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Evaluates the efficacy of percutaneous cholecystostomy (PC) in patients with acute cholecystitis. Diagnoses in critically ill patients; Clinical determinants of patient status and association with outcome; Result of catheter placement; Radiographic findings; Procedure-related variables; Survival rate.

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To determine whether exposure to proximal intestinal contents per se is an adequate stimulus for ileal adaptation of the magnitude seen after jejunectomy, rats were prepared by transposing 30 cm of distal ileum to the duodenojejunal junction or by sham operation. One month after surgery, mucosal mass (wet weight, protein content, and DNA content) and digestive enzyme activities were measured in segments of small intestine and compared between the groups. Measurements of mucosal mass in transposed ileum more than doubled those in control jejunum (p <0.001). Mean enzyme activities/cm bowel length in transposed ileum approached or surpassed measurements in control jejunum. In contrast to the other enzymes studied, mean sucrase specific activities were similar in transposed ileum and control jejunum, values five fold greater than that of control ileum (p <0.002). We conclude that exposure of ileum to proximal intestinal contents reproduces the adaptive response that follows jejunectomy, without requiring short bowel. Sucrase responds to this exposure in a unique fashion. [ABSTRACT FROM AUTHOR]

Chronically ill and neurologically impaired children may require enteric tube feedings indefinitely to maintain adequate nutrition. When transgastric feedings are not feasible, a permanent feeding jejunostomy may be required. Since 1979, we have constructed a continent feeding jejunostomy in 16 children using a shortened Maydl Roux-en-Y limb with an intussuscepted nipple-valve mechanism. The jejunostomy is matured as a stoma through the abdominal wall, while the nipple valve is stabilized in the abdominal cavity anchored to the posterior fascia and peritoneum. Bolus or drip feedings can be initiated when gastrointestinal function resumes. Between feedings, the tube is removed as the jejunostomy is continent and can be covered with a gauze pad. No deaths were attributed to the operation, although more than 50% of these children died within 2 years from complications of their primary disease. The jejunostomy functioned well and was completely continent in 14 patients. The creation of a feeding jejunostomy with an intussuscepted nipple valve assures continence, avoids the complications of chronic indwelling tubes, and decreases the risk of regurgitation. Furthermore, the continent jejunostomy permits bolus feedings and requires minimal care. The use of this procedure is advocated whenever permanent feeding jejunostomy is anticipated. [ABSTRACT FROM AUTHOR]