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At least 289 records · Page 16Linked to original sources
PubMed1998

Non-parasitic chyluria: a case report and review of the literature.

Chyluria is due to the passage of chyle into the urine giving it a typical milky appearance. Although rarely seen in our countries it is well-known in areas where infections with Wuchereria bancrofti are endemic. Chyluria can also have non-parasitic causes of which only a few cases have been described. We briefly discuss etiologies and pathogenesis of chyluria and present a case of non-parasitic chyluria successfully treated by surgery. A short and critical review of the different treatment modalities is made.

Adult↗
PubMed1981

Bilateral chylothorax. Rare complication of neck dissection.

Bilateral chylothorax is an extremely serious complication that affects the cardiorespiratory system and places the patient in serious danger of respiratory collapse. In cases of postoperative chyle fistula or chylomas, one should consider the possibility of chylothorax. Chest film and, subsequently, diagnostic thoracentesis can provide the diagnosis. Conservative treatment, such as repeated thoracentesis, low-triglyceride diet, and possibly closed thoracostomy tube drainage, should be used. The surgical approach for the ligation of the thoracic duct should be reserved for cases that do not respond to the previously mentioned conservative measures.

Chylothorax↗
PubMed1993

Molecular screening. Prospects for a new approach.

Tumors arise through a series of genetic steps that involve alterations of various cellular genes. The recent revolution in molecular genetic techniques has allowed direct identification of genetic changes within tumors. Because these changes are intimately involved in tumor progression, they are specific markers for cancer. A novel assay based on the polymerase chain reaction allows detection of a rare cancer cell containing a specific point mutation among an excess background of normal cells. This technique has allowed identification of p53 gene mutations in pathologic tissue samples from primary head and neck cancer. A small population of cancer cells has been detected in a variety of histologically negative clinical specimens, including saliva, surgical margins, lymph nodes, and chyle. The precise detection of these rare cancer cells in various clinical samples has significant implications for otolaryngology-head and neck surgery. This approach holds promise for screening of head and neck cancer and may call for the reassessment of current histopathologic staging through utilization of new molecular genetic techniques.

Genes, p53↗
PubMed1984

Spontaneous chylothorax in newborns.

During a 22-year period, 12 cases of spontaneous chylothorax in newborns were diagnosed at a large pediatric tertiary care center. Seven infants had right-sided effusions; only one effusion occurred on the left. Severe bilateral accumulations occurred in four nonimmune hydropic premature infants. The diagnosis was made by the milky appearance and/or the presence of more than 80% lymphocytes in the pleural fluid. Early diagnosis of the pleural effusion as chyle was associated with a less protracted course than when diagnosis was delayed. The total pleural fluid losses varied from 130 to 3,308 mL. Initial treatment included chest taps and/or drains in all the infants and mechanical ventilation in six. Oral feedings with standard or medium-chain triglyceride formulas were given in five; total parenteral nutrition was administered in seven. The conditions of two infants with copious and persistent drainage improved following surgery. All but one infant survived, and the chylothoraxes never recurred.

Chylothorax↗
PubMed1977

Chylothorax: a complication of Dwyer's anterior instrumentation.

The authors report the development of an extensive right chylothorax several days after Dwyer's anterior instrumentation in a 6-year-old girl with a severe progressing infantile scoliosis. Instrumentation extended from T11 to L4 with removal of the tenth rib and with splitting of the diaphragm. The postoperative course was initially without any problems. However, respiratory distress on the tenth day after surgery was accompanied by mediastinal shift and the symptoms were relieved with aspiration of 600 ml of chyle from the right pleural cavity. The literature on this complication of chylothorax is reviewed; it has been observed in cardiothoracic surgery. The management of the case is reported in detail and methods of detection and treatment are discussed.

Child↗
PubMed1979

Chylous ascites and obstructive lymphoedema of the small bowel following abdominal radiotherapy.

The case history of a patient who developed chylous ascites following abdominal irradiation for recurrent carcinoma of the colon is presented. Laparotomy revealed generalized radiation damage of the small bowel with a particularly severely affected segment of jejunum, from the serosal surface of which chyle was seen to be leaking. Mesenteric lymphangiography revealed an obstruction to lymphatic drainage in the mesentery. Resection of the worst affected segment of bowel prevented further development of chylous ascites.

Aged↗
PubMed1992

Aetiology and treatment of chylous ascites.

