scholarly journals Successful treatment of congenital chylothorax with skimmed milk and long course octreotide

2018 ◽  
Vol 11 (1) ◽  
pp. bcr-2018-226347 ◽  
Author(s):  
Tanushree Sahoo ◽  
Mukul Kumar Mangla ◽  
Amanpreet Sethi ◽  
Anu Thukral
Keyword(s):  
Management Strategies ◽  
Newborn Infants ◽  
Medium Chain Triglyceride ◽  
High Dose ◽  
Safe Alternative ◽  
Prolonged Duration ◽  
Congenital Chylothorax ◽  
Skimmed Milk ◽  
Multimodal Management ◽  
Long Course

Congenital chylothorax (CC) is a rare entity in neonatal period requiring multimodal management strategies. Despite optimum treatment, some cases remain refractory posing significant challenge to the treating physician. We here describe a 33-week preterm neonate presenting with refractory congenital chylothorax who needed treatment with combination of skimmed milk, high dose and prolonged duration octreotide for resolution. This case highlighted that octreotide has a good safety profile in newborn infants with congenital chylothorax and locally available skimmed milk fortified with medium chain triglyceride (MCT) oil is a cheap and safe alternative.

scholarly journals Treatment of Congenital Chylothorax Using High-Dose Octreotide

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Jinkyung Seo ◽  
Sook Kyung Yum
Keyword(s):  
Treatment Options ◽  
Medium Chain Triglyceride ◽  
Intestinal Secretion ◽  
Bottle Feeding ◽  
High Dose ◽  
Optimal Dosage ◽  
Severe Respiratory Distress ◽  
Threatening Condition ◽  
Octreotide Therapy ◽  
Congenital Chylothorax

Introduction: Neonatal chylothorax is a rare and potentially life-threatening condition with a reported incidence of 1 in 5,800 - 24,000 and a high mortality rate of up to 64%. Octreotide is one of the treatment options available to reduce both the splanchnic blood flow and the intestinal secretion of electrolytes and water. However, there is no uniform guideline for the optimal dosage of octreotide in the treatment of congenital chylothorax. Case Presentation: We present the case of a neonate diagnosed with congenital chylothorax. At birth, the neonate manifested severe respiratory distress warranting cardiopulmonary resuscitation for 25 min. During admission, intravenous octreotide treatment was initiated and feeding was changed from breast milk to a medium-chain triglyceride-enriched formula. Bilateral hilar enlargement and diffusely increased opacities waxed and waned, and we gradually increased the octreotide dosage daily by 1 ~ 2 mcg/kg/h. After 3 days of octreotide administration at the rate of 20 mcg/kg/h, chest x-ray showed regression of pleural effusion. The patient was discharged with full bottle feeding achieved. Conclusions: High-dose octreotide therapy (with doses up to 20 mcg/kg/h) may be recommended for patients with idiopathic congenital chylothorax. However, patients should be carefully monitored for side-effects such as hyperglycemia, necrotizing enterocolitis, transient hypothyroidism, and ileus.

scholarly journals Dietary treatment of congenital chylothorax with skimmed breast milk

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Michaela Höck ◽  
Alexander Höller ◽  
Marlene Hammerl ◽  
Karina Wechselberger ◽  
Jakob Krösslhuber ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Breast Milk ◽  
Dietary Intervention ◽  
Medium Chain Triglyceride ◽  
Favourable Outcome ◽  
University Hospital ◽  
Positive Effects ◽  
Congenital Chylothorax ◽  
Skimmed Milk ◽  
Long Chain

Abstract Background Congenital chylothorax (CC) is a rare but potentially life-threatening condition in newborns. It is defined as an accumulation of chyle in the pleural cavity. The few publications regarding medical management and therapeutic dietary intervention motivated us to share our experience. Methods Neonates diagnosed with congenital chylothorax and treated at Innsbruck Medical University Hospital between 2013 and 2020 (n = 6, gestational age: 36 3/7, 32 5/7, 36 4/7, 35 0/7, 35 4/7, 37 3/7 weeks) were eligible for this report. The cornerstones of treatment for chylothorax conventionally consist of chest tube drainage (CTD), respiratory support, dietary restriction of long-chain triglycerides (LCT) or total parenteral nutrition (TPN). In further course the introduction of a medium-chain triglyceride (MCT)-based formula followed by an overlapping switch to a formula with low LCT and high MCT, containing the essential long-chain fatty acids (LCFA), is attempted. In three patients we used fat-modified (skimmed) breast milk to provide a high protein and low fat diet and to avoid the discontinuation of breast milk. Results The outcome of an early introduction of LCFA in the form of skimmed breast milk after resolution of chylothorax diverse. One patient had a favourable outcome, meaning no recurrence of pleural effusion, adequate weight gain and a content mother, while another patient had a relapse of pleural effusion after the administration of skimmed milk and was therefore transitioned back to Basic F® . The CC of patient 5 was difficult due to Noonan syndrome. Two weeks after the introduction of skimmed breast milk the mother wanted to stop to express breast milk, so nutrition was changed to Basic F®. Conclusion The first-line therapy of chylothorax is a combination of respiratory stabilization and dietary modification. The use of skimmed breast milk is advisable in CC and feasible by means of a simple milk defatting procedure. It offers benefits to mothers who wish to resume breast feeding after resolution of chylothorax and has proven positive effects, above all in preterm infants as optimal nutrition with protective components superior to formula feeding. However, the nutritional analysis of the skimmed milk and the correlation to a re-accumulation of pleural fluid remains a question to be answered.

