Biomedical subjects
Publications and source records attributed to D A Rives.
Laparoscopic appendectomy was performed on 109 patients over a 3-year-period--1988 to 1991. All procedures were uneventful and all patients resumed normal activity within a shorter period than had been experienced with open appendectomy. Patients had a superior cosmetic result and experienced significantly less postoperative discomfort.
Numerous investigators have reported the safety, cost effectiveness, and low morbidity and mortality of percutaneous endoscopic gastrostomy (PEG) but not studies compare the results of gastroenterologists and surgeons performing PEG. In a retrospective review of PEG performed at our institution, morbidity and mortality were compared between these two groups. The procedure was performed by either the surgical service (n = 49) or gastroenterology service (n = 51). One hundred PEGs were successfully placed in 92 patients. Three placement failures occurred in the gastroenterology group. Major complications were defined as conditions requiring operative intervention or resulting in death. Minor complications, using a defined list (13 different complications), were those not serious or life-threatening, which were managed medically or resolved without treatment. Twenty-nine minor (17 patients) complications and 3 major (3 patients) complications occurred in the gastroenterology group. Thirteen minor (11 patients) complications and 4 major (4 patients) complications occurred in the surgery group. Overall 30-day mortality was 14 per cent (13 patients), two of which were probably procedure-related in the gastroenterology group. In both groups, there was no difference in the numbers of patients who had complications (P greater than 0.05). The complication rate (numbers of complications/number of patients) doubled in the gastroenterology group compared with the surgery group for minor (P less than 0.04) and total complications (minor and major--P less than 0.06). Since PEG is a procedure frequently performed by gastroenterologists, it is imperative that surgeons, particularly those not performing endoscopy, be aware of the potential morbidity associated with PEG.
Enteral nutrition is best delivered via a small bore feeding tube whose tip lies in the proximal jejunum. A major obstacle to tube placement is the lack of a reliable means of assuring passage through the pylorus. A simple, quick method of tube placement using endoscopic assistance that was successful in 18 of 20 (90%) attempts is described.
A case of fibromatosis of the breast with positive cytosol assays for estradiol and progesterone receptors is described. Estrogen and progesterone receptors in fibromatosis have been only rarely reported in the English literature, and never, to our knowledge, in fibromatosis of the breast. We discuss the implications of these findings and review the literature.