Gastrostomy vs nasogastric tube feeding in patients with head and neck cancer during radiotherapy alone or combined chemoradiotherapy

INTRODUCTION: Patients with head and neck cancer (HNC) submitted to radiotherapy alone or combined chemoradiotherapy present a high prevalence of malnutrition at baseline. Prophylactic use of gastrostomy has been suggested for these patients for delivering enteral nutrition. On the other hand, other authors have failed to demonstrate the effectiveness of this measure over nasogastric tube feeding. MATERIAL AND METHODS: We studied 40 patients with HNC with moderate or severe malnutrition who were offered either prophylactic percutaneous gastrostomy before starting oncologic treatment or close follow-up with nutritional counseling with the placement of a nasogastric tube when necessary. RESULTS: There were no significant changes throughout the study period in weight (p = 0.338), body mass index (BMI) (p = 0.314) or serum proteins (p = 0.729), and these changes showed no differences between the gastrostomy vsnasogastric tube feeding groups. The amount of delivered energy was above the estimated energy needs with both gastrostomy and nasogastric tube feeding, but there were no differences in the total energy provided by enteral nutrition between groups. Patients in the gastrostomy group received enteral nutrition support for a longer period of time (p = 0.007). CONCLUSIONS: Both gastrostomy and nasogastric tube feeding are effective methods of delivering enteral nutrition in patients with HNC submitted to radiotherapy alone or combined chemoradiotherapy, with no differences between them in terms of avoiding further nutritional deterioration.

Hiperparatiroidismo primario. Una alternativa a la cirugía / Primary hyperparathyroidism. An alternative to the surgery

El hiperparatiroidismo primario es una enfermedad causada por un adenoma/hiperplasia en las glándulas paratiroides, en la que la hipercalcemia debida a una excesiva secreción de parathormona (PTH) es el rasgo principal, y cuyo único tratamiento definitivo es la cirugía. Hay pacientes en los que la cirugía supone un gran riesgo, o que la rechazan, y en los cuales la hipercalcemia no puede ser controlada mediante el tratamiento médico convencional con hidratación, diuréticos y/o bisfosfonatos. Proponemos el uso de dos fármacos indicados en el tratamiento de la hipercalcemia de otras etiologías: el ácido zoledrónico, bisfosfonato de uso parenteral, y el cinacalcet, calcimimético que disminuye la secreción de PTH. Presentamos el caso de una mujer con hipercalcemia por un hiperparatiroidismo primario causado por un adenoma, tratado con ambos fármacos (AU)

Primary hyperparathyroidism is caused by an adenoma/hyperplasia in the parathyroid glands in which hypercalcemia is mainly due to an increased secretion of parathormone (PTH). The only definitive treatment is surgery. There are some patients at high surgical risk or who refuse surgery, and whose hypercalcemia cannot be controlled with conventional medical therapy such as hydration, diuretics and/or oral biphosphonates. We suggest the use of two drugs indicated for the treatment of hypercalcemia of other etiologies: zoledronic acid, a parenteral bisphosphonate, and cinacalcet, a calcimimetic agent that reduces PTH secretion. We present the case of a woman with hypercalcemia due to primary hyperparathyroidism caused by an adenoma, who was treated with both drugs (AU)