Background and aims:Peristomal wound infections are common complications of percutaneous endoscopic gastrostomy(PEG).The Funada-style gastropexy device has two parallel needles with a wire loop and suture thread,and w...Background and aims:Peristomal wound infections are common complications of percutaneous endoscopic gastrostomy(PEG).The Funada-style gastropexy device has two parallel needles with a wire loop and suture thread,and was developed about 20 years ago in Japan.This kit has allowed us to perform dual gastropexy very easily;PEG with gastropexy has become a very popular technique in Japan.The present study aimed to compare the advantages and disadvantages of PEG with the gastropexy technique with the standard‘pull’method.Methods:We retrospectively reviewed 182 consecutive,non-randomized patients undergoing PEG in our hospital,and a comparative analysis was made between the gastropexy(87 patients)and non-gastropexy(95 patients)groups.Results:The rates of patients having erythema(11.6%vs.47.9%;P<0.001),exudates(2.3%vs.14.9%;P<0.01)and infection(0%vs.6.4%;P紏0.01)in the peristomal area were lower in the gastropexy than in the non-gastropexy group.The rate of minor bleeding from the peristomal area was higher in the gastropexy than in the non-gastropexy group(12.8%vs.2.1%;P<0.01),but no patient required a blood transfusion.Mean procedure time was longer in the gastropexy group than in the non-gastropexy group(31 vs.24 min;P<0.001).The 30-day mortality rates were 4.7%and 5.3%respectively,and these deaths were not related to the gastrostomy procedure.Conclusion:PEG with gastropexy markedly reduces peristomal inflammation.Although minor bleeding and a longer procedure time were disadvantages,there were no severe complications.The findings suggested that PEG with Funada-style gastropexy was a safe and feasible method for reducing early complications of PEG.展开更多
Management of surgically placed ostomies is an important aspect of any general surgical or colon and rectal surgery practice. Complications with surgically placed ostomies are common and their causes are multifactoria...Management of surgically placed ostomies is an important aspect of any general surgical or colon and rectal surgery practice. Complications with surgically placed ostomies are common and their causes are multifactorial. Parastomal ulceration, although rare, is a particularly difficult management problem. We conducted a literature search using MD Consult, Science Direct, OVID, Medline, and Cochrane Databases to review the causes and management options of parastomal ulceration. Both the etiology and treatments are varied. Different physicians and ostomy specialists have used a large array of methods to manage parastomal ulcers; these including local wound care; steroid creams; systemic steroids; and, when conservative measures fail, surgery. Most patients with parastomal ulcers who do not have associated IBD or peristomal pyoderma gangrenosum （PPG） often respond quickly to local wound care and conservative management. Patients with PPG, IBD, or other systemic causes of their ulceration need both systemic and local care and are more likely to need long term treatment and possibly surgical revision of the ostomy. The treatment is complicated, but improved with the help of ostomy specialists.展开更多
Freshwater planorbid mollusks belonging to the genus Biomphalaria act as intermediate hosts for Schistosoma mansoni, the etiological agent of human intestinal schistosomiasis, in the Neotropical Region. Identification...Freshwater planorbid mollusks belonging to the genus Biomphalaria act as intermediate hosts for Schistosoma mansoni, the etiological agent of human intestinal schistosomiasis, in the Neotropical Region. Identification ofBiomphalaria spp. are carried out based on morphological characters, and the Schistosoma infection are determined by the presence of cercariae （verified through microscope preparation and mounting）. Recently, the geometric morphometrics has proven to be a useful tool for determining shape differences in disease vectors arthropods. Due to this, we used geometric morphometrics to determine Biomphalaria glabrata shell differences （shape and size） between uninfected and infected specimens. We digitalized 12 anatomical points over the shell left side （from umbilicus to the last whorl） by combining type I and II landmarks and sliding semilandmarks; the coordinates were aligned by generalized Procrustes analysis. Principal component analyses were implemented for examining main variation axes, and discriminant analysis for testing group membership significance. We found significant separation between infected and uninfected shell conformation. All specimens were 100% correctly classified. The main differences occur in the peristome. The Kruskal-Wallis test finds significant differences in shell isometric size among infected and uninfected specimens. These findings correspond to other studies of traditional morphometrics, that infected snails showed the reduction in shell size in contrast to those uninfected specimens展开更多
