Percutaneous endoscopic gastrostomy and peristomal infection: an avoidable complication with the use of a minimum skin incision.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a fast and simple method. Although considered safe, PEG is associated with many potential complications. Peristomal infection is the complication most frequently reported. OBJECTIVE: To analyze patients who underwent PEG and the association of peristomal infection with the extent of skin incision (SI) and usage of prophylactic antibiotics (PA). METHODS: A retrospective review of the records of 120 patients who underwent PEG was carried out. Patients were divided into 3 subgroups: (1) Patients with SI 10 mm/without PA, (2) Patients with SI up to 5 mm/without PA, and (3) Patients with SI up to 5 mm/with PA. RESULTS: Peristomal infection occurred in 12.8% of patients from subgroup 1, and in 2.2% of patients from subgroup 2. There was no infection in subgroup 3. Peristomal infection was associated with the SI extent (P=0.01) and there was no association with PA (P=0.3). SI >5 mm presented an odds ratio of 10.5 (95% confidence interval, 1.58-68.42) for the occurrence of peristomal infection. CONCLUSIONS: The use of PA did not seem to reduce peristomal infection rates. However, minimal SI was significantly associated with reduction of this complication.

Safe limits for aspirate volume under wet liposuction.

BACKGROUND: Hypovolemia is a hemodynamic disorder occasionally associated with liposuction. The purpose of this study is to settle a safe limit for the volume of aspirate under wet liposuction relating this volume to body weight. The criteria used to establish this limit were based on the Advanced Trauma Life Support (ATLS). METHODS: Thirty patients underwent wet liposuction and were submitted postoperatively to a 24-h noninvasive monitoring control of vital signs. Tachycardia (over 100 bpm) and systolic hypotension (below 100 mmHg) were recorded as well as urinary volume and respiratory rate. Hemoglobin, hematocrit, and leukocyte counts were determined preoperatively and also determined 1 and 6 h postoperatively. RESULTS: The volume of aspirate ranged from 1,480 to 3,980 ml (2.6% to 6.9% of body weight). Hemoglobin count decreased around 6 h postoperatively compared to the immediate preoperative period (p<0.0001). An increase of leukocytes was observed around 6 h postoperatively when compared with the preoperative period-nearly 30 min before surgery (p<0.0001). No association was found between hemoglobin or leukocyte counts and volume of aspirate. In 15 patients, tachycardia and/or hypotension were recorded postoperatively. These hemodynamic disorders were associated to volumes of aspirate higher than 5% of body weight. CONCLUSIONS: Under wet liposuction, a volume of aspiration not superior to 5% of body weight is proposed as a safe limit. It has been found as a clue to avoid hypovolemia and subsequently the shock. This statement is in agreement with ATLS guidelines.

Immunoreactivity of cytokeratins 7 and 20 in goblet cells and columnar blue cells in patients with endoscopic evidence of Barrett's esophagus.

CONTEXT: Barrett's esophagus is characterized by the presence of goblet cells. However, when alcian-blue is utilized, another type of cells, called columnar blue cells, is frequently present in the distal esophagus of patients with endoscopic evidence of Barrett's esophagus. Cytokeratin 7 and 20 immunoreactivity has been previously studied in areas of intestinal metaplasia at the esophagogastric junction. However, the expression of these cytokeratins in columnar blue cells has not been characterized. OBJECTIVE: To compare the expression of cytokeratin 7 and 20 in goblet cells and columnar blue cells in patients with endoscopic evidence of Barrett's esophagus. METHODS: Biopsies from 86 patients with endoscopic evidence of Barrett's esophagus were evaluated. The biopsies were stained for cytokeratin 7 and 20. RESULTS: Goblet cells were present in 75 cases and columnar blue cells in 50 cases. Overall, cytokeratin 7 expression was similar in goblet cells and columnar blue cells (P = 0.25), while cytokeratin 20 was more common in goblet cells (P <0.001). In individuals with both cell types, however, cytokeratin 7 staining was the same in goblet and columnar blue cells in 95% of the cases, and cytokeratin 20 staining was the same in 77%. CONCLUSION: Goblet cells and columnar blue cells have similar immunohistochemical staining patterns for cytokeratins 7 and 20 in patients with endoscopic evidence of Barrett's esophagus.