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[PMID]: 29524461
[Au] Autor:Srinivasa RN; Chick JFB; Gemmete JJ; Hage AN; Srinivasa RN
[Ad] Address:Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Health Systems, 1500 East Medical Center Drivem Ann Arbor, MI 48109.
[Ti] Title:Endolymphatic Interventions for the Treatment of Chylothorax and Chylous Ascites in Neonates: Technical and Clinical Success and Complications.
[So] Source:Ann Vasc Surg;, 2018 Mar 07.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:INTRODUCTION: To report the technical and clinical success of performing minimally invasive endolymphatic embolization in neonates presenting with a chylothorax or chylous ascites. MATERIALS AND METHODS: 3 neonates, 2 males and 1 female, with a mean age of 28 days (range: 19-39 days) presented with a chylothorax (2) or chylous ascites (1) which was refractory to conservative management. All 3 patients (1 previously reported) underwent intranodal lymphangiography followed by thoracic duct embolization with 1 patient undergoing additional sclerosis of the retroperitoneal abdominal lymphatics. RESULTS: Lymphangiography, thoracic duct embolization, and sclerosis of the retroperitoneal abdominal lymphatics was technically successful. The chylothorax resolved in both patients. Persistent chylous ascites was noted after treatment that resolved after surgical placement of a vicryl mesh and fibrin sealant. 1 major complication occurred with non-target embolization of glue into the lungs requiring embolectomy. CONCLUSION: Thoracic duct and retroperitoneal abdominal lymphatic embolization can be performed in neonates. Resolution of chylothorax was seen in two patients (one previously reported) following embolization, while 1 patient with chylous ascites required surgical management after endolymphatic intervention.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

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[PMID]: 29333814
[Au] Autor:Althabe M; Rodríguez R R; Balestrini M; Charroqui A; Krynski M; Lenz AM; Montonati M; Moreno G; Pilan ML; Magliola R; García Delucis P
[Ad] Address:Unidad de Cuidados Intensivos,Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina. maria.althabe@gmail.com.
[Ti] Title:Morbilidad en cirugía de cardiopatìa congénita en un hospital público en Argentina. Morbidity in congenital heart surgery in a public hospital in Argentina.
[So] Source:Arch Argent Pediatr;116(1):e14-e18, 2018 Feb 01.
[Is] ISSN:1668-3501
[Cp] Country of publication:Argentina
[La] Language:eng; spa
[Ab] Abstract:OBJECTIVE: To describe the complications associated with heart surgery, compare them to a reference population, and identify mortality risk factors. PATIENTS AND METHODS: Retrospective and descriptive study. All patients who underwent surgery at Hospital Garrahan in the 2013-2015 period were included. Age, weight, procedure, mechanical ventilation, length of stay in days, morbidity, and course were recorded. Renal failure requiring dialysis, neurological deficit, permanent pacemaker, circulatory support, phrenic nerve or vocal cord palsy, reoperation, wound infection, chylothorax, and tracheotomy were considered morbidities. A descriptive, statistical analysis by risk category was done using the Society of Thoracic Surgeons (STS) morbidity score. RESULTS: 1536 patients, median age: 12 months (interquartile range [IQR] 25-75: 3-60), weight: 8 kg (IQR 25-75: 4.4 to 17.5), mortality: 5%. A total of 361 events were recorded in 183 patients. An unplanned reoperation was the most common event (7.2%); the rest occurred in < 3% of patients. Compared to patients without complications, patients who had events required more days on mechanical ventilation: 9.95 (IQR 25-75: 7.6512.24) versus 1.8 (IQR 2575: 1.46-2.14), p< 0.00001; a longer length of stay: 28.8 (IQR 25-75: 25.1-32.5) versus 8.5 (IQR 25-75: 7.9-9.2), p< 0.0001; and had a higher mortality: 19.6% versus 3.1% (RR: 4.58, 95% CI: 3.4 to 6.0), p< 0.0001. Circulatory support and renal failure were associated with a higher mortality. CONCLUSIONS: An unplanned reoperation was the most common event. Patients with complications required more days on mechanical ventilation and a longer length of stay and had a higher mortality. Circulatory support and renal failure were associated with a higher mortality.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.5546/aap.2018.eng.e14

