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At least 217 records · Page 12Linked to original sources
PubMed1988

Metabolism of chylomicron arachidonic and linoleic acid in the rat.

Chyle and chylomicrons, obtained after feeding thoracic duct cannulated rats [3H]arachidonic (20:4) and [14C]linoleic acid (18:2) in cream, were injected i.v. into recipient animals. 7.5-15 min after injection, the 14C/3H ratio of the triacylglycerols remaining in plasma was about half of that in the injected chylomicrons, indicating that the chylomicron remnants formed retained relatively more [3H]20:4 than [14C]18:2. The 14C/3H ratio of plasma diacylglycerols was about 6-fold lower than that of plasma free fatty acids. The proportion of [3H]20:4 found in plasma cholesteryl esters was several-fold higher than that of [14C]18:2. Inhibition of hepatic lipase by a specific antiserum did not significantly influence the clearance of triacylglycerols, but increased the amount of 3H in plasma diacylglycerols. It also prevented the rapid clearance of phosphatidylethanolamine from plasma. The liver uptake of [3H]20:4 exceeded that of [14C]18:2. Antiserum against hepatic lipase diminished the difference. In contrast, the 14C/3H ratio of adipose tissue was higher than that of the injected chyle lipoproteins.

Adipose Tissue↗
PubMed2006

Chylothorax.

Chylothorax is a rare complication of pulmonary resection. It requires prompt treatment, which is initially conservative. This treatment consists of drainage, nutritional support, and measures to diminish chyle flow. Surgical intervention is indicated when conservative management is ineffective. Delay in surgical intervention leads not only to serious metabolic, nutritional, and immunologic disturbances from the loss of chyle but also increases the risk for adhesion formation, loculation, organization, and infection of the chylothorax, making subsequent surgical attempts difficult and increasing postoperative morbidity and mortality. VATS provides a minimally invasive approach for the treatment of chylothorax complicating pulmonary resection. Clipping of the thoracic duct or chemical pleurodesis may be performed with minimal morbidity and mortality. Conservative treatment is expensive and fails in most patients who have high-output chylous fistulae. On the other hand, VATS is uniformly effective, is less expensive, and has low morbidity. Indeed, VATS is rapidly becoming the preferred approach for the management of chylothorax complicating pulmonary resection. The need to prevent the occurrence of a chylothorax by careful dissection techniques and liberal clipping of lymphatic vessels particularly in areas of high anatomic risk during the initial operation cannot be overemphasized.

Chylothorax↗
PubMed2004

[Chyloperitoneum complicated by intestinal occlusion].

INTRODUCTION: Acute chylous ascites is an affection rarely encountered among acute painful abdominal syndromes. OBSERVATION: An acute chylous ascites was observed in a 76 Year-old man without prior history. Its etiology was an acute pancreatitis. Intestinal occlusion on the 15th day post-surgery required adhesiolysis. DISCUSSION: Intestinal occlusion is exceptional after chylous acsites despite the potential adherence of the chyle. Regarding the pathogenesis, analysis of the literature and our case report suggest either a bridle, adherences, or a peri-intestinal sheath due to the organisation of the chyle at the origin of the occlusion following chyloperitonitis. CONCLUSION: Although an etiology of chylous ascites can be an intestinal occlusion, it can, although rarely, also be a more or less late complication.

Acute Disease↗
PubMed1999

Successful management of post-esophagectomy chylothorax/chyloperitoneum by etilefrine.

Post-operative chylothorax and chyloperitoneum resulting from a thoracic duct injury are possible complications of esophagectomy for carcinoma. Management of such conditions includes conservative methods (pleural drainage, chyle flow reduction and supportive nutrition) and surgery. Etilefrine, a sympathomimetic drug used in the management of postural hypotension, also causes smooth muscle contraction of the thoracic duct. We successfully treated three patients with post-esophagectomy chylothorax and chyloperitoneum using intravenous etilefrine. Etilefrine infusion allowed chyle flow resolution in a few days without any side-effects. As result of this experience, we believe that etilefrine deserves to be considered as an alternative therapy in the management of post-esophagectomy chylothorax/chyloperitoneum.

