Objective To improve the understanding of treatment with streptococcus a group for injection (SAGI) for neonatal congenital chylothorax. Methods The therapeutic effect of intrapleural injection of SAGI in two newborn infants with congenital chylothorax was analyzed and the literatures was reviewed from Wanfang and PubMed database until June 2015. Finally 38 articles were screened including 18 articles of neonatal and fetal chylothorax treated with intrapleural injection of SAGI, and a total of 87 cases of congenital chylothorax. The clinical data and the newborn's therapeutic response to SAGI of 87 cases and the 2 cases in this study were summarized. Results Two cases of full term were diagnosed of newborn congenital chylothorax according to pleural puncture and respectively admitted to the hospital on the 24th and 1st day after birth .The therapeutic response was not good through the chest drainage or diet treatment, then pleurodesis by intrapleural injection of SAGI was applied on the 20th day and 5th day after admission, respectively and chylous fluid was reduced sharply, finally the patients were recovered and discharged from the hospital. Totally, 80 cases out of the 89 cases were antenatally treated with pleurodesis with SAGI for congenital chylothorax, and 18 cases had gene mutation related diseases or abnormal chromosome karyotype. Intrauterine death occurred in 14 cases and 2 cases of abnormal chromosome karyotype died less than one year old after successful treatment about chylothorax. Twenty-three cases were partially effectively treated, while 41 cases had obvious curative effect. In the other 7 cases of neonatal chylothorax, the treatment efficacy of SAGI after conservative treatment or octreotide administration after birth was remarkable. In this paper, congenital chylothorax in the two cases achieved rapid and effective control due to chest drainage, diet control and combination with SAGI. Conclusion That SAGI should be considered as a therapeutic option for neonatal chylothorax, and its earlier usage may bring with expectation of the quick reduction of the chylous fluid, early removal of the chest tube, less risk of complication related to infection and less time of fasting and hospitalization.
Key words:
Streptococcus a group for injection
;
Chylothorax
;
congenital/newborn infants
;
Pleurodesis
Fig.2
Variation of the volume of chest drainage and intestinal feeding amount for case 2 during hospitalization
2 文献复习
2.1 资料来源
以“(注射用A群链球菌or A群链球菌制剂)AND(乳糜胸or乳糜腹)”为检索词检索万方数据库,发现1篇文献使用注射用A群链球菌成功治疗难治性新生儿乳糜胸2例。以“(OK-432 or sapylin or picibanil)AND(chylothorax)”为检索词检索PubMed数据库,检索时间截止2015年6月,共检索出文献44篇,经过阅读摘要后剔除与本研究目无关以及重复发表的文献,最后有37篇报道,其中注射用A群链球菌治疗成人乳糜胸20篇,产前治疗胎儿乳糜胸13篇,出生后治疗新生儿先天性乳糜胸的报道有4篇共5例。
ACHYLOTHORAX IS AN ACCUMULATION of lymphatic fluid that collects in the pleural space. It is the most common cause of a large pleural effusion in the newborn.Estimated incidences vary from 1 in 10,000 deliveries to 1 in 2,000 admissions to the NICU.Chylothorax may be unilateral or, infrequently, bilateral and can occur spontaneously or be acquired secondary to trauma or surgical procedures. The right lung is more commonly affected than the left.
KATANYUWONGP,DEARANIJ,DRISCOLLD.The role of pleurodesis in the management of chylous pleural effusion after surgery for congenital heart disease[J].,2009,30(8): 1112-1116.
This study aimed to determine the incidence and outcome of postoperative chylous pleural effusion as well as the efficacy of pleurodesis for its management after surgery for congenital heart disease. Medical and surgical databases were used to identify all patients who had surgery for congenital heart disease and subsequently experienced postoperative chylous pleural effusion. Medical records were reviewed and daily chest drainage and management strategies were recorded. From January 2000 to June 2006, 1,166 cardiac operations were followed by 19 cases of chylous pleural effusion, for an incidence of 1.6%. The diagnosis was made a mean of 9 days after the operation. The patients were divided into two groups according to treatment strategy. Group 1 included 9 patients who had received only conventional medical treatment consisting of parenteral nutrition and/or medium-chain triglyceride formula and/or a low-fat diet and/or somatostatin. Group 2 included 10 patients who initially received conventional medical treatment, then subsequently received chemical or mechanical pleurodesis. The amount of the chylous drainage was significantly less in group 1 (14 ml/kg/day) than in group 2 (24 ml/kg/day) (P < 0.05), suggesting a more severe problem in group 2. For group 2, the amount of drainage was significantly less after chemical or mechanical pleurodesis (8 vs 24 ml/kg/day; P < 0.05) than before. Seven patients (70%) responded favorably to the first pleurodesis, and two patients (20%) required more than one pleurodesis. One patient (10%) did not respond to pleurodesis but was treated successfully with thoracic duct ligation. There were no deaths. Pleurodesis is a safe and effective method for treating chylous effusion after surgical treatment of congenital heart disease, especially after failed conservative treatment. However, some patients may need more than one pleurodesis.