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[PMID]: 29510243
[Au] Autor:Defize IL; Schurink B; Weijs TJ; Roeling TAP; Ruurda JP; van Hillegersberg R; Bleys RLAW
[Ad] Address:Department of Anatomy, University Medical Center Utrecht, Universiteitsweg 100, P.O Box 85060, 3508 AB Utrecht, The Netherlands; Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
[Ti] Title:The anatomy of the thoracic duct at the level of the diaphragm: a cadaver study.
[So] Source:Ann Anat;, 2018 Mar 03.
[Is] ISSN:1618-0402
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:BACKGROUND: Injury and subsequent leakage of unrecognized thoracic duct tributaries during transthoracic esophagectomy may lead to chylothorax. Therefore, we hypothesized that thoracic duct anatomy at the diaphragm is more complex than currently recognized and aimed to provide a detailed description of the anatomy of the thoracic duct at the diaphragm. BASIC PROCEDURES: The thoracic duct and its tributaries were dissected in 7 (2 male and 5 female) embalmed human cadavers. The level of origin of the thoracic duct and the points where tributaries entered the thoracic duct were measured using landmarks easily identified during surgery: the aortic and esophageal hiatus and the arch of the azygos vein. MAIN FINDINGS: The thoracic duct was formed in the thoracic cavity by the union of multiple abdominal tributaries in 6 cadavers. In 3 cadavers partially duplicated systems were present that communicated with interductal branches. The thoracic duct was formed by a median of 3 (IQR: 3-5) abdominal tributaries merging 8.3 centimeters (IQR: 7.3-9.3cm) above the aortic hiatus, 1.8 centimeters (IQR: -0.4-2.4cm) above the esophageal hiatus, and 12.3 centimeters (IQR: 14.0--11.0cm) below the arch of the azygos vein. CONCLUSION: This study challenges the paradigm that abdominal lymphatics join in the abdomen to pass the diaphragm as a single thoracic duct. In this study, this occurred in 1/7 cadavers. Although small, the results of this series suggest that the formation of the thoracic duct above the diaphragm is more common than previously thought. This knowledge may be vital to prevent and treat post-operative chyle leakage.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher

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[PMID]: 29509541
[Au] Autor:Gîndea C; Constantin A; Hoara P; Caragui A; AlKadour A; Constantinoiu S
[Ti] Title:Early Postoperative Complications of Thoracic Esophageal Diverticula: A Review of 10 Cases from "Saint Mary" Hospital, Bucharest, Romania.
[So] Source:Chirurgia (Bucur);113(1):144-155, 2018 Jan-Feb.
[Is] ISSN:1221-9118
[Cp] Country of publication:Romania
[La] Language:eng
[Ab] Abstract:Thoracic esophageal diverticulum is a rare pathology frequently associated with esophageal motility disorders. Surgery is the only option in patients with severe symptoms. METHOD: This is a retrospective case series study of 10 patients who underwent diverticulectomy for thoracic (epiphrenic or mid-esophageal) diverticula. It was recorded: main preoperative symptoms, usual blood tests, barium swallow, upper endoscopy and esophageal manometry. We analyzed the postoperative complications, length of stay in hospital and intensive care unit. Most patients presented with regurgitation and/or dysphagia. The surgical approach was through left thoracotomy or abdominal for epiphrenic diverticula and through right thoracotomy or thoracoscopy for mid-esophageal diverticula. 4 patients had severe complications: 3 had major leaks (one death) and one had chylothorax. DISCUSSIONS: Surgery for thoracic diverticula is associated with high mortality and morbidity rates. Leak from the suture line is the most common complication, unlike chylothorax which is a rare complication. Thoracic diverticula represent a benign pathology which can have "žmalignant" postoperative complications. A thorough preoperative work-up is mandatory for choosing the appropriate surgical technique. Use of multiple cartridges for stapling suture increase the risk of leakage, but oversewing the suture may diminish it.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:In-Data-Review

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[PMID]: 29508361
[Au] Autor:Costa KM; Saxena AK
[Ad] Address:Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK.
[Ti] Title:Surgical chylothorax in neonates: management and outcomes.
[So] Source:World J Pediatr;, 2018 Mar 05.
[Is] ISSN:1867-0687
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:BACKGROUND: Postoperative chylothorax occurs due to trauma to lymphatic vessels and can occur after any thoracic procedure. This study reviewed recent literature to evaluate the management and outcomes of surgical chylothorax in neonates. METHODS: PubMed database was searched for articles in English, Portuguese and Spanish from 2000 to 2016. Data were collected for surgery, chylothorax management, complications, mortality and length of hospital stay (LOS). RESULTS: Twenty studies offered 107 neonates: congenital diaphragmatic hernia (CDH) (n = 76, 71%), cardiac malformations (n = 25, 23.4%), esophageal atresia (n = 5, 4.7%) and CDH + extralobar sequestration (n = 1, 0.9%). Medium-chain triglycerides (MCT) was the initial treatment in 52 neonates (48.6%), prednisolone + MCT in one (0.9%), total parenteral nutrition in 51 patients (47.7%), and three patients (2.8%) did not require any treatment. Octreotide and somatostatin were used as second or third line treatment in 25 neonates (23.4%), and 15 neonates (14%) underwent 17 surgeries, including thoracic duct ligation (TDL) (n = 9); pleurodesis (n = 3) (2 patients required TDL); TDL + pleurodesis (n = 2), and TDL + placement of hemostat (n = 1). Complications due to the chylothorax were reported in 27 neonates (25.2%): hypoalbuminemia + hyponatremia (n = 18), hypoalbuminemia (n = 4), hypoalbuminemia with cutaneous flushing as colateral effect of somatostatin (n = 1), loose stool after somatostatin use (n = 1), pneumonia (n = 1), congestive heart failure + hypernatremia (n = 1), and hyponatremia (n = 1). There were 21 deaths (19.6%) and median LOS was 53.4 days (30-93.1 days). CONCLUSIONS: Conservative management is appropriate as initial treatment for neonatal postsurgical chylothorax. Octreotide and somatostatin are safe in neonates and surgical approach should be considered in prolonged leaks.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher
[do] DOI:10.1007/s12519-018-0134-x

