共查询到20条相似文献，搜索用时 15 毫秒
1.
Ivo P. van de Peppel Marcela Doktorova Gitte Berkers Hugo R. de Jonge Roderick H.J. Houwen Henkjan J. Verkade Johan W. Jonker Frank A.J.A. Bodewes 《Journal of cystic fibrosis》2019,18(2):286-293
Objective
Disruption of the enterohepatic circulation of bile acids (BAs) is part of the gastrointestinal phenotype of cystic fibrosis (CF). Ivacaftor (VX-770), a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator, improves pulmonary function in CF patients with class III gating mutations. We studied the effect of ivacaftor on the enterohepatic circulation by assessing markers of BA homeostasis and their changes in CF patients.Methods
In CF patients with an S1251N mutation (N?=?16; age 9–35?years S125N study/NTR4873) or a G551D mutation (N?=?101; age 10–24?years; GOAL study/ NCT01521338) we analyzed plasma fibroblast growth factor 19 (FGF19) and 7α-hydroxy-4-cholesten-3-one (C4) levels, surrogate markers for intestinal BA absorption and hepatic synthesis, respectively, before and after treatment with ivacaftor.Results
At baseline, median FGF19 was lower (52% and 53%, P?<?.001) and median C4 higher (350% and 364%, P?<?.001), respectively, for the S1251?N and G551D mutation patient groups compared to healthy controls. Treatment with ivacaftor significantly increased FGF19 and reduced C4 levels towards normalization in both cohorts but this did not correlate with CFTR function in other organs, as measured by sweat chloride levels or pulmonary function.Conclusions
We demonstrate that patients with CFTR gating mutations display interruption of the enterohepatic circulation of BAs reflected by lower FGF19 and elevated C4 levels. Treatment with ivacaftor partially restored this disruption of BA homeostasis. The improvement did not correlate with established outcome measures of CF, suggesting involvement of modulating factors of CFTR correction in different organs. 相似文献2.
Razan M. Bader Maureen M. Jonas Paul D. Mitchell Shanna Wiggins Christine K. Lee 《Journal of cystic fibrosis》2019,18(2):280-285
Background
Hepatic steatosis is a common manifestation of CF-related liver disease(CFLD). Controlled attenuation parameter(CAP) measurement during transient elastography(TE) semiquantifies liver steatosis. We examined the relationship between CAP and CFLD severity, clinical factors and liver stiffness measurements(LSM).Methods
This is a cross-sectional study of CF patients seen for outpatient care between January 2013–March 2014. CFLD severity was categorized as no CFLD, CFLD without portal hypertension(PHTN) and CFLD with PHTN, based on published criteria.Results
129 patients (median 18.4y; 57% male) had valid CAP. 70(54%) had no CFLD, 44(34%) CFLD without PHTN, and 15(12%) CFLD with PHTN. The median CAP was 210?dB/m (IQR 181–239). Steatosis(CAP ≥230?dB/m) was seen in 27% of subjects without CFLD, 48% in CFLD but no PHTN, and 20% in with CFLD and PHTN(P?=?.04). CAP was higher for subjects with CFLD without PHTN (P?<?.05). There was no CAP difference between subjects with no CFLD and those with CFLD and PHTN (P?≥?.65). LSM was not different between no CFLD and CFLD without PHTN (P?=?.07), but each of these groups had lower LSM compared to subjects with CFLD and PHTN(P?<?.001 for each). Except for direct bilirubin, CAP was not associated with clinical markers of liver disease.Conclusion
CAP was normal in 86(67%) of patients with CF and was not associated with standard clinical markers of liver disease. CAP was higher in patients with liver disease, which could possibly reflect the loss of steatosis observed with progression to cirrhosis and portal hypertension. 相似文献3.
