Fátima Carvalho

Octreotide in the treatment of neonatal postoperative chylothorax: report of three cases and literature review

Chylothorax is a well-recognized complication after neonatal cardiothoracic surgery. Management strategies include cessation of enteral feedings, repeated aspiration, chest drainage, and total parenteral nutrition. Somatostatin and its analogue, octreotide, have been used with promising results. The authors present three cases of neonatal postoperative chylothorax in which octreotide was used. After literature review, we can say that octreotide is relatively safe, and may reduce clinical course and complications associated with neonatal postoperative chylothorax. One should be aware of possible association between octreotide and necrotizing enterocolitis. Prospective controlled trials supporting octreotide use are lacking.

Fibrinolytics in the Treatment of Complicated Pleural Effusions

INTRODUCTION The treatment of complicated pleural parapneumonic effusions with intrapleural instillation of fibrinolytics, has shown similar results as surgical treatment. The present study aimed to evaluate the results of the use of intrapleural instillation of fibrinolytics in the treatment of complicated pleural parapneumonic effusions, in patients followed in our hospital. MATERIAL AND METHODS A retrospective review of all the patients (aged between one month and 18 years) diagnosed with complicated parapneumonic effusions, which had chest drain insertion with intrapleural instillation of fibrinolytic, between January 2005 and December 2013, was undertaken. RESULTS A total of 37 patients were identified. Mean duration of hospital stay was 17 ± 7.60 days. Chest drain was placed in the first 48 h of hospital admission in most of the patients (89.2%), with a mean of six days of drainage. Treatment failure was reported in 2.7% of cases and was related with effusion recurrence. This patient underwent video-assisted thoracoscopic surgery with the need to convert to open thoracotomy. A favorable outcome was achieved in 96.9 % of cases. DISCUSSION In our review, therapeutic success rate was as expected, with a failure rate below those reported in literature. We present intrapleural instillation of fibrinolytics and video-assisted thoracoscopic surgery as part of the same protocol, in which fibrinolytic therapy is the first-line treatment. CONCLUSION The therapeutic option presented shows a low failure rate and avoids a more aggressive surgical procedure. We consider this an effective treatment option, with low sequelae rate.

QUISTO BRANQUIAL: A PROPÓSITO DE UM CASO CLÍNICO

Introducao: As anomalias dos arcos branquiais correspondem a 30% de todas as anomalias congenitas cervicais, sendo um importante diagnostico diferencial a considerar na patologia do pescoco em idade pediatrica. A sua apresentacao clinica pode variar entre quistos, sinus ou fistulas, e a sua localizacao mais comum e ao longo da face anterior do musculo esterno-cleidomastoideu. Apesar de muitos medicos considerarem o seu diagnostico facil e aparente, artigos recentes descrevem baixos indices de acuracia diagnostica. Uma historia clinica detalhada, que inclua a idade do doente, o tamanho e a duracao da lesao, bem como a presenca ou ausencia de sintomas associados e de crucial importância para um correto diagnostico.Caso Clinico: Apresentamos um caso clinico de uma crianca do sexo feminino com 10 anos, sem antecedentes pessoais de relevo, referenciada a consulta externa de Cirurgia Pediatrica pelo Medico Assistente por uma tumefacao cervical direita assintomatica, com meses de evolucao, detetada no exame objetivo de rotina. Na nossa consulta, detetada tumefacao cervical direita no terco medio do pescoco, anteriormente ao musculo esternocleido-mastoideu, de consistencia elastica, com cerca de 30cm x 25cm. Do estudo complementar realizado apresenta ecografia com descricao de lesao compativel com quisto branquial. Doente submetida a exerese cirurgica completa da lesao, sob anestesia geral. Resultado anatomopatologico definitivo a confirmar a presenca de um quisto branquial do tipo amigdaloide.Comentarios: Os quistos branquiais correspondem a 17% de todas as massas cervicais encontradas em idade pediatrica. A grande maioria destes origina-se a partir do segundo arco branquial. Os quistos branquiais devem ser lembrados no diagnostico diferencial de qualquer tumefacao na porcao lateral do pescoco, principalmente quando ocorrem nas primeiras decadas de vida. Um diagnostico pre-operatorio incorreto destas lesoes nao e incomum, sendo os principais diagnosticos diferenciais o linfangioma, a linfadenite cervical, o quisto do ducto tireoglosso, os quistos dermoides e neoplasias, entre outros. O estudo imagiologico e de crucial importância nesta patologia, quer para orientar o diagnostico, quer para facilitar a tecnica cirurgica, sendo que apenas a histologia da lesao nos da o diagnostico definitivo. O tratamento de escolha e a excisao cirurgica completa.