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At least 199 records · Page 11Linked to original sources
PubMed1991

Nutritional support in patients with low volume chylous fistula following radical neck dissection.

One of the well known complications of radical neck dissection is a chylous fistula, which results from injury to the thoracic duct as it enters the left subclavian vein. Such fistulae may cause considerable increased morbidity to a patient who is already debilitated by malignancy and by the increased catabolic response to surgery. Further surgery may be appropriate for those with a high fistula output but conservative therapy is normally advocated for the remainder. Nutritional and electrolyte support for these patients is essential and poses potential problems in management. We present three such patients. One was fed parenterally and two enterally and in all cases the fistulae closed spontaneously. We examine the known physiological stimuli to chyle production and conclude that the enteral feedings of these patients with fat or an isomolar enteral feed does not, contrary to current belief, increase chyle flow or delay the healing of these fistulae.

Chyle↗
PubMed1998

Orally fed digalactosyldiacylglycerol is degraded during absorption in intact and lymphatic duct cannulated rats.

Membrane lipids of green plants digalactosyldiacylglycerol (DGalDG) and monogalactosyldiacylglycerol (MGalDG) are hydrolyzed in vitro by human duodenal contents, pancreatic juice and bile salt stimulated lipase and guinea pig and rat pancreatic lipase-related protein 2 to free fatty acids, di- and monogalactosylmonoacylglycerols and water soluble galactose-containing compounds. The fate of intermediate products is unknown. We have investigated the digestion and absorption of DGalDG in rats. [3H]- and [14C]-labeled DGalDG in galactolipid dispersions, and 200 g/L soybean triacylglycerol (TG) oil-galactolipid emulsions of different concentrations were fed orally to intact and lymphatic duct cannulated rats. Chyle, gastrointestinal tract, liver and plasma were analyzed for radioactivity in different lipid classes. Recovery of [3H] also was determined in feces. Comparison was made with an emulsion of [14C]dipalmitoyl-phosphatidylcholine ([14C]DPPC), soybean TG oil and soybean phosphatidylcholine (PC). Less than 2% of the radioactivity in chyle was found in DGalDG, >70% of the radioactivity in triacylglycerol (TG), and the remaining part in glycerophospholipids. In intact rats, <1.5% of radioactivity in liver and plasma was identified as DGalDG. In experiments where 120 mg galactolipid-phospholipid mixture or 120 mg PC were given in a soybean TG oil-emulsion, the absorption of galactolipid fatty acids was less complete than PC-fatty acids, as indicated by analysis of feces and intestinal contents. Galactolipids are not absorbed intact or as reacylated monoacyl compounds by rats.

Administration, Oral↗
PubMed2006

The community management of chylous fistula using a pancreatic lipase inhibitor (orlistat).

We describe two innovative ideas in the treatment of iatrogenic chyle leak. The first is the early use of a pancreatic lipase inhibitor (Orlistat) to reduce fat absorption and chyle production, with consequent faster fistula healing. The second is the treatment of these patients at home in the community by district nurses backed by the hospital staff. This domiciliary approach has a positive psychological effect on the patient, permits the patient to take responsibility for their treatment, and reduces hospital length of stay minimising patient exposure to nosocomial infections.

Attitude to Health↗
PubMed1977

Low thoracic duct ligation for postoperative chylous effusions in infants and children.

Three patients aged from three months to six years underwent thoracic duct ligation at the level of the diaphragm for chylothorax which occurred following cardiac operations. Another three-month-old patient underwent thoracic duct ligation for massive postoperative chylopericardium. Indications for operation were a large recurrent chyle accumulation or prolonged chyle drainage. Operative ductograms to deliniate the cisterna chyli and to exclude the presence of multiple lymph channels were performed in three patients. Excellent postoperative results were obtained in all patients for periods of up to two years. Low thoracic dust ligation is a reliable means of control of postoperative chylothorax and lengthy persistence with conservative treatment is no longer necessary.

Child↗
PubMed1987

Absorption and lymphatic transport of exogenous and endogenous arachidonic and linoleic acid in the rat.