Binyu Lu Li Li Molly Schneider Craig A. Hodges Calvin U. Cotton James D. Burgess Thomas J. Kelley 《Journal of cystic fibrosis》2019,18(2):175-181
Background
Previous studies have demonstrated that CF epithelial cells exhibit increased cholesterol content at the plasma membrane compared to wild type controls as measured by electrochemical methods. Microtubule dysregulation that impacts intracellular transport has also been identified in CF cells and is reversible with histone deacetylase 6 (HDAC6) inhibition, a regulator of tubulin acetylation. The hypothesis of this study is that increased membrane cholesterol content in CF cells is dependent on HDAC6 regulation.Methods
Electrochemical measurement of membrane cholesterol in mouse trachea and in primary human CF bronchial epithelial cells is used to monitor CFTR correction and manipulation of cholesterol processing by HDAC6 inhibition.Results
Data demonstrate that induction of Cftr expression in an inducible CF mouse model restores tubulin acetylation levels and normalizes membrane cholesterol content. To test the relationship between tubulin acetylation, membrane cholesterol levels were measured in a CF mouse model depleted of Hdac6 expression (CF/HDA). CF/HDA mouse trachea have WT membrane cholesterol levels while CF mice have approximately two-fold increase in membrane cholesterol compared to WT consistent with previous studies. Pharmacological inhibition of HDAC6 in primary human CF bronchial epithelial cells also reduces membrane cholesterol levels.Conclusions
This study demonstrates that elevated membrane cholesterol in CF epithelium is regulated by HDAC6 function and that the electrochemical measure of membrane cholesterol correlates with both genetic and pharmacological CFTR correction. 相似文献4.
Hirohisa Okabe Takayuki Ohsaki Katsuhiro Ogawa Nobuyuki Ozaki Hiromitsu Hayashi Shinichi Akahoshi Yoshiaki Ikuta Kenichi Ogata Hideo Baba Hiroshi Takamori 《American journal of surgery》2019,217(4):677-681
Background
We aim to clarify if frailty affects severe postoperative complications in elective colorectal surgery.Methods
Consecutive 269 colorectal cancer patients older than 65 years undergoing curative surgery were enrolled in this study. The relevance of the frailty and sarcopenia to postoperative outcome was assessed. Clinical frailty (CF) was defined as clinical frailty scale (CFS)?≥?4. Sarcopenia was assessed by measuring skeletal muscle area using computed tomography.Results
Seventy-eight patients (29%) had CF and 159 patients (59%) had sarcopenia. CF was significantly associated with older age (P?=?0.0008), postoperative severe complications (P?=?0.001), and postoperative in-hospital stay (P?<?0.0001), although sarcopenia was not. Logistic regression analysis revealed that low anterior resection and CF were independent predictors of severe postoperative complications (P?=?0.038 and P?=?0.001, respectively).Conclusion
CF, but not sarcopenia, is a robust predictor of severe postoperative complications in patients with colorectal cancer. 相似文献5.
Nikhil T. Awatade Sofia Ramalho Iris A.L. Silva Verónica Felício Hugo M. Botelho Eyleen de Poel Annelotte Vonk Jeffrey M. Beekman Carlos M. Farinha Margarida D. Amaral 《Journal of cystic fibrosis》2019,18(2):182-189
Background
New therapies modulating defective CFTR have started to hit the clinic and others are in trial or under development. The endeavour of drug discovery for CFTR protein rescue is however difficult one since over 2000 mutations have been reported. For most of these, especially the rare ones, the associated defects, the respective functional class and their responsiveness to available modulators are still unknown. Our aim here was to characterize the rare R560S mutation using patient-derived materials (rectal biopsies and intestinal organoids) from one CF individual homozygous for this mutation, in parallel with cellular models expressing R560S-CFTR and to assess the functional and biochemical responses to CFTR modulators.Methods
Intestinal organoids were prepared from rectal biopsies and analysed by RT-PCR (to assess CFTR mRNA), by Western blot (to assess CFTR protein) and by forskolin-induced swelling (FIS) assay. A novel cell line expressing R560S-CFTR was generated by stably transducing the CFBE parental cell line and used to assess R560S-CFTR processing and function. Both intestinal organoids and the cellular model were used to assess efficacy of CFTR modulators in rescuing this mutation.Results
Our results show that: R560S does not affect CFTR mRNA splicing; R560S affects CFTR protein processing, totally abrogating the production of its mature form; R560S-CFTR evidences no function as a Cl? channel; and none of the modulators tested rescued R560S-CFTR processing or function.Conclusion
Altogether, these results indicate that R560S is a class II mutation. However, unlike F508del, it cannot be rescued by any of the CFTR modulators tested. 相似文献6.