Adult↗
PubMed2002

Valves in the subsidiary lymph trunks in the neck.

INTRODUCTION: The thoracic duct drains both lymph and chyle into the confluence of the great veins in the root of the neck. The venous termination of the duct is protected from retrograde flow of blood by valves. However, little attention has been focused on the presence or absence of valves in the subsidiary lymph trunks in the neck. AIMS: The aim of this study was to determine whether there are valves in the subsidiary lymphatic system in the neck. MATERIAL AND METHODS: The left side of the neck was explored in ten formalin-fixed cadavers. Subsidiary lymphatic trunks were carefully preserved for stereomicroscopic examination. RESULTS: Eight subsidiary trunks were identified comprising four jugular, two subclavian and two bronchomediastinal trunks. Both subclavian lymph trunks drained directly into a vein. A bicuspid ostial valve was present at the termination of the trunks. The bronchomediastinal and jugular trunks drained into the thoracic duct prior to its venous termination. Valvular structures were identified along the bronchomediastinal trunks and at their termination with the thoracic duct. No valves were identified in the jugular trunks. CONCLUSION: The absence of valves in the jugular lymph trunks is proposed as a possible contributory factor in the creation of chyle leaks following neck dissections.

Humans↗
PubMed1991

Bilateral chylothorax.

A 2.5-kg female developed bilateral chylothoraces 10 days after surgery for coarctation of the aorta. Initial conservative management consisted of intermittent positive pressure ventilation, drainage of chylous fluid and enteral feeding, but there was no diminution in loss of chyle. Ligation of the thoracic duct and pleurectomy were performed subsequently to reduce the large daily losses of chyle, amounting to nearly three times the child's circulating blood volume. Brawny oedema of the right upper quadrant of the body developed rapidly after the duct ligation and right pleurectomy. A further period of conservative treatment was required before the latter complication resolved. The literature relating to this iatrogenic complication and to fluid and nutritional losses in paediatric chylothorax is reviewed and discussed.

Aortic Coarctation↗
PubMed1981

Acute chylous peritonitis.

The extravasation of chyle into the peritoneal cavity is rarely associated with the sudden development of clinical signs and symptoms of peritonitis. A review of the English literature has documented 56 cases of this unusual disorder. We report a recent case at our institution, describing the pertinent clinical, laboratory, and operative findings. The chronic form of chylous ascites, usually associated with malignant obstruction of the lymphatics, does not cause this acute syndrome. With the acute form exploration is usually undertaken because of the clinical findings of peritonitis. A surgically correctable etiology is frequently found, although 55% of the cases have not been clearly associated with a causative factor. In those cases considered idiopathic, the natural history of the disease is spontaneous closure of the chyle leak with regression of the ascites.

Acute Disease↗
PubMed2006

Surgical management of a double-chambered right ventricle and chylothorax in a Labrador retriever.

A 22-month-old, male Labrador retriever was presented with anorexia, dyspnoea, and fainting. The dog was diagnosed with a double-chambered right ventricle and tricuspid valve dysplasia using echocardiography and cardiac catheterisation. A marked bilateral pleural effusion was also present and chemical analysis of the fluid confirmed the diagnosis of chylothorax. Using echocardiography, a pressure gradient of 87.1 mmHg was found between the proximal and distal chambers of the double-chambered right ventricle. Initiation of cardiopulmonary bypass allowed the anomalous muscle bundle that divided the right ventricle into two chambers to be resected via a right ventriculotomy. The fainting completely resolved postoperatively, and this treatment seemed quite effective in the reduction of pressure overload ascribable to ejection disturbance. Because the tricuspid dysplasia was not corrected in the first operation, the postoperative chyle effusion was reduced but did not cease. A combination of thoracic duct ligation and passive pleuroperitoneal shunting was effective in the resolution of the chyle effusion.

Animals↗
PubMed1973

The effects of triglyceride absorption upon glucagon, insulin, and gut glucagon-like immunoreactivity.

