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 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.

Conservative Management of Persistent Pleural Effusion Using Somatostatin

2003 ◽  
Vol 11 (1) ◽  
pp. 70-71
Author(s):  
Kiyoshi Haneda ◽  
Yoshimi Shoji ◽  
Tsunenori Katakura ◽  
Shuichiro Abe ◽  
Yuki Ogata ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Parenteral Nutrition ◽  
Pulmonary Edema ◽  
Continuous Infusion ◽  
Total Parenteral Nutrition ◽  
Conservative Management ◽  
Chest Tube ◽  
Myocardial Dysfunction ◽  
Somatostatin Analog ◽  
Tube Drainage

Persistent pleural effusion developed in an 81-year-old man with acute pulmonary edema due to myocardial dysfunction. Daily chest tube drainage was 1,000 to 1,400 mL. Despite total parenteral nutrition and albumin supplementation, drainage did not decrease. However, continuous infusion of a somatostatin analog was effective in controlling the effusion.

Unrepaired Complete Tracheal Rings: Natural History and Management Considerations

2018 ◽  
Vol 158 (4) ◽  
pp. 729-735 ◽  
Author(s):  
Lyndy J. Wilcox ◽  
Catherine K. Hart ◽  
Alessandro de Alarcon ◽  
Claudia Schweiger ◽  
Nithin S. Peddireddy ◽  
...  
Keyword(s):  
Conservative Management ◽  
Chart Review ◽  
Surgical Intervention ◽  
Case Series ◽  
Strong Positive Correlation ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Select Group ◽  
Academic Center ◽  
Over Time

Objectives To document the natural growth pattern of unrepaired complete tracheal rings (UCTRs) and describe the patient population managed conservatively. Study Design Case series with chart review. Setting Tertiary pediatric academic center. Subjects/Methods Medical records of patients with confirmed complete tracheal rings on bronchoscopy from 1993 to 2017 were reviewed. Patients aged 0 to 18 who had documented tracheal sizing over time and did not require surgical intervention were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings. Comorbidities and airway characteristics were documented in addition to endoscopic findings. These were compared with children requiring surgical repair. Results In total, 149 patients with complete tracheal rings were identified. Twenty-five had UCTRs for an overall 16.8% rate of conservative management. Nineteen patients met inclusion criteria and underwent a total of 90 microlaryngoscopy and bronchoscopies (MLBs) with sizing. The growth of the UCTRs over time, based on MLB sizing, was chronicled. The median airway growth noted was 0.38 mm/y. A moderately strong positive correlation was seen between age and airway size ( rs = 0.72, P < .0001). Children with UCTRs were less likely to have long-segment involvement than those who required repair (92%, P = .024). Conclusions A select group of children with complete tracheal rings can be managed expectantly without surgical intervention. Conservative management may be less successful in children with long-segment complete tracheal rings. Airway growth does occur in this population and can be monitored over time. Having a standardized method for sizing UCTRs allows for more effective communication between providers and assurance of continued growth of the airway while following these patients.

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.

Optic Nerve Sheath Decompression

2011 ◽  
Author(s):  
Thomas N. Hwang ◽  
Timothy J. McCulley
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Conservative Management ◽  
Weight Control ◽  
Visual Loss ◽  
Surgical Intervention ◽  
Case Series ◽  
Optic Nerve Sheath ◽  
Nerve Sheath ◽  
Csf Shunting

Optic nerve sheath decompression (ONSD) or fenestration refers to a surgical technique that creates a window through the dural and arachnoid meningeal layers of the retrobulbar optic nerve sheath to release pressure on the optic nerve. ONSD for treatment of visual loss secondary to refractory papilledema was first described by DeWecker in 1872. Later that century, Carter and Müller published the second case series of optic nerve sheath fenestrations. However, despite these and several additional reports, the clinical benefit of performing this procedure was still questioned. In addition, alternative cerebrospinal shunting procedures were developed for patients with increased intracranial pressure. Renewed interest arose in 1964 when Hayreh demonstrated the effectiveness of ONSD in relieving experimental papilledema in rhesus monkeys. Various supporting clinical publications have since followed, starting with Smith, Hoyt, and Newton’s description in 1969 of relief of chronic papilledema by ONSD. Surgical intervention is considered for patients with progressive visual loss secondary to elevated intracranial pressure (ICP) in whom conservative management, such as medications (acetazolamide and furosemide) and weight control, has failed. Occasionally surgery is used primarily in patients whose visual function has already reached a critical level. Examples include patients in whom vision has declined to a disabling level in hopes that rapid papilledema resolution will result in some visual return. Surgery is also considered primarily in those with little remaining vision, in whom any further visual loss would carry substantial functional impact should conservative management fail. Once surgical intervention is deemed necessary, ONSD is one of several options. Cerebrospinal fluid (CSF) shunting in the form of ventricular–peritoneal (VP) or lumbar–peritoneal (LP) shunting can be considered. A deciding factor for some is the presence of headache, which is more effectively managed with VP or LP shunting. Comparative trials of ONSD and other CSF shunting procedures are lacking. Consequently, some medical centers opt for ONSD as the first-line surgical option, while others recommend alternative shunting procedures. At present, the only uniformly accepted therapeutic indication for ONSD is management of visual loss related to elevated ICP. The most common setting for ONSD is idiopathic intracranial hypertension.

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.

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