Gastrostomy is used to feed palliative patients with dysphagia. Currently, the preference is given to percutaneous puncture methods of gastrostomy, which do not require general anesthesia. Percutaneous puncture techniques are possible only if the patency of the upper parts of the digestive tract still exists for the «pull method» and can require additional X-ray irradiation in case of the «push method». These operations require expensive disposable kits, which affects the prevalence and availability of the technique. Therefore, the use of an alternative minimally invasive gastrostomy through minilaparotomy is justified. Minimal-invasive pressure gastrostomy is known for a long time, and in combination with small access, it can be successfully used to provide nutrition for palliative patients with dysphagia. Most patients with dysphagia have a thin anterior abdominal wall, which allows using minimal access. It is important to choose the right place of the incision so that access is in the area of the formation of the fistula. To obtain additional diagnostic information one can use a radiography of the abdominal cavity, which shows the gas bubble of the stomach, and other high-tech methods: ultrasound, spiral computed tomography, etc. At the same time such patients do not require general anesthesia, it is possible to perform the operation under a local anesthesia. The article provides a detailed description of the technique of minimal invasive laparotomy gastrostomy and two clinical observations of palliative patients who underwent this operation.
Introduction. Post-transcriptional mechanisms play a crucial role in the biological course and clinical manifestations of papillary thyroid cancer (PTC). Recent studies show that an increased content of oncogenic or reduced content of oncosuppressive microRNAs increases the aggressiveness of the tumor and correlates with an unfavorable prognosis of treatment, which allows them to be used in personalizing the treatment tactics of patients with PTC. The study objective is to compare the level of expression of 12 PTC-specific microRNAs and the frequency of V600E mutation of the BRAF gene in patients with different risk of relapse. Materials and methods. The study included 175 patients with PTC. For quantitative analysis of microRNA expression, a reverse transcription reaction followed by a real-time polymerase chain reaction in formalin-fixed paraffin blocks was used. Correlations between 12 microRNA expression and BRAF mutation with different clinical and anatomical features of PTC the risk of relapse according to the American Thyroid Association Risk Stratification System (2009) were analyzed. Results. We demonstrated that miR-146b, miR-221, miR-144, miR-451a, and miR-7 expression correlated with features such as extrathyroid tumor growth, larger size, multifocus, lymph node metastasis, and the presence of distant metastases of the PTC. Most importantly, miR-221, miR-144, miR-451a, and miR-7 expression correlated with risk levels, suggesting their potential significance in stratifying the risk of relapsing PTC. The dependence of the clinical behavior of PTC on the BRAF mutation has not been established.Conclusion. The result of the study will contribute to the individual choice of preoperative treatment tactics for patients with PTC.
Complete care of a patient is important in palliative medicine. The necessity of nutrition support is determined by the severity of nutritive, trophic deficit, features of diseases which can cause (or which have already caused) protein-energy deficiency. Nutritive support is a multidisciplinary problem: it concerns not only a dietitian and an intensive care specialist but also a surgeon, a gastroenterologist, an oncologist, a dentist and other specialists who face patients unabled to satisfy their needs by physiological way. The feeding using gastral tube or gastrostomy should be special because oral cavity is switched off the nutrition. Efficiency of treatment rises while adapting enteral nutrition to specialties of digestion and metabolism in various types of pathology. Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction and in patients who are critically ill. Enteral nutrition is often used for children as well as for adults. Children may require enteral feeding for a wide range of underlying conditions, such as for malnutrition, for increased energy requirement, for metabolic disorders and also for children with neuromuscular disorders. Two main steps help to solve the problem of malnutrition: choosing the composition of formula and choosing the way to deliver the formula. This article gives a specification in using various feeding formulas according to different diseases and describes different ways to deliver the formula (from gastral tube to gastrostomy). If swallowing reflex is absent the formula should be delivered directly to stomach. The best way for a long-term or permanent nutrition support is feeding using gastrostomy. This article describes some surgical aspects of different types of gastrostomy from classical one to modern percutaneous endoscopic gastrostomy.
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