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1. Chylothorax after surgery on congenital heart disease in newborns and infants -risk factors and efficacy of MCT-diet

Author

Schlensak Christian, Schulte-Mönting Jürgen, Glöckler Martin, Arnold Raoul, Zürn Christoph, Biewer Eva S, and Dittrich Sven

Subjects
Surgery, RD1-811, Anesthesiology, RD78.3-87.3
Abstract

Abstract Objectives To analyze risk factors for chylothorax in infants after congenital heart surgery and the efficacy of median chain triglyceride diet (MCT). To develop our therapeutic pathway for the management of chylothorax. Patients and methods Retrospective review of the institutional surgical database and patient charts including detailed perioperative informations between 1/2000 and 10/2006. Data analyzing with an elimination regression analysis. Results Twenty six out of 282 patients had chylothorax (=9.2%). Secondary chest closure, low body weight, small size, longer cardiopulmonary bypass (242 ± 30 versus 129 ± 5 min) and x-clamp times (111 ± 15 versus 62 ± 3 min) were significantly associated with chylothorax (p < 0.05). One patient was cured with total parenteral nutrition (TPN) and one without any treatment. 24 patients received MCT-diet alone, which was successful in 17 patients within 10 days. After conversion to regular alimentation within one week only one chylothorax relapsed. Out of 7 patients primarily not responsive to MCT-diet, 2 were successfully treated by lysis of a caval vein thrombosis, 2 by TPN + pleurodesis + supradiaphragmatic thoracic duct ligation, one by octreotide treatment, and two patients finally died. Conclusions Chylothorax may appear due to injury of the thoracic duct, due to venous or lymphatic congestion, central vein thrombosis, or diffuse injury of mediastinal lymphatic tissue in association with secondary chest closure. Application of MCT alone was effective in 71%, and more invasive treatments like TPN should not be used in primary routine. After resolution of chylothorax, MCT-diet can be converted to regular milk formula within one week and with very low risk of relapse.

Published
2010
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2. Transanal total mesorectal excision: international registry results of the first 720 cases

Author

Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, Albert M, Al Furajii H, Allison A, Arezzo A, Aryal K, Ashraf S, Atallah S, Baig K, Baral J, Bemelman W, Berger D, Boni L, Bonjer J, Bordeianou L, Borreca D, Buchs NC, Cahill R, Campbell K, Capolupo G, Caricato M, Cassinotti E, Chambers W, Courtney ED, Cunningham C, Dalton S, Dawson R, Delrio P, de Graaf E, De Paolis P, D'Hondt M, D'Hoore A, Doornebosch P, Erikson JR, Estevez-Schwarz L, Fabryko M, Fernandez-Hevia M, Forsmo H, Francis N, Garimella V, Gecim IE, Geissmann D, Gill K, Glockler M, Grieco M, Grolich T, Guy R, Hayes J, Hoffman TJ, Houben B, Ito M, Jelic F, Jones O, Joy H, Kala Z, Katory M, Kneist W, Knol J, Korsgen S, Kukreja N, Kunz R, Lacy A, Lal R, Lang H, La Vaccara V, Lezoche E, Lima MA, Mamedli Z, Mansfield S, Marsanic P, Mellano A, Mendes CRS, Merrie A, Miles A, Miroshnychenko Y, Morino M, Muratore A, Nicol D, Oh JH, O'Loughlin P, Pandey S, Paraoan M, Pei CFW, Perez RO, Pfeffer F, Picchetto A, Pockney P, Radley S, Rasulov A, Rega D, Ris F, Riss S, Sains P, Samarasinghe S, Juliao GPS, Seitinger G, Shaikh I, Sietses C, Sileri P, Fernandez VS, Smith S, Sohn DK, Speakman C, Stevenson A, Stift A, Sylla P, Tanis P, Teso EP, Tuech JJ, Tuynman J, van der Zaag E, van Duijvendijk P, Van Nieuwenhove Y, Vansteenkiste F, Velthuis S, Venkatsubramaniam A, Vorburger S, Wassenaar E, Wegstapel H, Wolthuis A, Wu L, Penna, M, Hompes, R, Arnold, S, Wynn, G, Austin, R, Warusavitarne, J, Moran, B, Hanna, Gb, Mortensen, Nj, Tekkis, Pp, Albert, M, Al Furajii, H, Allison, A, Arezzo, A, Aryal, K, Ashraf, S, Atallah, S, Baig, K, Baral, J, Bemelman, W, Berger, D, Boni, L, Bonjer, J, Bordeianou, L, Borreca, D, Buchs, Nc, Cahill, R, Campbell, K, Capolupo, G, Caricato, M, Cassinotti, E, Chambers, W, Courtney, Ed, Cunningham, C, Dalton, S, Dawson, R, Delrio, P, de Graaf, E, De Paolis, P, D'Hondt, M, D'Hoore, A, Doornebosch, P, Erikson, Jr, Estevez-Schwarz, L, Fabryko, M, Fernandez-Hevia, M, Forsmo, H, Francis, N, Garimella, V, Gecim, Ie, Geissmann, D, Gill, K, Glockler, M, Grieco, M, Grolich, T, Guy, R, Hayes, J, Hoffman, Tj, Houben, B, Ito, M, Jelic, F, Jones, O, Joy, H, Kala, Z, Katory, M, Kneist, W, Knol, J, Korsgen, S, Kukreja, N, Kunz, R, Lacy, A, Lal, R, Lang, H, La Vaccara, V, Lezoche, E, Lima, Ma, Mamedli, Z, Mansfield, S, Marsanic, P, Mellano, A, Mendes, Cr, Merrie, A, Miles, A, Miroshnychenko, Y, Morino, M, Muratore, A, Nicol, D, Oh, Jh, O'Loughlin, P, Pandey, S, Paraoan, M, Pei, Cfw, Perez, Ro, Pfeffer, F, Picchetto, A, Pockney, P, Radley, S, Rasulov, A, Rega, D, Ris, F, Riss, S, Sains, P, Samarasinghe, S, Juliao, Gp, Seitinger, G, Shaikh, I, Sietses, C, Sileri, P, Fernandez, V, Smith, S, Sohn, Dk, Speakman, C, Stevenson, A, Stift, A, Sylla, P, Tanis, P, Teso, Ep, Tuech, Jj, Tuynman, J, van der Zaag, E, van Duijvendijk, P, Van Nieuwenhove, Y, Vansteenkiste, F, Velthuis, S, Venkatsubramaniam, A, Vorburger, S, Wassenaar, E, Wegstapel, H, Wolthuis, A, Wu, L, Surgery, CCA - Cancer Treatment and quality of life, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, and AGEM - Digestive immunity

