Percutaneous endoscopic gastrostomy tube feeding is widely used for patients with swallowing dysfunction and a history of repeated aspiration pneumonitis. However, liquid nutrient feeding via percutaneous endoscopic gastrostomy is not effective enough to prevent aspiration pneumonitis and related inflammatory responses. We performed this prospective multi-centre study to clarify the efficacy of half-solidification of nutrients to prevent fever possibly caused by aspiration pneumonitis in elderly patients with percutaneous endoscopic gastrostomy. The study subjects were 42 elderly patients undergoing percutaneous endoscopic gastrostomy feeding (mean age 85.8 years). All subjects were fed half-solid as well as liquid nutrients for 8 weeks respectively in a cross over design. We counted the number of days with fever caused by pneumonitis and unidentified origin. Thirty-two of 42 patients were successfully observed in both nutrient periods. Fever was frequently observed in both nutrient periods, however, the percentage of observational days with fever during half-solid nutrient feeding was significantly lower than that during liquid nutrient feeding (15.3 ± 0.3 vs 19.8 ± 0.4%, p = 0.030). The percentage of observational days when patients had diarrhea was not significantly different (10.1 ± 3.8 vs 7.2 ± 3.2%, p = 0.357). In conclusion, half-solid nutrient feeding was determined to be effective for reducing fever in patients with percutaneous endoscopic gastrostomy feeding.

Post-traumatic vomiting was clinically analyzed. One hundred and forty seven patients with head injury came to our hospital consecutively from April 1991 to August 1991. Of 147 patients, 26 exhibited vomiting post-traumatically. The incidence of loss of consciousness, that of fractures on plain X-ray films, and that of traumatic intracranial lesions demonstrated on CT were compared between two patient groups, i.e., a group of patients with post-traumatic vomiting and another one without it. None of them were revealed to be significantly different between the two groups, respectively. It was concluded from the results that the existence of post-traumatic vomiting implied neither severe traumatic impact nor serious intracranial damage. The plausible mechanisms of post-traumatic vomiting are discussed, taking account of the statistical data on the patients' age, sites of impact, and past histories.

No abstract

No abstract