The effects of a fat meal upon plasma insulin, glucagon, and glucagon-like immunoreactivity (GLI) have been studied in conscious dogs and in human volunteers. In dogs the intraduodenal instillation of 10 g/kg of peanut oil was accompanied by increases in the mean plasma levels of all three polypeptides that averaged 5 muU/ml, 107 pg/ml, and 2.1 ng/ml, respectively. 3 g/kg of peanut oil, when emulsified with egg yolk, elicited a much greater response of the three hormones, and a physiologic dose of 1 g/kg in emulsified form also caused a significant rise in glucagon and GLI. The islet cell hormone response was not ascribable to chylomicronemia since intravenous infusion of canine chyle failed to stimulate glucagon secretion; moreover, in dogs with a thoracic duct fistula in which chyle was excluded from the circulation, the intraduodenal administration of a fat meal elicited the normal islet cell hormone response, as well as a rise in GLI. 10 g/kg of medium-chain triglycerides failed to elicit these same responses. In six human volunteers the oral administration of 3 g/kg peanut oil was accompanied by increments of 2 muU/ml, 26 pg/ml, and 1.5 ng/ml in the mean levels of insulin, glucagon, and GLI. The changes in insulin and glucagon in man were neither statistically significant nor biologically impressive. It is concluded that in dogs fat absorption is accompanied by prompt and substantial increases in plasma glucagon and GLI and a small transient rise in insulin. The evidence favors an enterogenic signal to the islets of Langerhans rather than their stimulation by chylomicrons. Pancreozymin is qualified to serve as such a signal. The physiologic implications of this study are considered.

Animals↗
PubMed1994

Lymphatic drainage system after left radical neck dissection.

The thoracic duct is the main lymphatic vessel that drains most of the body's lymph and all of the intestinal chyle into the venous system. The thoracic duct may be ligated during left radical neck dissection (RND) without any significant sequelae. The lymphatic system must, therefore, have collateral channels. The present study shows an increased incidence of pleural effusion after left RND when compared to right RND. We suggest that this represents the inability of the collateral system to immediately accommodate the increased volume of chyle.

Carcinoma, Squamous Cell↗
PubMed1997

Chylothorax and pseudochylothorax.

Chylothorax is the occurrence of chylus (lymph) in the pleura due to damage to the thoracic duct. There is a high content of triglycerides, and chylomicrons can be seen. It is usually right-sided, since most of the duct is within the right hemithorax. With damage at the level of the aorta, the chyle will appear on the left. Traumatic rupture occurs after accidents or surgery. Of nontraumatic causes, the most common is a malignant lymphoma. Computed tomography (CT) scan of the thorax and upper abdomen should be performed. Lymphography can show where the leakage or blockage is situated. With repeated drains, large amounts of fat, proteins, and lymphocytes are lost. Treatment is with low-fat diet or parenteral nutrition to decrease the amount of chyle, but chemical pleurodesis or ligation of the thoracic duct, usually via thoracoscopy, is often necessary. Pseudochylothorax (cholesterol pleurisy) occurs with long-standing fluid in a fibrotic pleura. The fluid has a high content of cholesterol but no triglycerides or chylomicrons. In both conditions, the pleural fluid is thick, opalescent, whitish or the colour of cafe-au-lait.

Cholesterol↗
PubMedDate not supplied

Thoracic duct ligation and pericardectomy for treatment of idiopathic chylothorax.