OKAZAKIT,IWATANIS,YANANIT,et al.Treatment of lymphangioma in children: our experience of 128 cases[J].,2007,42(2): 386-389.
Sclerotherapy with OK-432 was not as effective as reported in the literature. We recommend OK-432 injection therapy alone for SI and MA types and surgical excision after pretreatment with OK-432 for MI and CA types.
YIM GW,KWON JY,YWP.Successful antenatal treatment of early fetal chylothorax with OK-432 pleurodesis[J].,2009,52: 752-758.
ABSTRACT Fetal chylothorax is a rare congenital manifestation that shows variable clinical outcome ranging from complete spontaneous resolution to progression into hydrops or lung hypoplasia. There is no consensus in the literature as to the optimal antenatal management despite several complications such as preterm delivery, pulmonary hypoplasia, and perinatal death. Pleuroamniotic shunting has been the treatment of choice in fetal chylothorax. Recently, new fetal therapy such as OK-432 (Picibanil) pleurodesis is being introduced. Herein, we present two cases of women referred at early 2nd trimester because of fetal hydrothorax by routine ultrasonography. Cytology obtained by thoracocentesis revealed abundant lymphocytes, suggesting chylothorax. Effusion was aspirated and OK-432 (Picibanil) was injected into the pleural space of fetus. On follow up ultrasonography, the pleural effusion was nearly resolved by adhesion of the intrathoracic space and resulted in the delivery of a healthy neonate. Intrapleural OK-432 injection may be feasible therapeutic option for selected cases in early 2nd trimester with persistent chylothorax for effective control of pleural effusion with no adverse effects. 134310 39036631 512335 6676 8923 01552233 1343343709 39309789 39653709, 662175 3170 892319 333109 60219789 743793 333781 9301 74372389 2363 5123213677 9405977781 32857935 57 20023709 3763 57 6810 153733 09166399. 134310 39036635 0916159389 93053107 3511, 51232136 06 4916 2735 63601537 94 237663 3918 717707 419367 21 3325 34803437 1137470175 39799789 39653399. 890781 3323 9763 1137 494789 2332 62029731 2931 18513301, 6139833189 5123 667977 2004767935 93962129 (pleuroamniotic shunt)33 3591 47012199. 9396 212935 7437 85293437 25033377 8331 10700909 376921 45832389 OK-43207 333063 3170895123 660439482935 17019133 15799779 3399. OK-43289 2410362035 052247013135 698109 17309789 20513709, 66768909 35306905 2736 053835 5863 6604394835 313743 39036635 712107 39096399. 3323 333189 3921 31213198523 31223437 5123 662107 1537 74372319 317089 660443312935 27686921 134310 39036635 35936577 942723 662135 2035 7121275579 OK-43207 333063 660439482909 10703437 1907 22907 746769218523 3307 15796989 013399.
LEUNG VK,SUEN SS,TING YH,et al.Intrapleural injection of OK-432 as the primary in-utero treatment for fetal chylothorax[J].,2012,18(2): 156-159.
Chylothorax is a rare congenital condition associated with significant perinatal mortality and morbidity. Previous treatments with repeated thoracocentesis or thoracoamniotic shunting were technically demanding, and associated with significant procedure-related complications and neonatal complications. Here we report the first successful case in Hong Kong treated by a simple and effective intervention, namely pleurodesis with OK-432, in a fetus presenting at 20 weeks of gestation with bilateral pleural effusion.
