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Percutaneous endoscopic gastrostomy:Indications,technique,complications and management

World Journal of Gastroenterology 2014年第24期20卷 7739-7751页

作者： Ata A Rahnemai-Azar Amir A Rahnemaiazar Rozhin Naghshizadian Amparo Kurtz daniel T farkas Department of Surgery Bronx-Lebanon Hospital CenterAlbert Einstein College of MedicineBronxNY 10457United States

Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the “pull” technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and relate

关键词： Gastrostomy tube Percutaneous Enteral feeding Indication Contraindication Complication Management

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Small bowel perforation from a migrated biliary stent: A case report and review of literature

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World Journal of Gastrointestinal Endoscopy 2021年第10期13卷 543-554页

作者： Konstantinos A Zorbas Shane Ashmeade William Lois daniel T farkas Department of Surgery Bronx Care Health SystemNew YorkNY 10457United States

BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents,but fortunately has an incidence of less than 1%.CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome,chronic obstructive pulmonary disease,alcoholic liver cirrhosis,portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local *** further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic *** This case presentation reports on the unusual finding of two migrated biliary stents,with one causing *** addition,we review the relevant literature on migrated stents.

关键词： Biliary stent Biliary stent migration Small bowel perforation Endoscopic retrograde cholangiopancreatography Case report

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Influence of carbon-based cathodes on biofilm composition and electrochemical performance in soil microbial fuel cells

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Environmental Science and Ecotechnology 2023年第4期16卷 106-116页

作者： Arpita Nandy daniel farkas Belén Pepió-Tárrega Sandra Martinez-Crespiera Eduard Borràs Claudio Avignone-Rossa Mirella Di Lorenzo Department of Chemical Engineering and Centre for Biosensors Bioelectronics&Biodevices(C3Bio)University of BathClaverton DownBA27AYUK Department of Microbial Sciences University of SurreyGuildfordGU27XHUK LEITAT Technological Center C/de la Innovació208225TerrassaBarcelonaSpain

Increasing energy demands and environmental pollution concerns press for sustainable and environmentally friendly *** microbial fuel cell(SMFC)technology has great potential for carbon-neutral bioenergy generation and self-powered electrochemical *** this study,an in-depth assessment on the effect of several carbon-based cathode materials on the electrochemical performance of SMFCs is provided for the first *** innovative carbon nanofibers electrode doped with Fe(CNFFe)is used as cathode material in membrane-less SMFCs,and the performance of the resulting device is compared with SMFCs implementing either Pt-doped carbon cloth(PtC),carbon cloth,or graphite felt(GF)as the *** analyses are integrated with microbial analyses to assess the impact on both electrogenesis and microbial composition of the anodic and cathodic *** results show that CNFFe and PtC generate very stable performances,with a peak power density(with respect to the cathode geometric area)of 25.5 and 30.4 mW m^(−2),*** best electrochemical performance was obtained with GF,with a peak power density of 87.3 mW m^(−2).Taxonomic profiling of the microbial communities revealed differences between anodic and cathodic *** anodes were predominantly enriched with Geobacter and Pseudomonas species,while cathodic communities were dominated by hydrogen-producing and hydrogenotrophic bacteria,indicating H_(2)cycling as a possible electron transfer *** presence of nitrate-reducing bacteria,combined with the results of cyclic voltammograms,suggests microbial nitrate reduction occurred on GF *** results of this study can contribute to the development of effective SMFC design strategies for field implementation.

关键词： Soil microbial fuel cells ORR catalyst Carbon nanofibre Microbial profiling

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Laparoscopic vs open partial colectomy in elderly patients:Insights from the American College of Surgeons- National Surgical Quality Improvement Program database

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World Journal of Gastroenterology 2015年第45期21卷 12843-12850页

作者： Umashankkar Kannan Vemuru Sunil K Reddy Amar N Mukerji Vellore S Parithivel Ajay K Shah Brian F Gilchrist daniel T farkas Department of Surgery Bronx-Lebanon Hospital Center

AIM: To compare the outcomes between the laparoscopic and open approaches for partial colectomy in elderly patients aged 65 years and over using the American College of Surgeons- National Surgical Quality Improvement Program(ACS NSQIP) database. METHODS: The ACS NSQIP database for the years 2005-2011 was queried for all patients 65 years and above who underwent partial colectomy. 1:1 propensity score matching using the nearest- neighbor method was performed to ensure both groups had similar preoperative comorbidities. Outcomes including postoperative complications, length of stay and mortality were compared between the laparoscopic and open groups. χ2 and Fisher's exact test were used for discrete variables and Student's t-test for continuous variables. P < 0.05 was considered significant and odds ratios with 95%CI were reported when applicable. RESULTS: The total number of patients in the ACS NSQIP database of the years 2005-2011 was 1777035. We identified 27604 elderly patients who underwent partial colectomy with complete data sets. 12009(43%) of the cases were done laparoscopically and15595(57%) were done with open. After propensity score matching, there were 11008 patients each in the laparoscopic(LC) and open colectomy(OC) cohorts. The laparoscopic approach had lower post-operative complications(LC 15.2%, OC 23.8%, P < 0.001), shorter length of stay(LC 6.61 d, OC 9.62 d, P < 0.001) and lower mortality(LC 1.6%, OC 2.9%, P < 0.001). CONCLUSION: Even after propensity score matching, elderly patients in the ACS NSQIP database having a laparoscopic partial colectomy had better outcomes than those having open colectomies. In the absence of specific contraindications, elderly patients requiring a partial colectomy should be offered the laparoscopic approach.