[3H]Arachidonic (20:4) and [14C]linoleic acid (18:2) were fed to thoracic duct-cannulated rats in test meals of either tracers alone, cream, Intralipid, pure arachidonic acid, or pure linoleic acid. Less [3H]20:4 than [14C]18:2 was recovered in chyle during the first 5 h. After cream feeding, the proportion of radioactivity found in phospholipids was high and increased during the first 3 h. After the meal (3-5 h) 61 +/- 6% of the 3H and 57 +/- 10% of the 14C was in phosphatidylcholine, and 11 +/- 3% of the 3H and 3.0 +/- 4% of the 14C was in phosphatidylethanolamine. Changing the fat vehicle to Intralipid or pure 18:2 decreased the proportion of label in the phospholipids and increased the 3H and 14C radioactivity in the triacylglycerol fraction, the distribution of 14C being influenced more than that of 3H. After feeding the tracers in 200 microliters of pure 20:4, greater than 90% of both isotopes was in triacylglycerol. During fasting, triacylglycerol transported 56% (0.7 mumol/h), phosphatidylcholine transported 34% (0.4 mumol/h), and phosphatidylethanolamine transported 10% (0.1 mumol/h) of the 20:4 mass. After cream or Intralipid feeding, the output of 20:4-containing phosphatidylcholine and phosphatidylethanolamine increased 2.1- to 2.8-fold, whereas the transport of 20:4 with triacylglycerol remained constant. Phospholipids thus became the predominant transport form for 20:4. After feeding 200 microliters of 20:4, the intestine produced, however, 20:4-rich triacylglycerols that transported 89% of the chyle 20:4.

Animals↗
PubMedDate not supplied

Do we still need to collect stool? Evaluation of visualized fatty acid absorption: experimental studies using rats.

BACKGROUND: Short-gut syndrome is likely to impair enteric fat utilization. This study was undertaken to develop a clinical test of lipid absorption without fecal collection. METHODS: The absorption of enterally fed radioactive long-chain fatty acid, beta-methyl-p-(123I)-iodophenylpentadecanoic acid was investigated with continuous chyle collection in rats. The changes in excretion and time-dependent biodistribution of radioactivity of the enterally fed agent were assessed in normal control animals. Similarly, sequential urinary excretion and biodistribution were studied along with scintigraphy using sham-operated and short-gut animals. RESULTS: Approximately 64% of the enterally fed radioactivity was recovered in the collected chyle (24 hours). A comparison of normal control, sham-operated, and short-gut animals showed significantly less urinary and greater fecal excretions of radioactivity in short-gut animals. With the use of sequential scintigraphy, the small intestine, whole-body soft tissues, and urinary bladder were well visualized in sham-operated animals, whereas the large intestine and feces were demonstrated earlier in short-gut animals. CONCLUSIONS: Our results suggest that enteral feeding of the agent might be feasible for determining lipid absorption from the the dynamic changes of radioactivity in visualized abdominal organs and in urine.

Animals↗
PubMed1985

Efficient hepatic uptake of chylomicron remnant cholesterol in rats with a portacaval anastomosis.

Portacaval-shunted and sham-operated male rats, fed ad libitum and of similar weight, were studied 2-3 weeks after surgery. At this time serum cholesterol levels did not differ significantly between the two groups, whereas serum triacylglycerols and phospholipids were lower in the shunted group. These animals also showed an increased serum bile acid level and an increased serum estradiol to testosterone ratio. The metabolism of native chyle labeled with [3H]cholesterol and [14C]linoleic acid or of preformed chylomicron remnants with the same labeling was studied in the groups of rats. Ten minutes after intravenous injection of chylomicron remnants 10.6 +/- 0.5% (means +/- SEM, n = 8) of the injected [3H]cholesterol and 7.6 +/- 0.4% of the [14C]linoleic acid were found per 1 g liver in the portacaval-shunted rats; the corresponding figures in the sham-operated group (n = 8) were 6.4 +/- 0.4 and 4.9 +/- 0.3, respectively (p less than 0.001 for both 3H and 14C). Thus, despite a greater than 40% reduction of liver weight induced by the shunting procedure, the total liver uptake of chylomicron remnants was not significantly decreased. The uptake of chylomicron lipids per unit liver weight was normal in the atrophic livers of portacaval-shunted rats also when very large loads of chyle were administered.

Animals↗
PubMed1999

Early complications. Chylothorax.

Postpneumonectomy chylothorax is a very common but serious complication. Drainage of the pneumonectomy space, metabolic and nutritional support with TPN, and absolute enteral rest may lead to control of the leak. Failure of these measures to obtain a rapid resolution of the chyle losses should be followed by early surgical intervention in most instances in an effort to alleviate the chronic metabolic, nutritional, and immunological consequences of prolonged chyle losses.

Chyle↗
PubMed2000

Spontaneous chylothorax--case report.

A-19-year old male patient complained of shortness of breath. Aspiration of the pleural fluid revealed chylothorax. Right chest tube was inserted. His ABG showed hypoxaemia with relative hypercarbia. He underwent right thoracotomy and thoracic duct ligation under general anaesthesia and double lumen endobroncheal intubation. During surgery he lost 1.5 L of blood and 4 L chyle. He was transferred to the SICU intubated and on mechanical ventilation. On the subsequent days chyle leak was reduced to a minimum of 10 ml/hr. On the 9th postoperative day the patient was extubated. He was receiving TPN 2600 kcal/day. He was transferred to the normal floor on the 15th day. After 7 day he was readmitted, his chest showed severe lung fibrosis and consolidation. His ABG showed severe hypercarbia (PaCO2 = 126 mmHg). The patient was intubated. His condition deteriorated and he was considered for lung transplantation. No donor was available. Later he arrested and died. Anaesthesia and surgical management of spontaneous chylothorax is challenging. The mortality rate is high.

