Diagnosis of hepatic hydrothorax in the absence of ascites by intraperitoneal injection of 99m-Tc-Fluor colloid.
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In supine rabbits injection of 2 ml of saline into the lower right diaphragmatic region increased pleural liquid pressure at the injection point and, to a minor extent, on the costal and mediastinal side, indicating a redistribution of liquid among the pleural compartments. Over a period of 120 min end-expiratory liquid pressure on the diaphragmatic and costal surfaces approached the control value as a result of local reabsorption. No difference in the time course of liquid pressure was found on injection of either saline or homologous plasma. This was confirmed by measuring the volume of saline or plasma remaining in the cavity 90 min after injection; the net absorption flow amounted to 0.22 ml . kg-1 . h-1. These results suggest that local absorption mechanisms are relatively independent of the Starling pressure gradients acting across the pulmonary-perfused (-10.2 and 6.6 cmH2O with saline and plasma, respectively, the negative sign indicating a reabsorption gradient) and systemically perfused mesothelium (3.3 and 20.1 cmH2O with saline and plasma, respectively).
A 29-year-old, primiparous woman was referred to our hospital at 21 weeks of gestation because of right pleural effusion in the fetus shown by routine ultrasonographic examination. Cytology revealed abundant lymphocytes, suggesting chylothorax. We removed the pleural effusion and injected OK-432 into the chest cavity at 24 and 25 weeks of gestation. Pleural effusion declined and an adhesion between the lung surface and the pleural membrane seemed to form. At 33 weeks of gestation, a female infant was born by cesarean section (1,090 g and Apgar score 6/8). Although she demonstrated slight retraction and tachypnea, management could be achieved by administration of oxygen alone without mechanical ventilation. Later, the baby was diagnosed as suffering from the Cornelia de Lange syndrome with characteristic features. OK-432 injections could thus prevent complications of chylothorax and hypoplastic lungs, without injury to either the baby or the mother.
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Blind nasoenteric intubation was attempted in a patient with chronic parkinsonism. The tube was inadvertently misplaced and penetrated the left pleural cavity. The next day, the patient developed cardiopulmonary arrest during dietary supplement infusion. This complication ultimately led to the patient's death. We have reviewed the known complications of nasoenteric tube placement and conclude that difficult insertion in patients at risk from tube misplacement should be followed by chest radiography to confirm the correct placement of the tube before nutritional support is started.
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