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The authors report the clinical and computed tomographic (CT) findings in six patients with chyliform pleural effusion. All six patients had a medical history of pleurisy before presentation; five of them had tuberculous pleural effusion. The CT scans of all six patients showed variable amounts of pleural fluid collection with a layering of fat at the nondependent site.
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Chylous fistula complicates 1.1% of all radical neck dissections, and 2.4% of left-sided dissections. The standard treatment of established chylous leak in the reported cases is a pressure dressing applied to the lower neck. Here we present a case of chylous fistula, where conservative methods failed to cope with this complication. The additional application of a fibrin adhesive set was a successful modality of treatment.
OBJECTIVES: To evaluate and compare the results of regimen A (3 instillations at 8-hourly intervals in 1 day) with the control regimen B (9 instillations at 8-hourly intervals in 3 days) of using 1% silver nitrate solution for renal pelvic instillation sclerotherapy in 'clinically significant' filarial chyluria. MATERIALS AND METHODS: Forty-seven patients with clinically significant chyluria attending on 2 different days our urology clinic were prospectively randomized between two groups; the study group received regimen A (n = 21) while the control group received regimen B (n = 26). The variables evaluated included visualization of pyelolymphatic fistulae on retrograde pyelography, hospital stay, outcome and morbidity of the two regimens. RESULTS: Patients in both groups were comparable for age and sex. The morbidity (fever, symptomatic UTI, hematuria) following regimen A was less than that of regimen B although not statistically significant. The average hospital stay was 3 days for regimen A and 5.5 days for regimen B (p = 0.001). The initial success rate was 80.95% in group A and 92.30% in group B (p = 0.47). The mean duration of follow-up was 15 months (range 9-18). There was no significant difference in recurrence between the two groups during follow-up (group A: 21.05% and group B: 22.72%; p = 0.98). CONCLUSIONS: Regimen A was as effective as regimen B. Regimen A had the advantages of having less morbidity and shorter duration of hospital stay. We recommend only a 3-instillation regimen in patients with clinically significant chyluria, particularly those who demonstrate pyelolymphatic fistulae on retrograde pyelography.
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A sudden-onset chyluria after trauma was evaluated giving evidence of a lymphatic-urinary fistula in the right kidney. Treatment with somatostatin normalized the urinary pattern and the result was maintained even after the discontinuation of the therapy.
A chyliform effusion is an uncommon high lipid pleural effusion that does not result from a leakage of the thoracic duct. Characteristically, it emerges from chronic pleurisy and contains high levels of cholesterol. The origin of this cholesterol is unknown, but it is often attributed to the degeneration of red and white blood cells. In this study we have carried out detailed lipoprotein analyses in a chyliform effusion, a chronic tuberculous effusion and three inflammatory effusions of recent onset, in an attempt to elucidate the process of cholesterol accumulation and possible lipoprotein alterations. Mean cholesterol was 92 mg/dl in the inflammatory exudates and 1,237 mg/dl in the chyliform effusion. In inflammatory effusions of recent onset most cholesterol was bound to low density lipoprotein (LDL) with corresponding apoprotein B levels. The chronic tuberculous exudate showed a shift of cholesterol binding towards high density lipoprotein (HDL). In the chyliform effusion most cholesterol was found in the HDL region. Our results suggest that in acute inflammation, the pleural barrier opens to plasma LDL. We hypothesize that in chronicity this cholesterol becomes trapped in the pleural space and undergoes a change in lipoprotein binding characteristics. In a chyliform effusion, cholesterol further accumulates and builds complexes containing triglycerides and proteins. In clinical routine, total cholesterol values above 200 mg/dl strongly suggest a chyliform effusion. Since triglyceride values may be as high as in chylous effusions (greater than 110 mg/dl), the diagnostic routine in all suspected high lipid effusions should involve cholesterol and triglyceride measurements.
We investigated in conscious dogs the effects of intravenously administered 5-hydroxytryptophan (5-HTP) and cisapride on the postprandial jejunal mechanical activity by means of six closely spaced extraluminal strain gauge transducers. Drugs were given after administration of a nutrient meal. 5-HTP was given additionally after the administration of a noncaloric cellulose meal. Computer assistance was used to determine the temporal and spatial relationship of contractions and thereby to evaluate the length of spread of contractile waves. Both substances increased the propulsive activity, the contractile force and the motility index and fastened the transit rate of digesta. 5-HTP exhibited the most potent effect when given after administration of the nutrient meal.
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