文摘Background and aims:Peristomal wound infections are common complications of percutaneous endoscopic gastrostomy(PEG).The Funada-style gastropexy device has two parallel needles with a wire loop and suture thread,and was developed about 20 years ago in Japan.This kit has allowed us to perform dual gastropexy very easily;PEG with gastropexy has become a very popular technique in Japan.The present study aimed to compare the advantages and disadvantages of PEG with the gastropexy technique with the standard‘pull’method.Methods:We retrospectively reviewed 182 consecutive,non-randomized patients undergoing PEG in our hospital,and a comparative analysis was made between the gastropexy(87 patients)and non-gastropexy(95 patients)groups.Results:The rates of patients having erythema(11.6%vs.47.9%;P<0.001),exudates(2.3%vs.14.9%;P<0.01)and infection(0%vs.6.4%;P紏0.01)in the peristomal area were lower in the gastropexy than in the non-gastropexy group.The rate of minor bleeding from the peristomal area was higher in the gastropexy than in the non-gastropexy group(12.8%vs.2.1%;P<0.01),but no patient required a blood transfusion.Mean procedure time was longer in the gastropexy group than in the non-gastropexy group(31 vs.24 min;P<0.001).The 30-day mortality rates were 4.7%and 5.3%respectively,and these deaths were not related to the gastrostomy procedure.Conclusion:PEG with gastropexy markedly reduces peristomal inflammation.Although minor bleeding and a longer procedure time were disadvantages,there were no severe complications.The findings suggested that PEG with Funada-style gastropexy was a safe and feasible method for reducing early complications of PEG.
文摘Management of surgically placed ostomies is an important aspect of any general surgical or colon and rectal surgery practice. Complications with surgically placed ostomies are common and their causes are multifactorial. Parastomal ulceration, although rare, is a particularly difficult management problem. We conducted a literature search using MD Consult, Science Direct, OVID, Medline, and Cochrane Databases to review the causes and management options of parastomal ulceration. Both the etiology and treatments are varied. Different physicians and ostomy specialists have used a large array of methods to manage parastomal ulcers; these including local wound care; steroid creams; systemic steroids; and, when conservative measures fail, surgery. Most patients with parastomal ulcers who do not have associated IBD or peristomal pyoderma gangrenosum （PPG） often respond quickly to local wound care and conservative management. Patients with PPG, IBD, or other systemic causes of their ulceration need both systemic and local care and are more likely to need long term treatment and possibly surgical revision of the ostomy. The treatment is complicated, but improved with the help of ostomy specialists.
文摘Freshwater planorbid mollusks belonging to the genus Biomphalaria act as intermediate hosts for Schistosoma mansoni, the etiological agent of human intestinal schistosomiasis, in the Neotropical Region. Identification ofBiomphalaria spp. are carried out based on morphological characters, and the Schistosoma infection are determined by the presence of cercariae （verified through microscope preparation and mounting）. Recently, the geometric morphometrics has proven to be a useful tool for determining shape differences in disease vectors arthropods. Due to this, we used geometric morphometrics to determine Biomphalaria glabrata shell differences （shape and size） between uninfected and infected specimens. We digitalized 12 anatomical points over the shell left side （from umbilicus to the last whorl） by combining type I and II landmarks and sliding semilandmarks; the coordinates were aligned by generalized Procrustes analysis. Principal component analyses were implemented for examining main variation axes, and discriminant analysis for testing group membership significance. We found significant separation between infected and uninfected shell conformation. All specimens were 100% correctly classified. The main differences occur in the peristome. The Kruskal-Wallis test finds significant differences in shell isometric size among infected and uninfected specimens. These findings correspond to other studies of traditional morphometrics, that infected snails showed the reduction in shell size in contrast to those uninfected specimens