Subjects
Male, SURGERY, medicine.medical_treatment, Anal Canal, registry, Body Mass Index, 0302 clinical medicine, Postoperative Complications, Risk Factors, PATHOLOGICAL OUTCOMES, Registries, Intraoperative Complications, Neoadjuvant therapy, Digestive System Surgical Procedures, 11 Medical and Health Sciences, Aged, 80 and over, education.field_of_study, Anal canal, Middle Aged, Total mesorectal excision, Neoadjuvant Therapy, RANDOMIZED CLINICAL-TRIAL, Dissection, medicine.anatomical_structure, Treatment Outcome, transanal total mesorectal excision, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Life Sciences & Biomedicine, Adult, medicine.medical_specialty, Adolescent, Population, Perforation (oil well), LOW-RECTAL-CANCER, Rectum, 03 medical and health sciences, Young Adult, medicine, Humans, Minimally Invasive Surgical Procedures, education, rectal cancer, MARGIN INVOLVEMENT, Mesorectal, Aged, Neoplasm Staging, Science & Technology, poor histological outcomes, LAPAROSCOPIC-ASSISTED RESECTION, business.industry, Rectal Neoplasms, TaTME Registry Collaborative, Surgery, Surgery, poor histological outcomes, rectal cancer, registry, risk factors, transanal total mesorectal excision, business
Abstract

OBJECTIVE: This study aims to report short-term clinical and oncological outcomes from the international transanal Total Mesorectal Excision (taTME) registry for benign and malignant rectal pathology. BACKGROUND: TaTME is the latest minimally invasive transanal technique pioneered to facilitate difficult pelvic dissections. Outcomes have been published from small cohorts, but larger series can further assess the safety and efficacy of taTME in the wider surgical population. METHODS: Data were analyzed from 66 registered units in 23 countries. The primary endpoint was "good-quality TME surgery." Secondary endpoints were short-term adverse events. Univariate and multivariate regression analyses were used to identify independent predictors of poor specimen outcome. RESULTS: A total of 720 consecutively registered cases were analyzed comprising 634 patients with rectal cancer and 86 with benign pathology. Approximately, 67% were males with mean BMI 26.5 kg/m. Abdominal or perineal conversion was 6.3% and 2.8%, respectively. Intact TME specimens were achieved in 85%, with minor defects in 11% and major defects in 4%. R1 resection rate was 2.7%. Postoperative mortality and morbidity were 0.5% and 32.6% respectively. Risk factors for poor specimen outcome (suboptimal TME specimen, perforation, and/or R1 resection) on multivariate analysis were positive CRM on staging MRI, low rectal tumor CONCLUSIONS: TaTME appears to be an oncologically safe and effective technique for distal mesorectal dissection with acceptable short-term patient outcomes and good specimen quality. Ongoing structured training and the upcoming randomized controlled trials are needed to assess the technique further.

Published
2017

3. Preoperative assessment of the aortic arch in children younger than 1 year with congenital heart disease: utility of low-dose high-pitch dual-source computed tomography. A single-centre, retrospective analysis of 62 cases

Author

Glockler, M., primary, Halbfass, J., additional, Koch, A., additional, Dittrich, S., additional, Achenbach, S., additional, Ruffer, A., additional, Ihlenburg, S., additional, Cesnjevar, R., additional, May, M., additional, Uder, M., additional, and Rompel, O., additional

Published
2013
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