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Sample records for chyle

  1. Conservative Management of an Intraoperative Chyle Leak: A Case Report and Literature Review.

    Science.gov (United States)

    Meyer, Charles D; McLeod, Ian K; Gallagher, Daniel J

    2016-09-01

    Chyle leaks are a rare but potentially fatal complication of head and neck surgery carrying an incidence as high as 8.3%. The development of a chyle leak carries significant morbidity ranging from delayed wound healing to oropharyngeal fistulas. Presented here is a case of a chyle leak that developed following a left posterolateral neck dissection that was successfully managed with a combination of drain suction, pressure dressing, and a fat-restricted diet. However, the patient's course was complicated by repeated chyle leak recurrences that may have been associated with the initiation of medium-chain triglyceride supplementation. Although further research is required to establish a causal relationship, these findings support the concerns of other investigators about the possible counterproductive role of medium-chain triglyceride supplementation in the management of chyle leaks. PMID:27612380

  2. Localization of chyle leakage site in postoperative chylothorax by oral administration of I-123 BMIPP.

    Science.gov (United States)

    Sugiura, Kimihiko; Tanabe, Yoshio; Ogawa, Toshihide; Tokushima, Takeshi

    2005-10-01

    The authors present a 71-year-old woman who had a right chylothorax after right upper lobectomy for lung cancer. As the chylothorax was considered to be due to thoracic duct injury at the time of operation, lymphoscintigraphy was performed by oral administration of I-123 beta-methyl-iodophenyl pentadecanoic acid (BMIPP). After visualization of the stomach and intestine, abnormal accumulation of the radiotracer was found initially around the right pulmonary hilum and then spread laterally in the upper pleural cavity, indicating chyle leakage in the region of the right pulmonary hilum. Scintigraphic finding was well correlated with the subsequent thoracoscopic observation, showing chyle leakage from a lymphatic tributary near its confluence to the thoracic duct at the level of the azygos continuation. The disruption site was ligated by video-assisted-thoracoscopic-surgery procedure with successful termination of the chyle leakage. Lymphoscintigraphy by oral administration of I-123 BMIPP is thought to be a useful method for localization of chyle leakage in patients with chylothorax induced by thoracic surgery. PMID:16363625

  3. The origin of cholesterol in chyle demonstrated by nuclear indicator methods

    International Nuclear Information System (INIS)

    In order to obtain information about the mechanism of the intestinal absorption of cholesterol, rats having a lymphatic abdominal fistula are used. The animals receive either 4-14C- cholesterol subcutaneously or orally, or the 1-14C acetate. The study of the specific radio-activities of the cholesterol in chyle, in serum, in the lining, and in the intestinal contents makes it possible to define the roles played by the transfer cholesterol from the serum, by the cholesterol synthesised intestinally, and by the absorption cholesterol, in the formations of the lymph and of the chylomicrons. A new theory is proposed for the mechanism of cholesterol absorption. (author)

  4. Chyle Fistula after Neck Dissection for an Unusual Breast Cancer Recurrence.

    Science.gov (United States)

    Harlak, Ali; Karahatay, Serdar; Onguru, Onder; Mentes, Oner; Gerek, Mustafa; Tufan, Turgut

    2008-01-01

    BACKGROUND: Chyle fistula is one of the rare complications of neck dissections. Even though no consented algorithm for the management of this entity has been established yet, conservative treatment options including somatostatin analogues have been suggested as an adequate modality for low output fistulas. CASE REPORT: Here we present a patient with a right-sided neck fistula which was resistant to conventional treatment, and was finally treated by surgery. The neck dissection was performed for a malignant right neck mass that was accepted as the lymph node metastasis of formerly treated papillary thyroid carcinoma. The pathology of the specimen revealed a contralateral neck metastasis of previously treated breast carcinoma. CONCLUSION: We assume that consecutive surgeries on axillary and neck lymph pathways resulted in such a complicated and exceptional case. PMID:21076608

  5. [Conservative treatment of chyle fistula of the neck following a reintervention of cervical bilateral lymphectomy for medullary carcinoma of the thyroid. Case report].

    Science.gov (United States)

    Giove, Eleonora; Merlicco, Domenico; Nacchiero, Eleonora; Marzaioli, Rinaldo

    2010-01-01

    Chyle fistula is an uncommon serious complication of neck surgery, occurring in 1-3% of radical neck dissections. An untreated chyle leak is a potentially dangerous condition that may rarely lead to hypovolemia, hyponatremia, hypochloremia, hypoproteinemia and lymphopenia. Anatomic variants of the terminal portion of the thoracic duct and suction drainage in the neck wound play a primary role in causing this kind of lesion. Poor is the literature concerning chyle fistula, due to its rarity, and mostly case reports; still debated--prevalently empiric--is the management of this disease. The Authors report a case of chyle fistula following a reintervention of cervical bilateral lymphectomy for medullary carcinoma of the thyroid in a 75 years old female. In the reported case the chyle fistula was successfully treated conservatively, in early post-operative period with a low-fat diet and total parenteral nutrition, definitely followed by sclerosant therapy. The injection of a sclerosant agent (4 g of sterile medical talc diluted in isotonic sodium chloride solution) into the supraclavicular wound bed, through the drainage tube (clamped for 2 hours), determined rapid decline in fistula output, hence obviating surgical intervention.

  6. Influence of Chyle Blood with Different Pretreatment Methods to Coagulation Indexes Results Detected by Optical Method%乳糜血不同前处理方法对光学法凝血指标检测结果的影响

    Institute of Scientific and Technical Information of China (English)

    何亚萍; 乔国昱; 张国栋; 刘树平; 轩维清

    2013-01-01

    Objective Comparison of high speed centrifugation and dilution method in celiac blood coagulation detection in which one was more able to meet the clinical demand. Methods Collected 30 normal (no hemolysis,no chyle,without jaun dice,TG0. 05). In severe chyle blood group,dilution method in the detection of PT was significantly higher than that of high speed centrifugation,the difference was statistically significant (tPT =4. 013, P0.05).在重度乳糜血组,稀释法中PT的检测结果明显高于高速离心法,差异有统计学意义(tPT=4.013,P<0.05),FIB的含量明显高于高速离心法,差异有统计学意义(tFIB=3.689,P<0.05).结论 高速离心法优于稀释法,抗干扰能力强,更适合于临床对溶栓治疗监测、疗效观察及出血性疾病诊断的需要.

  7. Successful management of chylous ascites with total parenteral nutrition, somatostatin, and fibrin glue

    Institute of Scientific and Technical Information of China (English)

    HUANG Qi; GE Bu-jun; LIU Li-ming; TU Zhi-yuan; ZHANG Guo-fen; FAN Yue-zu

    2007-01-01

    @@ Chylous ascites, an uncommon disease usually caused by obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands, is defined as the accumulation of chyle in the peritoneal cavity.

  8. Chylous Fistula following Axillary Lymphadenectomy: Benefit of Octreotide Treatment

    Directory of Open Access Journals (Sweden)

    Elena González-Sánchez-Migallón

    2016-01-01

    Full Text Available Chyle leak following axillary lymph node clearance is a rare yet important complication. The treatment of postoperative chyle fistula still remains unclear. Conservative management is the first line of treatment. It includes axillary drains on continuous suction, pressure dressings, bed rest, and nutritional modifications. The use of somatostatin analogue is well documented as a treatment for chylous fistulas after neck surgery. We present a case of chylous fistula after axillary surgery resolved with the use of octreotide.

  9. Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment

    Directory of Open Access Journals (Sweden)

    Jean-François Rodier

    2011-05-01

    Full Text Available The use of somatostatin analogs is a new conservative therapeutic approach for the treatment of chyle fistulas developing after thyroid cancer surgery. The combination therapy with a total parenteral nutrition should avoid the high morbidity of are-intervention with an uncertain outcome. This promising trend is supported by the present case report of a chyle leak occurring after total thyroidectomy with central and lateral neck dissection for a papillary carcinoma, which was treated successfully without immediate or distant sequelae.

  10. Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment?

    Science.gov (United States)

    Rodier, Jean-François; Volkmar, Pierre-Philippe; Bodin, Frédéric; Frigo, Séverine; Ciftci, Sait; Dahlet, Christian

    2011-01-01

    The use of somatostatin analogs is a new conservative therapeutic approach for the treatment of chyle fistulas developing after thyroid cancer surgery. The combination therapy with a total parenteral nutrition should avoid the high morbidity of a re-intervention with an uncertain outcome. This promising trend is supported by the present case report of a chyle leak occurring after total thyroidectomy with central and lateral neck dissection for a papillary carcinoma, which was treated successfully without immediate or distant sequelae. PMID:21734879

  11. Overexpression of Angiopoietin-Like Protein 4 Protects Against Atherosclerosis Development

    NARCIS (Netherlands)

    Georgiadi, A.; Wang, Y.; Stienstra, R.; Tjeerdema, N.; Janssen, A.; Stalenhoef, A.; Vliet, J.A. van der; Roos, A. de; Tamsma, J.T.; Smit, J.W.; Tan, N.S.; Müller, M.; Rensen, P.C.; Kersten, S.