J. Abbott T. Havermans S. Jarvholm E. Landau Y. Prins U. Smrekar D. Staab L. Verity M. Verkleij 《Journal of cystic fibrosis》2019,18(2):299-303
Objectives
The Cystic Fibrosis (CF) International Mental Health Guidelines Committee published consensus statements for screening and treating depression and anxiety in individuals with CF and their caregivers. This work aimed to evaluate the dissemination and implementation of the guidelines in Europe two years following their publication.Methods
A 28-item survey was developed by the multidisciplinary ECFS Mental Health Working Group and emailed to approximately 300 CF centres across Europe. The survey evaluated (a) who should be responsible for mental health (MH) care, (b) the current awareness and agreement of the guidelines, (c) the provision of recommended MH screening and follow-up care, and (d) successes, barriers and required resources/training needs.Results
Responses were received from 187 centres (28 countries represented). There was consensus that a psychologist should be responsible for MH care, although members of the multidisciplinary team (MDT) believed they should also share this responsibility. Sixty-two percent of respondents were aware of the guidelines; 82% percent fully, and 12% partially, agreed with them. Fifty percent (94 centres) had implemented screening. In the past year approximately 6000 patients and 2000 caregivers had been screened, with 80% of respondents using the recommended screening tools. Respondents reported 551 referrals for moderate/severe psychopathology and 84 urgent suicide ideation referrals.Conclusions
The challenges of different healthcare systems and language barriers are being overcome with a greater awareness of the importance of mental health among the MDT. MH screening is feasible and gaining momentum in both Western and Eastern Europe. 相似文献7.
Ranjani Somayaji Michael D. Parkins Anand Shah Stacey L. Martiniano Michael M. Tunney Jennifer S. Kahle Valerie J. Waters J. Stuart Elborn Scott C. Bell Patrick A. Flume Donald R. VanDevanter 《Journal of cystic fibrosis》2019,18(2):236-243
Background
Antimicrobial susceptibility testing (AST) is a cornerstone of infection management. Cystic fibrosis (CF) treatment guidelines recommend AST to select antimicrobial treatments for CF airway infection but its utility in this setting has never been objectively demonstrated.Methods
We conducted a systematic review of primary published articles designed to address two PICO (patient, intervention, comparator, outcome) questions: 1) “For individuals with CF, is clinical response to antimicrobial treatment of bacterial airways infection predictable from AST results available at treatment initiation?” and 2) “For individuals with CF, is clinical response to antimicrobial treatment of bacterial airways infection affected by the method used to guide antimicrobial selection?” Relationships between AST results and clinical response (changes in pulmonary function, weight, signs and symptoms of respiratory tract infection, and time to next event) were assessed for each article and results were compared across articles when possible.Results
Twenty-five articles describing the results of 20 separate studies, most of which described Pseudomonas aeruginosa treatment, were identified. Thirteen studies described pulmonary exacerbation (PEx) treatment and seven described ‘maintenance’ of chronic bacterial airways infection. In only three of 16 studies addressing PICO question #1 was there a suggestion that baseline bacterial isolate antimicrobial susceptibility was associated with clinical response to treatment. None of the four studies addressing PICO question #2 suggested that antimicrobial selection methods influenced clinical outcomes.Conclusions
There is little evidence that AST predicts the clinical outcome of CF antimicrobial treatment, suggesting a need for careful consideration of current AST use by the CF community. 相似文献8.
