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Introduction Many children with gastric feeding intolerance require postpyloric tube feeding via a gastrojejunal (GJ) tube. Placement or positioning of these tubes is typically a procedure with a low dose of radiation. Although the risk of developing cancer from radiation exposure owing to computed tomography scans is well-documented in children, the risk of cumulative radiation exposure owing to frequent GJ tube replacement often goes unnoticed in the clinical decision-making process. We sought to define the frequency and cost of GJ tube replacement, quantify the radiation doses associated with the initial placement and replacements, and assess the number of conversions to surgical jejunostomies. Methods All pediatric patients who underwent GJ tube placement or replacement by Interventional Radiology (IR), surgery, and gastroenterology between 2010 and 2018 at a single center were reviewed. We evaluated the total cost of the initial placement and replacement of each GJ tube, the total number of replacements, and the cumulative radiation dose (mGy). Results We identified 203 patients who underwent GJ tube placement and/or replacement, of which 150 had radiation data available. Patients underwent a median of five GJ tube replacement procedures, and there was a wide range in the number of replacements per patient, from zero to 88. Patients were exposed to a median cumulative dose of 6.0 mGy (IQR: 2.2, 22.6). Nine percent of patients with available radiation data were exposed to more than 50 mGy, solely from GJ tube replacements. The median cost per replacement was $1170. The sum of the cost of the replacements for dislodged GJs translated to more than $1.4 million during the study period. Conclusions Overall, the average dose per GJ replacement was 3.50 mGy among all patients with available data. Nine percent of patients (14/150) were exposed to greater than 50 mGy cumulative radiation solely from GJ replacements. Patients who receive more than 50 mGy of cumulative radiation dose, who undergo seven GJ tube replacements in one year, or two consecutive GJ tube replacement procedures with radiation doses exceeding 10 mGy (per replacement) should be considered for a surgical jejunostomy. Level of evidence IV Type of study Treatment study.

The presence of oral or naso-enteral probes during non-invasive mechanical ventilation (NIMV) increases the risk of leakage and patient discomfort. The objective of this study was to evaluate the effectiveness of a novel tube adapter for NIMV (TA-NIMV) in relation to leakage and comfort level.A non-randomized quasi-experimental design was performed in an adult intensive care unit of a highly complex hospital, in which patients were their own controls. We included adult patients who required NIV with oronasal mask and who simultaneously had oral or naso-enteric tubes. The interventions were as follows: every participant received two therapies, one with the TA-NIMV and one conventional therapy of NIMV (CT-NIMV). Comfort could be evaluated in 99 patients with a Glasgow Coma Scale of 15. The outcomes of interest was the average percentage of air leak and patient comfort during each intervention.196 patients were included in the study during a 16-month period. The mean air leak percentage was 9.2% [standard deviation (SD), 7.7] during TA-NIMV and 32.5% (SD, 12.5) during CT-NIMV (p0.001). 84.9% reported being comfortable or very comfortable during TA-VMNI. 66.7% Uncomfortable or Very uncomfortable during CT-NIMV (p0.001).Higher comfort levels and lower air leakage volume percentages were achieved using the TA-NIMV than those achieved by CT-NIMV.

Purpose Outcomes associated with primary laparoscopic gastrojejunal (GJ) tube placement in the pediatric population were evaluated. Methods A single-institution, retrospective review examined patients undergoing laparoscopic GJ tube placement between June 2011 and December 2014. Outcomes included gastric feeding tolerance, subsequent fundoplication, complications, and mortality. Results Ninety laparoscopic GJ tubes were placed. Median follow-up was 342days (interquartile range [IQR]=141–561days). Median patient age was 5months (IQR=3–11months) and weight was 5.2kg (IQR=4–8.4kg). The most common indications for placement were gastroesophageal reflux (n=85, 94.4%) and/or aspiration (n=40, 44.4%). Most common comorbidities included cardiac (n=34, 37.8%) and respiratory (n=29, 32.2%) diseases. The complication rate was 17.8%, including one case of intestinal perforation. Thirty-four (37.7%) patients transitioned to gastric feeding within 1year; time to conversion was 156days (IQR=117–210days); of those, 18.9% patients transitioned to oral feedings. A fundoplication was later performed in 4 children for persistent reflux. Mortality was 23.3% with no procedural-related deaths. Conclusion Primary laparoscopically placed GJ tubes are a reliable means of enteral access for pediatric patients with gastric feeding intolerance. Many of these children are successfully transitioned to gastric and/or oral feedings over time. Further studies are needed to characterize which patients are best served with a GJ tube versus alternatives such as fundoplication. Level of evidence III (treatment) Type of study Retrospective