    2013-01-01

    Objective: Macrophage foam cells play a crucial role in several pathologies including multiple sclerosis, glomerulosclerosis, and atherosclerosis. Angiopoietin-like protein 4 (Angptl4) was previously shown to inhibit chyle-induced foam cell formation in mesenteric lymph nodes. Here we characterized

  12. Is octreotide treatment useful in patients with congenital chylothorax?

    NARCIS (Netherlands)

    Horvers, M.; Mooij, C.F.; Antonius, T.A.J.

    2012-01-01

    BACKGROUND: Congenital chylothorax (CC) is a severe congenital disorder characterized by the collection of chyle in the pleural space. Recent case reports suggest that the use of octreotide in the treatment of CC may be useful. OBJECTIVE: To evaluate the effect of octreotide on pleural effusions in

  13. Robotic surgery for treatment of chyluria.

    Science.gov (United States)

    Barman, Naman; Palese, Michael

    2016-03-01

    Chyle is a milky lymphatic fluid that is normally formed in the small intestine to aid in the absorption of dietary fats. Occasionally, chyle leaks into the kidney, ureter, or bladder, which results in chyluria. Chyluria is most commonly caused by the parasite Wuchereria bancrofti and is therefore extremely rare in the USA. The use of robotic surgery for treatment has been suggested as a viable option, but has not been thoroughly reported in the literature. This article reviews the literature on the various treatment options for chyluria and presents the case of a 75-year-old Indian female from the USA who was diagnosed with non-parasitic, persistent chyluria and treated with right robotic ureterolysis, renal hilar dissection and intraperitonealization of the ureter. PMID:26861449

  14. Chylopericardium as a complication of cardiac surgery: Report of two cases and review of the literature

    OpenAIRE

    Velinović Miloš; Vraneš Mile; Kočica Mladen; Đukić Petar; Mikić Aleksandar; Vukomanović Vladislav; Kačar Saša; Putnik Svetozar; Divac Ivan; Marković Dejan; Seferović Petar M.; Ristić Arsen D.

    2007-01-01

    Chylopericardium refers to existing communication between the pericardial sac and the thoracic duct carrying the chyle. The objective of our report was to highlight the specificity of diagnosis and treatment of this rare but tedious condition through the analysis of two case reports. Male patient, aged 63 years, with chylopericardium was diagnosed perioperatively (implantation of artificial aortic - St. Jude No 21 and mitral valve - St. Jude No 29). Etiology of pericardial effusion was establ...

  15. Spontaneous chylous peritonitis mimicking acute appendicitis: A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Fu-Chi Fang; Sheng-Der Hsu; Chuang-Wei Chen; Teng-Wei Chen

    2006-01-01

    Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rarely suspected preoperatively. We report a case of spontaneous chylous peritonitis that presented with typical symptoms of acute appendicitis such as intermittent fever and epigastric pain radiating to the lower right abdominal quadrant before admission.

  16. Non-Parasitic Chyluria: Our Experience With Sclerotherapy With Solution of Povidone-Iodine and Destrose and A Review of the Literature.

    Science.gov (United States)

    Guttilla, Andrea; Beltrami, Paolo; Bettin, Laura; Galantini, Andrea; Dal Moro, Fabrizio; Ficarra, Vincenzo; Zattoni, Filiberto

    2016-09-01

    Chyluria is the passage of chyle in the urine. The cause seems to be the rupture of retroperitoneal lymphatics into the pyelocaliceal system, giving urine a milky appearance. This condition if left untreated it leads to significant morbidity because of hematochyluria, recurrent renal colic, nutritional problems due to protein losses and immunosuppression resulting from lymphocyturia. We report our experience with the use of povidone iodine with dextrose solution as a sclerosing agent in the management of chyluria in two patients. PMID:27413693

  17. Chylous leakage post mastectomy and axillary clearance: clinical aspect, causes and review of literature.

    Science.gov (United States)

    Chan, A C; Sarojah, A

    2013-06-01

    Chylous leakage after mastectomy & axillary clearance is a rare complication. The incidence is less than 0.5%. Anatomical variations in the termination of thoracic duct can occur, rendering it susceptible to injury during axillary dissection. Most chyle leaks in the axilla are managed through conservative measures. Surgical intervention is required in high output chylous leaks. We encountered a case of chylous leak post mastectomy with axillary clearance, which was successfully treated conservatively.

  18. Cellular immune surveillance of central nervous system bypasses blood-brain barrier and blood-cerebrospinal-fluid barrier: revealed with the New Marburg cerebrospinal-fluid model in healthy humans.

    Science.gov (United States)

    Kleine, Tilmann O

    2015-03-01

    In healthy human brain/spinal cord, blood capillaries and venules are locked differently with junctions and basement membrane (blood-brain barrier, blood-venule barrier). In choroid plexus, epithelial tight junctions and basement membrane lock blood-cerebrospinal-fluid (CSF) barrier. Lymphocytic cell data, quantified with multicolour flow-cytometry or immuno-cytochemical methods in sample pairs of lumbar CSF, ventrictricular CSF and peripheral venous blood, are taken from references; similarly, data of thoracic duct chyle and blood sample pairs. Through three circumventricular organs (median eminence, organum vasculosum lamina terminalis, area postrema), 15-30 μl blood are pressed by blood pressure through fenestrated capillaries, matrix/basement membrane spaces and ependyma cell lacks into ventricular/suboccipital CSF to generate CD3(+) , CD4(+) , CD8(+) , CD3(+) HLA-DR(+) , CD16(+) 56(+) 3(-) NK, CD19(+) 3(-) B subsets; some B, few NK cells adhere in circumventricular organs. Into lumbar CSF, 10-15 μl thoracic chyle with five lymphocyte subsets (without CD3(+) HLA-DR(+) cells) reflux, when CSF drains out with to-and-fro movements of chyle/CSF along nerve roots. Lymphocytes in lumbar CSF represent a mixture of blood and lymph lymphocytic cells with similar HLA-DR(+) CD3(+) cell counts in ventricular and lumbar CSF, higher CD3(+) , CD4(+) , CD8(+) subsets in lumbar CSF, and few NK and B cells due to absorption in circumventricular organs. The Marburg CSF Model reflects origin and turnover of lymphatic cells in CSF realistically; the model differs from ligand-multistep processes of activated lymphocytes through blood-brain-, blood-venule-, and blood-CSF-barriers; because transfer of inactivated native lymphocytes through the barriers is not found with healthy humans, although described so in literature. PMID:25641944

  19. Fístula linfática cervical: manejo conservador Neck chylous fistula: conservative treatment

    Directory of Open Access Journals (Sweden)

    Mª J. López Otero

    2010-12-01

    Full Text Available La fístula quilosa, por daño del conducto torácico, aparece en el 1-2,5% de los pacientes sometidos a disección cervical. Las complicaciones asociadas incluyen desnutrición, compromiso inmune, formación de fístulas y necrosis cutánea con exposición carotídea, e incluso ruptura. De la literatura actual no se puede deducir ningún algoritmo de tratamiento definitivo, pero parece existir un consenso en realizar un manejo conservador de la mayoría de los casos. El manejo médico se basa en la teoría de que si se disminuye el flujo de quilo se permitirá el cierre espontáneo de la fístula, e incluye: drenaje conectado a vacío, reposo, vendaje compresivo (en discusión, intervención nutricional y uso de análogos de somatostatina. El manejo nutricional implica el uso de dietas bajas en grasa suplementadas con Triglicéridos de Cadena Media (MCT, Nutrición Enteral con TCM o Nutrición Parenteral total (NPT.Injury to the thoracic duct, leading to chyle leak, occurs in 1-2,5% of patients who undergo neck dissection. Associated complications include malnutrition, immune compromise, fistula formation and carotid blowout. No definitive treatment algorithm can be deduced from the current literature, but on last reviews, there is an agreement on the conservative management. Medical management is based on that decreasing chyle flow will allow for spontaneous closure of the chyle leak. Conservative treatment includes: closed vacuum drainage, bed-rest, nutrition modification and synthetic somatostatin analog. Nutrition modification involves a low-fat diet supplemented with medium-chain triglycerides (MCT, enteral nutrition with high percentage of MCT or parenteral nutrition.

  20. Observation of Lymphangioma of the Duodenum by a Magnifying Endoscope with a Narrow-Band Imaging System

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    Masaya Iwamuro

    2013-05-01

    Full Text Available Among duodenal tumors, lymphangioma is relatively infrequent. In this case report, we describe the case of a 65-year-old Japanese man with duodenal lymphangioma diagnosed by esophagogastroduodenoscopy. Endoscopically, the tumor appeared as a soft submucosal tumor with white spots. When the white spots were grasped by biopsy forceps, milky liquid exuded from the tumor. Additionally, observation by a magnifying endoscope with narrow-band imaging revealed elongated microvessels on the surface. We speculated that this feature was formed because the duodenal villi were dilated and the microvessels were stretched due to the retention of chyle. These endoscopic findings are key features in the diagnosis of duodenal lymphangioma.