Young Mee Choi Kristen Campbell Kari Hayes Rebecca Jacobson Gregory Kobak Steven Moulton 《Journal of pediatric surgery》2019,54(4):707-711
Objectives
Abdominal wall thickness (AWT) is a key measurement when placing or replacing low profile gastrostomy devices. This measurement varies, depending on nutritional status and body habitus. We developed a mathematical model to estimate AWT using a compendium of body measurements.Methods
Ultrasonography was used to measure AWT at the initial gastrostomy site in subjects aged 22?days to 24?years old. Other body measurements (height, weight, waist circumference and distance from xiphisternum to pubis) were also obtained. Multiple linear regression was used to develop two separate models using age of 2?years to separate the groups. For analysis, AWT is log transformed.Results
Data from 97 subjects were used for analysis.The final model for those ≤ 24?months old is the following:ln(Estimated AWT)?=?? 1.255?+?0.082*(1 if age 3–24?months, 0 if <3?months)?+?0.022*(waist circumference in cm).The final model for those > 24 months old is the following:ln(Estimated AWT)?=?? 1.335?+?0.271*(1 if age >84?months, 0 if 24–84 months)?+?0.082*(BMI)Conclusion
This model to estimate AWT is useful for determining the length of a gastrostomy device at initial placement and with subsequent changes. More data are needed to refine and further validate the model.Level of evidence
Level IV, study of prognostic test. 相似文献9.
Tobias G.P. Engel Lydie Slabbers Carmen de Jong Willem J.G. Melchers Ferry Hagen Paul E. Verweij Peter Merkus Jacques F. Meis 《Journal of cystic fibrosis》2019,18(2):221-226
Background
Progressive lung injury in Cystic Fibrosis (CF) patients can lead to chronic colonization with bacteria and fungi. Fungal colonization is obtained from the environment which necessitates locally performed epidemiology studies. We prospectively analyzed respiratory samples of CF patients during a 3-year period, using a uniform fungal culture protocol, focusing on filamentous fungi and azole resistance in Aspergillus fumigatus.Methods
Over a 3-year period, all respiratory specimens collected from CF patients in 5 Dutch CF centers, were analyzed. Samples were inoculated onto the fungal culture media Sabouraud dextrose agar (SDA) and Medium B+. All fungal isolates were collected and identified in one centre, using Amplified Fragment Length Polymorphism (AFLP) fingerprinting, rDNA PCR and ITS, calmodulin and β-tubulin sequencing. Azole resistance was assessed for all A. fumigatus using a qPCR assay followed by phenotypic confirmation.Results
Filamentous fungi were recovered from 699 patients from at least one respiratory sample, corresponding with 3787 cultured fungal species. A. fumigatus was cultured most often with a mean prevalence of 31.7%, followed by Penicillium species (12.6%), non-fumigatus Aspergillus species (5.6%), Scedosporium species (4.5%) and Exophiala dermatitidis and Cladosporium species (1.1% each). In total 107 different fungal species were identified, with 39 Penicillium species and 15 Aspergillus species. Azole resistance frequency in A. fumigatus was 7.1%, with TR34/L98H being the dominant resistance mechanism.Conclusion
A vast diversity of filamentous fungi was demonstrated, dominated by Aspergillus and Penicillium species. We observed a mean azole resistance prevalence of 7.1% of A. fumigatus culture positive patients. 相似文献10.
11.
Juliana I. Sesma Bryant Wu Timothy J. Stuhlmiller David W. Scott 《Journal of cystic fibrosis》2019,18(2):244-250
Background
In healthy lungs, epithelial sodium channel (ENaC) is regulated by short, palate, lung, and nasal clone 1 (SPLUNC1). In cystic fibrosis (CF), ENaC is hyperactivated in part due to a loss of SPLUNC1 function. We have developed SPX-101 to replace the lost function of SPLUNC1 in the CF lung.Methods
Expression of SPLUNC1 was determined in sputum from healthy and CF donors. Stability of SPLUNC1, S18 (the ENaC regulatory domain of SPLUNC1), and SPX-101 was determined in sputum from CF donors and towards neutrophil elastase. Activity of SPX-101 after exposure to CF sputum was determined in airway epithelial cells from CF donors and in the βENaC transgenic mouse model.Results
SPLUNC1 protein expression is significantly reduced in CF as compared to healthy sputum. SPLUNC1 is rapidly degraded in CF sputum as well as by a number of individual proteases known to be found in the sputum. SPX-101, but not S18, is stable in CF sputum. Finally, SPX-101 retains its ability to internalize ENaC, regulate airway surface liquid height, and increase survival of βENaC mice after exposure to CF sputum.Conclusions
Our results demonstrate that SPX-101, but not SPLUNC1 or S18, is stable in CF sputum. These results support the therapeutic development of SPX-101 for the treatment of cystic fibrosis. 相似文献12.
