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Chyloptysis (chylous sputum) due to thoracic lymphangiectasis with successful surgical correction.

A 73-year-old woman with a two-year history of recurrent episodes of respiratory distress is described. The finding of an elevated triglyceride value of 23.4 mmol/L (2072 mg/dL) and a normal cholesterol value in her sputum led to the correct diagnosis of chyloptysis after lymphangiography was performed. It is thought that congenital incompetence of the lymphatic valves was the cause of chyloptysis.

Aged↗

[Chyluria].

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Child↗

Cardiac tamponade resulting from massive chylopericardium after an aorta-coronary bypass operation.

Isolated chylopericardium after a cardiac operation is a rare clinical entity. A case of isolated chylopericardium with cardiac tamponade after a single aorta-coronary artery bypass graft in a 49-year-old man is presented. Nonsurgical management was unsuccessful. Multiple surgical procedures were necessary for complete control of this difficult problem. The cause of chylopericardium in this patient appears to have been injury to the tributaries of lymphatic ducts in the pericardium.

Cardiac Tamponade↗

[Clinical variants of disorders in mesenteric lymph outflow].

The authors distinguish 4 variants of disturbances of the mesenterial lymph outflow (DMLO). Six patients with DMLO observed in the clinic had obstruction of the thoracic duct of different genesis as the cause of DMLO. Lymphovenostomy was successfully used for treatment of chyluria and lymphorrhea and should be considered a pathogenetic method for treatment of DMLO.

Adolescent↗

The use of topical tetracycline in the management of persistent chylous fistulae.

The management of chylous fistulae remains controversial. A detailed conservative protocol and guidelines regarding surgical intervention are lacking in the literature. This paper presents our experience in the management of two cases of persistent chylous fistulae by successfully employing topical tetracycline. Our regimen of management is discussed and illustrated with the above two cases. An updated review of the pertinent anatomy, physiology, and literature is presented.

Administration, Topical↗

Mesenteric chylous cyst associated with Crohn's disease.

Mesenteric cysts are rare, and mesenteric chylous cysts are extremely rare. A case report is presented of a patient with Crohn's disease and a mesenteric chylous cyst. Included in this case report is a full discussion of the preoperative radiological work-up (including barium enema, sonogram, and CT scan), the operative findings, and the pathological findings. It is suggested that there may be a causal relationship between the Crohn's disease and the mesenteric chylous cyst.

Adult↗

The association of clinical filariasis and Wuchereria bancrofti infections in Jakarta.

In a study carried out in Jakarta, Indonesia between 1969--1977, patients with clinical manifestations of filariasis were examined for microfilaremia. Finger blood (3 X 20 microliter) were examined by conventional methods, venous blood by membrane filtration, urine and hydrocele fluid by concentration methods. A total of 1,422 patients were examined and 182 (12.8%) were positive by blood smear; however, examination by membrane filtration and concentration of urine and hydrocele fluid did not appreciably increase the association between clinical manifestations and Wuchereria bancrofti infection. Approximately 16% of the patients without patent infection were indirectly associated with filariasis, since they co-habitated with persons with microfilaremia. Results of these studies showed that more than 60% of the patients were without patent infection. Factors that may be responsible for these findings are briefly discussed.

Adolescent↗

Intestinal cholesterol absorption in the chyluria model.

Isotopic methods for the measurement of dietary cholesterol absorption were compared with the lymph cholesterol balance procedure in filarial chyluria patients. After a single intravenous injection of radioactive cholesterol, absorption was found to be 746 +/- 136 mg/day by method I, which is based upon the fecal endogenous neutral steroid mass measurement, and 471 +/- 135 mg/day by the simultaneously measured lymph/plasma ratio of cholesterol specific activity (dpm/mg). The corresponding value, determined as the difference between lymph cholesterol transport on a cholesterol-containing diet (1500 mg) and on a cholesterol-free diet, was 622 mg/day. When radioactive cholesterol (1487 mg/day) was fed daily to a second patient, absorption determined by isotopic fecal recovery (353 mg/day) matched that obtained by the lymph balance procedure (326 mg/day). Transudation of plasma cholesterol into the intestinal lymph, estimated by the single intravenous injection of radioactive beta-sitosterol, was independent of both the luminal content of plant sterols and the absorption of dietary cholesterol. The absorption of endogenous cholesterol was calculated by: 1) subtracting the cholesterol originating from plasma (transudation) together with the absorbed dietary cholesterol found in lymph from the total mass of cholesterol transported in lymph, and 2) the lymph balance method, i.e., after interrupting the endogenous cholesterol mucosal uptake by beta-sitosterol feeding (9 g/day) while on a cholesterol-free diet. Endogenous cholesterol was preferentially absorbed compared to dietary cholesterol, but there was no competition for absorption. The major portion of dietary cholesterol found in lymph was esterified, but esterification was not a prerequisite for absorption.

Adult↗

Chylothorax.

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Chyle↗

[Primary and secondary chylopericardium].

Primary chylopericardium proved to be the (rare) cause of chronic, symptom-poor pericardial effusion in a 19-year-old man. Echocardiography and pericardiocentesis provided a firm diagnosis. Lymphography demonstrated extravasation into the mediastinum but no direct connection into the pericardial sac. Ligation of the thoracic duct at diaphragmatic level and pericardiostomy achieved a cure. Secondary chylopericardium requires treatment of the underlying disease, e.g. mediastinal tumor. Chylopericardium after thoracic or cardiac operation without signs of tamponade is preferably treated conservatively by pericardiocentesis and diet.

Adult↗