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At least 343 records · Page 19Linked to original sources
PubMed1985

Chylous ascites complicating genitourinary oncological surgery.

Chylous ascites is an uncommon complication of retroperitoneal surgery. We report 2 cases of intraperitoneal chyle fistulas, one following retroperitoneal lymphadenectomy for testis cancer and the other after radical nephrectomy with regional lymphadenectomy for renal cell carcinoma. Both patients were treated successfully with medium chain triglyceride diets. We believe that most patients with chylous ascites will respond to simple dietary manipulation, and do not require complex and potentially morbid treatment regimens.

Adenocarcinoma↗
PubMed1997

Intralipid rapidly attenuates the agonist-induced activation of rat platelets in vitro.

This study examines the uptake of Intralipid by rat platelets and the effect of Intralipid on platelet activation and platelet lipid composition in vitro. 3H-cholesteryl hexadecyl ether labeled Intralipid (3H-Intralipid) was incubated with rat platelets for up to 4 hours. A significant uptake of 3H-Intralipid occurred as indicated by the increase of 3H in platelets with time. Addition of unlabelled Intralipid or chyle chylomicrons decreased the uptake of labeled Intralipid by the platelets, whereas Intralipid had less effect on the uptake of 14C linoleic acid labeled chylomicrons. Incubation of rat platelets with Intralipid caused a dose dependent inhibition of ADP, collagen and thrombin induced platelet aggregation and serotonin release. Both an attenuated response and a reduction of platelet cholesterol contents was seen within 10 minutes. Intralipid thus causes a rapid, dose- dependent inhibition of agonist-induced activation of rat platelets in vitro. This inhibition is linked to a loss of cholesterol and to an uptake of Intralipid particles by the platelets.

Animals↗
PubMed1989

Critical care surgical techniques.

A veterinarian dealing with critical and trauma patients must be proficient with techniques for tracheostomy, thoracostomy tube placement for chest drainage, diagnostic peritoneal lavage, and autotransfusion. The utilization of these techniques may be life-saving in the critical patient. A tracheostomy is indicated in any patient with upper airway obstruction that cannot be managed with supplemental oxygen and/or orotracheal intubation. A tracheostomy tube with an inner cannula is preferred. Tracheostomy tubes should be cleaned at 3- to 4-h intervals, and methods should be employed to decrease thick tracheal secretions and to remove them from the trachea. A patient with a tracheostomy tube should be monitored continuously. A thoracostomy tube is indicated in any patient with large and/or continuous accumulation of air, blood, fluid, or chyle in the pleural space. The thoracostomy tube should be at least the same size as the patient's main stem bronchus. The thoracostomy tube is placed aseptically at the seventh intercostal space at the junction of the upper one third and lower two thirds of the lateral chest wall. Fluid or air may be removed from the chest intermittently with a three-way stopcock attached to the thoracostomy tube and a 60-ml syringe. If continuous drainage is needed, a continuous underwater seal and suction system should be used. Diagnostic abdominal paracentesis and peritoneal lavage are useful techniques in the determination of abdominal trauma, hollow viscus rupture, peritonitis, hepatic trauma, and urinary system trauma. When a multiholed catheter and lavage are used, the accuracy of detecting abdominal trauma is 95 per cent. When only needle paracentesis is used, the accuracy drops to 47 per cent. Abdominal lavage fluid can be analyzed for bacteria, whole blood, white blood cells, free bilirubin, creatinine, blood urea nitrogen, amylase, alkaline phosphatase, and alanine aminotransferase. Large volumes of whole blood recovered from abdominal or thoracic paracentesis can be reinfused into the patient if needed, providing it is not contaminated or markedly hemolyzed. The blood should be collected aseptically into blood bottles or bags. If the bleeding is ongoing or the blood only a few hours old, anticoagulants should be used. If the hemorrhage is several hours old, then clotting and defibrination has already occurred and the blood can be collected into "dry" bags or bottles. Before use, abdominal blood should be analyzed for urine, bile or fecal contamination. Blood collected from the thoracic cavity is much less likely to be contaminated. Autotransfused blood is administered through a standard blood administration set.

