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At least 253 records · Page 14Linked to original sources
PubMed1984

Combined chylopericardium and chylothorax after total correction of Fallot's tetralogy.

Chylothorax as a complication of cardiovascular surgery has a reported incidence of lower than 0.5% and is extremely rare following intrapericardial procedures. Chylopericardium in particular has a reported incidence even lower than that of chylothorax. The origin of these complications is, in either case, a direct injury to the thoracic duct or a thrombosis at the junction of the left jugular and subclavian veins obstructing thoracic duct drainage and, finally, injury to the anterior mediastinum lymphatics in the thymus area. A case is presented where chylopericardium occurred in combination with chylothorax after operation for total correction of Fallot's tetralogy. The management was conservative, consisting of evacuation of chyle and adequate protein replacement along with a low fat diet. The alternative, operative management in the form of a low ligation of the thoracic duct, should be considered if the conservative management fails after 2 weeks of trial.

Child↗
PubMedDate not supplied

[Spontaneous occlusion of a thoracic duct fistula following leftsided shoulder girdle amputation].

Reference is made to the anatomy and variant courses of the thoracic duct, as well as to possibilities of surgical and conservative therapy. A chylous fistula developed in a 53-year old man after his left shoulder girdle had been amputated because of a recurrent low grade chondrosarcoma. Nineteen liters of chyle were excreted over a 5-week period. It was possible to achieve a spontaneous occlusion of the fistula by means of repeated punctures, compression bandages, and a low-fat diet.

Amputation, Surgical↗
PubMed1991

[Multicystic chylous lymphangioma in the mesentery of the small intestine].

In the search for metastases computed tomography and ultrasonography of the abdomen were performed in a 47-year-old man with a known malignant melanoma in the left lower leg. Numerous fluid-filled cavities, about 8 cm in diameter, were an incidental finding. He died two years after diagnosis of the melanoma, which had extensively metastasized. At autopsy a large multicystic tumour (21 x 15 x 8 cm) was found in the mesentery of the small intestine. The cysts were filled with chyle. Histologically they proved to be multicystic lymphangiomas. Mesenteric lymphangiomas are very rare, multicystic ones and manifestation in adults even more so.

Brain Neoplasms↗
PubMed2003

Acute chylothorax in children: selective retention of memory T cells and natural killer cells.

OBJECTIVE: To assess for immunodeficiency in patients with hypogammaglobulinemia in the setting of draining acute chylothorax. STUDY DESIGN: Humoral and cellular immunity was evaluated in 8 patients with chylothorax. Chylous fluid was also analyzed to document cellular losses. Data regarding clinical course and immunologic characteristics were reviewed retrospectively. RESULTS: All patients had hypogammaglobulinemia (IgG=179+/-35 mg/dL) as well as lymphopenia (985+/-636 cells/mm(3)). T cells were decreased and natural killer cells increased in peripheral blood. The converse was found in chylous fluid. The ratio of CD3+/CD45RA+ naive: CD3+/CD45RO+ memory T cells was greater in chyle than in peripheral blood. In vitro proliferative responses to antigens and mitogens were similar to control subjects, and previously immunized patients maintained evidence of protective vaccine-specific humoral immunity. To treat hypogammaglobulinemia, patients received intravenous immunoglobulin (IVIG) to maintain IgG within normal range; 6 of 8 patients had serious infections before receiving IVIG compared with 4 of 8 patients during the period of IVIG administration. CONCLUSION: Draining chylothorax resulted in IgG and lymphocyte depletion with preferential retention of memory T cells and natural killer cells in the circulation. Overall, protective-specific antibody levels and T cell function were maintained. IVIG administration did not lead to discernible protection from infectious complications in this small group of patients.

Acute Disease↗
PubMed1995

Laparoscopic nephrolysis for chyluria: case report of long-term success.