SOTO-MARTINEZM,MASSIEJ.Chylothorax: diagnosis and management in children[J].,2009,10(4): 199-207.
Chylothorax is the accumulation of chyle in the pleural space, as a result of damage to the thoracic duct. Chyle is milky fluid enriched with fat secreted from the intestinal cells and lymphatic fluid. Chylothorax in children, is most commonly seen as a complication of cardiothoracic surgery but may occur in newborns or conditions associated with abnormal lymphatics. The diagnosis is based on biochemical analysis of the pleural fluid, which contains chylomicrons, high levels of triglycerides and lymphocytes. Investigations to outline the lymphatic channels can prove helpful in some cases. Initial treatment consists of drainage, dietary modifications, total parenteral nutrition and time for the thoracic duct to heal. Somatostatin and its analogue octreotide may be useful in some cases. Surgery should be considered for patients who fail these initial steps, or in whom complications such as electrolyte and fluid imbalance, malnutrition or immunodeficiency persist. Surgical intervention may be attempted thoracoscopically with repair or ligation of the thoracic duct.
WASMUTH-PIETZUCHA,HANSMANNM,BARTMANNP,et al.Congenital chylothorax: lymphopenia and high risk of neonatal infections[J].,2004,93(2): 220-224.
To describe the clinical course of patients with congenital chylothorax focusing on infectious complications. Congenital chylothorax is a common manifestation of non-immune hydrops fetalis (NIHF). The drainage of chyle leads to loss of cellular and plasmatic factors that influence the patient's immune response and increase the risk of infections.In a retrospective analysis of 24 preterm infants with NIHF treated between 1998 and 2002, congenital chylothorax was diagnosed in 7 patients.All 7 patients were treated conservatively with pleural drainage over a median period of 22 d (range 10-36 d). Lymphopenia was found in all patients (median of minimal lymphocyte counts 285/microl, range 80-770). The nadir was on day 5 (2-6 d). Lymphopenia lasted for 12 d median (range 4-39 d) and was significantly correlated with the duration of lymph drainage (p = 0.001). Cell-surface analysis of peripheral blood lymphocytes was performed in two patients. Both patients had a decreased number of total T cells. Four out of seven (57%) patients developed nosocomial infections. This incidence of nosocomial infections in patients with congenital chylothorax is about three times higher than that in other neonatal patients. None of the children suffered from fungal or viral infection. Although there was a very high incidence of infections, no correlation between lymphopenia and the occurrence of infections could be shown.Drainage of congenital chylothorax results in the loss of lymphocytes and bears a high risk of infections.
ROCHAG.Pleural effusions in the neonate[J].,2007,13(4): 305-311.
The ability to recognize, understand, and treat pleural effusions in the pediatric population is important for pediatric health care providers. The topic of pleural effusions has been extensively studied in the adult population. In recent years, these studies have extended into the pediatric population. This review describes pleural effusions in detail, including the different types and underlying pathophysiology. We then go on to provide a comprehensive review of the recent literature regarding the diagnosis and treatment of pleural effusions in the pediatric population.
Abstract The objective of this paper is a retrospective study of all infants treated for congenital chylothorax at the Royal Children's Hospital (RCH), Melbourne, Australia and King Fahad National Guard Hospital (KFNGH), Riyadh, Kingdom of Saudi Arabia. The charts of all infants with congenital chylothorax admitted to RCH over a period of 13 years, June 1982-August 1994, and admissions to KFNGH over a 7-year period, June 1992-August 1998 inclusive, were reviewed including management outcome and complications. There were 19 infants, 13 from RCH and 6 from KFNGH; 11 females and 8 males. Three infants were managed antenatally. Fifteen infants presented immediately after birth. Seven were born with hydrops fetalis, 6 infants had syndromes and 10 infants were born prematurely. Regular infant feeding formula and/or breast milk were used successfully in 12 infants, while in 7 infants medium chain triglycerides (MCT) rich formula was used. Sixteen infants were mechanically ventilated with 75% of them ventilated for < or = 28 days. Fifteen infants received total parenteral nutrition (TPN), and in 80% for < or = 32 days. Hydropic infants had longer duration of mechanical ventilation and hospital stay with mean (range) of 33.9 (3-120) and 115 (23-225) days, respectively, compared with 18 (1-62) and 34.3 (14-88) days for nonhydropic infants. Five infants underwent surgery with failure in four. Sepsis and bronchopulmonary dysplasia were the main complications. The survival rate was 100% regardless of the mode of therapy. The prognosis of Isolated congenital chylothorax in term, and preterm infants is good even in the presence of hydrops. Breast milk and/or regular infant feeding formula should be used initially before proceeding to MCT-rich formula, which may be necessary in some cases. Surgery should be considered if conservative management of congenital chylothorax fails after 4-5 weeks.