Saad Shebrain Mohamed Arafeh Gitonga Munene Cynthia Shattuck Lisa Miller Steven Lu David Schutter 《American journal of surgery》2019,217(3):568-571
Introduction
Ranking candidates for residency positions is challenging. We hypothesize that applicant academic achievements and performance during the interview are equally important in the ranking process.Methods
This is a retrospective study. Of 53 candidates interviewed during 2016–2017 cycle, 44 (83%) were ranked for 3 PGY1 positions. Each candidate was interviewed and scored in each of the following: USMLE Step 1 score, USMLE Step 2 score, research (RS), letters of recommendation (LOR), personal statement (PS), the way the candidate represented him/herself (RP), interest in the area (IN), answers to standardized questions (SQ), and degree of connection between the candidate and the interviewer (CN).Results
Correlation and multiple regression analyses indicated an inverse relationship between ranking the candidates and USMLE2 (r?=??0.14, p?=??0.364), LOR (r?=??0.513, p?<?0.001), PS (r?=??0.414, p?=?0.006), RP (r?=??0.485, p?=?0.001), CN (r?=??0.605, p?<?0.001), IN (r?=??0.349, p?=?0.022), and SQ (r?=??0.480, p?=?0.001), USMLE1 (r?=??0.036, p?=?0.838) and RS (r?=??0.008, p?=?0.96). After controlling for the other variables, only CN reached statistical significance (p?=?0.033).Conclusion
Candidate non-cognitive measures during the interview weigh higher than academic performance in the ranking process. 相似文献13.
Adegboyega Timothy Adewale Steven M. Rowe George M. Solomon 《Journal of cystic fibrosis》2019,18(2):e11-e13
Purpose
To raise awareness of colocolonic intussusception as a gastrointestinal complication of CF mimicking distal intestinal obstruction syndrome (DIOS) and discuss risk of recurrence.Case summary
A 33-year-old Caucasian male with cystic fibrosis presented with an acute abdomen diagnosed via imaging as colocolonic intussusception. He was managed with fluid replacement therapy and polyethylene glycol. He was re-admitted due to recurrence likely secondary to recurrent constipation and development of a fecalith. Surgery was contraindicated due to absence of tissue ischemia or necrosis.Discussion
Several possible etiological factors have been described, especially some that tend to occur within the context of CF disease, such as DIOS and PERT, and symptoms of colocolonic intussusception are similar to those of other causes of an acute abdomen but distinguishable by advanced imaging modalities. Due to risk of recurrence, an etiology of intussusception should be sought.Conclusion
Colo-colonic intussusception is a rare cause of an acute abdomen in the adult Cystic Fibrosis (CF) patient and may be associated with underlying constipation or presence of a fecalith. 相似文献14.
Yasmine Yousef Etienne St-Louis Robert Baird Emily R. Smith Elena Guadagno Dickens St-Vil Dan Poenaru 《Journal of pediatric surgery》2019,54(4):831-837
Background
The Lancet Commission on Global Surgery highlighted global surgical need but offered little insight into the specific surgical challenges of children in low-resource settings. Efforts to strengthen the quality of global pediatric surgical care have resulted in a proliferation of partnerships between low-and middle-income countries (LMICs) and high-income countries (HICs). Standardized tools able to reliably measure gaps in delivery and quality of care are important aids for these partnerships. We undertook a systematic review (SR) of capacity assessment tools (CATs) focused on needs assessment in pediatric surgery.Methods
A comprehensive search strategy of multiple electronic databases was conducted per PRISMA guidelines without linguistic or temporal restrictions. CATs were selected according to pre-defined inclusion criteria. Articles were assessed by two independent reviewers. Methodological quality of studies was appraised using the COSMIN checklist with 4-point scale.Results
The search strategy generated 16,641 original publications, of which three CATs were deemed eligible. Eligible tools were either excessively detailed or oversimplified. None used weighted scores to identify finer granularity between institutions. No CATs comprehensively included measures of resources, outcomes, accessibility/impact and training.Discussion
The results of this study identify the need for a CAT capable of objectively measuring key aspects of surgical capacity and performance in a weighted tool designed for pediatric surgical centers in LMICs.Type of Study
