ABSTRACT
Background: To date, no studies comparing complication rates between patients with nutritional percutaneous endoscopic gastrostomy (N-PEG) and Parkinson's disease (PD) patients with percutaneous endoscopic gastro-jejunostomy (JET-PEG) for treatment administration have been published. Our study aimed to compare complication rates and the number of re-endoscopies between N-PEG and JET-PEG patients. Methods: Individuals requiring N-PEG or JET-PEG insertion between 2014 and 2021 were included in this single-center retrospective observational study. Complications were divided into time-related medical and technical complications. Reasons for post-insertion re-endoscopies and their number were also analyzed. Results: Eighty-seven subjects, 47 (54.02%) in JET-PEG group and 40 (45.98%) in the N-PEG group, were included. Early and technical complications were more frequent in JET-PEG vs. N-PEG subjects (70% vs. 10% [p < 0.001], and 54.5% vs. 5.1% [p < 0.001], respectively). The presence of psychiatric disease was associated with a higher number of early complications (p < 0.002). All three types of complications were significantly more frequent in subjects where a healthcare professional did not handle PEG (p < 0.001). Subjects with JET-PEG required a higher number of re-endoscopies compared to the N-PEG group (57.1% vs. 35%, p = 0.05). Conclusions: Complications are significantly more common in individuals with JET-PEG than those with N-PEG, which can be attributed to higher mobility in PD patients.
ABSTRACT
Background: Paenibacillus constitutes a genus of gram-positive, facultatively anaerobic, rod-shaped bacteria that act as potentially opportunistic pathogens. With only a few documented case studies to date, Paenibacillus species are rarely the cause of a disease in humans. Case summary: We report a case involving a 64-year-old male with known mild mitral regurgitation, who presented with fever and dyspnoea. Initially treated with empirical antibiotics, his blood cultures cultivated Paenibacillus thiaminolyticus, a previously unreported cause of endocarditis. Transoesophageal echocardiography demonstrated vegetations on the both leaflets of mitral valve along with severe mitral regurgitation, thus confirming a diagnosis of endocarditis. The patient was referred for cardiac surgery; however, the procedure was delayed due to complications related to a known hepatic cyst and additionally contraction of COVID-19 infection. The patient subsequently underwent mitral valve replacement without complications. Discussion: Because of its rarity, guidelines to recommend specific antibiotics to treat Paenibacillus infective endocarditis are absent. To confirm the pathogen, molecular methods such as mass spectrometry or 16S rRNA sequencing are required. Early targeted antibiotic therapy and cardiac surgery are warranted to achieve good clinical outcomes.
ABSTRACT
Home parenteral nutrition is a therapeutic option for chronic intestinal failure. A tunnelled central venous catheter is commonly used for self-application of nutrition and hydration over a long period of time; that is, months or years. Air embolization within the venous circulation can be caused by inconsistent self-handling of the catheter in combination with air bubbles in the infusion set. Paradoxical air embolization within the brain and coronary arteries together with catheter perforation is a rare medical and technical complication. The authors report the case of a 63-year-old woman with type 3 chronic intestinal failure treated with home parenteral nutrition. During the first year of treatment and use of the catheter a fatal complication occurred. The patient experienced recurring asystolic episodes and strokes with monoplegia during flushing of the catheter. Although 2 resuscitations were successful, the third was not, and the patient died. The cause of these life-threatening complications was an unknown patent foramen ovale, with paradoxical air embolization within the coronary and brain arteries. The authors discuss the clinical consequences of arterial and venous air embolization, the differences between these and the therapeutic algorithm with a link to practice. LEARNING POINTS: Home parenteral nutrition using a Hickman central venous catheter is a therapeutic option for chronic intestinal failure.Paradoxical air embolization is a rare complication with an unknown patent foramen ovale.A very small volume of air (0.5-3 ml) in coronary or brain arteries can cause fatal complications such as asystole and brain ischaemia.