Abstract Neonatal chylothorax results from the accumulation of chyle in the pleural space and may be either congenital or an acquired condition. Congenital chylothorax is most likely due to abnormal development or obstruction of the lymphatic system. It is often associated with hydrops fetalis. It can be idiopathic or may be associated with various chromosomal anomalies including Trisomy 21, Turner syndrome, Noonan syndrome, and other genetic abnormalities. Congenital pulmonary lymphangiectasia and generalized lymphangiomatosis have also been reported to be associated with congenital chylothorax. Several case reports indicate that congenital chylothorax can recur in subsequent offspring, suggesting a possible underlying genetic etiology. It is important to identify infants with chylothorax, as there are specific issues that need to be addressed in the management of these patients. We present a case of newborn with trysomy 21 (trisomy 21 was diagnosed antenatally by amniocentesis with support of Association "Perinatology"), who developed moderate Respiratory Distress Syndrome, chest X-ray and US reveal pleural effusion on right side rapid intervention was made before deterioration, requiring intensive life-saving measures. In the neonate, chylous effusion is not a common cause of pleural effusions. It is characterized as an exudate because of the high protein and lipid content once the infant is fed. The fluid will be clear/yellow to slightly cloudy in the unfed state and will quickly become milky following feeding, as chylomicrons appear in the fluid. Lymphocytes predominate in the differential cell count of chyle. The volume of fluid output can be high, and management can be challenging. We review the common manifestations of congenital chylotoraxes and emphasize the importance of early diagnosis and intervention in preventing devastating outcomes from this condition.
CREMONINIG,POGGIA,CAPUCCIR,et al.Rare case of massive congenital bilateral chylothorax in a hydropic fetus with true mosaicism 47,XXX/46,XX[J].,2014,40(1): 259-262.
Fetal is a rare condition that occurs sporadically or can be associated with abnormal karyotype or structural . We report a unique case of fetal congenital bilateral associated with mosaicism 47,/46,XX. A female fetus affected by massive bilateral and ascites was diagnosed at 34(+1) weeks of . Previous ultrasonographic exams were completely normal. Immune causes of were excluded. Elective cesarean section was performed soon after bilateral thoracocentesis. The analysis of drained pleural fluid revealed its lymphatic nature. The fetal karyotyping, performed on chorionic villi at the 11th week, had shown mosaicism 47,/46,XX, later confirmed in the newborn's blood. We hypothesized that may be part of the phenotypic spectrum of 47 XXX karyotype and we suggest an ultrasound follow-up of the fetus at closer intervals than the routine timing for this condition, even if it is not usually characterized by severe phenotypic features.
Abstract The objective of this paper is a retrospective study of all infants treated for congenital chylothorax at the Royal Children's Hospital (RCH), Melbourne, Australia and King Fahad National Guard Hospital (KFNGH), Riyadh, Kingdom of Saudi Arabia. The charts of all infants with congenital chylothorax admitted to RCH over a period of 13 years, June 1982-August 1994, and admissions to KFNGH over a 7-year period, June 1992-August 1998 inclusive, were reviewed including management outcome and complications. There were 19 infants, 13 from RCH and 6 from KFNGH; 11 females and 8 males. Three infants were managed antenatally. Fifteen infants presented immediately after birth. Seven were born with hydrops fetalis, 6 infants had syndromes and 10 infants were born prematurely. Regular infant feeding formula and/or breast milk were used successfully in 12 infants, while in 7 infants medium chain triglycerides (MCT) rich formula was used. Sixteen infants were mechanically ventilated with 75% of them ventilated for < or = 28 days. Fifteen infants received total parenteral nutrition (TPN), and in 80% for < or = 32 days. Hydropic infants had longer duration of mechanical ventilation and hospital stay with mean (range) of 33.9 (3-120) and 115 (23-225) days, respectively, compared with 18 (1-62) and 34.3 (14-88) days for nonhydropic infants. Five infants underwent surgery with failure in four. Sepsis and bronchopulmonary dysplasia were the main complications. The survival rate was 100% regardless of the mode of therapy. The prognosis of Isolated congenital chylothorax in term, and preterm infants is good even in the presence of hydrops. Breast milk and/or regular infant feeding formula should be used initially before proceeding to MCT-rich formula, which may be necessary in some cases. Surgery should be considered if conservative management of congenital chylothorax fails after 4-5 weeks.
