Novel technique to manage refractory chylous ascites with carbon nanoparticle suspension in infants

Gao, Qi; Xie, Weike; Wang, Qi; Wei, Guangbing; Yao, Na; Li, Zhongwen; Wang, Yihe; Lu, Chaoxiang; Pan, Yongkang; Sun, Xuejun

doi:10.1016/j.jpedsurg.2019.09.041

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…Patients 1–4 were given MCT-milk about for one week before the procedures, and on the remaining dates, as per our previous report. All of our surgical procedure types were compatible with those in previous reports [ 8 ]. We collected data on demographic characteristics (Table 1 ), drainage quality and volume, critical care management, infant feeding patterns and outcomes.…”

Section: Methodsmentioning

confidence: 56%

“…During the surgical resection of a tumor, CNS particles migrate quickly in lymphatic vessels and accumulate in lymph nodes, staining them black. CNS has high specificity for the lymphatic system as a lymph [ 14 ] and lymphatic vessel tracer [ 8 ]. The CNS moves along the lymphatic vessels to the leakage site within a few minutes after submucosal injection.…”

Section: Discussionmentioning

confidence: 99%

“…The children’s guardians were expressly informed about the surgery risks and benefits, and informed consent was obtained. Seven cases were included (4 CNS cases were previously reported [ 8 ], Table 1 ). All the patients were diagnosed with CA based on abdominal cavity fluid analysis and had a systemic examination performed to confirm that there were no other systemic diseases.…”

Section: Methodsmentioning

confidence: 99%

“…MCT could cure some types of mild CA, but unfortunately, many patients will still worsen over time. Eventually, surgical intervention with peritoneovenous shunting [ 5 ], Denver shunt [ 6 ], lymphangiography balloon-occluded retrograde abdominal lymphatic embolization [ 1 , 7 ], or ligation of the lymphatic duct [ 8 ] should be considered.…”

Section: Introductionmentioning

confidence: 99%

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Chylous ascites with lymphatic leakage localization: technical aspects and clinical applications

Wang

Gao

2022

BMC Surg

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Background Carbon nanoparticle suspension (CNS) was applied to locate the lymphatic leakage in chylous ascites (CA). However, the flow speed and distance of the CNS were particularly decreased in the following two cases (patient 5 and 6). This study aimed to investigate and improve the flow speed and distance of the CNS via a rat model. Methods Seven patients with CA were accepted for surgery in the past two years. Clinical data were recorded. Rats were divided into two groups to confirm the hypothesis regarding whether accepting milk or orally administered food before surgery was the key factor in CA surgery with CNS. The animals were divided into 2 groups: experimental group of 5 rats receiving fat emulsion injection (2 g/kg) 30 min before the operation and control group of 5 rats receiving saline. We analyzed flow speed and distance of the CNS in two groups of rats. The hypothesis established was that CNS movements pattern differ depending on the degree of capillary lymph duct filling. Finally, the late case reconfirmed the hypothesis again. Results In animal experiments, the CNS in the preoperative high-fat feeding group moved faster and over a longer distance than that in the control group (0.51 ± 0.09 cm vs. 0.19 ± 0.10 cm, respectively; p < 0.05). Based on this, the CNS was applied to the seventh patient, who had been given a diet with a slightly higher fat content 3 days before the operation, and marked improvement with a complete cure was recorded. Conclusions The capillary lymph duct was beginning to swell after dietary intake. The dilation of the lymph vessel could make it easier for the CNS to move and reach the leakage.

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Section: Methodsmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chylous ascites with lymphatic leakage localization: technical aspects and clinical applications

Wang

Gao

2022

BMC Surg

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“…Anthracyclines, as a chemotherapeutic agent, have shown good advantages in the treatment of various malignant tumors of the body, especially for lymphomas, such as gastric cancer, colorectal cancer, and breast cancer, and epirubicin and adriamycin are currently the most used (23)(24)(25)(26)(27). Although such drugs have obvious efficacy, they have very serious toxicity, of which the most important concern is cardiotoxicity.…”

Section: Comparison Of Nursing Intervention Resultsmentioning

confidence: 99%

Nano Carbon Tracing-based Treatment of Breast Cancer Lymphadenectomy and Nursing Intervention of Postoperative Lymphedema

Li¹,

Fu²,

Li³

et al. 2022

Cell Mol Biol (Noisy-le-grand)

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To investigate the tracing and therapeutic effects of carbon nanoparticles epirubicin (CNP-EPI) on axillary lymphadenectomy for breast cancer and postoperative lymphedema nursing intervention, a total of 60 breast cancer patients in Harbin Medical University Cancer Hospital were selected for the study subjects and randomly divided into group A (n=30) and group B (n=30). They were subcutaneously injected with 1 mL of CNP-EPI 1 day before surgery and 3 days before surgery, respectively, and underwent axillary lymph node dissection. Lymphedema nursing intervention and routine care were implemented in groups A and B, respectively. After adsorption of 2 mL of 6 mg/mL epirubicin by 1 mL carbon nanoparticles, epirubicin could be slowly released with a cumulative release rate of 64.7 %. The black staining rate was 80.2 % (341/425) in group A and 57.7 % (217/376) in group B, and the difference was statistically significant (P < 0.05). The black staining rate in metastatic lymph nodes was 73.1 % (23/52) in group A and 65.9 % (27/41) in group B (P > 0.05). The incidence rate of edema at 1, 3, and 6 months after operation in group A was significantly lower than that in group B (P < 0.05). Carbon nanoparticles have strong adsorption properties and slow drug release ability; subcutaneous injection of CNP-EPI axillary lymph nodes around the areola 1 day before surgery has a better lymphatic tracing effect; lymphedema nursing intervention can effectively reduce the incidence of prognostic lymphedema.

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Intranodal Ultrasound-Guided Percutaneous Methylene Blue Injection for the Identification of Leakage Point during Laparoscopic Repair of Refractory Chylous Ascites after Laparoscopic Lymphadenectomy for Kidney Cancer

Otaola-Arca

Vargas

Hasson

et al. 2022

Case Reports in Urology

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Chylous ascites is an uncommon complication after surgery that can result in malnutrition and immunodeficiency. Therefore, surgical interventions are reserved for refractory patients, and the primary success factor for these interventions is locating the point of leakage, which is often tricky. We describe a case of a 56-year-old male with chylous ascites after laparoscopic radical nephrectomy and lumbo-aortic lymphadenectomy for kidney cancer. The patient was initially managed with dietary modifications and drainage placement. Afterward, lymphography with Lipiodol, percutaneous embolization of the leakage point, and total parenteral nutrition were established. Finally, the patient underwent laparoscopic repair after identifying the leakage point by injecting methylene blue through an inguinal node. Complete resolution was achieved, and no complications related to the procedure were recorded. Intranodal methylene blue injection can be an invaluable tool to identify the point of leakage in selected patients to improve the outcomes of surgical repair of refractory chylous ascites.

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Novel technique to manage refractory chylous ascites with carbon nanoparticle suspension in infants

Cited by 4 publications

References 27 publications

Chylous ascites with lymphatic leakage localization: technical aspects and clinical applications

Chylous ascites with lymphatic leakage localization: technical aspects and clinical applications

Nano Carbon Tracing-based Treatment of Breast Cancer Lymphadenectomy and Nursing Intervention of Postoperative Lymphedema

Intranodal Ultrasound-Guided Percutaneous Methylene Blue Injection for the Identification of Leakage Point during Laparoscopic Repair of Refractory Chylous Ascites after Laparoscopic Lymphadenectomy for Kidney Cancer

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