Biomedical subjects

R A Pugash

Publications and source records attributed to R A Pugash.

22 records · Page 2Linked to original sources

PubMed1995

Ultrasound guidance in percutaneous gastrostomy and gastrojejunostomy.

OBJECTIVE: To evaluate the utility of ultrasound (US) guidance in the percutaneous placement of gastric feeding tubes in patients in whom placement of a nasogastric tube is not possible. PATIENTS AND METHODS: Records from feeding tube placements performed between January 1991 and August 1994 were reviewed. Of the 238 procedures performed, 27 cases (11%) involved initial US guidance, rather than nasogastric tube assistance, because of upper gastrointestinal obstruction. RESULTS: US allowed rapid puncture and subsequent insufflation of the stomach in 26 of the 27 patients, and there were no complications related to its use. In the other patient the position of the transverse colon prevented suitable visualization for puncture, and surgical placement of the feeding tube was necessary. CONCLUSION: US guidance is a safe and effective means by which the stomach can be punctured and distended before placement of a percutaneous feeding tube for patients in whom nasogastric intubation is not possible.

Aged↗

PubMed1993

Manipulation by catheter of unopened LGM filter.

The use of the transfemoral and transjugular venous routes for placement of inferior vena cava filters is accepted practice. However, the transjugular route is associated with substantially higher rates of incomplete filter opening for the LGM Vena Tech filter (Vena Tech, Evanston, Ill.). The appropriate course of action when a filter fails to open is unclear from the literature. Current recommendations include close observation or placement of a second filter above the unopened device. The authors report a case in which an incompletely opened filter delivered through the transjugular route was directly manipulated with a multipurpose catheter. The filter opened sufficiently to provide stability and obviate the need for a second filter. The authors recommend that manipulation by catheter be considered as the first option at the time of placement should an LGM filter fail to open completely.

Catheterization, Central Venous↗

PubMed1990

Perforating duodenal diverticulitis.

Two cases of perforating duodenal diverticulitis are reported, one with enterolith formation, and the other with sonographic evidence of retroperitoneal emphysema. The possible complications of duodenal diverticula, as well as the difficulties encountered in preoperative diagnosis, are discussed.

Aged↗

PubMedDate not supplied

Radiologic peroral gastrostomy.

PURPOSE: To develop an improved percutaneous technique for the insertion of large-bore gastrostomy tubes. MATERIALS AND METHODS: With use of fluoroscopic guidance, the stomach is punctured and the esophagus is catheterized in a retrograde fashion. A guide wire is passed from the gastrostomy site, up the esophagus, and out of the patient's mouth. A large-bore (20-24 F) endoscopic push-type gastrostomy tube is advanced over the wire, through the mouth, down the esophagus, and out of the gastrostomy site. RESULTS: Thirty-one successful tube placements were performed in 32 attempts (97% success rate). There were no major procedural or postprocedure complications. Minor complications included one lip laceration (one of 31 = 3%), one minor exit site infection (one of 31 = 3%), and two inadvertent tube dislodgements (two of 31 = 6%). CONCLUSIONS: Radiologic placement of large-bore endoscopic gastrostomy tubes is possible without endoscopy. The procedure is rapid, easy to perform, and safe.

Enteral Nutrition↗