  1. Tension chylothorax following pneumonectomy

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    Hemang Yadav

    2015-01-01

    Full Text Available Post-pneumonectomy chylothorax is an uncommon complication following surgery, with an estimated incidence of less than 0.7%. Post-pneumonectomy tension chylothorax, where rapid accumulation of chyle in the post-pneumonectomy space results in hemodynamic compromise, is exceedingly rare, with just 7 cases previously reported. All prior cases of tension chylothorax were managed operatively with decompressive chest tube placement followed by open thoracic duct repair. Our case is the first reported tension chylothorax to be managed conservatively by thoracostomy drainage coupled with a period of parenteral nutrition followed by a medium chain triglyceride-restricted diet.

  2. Nontraumatic chylothorax: Revisited

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    Banerjee Debasish

    2007-01-01

    Full Text Available A 2-month-old girl came with breathlessness of 5 days′ duration. Clinical examination and plain chest radiograph showed it to be pleural effusion. On sonographically guided aspiration, the effusion fluid was found to be chyle. Introduction of intercostal thoracic drainage tube and antibiotics helped the baby to recover. It is mainly the role of nutritional support in the form of using medium-chain-triglyceride-containing feed, which is discussed in details in the case report. There was no need of any surgery.

  3. Four Cases of Chylous Ascites following Robotic Gynecologic Oncological Surgery

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    Ahmet Göçmen

    2014-01-01

    Full Text Available Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels. The most common causes of chylous ascites are therapeutic interventions and trauma. In this report, we present four cases of chylous ascites following robot-assisted surgery for endometrial staging and the treatment strategies that we used. After retroperitoneal lymph node dissection, leaving a drain is very useful in diagnosing chylous ascites and observing its resolution; furthermore, the use of octreotide in conjunction with TPN appears to be an efficient treatment modality for chylous ascites and should be considered before any invasive intervention.

  4. Laparoscopic ligation of the thoracic duct in management of chylothorax.

    Science.gov (United States)

    Icaza, Orlando J; Andrews, Kris; Kuhnke, Mark

    2002-04-01

    Laparoscopic ligation of the cisterna chyli at the level of the aortic hiatus was performed in a 69-year-old woman with post-lobectomy chylothorax refractory to 3 weeks of conservative therapy and one repeat thoracotomy with attempted ligation of a leaking lymphatic channel. This laparoscopic procedure was successful, and resolution of the chylothorax was achieved. We feel that this technique offers surgeons a valid, minimally invasive treatment option for a persistent chylothorax in which conservative management or more direct thoracic procedures have failed to control the chyle leak. PMID:12019574

  5. Acute chylous peritonitis due to acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Georgios K Georgiou; Haralampos Harissis; Michalis Mitsis; Haralampos Batsis; Michalis Fatouros

    2012-01-01

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse.The development of chylous ascites is usually a chronic process mostly involving malignancy,trauma or surgery,and symptoms arise as a result of progressive abdominal distention.However,when accumulation of "chyle" occurs rapidly,the patient may present with signs of peritonitis.Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation,appendicitis or visceral ischemia.Less than 100 cases of acute chylous peritonitis have been reported.Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis.This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis,and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis.The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer,since,due to hypertriglyceridemia,serum amylase values appeared within the normal range.Moreover,abdominal computed tomography imaging was not diagnostic for pancreatitis.Following abdominal lavage and drainage,the patient was successfully treated with total parenteral nutrition and octreotide.

  6. Acute chylous peritonitis due to acute pancreatitis.

    Science.gov (United States)

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis

    2012-04-28

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide.

  7. A patient with traumatic chylothorax

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    Barkat A

    2012-09-01

    Full Text Available Amina Barkat,1 Ilham Benbouchta,1 Lamia Karboubi,1 Zineb Ghanimi,2 Meryem Kabiri11National Reference Center in Neonatology and Nutrition, Children's Hospital, Rabat, Morocco; 2University Mohammed V souissi of Rabat, Rabat, MoroccoAbstract: Chylothorax refers to the accumulation of chyle in the pleural cavity. Although rare, it is the most frequent cause of pleural effusion in the neonatal period. Its incidence is estimated at one in 15,000 neonates. The causes of chylothorax are multiple, and there are several major types of chylothorax defined by origin, ie, traumatic (and iatrogenic chylothorax, medical (spontaneous chylothorax, and congenital chylothorax. A case of neonatal chylothorax following surgery for esophageal atresia and our therapeutic approach to this entity are presented. Conservative therapy with total enteral nutrition and drainage were sufficient. Treatment for chylothorax is essentially medical, ie, pleural drainage, removal of dietary fats, treatment of any medical cause, and use of drugs to reduce production of chyle. In the event of failure or reappearance of a large effusion, surgical treatment is needed.Keywords: chylothorax, octreotide, somatostatin, children

  8. Acute chylous peritonitis due to acute pancreatitis.

    Science.gov (United States)

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis

    2012-04-28

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide. PMID:22563182

  9. Role of Interventional Radiology in the Management of Chylothorax: A Review of the Current Management of High Output Chylothorax

    International Nuclear Information System (INIS)

    Chylothorax is an uncommon type of pleural effusion whose etiology may be classified as traumatic or nontraumatic. Low-output chylothoraces usually respond well to conservative management, whereas high-output chylothoraces are more likely to require surgical or interventional treatment. Conservative management focuses on alleviation of symptoms, replacement of fluid and nutrient losses, and reduction of chyle output to facilitate spontaneous healing. Surgical management can be technically difficult due to the high incidence of variant anatomy and the high-risk patient population. Percutaneous treatments have rapidly developed and evolved during the past 14 years to represent a minimally invasive treatment compared with the more invasive nature of surgery. Percutaneous therapies provide a range of treatment options despite difficult or variant anatomy, with a reported high success rate coupled with low morbidity and mortality. This article is a review of etiology, diagnosis, and treatment of chylothorax, with a focus on interventional management techniques.

  10. Primary chylous vaginal discharge in a 9-year-old girl: CT-lymphangiogram and MR appearance

    International Nuclear Information System (INIS)

    Chylous reflux is a manifestation of primary or secondary lymphatic obstruction. Primary lymphatic obstruction is defined as lymphangiectasia and incompetency of lymphatic valves without an underlying cause. Lymphangiectasia resulting from trauma, neoplasm, irradiation, or inflammation characterizes secondary lymphatic obstruction. Leakage of chyle into the uterus, vagina, bladder, or rectum can occur with either primary or secondary lymphatic obstruction. We report a patient with chylous vaginal discharge, a rare presentation of primary chylous reflux syndrome. CT-lymphangiography and magnetic resonance imaging clearly depicted this disorder. To our knowledge, only 20 cases of chylous vaginal discharge have been reported previously; chylous vaginal drainage occurred in the absence of chylous uterine reflux in only three. Although this is a rare anomaly, chylous reflux should be considered in a child with chronic vaginal discharge and lower extremity swelling. (orig.). With 3 figs

  11. Successful management of chylous ascites with total parenteral nutrition and octreotide in children

    Directory of Open Access Journals (Sweden)

    Chao Yang

    2013-12-01

    Full Text Available Purpose: To evaluate the effects of total parenteral nutrition and octreotide on pediatric patients with chylous ascites post-operative. Methods: Four patients were diagnosed with chylous ascites from nov 2009 to nov 2012. Total parenteral nutrition and octreotide was administered to 2 patients, while the other two only received fasting and total parenteral nutrition. All patients had persistent peritoneal drainage, with the quantity and quality of drainage fluid observed daily. Results: Two patients who received somatostatin therapy completely recovered within 7d without any recurrence while on a normal diet. The other two patients who only received fasting and total parenteral nutrition was cured 24-30d after therapy. Conclusion: Total parenteral nutrition along with octreotide can relieve the symptoms and close the chyle leakage in patients with chylous ascites rapidly. It seems to be an effective therapy available for the treatment of chylous ascites.

  12. Role of Interventional Radiology in the Management of Chylothorax: A Review of the Current Management of High Output Chylothorax

    Energy Technology Data Exchange (ETDEWEB)

    Lyon, Stuart, E-mail: lyonsey@optusnet.com.au; Mott, Nigel, E-mail: nigelmott76@hotmail.com; Koukounaras, Jim; Shoobridge, Jen [Alfred Hospital, Department of Radiology (Australia); Hudson, Patricio Vargas [Clinica Alemana, Department of Radiology (Chile)

    2013-06-15

    Chylothorax is an uncommon type of pleural effusion whose etiology may be classified as traumatic or nontraumatic. Low-output chylothoraces usually respond well to conservative management, whereas high-output chylothoraces are more likely to require surgical or interventional treatment. Conservative management focuses on alleviation of symptoms, replacement of fluid and nutrient losses, and reduction of chyle output to facilitate spontaneous healing. Surgical management can be technically difficult due to the high incidence of variant anatomy and the high-risk patient population. Percutaneous treatments have rapidly developed and evolved during the past 14 years to represent a minimally invasive treatment compared with the more invasive nature of surgery. Percutaneous therapies provide a range of treatment options despite difficult or variant anatomy, with a reported high success rate coupled with low morbidity and mortality. This article is a review of etiology, diagnosis, and treatment of chylothorax, with a focus on interventional management techniques.