Animals↗
PubMed2001

Cloning and functional analysis of the Sry-related HMG box gene, Sox18.

The Sox gene family (Sry like HMG box gene) is characterised by a conserved DNA sequence encoding a domain of approximately 80 amino acids which is responsible for sequence specific DNA binding. We initially published the identification and partial cDNA sequence of murine Sox18, a new member of this gene family, isolated from a cardiac cDNA library. This sequence allowed us to classify Sox18 into the F sub-group of Sox proteins, along with Sox7 and Sox17. Recently, we demonstrated that mutations in the Sox18 activation domain underlie cardiovascular and hair follicle defects in the mouse mutation, ragged (Ra) (Pennisi et al., 2000. Mutations in Sox18 underlie cardiovascular and hair follicle defecs in ragged mice. Nat. Genet. 24, 434-437). Ra homozygotes lack vibrissae and coat hairs, have generalised oedema and an accumulation of chyle in the peritoneum. Here we have investigated the genomic sequences encoding Sox18. Screening of a mouse genomic phage library identified four overlapping clones, we sequenced a 3.25 kb XbaI fragment that defined the entire coding region and approximately 1.5 kb of 5' flanking sequences. This identified (i) an additional 91 amino acids upstream of the previously designated methionine start codon in the original cDNA, and (ii) an intron encoded within the HMG box/DNA binding domain in exactly the same position as that found in the Sox5, -13 and -17 genes. The Sox18 gene encodes a protein of 468 aa. We present evidence that suggests HAF-2, the human HMG-box activating factor -2 protein, is the orthologue of murine Sox18. HAF-2 has been implicated in the regulation of the Human IgH enhancer in a B cell context. Random mutagenesis coupled with GAL4 hybrid analysis in the activation domain between amino acids 252 and 346, of Sox18, implicated the phosphorylation motif, SARS, and the region between amino acid residues 313 and 346 as critical components of Sox18 mediated transactivation. Finally, we examined the expression of Sox18 in multiple adult mouse tissues using RT-PCR. Low-moderate expression was observed in spleen, stomach, kidney, intestine, skeletal muscle and heart. Very abundant expression was detected in lung tissue.

Amino Acid Sequence↗
PubMed1998

Infected spontaneous chylothorax.

Infection of a chylothorax is thought not to occur because chyle is inherently bacteriostatic. We report a case of an infected chylothorax occurring in an immunocompromised patient with pneumonia. To our knowledge, this is the first description of such a case.

Adult↗
PubMed2003

Chylothorax: case report and review of the literature.

Chylothorax is a rare entity with both traumatic and non-traumatic etiologies. Chyle depletion has significant nutritional, metabolic and immunologic consequences. We present a case of a patient with chylothorax who presented to the Emergency Department on numerous occasions with complications related to his chylothorax.

Adult↗
PubMed2002

[Long-term followup of primary intestinal lymphangiectasia in the child. Six case reports].

UNLABELLED: Primary intestinal lymphangiectasia induce symptoms of protein-losing gastroenteropathy. Only very few studies evaluate the long term follow up of such patients. We reviewed six children diagnosed at 17 +/- 12 months and followed for 11 +/- 4.9 years. CASE REPORTS: As soon as the diagnosis was made the patients were submitted to a strict low fat diet with added medium chain triglycerides and intermittent liposoluble vitamins perfusions. The diet allowed the disappearance of symptoms for all the patients but laboratory findings indicated continuing chyle leak for most of the children. Only one child who had normal biological parameters tolerates a normal diet since four years. Relaxation of the diet by two patients who had moderate hypoalbuminemia and lymphopenia led to severe clinical relapses 14 and 17 years after the diagnosis period with therapeutic difficulties. Three patients with long term strict low fat diet remain asymptomatic. CONCLUSION: In most asymptomatic patients, the underlying lymphatic defect remains with permanent biological abnormalities. Clinical relapses may be severe and difficult to treat; thus the need for dietary treatment appears to be permanent.

Adolescent↗
PubMed1997

Post-thoracotomy chylothorax--a cure in the abdomen?