Chylothorax is a devastating disease, and the success rates from either medical or surgical management are less than satisfactory. In some animals with chylothorax, a thickening of the pericardium occurs that is associated with chronic irritation induced by chyle. We hypothesized that pericardial thickening would lead to increased right-sided venous pressures and that abnormal venous pressures would act to impede the drainage of chyle via lymphaticovenous communications after thoracic duct (TD) ligation. We also hypothesized that serosanguineous effusions that occurred after TD ligation could effectively be treated or prevented by pericardectomy in affected animals. TD ligation plus pericardectomy was performed in 17 animals, and pericardectomy alone was performed in an additional 3 animals that presented during a 5.5-year period to the Texas A&M University (College Station, TX). Nineteen animals presented for an evaluation of idiopathic chylothorax (9 dogs and 10 cats), and 1 dog presented for serosanguineous pleural fluid after TD ligation that had been performed elsewhere. Echocardiography was normal in all animals, except for a subjectively thickened pericardium in 7 cats and 6 dogs. Clinical signs of pleural fluid accumulation resolved in 10 of 10 dogs and in 8 of 10 cats after surgery. The overall success rate for the surgical treatment of chylothorax (ie, the resolution of pleural fluid accumulation) in this study was 90% (100% in dogs and 80% in cats). These data suggest that TD ligation in conjunction with pericardectomy has a favorable outcome in animals with idiopathic chylothorax.

Animals↗
PubMed2005

Unusual findings during abdominal placement of a ventriculoperitoneal shunt: report of three cases.

The authors present three cases of infants born with myelodysplasia. Each infant underwent closure of a myelomeningocele and within 2 to 4 days placement of a ventriculoperitoneal (VP) shunt. In each case, on opening the peritoneal cavity, the authors observed egress of a dark or creamy dark fluid. None of the patients had a history of abdominal birth trauma. The decision was made to continue the procedures and send samples of the unusual fluids to the laboratory for culture and analysis. The cultures proved to be nondiagnostic and the characteristics of the fluid samples were most consistent with those of blood-tinged chyle. The authors hypothesize that, occasionally, the mechanical tautness that is created with repair of myelomeningoceles is sufficient to rupture small lymphatic vessels and accompanying blood vessels of the abdomen. An alternative hypothesis is that abdominal compression due to closure of the myelomeningocele may temporarily compress the liver, leading to raised intraportal pressures and resulting in weeping of chyle from the gastrointestinal tract. This abnormal fluid accumulation did not lead to chronic ascites, VP shunt infection, or dysfunction at long-term follow-up examination and abdominal visceral function has not been an issue.

Ascitic Fluid↗
PubMed2006

A case of chylous fistula after axillary dissection in breast-conserving treatment for breast cancer.

Chyle fistula is not a well-known complication of axillary dissection in patients with breast cancer. Although rare, this complication can occur as a result of anatomic variation of the thoracic duct and its venous anastomosis. Injury to the lateral terminating branches or lymphatic trunk, leading to retrograde chyle flow, is more likely than direct injury to the duct. We report a case of chylous fistula after axillary dissection in a patient with breast cancer, review the literature, and discuss the management of this rare complication.

Axilla↗
PubMed1992

Incorporation of dietary [14C]arachidonic acid and [3H]eicosapentaenoic acid into tissue lipids during absorption of a fish oil emulsion.

A preferential incorporation of dietary arachidonic acid (20:4, n-6) into chyle lipoprotein phospholipids, a relative resistance of 20:4 esters of chyle triacylglycerol (TG) to hydrolysis by lipoprotein lipase, a preferential utilization of 20:4 for phospholipid acylation, and a low rate of oxidation of 20:4 are factors that may contribute to the differences seen in the incorporation into tissue lipids between absorbed 20:4 and the predominant dietary 16-18 carbon fatty acids. In this study we fed [14C]20:4 and [3H]eicosapentaenoic acid (20:5, n-3) as free fatty acids in a fish oil emulsion to rats and analyzed the radioactivity in different tissue lipids after 1, 2, and 4 h. The purpose was to examine the degree of similarity in the fate of the two major eicosanoid precursors during the absorption of a fish oil meal. The recovery after 2 and 4 h of 14C exceeded that of 3H in lipids of small intestine, serum, liver, heart, kidneys, and spleen. The differences increased with time, e.g., the liver contained 9.7 (+/- 0.7)% 3H and 17.9 (+/- 1.4)% of the 14C (P less than 0.001), and the upper half of the small intestine 10.0 (+/- 0.8)% of the 3H and 22.8 (+/- 1.1)% of the 14C (P less than 0.001) after 4 h. The 14C and 3H radioactivity per g tissue after 4 h ranked as follows: liver and brown adipose tissue greater than kidneys greater than heart, lungs, spleen, and serum greater than colon greater than white adipose tissue and testes, the differences between tissues being up to 50-fold. There were up to fourfold variations in the 14C/3H ratios between tissues after 4 h, the highest value being observed in the heart and the lowest in white adipose tissue. Of the radioactivity retained in liver and intestine, more 14C and 3H was in phospholipids and less in triacylglycerol (TG), the differences being largest in the liver, e.g., after 4 h 57.6 (+/- 0.8)% of the 14C and 29.9 (+/- 0.9)% of the 3H (P less than 0.001) in the liver was in phosphatidylcholine (PC). In both intestine and liver the highest 14C/3H ratios were found in phosphatidylinositiol (PI). Also phosphatidylethanolamine (PE) contained more 14C than 3H but the quantitative differences were relatively small after 4 h. In heart the proportions of 3H and 14C found in PE and PI did not differ, whereas more of the 14C was in PC and more of the 3H was in cardiolipin and phosphatidylserine.(ABSTRACT TRUNCATED AT 400 WORDS)