A series of 45 patients with chylous ascites has been reviewed. The age at presentation ranged from 1 to 80 (median 12) years; 23 patients were aged < or = 15 years. Thirty-five patients had an abnormality of the lymphatics (primary chylous ascites); in the remaining ten, the ascites was secondary to other conditions, principally non-Hodgkin's lymphoma (six patients). Two principal mechanisms of ascites formation were identified using lymphangiography and inspection at laparotomy: leakage from retroperitoneal megalymphatics, usually through a visible lymphoperitoneal fistula (14 patients); and leakage from dilated subserosal lymphatics of the small intestine, invariably associated with leaking lacteals causing protein-losing enteropathy (24 patients). Both sites of leakage were present in a further five patients. In the remaining two patients, chyle was leaking from normal mesenteric lymphatics, in one via a ruptured mesenteric lymph cyst and in the other from the site of a previous lymph node biopsy. Other associated lymphatic abnormalities were present in 36 patients, lymphoedema of the leg being the commonest (26 patients). All patients were initially treated conservatively with dietary manipulation; this was the most satisfactory treatment for those with leaking small bowel lymphatics. Surgery (fistula closure, bowel resection or insertion of a peritoneovenous shunt) was performed in 30 patients. Closure of a retroperitoneal fistula, when present, was the most successful operation, curing seven of the 12 patients so treated.

Adolescent↗
PubMed2001

Endogenous origin of the lymphatics in the avian chorioallantoic membrane.

The lymphatics of the intestinal organs have important functions in transporting chyle toward the jugulosubclavian junction, but the lymphangiogenic potential of the splanchnic mesoderm has not yet been tested. Therefore, we studied the allantoic bud of chick and quail embryos. It is made up of endoderm and splanchnic mesoderm and fuses with the chorion to form the chorioallantoic membrane (CAM) containing both blood vessels and lymphatics. In day 3 embryos (stage 18 of Hamburger and Hamilton [HH]), the allantoic mesoderm consists of mesenchymal cells that form blood islands during stage 19 (HH). The endothelial network of the allantoic bud, some intraluminal and some mesenchymal cells express the hemangiopoietic marker QH1. The QH1-positive endothelial cells also express the vascular endothelial growth factor receptor-3 (VEGFR-3), whereas the integrating angioblasts and the round hematopoietic cells are QH1-positive/VEGFR-3-negative. The ligand, VEGF-C, is expressed ubiquitously in the allantoic bud, and later predominantly in the allantoic epithelium and the wall of larger blood vessels. Allantoic buds of stage 17-18 (HH) quail embryos were grafted homotopically into chick embryos and reincubated until day 13. In the chimeric CAMs, quail endothelial cells are present in blood vessels and lymphatics, the latter being QH1 and VEGFR-3 double-positive. QH1-positive hematopoietic cells are found at many extra- and intraembryonic sites, whereas endothelial cells are confined to the grafting site. Our results show that the early allantoic bud contains hemangioblasts and lymphangioblasts. The latter can be identified with Prox1 antibodies and mRNA probes in the allantoic mesoderm of day 4 embryos (stage 21 HH). Prox1 is a specific marker of the lymphatic endothelium throughout CAM development.

Animals↗
PubMed1993

Esophagogastrectomy: reoperation for complications.

From 1961 to 1991, a total of 1,452 esophagectomies were performed for esophageal cancer at Memorial Sloan-Kettering Cancer Center. Of these patients, 40 (2.7%) developed complications requiring a second operation during the same hospitalization. The majority of the carcinomas were located in the midesophagus or the gastroesophageal junction. The pathologic diagnosis was squamous cell carcinoma in two-thirds of the patients. Few comorbid factors could be identified. Twenty-nine patients (72%) had a standard Ivor-Lewis resection, 5 (12%) had a transhiatal resection, 5 (12%) had a transabdominal approach, and 1 (3%) had a cervical approach only. Complications requiring reoperation were the following: respiratory failure in 13 patients, anastomotic leak in 6, bowel obstruction in 5, major bleeding in 4, wound dehiscence in 4, tracheo-esophageal fistula in 3, feeding tube malposition in 2, empyema in 1, chyle leak in 1, a positive margin in 1. Twelve of these same patients had a persistent or second complication and required a third operation. Among the 40 patients in this study, the mortality was 40%.

Adenocarcinoma↗
PubMed1995

Role of platelet factor Xa in chylomicron-prothrombin complexes induced platelet activation.