Although the excess of thyroid hormones has been found to be associated with many effects on the heart and vasculature, the adaptive changes of various conductive and resistance arteries from different vasculature are largely unknown. In this study, we compared changes in vascular reactivity between aortic and femoral arterial rings in hyperthyroidism rat model. Our results indicate that daily gastric feeding of euthyrox to rat with dosage of 100 microg group (H1) or 200 microg group (H2) for 25 days was sufficient to induce a thyrotoxicosis. The serum TT3 and TT4 levels, heart weight (HW), body weight (BW), HW/BW ratio and mean diameter of myocardiac cells of the rat were significantly greater (P0.05) in that two hyperthyroidism groups than in control group (E). It demonstrates that the gastric feeding of euthyrox may provide a reliable, cheaper and convenient method to induce hyperthyroid state with varying severity and duration. Our results also suggest that the contractile responses to phenylephrine (PE) and the relaxation responses to acetylcholine (Ach) or sodium nitroprusside (SNP) were reduced and enhanced, respectively, in vascular rings from H1 and H2 rats compared with E rats (P0.05). The above vasoconstriction and vasorelaxation responses to agonists at least in large, elastic and medium-sized muscular arteries, which might be important vascular changes accounting for the enhancement of ventriculoatrial coupling and the reduction in peripheral vascular resistance during hyperthyroidism.

In veterinary patients, postgastric feeding is indicated for uncontrollable gastric vomiting, gastroparesis, biliary tract disease, pancreatitis, and for patients at increased risk for aspirating secondary to decreased mentation, prolonged recumbency, or an unprotected airway. Postgastric feeding may be implemented via the placement of a jejunal feeding tube. These tubes can be placed surgically (jejunostomy tubes) or with fluoroscopic or endoscopic guidance. This article will focus on methods of jejunal feeding-tube placement, advantages and disadvantages of the methods described, and complications associated with jejunal feeding.

Twenty, 5-week-old, male, Sprague-Dawley rats were divided into a control and a cyclosporin A (CSA) group for evaluating effects of the drug on condylar cartilage. Animals in the treatment group daily received CSA (15 mg/kg body wt) in mineral oil by gastric feeding over a 4-week observation interval. Control animals received mineral oil only. Five animals from each group were killed at weeks 2 and 4 of study. After histological processing, five tissue sections from the mid-region of the condyle were selected and examined. Three compositional zones (articular fibrous, proliferative, and hypertrophic) of the superior, posteriosuperior and posterior regions of the condylar cartilage were evaluated by light microscopy. At week 2, total condylar cartilage thickness was similar in the CSA and control groups, but the thickness of each zone was altered in CSA-treated animals, including a decrease of the fibrous and proliferative zones and an increase in hypertrophic zone compared to control (P0.05). At week 4, CSA-treated animals exhibited overall decreased cartilage thickness, including decreased thickness of each zone compared to control (P0.05). The results suggest that CSA has an inhibitory effect on the maturation of the mandibular condyle in rats.

Summary Fluoroscopic removal of radio-opaque foreign bodies from the stomach Fluoroscopic removal of smooth radioopaque foreign bodies from the stomach can be proposed to asymptomatic patients. The authors report the case of the removal of two foreign bodies from the stomach using a less invasive technique which requires a gastric feeding tube and a metallic guidewire.

