A simple and inexpensive method of removal or replacement of gastrostomy tubes

Article Abstract:

Many patients with disabling disorders that interfere with chewing or swallowing require enteral nutrition, which is provided by the placement of a gastrostomy tube into the stomach. This method was originally accomplished surgically, but is now usually achieved with percutaneous endoscopic gastrostomy (PEG), a less invasive technique with fewer complications. The gastrostomy tubes are also usually removed by using endoscopic techniques, which require a flexible tube with an optical system. This study examined the safety of removing gastrostomy tubes with nonendoscopic methods, specifically by simply cutting the tubes so that their inner contents can be eliminated. This method was assessed in 64 patients who needed to have their tubes removed or replaced. Radiographs were taken in 57 patients to confirm that the tubes were eliminated. Results revealed that complete elimination occurred in 84 percent of the patients who were X-rayed within an average of 23.6 days; if 8 patients who could not be radiographed for a period of time were eliminated from these calculations, the average period between cutting the tube and elimination was 9.8 days. The radiographs of eight of nine patients showed the components in the intestine, with no adverse effects. One patient required endoscopic removal of the gastrostomy tube. In seven patients who were not X-rayed, one passed the contents in his stool and the other six had no problems. These results indicate that simply cutting a gastronomy tube is a simple, safe, and inexpensive method for tube removal. However, persons with intestinal blockages or certain diseases should have their gastrostomy tubes removes endoscopically. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Innovations, Enteral feeding, Enteral nutrition, Percutaneous endoscopic gastrostomy, Tube feeding, Stomach, Gastrointestinal intubation

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Total hip replacement

Article Abstract:

A Consensus Development Conference on Total Hip Replacement, held in September 1994, focused on the latest fixation techniques, surgical preparations and results, complications, and future research. Total hip replacement appears to be both safe and effective in treating the pain and disability associated with joint failure, commonly caused by osteoarthritis. Fewer complications result because of the use of antibiotics to prevent infection and anticoagulants to reduce thrombosis. New fixation techniques are being used, such as noncemented units that depend on bone growth into porous areas for fixation. However, a cemented femoral unit has produced excellent functioning. Bone loss, fixation failure, and inflammatory response to particulate materials are problems which can occur over the long term.

Care and treatment, Prostheses and implants, Prosthesis

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A 76-year-old woman considering total hip replacement

Article Abstract:

Total hip replacement should be considered for people with severe hip arthritis that interferes with daily activities and does not respond to non-surgical treatments. Such treatments include water aerobics, walking, cycling and non-steroidal anti-inflammatory drugs. Over 100,000 hip replacements have been done in the US since the 1970s and 85% of the patients followed for up to 20 years still have an intact hip. It is very effective in relieving pain and usually improves mobility also.

Evaluation, Artificial hip joints, Hip prostheses

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