techniques has allowed to identifying the raw materials and technology applied by the ancient artisans.

Analytical characterization of recently excavated megalithic sarcophagi potsherds in Veeranam village, Tiruvannamalai dist., Tamilnadu, India.

Analytical characterization of megalithic sarcophagi potsherds from Veeranam, Tiruvannamalai dist., Tamilnadu has been performed using Fourier transform infrared spectroscopy (FTIR), Powder X-ray diffraction (PXRD), Thermal analysis (TG-DTA), Scanning Electron Microscopy (SEM) coupled with an energy-dispersive X-ray spectrometer (EDX) and Energy dispersive X-ray fluorescence spectrometry (EDXRF). The EDXRF data of the potsherds were processed using multivariate statistical methods. Principal Component Analysis (PCA) and hierarchical cluster analysis allow us to identify grouping and structure in the data. The analytical results achieved in this study allowed us to estimate the firing temperature and manufacturing techniques. The methodological approach was successfully applied to the mineralogical, chemical and thermal characterization of the potsherds.

Sharp recanalization of central venous occlusions: a useful technique for haemodialysis line insertion.

Central venous occlusions can be difficult to traverse using conventional catheter and wire techniques. We describe six procedures in five patients using a technique of "sharp" recanalization and subsequent line insertion. The technique was successful in all of the cases, with the line functional for a mean duration of 13 months. This technique can permit successful dialysis catheter placement in patients who have failed with traditional techniques.

Spontaneous resolution of a colloid cyst of the third ventricle.

We report a case of an asymptomatic colloid cyst of the third ventricle in a 35-year-old male, which on follow-up MRI at 15 months appears to have spontaneously resolved. To our knowledge, this is the first such case reported and supports the role of conservative management of small asymptomatic colloid cysts.

Intra-mucosal acidosis as a predictor of cardiac outcome following abdominal aortic aneurysm surgery.

OBJECTIVE: To assess if sigmoid ischaemia is a prognostic indicator of early and late post-operative cardiac morbidity and mortality. MATERIALS AND METHODS: Patients undergoing elective abdominal aortic aneurysm repair (AAAR) were included in the study. Demographic details and risk factors for heart disease were recorded. Sigmoid pHi was measured at the time of surgery using a silicone tonometer and perioperative morbidity and mortality were recorded in all patients. Seven years following surgery the patients and their general practitioners were contacted to determine the patient's health. RESULTS: Thirty-eight patients were included in the study. Within the follow-up period, 22 (58%) had died. Eight patients died of cardiac failure or myocardial infarction. The pHi in patients with cardiac related deaths [6.99 (6.84-7.10)] was significantly lower than those with non-cardiac related deaths [7.11 (7.04-7.21), p<0.05]. Similarly, patients who suffered acute cardiac events (within 30 days following AAA repair) had lower pHi [7.01 (6.88-7.12)] compared to those who did not [7.09 (6.90-7.19), p<0.05]. CONCLUSION: The results show that sigmoid ischaemia is more frequent amongst patients that develop cardiac events after AAAR and is associated with a worse long term outcome. This suggests that global hypoperfusion as a result of an under performing heart may be partly responsible for the sigmoid ischaemia in patients following AAAR. Therefore, low sigmoid pHi may predict an increased risk of cardiac complications in these patients.

Scaphoid and pronator fat stripes are unreliable soft tissue signs in the detection of radiographically occult fractures.

AIM: To determine the clinical value of scaphoid and pronator fat stripes in identifying occult underlying scaphoid and distal radius fractures, respectively. MATERIALS AND METHODS: In our department, all patients with clinically suspected scaphoid fractures and normal scaphoid series of radiographs undergo magnetic resonance imaging (MRI) of the wrist. We selected 50 cases with unequivocal MRI evidence of scaphoid fracture, 50 cases with distal radius fracture and 50 cases with no MRI evidence of bony injury. All 150 initial plain radiographs were examined retrospectively in random order without knowledge of the MRI findings and the scaphoid and pronator fat stripes scrutinized. RESULTS: The scaphoid fat stripe was abnormal in only 25 cases (50%) with confirmed scaphoid fracture on MRI. The pronator fat stripe was abnormal in 13 cases (26%) with confirmed distal radius fracture. In the 50 cases with no MRI evidence of bony injury, the scaphoid fat stripe and pronator fat stripe were abnormal in 25 (50%) and 15 (30%) cases, respectively. The sensitivity and specificity for an abnormal scaphoid fat stripe was 50%. The sensitivity and specificity for an abnormal pronator fat stripe was 26 and 70%, respectively. CONCLUSION: Scaphoid and pronator fat stripes are poor predictors of the presence or absence of underlying occult fractures.