Newborn Platelet Dysfunction: a Storage Pool and Release Defect

1976 ◽  
Vol 36 (01) ◽  
pp. 200-207 ◽  
Author(s):  
Donald G. Corby ◽  
Thomas F. Zuck
Keyword(s):  
Specific Activity ◽  
Platelet Rich Plasma ◽  
Adenine Nucleotides ◽  
Blood Platelets ◽  
Newborn Infants ◽  
Specific Radioactivity ◽  
High Dose ◽  
Platelet Dysfunction ◽  
Paired Samples ◽  
Normal Adults

SummaryPer cent aggregation, release and content of adenine nucleotides, and specific radioactivity were evaluated in citrated platelet-rich plasma (PRP) prepared from paired samples of maternal and cord blood. Platelets of newborn infants aggregated normally in response to high dose ADP (20 μM), strong collagen suspensions, and thrombin; however, when compared with PRP from the mothers or from normal adults, per cent aggregation in response to lower concentrations of ADP (2 μM), weak collagen, and part particularly epinephrine was markedly reduced. Nucleotide release after stimulation of the newborns’ PRP with the latter two inducers was also impaired. ATP and ADP content of the newborns’ platelets was also significantly less than that of their mothers or of normal adults, but specific activity was normal. The data suggest that the impairment of ADP release in the platelets of newborn infants is due to decreased sensitivity to external stimuli. Since metabolic ATP is necessary for the platelet release reaction, it is postulated that the platelet dysfunction results from a lack of metabolic ATP.

scholarly journals Angiogenesis as a Therapeutic Target in Endometriosis

2014 ◽  
Vol 27 (4) ◽  
pp. 489 ◽  
Author(s):  
Dusan Djokovic ◽  
Carlos Calhaz-Jorge
Keyword(s):  
Drug Resistance ◽  
Literature Search ◽  
Molecular Mechanisms ◽  
Management Strategies ◽  
Angiogenesis Inhibitors ◽  
Resistance Development ◽  
Key Factor ◽  
Successful Establishment ◽  
Multimodal Management ◽  
Gynecological Disorder

<p><strong>Introduction:</strong> Angiogenesis is a key factor for the successful establishment and growth of endometriotic lesions.<br /><strong>Material and Methods:</strong> We performed a literature search in PubMed and reviewed the most pertinent studies published until January 2014 and focused on the endometriosis-associated angiogenesis and/or anti-angiogenic strategies for the treatment of this gynecological disorder.<br /><strong>Results:</strong> The present review provides a concise summary of the known molecular mechanisms that promote vascularization of endometriotic lesions and may serve as potential therapeutic targets. We also present a systematic overview of the inclusive and exclusive anti-angiogenic agents that have been already studied in cell cultures, animal models and/or endometriosis patients.<br /><strong>Discussion and Conclusion:</strong> The integration of anti-angiogenic approaches in the multimodal management strategies for endometriosis patients will be conditioned by the outcomes of future assessments regarding the effectiveness of such treatments, the risk of drug resistance development and the incidence of unacceptable side effects.<br /><strong>Keywords:</strong> Angiogenesis Inhibitors/therapeutic use; Endometriosis/drug therapy.</p>

Case Reports On The Multimodal Management of Refractory Chronic Oncological Pain of The Chest Wall: The Use of The Spinal Erector Plane Neurolysis

2021 ◽  
Author(s):  
John Cardenas ◽  
Juan Felipe Vargas-Silva ◽  
Alejandro Ramirez
Keyword(s):  
Pain Management ◽  
Chest Wall ◽  
Case Reports ◽  
Management Strategies ◽  
Erector Spinae ◽  
Opioid Rotation ◽  
Interventional Pain Management ◽  
Multimodal Management ◽  
Advanced Stage Cancer

Abstract Chronic pain of oncological origin is one of the most frequent complications and is difficult to control, that results in a decrease in the quality of life and disability among patients suffering from this pathology. Primary or metastatic tumors originating from lung, colonic, or breast neoplasms can invade the chest wall, causing progressive respiratory pain and symptoms that require multiple interventions to achieve adequate control. Many of these cases presenting with advanced-stage cancer are often incurable; thus, pain management and palliative care are primary objectives. Multimodal management is the strategy of choice in these cases through the participation of a multidisciplinary team. Analgesic therapy covers the use of potent opioids, opioid rotation, adjuvant analgesics, and interventional pain management strategies. We report two cases of chronic oncological pain of the chest wall refractory to pharmacological analgesic management. The optimization of multimodal management and the performance of neurolysis by phenolization of the erector spinae plane achieved an adequate response.