Laparoscopic nephrolysis was performed in an 81-year-old man with recurrent chyluria. A total of five trocars were used for approaching the lymphatic ducts over the right ureter and renal hilum. The lymphatic ducts identified were easily ligated under laparoscopic magnification. The recovery of this patient was quick and uneventful. The follow-up urinalysis for chyle was negative, and his serum albumin concentration increased from 3.0 g/dL to 4.2 g/dL at 2 years postoperatively. This case report attests to the long-term efficacy of a laparoscopic approach to ligation of lymphatic fistulas for the treatment of recalcitrant chyluria.

Aged↗
PubMed2005

Lymphoscintigraphic demonstration of chylous leak after axillary lymph node dissection.

Chyle leak is a potentially serious complication resulting from violation of the thoracic duct, right lymphatic duct, or one of their terminal branches. It may impair nutrition and immunity, compromise and delay wound healing, prolong hospitalization, and delay adjuvant therapy. After surgery for breast carcinoma, this is a rare occurrence. Here, the author describes a novel application of lymphoscintigraphy showing thoracic duct injury after a wide excision and axillary clearance.

Axilla↗
PubMed1991

Chylous reflux into abdominal skin simulating lymphangioma circumscriptum in a patient with primary intestinal lymphangiectasia.

A 47-year-old man with primary intestinal lymphangiectasia developed chylous reflux into the skin of the right flank. The clinical appearance resembled lymphangioma circumscriptum with multiple dome-shaped vesicles filled with milky-white fluid which discharged on to surrounding skin. Backflow of chyle into the skin of the lower limb, perineum or external genitalia has been described as a rare finding in patients with primary lymphoedema but we believe this to be the first case involving the abdomen and the first case describing chylous reflux into the skin in a patient with intestinal lymphangiectasia.

Blister↗
PubMed1978

Chyluria--a 10 year follow-up.

One hundred and sixty-one cases of chyluria have been studied. The possible aetiological factors, the approach to investigation and the methods and results of treatment have been discussed. In this series, the diagnosis was established by the presence of chyle in the urine. Lymphography was carried out in 90 patients for the localisation of the site of lymphatic reflux while cystoscopic examination after fatty meal was useful in determining the side with the heavier leakage. One hundred and nineteen cases responded to conservative treatment and only 42 cases required operative treatment. Stripping of the renal pedicle via the retroperitoneal route gave the best results.

Adolescent↗
PubMed1978

Gastric ulceration and the concentration of salicylate in plasma in rats after administration of 14C-labelled aspirin and its synthetic triglyceride, 1,3-dipalmitoyl-2(2'-acetoxy-[14C]carboxylbenzoyl) glycerol.

Triglycerides containing aspirin in place of one or more fatty acid residues of the molecule have been synthesized. Metabolism of the compound with the labelled (14C) drug residue introduced specifically into the 2-position of the triglyceride is reported. Plasma salicylate concentrations with this synthetic glyceride were determined and compared with those obtained with commercially available aspirin labelled with the 14C-isotope. Both compounds gave a therapeutic concentration of salicylate in the plasma after ingestion. The 1,3-di-fatty acyl-2-aspirin glyceride was absorbed through the intestine as 2-aspirin monoglyceride, some 20% of which was transported through the thoracic-duct chyle and about 30% through the portal system. Whereas pronounced ulceration of the rat stomach occurred with free aspirin, the above fatty acyl glyceride of aspirin produced no ulceration.

Animals↗
PubMed1987

How should chylothorax be managed?

The management and complications of chylothorax occurring beyond the neonatal period were reviewed retrospectively. Records from 15 patients treated between 1976 and 1986 were analysed; a combination of thoracocentesis, chest drain insertion, and dietary modification were successful in abolishing chyle leakage in 10 cases. One child died from complications of cardiac surgery rather than from the chylothorax, and surgical intervention was necessary in the remaining four patients and included pleurectomy in three and thoracic duct ligation in the fourth. Lymphopenia, hypoalbuminaemia, hyponatraemia, and weight loss were the most common complications of conservative management and tended to occur in those patients with the longest duration of drainage. Postoperative recovery after pleurectomy and thoracic duct ligation was uneventful. We conclude that conservative management of chylothorax will be successful in most cases. Complications of such a policy are fairly common but rarely serious.

