Esophagitis dissecans superficialis (EDS), also known as sloughing esophagitis, is a rare and frequently underrecognized esophageal disorder characterized by superficial sloughing of the esophageal mucosa. Its variable clinical presentation and overlap with structural esophageal abnormalities may result in misdiagnosis and unnecessary diagnostic or therapeutic interventions. We report a case of a 25-year-old woman with no history of chronic degenerative, autoimmune, or atopic disease who presented with abrupt retrosternal chest pain, recurrent vomiting, progressive esophageal dysphagia, halitosis, hematemesis, and marked unintentional weight loss. Initial evaluation showed a double-lumen appearance on barium esophagography and an upper endoscopic appearance initially interpreted as a large pharyngoesophageal diverticulum. Repeat endoscopy subsequently revealed extensive longitudinal sloughing and detachment of the esophageal mucosa, supporting the diagnosis of EDS. Histopathologic evaluation demonstrated a submucosal blistering lesion infiltrated by eosinophils, without evidence of malignancy or dysplasia. These findings raised suspicion for esophageal bullous pemphigoid; however, direct immunofluorescence was unavailable, and an autoimmune bullous disorder could not be definitively confirmed. Additional computed tomography imaging showed no evidence of esophageal disruption, mediastinal collection, pneumomediastinum, malignancy, or another structural abnormality. Severe oral intolerance, recurrent vomiting, persistent dysphagia, and marked nutritional compromise led the nutrition support team to select temporary total parenteral nutrition as an individualized strategy pending clinical and endoscopic reassessment. The severe mucosal involvement and suspected autoimmune bullous component prompted empiric treatment with intravenous corticosteroids. The patient achieved clinical stabilization, and outpatient endoscopic reassessment was scheduled. In the absence of follow-up endoscopic findings, no conclusions regarding mucosal healing or treatment efficacy could be drawn. This case highlights the importance of careful clinical, endoscopic, radiologic, and histopathologic correlation in severe or atypical presentations of EDS, particularly when the findings mimic a structural esophageal disorder.

Robotic colorectal surgery is increasingly complex, expanding from pelvic to multiquadrant procedures. Reports on the impact of institutional robotic platform transition remain limited. This study evaluated the challenges and effects of transitioning from the da Vinci Si (dV Si) to the da Vinci X/Xi (dV X/Xi) platform. A prospective observational cohort with historical comparison describing an institutional experience that included consecutive elective robotic colorectal cancer resections performed in 2023 (dV Si) and 2024 (dV X/Xi). The primary endpoint was the learning curve for console time. Secondary outcomes included total operative time, port placement time, length of stay (LOS), ileus, anastomotic leakage, severe complications (Clavien-Dindo ≥ 3), reoperation, and 30-day mortality. An institutional learning curve for the surgical team was constructed and evaluated using the cumulative sum (CUSUM) test. A total of 121 procedures were analyzed (dV Si: n = 49; dV X/Xi: n = 72). Procedural profile shifted significantly (p = 0.002), with increased multiquadrant resections in the dV X/Xi group. Console time was longer in dV X/Xi group (p = 0.05), while total operative time and LOS were similar in the two groups. Postoperative outcomes were comparable. Parenteral nutrition was less frequently required in the dV X/Xi group (p = 0.02). CUSUM analysis showed a console learning plateau at 48 cases.We describe a real-world experience of robotic platform transition, demonstrating that it enabled an expanded range of procedures without compromising short-term outcomes.

Total parenteral nutrition (TPN) is a nutritional therapy in children when oral or enteral feeding is not possible, fails to meet nutritional requirements or is contraindicated due to underlying clinical conditions. There are many cases where children who are given one or more than one intravenous medication also need TPN. In order to minimise vein access, these medications are commonly administered via a Y-site IV connection where they admix with TPN, implying a need for compatibility studies before admixing the medication into the nutritional fluid. In this study, previously developed and validated HPTLC methods were verified for their suitability to evaluate the concentrations of three commonly used medications in neonatal intensive care units (NICUs), namely caffeine citrate, ibuprofen arginine, and midazolam hydrochloride. Silica gel 60 F254 HPTLC plates were used as the stationary phase, and acetone: toluene: chloroform (4:3:3, v/v/v), toluene: methanol: ethyl acetate: glacial acetic acid (5.5:3.2:1:0.3, v/v/v/v), and cyclohexane: toluene: diethylamine (7:1.5:1.5, v/v/v) with one drop of 25% ammonia solution were used as mobile phases. The compatibility of the three drugs in their respective TPN admixtures was then assessed at various time points over a 24 h period using these HPTLC methods. Each drug admixed in TPN was directly applied onto the HPTLC plates without further sample pre-treatment. Paired Two-One-Sided Test (TOST) equivalent testing revealed that the concentrations of the selected drugs in TPN were unchanged over the monitoring period (p > 0.05), confirming chemical compatibility. These findings were in line with previous studies that concluded compatibility and reported similar RF and LOD/LOQ values (1.95/5.90 ng/band for caffeine, 252.22/764.30 ng/band for ibuprofen and 10.82/32.78 ng/band for midazolam; R[2] ≥ 0.99). As no additional sample pre-treatment was required, HPTLC-based compatibility studies of drug-TPN admixtures may simplify the analytical workflow, making them a cost-effective and time-efficient approach to compatibility testing.

Postoperative chylothorax remains a significant complication after congenital heart surgery; however, little is known about temporal changes in pleural fluid characteristics during prolonged disease. We retrospectively reviewed 82 children with postoperative chylothorax treated between 2007 and 2023 to evaluate the outcomes of a stepwise treatment strategy, identify factors associated with refractory disease, and investigate serial pleural fluid findings. Patients were managed with dietary modification, total parenteral nutrition, octreotide, and additional intervention when necessary. Conservative management successfully resolved chylothorax in 70 patients (85.4%), whereas 12 (14.6%) required additional intervention. Multivariable Firth penalized logistic regression identified greater pleural drainage volume (adjusted OR, 1.83 per 10 mL/kg/day increase; P = 0.025) and superior vena cava stenosis or obstruction (adjusted OR, 75.94; P < 0.001) as independent predictors of additional intervention or death. Serial pleural fluid analyses demonstrated progressive declines in white blood cell counts despite persistent mononuclear cell predominance, while triglyceride concentrations remained below the conventional diagnostic threshold throughout prolonged chylothorax. These findings suggest that conventional pleural fluid criteria alone may underestimate persistent postoperative chylothorax during long-term follow-up. Assessment of refractory chylothorax should therefore integrate the clinical course, hemodynamic findings, and imaging studies in addition to pleural fluid analysis.