  13. 贵州省血液中心2013年成分血报废原因分析%Analysis of the causes of blood transfusion in the blood center of Guizhou Province in 2013

    Institute of Scientific and Technical Information of China (English)

    张喆

    2015-01-01

    目的:了解血液报废的情况及原因,探讨应对策略与措施。方法:对贵州省血液中心2013年1月~2013年12月,对报废的血液进行统计分析。结果:12个月共报废34211单位,报废率12.10%,其中,乳糜血报废血浆19225单位,报废率6.80%,丙氨酸氨基转移酶(ALT)报废8027单位,报废率2.84%。结论:在成分血制备中,乳糜血浆报废量最大,是非检验报废的首要因素。丙氨酸氨基转移酶(ALT)报废尤其在2月、7月增高,此时间段为贵州省血液中心团体无偿献血采集高峰时间,在采集前加强对团体单位的丙氨酸氨基转移酶(ALT)检测将有可能降低血液报废率。%Objective:to understand the situation and the causes of the blood discarding,and to explore the strategies and measures to deal with it.Methods:to analyze the blood of the blood center of Guizhou province from January 2013 to December 2013.Results:12 months were scrapped 34211,scrap rate 12.10%.Among them,chyle blood scrap plasma 19225 units,scrap rate 6.80%,alanine aminotransferase (ALT)scrap 8027 units,scrap rate of 2.84%.Conclusion:the blood component preparation,chyle plasma scrap is the largest,is the primary factor of non test scrap.Alanine aminotransferase (ALT)was scrapped in particular in February and July, the time period is the peak time of blood collection in Guizhou Province,and the detection of alanine aminotransferase (ALT)in the collection before the acquisition of the group can reduce the rate of blood rejection.

  14. Quilopericardio

    Directory of Open Access Journals (Sweden)

    Dr. Elliott Garita Jiménez

    2007-05-01

    Full Text Available El quilopericardio es una entidad relativamente rara, inclusive para quienes nos dedicamos a tratar enfermos con patología del tórax. Generalmente existe una anomalía del conducto linfático o de sus tributarios, ya sea por neoplasias, o por lesiones. Estas últimas pueden ser civiles o iatrogénicas. En algunos pocos enfermos no se encuentra una causa clara y se les clasifica como de origen idiopático. El manejo inicial es mediante el drenaje y administración de dietas especiales, sin embargo un grupo de enfermos requiere cirugia que generalmente consiste en ligadura del conducto torácico. Presentamos 2 casos de pacientes con quilotórax, uno por linfangiomas y otro idiopático, ambos fueron finalmente intervenidos, evolucionando satisfactoriamente.Chylopericardium is an uncommon condition even for medical personnel dedicated to the treatment of chest diseases. Usually there is an anomaly of the thoracic duct or of its tributaries, causing leakage of chyle inside the pericardial sac. Benign or malignant neoplasms and a variety of injuries can either obstruct or damage this structure, although in few cases no apparent cause is found. Initially the patients are handled by drainage and special diets; however some must be subjected to thoracic duct ligature. We present herein the cases of 2 patients with chylopericardium, 1 caused by lymphangiomas and the other idiopathic in nature, both underwent surgery with good results.

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

    Energy Technology Data Exchange (ETDEWEB)

    Gloviczki, P.; Calcagno, D.; Schirger, A.; Pairolero, P.C.; Cherry, K.J.; Hallett, J.W.; Wahner, H.W.

    1989-05-01

    Lymphoscintigraphy (LS), performed with technetium 99m-labeled antimony trisulfide colloid, 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.

  16. Rapid Decline of Follicular Lymphoma-Associated Chylothorax after Low Dose Radiotherapy to Retroperitoneal Lymphoma Localization

    Directory of Open Access Journals (Sweden)

    Lien Van De Voorde

    2014-01-01

    Full Text Available Chylothorax is caused by disruption or obstruction of the thoracic duct or its tributaries that results in the leakage of chyle into the pleural space. A number of interventions have been used to treat chylothorax including the treatment of the underlying disease. Lymphoma is found in 70% of cases with nontraumatic malignant aetiology. Although patients usually have advanced lymphoma, supradiaphragmatic disease is not always present. We discuss the case of a 63-year-old woman presenting with progressive respiratory symptoms due to chylothorax. She was diagnosed with a stage IIE retroperitoneal grade 1 follicular lymphoma extending from the coeliac trunk towards the pelvic inlet. Despite thoracocentesis and medium-chain triglycerides (MCT, diet chylothorax reoccurred. After low dose radiotherapy (2×2 Gy to the abdominal lymphoma there was a marked decrease in lymphadenopathy at the coeliac trunk and a complete regression of the pleural fluid. In this case, radiotherapy was shown to be an effective nontoxic treatment option for lymphoma-associated chylothorax with long-term remission of pleural effusion.

  17. [Thoracic duct collaterals of lymphatic and pulmonary origin. Anatomy and chylothorax after pulmonary surgery].

    Science.gov (United States)

    Riquet, M; Hidden, G; Debesse, B

    1989-01-01

    Dye injection of lung segments reveals the existence of lymphatic drainage of the lungs generally into cervical venous confluents and more rarely into the arch of the thoracic duct in the neck and also occasionally into the thoracic duct in the mediastinum. Direct drainage of the lymph into the thoracic duct was observed in 10 cases out of a series of 589 injections of lung segments in adult cadavers. In one half of cases, the thoracic duct was injected from the left suprabronchial lymph node chain, the origin of the left recurrent chain, and in one quarter of cases from the lateral anteroposterior right major azygos and left azygo-aortic lymph node chains, not recognised by the classical authors. More rarely, direct lymphatic collaterals drained certain segments of the lower lobes into the thoracic duct via the triangular ligament. Analysis of cases of chylothorax occurring after lung resection and observed in the authors' department or in the literature reveals that most of them can be attributed to a chyle leak from one of these pulmonary lymph collaterals. These pathways are probably also involved in the development of medical or idiopathic chylothorax. PMID:2686514

  18. Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants.

    Science.gov (United States)

    Fogg, Kristi L; DellaValle, Diane M; Buckley, Jason R; Graham, Eric M; Zyblewski, Sinai C

    2016-08-01

    Chylothorax is a well-described complication after cardiothoracic surgery in children. Medical nutritional therapy for chylothorax includes medium-chain triglyceride (MCT) formulas and reduction in enteral long-chain triglyceride intake to reduce chyle production. Human milk is usually eliminated from the diet of infants with chylothorax because of its high long-chain triglyceride content. However, given the immunologic properties of human milk, young infants with chylothorax may benefit from using human milk over human milk substitutes. We performed a retrospective cohort study to describe the feasibility and efficacy of defatted human milk (DHM) for the treatment for chylothorax in infants after cardiac surgery and to compare growth outcomes between infants treated with DHM (n = 14) versus MCT formula (n = 21). There were no differences in mortality or length of hospital stay between the DHM and MCT formula treatment groups. The DHM treatment group had a significantly higher weight-for-age z-score at hospital discharge compared to the MCT formula group with median z-scores of -1 (-2 to 0.5) and -1.5 (-2 to 0), respectively (p = 0.02). In infants with chylothorax after cardiac surgery, DHM is a safe and feasible medical nutritional treatment and may have potential benefits for improved nutrition and growth.

  19. Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants.

    Science.gov (United States)

    Fogg, Kristi L; DellaValle, Diane M; Buckley, Jason R; Graham, Eric M; Zyblewski, Sinai C

    2016-08-01

    Chylothorax is a well-described complication after cardiothoracic surgery in children. Medical nutritional therapy for chylothorax includes medium-chain triglyceride (MCT) formulas and reduction in enteral long-chain triglyceride intake to reduce chyle production. Human milk is usually eliminated from the diet of infants with chylothorax because of its high long-chain triglyceride content. However, given the immunologic properties of human milk, young infants with chylothorax may benefit from using human milk over human milk substitutes. We performed a retrospective cohort study to describe the feasibility and efficacy of defatted human milk (DHM) for the treatment for chylothorax in infants after cardiac surgery and to compare growth outcomes between infants treated with DHM (n = 14) versus MCT formula (n = 21). There were no differences in mortality or length of hospital stay between the DHM and MCT formula treatment groups. The DHM treatment group had a significantly higher weight-for-age z-score at hospital discharge compared to the MCT formula group with median z-scores of -1 (-2 to 0.5) and -1.5 (-2 to 0), respectively (p = 0.02). In infants with chylothorax after cardiac surgery, DHM is a safe and feasible medical nutritional treatment and may have potential benefits for improved nutrition and growth. PMID:27090650

  20. Primary chylopericardium: report of a case.

    Science.gov (United States)

