Chloride Reduction Therapy with Furosemide: Short-Term Effects in Children with Acute Respiratory Failure.

From the perspective of the Stewart approach, it is known that expansion of the sodium chloride ion difference (SCD) induces alkalosis. We investigated the role of SCD expansion by furosemide-induced chloride reduction in pediatric patients with acute respiratory failure. We included patients admitted to our pediatric intensive care unit intubated for acute respiratory failure without underlying diseases, and excluded patients receiving extracorporeal circulation therapy (extracorporeal membrane oxygenation and/or renal replacement therapy). We classified eligible patients into the following two groups: case-those intubated who received furosemide within 24 hours, and control-those intubated who did not receive furosemide within 48 hours. Primary outcomes included SCD, partial pressure of carbon dioxide (PaCO 2 ), and pH results from arterial blood gas samples obtained over 48 hours following intubation. Multiple regression analysis was also performed to evaluate the effects of SCD and PaCO 2 changes on pH. Twenty-six patients were included of which 13 patients were assigned to each of the two groups. A total of 215 gas samples were analyzed. SCD (median [mEq/L] [interquartile range]) 48 hours after intubation significantly increased in the case group compared with the control group (37 [33-38] vs. 31 [30-34]; p = 0.005). Although hypercapnia persisted in the case group, the pH (median [interquartile range]) remained unchanged in both groups (7.454 [7.420-7.467] vs. 7.425 [7.421-7.436]; p = 0.089). SCD and PaCO 2 were independently associated with pH ( p < 0.001 for each regression coefficient). As a result, we provide evidence that SCD expansion with furosemide may be useful in maintaining pH within the normal range in pediatric patients with acute respiratory failure complicated by concurrent metabolic acidosis.

Hematological and biochemical characteristics and diagnostic imaging results in acute T cell-mediated rejection after pediatric liver transplantation.

BACKGROUND: Liver biopsy is the gold standard for diagnosing TCMR after LT. However, complications caused by liver biopsy may occur especially during the immediate post-transplantation period and other effective methods for predicting TCMR have not been established. Thus, we investigated whether hematological and biochemical characteristics and Doppler ultrasonography findings are associated with acute TCMR. METHODS: A multiple logistic regression analysis was performed to identify the prognostic factors of acute TCMR, defined as a RAI ≥4. Then, a ROC curve analysis was conducted to evaluate for diagnostic performance. The relationship between prognostic factors and each histological category of RAI was investigated. RESULTS: Eighty-nine liver biopsies were performed on 85 patients between January 2012 and December 2019. The RAI of 62 (69.7%) liver biopsies was ≥4. AEC (×104 /µl), direct bilirubin level (mg/dl), and MHVV (cm/s) were found to be associated with acute TCMR (OR: 4.96, 95% CI: 1.44-17.0, p = .011; OR: 1.41, 95% CI: 1.04-1.91, p = .025; OR: 1.05, 95% CI: 1.02-1.08, p < .001, respectively). The area under the ROC curves for predicting acute TCMR was 0.86 (95% CI: 0.78-0.94). There was a correlation between AEC, direct bilirubin level, and MHVV as well as the severity of RAI. CONCLUSIONS: AEC, direct bilirubin level, and MHVV were the independent risk factors for acute TCMR. This study could provide information regarding the identification of patients requiring liver biopsy.

Impact of extensive negative pressure wound therapy on neonatal respiration: A case report.

An extensive topical negative pressure wound therapy (NPWT) from the abdominal to chest walls in neonates may decrease the compliance of the chest wall. Therefore, it is important to monitor respiratory function carefully during the procedure.

Ultrasound-Guided Postpyloric Feeding Tube Placement in Critically Ill Pediatric Patients.

OBJECTIVES: Various methods to insert postpyloric feeding tubes at the bedside have been reported, but the optimal method remains controversial. The objective of this study was to evaluate the effect of ultrasound-guided postpyloric feeding tube placement in critically ill children. DESIGN: Single-center retrospective observational study. SETTING: PICU of tertiary children's hospital. PATIENTS: Children under the age of 16 who underwent postpyloric feeding tube placement in our PICU between September 2017 and August 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 115 patients were included in this study: 30 patients underwent ultrasound-guided postpyloric feeding tube placement and 85 patients underwent blind postpyloric feeding tube placement; the insertion attempts were 32 and 93, respectively. There were no significant differences in patient demographics between the ultrasound-guided group and the blind group. The first-pass success rate of the ultrasound-guided group was higher than that of the blind group (94% [30/32] vs 57% [53/93]; p < 0.001). The median insertion time in the ultrasound-guided group with successful postpyloric feeding tube insertion was 18 minutes (interquartile range, 15-25; range, 8-45; n = 21). There were no complications or adverse events during the placement. CONCLUSIONS: In this single-center study, ultrasound-guided postpyloric feeding tube placement was feasible and a significantly high first-pass success rate was observed for critically ill children. Additional investigation with a larger pool of operators and randomized controlled patient assignment is required.