Child↗
PubMed1979

A case of isolated primary chylopericardium.

Primary chylopericardium presented as radiographic cardiomegaly in an asymptomatic 19-year-old man. Normal findings at cardiac catheterisation and angiographic demonstration of cardiac displacement from the diaphragm suggested a collection of fluid below the heart which was confirmed by M and B mode ultrasound scanning. Thoracic blood pool isotope scanning indicated that the lumen was a pericardial effusion rather than a cyst. Lymphangiography did not indicate any direct lymphatic communication though a small pool of contrast appeared in the pericardium and the diagnosis of chylopericardium was confirmed by pericardiocentesis. Surgical treatment was undertaken after rapid reaccumulation of chyle and the patient remains well 6 months later.

Adult↗
PubMed1975

Isolated chylopericardium due to mediastinal lymphangiomatous hamartoma;.

Isolated chylopericardium is a rare cause of pericardial effusion. Intrapericardial chyle was first noticed by Hasebroek (1888) at necropsy. Twenty years ago Groves and Effler (1954) first reported a clinical case of isolated chylopericardium. The present case is similar to theirs in several respects, and is the nineteenth case to be reported. To our knowledge this is the first British report of an isolated chylopericardium and is the fourth case of isolated chylopericardium due to a mediastinal lymphangiomatous hamartoma to be successfully treated.

Adult↗
PubMed1975

Management of chylous fistulas;.

Chylous fistula following radical neck dissection is a disturbing and potentially serious complication. Meticulous surgical technique in the areas of the thoracic duct on the left and the lymphatic ducts on the right will usually prevent the occurrence of a chylous leak. If one should develop, however, a pressure dressing alone is usually not sufficient to tamponade the leaking vessel. The patient should be returned to the operating room where the leak is identified and ligated. Loss of chyle from the body will rapidly deplete the body stores of fluid, proteins, and electrolytes. Careful monitoring of serum electrolytes and proteins and accurate replacement of these substances is essential. The anatomy, physiology, surgical technique, and treatment of the lymphatics and chylous fistulas at the base of the neck are considered herein.

Chyle↗
PubMed1998

Therapeutic digoxin level in chylous drainage with no detectable plasma digoxin level.

A patient receiving digoxin for long-standing congestive heart failure developed a chylothorax following removal of an infected aortic graft. Drainage of the chylothorax resulted in plasma digoxin concentrations which were near zero while the digoxin levels in the chylous drainage fluid were therapeutic. The sequestration of even low lipid-soluble drugs, such as digoxin, in chyle should be recognized to prevent subtherapeutic plasma levels in patients undergoing chylothorax drainage.

Aged↗
PubMed2004

Chyloptysis in adults: presentation, recognition, and differential diagnosis.

Chyloptysis is a rare finding, and the accompanying respiratory symptoms are usually nonspecific. The recognition of the chylous nature of the sputum is requisite for proper diagnosis, especially if chyloptysis is not accompanied by chylous pleural effusion. The key to the differential diagnosis of chyloptysis is to consider illnesses that can induce reflux of chyle into the bronchial tree. There are two mechanisms postulated: the first requires the presence of an abnormal communication between the bronchial tree and the lymphatic channels, and the second requires a bronchopleural fistula in the context of a chylous pleural effusion. Chyloptysis in adults should prompt assessment for evidence of lymphatic obstruction from trauma, radiation, and malignancy, and to exclude diseases with known association with chyloptysis, ie, lymphangioleiomyomatosis, yellow nail syndrome, or thoracic lymphangiectasis. A lymphangiogram is recommended to define the abnormality. In the case of lymphangiectasis, patients respond to either dietary modification and/or ligation of the thoracic duct.

Adult↗