    Chiu, C H; Su, W J; Chang, J P; Chang, C H

    1993-05-01

    A 14-year-old girl was admitted due to exertional dyspnea of one month's duration. A grade 3/6 holosystolic murmur with distant heart sounds was heard at the left sternal border. Chest roentgenograms and echocardiograms showed a large amount of pericardial and left pleural effusion and a small perimembranous ventricular septal defect. Subxyphoid pericardial drainage and left pleural intubation were performed. The fluid from both sites was defined as chyle by the milky white appearance, presence of microscopic fat droplets and the lymphocyte predominance in the white cell count. Lymphangiograms and a chest computed tomographic scan demonstrated thoracic duct obstruction and leakage of contrast to pericardial and pleural spaces. The patient was treated with a medium chain triglyceride diet. Unfortunately, massive reaccumulation of the effusion was later noted. Therefore, a median sternotomy with ligation of the thoracic duct, creation of a posterior pericardio-pleural window and implantation of a left pleuro-peritoneal shunt with a Denver peritoneo-venous shunt were performed. Follow-up for one year with two-dimensional echocardiograms showed no more accumulation of the pericardial effusion. PMID:8104602

  1. Octreotide for the Management of Chylothorax in newborns, case report

    Directory of Open Access Journals (Sweden)

    Reza Saeidi

    2015-02-01

    Full Text Available Chylothorax is the most common cause of pleural effusion in neonates. It is usually idiopathic. Neonatal chylothorax successfully respond to octreotide treatment and can reduce the duration of hospitalization. A number of therapeutic interventions have been used to reduce chyle production and promote resolution of a chylothorax. Initial management typically includes restriction or temporary cessation of enteral feedings. Enteral feedings high in medium-chain triglycerides (MCT or parenteral nutrition may be used. These strategies alone are not successful in all patients. In the last several years, octreotide has become another option for management of patients with chylothorax. octreotide has a number of effects on the gastrointestinal system, including a decrease in splanchnic blood flow and inhibition of serotonin, gastrin, vasoactive intestinal peptide, secretin, motilin, and pancreatic polypeptide. We report an infant who had spontaneous chylothorax with patent ductus arteriosus that was managed primarily as congenital heart disease. Our case was treated successfully with octreotide without the need to insertion of chest tube.

  2. Chylous ascites:Treated with total parenteral nutrition and somatostatin

    Institute of Scientific and Technical Information of China (English)

    Qi Huang; Zhi-Wei Jiang; Jun Jiang; Ning Li; Jie-Shou Li

    2004-01-01

    AIM: To determine the effects of total parenteral nutrition and somatostatin on patients with chylous ascites.METHODS: Five patients were diagnosed with chylous ascites on the basis of laboratory findings of ascites sample from Nov 1999 to May 2003. Total parenteral nutrition and somatostatin or its analogue was administered to 4 patients,while the other one only received total parenteral nutrition.All the patients had persistent peritoneal drainage, with the quantity and quality of drainage fluid observed daily.Necessary supportive treatments were given to the patients individually during the therapy.RESULTS: Two of 4 patients who received somatostatin therapy obtained complete recovery within 10 d without any recurrence while on a normal diet. In these 2 patients,the peritoneal drainage reduced to zero in one and the other's decreased from 2 000 mL to 80 mL with a clear appearance and negative qualitative analysis of chyle. Recurrent chylous ascites, though relieved effectively by the same method every time, developed in one patient with advanced pancreatic cancer. The other patient's lymphatic fistula was blocked with the fibrin glue after conservative treatment. The patient who only received total parenteral nutrition was cured 24 d after therapy.CONCLUSION: Total parenteral nutrition along with somatostatin can relieve the symptoms and close the fistula in patients with chylous ascites rapidly. It appears to be an effective therapy available for the treatment of chylous ascites caused by various disorders.

  3. Radiographic imaging features of thoracic complications after pneumonectomy in oncologic patients

    International Nuclear Information System (INIS)

    Purpose: The morbidity and mortality for pneumonectomy in patients has been reported to be as high as 24%. To determine if a subset of patients undergoing pneumonectomy for a malignancy would have similar complication rates and appearances, we performed a review of the radiographic findings of patients at our institution. Method: A retrospective review of a thoracic surgery database was performed at our institution for patients who underwent pneumonectomy between January 2001 and April 2004. All images were reviewed on the institutional patient archive communication system, by two experienced, fellowship trained, thoracic radiologists. Results: There were 144 patients (112 men and 32 women) with a mean age of 52 years (range 21–83 years). Of the 144 patients, thoracic complications were present in 52 (36%) patients consisting of pneumonia in 19 (13%), empyema/pleural space infection in 9 (6%), adult respiratory distress syndrome (ARDS) in 8 (6%), bronchopleural fistula in 7 (5%), gortex graft failure/organ herniation in 4 (3%), chylothorax/chyle leak in 2 (1%), pulmonary embolus in 2 (1%), pulmonary hemorrhage in 1 (<1%). Conclusion: In oncologic patients, post-pneumonectomy complications occur in over a third of patients and can be life threatening. The presentations are similar to other pneumonectomy patients and are often radiographically detectable. Therefore it is important for radiologist to be aware of the radiographic manifestations of these complications so that appropriate immediate treatment is instituted.

  4. Quilotórax espontâneo associado a atividade física leve Spontaneous chylothorax associated with light physical activity

    Directory of Open Access Journals (Sweden)

    José Carlos Miranda Torrejais

    2006-12-01

    Full Text Available O quilotórax ocorre quando há ruptura, laceração ou obstrução do ducto torácico, com liberação de quilo no espaço pleural. Pode acontecer em malformações linfáticas congênitas, linfomas, tumores de mediastino, doenças infecciosas, procedimentos cirúrgicos, traumas automobilísticos, ou ser idiopático. Apresenta sinais clínicos de dispnéia, hipotensão, edema generalizado e cianose. O diagnóstico geralmente é feito por toracocentese e o tratamento é conservador. O quilotórax espontâneo é uma condição incomum de derrame pleural, e somente é hipótese diagnóstica após a exclusão das demais causas. Descrevemos um caso de quilotórax espontâneo associado a atividade física leve em academia de ginástica.Chylothorax occurs when there is rupture, laceration or obstruction of the thoracic duct, resulting in the release of chyle into the pleural space. Chylothorax can occur in cases of congenital lymphatic malformation, lymphoma, mediastinal tumor and infectious disease, as well as during surgical procedures and after traffic accident-related trauma. It can also be idiopathic. The condition presents clinical signs of dyspnea, hypotension, generalized edema and cyanosis. The diagnosis is usually made through thoracocentesis, and the treatment is conservative. Spontaneous chylothorax is an uncommon form of pleural effusion, and its diagnosis should be hypothesized only after all other causes have been ruled out. Herein, we describe a case of spontaneous chylothorax associated with light physical activity at a fitness center.

  5. [Comparison of remnant lipoprotein-cholesterol measurements: the immune adsorption method (RLP-C) and the direct assay with detergent (RemL-C)].

    Science.gov (United States)

    Hihara, Mari; Sato, Itsuko; Hayashi, Fujio; Sugiyama, Daisuke; Kawano, Seiji; Fujioka, Yoshio; Ishikawa, Yuichi; Kumagai, Shunichi

    2009-01-01

    Elevation of serum remnant lipoprotein concentration is an emerging risk factor for coronary artery disease. An immunoseparation procedure for remnant-like particle cholesterol(RLP-C) has been evaluated extensively in recent years. In addition, a new detergent-based method has been developed and applied to automated analyzer as "MetaboLead RemL-C" (RemL-C, KYOWA MEDEX CO., LTD.). Then, we compared the concentrations of remnant lipoproteins as RemL-C with those as RLP-C in various conditions. RemL-C assay was intra-assay-reproducible (n=20, CVs: 0.6-2.2%), and reproducible for 2 days in the refrigeration and for 8 hours in room temperature. This assay was also inter-assay-reproducible (during 5 days in the deep freezing, CVs: 1.6-3.0%). The available range for RemL-C assay was between 0.09 and 121.1 mg/dl. There were no detectable interferences from hemoglobin, free/conjugated bilirubin, chyle, and Intrafat. However, heparin influenced the titer of RemL-C concentrations. Correlation of values between RLP-C and RemL-C in 123 samples was excellent (r=0.924, p<0.001). However, different responses to intermediate lipoprotein fraction derived from a patients with type III hyperlipidemia were observed. In conclusion, RemL-C and RLP-C measurements may have a similar clinical significance. Differences in sensitivity for intermediate lipoprotein fraction between both methods may exist.