Absorption↗
PubMed2005

[The diagnosis and therapy of chylous ascites].

OBJECTIVE: To discuss the diagnosis and therapy of chylous ascites. METHODS: To diagnose 40 patients of chylous ascite with regular test and quantitative analysis of chyle, direct lymphangiography, CT (immediately after direct lymphangiography), lymphangioscintigraphy, MRI. Twenty-two patients received conservative therapy, 18 patients received retroperitoneal lymphangiectomy and (or) lymph-vein shunting. RESULTS: Lymphatic dysplasia and chylous reflux were found in almost every patient, total parenteral nutrition showed good results. Followed up from 1 month to 5 years, in conservative therapy group, 9 patients were controlled well clinically, the condition of 6 patients was improved better. Seven patients showed no effect. In operation group, 11 patients were controlled well clinically. Four patients got mitigated. Total 7 patients died, although 4 of them ameliorated temporarily. CONCLUSIONS: Direct lymphangiography, CT (immediately after direct lymphangiography) are the most important diagnosis methods. The influence of the therapy to the malformed lymphatic system of patients should be well considered. Lymph-vein shunting, such as thoracic duct-left external jugular vein anastomosis, gastroenteral or retroperitoneal lymphatics-testicular or ovarian vein anastomosis, could improve the circulation of lymph and chyle of patients. Lymphatic microsurgery will play more and more important roles in the treatment of chylous diseases.

Adolescent↗
PubMedDate not supplied

[Chylothorax. An infrequent complication in surgical exeresis of the esophagus].

We report a case of massive bilateral chylothorax occurring after surgical resection of the esophagus in a patient with esophageal neoplasm. The surgical approach consisted of a thoracotomy and a cervicostomy. The relevance of this case is based on the low incidence of chylothorax after esophageal surgery. The literature indicates an incidence of about 0.9 to 3%. In our series of 200 patients operated on during the last 10 years we found and incidence of 2%. The patient herein reported presented an immediate postoperative clinical picture of respiratory insufficiency associated with the presence of milky fluid in the pleural drainage. Hematologic and biochemical examination of the pleural fluid confirmed the diagnosis of chylothorax. During the first 24 hours we collected a total volume of 2,500 ml of chyle. The patient was treated with conservative procedures including parenteral nutrition and intravenous reposition of fluids. After 48 hours the total volume of chyle reached 8,500 ml and the patient died.

Carcinoma, Squamous Cell↗
PubMed1991

[Chylous ascites imitating acute appendicitis].

Acute accumulation of chyle in the peritoneal cavity is rare. It is usually idiopathic and the diagnosis is made at laparotomy, when indicated because of signs of acute peritonitis. Drainage is the only treatment required and the prognosis is excellent. A 33 year-old man who was operated on for signs of acute peritonitis is described. There was more than a liter of chyle, but no underlying pathological condition was found. 3 months after discharge, physical and laboratory examinations were normal, with no evidence of chylomicron retention disease.

Adult↗