Operative control via a thoracic approach of chylothorax can be difficult to achieve, particularly if the chyle leak is secondary to previous thoracic surgery. This report describes the ligation of the thoracic duct at the level of the diaphragmatic hiatus, via an abdominal approach. This technique was the definitive management in four of the last 5 patients presenting with chylothorax in our unit. Typically the leak ceased within 24 h with early discharge of the patient from hospital.

Abdomen↗
PubMed2002

Postoperative chylothorax.

Chylothorax is an unusual complication of surgical procedures within the chest. Early recognition is important so that appropriate conservative measures can be applied. Operative intervention after a short course of supportive therapy will control most chyle fistulas. Methods of diagnosis in the postoperative setting and literature supporting various treatment options are the focus of this article.

Chylothorax↗
PubMed2002

Early complications after Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy: risk factors and management.

BACKGROUND: Esophageal resection represents a major surgical and physiologic insult carrying major morbidity and mortality. We present the results of esophagectomy in a specialist unit with emphasis on early complications and their management. STUDY DESIGN: From January 4, 1990 through January 6, 2000, 228 patients have undergone Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy for malignancy under the care of one surgeon. The median age was 64 years (range 39 to 77 years), with a male to female ratio of 2.3:1 and a predominance of adenocarcinoma (n = 146) compared with squamous cell carcinoma (n = 75) and other tumors (n = 7). Detailed prospective data were collected on preoperative status, operative parameters, and postoperative complications. RESULTS: Median ICU stay was 1 day (range 1 to 47 days) and the median postoperative hospital stay in patients surviving surgery (n= 219) was 13 days (range 9 to 159 days). There were 119 separate postoperative complications occurring in 45% of patients (102 of 228), comprising predominantly pulmonary morbidity. Major respiratory complications (17%) were significantly associated with poor preoperative spirometry (p = 0.002) and a history of smoking (p = 0.03). Seven percent of patients (16 of 228) suffered cardiovascular or thromboembolic complications. Major surgical complications occurred in 10% of patients (22 of 228) including mediastinal leaks in 4%. Isolated anastomotic leaks (2%) were successfully treated conservatively in all cases; extensive leaks from ischemic gastric conduits (1%) or gastrotomy dehiscence (1%) underwent further exploration and either local repair or resection and exclusion. Reoperation for hemostasis was required in 3% (6 of 228) and only 1% of patients (2 of 228) developed chyle leaks. Thirty-day mortality was 2%, rising to 4% for in-hospital mortality. The nine fatalities were significantly older (p = 0.02) than those who survived and 67% (6 of 9) had suffered primary surgical complications. CONCLUSIONS: Overall morbidity after radical esophagectomy is high, but early recognition and aggressive management of complications can minimize subsequent mortality. Concentration of facilities and surgical expertise in specialist units together with more careful patient selection can decrease mortality further.

Adenocarcinoma↗
PubMed1995

Disorders of lymph flow.