  6. Chylous Ascites

    Directory of Open Access Journals (Sweden)

    Siva K Talluri

    2011-01-01

    Full Text Available Context: Chylous ascites is the accumulation of milky chyle in the peritoneal cavity. Chylous ascites has been reported after surgeries like abdominal aortic aneurysm repair, radical gastrectomy, duodenectomy, nephrectomy and Wilm′s tumor resection. Our literature search did not reveal any reports of chylous ascites after a gastric ulcer resection. We report about an elderly woman with a rare complication of chylous ascites after an emergent surgery for a perforated gastric ulcer. Case Report : A 70-year-old woman developed sudden respiratory distress on 5 th post-operative day after an elective C3-C7 cervical discectomy and fusion. Her past medical history was significant for cervical spondylosis. The Computed Tomography (CT scan of the chest revealed air under the diaphragm suspicious for hollow viscus perforation. She underwent an emergent surgery for drainage of hematoma in the neck along with an emergent laparotomy to repair a large perforated gastric ulcer distal to the gastro-esophageal junction. The patient had worsening of abdominal distention on 4 th post-operative day. The CT scan of abdomen showed fluid collection in the abdomen. The abdominal drain revealed large amount of serous milky fluid at the rate of 1500 ml per day. The fluid analysis showed that the triglyceride level was 170 mg/dl and cholesterol level was 15 mg/dl. The fluid cultures did not grow any organism. She responded to treatment with octreotide and a diet of medium chain triglyceride oil. Conclusion: Any obstruction or damage to the lymphatic channels results in chylous ascites. Lymphomas, metastatic malignancies, and abdominal surgeries commonly cause chylous ascites. Ascitic fluid triglyceride level greater than 110 mg/dl is diagnostic of chylous ascites. Chylous ascites is a rare complication of a peptic ulcer resection which can be managed effectively with octreotide.

  7. Analytical performance and accuracy verification of four domestic and two imported enzymatic creatinine assay kits%四种国产和两种进口酶法肌酐试剂的分析性能及准确度验证

    Institute of Scientific and Technical Information of China (English)

    国秀芝; 邱玲; 吴洁; 赵芳; 程歆琦; 佟大伟; 嵇巍; 刘茜; 韩建华

    2013-01-01

    Objective To assessed the analytical performance of six commercial enzymatic creatinine (Cr) reagents and compared the accuracy among them.Four reagents came from domestic manufactures (Maker Biotechnology,Beijing Strong Biotechnologies,Biosino Bio-technology & Science,BaiDing Biological Engineering,labeled as A,B,C,D respectively) and the other two reagents came from oversea manufactures (Sekisui Medical Technology,Japan and Wako Pure Chemical Industries,Japan,labeled as E,F respectively).Methods Performance verification test.70 serum samples were obtained from chronic kidney disease outpatients and medical center healthy volunteers in Peking Union Medical College Hospital from May 2010.Among 30 patients ureh CKD (15 moles,15 females)aged 18 to 80 years old;40 healthy volunteers (20 males,20 females) aged 20 to 60 years old.To evaluate the within-run imprecision and total imprecision according to the CLSI EP15-A protocol,two level control materials were measured with six reagents in five days,with a frequency of four times a day.To verify the linear ranges according to the EP6-A protocol,a series of samples that mixed by high and low level serum or urine pools with specific ratio were tested.To evaluate the anti-interference ability,we tested the sera added specific concentration of substances (bilirubin,hemoglobin,chyle).To verify the reasonable dilution ratio,diluted sera in different ratio were tested.Correlations and deviation among the detection results of six reagents were evaluated by testing 50 fresh patient samples.Accuracy was evaluated by measuring the NIST SRM 967a and NIST SRM 909b standard substances.Results There were no significant differences between the domestic and imported Cr reagents,with the within-run CV ranging from 0.5% to 1.2% and the total CV ranging from 0.5% to 1.9%,all of which were lower than the allowed biological variation for imprecision (3.0%).Linear ranges of the six Cr reagents were all relatively wide.No significant

  8. Quilopericárdio idiopático primário: relato de caso Quilopericardio idiopático primario: informe de caso clínico Primary idiopathic chylopericardium: case report

    Directory of Open Access Journals (Sweden)

    Marcos Augusto de Moraes Silva

    2009-06-01

    Full Text Available O acúmulo de quilo no espaço pericárdico ou quilopericárdio é uma condição que, com maior frequência, ocorre após trauma, cirurgia cardíaca e torácica ou associado a tumores, tuberculose ou linfoangiomatose. Quando não é possível a identificação precisa da etiologia, o quilopericárdio é denominado primário ou idiopático. Essa é uma situação clínica rara. Descrevemos um caso em paciente do sexo feminino, com 20 anos de idade, tratada cirurgicamente. A propósito do caso, apresentamos breve revisão da literatura e comentários sobre quadro clínico, etiopatogenia, exames diagnósticos complementares e opções de tratamento.La acumulación de quilo en el espacio pericárdico o quilopericardio es una condición que con mayor frecuencia ocurre después de trauma, cirugía cardíaca y torácica o asociado a tumores, tuberculosis o linfoangiomatosis. Cuando no es posible la identificación precisa de la etiología, el quilopericardio se denomina primario o idiopático. Esta es una situación clínica rara. Describimos un caso en paciente del sexo femenino, con 20 años de edad, tratada quirúrgicamente. A propósito del caso, presentamos una breve revisión bibliográfica y comentarios sobre el cuadro clínico, la etiopatogenia, exámenes diagnósticos complementarios y opciones de tratamiento.The accumulation of chyle in the pericardial space, or chylopericardium, is a condition occurring most frequently after trauma, cardiac and thoracic surgery, or in association with tumors, tuberculosis or lymphangiomatosis. When its precise cause cannot be identified, it is called primary or idiopathic chylopericardium. This is a rare clinical entity. We report the case of a surgically treated 20-year-old female patient. A brief review of the literature and comments on the clinical presentation, etiopathogenesis, ancillary diagnostic tests and treatment options are also presented.

  9. Primary intestinal lymphangiectasia (Waldmann's disease).

    Science.gov (United States)

    Vignes, Stéphane; Bellanger, Jérôme

    2008-01-01

    Primary intestinal lymphangiectasia (PIL) is a rare disorder characterized by dilated intestinal lacteals resulting in lymph leakage into the small bowel lumen and responsible for protein-losing enteropathy leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia. PIL is generally diagnosed before 3 years of age but may be diagnosed in older patients. Prevalence is unknown. The main symptom is predominantly bilateral lower limb edema. Edema may be moderate to severe with anasarca and includes pleural effusion, pericarditis or chylous ascites. Fatigue, abdominal pain, weight loss, inability to gain weight, moderate diarrhea or fat-soluble vitamin deficiencies due to malabsorption may also be present. In some patients, limb lymphedema is associated with PIL and is difficult to distinguish lymphedema from edema. Exsudative enteropathy is confirmed by the elevated 24-h stool alpha1-antitrypsin clearance. Etiology remains unknown. Very rare familial cases of PIL have been reported. Diagnosis is confirmed by endoscopic observation of intestinal lymphangiectasia with the corresponding histology of intestinal biopsy specimens. Videocapsule endoscopy may be useful when endoscopic findings are not contributive. Differential diagnosis includes constrictive pericarditis, intestinal lymphoma, Whipple's disease, Crohn's disease, intestinal tuberculosis, sarcoidosis or systemic sclerosis. Several B-cell lymphomas confined to the gastrointestinal tract (stomach, jejunum, midgut, ileum) or with extra-intestinal localizations were reported in PIL patients. A low-fat diet associated with medium-chain triglyceride supplementation is the cornerstone of PIL medical management. The absence of fat in the diet prevents chyle engorgement of the intestinal lymphatic vessels thereby preventing their rupture with its ensuing lymph loss. Medium-chain triglycerides are absorbed directly into the portal venous circulation and avoid lacteal overloading. Other inconsistently effective

  10. 医院库存血液报废原因分析及防范措施%Analysis and countermeasures of blood discarding in hospital

    Institute of Scientific and Technical Information of China (English)

    张立萍; 蒋学兵; 成海; 王燕菊; 叶宇; 张蓉

    2011-01-01

    Objective: To find out the blood collection, transportation, blood regulation as well as the application of existing problems in order to put forward preventive and improvement measures, through the retrospective analysis of main reasons of banked blood discarding in our hospital. Methods: Form December 2001 to June 2009, 312 bags of non-testing unqualified blood were discarded according to relevant national standards in our hospital. The related data were collected,classified and statistical analyzed. Results: There were some reasons of the total of 312 bags of discarded blood such as broken bags, moderate chyle blood, expired blood, direct antiglobulin test positive of blood donors and so on. Conclusion:Before the blood is storaged in blood bank, serious checking, acceptance and joint checking blood bag during receiving and distribute blood are very important, the author consider we should regulate every link 'operation such as blood collection,transportation and applications in order to reduce blood wastage and ensure safe blood transfusion.%目的:通过回顾性分析我院库存血不同血液品种报废的主要原因,找出血液采集、运输、血液调控以及应用中存在的问题,提出防范与改进措施.方法:按国家相关标准,对我院2001年12月~2009年6月库存血非检验性不合格的312袋血液报废情况进行分类、统计.结果:主要原因为血袋破损、中重度乳糜血、过期报废、献血员直接抗人球蛋白试验阳性、临床申请用血但因患者去世导致血液过期报废等.结论:为减少血液浪费,确保质量合格的血液制品发放到临床.针对不同血液品种报废的主要原因采取针对性措施降低血液报废,加强献血知识和献血注意事项的宣传,规范血液采集、运输、应用等各环节操作,临床医生应根据患者病情合理申请适量的血液制品以及加强库存血液调控.