ERGAZZ,BAR-OZB,YATSIVI,et al.Congenital chylothorax: clinical course and prognostic significance[J].,2009,44(8): 806-811.
Abstract Objective To determine the underlying etiology, associated malformations, clinical course, and prognostic significance of congenital chylothorax. Study design A retrospective analysis of 11 neonates admitted to our neonatal intensive care unit with congenital chylothorax between January 2000 and June 2008. The post-discharge clinical and developmental course was evaluated by a telephone survey performed in July 2008. Results Antenatal diagnosis was established in 9 out of 11 infants by ultrasound examination; 5 had intrauterine pleural drainage. Eight infants had either structural or chromosomal abnormalities. The postnatal treatment included mechanical ventilation, drainage of pleural fluid and feeding with enriched medium chain triglyceride formula. Somatostatin was administered in one case. Six patients developed nosocomial infections. Two patients died after resolution of the chylothorax from deteriorating renal failure. Seven patients were traced for follow up and six of them achieved age appropriate developmental milestones. Conclusion The recovery from chylothorax and future prognosis were dependent on the underlying etiology. Chylothorax was often a secondary event, with apparently favorable clinical and developmental prognosis when the underlying or/and associated condition was treatable. Pediatr Pulmonol. 2009; 44:806鈥811. 漏 2009 Wiley-Liss, Inc.
MIYOSHIT,KATSURAGIS,IKEDAT,et al.Retrospective review of thoracoamniotic shunting using a double-basket catheter for fetal chylothorax[J].,2013,34(1): 19-25.
Abstract OBJECTIVE: From a single-center retrospective cohort with fetal chylothorax, we evaluated the factors related to the decision to use shunting, poor prognostic factors, and reported shunting outcomes with a new double basket-catheter device. METHODS: A retrospective single-center study was performed in 35 cases of fetal chylothorax. RESULTS: There were 35 cases of chylothorax: 23 with hydrops and 12 without hydrops. Twenty-one procedures were performed on 15 fetuses (11 with hydrops) with a single shunt in 11, two shunts in 3 and four shunts in 1. All 12 nonhydropic cases survived. In 23 hydropic cases, overall survival rates with and without thoracoamniotic shunting were 46 and 33%, respectively. The mortality rates of fetal hydropic cases with and without ascites were 93 and 11%, respectively. Fetal ascites, progression of fetal hydrops, and premature delivery at <33 weeks were significant risk factors for a poor prognosis. Progression of polyhydramnios after shunting was also associated with a poor prognosis. Obstruction of the catheter was observed in 38%. There were no direct fetal deaths associated with shunting. CONCLUSION: Thoracoamniotic shunting should be considered for pleural effusion before development of fetal hydrops, or at least before the appearance of fetal ascites. A double-basket catheter tends to be obstructive, but may be less invasive for fetuses. Copyright 漏 2013 S. Karger AG, Basel.
GUPTAV,MAHENDRI NV,TETEP,et al.Skimmed milk preparation in management of congenital chylothorax[J].,2014,51(2): 146-148.
Treatment for congenital chylothorax is based on adequate drainage of the pleural fluid and total parenteral nutrition followed by re-establishment of feeds using medium-chain-triglycerides based milk formulas which are expensive and not easily available.Two newborns (one term and one preterm) with congenital chylothorax.Skimmed milk preparation for enteral nutrition to provide high protein and low fat diet.Successful resolution of chylothorax.Skimmed milk preparation may be used for enteral nutrition of babies with congenital chylothorax where other feeding alternatives or commercial formulas are either not successful or are not available.
