Complete Suprapatellar Plica in a Handball Player: A Case Report.

We report on a 19-year-old female patient who was diagnosed with a complete suprapatellar plica syndrome. She underwent arthroscopic excision of the plica. Post-operatively, there was complete resolution of the symptoms, with return to sports activity. A complete suprapatellar plica is a rare condition that separates the suprapatellar pouch from the rest of the knee. Cases of symptomatic complete suprapatellar plica should be managed with conservative measures initially. If conservative therapy fails, surgical arthroscopic excision is required.

Agronomic performance of Marandu grass treated with plant growth biostimulants in the Amazon biome / Desempenho agronômico de capim-marandu tratado com bioestimulantes no bioma Amazônia

The aim was to evaluate the effect of different doses of two biostimulants on the productivity and canopy structure of Urochloa brizantha cv. Marandu grass in the establishment fase. The study was conducted in Universidade Federal Rural da Amazônia, Parauapebas, Pará, Brazil. One module of 35 plots of 25m² were established. A completely randomized experimental design was used, with seven treatments and five replicates. The treatments included a control, 0.5, 1, and 2kg/ha of biostimulant A (BIOST.A); and 0.25, 0.5, and 1L/ha of biostimulant B (BIOST.B). Three collections were performed. The data for application of the two biostimulants were analyzed separately, using the Dummy variable method and regression analysis. The application of 2kg/ha BIOST.A resulted in increases of 842kg/ha in the forage mass. The application of BIOST.B on Marandu grass resulted in a linear increase in stem mass. The application of 2kg/ha BIOST.A in the establishment of Marandu grass result in higher growth rates, forage accumulation, and stem proportion in the canopy.(AU)

Objetivou-se avaliar o efeito de diferentes doses de dois bioestimulantes sobre a produtividade e a estrutura do dossel do capim Urochloa brizantha cv. Marandu na fase de estabelecimento. O estudo foi realizado na Universidade Federal Rural da Amazônia, Parauapebas, Pará, Brasil. Um módulo de 35 parcelas de 25m² foi estabelecido. Utilizou-se delineamento experimental inteiramente ao acaso, composto de sete tratamentos e cinco repetições cada. Os tratamentos incluídos no controle foram: 0,5, 1 e 2kg/ha de bioestimulante A (BIOST.A); 0,25; 0,5 e 1L/ha de bioestimulante B (BIOST.B). Foram realizadas três coletas. Os dados para a aplicação dos dois bioestimulantes foram analisados separadamente, utilizando-se organização por método variável Dummy e análise de regressão. A aplicação de 2kg/ha BIOST.A resultou em incrementos de 842kg/ha na massa de forragem. A aplicação do BIOST.B na grama marandu resultou em aumento linear na produção de massa do caule. A aplicação de 2kg/ha BIOST.A no estabelecimento de erva de marandu resultou em maiores taxas de crescimento, acumulação de forragem e proporção de caule no dossel.(AU)

Effects of early mobilisation in patients after cardiac surgery: a systematic review.

BACKGROUND: Early mobilisation is prescribed after cardiac surgery to prevent postoperative complications, decrease length of hospital stay, and augment return to daily activities. OBJECTIVE: To evaluate the evidence for the effects of early mobilisation in patients after cardiac surgery on length of hospital stay, functional capacity and postoperative complications. DATA SOURCES: The data sources used were Medline, Embase, CINAHL, PEDro, Web of Science and Cochrane Central Register of Controlled Trials. STUDY SELECTION: Randomised controlled trials of early mobilisation after cardiac surgery. Study selection was not restricted by language or publication time. STUDY APPRAISAL AND SYNTHESIS METHODS: The methodological quality of each article was appraised with the PEDro scale. All review phases (selection, data extraction and appraisal) were conducted by two investigators, and a third investigator provided consensus. RESULTS: Nine trials were selected. The PEDro scale showed that the studies had a low risk of bias (range 5 to 9 points). The trials revealed diversity in techniques used for mobilisation, as well as periods considered early for the start of the intervention. Early mobilisation groups had improved outcomes compared with control groups without treatment. Generally, these advantages did not differ when groups of interventions were compared. LIMITATIONS: It was not possible to perform a meta-analysis due to the variability of the interventions proposed as early mobilisation. CONCLUSIONS: Regardless of the techniques used as mobilisation, the essential point is to avoid bed rest. Early mobilisation seems to be important to prevent postoperative complications, improve functional capacity and reduce length of hospital stay in patients after cardiac surgery.