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[PMID]: 29486888
[Au] Autor:Shirotsuki R; Uchida H; Tanaka Y; Shirota C; Yokota K; Murase N; Hinoki A; Oshima K; Chiba K; Sumida W; Hayakawa M; Tainaka T
[Ad] Address:Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya 466-8550, Japan.
[Ti] Title:Novel thoracoscopic navigation surgery for neonatal chylothorax using indocyanine-green fluorescent lymphography.
[So] Source:J Pediatr Surg;, 2018 Feb 01.
[Is] ISSN:1531-5037
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Postoperative chylothorax after surgery for esophageal atresia/tracheoesophageal fistula (TEF) is a rare but serious complication, especially in neonates. This study aimed to identify the thoracic duct and ligate chylous leakage sites, using thoracoscopic navigation of an indocyanine-green (ICG)-based near-infrared (NIR) fluorescence imaging system. METHODS: From November 2014 to April 2017, thoracoscopic intraoperative ICG-NIR imaging was performed in 10 newborns (11 surgeries) with first TEF operation or with persistent postoperative chylothorax after TEF operation. NIR imaging was performed 1h after an inter-toe injection of ICG. Thoracoscopic ligations against the NIR-detected leakage sites were performed with sutures. RESULTS: The thoracic duct or lymphatic leakage was directly visualized in each patient. In 8 surgeries with first thoracoscopic TEF operation, one case had suspected minor chylous leakage without postoperative chylothorax. Another case with no chylous leakage at the first operation resulted in chylothorax at postoperative day 11. In three neonates with postoperative chylothorax, leakage points were detected near the ablation site of the azygos vein during the first operation. These points were properly ligated, and postoperative chylous leakage ceased with no adverse events. CONCLUSIONS: Thoracoscopic ICG-NIR imaging encourages the repair of refractory chylothorax and seems reliable. LEVEL OF EVIDENCE: IV.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180228
[Lr] Last revision date:180228
[St] Status:Publisher

  7 / 3288 MEDLINE  
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[PMID]: 29484494
[Au] Autor:Ueno S; Fujino A; Morikawa Y; Iwanaka T; Kinoshita Y; Ozeki M; Nosaka S; Matsuoka K; Usui N
[Ad] Address:Department of Pediatric Surgery, Tokai University School of Medicine, 143, Shimokasuya, Isehara City, Kanagawa, Japan. ps_uenos@is.icc.u-tokai.ac.jp.
[Ti] Title:Treatment of mediastinal lymphatic malformation in children: an analysis of a nationwide survey in Japan.
[So] Source:Surg Today;, 2018 Feb 26.
[Is] ISSN:1436-2813
[Cp] Country of publication:Japan
[La] Language:eng
[Ab] Abstract:PURPOSE: Clinical guidelines on lymphatic malformation (LM) influencing the airway have been crafted in the Research Project for Intractable Diseases. We herein report an analysis of a nationwide survey of mediastinal LM and the therapeutic recommendations. METHODS: Eighty-seven registered cases with mediastinal involvement were analyzed with a review of the literature. RESULTS: Mediastinal LM was located more often in the upper and anterior mediastinum and was found without any accompanying symptoms in 56/87 cases. Tracheostomy was required in 23/87 cases, mostly < 2 years of age (87%). All patients who needed tracheostomy had a lesion in contact with the airway, while only 55% of those without tracheostomy had contact. Tracheostomy tended to be placed more when the longer segment of the airway was in contact with the LM. Multimodal treatments were performed in 29 patients, but the lesions remained in most cases, and chylothorax, hemorrhaging, nerve palsy, and infections were noted as complications. CONCLUSIONS: In patients with mediastinal LM, tracheostomy may be necessary, especially when the lesion is extensive and contacts the airway. Extirpation of the mediastinal LM may be the only therapeutic option, but in cases with few or no symptoms, non-surgical treatment should be considered in light of potential postoperative complications.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:Publisher
[do] DOI:10.1007/s00595-018-1640-0

