Delayed presentation of a baby with an oesophageal atresia on day 14 of life

2021 ◽  
Vol 14 (9) ◽  
pp. e244483
Author(s):  
Corne De Vos ◽  
Charlie Kohler ◽  
Natash Fourie ◽  
Pierre Goussard
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Respiratory Symptoms ◽  
Oesophageal Atresia ◽  
Case Reports ◽  
Case Series ◽  
Delayed Presentation ◽  
Feeding Problems ◽  
Referral Hospitals ◽  
High Index Of Suspicion

Delayed presentation of oesophageal atresia (OA) with a tracheo-oesophageal fistula (TOF) is rare. Only a few case reports and two larger case series have been published. We present a neonate who was referred to our unit on day 14 of life with a missed OA and a TOF, having survived without any feeds or total parenteral nutrition up until referral.We concluded that although such a delayed presentation is rare and avoidable, it does occur. This case highlights the necessity of good feedback to the referral hospitals with education on how to prevent this from recurring again. It also emphasises the necessity of a comprehensive clinical examination of all newborn babies. A high index of suspicion for OA with or without a TOF is essential in all babies with clinical drooling, feeding problems (from the first feed) and/or respiratory symptoms especially if combined with antenatal polyhydramnios.

scholarly journals Conservative Management of Postoperative Chylous Fistula with Octreotide and Peripheral Total Parenteral Nutrition

2017 ◽  
Vol 96 (7) ◽  
pp. 264-267 ◽  
Author(s):  
Jason Y.K. Chan ◽  
Eddy W.Y. Wong ◽  
S.K. Ng ◽  
C. Andrew van Hasselt ◽  
Alexander C. Vlantis
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Neck Dissection ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Case Series ◽  
Somatostatin Analogue ◽  
Left Neck ◽  
Neck Irradiation ◽  
Chylous Fistula

Postoperative chylous fistula after neck dissection is an uncommon complication associated with significant patient morbidity. Octreotide acetate is a somatostatin analogue established in the treatment of chylothorax; however, its utility in the management of cervical chylous fistulae has not been fully evaluated. The investigators hypothesized that chylous fistula can be managed by a combination of octreotide and peripheral total parenteral nutrition (TPN). A retrospective review of cases compiled at our institution from 2009 to 2015 was conducted. Ten patients, all men, were identified as having a postoperative chylous fistula after a neck dissection. All patients were treated with peripheral TPN. and intravenous octreotide. Mean age of the patients was 63.0 years (range 49 to 82). Five (50.0%) had a neck dissection for the management of metastatic nasopharyngeal carcinoma and had previous neck irradiation. In 8 (80%) patients, chylous fistula occurred in the left neck. Seven (70.0%) of the leaks occurred within the first 2 postoperative days. Eight (80%) leaks were controlled using TPN and octreotide, with 2 (20%) patients requiring surgical intervention. No factors were significant in the successful conservative management of chylous fistulae. One patient with a chylous fistula of 1,800 ml/day was managed successfully without surgical intervention. The results of this case series suggest that chylous fistulae may be managed conservatively with octreotide and TPN. However, long-term evaluation is needed to define if and when surgical intervention is required for control.

scholarly journals Chronic Pulmonary Histoplasmosis—A Scoping Literature Review

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Jacob Baker ◽  
Chris Kosmidis ◽  
Anna Rozaliyani ◽  
Retno Wahyuningsih ◽  
David W Denning
Keyword(s):  
Case Series ◽  
Fungal Culture ◽  
Delayed Presentation ◽  
Antibody Testing ◽  
Historical Case ◽  
Pulmonary Histoplasmosis ◽  
Gradual Loss ◽  
Slow Progression ◽  
Scoping Literature Review ◽  
High Index Of Suspicion

Abstract Chronic pulmonary histoplasmosis (CPH) is an uncommon manifestation of Histoplasma infection with features similar to pulmonary tuberculosis (TB). In endemic areas, it may be misdiagnosed as smear-negative pulmonary TB. Historical case series mainly from patients with presumed TB described a high frequency of cavitation and poor prognosis, likely resulting from delayed presentation. More recent reports suggest that CPH can present with nodules, lymphadenopathy, or infiltrates, with cavities being a less common feature. Emphysema is the main risk factor for cavitary CPH. CPH is therefore an umbrella term, with chronic cavitary pulmonary histoplasmosis and Histoplasma nodules being the main long-term manifestations in nonimmunocompromised individuals. Diagnosis relies on a high index of suspicion, use of fungal culture of respiratory samples, antibody testing, and compatible radiological picture. Treatment with itraconazole for at least 12 months is recommended. Morbidity from CPH results from slow progression of cavities and gradual loss of lung function, especially if not recognized and treated. Studies on the epidemiology of CPH are needed in order to improve understanding of the disease.

scholarly journals Conservative Management of Postoperative Chylous Fistula with Octreotide and Peripheral Total Parenteral Nutrition

