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At least 415 records · Page 23Linked to original sources
PubMed2002

[Lymphoscintigraphy for chylothorax after replacement of descending thoracic aortic aneurysm].

A 77-year-old female with Stanford B chronic aortic dissection, received elective replacement of descending aorta. The aorta distal to the aneurysm was encircled with a tape, and replaced using the double barrel technique. After the operation, chest X-ray showed effusion on the bilateral side. The amount of milky fluid from drain increased to 2,000 ml per day. The chemical profiles of the fluids were compatible with chylothorax. The Thoracic duct near the diaphragm was closed through left mini-thoracotomy. But the leakage of chyle did not cease. The lymphoscintigraphy showed a leakage to right lower intrathorax near the diaphragm and native aorta. A defect of the thoracic duct was closed, and chylothorax was cured. This case shows that though detailed anatomical structure of thoracic duct is not revealed, lymphoscintigraphy is useful for the localization of leakage in patients with chylothorax of post-cardiovascular-surgery.

Aged↗
PubMed2002

Canine pancreas allotransplantation with enteric drainage.

BACKGROUND: Before embarking on a clinical human pancreas transplantation program we sought a canine animal model with enteric drainage to refine our technical skills, to evaluate the surgical risks and to study the rejection pictures under modern triple immunosuppression therapy. METHODS: Twenty donor-recipient pairs of unrelated mongrel dogs underwent pancreaticoduodenal allotransplantation with enteric drainage. All dogs were immunosuppressed by triple therapy with prednisolone, cyclosporine (Neoral) and mycophenolate mofetil (MMF). Rejection grade and surgical risk were evaluated. RESULTS: Group 1 included 10 (50%) dogs surviving at least 14 days. In group 2 surviving less than 14 days, the median survival was 5.5 days, ranging from 1 day to 13 days. The most common complications were duodenal stump leakage and wound infection. Duodenal stump leakage eventually led to mortality in 3 dogs of group 2. Two (in group 2) of the 3 wound infections became too severe to control and caused death. There were 2 dogs complicated with graft necrosis and 2 with graft vascular thrombosis individually, which all resulted in death. Other fatal complications included 1 chyle leakage, 1 intraabdominal abscess and 1 pneumonia individually. Ninety percent in each group developed rejection. Severe rejection developed in 5 (50%) dogs in group 2 (grade 4 and 5), p = 0.033, as compared with none in group 1. The rejection in most cases (90%) of group 1 was mild to moderate, with 4 grade 3, 3 grade 2 and 2 grade 1. CONCLUSIONS: Canine pancreas allotransplantation with enteric drainage is a feasible animal model to achieve survival longer than 14 days in 50% cases studied. Duodenal stump leakage was the most common fatal complication in this model. Severity of rejection was closely associated with posttransplant fatal complications and played a crucial role in determining the dog survival.

Animals↗
PubMed2002

[A case of diffuse malignant mesothelioma of the pleura with bilateral chylothorax].

We describe a case of bilateral chylothorax with malignant pleural mesothelioma. A 41-year-old woman was admitted to our hospital because of dyspnea. She had no history of exposure to asbestos. A chest radiograph and chest computed tomogram (CT) on admission revealed massive bilateral pleural effusion and a large tumor with pleural thickening in the left lateral and anterior parts of the pleura and mediastinum. Biochemical tests of pleural fluid revealed chyle. Two years before, she had been diagnosed through histological and histochemical examinations as having diffuse malignant pleural mesothelioma of the epithelial type. Chest-tube drainage was performed, and pleurodesis was induced by the intrathoracic injection of OK-432 at 10 KE per dose. The chylothorax disappeared after pleurodesis. To date, reports of malignant mesothelioma with nontraumatic chylothorax have been rare.

Adult↗
PubMed1992

[Acute chyloperitoneum].

A patient presenting with the symptomatology of an appendicular syndrome was later diagnosed as having an acute chylous ascites. The etiology was an acute edematous pancreatitis, the anatomy of the lymphatic pathways with the proximity of the pancreas explaining this etiology, as well as the possibility of a pancreatitis secondary to obstruction of the thoracic duct. The early post-operative clinical course was marked by an acute occlusion of small intestine on the 15th day, related to the adherence potency of the chyle. A general review of the acute chylous ascites syndrome showed the prognosis to be generally favorable, with a mortality of 4%, in contrast to the 40% mortality reported for the chronic chylous ascites of adults.

Acute Disease↗
PubMedDate not supplied

Women's illnesses - the Indian male perspective a search for linkage with Vedic concept of health & Hindu mythology.