Adult↗
PubMed1991

[Successful surgical treatment of primary chylopericardium in infant--a usefulness of intraoperative thoracic ductgraphy].

Asymptomatic eight-year old girl was admitted to our surgical department from ophthalmology complaining enlarged heart size at the routine check before operation of strabismus. By pericardiocentesis it was confirmed that pericardial effusion was chyle biochemically and microscopically. In spite of several medical trials (i.e. diuretics, pericardial drainage, complete starvation with parenteral nutrition), copious amount of chyle discharge, measured 180 ml per day, couldn't be controlled. Mediastinal mass lesion and thoracic duct anomaly were excluded by both thoracic CT and lymphangiography, and primary chylopericardium without thoracic duct anomalies was suspected preoperatively. The diagnosis of primary pericardium was confirmed by intraoperative thoracic ductography which visualized thoracic duct and it's tributaries more clear than that of preoperative lymphangiography. Low thoracic duct ligation with resection of duct 55 mm in length and fenestration of the pericardium through right thoracotomy was successfully carried out. She was discharged on 8th day after surgery without any problems. She is doing well 7 months postoperation after discharge with reduced heart size and returns to normal activity. We concluded that intraoperative thoracic ductography had some advantages in terms of more clear visualization of thoracic duct anastomosis, precise diagnosis of etiology and choice of surgical options.

Child↗
PubMed1988

Summary and prospects of fourteen years' experience with treatment of chyluria by microsurgery.

Since 1974, 125 cases of chyluria have been treated at our hospital using a microsurgical technique. The duration of illness was longer than 1 year in 94% of the cases. For male patients (95 cases), lymphaticovenous anastomosis was performed at the inguinal part of the spermatic cord and, for females (30 cases), at 3 different regions of the lower extremities, namely dorsum of foot, anterior aspect of leg and anterior aspect of thigh. Most of the patients in our series were followed for 6 months to 4 years (the longest 14 years). Among them, 59 cases were followed for more than 1 year. In 45 patients the urine was completely free from chyle (76.3%), and in 4 other patients the urine was weakly chyle positive or they had occasional mild attacks. The total effect rate was 83.1% (45 of 59). Lymphatic fistulae in the kidney did not close immediately after anastomosis, so chyluria persisted for variable periods in most cases, usually not longer than 6 months. In the surgical treatment of chyluria, lymphaticovenous anastomosis, undertaken at a superficial part of the body, was probably the operation of choice because of less damage, little postoperative morbidity and rare serous complications.

Adult↗
PubMed1979

Cytotoxic effect of the thoracic-duct-lymph incubated on lymphocytes.

It was found that lymphocytes cultured in the medium containing chyle were remarkably suppressed in responding to phytohemagglutinin as compared with the control culture without the fluid. This suppressive effect on the cell type seemed likely to be induced by cytotoxic substance produced from the fluid incubated. Various lipids were separated from the incubated-chyle by thin-layer and gas-liquid chromatographies and then their cytotoxic activity to the lymphocytes was examined. These experimental results suggested that unsaturated free fatty acids, made possibly from chylomicron by lipoprotein lipase, had a capability to cause lymphocytolysis. The patho-physiological and immunological significance of the cytotoxic products was discussed.

Animals↗
PubMedDate not supplied

[Diagnosis of chyliferous blockage by the hyperlipidemia test (author's transl)].

In our hyperlipidemia test, the total lipids curve, a plateau without a postprandial peak, allows an easy diagnosis of the chyliferous blockage. The malformation of chyliferous vessels produces the congenital forms: exsudative enteropathy, chyloperitoneum, spontaneous chylothorax, chylous cyst of the mediastinum, reflux of chyle in the pulmonary lymphatics, lymphoedema with chyle reflux in the lymphatics of the leg and chyluria. The acquired forms comprise the post-infectious sclerosis of the intestinal lymphatics and the neoplastic invasions of the mesenteric lymph nodes. The optical density curve brings some informations for a better understanding of lipid's absorption.

Adult↗
PubMed1983

[Chylopericardium, chylothorax and cystic lymphangioma. Review of the literature apropos of a case].

One case of chylopericardium associated with chylopneumothorax is reported. Published data make it clear that the pathogenesis of effusions of chyle is imperfectly known and still highly hypothetical. With the exception of tamponade, there are few pathognomonic and dramatic signs. TM and cross-sectional echography is of paramount importance, since it provides a qualitative and quantitative diagnosis of effusion, the nature of which is determined by chemical analysis. Effusions of chyle may be idiopathic or may developed after oesophago-cardio-pulmonary surgery, or even after blockade of lymphatic vessels or as a result of increased lymphatic flow rate or pressure. Although the course of the disease is usually favourable, infectious or haemodynamic complications (e.g. tamponade or constriction) may aggravate the prognosis. Treatment is exclusively surgical and consists of partial pericardectomy, which is unquestioned. There is no consensus of opinion about simultaneous ligature of the thoracic duct.