Efficiency of water use and nitrogen for goat milk production in irrigated pasture to different management / Eficiência de uso de água e nitrogênio para produção de leite de cabra em pastagem irrigada sob diferentes manejos

The aim was to determine the efficiency of use of water and nitrogen for forage production and goat-milk production on an irrigated Tanzania Guineagrass (Panicum maximum cv. Tanzânia) pasture subjected to different management practices. The management levels tested were combinations among nitrogen fertilization levels and post-grazing residual heights (ResH): Intensive (ResH = 33.0cm and 600.0kg N/ha.year-1); Moderate (ResH = 47.0cm and 300.0kg N/ha.year-1); Light (ResH = 47cm and 0kg N/ha.year-1); and Conventional (ResH = 33cm and 0kg N/ha year-1). The efficiency of water use for forage production was higher in intensive and Moderate management. The Conventional management was recommended only for forage production since there is no nitrogen input available because this result was similar to Intensive management in water efficiency. The efficiency of water use to produce goat milk was higher in Intensive management. Moderate management presented higher efficiency of nitrogen to produce forage. On the other hand, Intensive management was more efficient using nitrogen in goat milk production. The amount of water needed to produce one liter of goat milk varied from 893.20 to 3,933.50L. In the moderate management, up to 121.48kg forage and 21.56kg of milk were produced for every kilogram of N utilized. Intensive management is advantageous for water use efficiency as well nitrogen efficiency to produce goat milk in cultivated pasture.(AU)

Objetivou-se determinar a eficiência de uso de água e nitrogênio para a produção de forragem e de leite de cabra em pasto irrigado de capim-tanzânia, submetido a diferentes manejos. Os manejos testados foram combinações entre níveis de adubação nitrogenada e alturas residuais pós-pastejo (Altr): intensivo (Altr = 33,0cm e 600,0kg N/ha.ano-1); moderado (Altr = 47,0cm e 300,0kg N/ha.ano-1); leve (Altr = 47,0cm e 0kg N/ha.ano-1) e convencional (Altr = 33,0cm e 0kg N/ha.ano-1). A eficiência do uso de água para produção de forragem foi obtida nos manejos intensivo e moderado. O manejo convencional só foi interessante no caso da produção de forragem em situação de ausência de nitrogênio, não diferindo do manejo intensivo para a eficiência de uso de água. A eficiência de uso de água para a produção de leite foi maior no intensivo. A maior eficiência do uso de nitrogênio para produzir forragem foi no moderado, enquanto a maior eficiência de nitrogênio para a produção de leite foi no intensivo. A quantidade de água para produzir um litro de leite de cabra variou de 893,20 em manejo intensivo a 3.933,50L em convencional. Manejo intensivo é vantajoso para eficiência de uso de água e nitrogênio para a produção de forragem e de leite de cabra.(AU)

Frequências de cortes em nove leguminosas forrageiras tropicais herbáceas cultivadas ao sol e sob plantação florestal / Cutting frequencies of nine herbaceous tropical forage legumes cultivated under full sun light and under a forest plantation

O objetivo deste trabalho foi estudar a produção e o valor nutritivo de nove espécies de leguminosas forrageiras herbáceas tropicais, cultivadas sob dois níveis de irradiação luminosa e seis frequências de corte na estação chuvosa, em Anhembi (SP), Brasil. Parcelas puras foram estabelecidas ao sol e sob plantação de Eucalyptus grandis, com 8 anos de idade, com 1.000 árvores/ha, que interceptou mais de 80% da radiação luminosa incidente. Avaliou-se a taxa de acúmulo de matéria seca, a proteína bruta e a digestibilidade in vitro da matéria seca em amostras de plantas colhidas em intervalos de 30, 60, 90 e 180 dias, com cortes adicionais aos 120 e 150 dias. Sob pleno sol, as leguminosas testadas toleraram cortes mais frequentes (intervalos de 30 - 90 dias), exceto o Lablab. Na sombra, o grau de tolerância variou conforme a espécie; em termos de produção de MS e de persistência, a Centrosema e a Puerária se destacaram dentre as demais leguminosas comparadas, quando os cortes foram realizados em intervalos de 60 dias, enquanto o Arachis e o Estilosantes foram os mais produtivos quando os cortes ocorreram em intervalos de 120 dias, mantendo o valor nutricional. O Alysicarpus e a Aeschynomene não persistiram sob o nível de sombreamento que prevaleceu nesse experimento.