A multicentric ICMR study was done in rural north India during 1996- 1999. Qualitative data was gathered from adult males of the study area regarding their views on women's illnesses. "Heat" emerged as the chief etiological factor for most of the reproductive health problems of women. Diet was told as the major source of this heat. A linkage between Vedic/Ayurvedic concepts of diet/heat and our respondents' view on women's illnesses has been described in the article. Similar references in western literature have also been quoted. As per Vedic concepts blood and bones are intermediary products of food assimilation between chyle and semen. Respondents view that, melting of bones leads to vaginal discharge (equated to semen) has been traced to this concept. Leucorrhea emerged as a significant morbidity of women. These views of the respondents reflect their culture. Any attempt to change these should take into account the overall cultural aspects of the concerned population.

Female↗
PubMed2004

Evaluation of automated glycohemoglobin analyzer HLC-723G7 beta-thalassemia analysis mode.

We evaluated the new automated glycohemoglobin analyzer HLC-723G7 (G7) intended for beta-thalassemia diagnosis to determine correlation of hemoglobin (Hb) F and Hb A2 quantitation with the Variant beta-Thalassemia Short Program and to evaluate the performance of the G7 analyzer. Two hundred fifty EDTA blood samples with Hb A, A2, and F by Variant were analyzed for Hb A2 and Hb F by G7 device. Recovery, precision, and interference of the G7 analyzer were studied. The R2 values for Hb A2 and Hb F were 0.963 and 0.640, respectively. Recovery of Hb A2 and Hb F of low and high control samples ranged from 96% to 100% and 91% to 101%, respectively. The coefficients of variation (CVs) of intraassay precision ranged from 1.3% to 3.9% for Hb F and 0.0 to 1.9% for Hb A2. The CVs of interassay precision ranged from 1.9% to 5.6% for Hb F and 2.5% to 3.0% for Hb A2. The CVs for Hb F in both conjugated bilirubin and chyle substance groups were higher than the CVs for Hb A2. This evaluation revealed very good correlation of Hb A2 measurement between the G7 and the Variant devices. The performance evaluation demonstrated good recovery, precision, and low interference of both Hb A2 and Hb F measurements.

Chromatography, High Pressure Liquid↗
PubMed2004

[A case of gastric cancer initially presented by bilateral chylothorax].

The patient, a 66-year-old woman, visited our hospital with chief complaints of nocturnal coughing and dyspnea. Chest radiography revealed bilateral pleural effusion, and she was admitted to our hospital to undergo more thorough examination. The bilateral pleural effusion was identified as chyle. In cytodiagnosis, a number of poorly-differentiated adenocarcinoma cells in clumps were detected, and mucus was found in the cell bodies. The case was diagnosed as signet-ring cell carcinoma. Endoscopy of the upper digestive tract was performed for close examination of the primary lesion. As a result, a IIc lesion accompanied with concentrated folds and hypertrophy was found on the anterior wall of the body of the stomach. Biopsy of this site led to a diagnosis of signet-ring cell carcinoma, and these results were consistent with the cytodiagnostic findings of pleural effusion. Because gastric carcinoma associated with bilateral chylothorax is very rare in Japan, we report the results of our study with some discussions based on a review of the literature.

Aged↗
PubMed2004

Conservative treatment of postoperative chylothorax with octreotide.

Chylothorax is a rare but serious and well-recognized complication of general thoracic and cardiac procedures. No new invasive or non-invasive definitive therapies are available. This article reports the case of a 67-year-old woman who underwent myocardial revascularization and who developed a postoperative chylothorax necessitating continuous drainage and conservative management. When after 1 week this treatment still had not resolved the chylothorax, octreotide was instituted, leading to a rapid cessation of chyle production and rendering surgical management of this complication unnecessary.

Aged↗
PubMed2005

Laparoscopic nephrectomy: an early experience at Queen Mary Hospital.

OBJECTIVE: To report our early experience of laparoscopic nephrectomy. DESIGN: Prospective data collection. SETTING: Queen Mary Hospital, Hong Kong. PATIENTS: Transperitoneal laparoscopic nephrectomies were performed on 40 patients between July 1997 and December 2002. MAIN OUTCOME MEASURES: Demographic and perioperative data including operating time, blood loss, postoperative pain score, analgesic requirement, complications, time to resume oral intake, ambulatory state, and length of hospital stay. RESULTS: Laparoscopic nephrectomy was performed for 21 solid renal masses, five transitional cell carcinomas, and 14 non-functioning kidneys. Seven (17.5%) patients had previous abdominal surgery. The mean body mass index of the patients was 23.9 kg/m(2) and the mean operating time was 229 minutes. The mean estimated blood loss was 370 mL, and two patients required conversion to open surgery because of intra-operative bleeding. Other complications include diaphragmatic injury, port-site bleeding, chyle leakage, bleeding peptic ulcer, and myocardial ischaemia. The postoperative mean analgesic requirement was 26 mg of morphine sulphate equivalent. The mean time for patients to resume oral diet and full ambulation was 1.3 and 2.8 days, respectively, and the mean length of hospital stay was 6.7 days. The mean diameter of the solid renal tumour was 4.1 cm and the surgical margins of all resected specimen for malignant tumours were negative. CONCLUSION: Laparoscopic nephrectomy is a safe and efficacious approach for resection of benign non-functioning kidneys and malignant renal tumours.