Systematic Review.Level of Evidence
II. 相似文献15.
Laurence Delhaes Kada Touati Odile Faure-Cognet Muriel Cornet Françoise Botterel Eric Dannaoui Florent Morio Patrice Le Pape Fréderic Grenouillet Loic Favennec Solène Le Gal Gilles Nevez Alain Duhamel Andrew Borman Veroniek Saegeman Katrien Lagrou Elia Gomez Maiz-Luis Carro Jean-Philippe Bouchara 《Journal of cystic fibrosis》2019,18(2):212-220
Background
Fungi are increasingly recognized for their potential role in contributing to pulmonary damage in Cystic Fibrosis (CF). We therefore designed a prospective international study aimed at (i) determining the prevalence of fungi isolated from sputum samples collected from a large CF population, (ii) comparing the performance of different media used for fungal culture, and (iii) proposing a standardized protocol suitable for CF routine microbiology.Methods
An international, consensually designed prospective study was set up (https://www.ecfs.eu/special-projects/mucofong-international-project). All centers worked according to the same protocol approved by Lille Ethical Committee. CF sputa were inoculated onto eight semi-selective media incubated at 37?°C or 25?°C–30?°C for 15?days, and inspected twice weekly for fungal growth.Results
A total of 469 sputa were collected from patients at 18 European and one Australian CF centers. Positive cultures for fungal growth were significantly associated with patient ages. Aspergillus fumigatus was the most frequently isolated mold. We identified a growing European North-to-South gradient of Scedosporium prevalence, while yeasts, Aspergillus section Fumigati, Cladosporium and Penicillium were significantly more prevalent in the Northern regions.Conclusions
According to the CHi-squared Automatic Interaction Detector method, we propose a consensual protocol based on two media (YPDA or Sabouraud medium, and B(+) medium) to detect the main opportunistic molds in CF context; the use of an additional medium being recommended according to the patient's clinical status. This standardized protocol allows us to have an accurate overview of the respiratory mycobiome on the culturomic side in CF. 相似文献16.
Matthew T. Harting Austin Wheeler Todd Ponsky Benedict Nwomeh Chuck L. Snyder Nicholas E. Bruns Aaron Lesher Samir Pandya Belinda Dickie Sohail R. Shah 《Journal of pediatric surgery》2019,54(3):587-594
Importance
Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction.Objective
To review the current spectrum, potential strategies, and implementation process of telemedicine in pediatric surgery.Design
Review and opinion design.Setting
n/a.Participants
n/a.Main outcomes and measures
n/a.Results
n/a.Conclusions and relevance
Telemedicine is an emerging approach with the potential to facilitate efficient, cost-effective delivery of pediatric surgical services.Brief Abstract
Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. The objectives of this review are to explore common terms in telemedicine, provide an overview of current legislative and billing guidelines, review the current state of telemedicine in surgery and pediatric surgery, and provide basic themes for successful implementation of a pediatric surgical telemedicine program.Type of Study
Review.Level of Evidence
Level V. 相似文献17.