The aim of this study was to evaluate the production and nutritive value of nine tropical legumes under two light intensities and six cutting regimens in the wet season, in Anhembi (SP) - Brazil. Pure stands were established in full light and under an eight-year-old eucalyptus plantation with 1.000 plants per hectare. The trees intercepted over80% of the incident radiation. Dry matter herbage accumulation, dry matter in vitro digestibility and crude protein under the cutting intervals 30, 60, 90 and 180 days, with additional cuttings at 120 and 150 days were evaluated. With the exception of Lablab, all other tested legume species tolerated higher cutting frequency under when grown under full sun light then under shade. The degree of shade-tolerance varied according to the species; Centrosema and Pueraria produced well at cutting intervals of 60 days, showing higher dry matter production and persistence while Arachis and Stylosanthes showed better results under longer cutting intervals, keeping the nutritional value, and can be indicated for differential grazing. Alysicarpus and Aeschynomene did not persist under the prevailing conditions.

Cellular and molecular studies of the effects of a selective COX-2 inhibitor celecoxib in the cardiac cell line H9c2 and their correlation with death mechanisms.

Cardiovascular disease is one of the leading causes of death worldwide, and evidence indicates a correlation between the inflammatory process and cardiac dysfunction. Selective inhibitors of cyclooxygenase-2 (COX-2) enzyme are not recommended for long-term use because of potentially severe side effects to the heart. Considering this and the frequent prescribing of commercial celecoxib, the present study analyzed cellular and molecular effects of 1 and 10 µM celecoxib in a cell culture model. After a 24-h incubation, celecoxib reduced cell viability in a dose-dependent manner as also demonstrated in MTT assays. Furthermore, reverse transcription-polymerase chain reaction analysis showed that the drug modulated the expression level of genes related to death pathways, and Western blot analyses demonstrated a modulatory effect of the drug on COX-2 protein levels in cardiac cells. In addition, the results demonstrated a downregulation of prostaglandin E2 production by the cardiac cells incubated with celecoxib, in a dose-specific manner. These results are consistent with the decrease in cell viability and the presence of necrotic processes shown by Fourier transform infrared analysis, suggesting a direct correlation of prostanoids in cellular homeostasis and survival.

Cellular and molecular studies of the effects of a selective COX-2 inhibitor celecoxib in the cardiac cell line H9c2 and their correlation with death mechanisms

Cardiovascular disease is one of the leading causes of death worldwide, and evidence indicates a correlation between the inflammatory process and cardiac dysfunction. Selective inhibitors of cyclooxygenase-2 (COX-2) enzyme are not recommended for long-term use because of potentially severe side effects to the heart. Considering this and the frequent prescribing of commercial celecoxib, the present study analyzed cellular and molecular effects of 1 and 10 µM celecoxib in a cell culture model. After a 24-h incubation, celecoxib reduced cell viability in a dose-dependent manner as also demonstrated in MTT assays. Furthermore, reverse transcription-polymerase chain reaction analysis showed that the drug modulated the expression level of genes related to death pathways, and Western blot analyses demonstrated a modulatory effect of the drug on COX-2 protein levels in cardiac cells. In addition, the results demonstrated a downregulation of prostaglandin E2 production by the cardiac cells incubated with celecoxib, in a dose-specific manner. These results are consistent with the decrease in cell viability and the presence of necrotic processes shown by Fourier transform infrared analysis, suggesting a direct correlation of prostanoids in cellular homeostasis and survival.

Determinação do perfil fitoquímico de extrato com atividade antioxidante da espécie medicinal Cordia verbenacea DC. por HPLC-DAD / Phytochemical profile determination from extracts with antioxidant activity of the medicinal species of Cordia verbenacea DC. by HPLC-DAD

O presente trabalho teve por objetivo investigar a atividade antioxidante dos extratos das folhas de Cordia verbenacea obtido por maceração em etanol e partição em solventes orgânicos. O infuso das folhas também foi investigado. O teor de fenóis totais foi avaliado pelo método de Folin-Ciocalteau e o de flavonoides totais pela formação de complexo com cloreto de alumínio. O extrato etanólico, as subfrações e o infuso foram testados em diversas concentrações para determinar a atividade sequestradora de DPPH expressa em termos de sua CE50. A melhor atividade antioxidante encontrada foi para o extrato em acetato de etila, EA, CE50 15,0 ± 0,5 µg.mL-1. Os ensaios espectrofotométricos revelaram altas concentrações de fenóis e de flavonoides no extrato EA. A análise por HPLC-DAD foi realizada para se obter o perfil de UV-Vis dos picos cromatográficos do extrato EA. As características espectrais foram relacionadas a compostos fenólicos e flavonoídicos.