  11. Chylopericardium as a complication of cardiac surgery: Report of two cases and review of the literature

    Directory of Open Access Journals (Sweden)

    Velinović Miloš

    2007-01-01

    Full Text Available Chylopericardium refers to existing communication between the pericardial sac and the thoracic duct carrying the chyle. The objective of our report was to highlight the specificity of diagnosis and treatment of this rare but tedious condition through the analysis of two case reports. Male patient, aged 63 years, with chylopericardium was diagnosed perioperatively (implantation of artificial aortic - St. Jude No 21 and mitral valve - St. Jude No 29. Etiology of pericardial effusion was established by Sudan III staining of punctate specimen obtained by subxiphoid pericardial puncture. Probable cause of chylopericardium was the lesion of ductus thoracicus during cross-clamping of the superior caval vein with a Cooley clamp. Initial treatment included diet rich in medium-chain triglycerides which resulted in resolution of the effusion. During five-year follow-up, there were no recurrences of pericardial effusion. The second patient was female, 21 years old, with chylopericardium after partial pericardiectomy performed because of the chronic severely symptomatic pericardial effusion, resistant to other forms of treatment. Pericardiocentesis provided 650 ml of yellowish fluid with a high concentration of cholesterol (3.2 mmol/l, triglycerides (16.6 mmol/l, and proteins (64.7 g/l, which verified chylopericardium, most probably as a consequence of the lesion of ductus thoracicus during partial pericardiectomy. Diet rich in medium-chain triglycerides failed to decrease the effusion, after two weeks of treatment (daily secretion 250-350 ml. Lymphography revealed lesion of ductus thoracicus, most probably at Th9/Th10 level, with no direct visualization of extravasal accumulation of contrast media. Surgical ligation of ductus thoracicus was performed through the right thoracotomy. However, postoperative secretion increased to 1000 ml/day. Patient underwent redo surgery comprising the ligation of lymphatic vessels, guided by extravasation of intraoperatively

  12. Manejo nutricional en esofagectom a complicada por quilotrax Nutritional management of esophagectomy complicated by chylothorax

    Directory of Open Access Journals (Sweden)

    Lucía Llames

    2009-09-01

    Full Text Available La nutrición perioperatoria en cirugía mayor del tracto digestivo es un pilar básico dentro de la terapéutica de estos pacientes; considerando que un elevado porcentaje presenta malnutrición en el periodo preoperatorio y que es bien conocida la correlación entre la ingesta preoperatoria inadecuada y la aparición de complicaciones. Se presenta a continuación un caso clínico de sexo femenino a quien se realizó esofagectomía, que evolucionó con quilotorax en postoperatorio; y se describe el manejo nutricional que se llevó a cabo. El quilotorax, que es una complicación poco frecuente, tiene una mortalidad no despreciable debido a que produce alteraciones nutricionales, inmunológicas y de los fluidos corporales. El tratamiento adecuado es controvertido. Los principios del tratamiento conservador son reducir el flujo de quilo, drenar la cavidad pleural, prevenir las complicaciones sépticas y aportar nutrición enteral con triglicéridos de cadena media que van directamente al sistema porta o nutrición parenteral.Perioperative nutrition in digestive tract surgery (esophagectomy is a basic pillar as regards therapeutic measures, considering a high percentage of affected patients have preoperative malnutrition and since the correlation between inadequate preoperative intake and postoperative complications is widely known. Chylothorax is an unusual complication; it has a considerable mortality rate due to nutritional, immunological and body fluids alterations. Although the appropriate treatment is controversial, traditional principles in this treatment consist in reducing chyle flow, draining the pleural cavity, preventing sepsis complications and providing enteral nutrition with medium chain triglycerides (MCT, which go directly to the portal system. Total parenteral nutrition is the option when oral/enteral nutrition has failed. In this paper, a clinical case is introduced where a woman had esophagectomy which evolved into chylothorax

  13. Primary intestinal lymphangiectasia (Waldmann's disease

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    Bellanger Jérôme

    2008-02-01

    Full Text Available Abstract Primary intestinal lymphangiectasia (PIL is a rare disorder characterized by dilated intestinal lacteals resulting in lymph leakage into the small bowel lumen and responsible for protein-losing enteropathy leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia. PIL is generally diagnosed before 3 years of age but may be diagnosed in older patients. Prevalence is unknown. The main symptom is predominantly bilateral lower limb edema. Edema may be moderate to severe with anasarca and includes pleural effusion, pericarditis or chylous ascites. Fatigue, abdominal pain, weight loss, inability to gain weight, moderate diarrhea or fat-soluble vitamin deficiencies due to malabsorption may also be present. In some patients, limb lymphedema is associated with PIL and is difficult to distinguish lymphedema from edema. Exsudative enteropathy is confirmed by the elevated 24-h stool α1-antitrypsin clearance. Etiology remains unknown. Very rare familial cases of PIL have been reported. Diagnosis is confirmed by endoscopic observation of intestinal lymphangiectasia with the corresponding histology of intestinal biopsy specimens. Videocapsule endoscopy may be useful when endoscopic findings are not contributive. Differential diagnosis includes constrictive pericarditis, intestinal lymphoma, Whipple's disease, Crohn's disease, intestinal tuberculosis, sarcoidosis or systemic sclerosis. Several B-cell lymphomas confined to the gastrointestinal tract (stomach, jejunum, midgut, ileum or with extra-intestinal localizations were reported in PIL patients. A low-fat diet associated with medium-chain triglyceride supplementation is the cornerstone of PIL medical management. The absence of fat in the diet prevents chyle engorgement of the intestinal lymphatic vessels thereby preventing their rupture with its ensuing lymph loss. Medium-chain triglycerides are absorbed directly into the portal venous circulation and avoid lacteal overloading. Other

  14. ELISA检测肿瘤患者热休克蛋白90α的影响因素分析%Analysis of affecting factors in the detection of tumor patients heat shock protein 90α using ELISA

    Institute of Scientific and Technical Information of China (English)

    宋媛媛; 韩晓红; 郑翠玲; 赵国华; 许建萍; 刘敏; 李宁; 杜萍; 冯云

    2013-01-01

    (hemolytic hemoglobin,chyle) were prepared and analyzed.The differences of Hsp90α concentration in paired group were analyzed by t-test.Results There were statistical differences between EDTA-K2 group [(156.4 ±67.6) ng/ml] and EDTA-K3 group [(53.9 ± 26.6) ng/ml,t =10.68,P < 0.01].Comparing the levels of Hsp90α in the chyle concentration lower than 5% groups[(34.3 ±2.0) ng/ml] with normal control group[(37.7 ± 1.3) ng/ml],the value had significant difference (t =3.96,P < 0.05).The levels of Hsp90α in hemolytic hemoglobin[(94.2 ±7.2) ng/ml] were significantly higher than this of normal control [(67.0 ±4.4)ng/ml,t =-9.17,P <0.05].The levels of Hsp90α in RF concentration 25 U/ml group [(39.0 ±3.5) ng/ml] were higher than this of normal control[(35.3 ± 1.7) ng/ml,t =-2.37,P < 0.05].The levels of Hsp90α in bilirubin concentration 4 g/L group [(38.4 ± 2.1) ng/ml] were higher than this of normal control [(35.7 ± 1.4) ng/ml,t =-2.97,P < 0.05].Conclusions Exogenous and endogenous substances would interfere the detection of Hsp90α in tumor patients using ELISA method.Quality control should be implemented strictly during the experiments in order to avoid false positive and false negative results.

  15. Surgical treatment of iatrogenic chylothorax%医源性乳糜胸的外科治疗

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    方震宇; 夏军; 彭涛; 罗彬; 黄杰; 康敢军; 程邦昌

    2013-01-01

    Objective To investigate the optimal, surgical indications, approaches and procedures for iatrogenic chylothorax. Methods The clinical data of 46 cases with operative chylothorax after thoracic surgery were analyzed, including 36 cases of mid-upper esophageal cancer,6 cases of lung cancer,3 cases of mediastinal tumor and 1 case of adult patent ductus arteriosus. On the 6th ~41st day after surgery, all patients were reoperated to ligature the thoracic duct trunk or suture the leakage site, 3 cases underwent a third thoracotomy. Results Forty-four patients were cured(95. 6%),the complication rate was 43. 5% , and 2 patients died(4. 4%). Forty cases were followed up for 1 ~ 3 years and there was no recurrent chylothorax. Conclusion Re-operation should be performed in cases of iatrogenic chylothorax following recent post - thoracic surgery with conservative treatment, in which 24-hour chest drainage is > 1500 ml for 3 days, with no reduction trend. The right thoracic approach iss the first choice for the surgery because it could clearly reveal the thoracic duct trunk. In very extreme cases which fail the reoperation,the lariat and thoracic aorta could be dissociated through the left thoracic approach, and the missing thoracic duct could be revealed and ligated in the area between aorta and vertebra. The optimal approaches are the ligation of thoracic duct above the diaphragm and the suture of massive tissue. Surgeons should try their best to find and suture the chyle fistula.%目的 探讨医源性乳糜胸的最佳手术时机、径路和术式.方法 分析46例胸内脏器近期手术后并发乳糜胸的临床资料,含食管中上段癌36例,肺癌6例,纵隔肿瘤3例,成人动脉导管未闭症1例.术后6~41d,经再次开胸行胸导管主干结扎或漏口缝扎;另有3例行第三次开胸手术.结果 治愈44例(95.6%),发生并发症20例,并发症率43.5%,死亡2例(4.4%).随访获40例,随访时间1~3年,均未有乳糜胸复发.结论 胸内

