Inadequate drug loading and control of payload leakage limit the duration of the effect of liposomal drug carriers and may cause toxicity. Here, we report a liposome system as a depot for sustained drug delivery whose design is inspired by the low permeability of Archaeal membranes to protons and solutes. Incorporating methyl-branched phospholipids into lipid bilayers decreased payload diffusion across liposomal membranes, thereby enhancing the drug load capacity by 10-16% and reducing the release of small molecules in the first 24 h by 40-48%. The in vivo impact of this approach was demonstrated by injection at the sciatic nerve. Methyl-branched liposomes encapsulating the anesthetic tetrodotoxin (TTX) achieved markedly prolonged local anesthesia lasting up to 70 h, in comparison to the 16 h achieved with liposomes containing conventional lipids. The present work demonstrates the usefulness of methyl-branched liposomes to enhance liposomal depot systems for sustained drug delivery.
Introduction: Nonparasitic splenic cysts are rare in the pediatric population.1,2 Although they are typically asymptomatic, abdominal pain and early satiety can occur secondary to compression of adjacent organs. Management options include observation, cystectomy, partial or total splenectomy, and percutaneous aspiration with or without sclerotherapy.1 Given the 3.2% prevalence and 1.4% mortality rate of overwhelming postsplenectomy infection (OPSI),3 spleen-preserving techniques are highly desirable. However, there is no consensus regarding the best approach to achieve this. We present the case of a 15-year-old girl with a nonparasitic splenic cyst causing mass effect on adjacent organs and abdominal pain thought to be precipitating seizures in the setting of a complex brain malformation. We elected to manage this patient by performing a robot-assisted partial splenectomy. Materials and Methods: Magnetic resonance imaging showed a 4.2 × 4.3 × 2.8 cm simple appearing cystic structure within the upper splenic parenchyma. Treatment options discussed with the family included aspiration with sclerotherapy, robotic partial splenectomy, or robotic complete splenectomy. As the family wanted definitive treatment and the possibility of splenic preservation, a partial splenectomy was selected. All vaccinations were done preoperatively in case complete splenectomy was needed. To begin the robot-assisted repair, a camera was inserted into the umbilicus, and three 8 mm trocars were placed horizontally across the abdomen in line with the umbilical port. Dissection began with division of gastrosplenic attachments using the vessel sealer, followed by taking down the splenic flexure. The short gastric vessels were then divided using the vessel sealer until the superior aspect of the spleen was ischemic. The spleen was then divided across the superior pole with the vessel sealer device with good hemostasis, followed by using a Vicryl suture to oversew the cut edge of the spleen to further promote hemostasis. The resected portion of the spleen was then removed through the umbilical incision. Results: The patient recovered well postoperatively and was discharged home on postoperative day 2. Her pathology report was consistent with a simple epithelial cyst. Conclusion: Partial splenectomy avoids the morbidity associated with total splenectomy, including the 3.2% lifetime risk of OPSI, and has, therefore, gained significant attention for the past two decades.4 Previous comparison of a laparoscopic and robotic approach to partial splenectomy suggested that a robotic approach may allow for more delicate and precise vascular dissection, a lower blood loss, and better evaluation of the splenic remnant volume; these approaches maintained comparable operative times, hospital stay, complications, and conversion rates.5,6 Although further research will be needed for full evaluation of the advantages and disadvantages of each approach, a robot-assisted approach warrants consideration for complex pediatric splenic procedures. No competing financial interests exist. No funding was received for this article. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. This video was presented as a video presentation at the 2022 International Pediatric Endosurgery Group (IPEG) Annual Meeting (Miami, Florida). Runtime of video: 3 mins 51 secs
Venous aneurysms of the head and neck region are very uncommon. Aneurysms of the external jugular vein in children are exceedingly rare, and consequently the best approach to diagnosis and management has not been clearly defined. We present the case of a 15-year-old girl with a non-pulsatile, occasionally painful, enlarging fullness in her right supraclavicular fossa and neck. Imaging demonstrated a large and complex right external jugular vein aneurysm with thrombus. Given the symptomatic nature of this aneurysm, recurrent episodes of thrombosis, and the risk of thromboembolism, she underwent surgical excision. Thorough pre-operative planning with additional imaging to better understand the anatomy of this aneurysm was critical to a safe and successful intervention.
This is the first case to discuss the safe delivery of stereotactic body radiation therapy to a left lower lobe lung nodule in a patient with a third generation left ventricular assist device (Heartware®) and implantable cardioverter defibrillator.
Capillary malformation-arteriovenous malformation (CM-AVM) is characterized by multifocal fast-flow capillary malformations, sometimes with arteriovenous malformations/fistulas, skeletal/soft tissue overgrowth, telangiectasias, or Bier spots. Lymphatic abnormalities are infrequently reported. We describe seven patients with CM-AVM and lymphatic anomalies.Following IRB approval, we identified patients with CM-AVM and lymphatic anomalies seen at the Vascular Anomalies Center at Boston Children's Hospital from 2003 to 2023. We retrospectively reviewed records for clinical, genetic, laboratory, and imaging findings.We found seven patients with CM-AVM and lymphatic abnormalities. Five patients were diagnosed prenatally: four with pleural effusions (including one suspected chylothorax) and one with ascites. Pleural effusions resolved after neonatal drainage in three patients and fetal thoracentesis in the fourth; however, fluid rapidly reaccumulated in this fetus causing hydrops. Ascites resolved after neonatal paracentesis, recurred at 2 months, and spontaneously resolved at 5 years; magnetic resonance lymphangiography for recurrence at age 19 years suggested a central conducting lymphatic anomaly (CCLA), and at age 20 years a right spermatic cord/scrotal lymphatic malformation (LM) was detected. Chylous pericardial effusion presented in a sixth patient at 2 months and disappeared after pericardiocentesis. A seventh patient was diagnosed with a left lower extremity LM at 16 months. Six patients underwent genetic testing, and all had RASA1 mutation. RASA1 variant was novel in three patients (c.1495delinsCTACC, c.434_451delinsA, c.2648del), previously reported in two (c.2603+1G>A, c.475_476del), and unavailable in another. Median follow-up age was 5.8 years (4 months-20 years).CM-AVM may be associated with lymphatic anomalies, including pericardial/pleural effusions, ascites, CCLA, and LM.