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[PMID]: 29480539
[Au] Autor:Takeuchi S; Arai J
[Ad] Address:Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan.
[Ti] Title:Ultrasonographic confirmation of tracheal intubation for congenital chylothorax.
[So] Source:Pediatr Int;, 2018 Feb 26.
[Is] ISSN:1442-200X
[Cp] Country of publication:Australia
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180226
[Lr] Last revision date:180226
[St] Status:Publisher
[do] DOI:10.1111/ped.13493

  9 / 3288 MEDLINE  
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[PMID]: 29475120
[Au] Autor:Idota N; Nakamura M; Tojo M; Ichioka H; Shintani-Ishida K; Ikegaya H
[Ad] Address:Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan. Electronic address: idotan@koto.kpu-m.ac.jp.
[Ti] Title:Infant fatality case with excessive chylous ascites.
[So] Source:Leg Med (Tokyo);32:23-26, 2018 Feb 16.
[Is] ISSN:1873-4162
[Cp] Country of publication:Ireland
[La] Language:eng
[Ab] Abstract:An 11-month-old boy with marked abdominal distension was found dead in the prone position at home. Since there were many bruises in the non-protruding regions of the head, face, and abdomen, a medicolegal autopsy was performed the following day. The boy was smaller than average (height: 68.5 cm; weight: 7.8 kg); his extremities were thin; and his abdomen was remarkably bulging. Chylous ascites (1600 mL) was observed in the peritoneal cavity and chylous pleural effusion (left: 5 mL; right: 10 mL) in the thoracic cavity. A fibrous induration, approximately 2.0 × 1.5 cm in size, was observed in the root of the small bowel mesentery. Congenital chylothorax and chylous ascites were suspected. However, the remarkably withered thymus and an old injury in the superior labial frenulum suggested that the chylous ascites may have been further deteriorated by injuries sustained during physical abuse. Examination suggested that the death was sudden. Thus, we inferred that the cause of death was circulatory and respiratory failure due to excessive chylous ascites. Among the reported cases of chylous ascites in pediatric patients, some patients experiencing abuse were identified on the basis of their chief complaints of vomiting or abdominal distension. Medical and child welfare staff should be made aware of this information.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180223
[Lr] Last revision date:180223
[St] Status:Publisher

  10 / 3288 MEDLINE  
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[PMID]: 29279556
[Au] Autor:Shimakawa T; Naritaka Y; Miyazawa M; Asaka S; Shimazaki A; Yamaguchi K; Yokomizo H; Yoshimatsu K; Shiozawa S; Katsube T
[Ad] Address:Department of Surgery, Tokyo Women's Medical University Medical Center East.
[Ti] Title:Lymphangiography Was Useful in Postoperative Intractable Chylothorax after Surgery for Esophageal Cancer: A Case Report.
[So] Source:J Nippon Med Sch;84(6):268-273, 2017.
[Is] ISSN:1347-3409
[Cp] Country of publication:Japan
[La] Language:eng
[Ab] Abstract:Postoperative chylothorax after surgery for esophageal cancer is a rare but serious complication. Treatment initially consists of conservative therapy and, if it fails to provide improvement, it is important to perform surgical treatment without delay. We report on a recent case of intractable chylothorax. This report describes a 72-year-old man with Stage III esophageal squamous cell carcinoma. Subtotal esophagectomy, through a right thoracoabdominal approach with two-field lymphadenectomy, and cervical esophagogastric anastomosis via the retrosternal route, were performed. On the 12th postoperative day, a diagnosis of chylothorax was made. Conservative treatment was initiated, but it proved to be ineffective. Therefore, ligation of the thoracic duct via a thoracotomy was performed, but this was not effective, either. Lymphangiography undertaken to identify the site of the leak in the thoracic duct enabled a diagnosis of an extremely rare double thoracic duct and identification of the site of the leak in the thoracic duct, thereby allowing curative direct ligation of the site. This case underscores the remarkable usefulness of lymphangiography in dealing with intractable postoperative chylothorax.
[Mh] MeSH terms primary: Carcinoma, Squamous Cell/surgery
Chylothorax/diagnostic imaging
Esophageal Neoplasms/surgery
Postoperative Complications/diagnostic imaging
[Mh] MeSH terms secundary: Aged
Carcinoma, Squamous Cell/pathology
Chylothorax/surgery
Esophageal Neoplasms/pathology
Esophagectomy
Humans
Ligation
Lymph Node Excision
Male
Neoplasm Staging
Thoracic Duct/diagnostic imaging
Treatment Outcome
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180222
[Lr] Last revision date:180222
[Js] Journal subset:IM
[Da] Date of entry for processing:171228
[St] Status:MEDLINE
[do] DOI:10.1272/jnms.84.268


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