Adult↗
PubMed1978

Paraffin oil pneumonia. Analysis of saturated hydrocarbons in different human tissue.

Temperature-programmed gas chromatographic analysis on columns packed with Apiezon L as stationary phase is shown to be the best method for the qualitative and quantitative analysis of simple and complex hydrocarbon mixtures when compared with all the other applicable techniques (thin-layer chromatography, column chromatography, ultraviolet spectroscopy, infrared spectroscopy, nuclear magnetic resonance spectroscopy, mass spectrometry) described in this paper. Using the method in a patient with mineral oil pneumonia it could be demonstrated that he expectorated a maximum of 79.5 mg liquid paraffin daily and also transported equally complex saturated hydrocarbons in a concentration of 1.3 mg% in plasma and of 1.6 mg% in the cellular blood components. In an additional experiment the direct determination of liquid paraffin resorbed from the gastrointestinal tract was possible in a patient with a left chyle fistula in the neck. After a dose of 50 g liquid paraffin administered as a laxative, 246 ml chyle was collected within the following 14 h which yielded a total of 4.5 mg liquid paraffin. Its composition was identical with the administered laxative. Assuming a daily lymph volume of 1.51, the resorbed amount would correspond to a resorption rate of 0.5 (see article) liquid paraffin. The importance of these results as well as the diagnostic consequences arising from the described analytical technique are discussed in detail.

Adult↗
PubMedDate not supplied

Bilateral chylothorax complicating radical neck dissection: report of a case with no concurrent external chylous leakage.

Bilateral chylothorax as a complication of radical neck dissection is extremely rare. Six cases are reported in the English literature. All of these patients' cases were associated with a concurrent external chylous fistula, as evidenced by the appearance of a milky fluid confirmed to be chyle by chemical determination. Chyle had also been noted to leak during the operation. This presentation illustrates an additional case of bilateral chylothorax occurring after radical neck dissection, and the first case, to our knowledge, with no concurrent external lymph leakage. Anatomic and physiologic considerations are presented and possible mechanisms of pathogenesis are discussed. Chylothorax has two major complications--respiratory and metabolic. A short summary of the modern concepts of treatment is presented.

Adult↗
PubMed2003

Chylous effusions complicating lymphoma: a serious event with octreotide as a treatment option.

Chylous effusions have an identical appearance to milk and occur when the thoracic duct is blocked. Since chyle represents direct absorption of fat from the small intestine lacteals, it is rich in fat, calories, vitamins and immunoglobulins. Drainage of this milk-like fluid from any cavity (chest or abdomen) results in rapid weight loss and profound cachexia. The recognition of this milk-like fluid as chyle is urgent for the implementation of the correct treatment. In adults, lymphoma is one of the commonest malignancies to cause blockages in the thoracic duct. Once the diagnosis is made, conservative treatment with strict dietary adjustment often fails to prevent weight loss or resolve the underlying cause. Since the condition is uncommon, no guidelines exist. Many surgeons recommend early surgical intervention before the patient becomes too weak. Surgery may also fail. We report the case of a 62-year-old man with chylous effusions and a weight loss of 30 kg. The nature of the effusion was unrecognized for the first 16 weeks. Upon diagnosis, dietary adjustment was made and a lymphangiogram organized with a view to surgery. Literature searches revealed two cases in which somatostatin was used after surgical procedures failed. We therefore used octreotide (a synthetic analogue of somatostatin). We report complete resolution of the condition within 72 h leading to the resumption of a normal diet and discharge within 2 weeks.

Cardiac Surgical Procedures↗
PubMed1993

Chylothorax in the neonatal period.

Chylothorax is defined as an effusion of lymph in the pleural cavity. In the neonate both congenital and traumatic (iatrogenic) forms exist. Birth asphyxia and respiratory insufficiency are major symptoms of congenital chylothorax, requiring resuscitation and artificial ventilation. Antenatal diagnosis by ultrasound allows early therapeutic intervention such as ventilatory support and drainage of chylous fluid immediately after birth. Traumatic chylothorax is mainly seen after intrathoracic surgery. Treatment primarily consists of continuous or intermittent drainage of chyle with replacement of fluid-, electrolyte-, and protein losses and parenteral nutrition. Introduction of oral feeding is considered only after a substantial period without chyle production in the pleural cavity and consists of a medium-chain triglyceride containing formula. In a minority of cases surgical intervention is necessary.

Chylothorax↗