Objectives: To measure morbidity and mortality rates following insertion of gastrostomy tubes in head and neck cancer patients. To determine evidence for any relationship between gastrostomy insertion technique and complication rates. Design: A prospective cohort study and qualitative systematic review. Setting: Multi-cancer networks in the South West of England, Hampshire and the Isle of White. Participants: One hundred and seventy-two patients with head and neck cancer undergoing gastrostomy tube insertion between 2004 and 2005. Percutaneous endoscopic gastrostomy (PEG) was performed in 121 patients. Fifty-one patients had radiologically inserted gastrostomy (RIG). Twenty-seven studies reporting outcomes following 2353 gastrostomy procedures for head and neck cancer. Main outcome measures: Post-procedure mortality, major and minor complications. Results: In the present series, mortality rates were 1.0% (1 ⁄ 121) for PEG and 3.9% (2 ⁄ 51) for RIG. Overall major complication rates following PEG and RIG were 3.3% (4 ⁄ 121) and 15.6% (9 ⁄ 51) respectively. In our systematic review and meta-analysis of 2379 head and neck cancer patients, we observed fatality rates of 2.2% (95% CI 0.014-0.034) following PEG and 1.8% (95% CI 0.010-0.032) following RIG. Furthermore, major complication rates following PEG were 7.4% (95% CI 5.9-9.3%) and 8.9% (95% CI 7.0-11.2%) after RIG. Conclusions: Procedure related mortality rates following gastrostomy in head and neck cancer patients are higher than those in mixed patient populations. Major complication rates following RIG in head and neck cancer patients are greater than those following PEG. Major complications following PEG in patients with head and neck cancer appear no worse than in mixed pathology groups. We have identified that RIG is associated with increased morbidity and mortality in patients who are ineligible for PEG. The serious nature of the complications associated with gastrostomy particularly in patients with head and neck cancer requires careful consideration by the referring physician.The optimum technique for gastrostomy placement in patients with head and neck cancer remains controversial.1-4 Examination of the literature relating to complication and success rates of gastrostomy is made difficult by patient and pathology diversity and modifications of insertion technique. In 1995, Wollman et al.5 reported a metaanalysis investigating outcomes of 5752 patients following radiologic, endoscopic and surgical gastrostomy for all types of pathology. The authors concluded that radiologically inserted gastrostomies (RIG) were slightly more successful than percutaneous endoscopic gastrostomy (PEG) (99.2% versus 95.7%) and also safer, with statistically significant lower rates of major complications (5.9% versus 9.4%). Cancer comprised only 24-29% of the study populations and interpretation of the results in the context of head and neck cancer practice remains exigent. In this study, we examine outcomes following gastrostomy tube insertion in 172 consecutive patients trea...
A sensor array for analyzing hydrogen and ammonia gas mixtures in humid air has been developed, built into a rugged system, and calibrated for laboratory testing. The sensor array is comprised of four chemically sensitive field-effect transistors (CHEMFETs). Chemically sensitive layers for the sensors were developed and tested using a Kelvin probe. A combination of catalytic and noncatalytic thin layers (palladium and polyaniline) was selected for the four-sensor array. The work function responses of the CHEMFET sensor array to mixtures of hydrogen, ammonia, and humid air were measured. Chemometric multivariate methods, linear and nonlinear partial least squares, were used for the calibration of the sensor array using gas mixtures in the concentration range from 0 to 10 000 ppm hydrogen and ammonia in humid air. The sensor array for ammonia showed good sensitivity, selectivity, response time, and stability and is recommended for field deployment. In contrast, the sensor array for hydrogen, though highly sensitive to hydrogen, demonstrated inadequate stability, requiring further development before deployment is recommended.
Single-walled carbon nanotubes were examined as an adsorptive material for a thermally desorbed preconcentrator for organic vapors. The nanotubes were processed into a paper form and packed into a metal tube for flow-through sampling. Adsorbed vapors were released by a temperature-programmed desorption method and detected downstream with a flexural plate wave vapor sensor. The tested vapors, methyl ethyl ketone, toluene, and dimethyl methylphosphonate, were released from the packed column at different temperatures. The vapors were retained more strongly than previously observed for the widely used Tenax porous polymer, indicating a significant affinity of the single walled nanotubes for organic vapors.
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