Introduction. Chylothorax is a rare condition that results from abnormal accumulation of lymphatic fluid in the chest and one of the most common causes of pleural effusion in newborns. The aim of our study is to present our own experience of chemical pleurodesis using povidone-iodine in newborns with chylothorax. Materials and methods. In the present study, we studied data from 10 patients with chylothorax who, over the past years, starting in 2016, underwent chemical pleurodesis using the drug povidone-iodine. Congenital accumulation of lymph in the pleural cavity was recorded in 2 patients, acquired in 8 patients. The indications for this procedure were the absence of response to total parenteral nutrition for at least 10 days and the appointment of octreotide at the maximum dosage. Pleurodesis consisted in the introduction into the pleural cavity of a 4% solution of povidone-iodine with a calculated dose of 1 ml/kg. The povidone-iodine solution was kept inside the pleural cavity for the next 4 hours. Results. Chemical pleurodesis was successfully applied in all 10 patients. In 8 patients, a single prescription of the drug was sufficient, and in 2 remaining patients, the pleurodesis session was repeated. After the procedure of chemical pleurodesis, 2 patients developed respiratory distress syndrome caused by massive atelectasis of the homolateral lung, which was confirmed by X-ray examination. These patients required mechanical ventilation for 24 and 48 hours. The average time for the disappearance of chylothorax was 4 days. In the long-term follow-up, 1 patient died from progressive deterioration of pulmonary function against the background of lung hypoplasia. Conclusions. Our data demonstrate that povidone iodine pleurodesis is a effective treatment for chylothorax in newborns.
Currently, the two main causes of diseases of the gallbladder in children are biliary dyskinesia and the formation of gallbladder stones. Biliary dyskinesia is an independent disease and is caused mainly by reduced motility of the gallbladder, which leads to its insufficiently good emptying and is accompanied by chronic pain abdominal syndrome. The causes of stone formation in children differ from the sources of stone formation in adults. Metabolic disorders, mainly against the background of obesity, lead to the formation of cholesterol stones, which is the most common cause of cholelithiasis in children. Blood diseases is another factor of cholelithiasis associated with hemolysis, such as sickle cell anemia, hereditary spherocytosis, and thalassemia. Symptoms of gallbladder disease are mainly in chronic abdominal pain syndrome. Inflammation of the gallbladder is a fairly rare form of the course of gallstone disease in children. The current surgical technology for treatment of gallbladder diseases in children, as in adults, is cholecystectomy, which can be realized depending on the degree of mastery of endosurgical skills using standard four-port laparoscopic techniques or a single laparoscopic approach. This review addresses the issues of semiotics, etiology, diagnosis, and surgical treatment of gallbladder disease in pediatric patients. The scientific work answers many controversial questions regarding the diagnosis of biliary dyskinesia, the choice of diagnostic method for concomitant choledocholithiasis, and the selection of the most effective surgical approach.
Introduction. Transluminal endoscopic surgery performed through natural orifices can reduce the incidence of complications associated with the surgical procedure and the incidence of postoperative complications. The purpose of this study was to determine the feasibility of performing an experimental gastroenteroanastomosis in a live pig model using NOTES. Materials and methods. The experimental study was performed on living laboratory models pigs weighing from 25 to 30 kg. The studys preliminary phase allowed working out the technique using two animals removed from the experiment after its successful completion. The final phase included the implementation of gastrojejunoanastomosis in six animals with subsequent observation. In three animals, the procedure was performed with laparoscopic assistance using a single-channel video gastroscope. In the other three animals, it was performed without laparoscopy using a two-channel video gastroscope. Antibiotic therapy continued for seven days after surgery. The surviving animals were removed from the experiment after four weeks. Patency of the anastomosis was confirmed by repeated endoscopy and histological analysis of tissues. Results. All procedures were completed successfully in six animals (three males and three females). The formation of anastomosis required an average of 133.3 43.8 minutes (range, 80200 minutes). In one animal, bleeding during gastric wall incision was recorded and was stopped by electrocoagulation. One animal died because of an anastomotic leak and peritonitis, confirmed by autopsy. In the five surviving animals, repeated endoscopy demonstrated fully passable anastomoses covered by the mucosa. Conclusion. Gastrojejunal anastomosis using NOTES technology is technically possible but requires additional study.
For the first time, the congress was held online. For two days, 25 speakers from 9 countries shared their knowledge with the audience. Broadcasts of reports and symposia were attended by about 1,500 people worldwide.
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