ABSTRACT
BACKGROUND: When percutaneous endoscopic gastrostomy (PEG) is not possible, or fails, the patient is referred for laparoscopic gastrostomy or jejunostomy (LAG/J). METHOD: During 2005-2008, we performed laparoscopy-assisted feeding tube insertion on 15 patients. We assessed the outcome in terms of leaks, infection, longevity etc. The patients were followed-up for up to 12 months. RESULTS: The procedure was successful in 14/15 patients. However, thirteen died within little more than a year, of whom seven suffered from pneumonia or aspiration. DISCUSSION: Our study confirms that LAG/J is technically possible, carries a high morbidity, is a last ditch attempt and that it does not change the general prognosis of these debilitated patients.
Subject(s)
Stroke/therapy , Aged , Anastomotic Leak , Enteral Nutrition , Enterostomy , Female , Humans , Laparoscopy , Male , Pneumoperitoneum, Artificial , Treatment OutcomeABSTRACT
BACKGROUND: Duodenal ulcer perforation still occurs frequently in the 21st century inspite of the wide availability of proton pump inhibitors. METHOD: During 2005-2008, 34 patients underwent treatment of duodenal ulcer perforation at the University Hospital Lewisham, London. Laparoscopic or open repair of the perforation was used. In this study, we analysed the outcome of treatment in terms of complications, mortality and hospital stay with relevant to laparoscopy and open approach. RESULTS: Ten patients underwent laparoscopic closure and the remaining 24 patients underwent laparotomy. The mean hospital stay for the laparoscopic group was 6.6 days and for open repair group was 12.8 days. There were two wound infection related to open approach and four patients died during the post operative period however the cause of death was not related to the procedure. DISCUSSION: Laparoscopy has the advantage of avoiding a big incision and will enable the patient to get discharged home early. However, the only limiting factor is availability of expertise and competency of the surgeon.
Subject(s)
Duodenal Ulcer/complications , Duodenal Ulcer/surgery , Peptic Ulcer Perforation/surgery , Adult , Aged , Aged, 80 and over , Female , Hospitals, District , Humans , Laparoscopy , Length of Stay , Male , Middle Aged , Young AdultABSTRACT
INTRODUCTION: Patients with empyema of gall bladder have a higher mortality rate. We hypothesised a scoring system, which we call the Lewisham Score, to predict the development and diagnosis of empyema. MATERIAL AND METHODS: Patient with histologically proven acute cholecystitis who underwent operation over a five year period (2004-2009) were selected and a retrospective cohort analysis of those who developed empyema vs. simple acute cholecystitis was performed. Various parameters and the Lewisham score were compared. RESULTS: Patients with empyema were elderly females with a higher C-reactive protein and had a higher Lewisham Score of > 5 and those with simple cholecystitis had a lower Lewisham score (< 4) and lower C-reactive protein. DISCUSSION: Patients with proven acute cholecystitis and a Lewisham score > 5 should undergo cholecystectomy at the same admission.
Subject(s)
Cholecystitis, Acute/diagnosis , Cholecystitis/diagnosis , Aged , C-Reactive Protein , Cholecystectomy , Cholecystitis/blood , Cholecystitis/surgery , Cholecystitis, Acute/blood , Cholecystitis, Acute/surgery , Diagnosis, Differential , Female , Humans , Leukocyte Count , Male , Middle Aged , Retrospective StudiesABSTRACT
OBJECTIVE: It has previously been demonstrated that oral administration of ovine Colostrinin (CLN), a proline-rich polypeptide isolated from ovine colostrum, can effectively treat Alzheimer's disease patients. This study aims to determine whether CLN has effects on the aggregation and toxicity of synthetic beta-amyloid (Abeta), implicated as a causative agent of AD. DESIGN AND MEASUREMENTS: Using cell assays, we examined if pre-treatment of neuronal cells with CLN confers protection. RESULTS: The data from cytotoxicity assays (using MTT and LDH) demonstrated that pre-treatment of human neuronal SHSY-5Y cells with 5 microg/ml CLN, for 24 hours, confers neuroprotection against Abeta-induced neurotoxicity. Twenty-four hour pre-treatment with 5 microg/ml CLN was also shown to reduce Abeta 1-40-induced apoptosis in human neuronal cells as determined via qualitative and quantitative apoptosis assays. CONCLUSION: The neuroprotection conferred with CLN pre-treatment was reduced with the Fas ligand (FasL) binding antibody Nok1, suggesting that the effects of CLN may involve a Fas:soluble FasL interaction. These findings indicate that CLN could possibly play a role in the prevention of AD pathogenesis, though the inhibition of Fas-mediated apoptosis.