Blood Loss, Surgical↗
PubMed2006

[Cervical lymphorrea after nodal dissection: role of fasting based on clinical evidence].

The management of chylous fistula, subsequent to neck nodal dissection, includes either unstandardized conservative procedures and reoperation. The main reason of controversy in literature is probably due to the rarity (1-2.5%) of such troublesome complication due to inadvertent disruption of the thoracic duct itself or of its tributary branches. We report one case of severe cervical chylous fistula, occurred after left lateral dissection for advanced papillary thyroid carcinoma, and successfully restored by a conservative approach. None of the following treatment modalities was effective: pressure dressing, low-fat diet, octreotide, etilefrine, and local tetracycline sclerotherapy. Instead, fasting combined with total venous nutritional replacement was successful in curing the leak. It may be hypothesized that the beneficial effect on chyle production observed in the present patient in fasting condition, could be explained by a decrease of splancnic blood flow consequent to intestinal feeding rest. The other treatment procedures can be adjunctive methods with impredictable effect. As a standard approach with the aim to prevent and treat cervical lymphorrea, we suggest preoperatory fat meal, intraoperative search for milky leak by positive respiratory pressure, ligation of the thoracic duct (a mesh coverage when necessary) if inadvertently damaged, but not a systematic search for it. Moreover, according to the amount and the duration of the leakage, fasting combined with venous supplement by central or peripheral access, in combination with local treatment by sclerosing agents appears to be efficacious. In our opinion, neck reoperation or intrathoracic ligation of the thoracic duct represent the last therapeutic option of unresponsive or untractable cases.

Aged↗
PubMed2006

[Safety of donor of right lobe graft in living donor liver transplantation].

OBJECTIVE: To evaluate the safety of donors of right lobe graft. METHODS: We retrospectively studied 13 living donors of right lobe graft from January 2002 to June 2005. The right lobe grafts were obtained by transecting the liver on the right side of the middle hepatic vein. Liver transection was done by using an ultrasonic dissector without inflow vascular occlusion. The standard liver volume and the ratio of left lobe volume to the standard liver volume were calculated. RESULTS: The mean blood loss was 490 ml. The mean blood transfusion was 440 ml. In the perioperative period the mean albumin administered was 85 g. One donor had portal vein trifurcation, two had a right posterior bile duct and a right anterior bile duct draining into the left bile duct, respectively. One had bile ducts from left lateral and left internal segment and right duct draining into common hepatic duct. On postoperative day 1 the donors' liver functions were found impaired to some extent, but all the indices rapidly returned to the normal level at the end of the first week. Postoperative complications included 1 case of abdominal bleeding, 2 wound steatosis and 1 chyle leak. There was no donor mortality. All donors are well and have returned to their previous occupations. CONCLUSIONS: The donation of right lobe graft for adult living donor liver transplantation is safe provided that the patency of the remnant hepatic vasculature and bile duct is ensured, the volume of the remnant liver exceeds 30% of the total liver volume, and there is no injury to the remnant liver.

Adult↗
PubMed2006

[Comparison of surgical complication rate between laparoscopic and open radical resection for colorectal cancer].

OBJECTIVE: To compare the surgical complication rate between laparoscopic and open radical resection for colorectal cancer. METHODS: From September 2000 to December 2005, 491 cases with colorectal cancer were divided into two groups prospectively and nonrandomly,and received radical laparoscopic operation (LP, n=214) and open operation (OP, n=277). The intra- and post-operative complication rate were compared between the two groups. RESULTS: In laparoscopic groups, 14 cases (6.54%,14/214) were converted to open surgery,because of intra-operative complications in 7 cases,obesity or large tumors in 5 cases,narrow- pelvis in one case and retroperitoneal tumor in one case. The intra-operative complication rate was 4.8% (10/207) in LP group and 3.6% (10/277) in OP group (P > 0.05, chi2=0.446). There were no differences in post- operative intestinal obstruction, stoma leak, stoma bleeding, chyle leak, pulmonary infection except incision infection(5.5% vs 14.1%, P< 0.05) between LP and OP groups. The overall postoperative complication rate was 23.5% (47/200) in LP group and 36.8% (102/277) in OP group (P< 0.01, chi2=9.598). CONCLUSIONS: There is no difference in intra-operative complication rate between LP and OP groups,but the post-operative complication rate is significantly lower in LP group than that in OP group.

