ABSTRACT: To review our experience of placement of a mushroom-cage gastrostomy tube (Entristar®, Tyco Healthcare, Mansfield, MA), using
radiological guidance, in patients with amyotrophic lateral sclerosis (ALS). All procedures were performed under local anaesthesia
without sedation. Complications were recorded as peri-procedural, early (<24 h), late (>24 h), major or minor. Deaths were
recorded as related to the underlying ALS or secondary to radiological-inserted gastrostomy (RIG) placement. Replacement RIG
tube rate was recorded. Over a 5-year period RIG tubes were placed in 104 patients with ALS (male n = 52, female n = 52),
with a median age of 62years (range 34-86years). All procedures were technically successful. Of the RIG procedures, 21/104
(20.2%) were performed with respiratory support. The 30-day mortality rate was 7/104 (6.7%); no patient died as a result of
the procedure. There were 23/104 (22.1%) complications overall; 20/104 (19.2%) were minor and 3/104 (2.9%) major, requiring
surgery (n = 2) and radiological-guided abscess drainage (n = 1). A median interval between replacement RIG procedures in
20/104 (19.2%) patients was 141.5days (range 43-537days). A mushroom-cage RIG tube may be safely and effectively inserted
in a ‘one-step’ radiological procedure and may replace endoscopic-inserted gastrostomy tubes in the nutritional management
European Radiology 04/2012; 19(7):1763-1771. · 3.22 Impact Factor
ABSTRACT: We aimed to assess whether rural residence is associated with amyotrophic lateral sclerosis in the south-east of England using a population based register. Previous studies in different populations have produced contradictory findings. Residence defined by London borough or non-metropolitan district at time of diagnosis was recorded for each incident case in the South-East England ALS Register between 1995 and 2005. Each of the 26 boroughs or districts of the catchment area of the register was classified according to population density. Age- and sex-adjusted incidence of ALS was calculated for each region and the relationship with population density tested by linear regression, thereby controlling for the underlying population structure. We found that population density in region of residence at diagnosis explained 25% of the variance in ALS rates (r = 0.5, p < 0.01). Thus, in this cohort in the south-east of England, people with ALS were more likely to be resident in areas of high population density at diagnosis.
Amyotrophic Lateral Sclerosis 10/2010; 11(5):435-8. · 3.40 Impact Factor
ABSTRACT: Replicable risk factors for ALS include increasing age, family history and being male. The male: female ratio has been reported as being between 1 and 3. We tested the hypothesis that the sex ratio changes with age in a population register covering the south-east of England. The sex ratio before and after the age of 51 years was compared using a Z-test for proportions. Kendall's tau was used to assess the relationship between age group and sex ratio using incidence and prevalence data. Publicly available data from Italian and Irish population registers were compared with results. There was a significant difference in the proportion of females with ALS between those in the younger group (30.11%) and those in the older group (43.66%) (p = 0.013). The adjusted male: female ratio dropped from 2.5 in the younger group to 1.4 in the older group using prevalence data (Kendall's tau = -0.73, p = 0.039). Similar ratios were found in the Italian but not the Irish registry. We concluded that sex ratios in ALS may change with age. Over-representation of younger patients in clinic registers may explain the variation in sex ratios between studies. Menopause may also play a role.
Amyotrophic Lateral Sclerosis 03/2010; 11(5):439-42. · 3.40 Impact Factor