The effects of chylomicron-prothrombin complexes on platelet activation, including platelet aggregation, serotonin release, arachidonic acid release and increases of platelet cytosolic [Ca2+]i were examined. Furthermore the role of platelet factor Xa on the conversion of chylomicron bound prothrombin to thrombin was studied by using a synthetic inhibitor of factor Xa, TenStop. The chylomicron-prothrombin complexes could induce platelet aggregation and enhance the platelet serotonin release and arachidonic acid release in contrast to native chyle chylomicrons. An increase of platelet [Ca2+]i was observed during incubation with chylomicron-prothrombin complexes. TenStop inhibited platelet aggregation and serotonin release that were induced by chylomicron-prothrombin complexes in a dose-dependent manner, whereas the TenStop itself did not inhibit the platelet aggregation induced by thrombin and collagen. It is concluded that platelet activation induced by chylomicron-prothrombin complexes is related to the platelet factor Xa that could be the key factor in the conversion of chylomicron bound prothrombin to thrombin.

Animals↗
PubMedDate not supplied

Results of mandatory exploration for penetrating neck trauma.

Management of penetrating wounds to the neck remains controversial despite decades of discussion in the literature. We assessed 393 consecutive stab wounds penetrating the platysma operated at our trauma service between January 14, 1991 and September 30, 1992 to evaluate our policy of mandatory neck exploration (NE). Injury to the common (n = 19 cases), external (n = 7), internal carotid (n = 5), innominate (n = 2), subclavian (n = 20), vertebral (n = 12), facial (n = 2), and intercostal (n = 2) arteries; the external (n = 36), internal (n = 65), subclavian (n = 20), and innominate (n = 4) veins; the pharynx/esophagus (n = 21); and the trachea (n = 28) was considered a positive NE (n = 167). 226 NEs were negative. Except for hemiparesis and bruit, the presence of clinical signs (shock, active hemorrhage, hematoma, surgical emphysema, dysphagia, blowing wound) did not predict a positive NE. Clinical signs were absent in 30% of positive NEs and in 58% of negative NEs. Complications of positive NE included wound infection (n = 7 cases), chyle drainage (n = 6), cerebellar stroke (n = 1), pneumonitis (n = 8), reoperation for recurrent hemorrhage (n = 1), subclavian artery graft occlusion (n = 1), bronchopleural fistula (n = 1), and cerebrospinal fluid leak (n = 1). Negative NEs were complicated by a wound infection in four cases and pneumonitis in one case. The mean hospital stay was 4.3 days for those with a positive NE and 1.5 days for those with a negative NE.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Postoperative chylothorax following partial resection of mediastinal lymphangioma: report of a case.

We report herein the rare case of a 20-year-old man in whom a mediastinal lymphangioma was incidentally detected by a chest roentgenogram taken during a routine health examination. Both computed tomography and magnetic resonance imaging confirmed a mass measuring 3 x 7 cm in diameter in the left anterior mediastinum. A thoracoscopic exploration was done, which confirmed a diagnosis of mediastinal lymphangioma, and 3 days later a sternotomy was performed. However, the tumor could not be completely extirpated due to partial invasion. Following the thoracoscopic procedure, a chylous discharge developed which was difficult to treat conservatively and he continued to drain 700-1,000 ml of chyle daily 2 weeks following the tumor extirpation. Therefore, a right thoracotomy with ligation of the thoracic duct was performed which resolved the chylothorax. The patient remains well without any regrowth of the regional tumor 9 months after his operation.

Adult↗
PubMed1986

Primary lymphatic dysplasia in children: chylothorax, chylous ascites, and generalized lymphatic dysplasia.

Primary lymphatic "dysplasia", a congenital maldevelopment, interferes with function of the lymphatic system and causes effusion of chyle or lymph into the limbs and pleural or peritoneal cavity. Between 1955 and 1982, 38 Mayo Clinic patients were found to have a chylous effusion or dysplasia of the lymphatic system. In 22, the condition was secondary to surgery or other medical problems and in 16 it was primary. These cases were separated into three categories: chylothorax, chylous ascites, and generalized lymphatic dysplasia. Conservative therapy, such as a restricted fat diet or total parenteral nutrition with repeated thoracentesis or paracentesis, was effective in the children with isolated abnormalities of the lymphatic system (75% resolution rate, no deaths). All five children with documented generalized dysplasia reported in the literature had died; of the three reported here, one has died and two have become progressively worse.

Adolescent↗
PubMed1982

Chylothorax secondary to superior vena caval obstruction.

Bilateral lethal chylothoraces developed in a premature infant secondary to superior vena caval obstruction related to central venous catheterization for total parenteral nutrition. The accumulation of chyle in the lungs was preceded radiographically by the typical lymphatic pattern in the lungs, usually associated with lymphangiectasia. A nuclear medicine lymphangiogram showed abnormal accumulation of the isotope in the lungs secondary to the lymphatic obstruction.

Chylothorax↗
PubMed1997

Continuous extracorporeal stool-transport system: a new and economical procedure for transitory short-bowel syndrome in prematures and newborns.