  16. Alterations of intestinal mucosa structure and barrier function following traumatic brain injury in rats

    Institute of Scientific and Technical Information of China (English)

    Chun-Hua Hang; Ji-Xin Shi; Jie-Shou Li; Wei Wu; Hong-Xia Yin

    2003-01-01

    AIM: Gastrointestinal dysfunction is a common complication in patients with traumatic brain injury (TBI). However, the effect of traumatic brain injury on intestinal mucosa has not been studied previously. The aim of the current study was to explore the alterations of intestinal mucosa morphology and barrier function, and to determine how rapidly the impairment of gut barrier function occurs and how long it persists following traumatic brain injury.METHODS: Male Wistar rats were randomly divided into six groups (6 rats each group) including controls without brain injury and traumatic brain injury groups at hours 3,12, 24, and 72, and on day 7. The intestinal mucosa structure was detected by histopathological examination and electron microscopy. Gut barrier dysfunction was evaluated by detecting serum endotoxin and intestinal permeability. The level of serum endotoxin and intestinal permeability was measured by using chromogenic limulus amebocyte lysate and lactulose/mannitol (L/M) ratio, respectively.RESULTS: After traumatic brain injury, the histopathological alterations of gut mucosa occurred rapidly as early as 3 hours and progressed to a serious state, including shedding of epithelial cells, fracture of villi, focal ulcer, fusion of adjacent villi, dilation of central chyle duct, mucosal atrophy,and vascular dilation, congestion and edema in the villous interstitium and lamina propria. Apoptosis of epithelial cells,fracture and sparseness of microvilli, loss of tight junction between enterocytes, damage of mitochondria and endoplasm, were found by electron microscopy. The villous height, crypt depth and surface area in jejunum decreased progressively with the time of brain injury. As compared with that of control group (183.7±41.8 EU/L), serum endotoxin level was signnificantly increased at 3, 12, and 24 hours following TBI (434.8±54.9 EU/L, 324.2±61.7 EU/L and 303.3±60.2 EU/L, respectively), and peaked at 72 hours (560.5±76.2 EU/L), then declined on day 7

  17. 胸腹腔镜联合与常规三切口食管次全切除术治疗食管癌的比较研究%Comparison of thoracolaparoscopic and open three-field subtotal esophagectomy for esophageal cancer

    Institute of Scientific and Technical Information of China (English)

    刘宝兴; 李印; 秦建军; 张瑞祥; 刘先本; 孙海波; 刘士磊

    2012-01-01

    ),atelectasis (3.1% vs.10.5%,P<0.05),pleural effusion (3.1% vs.10.5%,P<0.05),acute respiratory distress (1.0% vs.7.6%,P<0.05) and arrhvthmia (4.1% vs.12.4%,P<0.05).No significant differences were observed in the number of lymph node harvested,operative time,anastomotic leak,thoracic abscess,chyle chest,re-laparotony,re-thoracotomy,vocal cord paralysis,renal failure,gastric emptying,and mortality (all P>0.05).Conclusion Thoracolaparoscopic subtotal esophagectomy is technically feasible and safe and is associated with less blood loss,less cadiopulmonary complication,and shorter hospital stay.

  18. 半胱氨酸蛋白酶抑制剂C透射比浊检测试剂盒性能验证%Cysteine protease inhibitor C turbidimetric assay kit Performance verification

    Institute of Scientific and Technical Information of China (English)

    何国坚; 胡劲辉; 肖庆

    2013-01-01

    Objective To evaluate the cysteine protease inhibitor (Cys-C) kit performance indicators by turbi-dimetric method ,using the Olympus Au600 automatic biochemical analyzer .Methods The Cys-C kit performance in-dex was evaluated according to the EP series files of US national clinical and laboratory standardization association (NCCLS) .Results Turbidimetric method had good stability .The experimental detection limit was 0 .11 μg/mL .The relative deviation (Bias) of three kinds of different concentration of fixed value quality control serum in accuracy eval -uation were all lower than 8% .The coefficient of variation (CV) for within-run and between-run assays of three kinds of different concentration of clinical patients mixed serum and three kinds of different concentration of fixed value quality control serum evaluation precision were lower than 5% .In the linear range of the evaluation had been found from the group of point ,and the linear regression equation was Y = 0 .017 934 + 0 .993 2 X ,r = 0 .993 .Dilution varia-tion P was 0 .42(P0 .05 = 0 .684 1) ,P< 0 .05 .The dilution variation can be accepted .The linear loss of quasi check was G = 3 .12(F0 .05 = 3 .29) ,G < F0 .05 .The linear was good .Interference test with relative deviation lower than 8% was the medical decision level ,IBil concentration was lower than 28 .2 umol/l ,DBil concentration lower than 29 .1μmol/L ,Hb concentration lower than 9 .7 g/L ,chyle turbidity lower than 2583 ,and Cys-C relative deviation was still in the acceptable range .Conclusion The Cys-C kit stability ,accuracy ,precision ,linearity and anti-interference ability are all in line with the requirements of clinical testing .%目的:在 Olympus Au600全自动生化仪上采用透射比浊法检测半胱氨酸蛋白酶抑制剂 C(Cys-C),评价 Cys-C 试剂盒性能指标。方法参考美国临床和实验室标准化协会 EP 系列文件,对 Cys-C 试剂盒性能指标作出评估。结果透射比浊法有较好的稳

  19. 儿童先天性脑积水的诊治探讨%Diagnosis and treatment of congenital hydrocephalus in children

    Institute of Scientific and Technical Information of China (English)

    刘智强; 刘水源; 林志雄; 梅文忠; 龚清永; 何理盛; 康德智; 吴喜跃

    2013-01-01

    associated with other organs malformations,including 1 case of hemivertebral deformity at T7 and right talipes equinovarns,1 case of chyle leakage,1 case of indirect inguinal hernia and 1 case of umbilical hernia.Ventriculoperitioneal shunt was performed in 26 cases,and 3 underwent cyst-peritoneal shunt surgery.Results Among the patients,26 cases had good prognosis after surgery,and the other 3 cases had poor outcome.13 appeared postoperative complications,including Shunt infection in 3,proximal shunt blockage or poor drainage in 3,peritoneal shunt blockage or poor drainage in 3,subdural effusion in 1,subdural effusion and subdural hematoma in 1,abdominal cyst in 1 and shunt tube into the right side of the scrotum and scrotal swelling in 1.Conclusion Congenital hydrocephalus in children often merges with other organs malformations;it's important to pay attention to the relevant examination and make clear diagnosis to improve the prognosis.

  20. 胸腔镜食管癌术前口服脂肪乳预防乳糜胸的临床研究%Oral administration of intralipid before esophagectomy by VATS for esophageal cancer prevents chylothorax

    Institute of Scientific and Technical Information of China (English)

    杨冉; 韩金利; 张卫民; 侯建彬

    2015-01-01

    Objective To explore whether preoperative oral administration of intralipid can decrease the rate of postoperative chylothorax in patients with esophageal cancer.Methods 458 patients with esophageal cancer undergoing esophagectomy by VATS (Video-Assisted Thoracoscopic Surgery) were analyzed and studied;among which,218 orally taking 250 ml intralipid 8 hours before the operation were set as an experimental group and the other 240 routinely prepared as a control group.The surgical procedure was McKeown operation by VATS or thoractomy if necessary.430 cases were failed VATS,and 28 cases were converted to open thoractomy.Thoracic duct ligation was performed for all the cases during the operation.The sex,age,location of the tumor,T stage,histologic types,surgical procedures,length of hospital stay,incidence of postoperative chylothorax,and other complications of both groups were calculated.Results There were no statistical differences in basic clinical features between these 2 groups.The incidence rate of postoperative chylothorax was lower in the experimental group than in the control group (0.92% vs.5.42%,P<0.01).2 cases of postoperative chylothorax in the experimental group were cured by conservative treatment;however,5 of the 13 cases of postoperative chylothorax in the control group were cured by conservative treatment and needed to be surgically treated,and 1 case died from lung infection and respiratory failure after the second surgery.There was no statistical difference in other postoperative complications between the 2 groups(P>0.05).Conclusions Oral administration of intralipid before esophagectomy for patients with esophageal cancer can make the thoracic duct filled with chyle,minimize the risk of iatrogenic injury,easily find the chylothorax,and lower the incidence of postoperative chylothorax.%目的 探讨食管癌患者术前口服脂肪乳能否降低术后乳糜胸发生率.方法 分析研究458例行胸腔镜手术