Background: Pleural effusion is rare and includes several disease entities in the neonatal period. The aim of this study was to investigate the etiology, management, and outcome of neonatal pleural effusions.<br/>Methods: We retrospectively collected all neonates who were admitted to the neonatal intensive care unit of Chung Shan Medical University Hospital, Taichung, Taiwan, with discharge diagnosis of pleural effusion, chylothorax, hydrothorax, hemothorax, and empyema, from January 1999 to December 2009. The characteristics, etiology, management, and outcome were analyzed.<br/>Results: There were 21 patients identified, 16 males (76%) and 5 females (24%). Eight patients (38%) had primary and 13 patients (62%) had secondary etiologies. The etiologies included four parapneumonic effusions or empyema (19%); nine chylothorax (42.8%) with four congenital and five iatrogenic after thoracic surgery; three percutaneously inserted central venous catheter extravasation (14%); one umbilical venous catheter extravasation (4.7%); three hydrops fetalis (14%); and one congestive heart failure (4.7%). Fifteen patients (71%) needed chest tube placement. Conservative management with complete cessation of enteral feedings and use of total parenteral nutrition followed with infant formula containing medium-chain triglyceride was successful in six of the patients (67%) with chylothorax. There were two patients (22%) with chylothorax who received somatostatin administration; one was successful and the other one failed. Thoracic duct ligation was performed uneventfully in two patients with acquired chylothorax. There were three mortalities (14.3%) in this study, which were related to causes other than pleural effusion.<br/>Conclusions: Pleural effusions in the neonatal stage may result from chylothorax, hydrops fetalis, extravasation of percutaneously inserted central venous catheter, parapneumonic effusion, congestive heart failure, or other less frequently occurring conditions. Diagnostic chest tap is required for subsequent management. Good outcome is the rule except in hydrops fetalis, which carries high mortality rate. Copyright (C) 2011, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.
CLEVELANDK,ZOOKD,HARVEYK,et al.Massive chylothorax in small babies[J].,2009,44(3): 546-550.
Surgery has a definitive role in the care of small babies with massive chylothorax. Daily output exceeding 50 mL/kg per day with no or minimal response to 3 days of maximal medical therapy may indicate a potential therapeutic benefit of surgery.
BEGHETTIM,LA SCALAG,BELLID,et al.Etiology and management of pediatric chylothorax[J].,2000,136(5): 653-658.
To determine the incidence and etiology of chylothorax and to assess our therapeutic management approach.We reviewed 51 patients diagnosed with chylothorax over a 12-year period. Cause, interval between operation and diagnosis, duration of chylothorax, and total volume loss per weight were recorded.Chylothorax was diagnosed in 46 children after cardiothoracic surgery, giving an incidence of 2.5% (46/1842); in 1 child chylothorax occurred after chest trauma, and in 4 the chylothorax was congenital or a manifestation of lymph angiomatosis. Three etiologic groups were identified: group 1, direct injury to the thoracic duct (33/51 = 65%); group 2, thrombosis and/or high venous pressure in the superior vena cava (14/51 = 27%); and group 3, congenital (4/51 = 8%). Conservative treatment was the only treatment in 80% of the patients. Surgical procedures consisted of 4 ligations of the thoracic duct, placement of 7 pleurodesis shunts, and placement of 2 pleuroperitoneal shunts. Patients in groups 2 and 3 were at higher risk for failure of conservative treatment (P <. 005). Longer duration of chylothorax and higher volume of drainage were present in group 2 compared with group 1 (P <.01).Conservative treatment was successful in 80% of the patients with our management approach. Prevention, early recognition, and treatment of potential complications, such as superior vena cava thrombosis or obstruction, may further improve success of conservative treatment. Congenital chylothorax seems different and may require a specific approach.
AUM,WEBER TR,FLEMINGl RE.Successful use of somatostatin in a case of neonatal chylothorax[J].,2003,38(7): 1106-1107.
A 2-week-old infant status postrepair of gastroschisis had spontaneous bilateral chylothoraces necessitating thoracostomy drainage. Voluminous chylous drainage persisted despite cessation of enteral feedings. On administration of the somatostatin analogue octreotide, pleural drainage diminished markedly and ceased entirely within 4 days. These results, along with reported successes in treatment of chylothorax after thoracic surgery, support the prospective investigation of somatostatin use in problematic chylothorax.
FUJITAT,DAIKOH.Efficacy and predictor of octreotide treatment for postoperative chylothorax after thoracic esophagectomy[J].,2014,38(8): 2039-2045.