Stephanie F. Polites Miho Watanabe Thomas Crafton Todd M. Jenkins Carlos R. Alvarez-Allende Adrienne M. Hammill Roshni Dasgupta 《Journal of pediatric surgery》2019,54(4):740-743
Purpose
There has been a paradigm shift from corticosteroid to propranolol treatment for infantile hemangiomas (IHs), with surgical resection reserved for complicated or persistent IHs. The purpose of this study was to determine if propranolol treatment was associated with decreased utilization of surgical resection compared to corticosteroids.Methods
A single center retrospective chart review of all corticosteroid or propranolol treated IHs between 2005 and 2014 was performed. Demographic and clinical data were collected. Both univariate and multivariate analyses were performed with the primary outcome of requiring surgical intervention.Results
Of 652 patients with IH, 52 were treated with oral corticosteroids and 195 with propranolol only. Surgical intervention was required in 14 (27%) of steroid patients vs 18 (9%) of propranolol patients (p?<?.001). On multivariable analysis patients treated with steroids had 3.3 the odds of requiring surgery when compared to propranolol patients (p?=?.001). Prematurity (< 37?weeks) was also associated with increased odds of surgery (OR?=?2.8, p?=?.003).Conclusion
Patients treated with propranolol required significantly fewer surgical interventions than those treated with corticosteroids suggesting a more efficacious treatment paradigm. Prematurity increases the need for surgical intervention regardless of the modality of medical treatment.Level of evidence
Level III, treatment study. 相似文献18.
Benjamin D. Carr Christa N. Grant Richard E. Overman Samir K. Gadepalli James D. Geiger 《Journal of pediatric surgery》2019,54(3):604-607
Background
Congenital chylous ascites poses a significant challenge in neonatal care, and often results in prolonged, complex hospital stays and increased mortality. Few effective options exist in refractory cases.Methods
Patients aged 0 to 12?months with refractory chylous ascites underwent retroperitoneal exploration after medical treatment and minimally invasive therapies were unsuccessful. The retroperitoneum was completely exposed via left and right medial visceral rotation and opening the lesser sac. Visible leaks were ligated, and alternating layers of fibrin glue and Vicryl mesh were used to cover the entire retroperitoneum.Results
All 4 patients had resolution of their chylous ascites. None required reoperation or reintervention for chyle leaks. All achieved goal enteral feeds at a median of 29?days postoperatively and were discharged from hospital at a median of 42?days postoperatively.Conclusions
Management of chylous ascites is extremely challenging in refractory cases. Complete retroperitoneal exposure with fibrin glue and Vicryl mesh application offers a definitive, reliable therapy for achieving cessation of lymphatic leakage and ultimate recovery for patients who fail all nonoperative approaches.Study type
Therapeutic.Level of evidence
IV 相似文献19.
Jaime Ruiz-Tovar Alejandro Garcia Carlos Ferrigni Juan Gonzalez Camilo Castellon Manuel Duran 《Surgery for obesity and related diseases》2019,15(2):228-235
Background
The essence of enhanced recovery after surgery (ERAS) program is the multimodal approach, and many authors have demonstrated safety and feasibility in fast-track bariatric surgery.Objectives
The aim of this study was to evaluate the postoperative pain after the implementation of an ERAS protocol in Roux-en-Y gastric bypass and to compare it with the application of a standard care protocol.Setting
University Hospital Rey Juan Carlos, Madrid, Spain.Methods
A prospective randomized clinical trial of all the patients undergoing Roux-en-Y gastric bypass was performed. Patients were randomized into the following 2 groups: those patients after an ERAS program and those patients after a standard care protocol. Postoperative pain, nausea or vomiting, morbidity, mortality, hospital stay, and analytic acute phase reactants 24 hours after surgery were evaluated.Results
One hundred eighty patients were included in the study, 90 in each group. Postoperative pain (16 versus 37 mm; P < .001), nausea or vomiting (8.9% versus 2.2%; P?=?.0498), and hospital stay (1.7 versus 2.8 d; P < .001) were significantly lower in the ERAS group. There were no significant differences in complications, mortality, and readmission rates. White blood cell count, serum fibrinogen, and C reactive protein levels were significantly lower in the ERAS group 24 hours after surgery.Conclusion
The implementation of an ERAS protocol was associated with lower postoperative pain, reduced incidence of postoperative nausea or vomiting, lower levels of acute phase reactants, and earlier hospital discharge. Complications, reinterventions, mortality, and readmission rates were similar to that obtained after a standard care protocol. 相似文献20.
Andrew B Nordin Karen Diefenbach Stephen P Sales Jeff Christensen Gail E Besner Brian D Kenney 《Journal of pediatric surgery》2019,54(4):718-722