Adolescent↗
PubMedDate not supplied

Successful octreotide treatment of chylothorax following coronary artery bypass grafting procedure. A case report and review of the literature.

Chylothorax occurs in 0.25 to 0.50% of cardiac operations performed through thoracotomy incisions and is more unusual after median sternotomy. A case of chylothorax following coronary artery bypass grafting is presented. Combined treatment with pleural drainage, "nothing per os", total parenteral nutrition and subcutaneous injection of somatostatin was effective and led to rapid cessation of chyle production.

Aged↗
PubMedDate not supplied

Intestinal lymphangiectasia: a forgotten cause of chronic diarrhea.

Intestinal lymphangiectasia is a rare autosomal dominant disorder or acquired condition that leads to lymph obstruction, poor chyle transport and concomitant problems. We describe the cases of two women with chronic diarrhea in whom the common signs of lymphagiectasia-hypoalbuminemia, lymphopenia and distal edema- were found. One of them also had pleural effusion and chylous ascites. The diagnosis was performed by intestinal biopsy. We herein review the histopathologic, radiographic and endoscopic features of this disorder and case reports in Mexican population.

Adolescent↗
PubMed2006

[Idiopathic chylothorax: usefulness of aetiologic survey and the follow-up].

Chylothorax is an uncommon condition. It's characterized by the presence of chyle in the pleura. The most common causes are malignancy and trauma. When an underlying cause is excluded, the chylothorax is called idiopathic. We report a case of a 68 aged woman, admitted for abundant chylothorax. Thoraco-abdominal computed tomography, magnetic resonance imaging of the chest and thoracotomy showed no lesion of the lymphatic duct. Fibrothorax has developed after pleurodesis. Stable clinical and radiological condition was noticed during 3 years. We discuss the difficulty in the exclusion of a malignancy and the necessity of the follow up for these patients.

Aged↗
PubMed1991

[Tension chylothorax following left-sided lung surgery].

This is a report on 3 patients who presented with chylothoraces (chylopleurae) with haemodynamic effect subsequent to left-side lung surgery. This complication occurred twice after pneumonectomy and once after atypical resection with extirpation of a mediastinal lymph node. Clinical signs and symptoms appeared with all the patients between the 5th and 8th postoperative day, as a result of the haemodynamic effect of the chylothorax in the sense of volume loss combined with heart tamponade. In one patient there was additionally the pattern of signs and symptoms of an acute abdomen, which could be explained by a descended diaphragm with compression of the abdominal organs in case of an additionally present phrenicoparesis. One patient was at first treated conservatively after application of thoracic drainage, feeding being exclusively parenteral, and was finally operated on after 10 days, whereas the other two patients were primarily subjected to surgery. The surgical methods employed consisted of right side ductal ligature after Lampson, ductal ligature from the left thoracic side and direct closure of the chyle leakage.

Cardiac Tamponade↗
PubMed1991

Traumatic chylothorax: a case report.

A case of traumatic chylothorax following a motor vehicle accident is presented. This is a rare injury following thoracic trauma and is associated with a high mortality and morbidity. Mechanisms of injury to the thoracic duct are described. A management strategy is suggested, which initially entails a trial of conservative therapy of adequate drainage, total parenteral nutrition (TPN) and total gut rest. If significant chyle losses persist after 2 weeks, surgery is indicated, as immunological factors may complicate recovery. The recommended surgical technique is transthoracic duct ligation directly or at the hiatus.

Accidents, Traffic↗
PubMed1990

Lymphoma-mimicking peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD).

Cloudy dialysate in a patient on continuous ambulatory peritoneal dialysis (CAPD) most commonly reflects an increased number of leukocytes secondary to bacterial peritonitis. In the absence of infection, increased quantities of eosinophils, red blood cells, fibrin, or chyle may produce cloudy dialysate in these patients. We report the case of a CAPD patient presenting with cloudy dialysate and symptoms suggestive of bacterial peritonitis. Analysis of the dialysate revealed no microorganisms. The turbidity of the dialysate was related to an increased number of atypical lymphocytes consistent with a B cell lymphoma. Peritoneal dialysis continued uneventfully despite neoplastic disease within the peritoneum. It is recommended that malignant involvement of the peritoneum be added to the differential diagnosis of cloudy dialysate occurring in CAPD patients.

Aged↗