Postoperative chylothorax sometimes follows thoracic esophagectomy for esophageal cancer. The effectiveness of octreotide treatment for it and factors that predict its response are unclear. This study aimed to evaluate the efficacy of octreotide for treating postoperative chylothorax following thoracic esophagectomy for esophageal cancer and factors that might predict successful treatment and allow chest drain removal.<br/>We assessed 521 consecutive patients who underwent thoracic esophagectomy for esophageal cancer to investigate the efficacy of octreotide for postoperative chylothorax. Among those with postoperative chylothorax, one group (group A) underwent conservative management, and the other (group B) was treated conservatively with added octreotide administration. We evaluated the clinical outcomes after octreotide administration and assessed the factors associated with successful treatment.<br/>Among the 521 patients, 20 (3.8 %) developed postoperative chylothorax: five in group A and 15 in group B. Two of the five (20 %) group A patients and 13 of the 15 (86.6 %) group B patients were treated successfully (p = 0.03). Factors significantly associated with treatment failure were (1) chest drain output of > 1,000 ml/day before treatment (p = 0.04); (2) no reduction in chest drainage by the second day of treatment (p = 0.016); (3) chest drainage of > 1,000 ml/day through the second day of treatment (p = 0.006).<br/>For patients with esophageal cancer who undergo thoracic esophagectomy, octreotide can be an effective treatment for postoperative chylothorax.
WHITE SC,SECKELER MD,MC CULLOCH M A,et al.Patients with single ventricle anatomy may respond better to octreotide therapy for chylothorax after congenital heart surgery[J].,2014,29(2): 259-264.
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PARAMESF,FREITASI,FRAGATAJ,et al.Octreotide--additional conservative therapy for postoperative chylothorax in congenital heart disease[J].,2009,28(7-8): 799-807.
INTRODUCTION: is a rare but serious postoperative condition in children with . Conventional medical treatment consists of specific long-term dietary modification, and surgical reintervention, such as lymphatic duct ligation, may be indicated in refractory cases. In recent years, an additional conservative treatment, octreotide, a synthetic analog of somatostatin, has been used in management of congenital and postoperative .: The objective of this work was to analyze the efficacy and safety of this treatment for after congenital heart surgery. We reviewed the records of sixteen patients with after surgery for between January 1999 and December 2007, and collected the following data: demographic information; type of surgical procedure; onset, duration and management of and treatment; and duration of hospital stay. To analyze efficacy we compared these parameters in children receiving conventional treatment only with those receiving octreotide. To analyze safety we compared the adverse effects of both treatments. Octreotide was administered at a dose of 4 to 10 microg/kg/hour, with monitoring of side effects.: The incidence of in our population was 1.6%. It occurred more often after Glenn and Fontan procedures (8 patients). Octreotide was begun three days after diagnosis of and continued for a median of seventeen days (ranging from 4 to 26 days), until complete resolution. Side effects were frequent (in 3 of the 8 patients) but of no clinical relevance. All patients responded to the therapy and there was no indication for further surgical intervention.: Octreotide is safe and effective in the treatment of postoperative in children with . It is a useful adjunctive therapy to the conventional treatment of this complication.
JARIR RA,RAHMAN SU,BASSIOUNY IS.Use of octeriotide in the management of neonatal chylothorax secondary to repair of congenital diaphragmatic hernia: a report of two cases and review of literature[J].,2012,1(2): 91-95.
Chylothorax, a known complication of surgery for Congenital Diaphragmatic hernia, can sometimes be resistant to treat. Octeriotide (Somatostatin analogue) can be useful in this situation. However, the dose and schedule of Octeriotide therapy in neonates is not well established. We report two cases of resistant chylothorax following surgery for congenital diaphragmatic hernia which were successfully managed by using an escalating infusion of octeriotide. The literature on the subject is also reviewed.
LAJEP,HALABYL,ADZICK NS,et al.Necrotizing enterocolitis in neonates receiving octreotide for the management of congenital hyperinsulinism[J].,2010,11(2): 142-147.