[Studies on the distribution of doripenem in pancreatic tissues, especially on the importance of the ratio in pancreatic tissue concentration of doripenem/serum concentration of doripenem].

Doripenem (DRPM) which is injectable carbapenem antimicrobial agent is a compound with high antimicrobial activity against severe acute pancreatitis in carbapenem agents. It does not have a report of the distribution in human pancreatic tissue until now. This time, we performed examination about the distribution in pancreatic tissue of DRPM. Blood and pancreatic tissues were collected from six patients who were administered DRPM intravenously at a dose of 0.5 g after 1 hour from the start of injection. The concentration of DRPM in the serum and pancreatic tissues were measured. The concentrations of DRPM in the pancreatic tissues and serum were 0.58-5.39 microg/g and 0.02-0.24 microg/mL, respectively. DRPM distributed in pancreatic tissues sufficiently, and we could expect that DRPM was useful agent of pancreas infection in acute pancreatitis.

Proposal for a morphological classification of intraductal papillary neoplasm of the bile duct (IPN-B).

PURPOSE: We propose a morphological classification of intraductal papillary neoplasm of the bile duct (IPN-B). METHODS: A retrospective analysis of 16 patients with IPN-B who had undergone surgical resection was conducted. These 16 cases were classified into three types based on the primary lesion's anatomical location: branch duct type (6 cases), main duct type (5 cases) and mixed type (5 cases). In this paper we have analyzed the characteristics of IPN-B according to our new classification. RESULTS: All branch duct type IPN-B was located in the left lobe and 5 of them were resected by left hepatectomy without extrahepatic bile duct resection (EBDR). On the other hand, all patients with main duct and mixed type IPN-B underwent EBDR in addition to hepatectomy or pancreatoduodenectomy. Microscopically, 2 of 6 patients with branch duct type IPN-B had no malignant component and, in the remaining 4 patients, cancer invasion was restricted to within the ductal wall. There were no cases of branch duct type IPN-B with lymph node metastasis and superficial intraductal tumor spread. In contrast, all patients with main duct and mixed duct type IPN-B had the malignant component. In all cases, lymph node metastasis was not observed, but superficial intraductal tumor spread was frequently found in extrahepatic bile duct lesions: 3 of main duct type and 3 of mixed type. Four patients with superficial intraductal spread had non-curative resection due to a cancer-positive ductal margin. Most patients with IPN-B obtained a good prognosis, but two patients with a cancer-positive ductal margin developed local recurrence. CONCLUSIONS: Our classification vividly reflects clinical and pathological characteristics of IPN-B and is useful to determine appropriate surgical strategy.

Liver retransplantation with external biliary diversion for progressive familial intrahepatic cholestasis type 1: a case report.

PFIC1, originally described as "Byler disease," is characterized by cholestatic feature and chronic diarrhea. Many patients require LT for the cure, but intractable diarrhea and prolonged growth retardation after LT are serious complications limiting the ultimate outcome of LT for this disease. EBD has recently been shown to be a promising and effective treatment. Recently, we successfully treated a five-yr-old boy with PFIC1 employing EBD after re-transplantation. The patient received LDLT at the age of one yr. Six months after initial transplantation, he developed repeated attacks and diarrhea followed by the development of liver dysfunction and ascites. Liver biopsy at three yr after LDLT revealed the features of chronic graft rejection. With a diagnosis of chronic graft rejection with liver failure, we performed a repeat LDLT with EBD in which the jejunal loop used for hepaticojejunostomy was taken out of the body surface through the abdominal wall. Ten months after surgery, he is doing well, having no attack of diarrhea.

[Three cases of advanced breast cancer successfully treated with a weekly dose of paclitaxel].

We report three cases with advanced breast cancer were treated with a weekly dose of paclitaxel (TXL). Case 1: A 52-year-old female, diagnosed as having bilateral breast cancer with metastatis to right lung (S9) and sternum. A TXL weekly regimen was started (80 mg/m2 with the administration of the drug for three weeks followed by one week rest as one course). After twelve courses of treatment, bilateral breast masses significantly regressed with the disappearance of bilateral axillary and parasternal lymph node metastasis. The tumor marker was normalized, too. After two years and four months, the patient is still alive and continuing the weekly TXL regimen. Case 2: A 51-year-old female with right breast cancer and skin ulcer formation. After completing two courses of weekly TXL regimen, her mass was markedly reduced in size, which made it possible for her to undergo a modified mastectomy. Case 3: A 52-year-old female with breast cancer which invaded the skin. As a result of two courses of weekly TXL therapy, the tumor responded significantly and a modified mastectomy was conducted. The TXL weekly regimen seems to be very effective in regressing breast tumors and can be given safely in the outpatient setting with an extremely high utility profile as neoadjuvant chemotherapy as well.