Between May 1994 and June 1995, nine newborns underwent surgery due to mechanical ileus or intrauterine perforation of the small bowel. Three were very-low-birth-weight infants weighing between 520 and 1,200 g. Surgery was performed in the first 2 days of life and split ileo- or jejunostomas were implanted. Early oral nutrition was initiated. To avoid non-use of the distal bowel and short-bowel syndrome, the aboral stoma was irrigated a few days later with the proximal feces. A new technique was applied to transport the chyle continuously from the oral to the aboral stoma: the stool was collected in an especially constructed stoma bag and transported distally by a roller pump. No major complications were seen. The general outcome was excellent in all cases, and reanastomosis under optimal bowel conditions was achieved in all patients without further problems.

Feces↗
PubMed1981

Endoscopic and histopathological study on primary and secondary intestinal lymphangiectasia.

Jejunal endoscopy and histopathological study of biopsied specimens were performed to clarify states of jejunal mucosa and the mechanism of enteric protein loss in six patients with protein-losing enteropathy, including four patients with intestinal lymphangiectasia, one patient with constrictive pericarditis associated with dilated lymphatics of the intestine, and one patient with Budd-Chiari syndrome. Three cardinal endoscopic findings, scattered white spots, white villi, and chyle-like substances covering the mucosa, were demonstrated in protein-losing enteropathy. Scattered white spots indicated markedly dilated lymphatics in the stroma of the villi. White villi seemed to be due to fats including chylomicrons or fat droplets in the absorptive cells, interepithelial spaces, and/or stroma, even though the biopsies were obtained in the fasting state. Therefore, white villi suggest impaired transport of fats from intestinal epithelial cells to intestinal lymphatics. These three cardinal findings are thought to be characteristic for protein-losing enteropathy secondary to lymphatic disorders.

Adolescent↗
PubMed1992

Lipoprotein receptor mediated metabolism of [14C]arachidonic acid labeled chylomicron remnants by Hep G2 cells.

During lipolysis of chylomicron triacylglycerol by lipoprotein lipase, arachidonic acid (AA) esters are hydrolyzed at a slower rate than the predominant 16-18 carbon fatty acid esters. The further metabolism of the AA that is hereby enriched in the chylomicron remnant acylglycerols has not been investigated. In the present study, we examined the low density lipoprotein (LDL) dependent and independent metabolism of [14C]AA present in chylomicron remnants in the human hepatoma cell line Hep G2. Mesenteric duct cannulated rats were fed [14C]AA and [3H]cholesterol in corn oil, and the chyle obtained was injected intravenously into hepatectomized rats to form chylomicron remnants labeled with [14C]AA in the triacylglycerol (TG) and with 3H in the cholesteryl ester portion. The remnants were then incubated with Hep G2 cells. The uptake of [14C]AA within 2-4 h was similar to that of [3H]cholesteryl ester. After uptake into the cells, [14C]AA was preferentially incorporated into phospholipids, a high proportion being found in phosphatidylcholine, phosphatidylethanolamine and phosphatidylinositol. [14C]AA and [3H]cholesteryl ester uptake were influenced to similar extents by factors unknown to regulate the LDL receptor and by an anti-LDL receptor antibody. Addition of compactin thus increased the uptake of [14C]AA by 50% in 4 h and mevalonolactone decreased the uptake by 86%. Using an anti-LDL receptor antibody, 25.0% of [3H]cholesterol/cholesteryl ester and 37.7% of [14C]AA binding to the cells at 4 degrees C were blocked. There was no lipolysis of [14C]TG or [14C]diacylglycerol by lipase secreted into the medium during incubations.(ABSTRACT TRUNCATED AT 250 WORDS)

Arachidonic Acid↗
PubMed1987

Lymphatic endothelial cell line (CH3) from a recurrent retroperitoneal lymphangioma.

An endothelial cell line derived from a massive recurrent chyle-containing retroperitoneal lymphangioma was isolated in monolayer culture. Scanning and transmission electron microscopy and immunohistochemistry confirmed a close resemblance to blood vascular endothelium with typical cobblestone morphology, positive immunofluorescence staining for endothelial marker Factor VIII-associated antigen and fibronectin, and prominent Weibel-Palade bodies. The endothelial cells also exhibited other ultrastructural features characteristic of lymphatic endothelium, including sparse microvillous surface projections, overlapping intercellular junctions, and abundant intermediate filaments. This endothelial cell line represents a new source of proliferating lymphatic endothelium for future study, including structural and functional comparison to blood vascular endothelium.

Adult↗