2017 ◽  
Vol 96 (7) ◽  
pp. 264-267 ◽  
Author(s):  
Jason Y.K. Chan ◽  
Eddy W.Y. Wong ◽  
S.K. Ng ◽  
C. Andrew van Hasselt ◽  
Alexander C. Vlantis
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Neck Dissection ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Case Series ◽  
Somatostatin Analogue ◽  
Left Neck ◽  
Neck Irradiation ◽  
Chylous Fistula

Postoperative chylous fistula after neck dissection is an uncommon complication associated with significant patient morbidity. Octreotide acetate is a somatostatin analogue established in the treatment of chylothorax; however, its utility in the management of cervical chylous fistulae has not been fully evaluated. The investigators hypothesized that chylous fistula can be managed by a combination of octreotide and peripheral total parenteral nutrition (TPN). A retrospective review of cases compiled at our institution from 2009 to 2015 was conducted. Ten patients, all men, were identified as having a postoperative chylous fistula after a neck dissection. All patients were treated with peripheral TPN and intravenous octreotide. Mean age of the patients was 63.0 years (range 49 to 82). Five (50.0%) had a neck dissection for the management of metastatic nasopharyngeal carcinoma and had previous neck irradiation. In 8 (80%) patients, chylous fistula occurred in the left neck. Seven (70.0%) of the leaks occurred within the first 2 postoperative days. Eight (80%) leaks were controlled using TPN and octreotide, with 2 (20%) patients requiring surgical intervention. No factors were significant in the successful conservative management of chylous fistulae. One patient with a chylous fistula of 1,800 ml/day was managed successfully without surgical intervention. The results of this case series suggest that chylous fistulae may be managed conservatively with octreotide and TPN. However, long-term evaluation is needed to define if and when surgical intervention is required for control.

scholarly journals Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus 2 infection: a systematic review

2021 ◽  
Author(s):  
J Cho ◽  
J Lee ◽  
CH Sia ◽  
CS Koo ◽  
BYQ Tan ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Respiratory Symptoms ◽  
Case Reports ◽  
Meta Analysis ◽  
Severe Disease ◽  
Late Phase ◽  
Cardiac Injury ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Venous Thromboembolic Events

Introduction: We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity. Methods: We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded. Results: 169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum. Conclusion: Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.

scholarly journals Lemierre’s Syndrome: A Thing of the Past?

2020 ◽  
Author(s):  
Nehal Dhaduk ◽  
Sudeepti Vedula ◽  
Aparna Govindan ◽  
Evelyne Kalyoussef
Keyword(s):  
Mortality Rate ◽  
Case Reports ◽  
Case Series ◽  
Lemierre’S Syndrome ◽  
Female Ratio ◽  
Clinical Presentations ◽  
Life Threatening ◽  
Lemierre's Syndrome ◽  
High Index Of Suspicion ◽  
Male To Female

Abstract Introduction: Lemierre’s syndrome (LS), infectious thrombophlebitis of the internal jugular vein, is a rare, life-threatening complication of oropharyngeal infections underrepresented in literature. We reviewed the etiology, clinical characteristics, treatment regiments and prognosis of LS in pediatric patients.Methods: PubMed and MEDLINE were searched from February 10, 2018 to July 28, 2018 for relevant studies. A systematic review was performed using the terms LS and pediatric case. Our criteria included reviews, case reports, and case series with patients under 18 years with a diagnosis of LS. Results: 70 cases of pediatric LS were identified. The male to female ratio was 1:1.7 with an average age of 10.7 years (5 weeks to 17 years). The most common initial clinical presentations were fever (90.0%), sore throat (38.6%), and neck pain or tenderness (35.7%), while the most frequent findings on physical exam were fever (31.4%) and neck involvement (28.6%). F. necrophorum was the predominant organism cultured (62.9%). Septic emboli were seen in 51.4% of cases with the lungs affected in 40 patients. Most commonly used treatments were antibiotics (91.4%) followed by anticoagulation (50.0%) and the overall mortality rate was 8.6%. The average time from initial presentation to diagnosis was 4.9 days. Conclusion: LS is a deadly condition with a staggering mortality rate despite the advent of antibiotic measures. Early identification and a high index of suspicion are necessary to prevent complications associated with LS. Despite its rarity it should remain on the differential for any patient with toxic signs and localized neck findings.

Using Arteriovenous Fistulae as a Dual Access for Hemodialysis and Total Parenteral Nutrition Administration is Feasible with a Good Outcome: A Case Series

2007 ◽  
Vol 8 (4) ◽  
pp. 305-308 ◽  
Author(s):  
V.C.Y Tang ◽  
M.A Morsy ◽  
E.S. Chemla
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Case Series ◽  
Central Line ◽  
Consecutive Series ◽  
Arteriovenous Fistulae ◽  
Central Venous Stenosis ◽  
End Stage ◽  
Line Infection

End stage renal failure patients requiring long term total parenteral nutrition (TPN) often have multiple central line placements due to line infection or occlusion. Sometimes this can cause central venous stenosis or even occlusion. We present three cases in this consecutive series, in which we have successfully used arteriovenous fistulae for both hemodialysis and long term TPN administration as an alternative route without any complications. We therefore think that native AVF and grafts can be used as dual access for hemodialysis and TPN administration provided careful case selection, counselling and follow-up.