The gastrointestinal response in rats nourished by continuous intragastric infusion of a variety of defined formula diets was compared with animals consuming the same diets orally. Two groups of rats were fed isocaloric amounts of DFD (73 kcal/day); group I : sham-operated, orally-fed: group 2: operated, intragastrically-fed. Diets included: Vivonex (V), Flexical (F), Vital, Vivonex high nitrogen, and a control casein rat liquid formula diet (C). After 2 wk rats were killed and the liver, pancreas, and small bowel removed. The bowel was divided into eight equal segments. Mucosal weight, DNA, and protein concentration per cm segment were measured. Pancreatic amylase activity (units/g), and liver weight and lipid content were measured. Weight gain was comparable in all oral-fed groups, but was decreased in all gastric-fed animals compared to the oral-fed group. Nitrogen retention was not influenced by route of feeding but was significantly lower for Vivonex and Flexical animals (p < 0.01) in both oral-fed and gastric-fed groups. There was significant accumulation of lipid in the liver of both oral-fed and gastric-fed animals sustained on Vivonex and Vivonex high nitrogen (p

The purpose of the study was to determine the effect of direct administration of diet into the stomach on total alimentation (quantity consumed voluntarily plus the quantity administered by young pigs. Ten cross-bred pigs, 82 days of age, were assigned to five treatments (two replicates of five pigs) consisting of a control (C) and four gastric fistulated (GF) pigs. The GF pigs were fed daily via the fistula 0, 20, 40 and 60% of the dry matter consumed voluntarily by the control pigs (17h per day). Relative to the control pigs, the GF-0, GF-20, GF-40 and GF-60 pigs, respectively, ate 102.4, 99.9, 91.7 and 97.3% the quantity of diet and gained 116.7, 111.1, 113.0 and 114.8% body weight; thus, the surgery, device and procedures were not detrimental. Voluntary consumption was physiologically regulated rapidly with good precision to adjust for the gastric fistula administered diet. Correlation and regression analysis of daily voluntary ingestion (y) versus gastric administration (x) of the six GF-20, -40 and -60 pigs gave a correlation coefficient, r = -0.926 (P less than 0.01), and regression coefficient, b= -1.089 (0.10 greater than P greater than 0.05). The statistical coefficients indicate that voluntary ingestion was suppressed somewhat more than the quantity administered into the stomach.

In a previous study, during the first week of bottle feeding in preterm infants, feeding efficiency and the occurrence of an arm posture correlated well with some aspects of perinatal assessment, with some aspects of the neonatal neurological evaluation, and with developmental assessment at 7 months of age (Casaer, Daniels, Devlieger, De Cock, & Eggermont, 1982). In the present study we wanted to answer two questions: First, is the typical arm posture of the fullterm infant during feeding seen in preterm infants during their first bottle feeding? Second, is the arm posture of the preterm infant a result of maturation (gestational age) or of feeding experience? We studied 100 consecutive preterm infants born at the University Obstetrical Department with a birth weight below 2,000 g. Only babies with major congenital abnormalities were excluded. Age at birth varied from 25 to 37 weeks (median, 32 weeks) and birth weights ranged from 780 to 1,995 g (median, 1,530 g). After parental or gastric feeding was changed to bottle feeding, one feeding session was observed weekly. A sketch of every arm posture was made during the observations and about every 2 min a picture was taken using a light-sensitive film so that no disturbing flashlights were employed. The observer did not interfere with the habits of the nursing staff such as wrapping the baby during feeding outside the incubator. Arm posture and eye condition were observed and coded after every nipple insertion and after every change in posture. The coding system is described,in Fig. 1. According to this coding system, arm postures were described by a series of three letters. An asymmetrical posture was coded separately left and right. When a change in arm posture was observed due to fatigue or sleep, only the initial arm posture was coded.