Subject(s)
Adenocarcinoma/genetics , Genetic Predisposition to Disease , Muir-Torre Syndrome/genetics , Palliative Care/methods , Skin Neoplasms/genetics , Stomach Neoplasms/genetics , Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Aged, 80 and over , Biopsy, Needle , Female , Follow-Up Studies , Gastric Bypass/methods , Gastroscopy/methods , Humans , Immunohistochemistry , Muir-Torre Syndrome/diagnosis , Muir-Torre Syndrome/surgery , Neoplasm Invasiveness/pathology , Pedigree , Risk Assessment , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Stomach Neoplasms/diagnosis , Stomach Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
Milk-alkali syndrome was considered "extinct" by 1985 because of the advent of non-alkaline ulcer medications (ie, histamine-2 receptor blockers and proton pump inhibitors). At that time, it was thought to cause <1% of hypercalcemia, which occurred when one ingested a sufficient quantity of calcium and alkali together. This case emphasizes the importance of considering this syndrome in patients who self-medicate for control of symptoms related to gastroesophageal reflux and peptic ulcer disease and for those using calcium supplementation for prevention or treatment of osteoporosis.
ABSTRACT
Enteral feeding through the percutaneous endoscopic gastrostomy (PEG) tube is usually initiated about 12 to 24 hours after insertion of the tube. There have been earlier studies evaluating the efficacy of early initiation of enteral feedings that had encouraging results. However, delayed initiation of feeding following PEG placement continues to be practiced widely. We believe that feeding can be done earlier without any increase in associated morbidity or mortality and with obvious reduction in the need for parenteral nutrition and healthcare costs. We evaluated a protocol to initiate enteral nutrition 4 hours after the PEG tube insertion with subsequent discharge of the outpatients on the same day. We conducted a prospective study to assess the efficacy of early initiation of PEG feeding. We enrolled 77 patients in our study who were having PEG tubes placed for enteral feeding. Only patients who had a PEG placed for gastric venting procedures were excluded from our study. During the course of our study, no patient had to be excluded for the latter reason. Patients were evaluated by the physician performing the procedure, 4 hours after the tube was inserted. Their vital signs were checked, and a thorough abdominal examination was performed. Minimal tenderness around the PEG site was the most frequent finding. Otherwise, all the patients had a benign abdominal examination. The tube was flushed with 60 mL of sterile water. Following the examination, orders were given to restart the feedings. These patients were followed for a 30-day period to evaluate complications associated with PEG tube placement and early initiation of PEG feeding. There was one case of aspiration pneumonia (1.3%) and one death that was attributed to the underlying disease out of our 77 patients. Early initiation of enteral feeding after PEG tube placement can be successfully completed with a systematic protocol and close observation. Not only was this protocol found to be safe, it can also have significant cost savings by eliminating the need for inpatient hospitalization for the procedure.