Intraspinal Sparganosis Diagnosed by Metagenomics Next Generation Sequencing：An Uncommon Infection

2021 ◽  
Author(s):  
Rongming Wang ◽  
Bobin Hu ◽  
Jianning Jiang ◽  
Minghua Su
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Lower Limb ◽  
Poor Prognosis ◽  
High Dose ◽  
Next Generation ◽  
Praziquantel Treatment ◽  
Long Course ◽  
Generation Sequencing ◽  
Complex Lesions

Abstract In this paper, we report a case of lumbago with lower limb fatigue. After a series of biochemical, immunological, imaging, and pathological examinations, the patient was diagnosed with intraspinal sparganosis based on metagenomics next generation sequencing. Due to the length of infection, the presence of multiple complex lesions, and the high risk of surgical treatment with poor prognosis, we did not advocate surgical treatment, but chose to administer a high dose and long course of praziquantel treatment for this case.

Aerobic and Anaerobic Bacterial Flora of the Maternal Cervix and Newborn Gastric Fluid and Conjunctiva: A Prospective Study

PEDIATRICS ◽  
1979 ◽  
Vol 63 (3) ◽  
pp. 451-455
Author(s):  
Itzhak Brook ◽  
Cynthia T. Barrett ◽  
Charles R. Brinkman ◽  
William J. Martin ◽  
Sydney M. Finegold
Keyword(s):  
Pathogenic Bacteria ◽  
Bacterial Flora ◽  
Newborn Infants ◽  
Gastric Fluid ◽  
Viridans Streptococci ◽  
Prolonged Duration ◽  
Bacteroides Fragilis Group ◽  
A Prospective Study ◽  
Aerobic And Anaerobic ◽  
Duration Of Pregnancy

Aerobic and anaerobic cultures were performed on cervical swabs from 35 mothers and their newborn infants' gastric aspirates and conjunctival sacs. Four hundred seventy-nine isolates were obtained; 287 were aerobes and 192 were anaerobes. The cervical and gastric cultures overall yielded a similar flora, but this was not always the case when one compared mothers with their own newborn infants. The conjunctival cultures yielded about half of the number of bacteria per specimen that the gastric contents yielded, and a repeat conjunctival culture done 48 hours later showed a marked reduction in the number of potentially pathogenic bacteria isolated. The predominant aerobes isolated were Staphylococcus epidermidis, diphtheroids, viridans streptococci and Haemophilus vaginalis. The predominant anaerohes were the Bacteroides fragilis group, Propionihacterium acnes, Peptococcus, other Bacteroides and Peptostreptococcus organisms. Statistical analysis revealed significant positive correlation between the isolation of certain groups of organisms and increased duration of pregnancy, increased baby's weight, and prolonged duration of labor.

Effect of High-Dose Dopamine on Urine Output in Newborn Infants

1987 ◽  
Vol XXXI (4) ◽  
pp. 231
Author(s):  
C. PEREZ ◽  
J. REIMER ◽  
M. SCHREIBER ◽  
D. WARBURTON ◽  
G. GREGORY
Keyword(s):  
Urine Output ◽  
Newborn Infants ◽  
High Dose

Variable duration of reproductive suppression in male coyotes (Canis latrans) treated with a high dose of the gonadotrophin-releasing hormone agonist deslorelin

2017 ◽  
Vol 29 (7) ◽  
pp. 1271 ◽  
Author(s):  
Marjorie J. MacGregor ◽  
Cheryl S. Asa ◽  
Donal C. Skinner
Keyword(s):  
Canis Latrans ◽  
Animal Health ◽  
Management Strategies ◽  
High Dose ◽  
Sperm Production ◽  
Releasing Hormone ◽  
Reproductive Axis ◽  
Gonadotrophin Releasing Hormone ◽  
Breeding Seasons

Effective and humane management strategies for coyotes (Canis latrans) remain elusive. We hypothesised that exposure to a high dose of a gonadotrophin-releasing hormone (GnRH) agonist would cause prolonged suppression of the reproductive axis. Two groups of male coyotes were administered 47 mg deslorelin in the form of either five 9.4-mg controlled-release Suprelorin (Peptech Animal Health, Macquarie Park NSW, Australia) implants (n = 3) or 10 4.7-mg implants (n = 5). In the first group, deslorelin suppressed plasma LH, testosterone and testes volume in two of three coyotes for three breeding seasons. In the second group, two of five deslorelin-treated coyotes had no sperm production after 1 year and plasma LH, FSH, testosterone and testes volume were suppressed. Although plasma gonadotropins and testosterone were suppressed in three treated coyotes in group two, testes volume and sperm production were evident. Because the duration of suppression differed among individual coyotes, we further hypothesised that a variation in deslorelin release underlay the variability. To test this, we analysed in vivo plasma profiles of deslorelin concentrations. These profiles suggested that deslorelin concentrations >100 pg mL–1 are required to maintain suppression in male coyotes. For field implementation, the development of an implant capable of releasing deslorelin for the life of the coyote is necessary.

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