The objective of the present study was to investigate the antioxidant activity of extracts from Cordia verbenacea leaves obtained by maceration in ethanol and partitioned with organic solvents. The infusion of leaves was also investigated. The total phenolic and total flavonoid content was evaluated by the Folin-Ciocalteau method and by the aluminum chloride complex method, respectively. The ethanol extract, the subfractions and the infusion were assayed at various concentrations to determine the DPPH scavenging activity expressed in terms of CE50. The best antioxidant activity was found on the ethyl acetate extract, EA, CE50 15.0 ± 0.5 µg.mL-1. The spectrophotometric assays revealed high phenol and flavonoid concentrations on the EA extract. The HPLC-DAD analysis was performed to reveal the UV-Vis profile of the chromatographic peaks of the EA extract. The UV spectral characteristics were related to phenol and polyphenol compounds.

Effects of gamma radiation on raspberries: safety and quality issues.

There is an ever-increasing global demand from consumers for high-quality foods with major emphasis placed on quality and safety attributes. One of the main demands that consumers display is for minimally processed, high-nutrition/low-energy natural foods with no or minimal chemical preservatives. The nutritional value of raspberry fruit is widely recognized. In particular, red raspberries are known to demonstrate a strong antioxidant capacity that might prove beneficial to human health by preventing free radical-induced oxidative stress. However, food products that are consumed raw, are increasingly being recognized as important vehicles for transmission of human pathogens. Food irradiation is one of the few technologies that address both food quality and safety by virtue of its ability to control spoilage and foodborne pathogenic microorganisms without significantly affecting sensory or other organoleptic attributes of the food. Food irradiation is well established as a physical, nonthermal treatment (cold pasteurization) that processes foods at or nearly at ambient temperature in the final packaging, reducing the possibility of cross contamination until the food is actually used by the consumer. The aim of this study was to evaluate effects of gamma radiation on raspberries in order to assess consequences of irradiation. Freshly packed raspberries (Rubus idaeus L.) were irradiated in a (60)Co source at several doses (0.5, 1, or 1.5 kGy). Bioburden, total phenolic content, antioxidant activity, physicochemical properties such as texture, color, pH, soluble solids content, and acidity, and sensorial parameters were assessed before and after irradiation and during storage time up to 14 d at 4°C. Characterization of raspberries microbiota showed an average bioburden value of 10(4) colony-forming units (CFU)/g and a diverse microbial population predominantly composed of two morphological types (gram-negative, oxidase-negative rods, 35%, and filamentous fungi, 41%). The inactivation studies on the raspberries mesophilic population indicated a one log reduction of microbial load (95% inactivation efficiency for 1.5 kGy), in the surviving population mainly constituted by filamentous fungi (79-98%). The total phenolic content of raspberries indicated an increase with radiation doses and a decrease with storage time. The same trend was found for raspberries' antioxidant capacity with storage time. Regarding raspberries physicochemical properties, irradiation induced a significant decrease in firmness compared with nonirradiated fruit. However, nonirradiated and irradiated fruit presented similar physicochemical and sensory properties during storage time. Further studies are needed to elucidate the benefits of irradiation as a raspberries treatment process.

Rapid detection and quantification of milk adulteration using infrared microspectroscopy and chemometrics analysis.

The application of attenuated total reflectance mid-infrared microspectroscopy (MIR-microspectroscopy) was evaluated as a rapid method for detection and quantification of milk adulteration. Milk samples were purchased from local grocery stores (Columbus, OH, USA) and spiked at different concentrations of whey, hydrogen peroxide, synthetic urine, urea and synthetic milk. Samples were place on a 192-well microarray slide, air-dried and spectra were collected by using MIR-microspectroscopy. Pattern recognition analysis by Soft Independent Modeling of Class Analogy (SIMCA) showed tight and well-separated clusters allowing discrimination of control samples from adulterated milk. Partial Least Squares Regression (PLSR) showed standard error of prediction (SEP) ~2.33, 0.06, 0.41, 0.30 and 0.014 g/L for estimation of levels of adulteration with whey, synthetic milk, synthetic urine, urea and hydrogen peroxide, respectively. Results showed that MIR-microspectroscopy can provide an alternative methodology to the dairy industry for screening potential fraudulent practice for economic adulteration of cow's milk.

Draft genome sequences of two Pseudomonas aeruginosa clinical isolates with different antibiotic susceptibilities.

