Post-stroke dysphagia: A review and design considerations for future trials.

Post-stroke dysphagia (a difficulty in swallowing after a stroke) is a common and expensive complication of acute stroke and is associated with increased mortality, morbidity, and institutionalization due in part to aspiration, pneumonia, and malnutrition. Although most patients recover swallowing spontaneously, a significant minority still have dysphagia at six months. Although multiple advances have been made in the hyperacute treatment of stroke and secondary prevention, the management of dysphagia post-stroke remains a neglected area of research, and its optimal management, including diagnosis, investigation and treatment, have still to be defined.

Parenteral nutrition: considerations for practice.

Malnutrition in the UK is estimated to affect 3 million people in the UK, costing the economy pound 13 billion a year. The effects can adversely affect an individual's wellbeing by exacerbating illness or reducing the prospect of a speedy recovery. The early identification of this actual or potential risk is recognised by using a validated nutritional screening tool as part of the patient assessment.

Closure of a large high-output gastrocutaneous fistula with combined postpyloric feeding and aggressive medical therapy.

Widening of the exit site of a percutaneous gastrostomy tube is a rare but difficult to manage complication, which leads to significant morbidity as a result of caustic material leak and associated cutaneous injury. Such defects fail to close with conservative measures such that invasive (surgical or endoscopic) intervention is often required. The authors present a 49-year-old woman with neurological dysphagia, 2 years after gastrostomy tube insertion with several months' history of leakage and widening of the hole at the exit site.