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Neonatal ascites
Published in Prem Puri, Newborn Surgery, 2017
Treatment of chylous ascites is usually conservative. The majority of patients respond to abdominal paracentesis and an enteral diet containing medium-chain triglycerides (MCTs) and high protein. Dietary management is an important treatment modality in chylous ascites. An MCT-based diet is accepted as the first measure to implement for reducing the chyle production in the peritoneal fluid.23 MCTs are not re-esterified within the intestinal cell and thus bypass the enteric lymphatics and directly enter the portal system. It is believed that the reduction in dietary long-chain fats (long-chain triglyceride [LCT]) reduces lymphatic flow and pressure within the lymphatic system and decreases the amount of lymph leakage. For severe or complicated chylous ascites or chylous ascites that persists after a maximum of 10 weeks of diet, total parenteral nutrition (TPN) has been successfully used in treating these infants by resting the gastrointestinal tract.24 Somatostatin analogs have been demonstrated to be effective in reducing lymphorrhea and may be proposed prior to considering the surgical approach. The exact mechanisms of somatostatin on drying lymphatic flow are not completely understood. It has been previously shown to decrease the intestinal absorption of fats, lower triglyceride concentration in the thoracic duct, and attenuate lymph flow in the major lymphatic channels.25 Satisfactory results were achieved by the administration of the somatostatin combined with TPN. 20,26 Surgical intervention is recommended if 1–2 months of conservative approach has failed.27 Successful surgical treatment of congenital chylous ascites by resecting the macroscopically localized anomaly or by ligation of an identifiable lymphatic leak has been described.28 A peritoneovenous shunt, of either Leveen or Denver type, also has been reported to be successful at least temporarily, in children in whom repeated attempts of a medical or surgical approach have failed. 16,29
Infective endocarditis in patients with liver cirrhosis: a systematic review
Published in Journal of Chemotherapy, 2021
Petros Ioannou, Eirini Savva, Diamantis P. Kofteridis
The mean age of patients with liver cirrhosis and IE was lower than the age of patients in cohorts with IE in the general population, which is 62-70 years.93–95 Male predominance was noted in the cirrhotic population in this study, which was similar to the general population in other studies.93–95 Etiology of cirrhosis was mainly viral and ethanol, which are the two most common causes of cirrhosis.96,97 As in the general population with IE, patients with liver cirrhosis had predisposing factors well known to be associated with occurrence of IE, such as bad teeth hygiene, prosthetic cardiac valves, intravenous drug use, previous cardiac surgery, previous IE, and having a CVC.93–95,98 However, peritoneovenous shunt was a unique factor found to be present in 11% of patients with liver cirrhosis and IE, and could, theoretically, be associated with the development of IE, even though further studies should evaluate this possibility. Almost 18% of cirrhotic patients with IE had a prosthetic cardiac valve, which is a proportion lower to that of the general population, where 25-50% of patients with IE had a prosthetic cardiac valve.93–95