scholarly journals Copper Deficiency and Cytopenia: A Systematic Review

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5025-5025
Author(s):  
Prakash Kharel ◽  
Karthik Gnanapandithan ◽  
Ramesh Kumar Pandey ◽  
Samir Jha ◽  
Alyssa Grimshaw ◽  
...  
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Full Text ◽  
Copper Deficiency ◽  
Case Reports ◽  
Controlled Vocabulary ◽  
Free Text ◽  
Hematological Manifestations

Copper Deficiency and Cytopenia: A Systematic Review Prakash Kharel, Karthik Gnanapandithan, Ramesh Kumar Pandey, Samir Jha, Alyssa Grimshaw, Smith Giri Introduction: Copper deficiency is rare in humans unless there is a condition that affects either copper uptake or metabolism, or dietary deficiency. However, the incidence appears to be rising due to increasing gastric bypass surgery and total parenteral nutrition (TPN) use. Published data on hematological manifestations due to copper deficiency are limited to case reports, case series and small retrospective studies, creating confusion among clinicians and hematologists. We performed a systematic review of all published case reports and series to characterize hematological manifestations associated copper deficiency with a focus on risk factors, clinical manifestations, treatments and outcomes. Methods: Using a combination of free text and controlled vocabulary, a systematic search of the electronic literature using MEDLINE and EMBASE for published material from inception to March 2019 was performed. Two authors independently screened the titles, abstracts, and the full text of the selected papers. Subsequently, the full text of each article was assessed for eligibility and details. From the 97 reports, we included 116 cases in which the clinical course, management and outcomes were described. Results: Of 5374 articles screened, a total of 268 articles were selected for full text review and a total of 97 reports describing 116 cases met our eligibility criteria. The median age at the time of presentation was 44 (interquartile range (IQR) 25-57) year, and 64 (55%) were males. Total of 37(32 %) had coexisting neurological symptoms. The median Hb was 7.7 gm/dl (IQR 6.2-9.5) and median WBC 2.3 (1.6-3.1). 94 (81%) of the patients had hemoglobin (Hb)< 10, 41(35%) had severe anemia Hb <7 at presentation. 80(69%) had leukopenia with white blood cell (WBC) <4K, of them only one patient had lymphopenia (1.28%), rest had neutropenia (98.72 %). Nearly half of these patients had macrocytic anemia (38, 55%) and only 3 cases had microcytic anemia. Of 78 patients with available data, 23(29%) had low platelet counts and 8 (10 %) had elevated platelet count. Zinc excess was implicated in almost half of these cases (39/87, 45%) and total parenteral nutrition (TPN) in 9 out of 87 cases (10%) Conclusion: Copper deficiency should be one of the reflexes in evaluation of patient who is at risk of copper deficiency specially as there is rise of bariatric surgery, survivors of significant bowel surgery patient requiring total parenteral nutrition or jejunal feed along with the baby boomers who will be the high number of patients using dentures and patient on zinc supplementation. There should always be a high degree of suspicion among clinicians when dealing with at-risk individuals to prevent irreversible complications and morbidity. Disclosures No relevant conflicts of interest to declare.

Issues in Contemporary Drug Delivery: Part V: Total Parenteral Nutrition

1992 ◽  
Vol 8 (1) ◽  
pp. 6-19
Author(s):  
Pamela A. Mohler ◽  
Umesh V. Banakar
Keyword(s):  
Drug Delivery ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Animal Studies ◽  
English Language ◽  
Human Subjects ◽  
Case Reports ◽  
Data Extraction ◽  
Compatibility Studies ◽  
Stability Data

Objective: To provide an overview of common compounding and administration guidelines for total parenteral nutrition (TPN). The compatibility of various drug products with TPN preparations is also discussed. Data Sources: References were selected from published bibliographies of specialized nutrition and drug-nutrient interaction articles, package inserts and manufacturer's information, and specific topic searches in MEDLINE computerized database (English language, through 1989). Study Selection: Studies that investigated stability were selected preferentially to those studying compatibility alone; when stability data were not available, compatibility studies were included. Studies using products marketed in the US were chosen preferentially to those using European products; studies and case reports using human subjects were selected in preference to animal studies. Sixty percent of the initially identified studies were selected for inclusion. Data Extraction: Studies were reviewed by the authors for internal consistency and statistical validity. Data Synthesis: Intravenous solutions can be manufactured to meet various nutritional specifications. As additional nutrients and drugs are incorporated, the risk of incompatibility and instability of the admixture increases. Stability data are relatively sparse, leading to a dependence on compatibility studies for decision making. Conclusions: A wide variety of TPN formulations can be compounded to meet the individual needs of patients of all ages and assorted disease states. Addition of specific drugs to the TPN preparation may improve the efficiency of drug delivery and improve overall therapeutic response. Care must be taken, however, to ensure that incompatible compounds are not combined in a single TPN preparation.

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