Pseudomonas aeruginosa is a primary cause of opportunistic infections. We have sequenced and annotated the genomes of two P. aeruginosa clinical isolates evidencing different antibiotic susceptibilities. Registered differences in the composition of their accessory genomes may provide clues on P. aeruginosa strategies to thrive in different environments like infection loci.

Electronic state spectroscopy of c-C5F8 explored by photoabsorption, electron impact, photoelectron spectroscopies and ab initio calculations.

The electronic transitions and resonance-enhanced vibrational excitations of octafluorocyclopentene (c-C5F8) have been investigated using high-resolution photoabsorption spectroscopy in the energy range 6-11 eV. In addition, the high-resolution electron energy loss spectrum (HREELS) was recorded under the electric dipolar excitation conditions (100 eV incident energy, approximately 0 degrees scattering angle) over the 5-14 eV energy loss range. A He(I) photoelectron spectrum (PES) has also been recorded between 11 and 20 eV, allowing us to derive a more precise value of (11.288 +/- 0.002) eV for the ground neutral state adiabatic ionization energy. All spectra presented in this paper represent the first and highest resolution data yet reported for octafluorocyclopentene. Ab initio calculations have been performed for helping in the assignment of the spectral bands for both neutral excited states and ionic states.

[Drug-related clinical research--a practical opportunity for the hospital pharmacist]. / La investigación clínica con medicamentos: una oportunidad práctica para el farmacéutico hospitalario.

OBJECTIVE: To describe a pharmacist s field of activity in drug-related clinical trials. METHOD: A non-systematic assessment of available scientific literature in international databases queried during the period of May 05 to 31, 2005. RESULTS: In all, 36 papers were obtained regarding the role of hospital pharmacists in the development of drug-related clinical trials. Most common activities included dispensation, storage, and inventory. Participation in ethics committees and study coordination represent an expanding area. CONCLUSIONS: Drug-related clinical research is an excellent practical setting for the hospital pharmacist. Activities related to investigational drug control, including dispensation, randomization scheme management, and patient follow-up, are an example. This is a novel though rapidly expanding scenario in Brazil.

Molecularly organized Langmuir-Blodgett films from a ruthenium biphosphine complex.

Langmuir-Blodgett (LB) films from a ruthenium complex mer-[RuCl3 (dppb)(4-Mepy)] (dppb = PPh2 (CH2)4PPh2; 4-Mepy = 4-methylpyridine), termed Ru-Pic, display a distinct color, which is different from the coloration exhibited by cast films or chloroform solutions. The solution and cast films are red, while the LB films are green-bluish. The manifestation of the blue color in the LB film finds its explanation in a unique absorption band at 690 nm, which is associated with the oxidation of the phosphine moieties. Fluorescence emission and absorption-reflection infrared spectroscopy measurements revealed the molecular organization in the LB films. In contrast, cast films showed a random distribution of complexes. Surface-enhanced Raman scattering was also used in an attempt to identify the main interactions in Ru-Pic.

Activation and significance of vacuolar H+-ATPase in Saccharomyces cerevisiae adaptation and resistance to the herbicide 2,4-dichlorophenoxyacetic acid.

The stimulation of the activity of the H(+)-ATPase present in the vacuolar membrane (V-ATPase) of Saccharomyces cerevisiae is here described in response to a moderate stress induced by 2,4-dichlorophenoxyacetic acid (2,4-D). This in vivo activation (up to 5-fold) took place essentially during the adaptation period, preceding cell division under herbicide stress, in coordination with a marked activation of plasma membrane H(+)-ATPase (PM-ATPase) (up to 30-fold) and the decrease of intracellular and vacuolar pH values, suggesting that activation may be triggered by acidification. Single deletion of VMA1 and genes encoding other V-ATPase subunits led to a more extended period of adaptation and to slower growth under 2,4-D stress. Results suggest that a functional V-ATPase is required to counteract, more rapidly and efficiently, the dissipation of the physiological H(+)-gradient across vacuolar membrane registered during 2,4-D adaptation.

New broad-host-range promoter probe vectors based on the plasmid RK2 replicon.

Broad-host-range plasmid RK2-based promoter probe vectors with a known nucleotide sequence were constructed. In the absence of an upstream promoter, the expression of two tested reporter genes (luc and lacZ) in Escherichia coli was virtually zero, while insertion of the Ptrc promoter resulted in strong inducer-dependent expression. The lacZ-based vectors were mobilized into Pseudomonas fluorescens ST, Pseudomonas putida KT2442, Sphingomonas spp. and Burkholderia spp. LB400, and expression analyses indicated that the properties observed in E. coli are maintained across the species barriers. In addition, the previously established knowledge of RK2 molecular biology allows easy manipulations of features such as plasmid copy number, further extending the application potential of the vectors.