Disturbances in blood capillary exchange of fluid, macromolecules, and cells across intact and abnormal microvessels and deranged lymphatic transport are integral, interacting components in disorders of tissue swelling. Lymphedema or low-output failure of the lymph circulation is often indolent for many years before lymphatic insufficiency (failure) and tissue swelling emerge and persist. Superimposed occult or overt infection (lymphangitis) are probably major contributors to progressive limb deformity (elephantiasis). Long-standing lymphedema is characterized by trapping in the skin and subcutaneous tissue of fluid, extravasated plasma proteins, and other macromolecules: impaired immune cell trafficking; abnormal processing of autologous and foreign antigens; heightened susceptibility to superimposed infection; local immunodysregulation; defective lymphatic (lymphangion) propulsion from an imbalance of mediators regulating vasomotion; soft-tissue overgrowth; scarring and hypertrophy; and exuberant angiogenesis occasionally culminating in vascular tumors (Fig. 8). In contrast to the blood circulation, where flow depends primarily on the propulsive force of the myocardium, lymph propulsion depends predominately on intrinsic truncal contraction, a phylogenetic vestige of amphibian lymph hearts. Whereas venous "plasma" flows rapidly (2-3 l/min) against low vascular resistance, lymph flows slowly (1-2 ml/min) against high vascular resistance. On occasion, impaired transport of intestinal lymph may be associated with reflux and accumulation and leakage of intestinal chyle in a swollen leg. Although the term "lymphedema" is usually reserved for extremity swelling, the pathogenesis of a wide variety of visceral disorders also may be traceable to defective tissue fluid and macromolecular circulation and impaired cell trafficking of lymphocytes and macrophages. Thus, lymph stasis, with impaired tissue fluid flow, underlies or complicates an indolent subclinical course with a long latent period and sporadic episodes of lymphangitis, which culminates in intense scarring. Examples are pulmonary fibrosis (e.g., pneumoconiosis), regional enteritis, retroperitoneal fibrosis, and perhaps chronic pancreatitis and cirrhosis of the liver. Transdifferentiation and ultimately transformation of endothelial and other vascular accessory cells during lymph stasis also may be pivotal to a wide range of dysplastic and neoplastic vascular disorders, including Stewart-Treves angiosarcoma, AIDS-associated Kaposi's sarcoma, and lymphangitic metastatic carcinomatosis. Lymphscintigraphy has now replaced conventional lymphography as the procedure of choice to corroborate the diagnosis of peripheral lymphedema, whereas MR imaging using paramagnetic and superparamagnetic contrast agents has the potential to yield huge dividends in furthering understanding of a variety of enigmatic edematous states, including lymphedema. Not only are better explanations and insights into swelling disorders likely to be forthcoming, but, equally important, these new, safe, noninvasive imaging techniques can and should be used to monitor the evolution and document the efficacy of commonly advocated operations and nonoperative remedies for defective lymph transport and function.

Diagnostic Imaging↗
PubMed1999

Management of spontaneous congenital chylothorax: oral medium-chain triglycerides versus total parenteral nutrition.

The aim of this article is to compare total parenteral nutrition (TPN) with oral medium-chain triglycerides-diets (MCT) in the management of spontaneous congenital chylothorax. We analyzed retrospectively the charts of 6 patients seen in our tertiary care center and of 11 comparable patients from the literature. All neonates were symptomatic at birth; 15 had bilateral chylothorax. In the neonates who received mainly TPN (n = 9), the chylothorax resolved significantly (p < 0.05) earlier (mean 10 days, SE 1) than in the others, who received mainly MCT (n = 8) (mean 23 days, SE 4). The mean chyle loss was not significantly different between the 2 groups. Our results suggest that TPN is more effective than oral MCT in the treatment of spontaneous congenital chylothorax. These results support the data of Peitersen et al, who reported that most of the positive results with MCT were achieved in postoperative chylothorax of the newborn.

Administration, Oral↗
PubMed2001

[Therapy of abdominal and thoracic chylous effusions 18 years after radiation therapy].

Chylothorax and chylascites are rare complications of neoplasm or surgical, but also non-surgical trauma. Extremely rare causes are a subclavian i.v. line, a mesenterical hamartoma, retrosternal goiter, liver cirrhosis, portal vein thrombosis, filariasis, tuberculosis, ruptured aortic aneurysm and radiotherapy. We report on a 60-year-old male with bilateral chylothorax and chylascites resistant to therapy 18 years after irradiation of the iliacal, paraaortal and mediastinal (46 Gray) and the left-sided supraclavicular (40 Gray) lymph nodes for a seminoma (T3N1M0 i.e. IIa, Lugano classification). A fat-free parenteral nutrition was started in order to bring the lymphatic flow down to a minimum. Chyle flow ceased after 3 1/2 weeks of treatment. An oral diet with middle chain triglycerides (MCT-diet), which are transported to the liver via the portal vein instead of the lymphatic system, achieved good control of residual chylous effusions.

Amino Acids↗
PubMed2006

[Chylopericardium following pulmonary tuberculosis].