关键词： Colectomy Laparoscopic Outcomes Elderly National S

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Gallstone ileus with multiple stones:Where Rigler triad meets Bouveret's syndrome

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World Journal of Gastrointestinal Surgery 2015年第12期7卷 394-397页

作者： Vinaya Gaduputi Hassan Tariq Amir A Rahnemai-Azar Anil Dev daniel T farkas Department of Medicine Bronx Lebanon Hospital Center Department of Surgery Bronx Lebanon Hospital Center

A 53-year-old man with multiple medical conditions presented to the emergency department with complaints of vomiting, anorexia and diffuse colicky abdominal pain for 3 d. A computed tomography scan of the abdomen and pelvis showed radiographic findings consistent with Rigler triad seen in small proportion of patients with small bowel obstruction secondary to gallstone impaction. In addition there was a gastric outlet obstruction, consistent with Bouveret's syndrome. The patient underwent an exploratory laparotomy and enterotomy with multiple stones extracted. The patient had an uneventful post-surgical clinical course and was discharged home.

关键词： Rigler triad Gallstone ileus Bouveret'ssyndrome Small bowel obstruction

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Carcinoma in situ in a 7 mm gallbladder polyp: Time to change current practice?

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World Journal of Gastrointestinal Endoscopy 2015年第9期7卷 912-915页

作者： David Kasle Amir A Rahnemai-Azar Shahida Bibi Vinaya Gaduputi Brian F Gilchrist daniel T farkas Department of Surgery BronxLebanon Hospital CenterAlbert Einstein College of Medicine Department of Medicine Bronx-Lebanon Hospital CenterAlbert Einstein College of Medicine

Detection of polypoid lesions of the gallbladder is increasing in conjunction with better imaging modalities. Accepted management of these lesions depends on their size and symptomatology. Polyps that are symptomatic and/or greater than 10 mm are generally removed, while smaller, asymptomatic polyps simply monitored. Here, a case of carcinoma-in-situ is presented in a 7 mm gallbladder polyp. A 25-year-old woman, who had undergone a routine cholecystectomy, was found to have an incidental 7 mm polyp containing carcinoma in situ. She had few to no risk factors to alert to her condition. There are few reported cases of cancer transformation in gallbladder polyps smaller than 10 mm reported in the literature. The overwhelming consensus, barring significant risk factors for cancer being present, is that such lesions should be monitored until they become symptomatic or develop signs suspicious for malignancy. In our patient's case this could have led to the possibility of missing a neoplastic lesion, which could then have gone on to develop invasive cancer. As gallbladder carcinoma is an aggressive cancer, this may have led to a tragic outcome.

关键词： Gallbladder Polyp Cholecystectomy Size Carcinoma

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Late Anatomic Findings after “Rescue CABG” for Peri-Operative Ischemia Following Aortic Root Replacement

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World Journal of Cardiovascular Surgery 2013年第2期3卷 70-76页

作者： Aarthi Ramarathnam Andrei Javier Emily A. farkas daniel Cornfeld Maryann Tranquilli John A. Elefteriades Department of Diagnostic Imaging Yale University School of Medicine New Haven USA Department of Surgery St. Louis University School of Medicine St. Louis USA Section of Cardiac Surgery Yale University School of Medicine New Haven USA

Background: Acute myocardial ischemia, seen in about 2% of aortic root replacements (ARR), is acutely life-threatening, manifesting as failure to wean from bypass, ventricular fibrillation, or unstable hemodynamics. The exact precipitating anatomic cause is usually not apparent at the time of surgery. In this report, we take advantage of late computed tomographic (CT) angiograms of long-term survivors of peri-operative ischemia after ARR to determine what abnormalities of the coronary button reattachments produced the peri-operative ischemia. Methods: The database of the Aortic Institute at Yale-New Haven was reviewed to identify all patients undergoing ARR over a 15-year period. Operative records, patient charts, and CT angiograms of patients who had peri-operative ischemia were reviewed in detail, including analysis by an imaging specialist. Results: 271 patients underwent ARR, 220 with mechanical and 51 with biological valved conduits. Hospital mortality was 2.95%. Clinical follow-up ranged from 1 to 182 months. Survival in discharged patients was 97.7% at 5 years and 95.2% at 7 years. Peri-operative ischemia was seen in 4 of 271 patients (1.5%). All four affected patients survived—with interventions including supplemental coronary bypass grafts (4 patients), intra-aortic balloon pump placement (2 patients), and left ventricular assist device insertion (1 patient). Late CT angiograms revealed severe but non-obstructive left main calcification serving as a focal point for coronary angulation in 2 patients, angulation without calcification in 1 patient, and totally normal anatomy in 1 patient. Conclusions: Myo- cardial ischemia after ARR is rare but acutely life-threatening. Prompt recognition and treatment by supplemental coronary artery bypass grafting preserves life and leads to good late survival. Intramural calcification (non-obstructive) of the distal left main coronary artery predisposes to angulation after coronary button creation and should be a “red flag”

关键词： Aneurysm Aortic Root Ischemia

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