A functional model system of an hypoxic nerve injury and its evaluation.

OBJECTIVES/HYPOTHESIS: Develop an hypoxic peripheral nerve injury model with a controlled injury type and two types of clinically relevant physiological measurements of function during and after recovery. The model, controlling for injury and measurement variables, would have predictable outcomes in function. The functional model could test potential therapeutic interventions with greater sensitivity. STUDY DESIGN: Twenty-one rats were used in preliminary studies evaluating peroneal nerve injury types and functional model evaluation. Forty-eight rats were used in a controlled and blinded evaluation of the injury model followed by treatment with hyperbaric oxygen (HBO) as a potential therapeutic intervention and evaluated with functional models. METHODS: Preliminary studies compared nerve injuries: epineurectomy, epineurectomy with crush and transection with autograft for rate of return of function and final extent of return of function. The gait analysis model was also evaluated and modified to decrease variability. The final study evaluated peroneal epineurectomy and nerve crush injury with serial gait analysis during recovery, final elicited maximum force measurements, and histological analysis. Half of the animals were treated with HBO during recovery (ANOVA or regression statistical analysis were used to determine group differences.). RESULTS: Preliminary studies suggested that the peroneal nerve injury model of an epineurectomy with crush of specified length and a modification of the gait analysis model would yield a useful and predictable injury outcome. The final study resulted in predicted and consistent injury outcomes. In the HBO treatment group, a 12% improvement in function 5 days after HBO treatment was demonstrated (P < .03), but no long-term or histological benefit was seen. CONCLUSION: A reliable hypoxic nerve injury model has been developed and tested utilizing two functional methods as the primary outcome variables.

Physiological analysis of the expression of the styrene degradation gene cluster in Pseudomonas fluorescens ST.

The effects of different carbon sources on expression of the styrene catabolism genes in Pseudomonas fluorescens ST were analyzed by using a promoter probe vector, pPR9TT, which contains transcription terminators upstream and downstream of the beta-galactosidase reporter system. Expression of the promoter of the stySR operon, which codes for the styrene two-component regulatory system, was found to be constitutive and not subject to catabolite repression. This was confirmed by the results of an analysis of the stySR transcript in P. fluorescens ST cells grown on different carbon sources. The promoter of the operon of the upper pathway, designated PstyA, was induced by styrene and repressed to different extents by organic acids or carbohydrates. In particular, cells grown on succinate or lactate in the presence of styrene started to exhibit beta-galactosidase activity during the mid-exponential growth phase, before the preferred carbon sources were depleted, indicating that there is a threshold succinate and lactate concentration which allows induction of styrene catabolic genes. In contrast, cells grown on glucose, acetate, or glutamate and styrene exhibited a diauxic growth curve, and beta-galactosidase activity was detected only after the end of the exponential growth phase. In each experiment the reliability of the reporter system constructed was verified by comparing the beta-galactosidase activity and the activity of the styrene monooxygenase encoded by the first gene of the styrene catabolic operon.

Percutaneous endoscopic gastrostomy: avoiding complications.

This study evaluates our complications arising directly or indirectly from placement or management of percutaneous endoscopic gastrostomy (PEG) tubes and provides recommendations for avoidance of complications. Seventy-one patients received PEG tube placement by otolaryngologists between January 1991 and May 1997. Records were reviewed for diagnoses, combined procedures, and complications. Addressing potential causes of complications prompted modification of our technique of PEG tube placement and management. Twenty-three patients received PEG for dysphagia/aspiration unrelated to neoplasia, 11 received PEG with staging endoscopy, 11 received PEG after treatment for head and neck neoplasm, and 26 received PEG at the time of primary resection. Major complications included retained PEG hub and delayed colon abscess ultimately resulting in death. Minor complications included skin abscesses, cellulitis, and early and late vasovagal response with PEG tube removal. An airway emergency, on attempted oral airway intubation, resulted in an aborted PEG attempt and constituted another complication outside the 4 groups stated above. The major complication was not found within a literature review. We have modified our management for avoidance of this complication. We believe the causes of the minor complications have been identified, and with additional modifications in our technique, we have not had any similar complications recently. The recommended techniques are discussed in detail.