The analog was used for the first time in the treatment of an infant with in 1986. Since then, it is commonly used in the management of congenital hyperinsulinemic . Despite a wide variety of potential adverse reactions, is generally well tolerated. It has been extensively demonstrated that reduces the splanchnic blood flow in a dose-dependent manner, affecting the entire gastrointestinal tract, and some concern has been recently raised regarding the potential implications of this effect in the development of in neonates receiving for the management of . The aim of this report is to present a series of patients treated at our institution in which we observed this association, and review the current related literature.
MATSUKUMAE,AOKIY,SAKAIM,et al.Treatment with OK-432 for persistent congenital chylothorax in newborn infants resistant to octreotide[J].,2009,44(3): 37-39.
Chylothorax is a relatively uncommon condition defined as an abnormal collection of lymphatic fluid within the pleural space. We are reporting the use of OK-432 for treatment of prolonged idiopathic congenital chylothorax in 2 newborn infants who failed to respond to conservative medical therapy, including octreotide injection.
OGITAS,TSUTOT,NAKAMURAK,et al.OK-432 therapy in 64 patients with lymphangioma[J].,1994,29(6): 784-785.
Intralesional injection of OK-432 was employed to treat 64 lymphangiomas between 1986 and 1992. This was used as primary therapy for 46 lesions (group A), as treatment following incomplete surgical removal in 14 (group B), and as therapy after failure of bleomycin in 4 (group C). In group A (n = 46), total shrinkage of the lesion, without serious complications, was noted in 23; there was marked shrinkage in 8, slight shrinkage in 12, and no response in 3. Of the cystic lesions (n = 24), significant shrinkage occurred in 22; of the cavernous lesions (n = 22), only 9 improved after treatment. In groups B (n = 14) and C (n = 4) there was significant clinical improvement occurred in 5 and 2, respectively. No recurrence was noted during follow-up (6 to 87 months). The only side effects were fever lasting 2 to 4 days and a local inflammatory reaction of 3 to 7 days' duration. The local inflammation did not cause any damage to the overlying skin and did not lead to scar formation. These data suggest that intralesional injection of OK-432 is effective treatment for lymphangiomas and should be considered as the primary method of treatment.
KIM JE,LEEC,PARK KI,et al.Successful pleurodesis with OK-432 in preterm infants with persistent pleural effusion[J].,2012,55(5): 177-180.
OK-432 (picibanil) is an inactivated preparation of Streptococcus pyogenes that causes pleurodesis by inducing a strong inflammatory response. Intrapleural instillation of OK-432 has recently been used to successfully treat neonatal and fetal chylothorax. Here we report a trial of intrapleural instillation of OK-432 in two preterm infants who were born with hydrops fetalis and massive bilateral pleural effusion. Both cases showed persistent pleural effusion, refractory to conservative treatment, up to postnatal days 26 and 46, respectively. An average of 80 to 140 mL of pleural fluid was drained daily. In case 1, the infant was treated with OK-432 during the fetal period at gestation 28 weeks and 4 days of gestation, but showed recurrence of pleural effusion and progressed into hydrops. Within two to three days after OK-432 injection, the amount of pleural fluid drainage was dramatically decreased and there was no reaccumulation. We did not observe any side effects related to OK-432 injection. We suggest that OK-432 should be considered as a therapeutic option in infants who have persistent pleural effusion for more than four weeks, with the expectation of the early removal of the chest tube and a good outcome.
XU ZH,WANG CF,ZHANG YQ,et al.A case of chylothorax treated curatively with Sapylin,a streptococcus preparation[J].,2007,8(12): 885-887.
Chylothorax is an uncommon disease where fatty fluid accumulates within the chest cavity. Conservative management, including repeated thoracentesis or pleurodesis, seems to be suitable to most cases. Herein, we present a case of efficacious pleurodesis by intrapleural injection of Sapylin, a streptococcus preparation, for the treatment of chylothorax. A 52-year-old non-smoking female farmer was diagnosed as idiopathic chylothorax after we ruled out possible causes including chest trauma, lymphoma, lung cancer, filariasis, tuberculosis, and etc. Two-time intra-thoracic injection of 3 Klinische Einheit (KE) Sapylin achieved rapid and effective control of chylothorax with no severe side effects. Sapylin may facilitate pleurodesis by producing a strong inflammatory response.
Use of octeriotide in the management of neonatal chylothorax secondary to repair of congenital diaphragmatic hernia: a report of two cases and review of literature