[Fixation of nasogastric tubes in agitated and uncooperative patients]. / Fixation des sondes naso-gastriques chez les patients agités et peu compliants.

To prevent extubation, nasogastric tubes (NGT) were attached to a fine bore polyurethane tube, which loops loosely around the nasal septum. In a prospective study 180 cases were evaluated concerning the efficacy and possible complications related to this techniques. On average, a nasal septal loop (NSL) remained 20.1 +/- 1.3 days and a NGT 14 +/- 0.9 days. Complications were rare. In 45 of the cases NGT had to be replaced after self extubation and in 2.2% extubation presented more than twice. We think NSL is an easy and useful technique to secure NGT in non-cooperative and/or agitated patients for a relatively short term enteral nutrition or gastric decompression.

Securing nasogastric tubes in non-cooperative patients.

To prevent extubation, nasogastric tubes (NGT) were attached to a fine bore polyurethane tube, which loops loosely around the nasal septum. In a prospective study, 124 cases were evaluated for the efficiency and possible complications. On average, a Nasal Septal Loop (NSL) remained 21,2 +/- 1,8 days and a NGT 13,8 +/- 1,1 days. Complications were rare. In 16,9% of the cases NGT had to be replaced after self extubation and in 2.4% extubation occurred more than twice. We think NSL is an easy and useful technique for securing NGT in non-cooperative and/or agitated patients for relatively short term enteral nutrition or gastric decompression.

Sensitivity and specificity of 99Tcm-HMPAO single-headed SPECT in dementia.

The sensitivity and specificity of 99Tcm-hexamethylpropyleneamine oxime (HMPAO) single-headed single photon emission computed tomography (SPECT) in dementia were evaluated in elderly patients with a mean age of 84 years suffering from dementia (n = 59) and compared to an age- and sex-matched control group with normal cognitive function (n = 14). The demented patients were classified as suffering from primary degenerative dementia (PDD, n = 51) based on DSM-III-R criteria. Moreover, PDD patients were divided into three subgroups of severity of cognitive impairment, according to their Folstein score. Multi-infarct dementia (MID, n = 8) was diagnosed based on clinical features, computed tomographic findings and Hachinski ischaemic score. Images were assessed qualitatively by visual interpretation of shades of colour in cortical regions. A SPECT defect confined to the frontal, parietal, temporal or (parieto) occipital lobe was defined as one lesion. The mean number of SPECT lesions was 1.4 (range 0-4) in the control group, 2.4 (range 0-8) in the PDD group and 2.9 (range 2-5) in the MID group and showed a significant difference (P < 0.02) between groups. To obtain an acceptable level of specificity of 64.3%, a cut-off value of three lesions had to be chosen. In the PDD group, sensitivity was then 25% for the mildly, 43.8% for the moderately and 46.7% for the severely affected PDD subgroup. In the MID group sensitivity was then 75%. Interestingly, in this elderly patient population the location of lesions was homogenously distributed in all groups, including the control group.

Pneumoperitoneum--a rare complication of cardiopulmonary resuscitation.

Pneumoperitoneum following cardiopulmonary resuscitation (CPR) results from a thoracic air leak (pneumothorax, pneumomediastinum) with escape of the air through diaphragmatic apertures (mostly foramen of Winslow) or primary perforation of the gastrointestinal tract (stomach or esophagus). We report three cases of pneumoperitoneum complicating CPR. As there was no clinical evidence of peritonitis, and the patients remained stable, a conservative approach was followed without surgical exploration. All patients recovered completely.

The body packer syndrome--cocaine smuggling in the gastro-intestinal tract.

Cocaine drug packets were found in the gastro-intestinal tract of seven persons, charged with and arrested for presumed drug smuggling. Plain abdominal roentgenograms were positive in 4, while computer tomography of the abdomen (CT-scan) was necessary in 3 others to make the diagnosis. There were no signs of acute intoxication or bowel obstruction. All patients were treated with enemas and/or laxatives in order to evacuate the hidden packets; no complications occurred. A clinical description of the seven cases is followed by a short review of the literature, mainly focused on the possible complications of ingested drug packets and possible methods of removal.

Venopulmonary fistula: a rare complication of central venous catheterization.

Venopulmonary fistula occurred in a 13-year-old girl, 2 weeks after insertion of a silicone parenteral nutrition catheter. "TPN pneumonia" evolved to life-threatening respiratory failure. Complete resolution of the respiratory insufficiency followed removal of the catheter.