Traumatic chylothorax in a young child: Case report and management.

INTRODUCTION: A chylothorax is an uncommon feature of paediatric chest trauma. CASE REPORT: We report a case of traumatic chylothorax following blunt chest trauma in an eight year-old girl with polytrauma after being hit by a motor vehicle. She was initially found to have a bilateral frontal skull fracture extending into the left parietal area, pulmonary contusions, left posterior rib fractures, left clavicular fracture and a degloving injury of her left foot. On the fifth day of her admission she developed progressive dyspnoea with signs of a pleural effusion, which was confirmed radiologically and drained by tube thoracostomy. Biochemical analysis confirmed chylothorax, which was managed conservatively with a fat free diet. The chest tube was removed after it stopped draining over 20 mL per 12 hours and she made a full recovery. DISCUSSION: Initial management of chylothorax is conservative with tube thoracostomy drainage and fat free diet. Traumatic chylothroax is a rare complication following chest trauma and can take days to develop and to become clinically apparent. It is therefore important to be vigilant for potential late complications in blunt chest trauma in children, especially if there are extensive rib fractures, a sign of major transmission of force to the thorax.

INTRODUCTION: Un chylothorax est une caractéristique clinique peu fréquente des traumatisme du thorax chez l'enfant. OBSERVATION: Nous signalons un cas de chylothorax traumatique suite à un traumatisme du thorax contondant chez une fillette de huit ans souffrant d'un polytraumatisme après avoir été percutée par un véhicule motorisé. Elle a d'abord été diagnostiquée avec une fracture frontale bilatérale du crâne s'étendant à la zone du pariétal gauche, des contusions pulmonaires, des fractures de la cage thoracique au niveau postérieur gauche, une fracture de la clavicule gauche et un dégantage du pied gauche. Au cinquième jour de son admission, elle a développé une dyspnée progressive avec des signes d'effusion pleurale, confirmée par radiologie, et drainée par tube de thoracostomie. Les analyses biochimiques ont confirmé un chylothorax, géré de manière conventionnelle par un régime sans matières grasses. Le drain thoracique a été retiré une fois le drainage passé à moins de 20 millilitres toutes les 12 heures et elle s'est totalement rétablie. DISCUSSION: La gestion initiale du chylothorax est conventionnelle, avec un drainage par tube de thoracostomie et un régime alimentaire sans matières grasses. Le chylothorax est une complication rare des traumatismes du thorax et peut mettre plusieurs jours à se développer et à apparaître cliniquement. Par conséquent, il est important de rester vigilant afin de détecter d'éventuelles complications tardives en cas de traumatisme du thorax contondant chez les enfants, notamment en cas de fractures graves de la cage thoracique, un signe de transmission de force majeure au niveau thoracique.

Stem cells and their role in renal ischaemia reperfusion injury.

BACKGROUND: Ischaemia-reperfusion injury (IRI) remains one of the leading causes of acute kidney injury (AKI). IRI is an underlying multifactorial pathophysiological process which affects the outcome in both native and transplanted patients. The high morbidity and mortality associated with IRI/AKI and disappointing results from current available clinical therapeutic approaches prompt further research. Stem cells (SC) are undifferentiated cells that can undergo both renewal and differentiation into one or more cell types which can possibly ameliorate IRI. AIM: To carry out a detailed literature analysis and construct a comprehensive literature review addressing the role of SC in AKI secondary to IRI. METHODS: Evidence favouring the role of SC in renal IRI and evidence showing no benefits of SC in renal IRI are the two main aspects to be studied. The search strategy was based on an extensive search addressing MESH terms and free text terms. RESULTS: The majority of studies in the field of renal IRI and stem cell therapy show substantial benefits. CONCLUSIONS: Studies were mostly conducted in small animal models, thus underscoring the need for further pre-clinical studies in larger animal models, and results should be taken with caution. SC therapy may be promising though controversy exists in the exact mechanism. Thorough scientific exploration is required to assess mechanism, safety profile, reproducibility and methods to monitor administered SC.

A brief recap of tips and surgical manoeuvres to enhance optimal outcome of surgically placed peritoneal dialysis catheters.

Background. Peritoneal dialysis (PD) is an effective option of renal replacement therapy for ESRF, offering advantages over haemodialysis. Peritoneal dialysis catheter (PDC) placement is thought to be the key to successful PD and the economic advantages are lost if a patient switches to HD in the 1st year. This paper is a brief document elaborating a recap of published literature, looking at various surgical tips and manoeuvres to enhance optimal outcome of PDC placement. Methods. A search strategy assessing for access team, preoperative antibiotic prophylaxis, type of catheter, catheter exit site, intraoperative catheter trial, optimal time to commence PD, hernia repairs, number of cuffs, catheter-embedding procedures, rectus sheath tunnelling, laparoscopic fixing, omentopexy, omentectomy, the "Y"-Tec system, resection of epiploic appendages, adhesiolysis, a trained surgeon, and perioperative catheter care protocol was used looking at various databases. Findings. The complications of catheterrelated dysfunction can be reduced with advanced planning of access placement, immaculate surgery, and attention to catheter insertion techniques. Conclusion. The success of a peritoneal dialysis programme depends upon functional and durable long term access to the peritoneal cavity; this depends on placement techniques and competent surgeons and psychosocial support to the patient. The various technical tips and manoeuvres elaborated here should be considered options carried out to improve outcome and reduce catheter dysfunction.

Extending anatomic barriers to right laparoscopic live donor nephrectomy.

OBJECTIVE: To analyze the effects of a right-sided-complex laparoscopic live donor nephrectomy, defined as bifurcation of the right renal artery behind the inferior vena cava. Right-sided laparoscopic live donor nephrectomy is now a widely accepted procedure when complex anatomy is encountered on the left. TECHNICAL CONSIDERATIONS: The present retrospective case note review involved 59 of 303 laparoscopic live donor nephrectomy procedures performed in a single center from January 2001 to April 2010 (group 1, simple, n=48; and group 2, complex, n=11). The effect of a donor right procedure on warm ischemia, graft function, and donor/recipient complications was analyzed. RESULTS: No difference in donor or recipient age or first and second warm ischemic times was found between the 2 groups. No difference was found in the estimated glomerular filtration rate or serum creatinine at 1 week and 3 and 6 months [estimated glomerular filtration rate (6/12), 49±15 vs 60±9 mL/min, P=.087; and serum creatinine (6 months), 159±116 vs 120±25 µmol/L; P=.356]. No cases of delayed graft function were reported, and none of the grafts developed vascular thrombosis. The cumulative estimated glomerular filtration rate at 6/12 was 51±15 mL/min and the serum creatinine was 153±108 µmol/L. Two patients (4%) required conversion to open surgery in group 1, and the cumulative conversion rate was 3.3%. In the complex group with retrocaval dissection, 8 kidneys were retrieved with a single artery and 3 had multiple vessels (2 with 2 vessels and 1 with 3 vessels; anastomotic time 26±6 minutes). CONCLUSION: Complex vasculature in a right-sided donation should not be considered a contraindication, because the kidneys procured had excellent function compared with those with single vasculature with no increase in the conversion or vascular thrombosis rate. In addition, the described techniques permit improved arterial length and, importantly, organs procured with a single artery.