Chylothorax and other pleural effusions in neonates
Prem Puri in Newborn Surgery, 2017
Pleuroperitoneal shunts, first used by Azizkhan et al.37 in 1983 to treat five ventilator-dependent infants with persistent chylothorax, are used as a surgical treatment option. The procedure avoids the risks associated with a more complicated open surgical procedure in high-risk infants and is considered safe, highly effective, and easy to perform. Pleuroperitoneal shunts provide a way of draining chyle from the pleural space to the peritoneal space but require manual compression of the shunt chamber.37 During the immediate postoperative period, the pumping chamber is compressed 50–100 times per hour in order to completely clear the hemithorax of chyle. As the infant’s clinical status improves, a gradual decrease in the frequency of shunt compression is begun. Resolution of pleural effusion often occurs within 2–3 weeks. The valve and pumping chamber sometimes become dysfunctional after several weeks due to an accumulation of fibrin and protein in the valve mechanism. Because it is less invasive, it is ideal for patients who require a relatively short or stabilizing procedure. Also, in case of both pleural effusion and intra-abdominal ascites, a combination of a pleuroperitoneal shunt and a peritoneovenous shunt may be required.
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
Related Knowledge Centers
- Ascites
- Internal Jugular Vein
- Peritoneal Fluid
- Peritoneum
- Superior Vena Cava
- Vein
- Pulmonary Edema
- Shunt
- Disseminated Intravascular Coagulation