HISTORY: A 22-year old man was admitted with a large pericardial effusion after he had been successfully treated for tuberculosis of the right lung for 6 months. Treatment had been discontinued according to plan 4 months before the current admission. The patient was only mildly symptomatic with exertional dyspnea of 3 weeks duration. Body temperature, pulse rate and blood pressure were within normal limits. The neck veins were not distended. INVESTIGATIONS AND DIAGNOSIS: Laboratory data were unremarkable. The patient underwent thoracoscopy for pericardial drainage. A large chylous effusion was removed. CLINICAL COURSE: Drainage ceased over the following months after the patient had been on a medium-chain triglyceride diet. On follow-up 9 months later, the patient was asymptomatic and without evidence of cardiopulmonary disease. CONCLUSION: We presume (A) that the tuberculous infection had affected the mediastinal lymph nodes and (B) that the fibrous contraction of perinodal tissue caused a temporary obstruction of the thoracic duct at a later stage in the course of the healing process with subsequent reflux of chyle into the pericardial cavity via lymphatic vessels that normally drain the pericardium.

Adult↗
PubMed1994

Chylothorax after pleuro-pulmonary surgery: a rare but unavoidable complication.

The incidence of chylothorax after pleuro-pulmonary operations as well as its treatment is reported. Of 1744 operations performed postoperative chylothorax developed in 13 (0.74%). It resulted in two cases from the transection of the thoracic duct, in six from the transection of the so-called minor lymph channels, which drain lymph from mediastinal nodes straight into the thoracic duct or drain lung segments into the thoracic duct via the pulmonary ligament; the transection of these channels occurred during mediastinal lymphadenectomy or during the section of the pulmonary ligament. In 5 patients the site of leakage was not determined as reoperation was not required. Conservative treatment with low-fat diet and medium-chain triglycerides and/or total parenteral nutrition was attempted in all but one patient but was successful only in 5 cases whose mean losses were 292 ml/day. Seven patients were reoperated after a mean of 11 days; their mean losses were 930 ml/day. One patient was reoperated on the third postoperative day without attempting conservative treatment; his mean loss was 850 ml/day. Lymphadenectomy seems to be an important risk factor for postoperative chylothorax. Chyle leakage around 500 ml/day or higher that tends to decrease below 500 ml/day after a few days of dietary manipulation usually stops within 10-20 days, while leakage over 500 ml/day that does not tend to decrease below 500 ml/day seldom if ever stops without surgery, so that a more aggressive attitude is justified.

Adult↗
PubMed2001

Octreotide for treatment of postoperative chylothorax.

Two infants who developed chylothorax after surgery for congenital heart disease were treated successfully with subcutaneous octreotide. Apart from reducing chyle output, octreotide decreased the triglyceride content of the pleural fluid.

Chylothorax↗
PubMed1989

Noninvasive evaluation of the swollen extremity: experiences with 190 lymphoscintigraphic examinations.

Lymphoscintigraphy (LS), performed with technetium 99m-labeled antimony trisulfide colloid (Cadema Medical Products, Inc., Middletown, N.Y.), was used as a noninvasive diagnostic examination to evaluate the lymphatic circulation in 190 extremities of 115 patients. Forty-six patients had primary lymphedema, 48 had secondary lymphedema, and 21 patients had other causes of limb swelling. To determine the value of LS in surgical decision making, preoperative and postoperative LS of 16 patients who underwent surgical repair of the lymphatic abnormality were studied separately. Semiquantitative evaluation of the lymphatic drainage and visual interpretation of the image patterns were reliable to differentiate lymphedema from edemas of other origin (sensitivity: 92%, specificity: 100%). Although certain image patterns were characteristic of either primary or secondary lymphedema, LS could not consistently differentiate between the two types. Episodes of cellulitis in lymphedema clearly delayed lymph transport. LS was helpful in patient selection and follow-up after lymphatic surgery, but it did not prove patency of lymphovenous anastomoses. It was diagnostic in the evaluation of lymphangiectasia and was used to document successful surgical treatment of reflux of chyle. LS is safe and reliable and has no side effects. It should replace contrast lymphangiography in the routine evaluation of the swollen extremity.

Adolescent↗