title: Indocyanine green lymphography and lymphaticovenous anastomosis for generalized lymphatic dysplasia with pleural effusion and ascites in neonates.
abstract: BACKGROUND
  The fatality rate of generalized lymphatic dysplasia (GLD) with chylous pleural effusion and ascites is particularly high when it persists over a prolonged period. The purpose of this report was to determine the utility of indocyanine green (ICG) lymphography and lymphaticovenous anastomosis (LVA) in GLD with chylous pleural effusion and ascites in neonates.
  
  
  METHODS
  We tested the lymphatic function in the 4 extremities for 8 GLD neonate patients using ICG lymphography, and on the basis of the results, we performed LVA for 5 of them. LVA was performed at the extremities under general anesthesia using incisions <1 cm in length. The outcome of LVA was evaluated with the amount of ascites discharged from thoracostomy tube or abdominal tube, except for 1 patient who had no drainage tube.
  
  
  RESULTS
  In all cases, ICG lymphography showed varying degrees of dermal backflow in the limbs with lymphostasis. After LVA surgery, effusion stopped in 2 cases and decreased in 1 case. In the cases where effusion stopped, backflow as observed with ICG lymphography was minimal, and in the case where effusion decreased but did not stop, backflow was moderate.
  
  
  CONCLUSIONS
  The application of ICG and LVA could possibly be used to diagnose and treat lymphatic pleural effusion or ascites.
authors.affiliation: Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan. Electronic address: mihara.plasticsurgery@gmail.com.
authors.forename: Makoto
authors.initials: M
authors.lastname: Mihara
authors.affiliation: Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan; Department of Plastic and Reconstructive Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Hara
authors.affiliation: Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Shibasaki
authors.affiliation: Department of Plastic and Reconstructive Surgery, School of Medicine, St. Marianna University, Kanagawa, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Seki
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Akitatsu
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Iida
authors.affiliation: Department of Intensive Care Unit, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Adachi
authors.affiliation: Department of Neonatology, Nagara Medical Center, Gifu, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Uchida
authors.affiliation: Department of Neonatology, Nagara Medical Center, Gifu, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Kaneko
authors.affiliation: Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Haragi
authors.affiliation: Department of Cardiac Surgery, Gunma Children's Medical Center, Gunma, Japan.
authors.forename: Arata
authors.initials: A
authors.lastname: Murakami
mesh_terms: D000714:Anastomosis, Surgical; D001201:Ascites / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D019465:Craniofacial Abnormalities / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D004322:Drainage; D005260:Female; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D007223:Infant; D007231:Infant, Newborn; D008201:Lymphangiectasis, Intestinal / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008220:Lymphography / Q000379:methods*; D008297:Male; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012867:Skin / Q000098:blood supply*; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery*
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green