Maximizing tolerance of enteral nutrition in severely injured trauma patients: a comparison of enteral feedings by means of percutaneous endoscopic gastrostomy versus percutaneous endoscopic gastrojejunostomy.

BACKGROUND: Intolerance of enteral nutrition interrupts caloric balance and increases hospital costs. This study proposes that enteral feeding by percutaneous endoscopic gastrojejunostomy (PEGJ) provides continuous uninterrupted nutrition with greater consistency than percutaneous endoscopic gastrostomy (PEG). METHODS: This prospective nonrandomly assigned study was conducted at a Level I trauma center from December of 1997 through October of 1998. All feeding tubes were placed by trauma/critical care surgeons for nutritional support. Feeding course was monitored for 14 days from time of tube placement. Demographic data and outcome variables compared were age, sex, Injury Severity Score, Abbreviated Injury Score, hospital length of stay, number of days to reach nutritional goal feedings, caloric goal, protein goal, cc/hr at goal, total parenteral nutrition usage, complications, and hospital charges. Statistical analyses used the independent samples t test, Cox regression, and Pearson chi2 with significance level set at 0.05. RESULTS: Patients receiving enteral nutrition by PEGJ reached nutritional goal sooner than patients who received enteral nutrition by PEG (p = 0.02). Thirty-seven of 46 PEGJ patients (80%) were at goal rate at day 3, whereas 28 of 43 PEG patients (65%) were at goal on day 3. Nine of 43 PEG patients (21%) and 3 of 46 PEGJ patients (7%) failed to reach goal within 14 days. CONCLUSION: This study suggests that enteral nutrition delivered by means of PEGJ is better tolerated than enteral nutrition delivered by means of PEG in trauma patients with no abdominal conditions that preclude percutaneous feeding tube placement.

Cerebral embolism and mitral stenosis: survival with and without anticoagulants.

Eighty-four patients with mitral stenosis and cerebral embolism have been followed up for 20 years. Half of the series (those treated in the early years) had no anticoagulant treatment and half were given long-term warfarin therapy. Mortality rate and causes of death have been reviewed, and comparison of survival times of treated and untreated groups by life-table analysis bears out the immediate need for anticoagulants when a diagnosis of systemic embolism is established. It is wise to continue the treatment for six months but it may be reasonable to discontinue it after one year with patients who can be assured of regular review.

Recording parameters of spatially modulated coherent wavefronts.

Various parameters of recording spatially modulated coherent light have been studied, with particular emphasis on the parameters related to constructing holograms. These include the ratio of the reference beam's intensity to that of the signal beam, the offset angle, the film's transfer characteristic, and the recording wavelength. Experimental results were obtained by recording interference patterns on highresolution film using the 6328-å line of the He-Ne laser. The bias level of the interference pattern was varied so as to vary the operating point on the curve representing the film's amplitude transmittance vs exposure characteristics. The percent modulation and the spatial frequency were also varied at each of the operating points. Interference patterns were recorded, using the 4880-åand 5145-å lines from the argon laser. From these data, the optimum bias level and the ratio of the signal beam to the reference beam for recording interference patterns are determined. The modulation transfer function of the film can also be determined.