WorldWideScience

Sample records for chyle

  1. Management of Chyle Leak after Head and Neck Surgery: Review of Current Treatment Strategies

    Science.gov (United States)

    Shi, Haoran; Sinha, Uttam K.

    2017-01-01

    Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body. Chyle extravasation can result in delayed wound healing, dehydration, malnutrition, electrolyte disturbances, and immunosuppression. Prompt identification and treatment of a chyle leak are essential for optimal surgical outcome. In this article we will review the current treatment options for iatrogenic cervical chyle leaks. PMID:28203252

  2. Chyle leak following right axillary lymph node dissection: A case report and review of current literature

    Directory of Open Access Journals (Sweden)

    J.D. Daggett

    2016-01-01

    Full Text Available This report discusses the case of a chyle leak following a right axillary lymph node dissection for breast cancer. This presented as a sudden change in drainage character from a right axillary surgical drain from serous to milky white shortly after restarting a diet. The diagnosis of chyle leak was confirmed by laboratory testing of the fluid and managed with closed suction drainage. Chyle leak is a rare, but increasingly recognized complication following axillary clearance for breast cancer and melanoma.

  3. The origin of cholesterol in chyle demonstrated by nuclear indicator methods; Origines du cholesterol du chyle mises en evidence par la methode des indicateurs nucleaires

    Energy Technology Data Exchange (ETDEWEB)

    Vyas, M

    1962-07-01

    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-{sup 14}C- cholesterol subcutaneously or orally, or the 1-{sup 14}C 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) [French] Pour obtenir des renseignements concernant le mecanisme de l'absorption intestinale du cholesterol, on utilise des rats porteurs d'une fistule lymphatique abdominale. Les animaux recoivent soit du cholesterol 4-{sup 14}C par voie sous-cutanee ou par voie orale, soit de l'acetate 1-{sup 14}C. L'etude des radioactivites specifiques du cholesterol du chyle, du serum, de la paroi et du contenu intestinal permet de preciser les roles joues par le cholesterol de transfert d'origine serique, par le cholesterol de synthese intestinale et par le cholesterol d'absorption, dans la formation de la lymphe et des chylomicrons. Une theorie nouvelle concernant le mecanisme de l'absorption du cholesterol est proposee. (auteur)

  4. [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.

  5. 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.

  6. 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.

  7. 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

  8. Rapid decline of follicular lymphoma-associated chylothorax after low dose radiotherapy to retroperitoneal lymphoma localization

    NARCIS (Netherlands)

    Van De Voorde, Lien; Vanneste, Ben; Borger, Jacques; Troost, Esther G C; Werner, Philo

    2014-01-01

    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 w

  9. The discovery of lymphatic system in the seventeenth century. Part I: the early history.

    Science.gov (United States)

    Suy, Raphael; Thomis, Sarah; Fourneau, Inge

    2016-08-01

    The early history of lymphatic anatomy from Hippocrates (ca. 460-377 B.C.) to Eustachius (1510-1574). The presence of lymphatic vessels and lymph nodes was reported by ancient anatomists without any accurate knowledge of their true functions. Lymph nodes were described as spongy structures, spread over the whole body for the support of vulnerable body parts. Digestion was explained as being the resorption of clear chyle from digested food by the open endings of chyle vessels. The first insights into the place of lymphatic components within nutrition emanated from the medical school of Alexandria (fourth century B.C.) where vivisection was a common practice. Herophilus and Erasistratus described mesenteric veins full of clear liquid, air or milk. For Galen of Pergamum, (104-210) mesenteric lymph nodes also had a nutritional function. He described three different types of mesenteric vessels, namely, the arterial vessels, for the transport of spirituous blood to the intestines; the venous side branches of the portal vein, for the transport of nutritive blood from the liver to the intestines; and small vessels, from the intestines to the mesenteric lymph nodes (serous lymph vessels?). According to Galen, chyle was transported via the above-mentioned mesenteric venous vessels from the intestines to the portal vein and liver, where it was transformed into nutritive blood. This doctrine would be obliterated in the seventeenth century by the discovery of systemic circulation and of the drainage of chyle through a thoracic duct to the subclavian veins.

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    Andrea Guttilla

    2016-09-01

    Full Text Available 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.

  12. Chylous ascites caused by acute pancreatitis with portal vein thrombosis

    OpenAIRE

    Park, Dong Eun; Chae, Kwon Mook

    2011-01-01

    Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also rev...

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Chyluria: the state of the art.

    Science.gov (United States)

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

    2017-03-27

    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 communication is caused by the obstruction of lymphatic drainage proximal to intestinal lacteals, resulting in dilatation of distal lymphatics and the eventual rupture of lymphatic vessels into the urinary collecting system.This condition, if left untreated, leads to significant morbidity because of hematochyluria, recurrent renal colic, nutritional problems due to protein losses and immunosuppression resulting from lymphocyturia.In this review, we summarize the state of the art of this condition and the newest treatments available.

  17. Chylous ascites caused by acute pancreatitis with portal vein thrombosis.

    Science.gov (United States)

    Park, Dong Eun; Chae, Kwon Mook

    2011-12-01

    Chylous ascites is defined as the accumulation of chyle in the peritoneum due to obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands. Chylous ascites that arises from acute pancreatitis with portal vein thrombosis is very rare. We report here on a case of chylous ascite that was caused by acute pancreatitis with portal vein thrombosis, in which the patient showed an impressive response to conservative therapy with total parenteral nutrition and octerotide. We also review the relevant literature about chylous ascites with particular reference to the management of this rare disease.

  18. A case of chylothorax in a patient with sarcoidosis: a rare and potentially fatal complication

    Directory of Open Access Journals (Sweden)

    Bikash Bhattarai

    2015-09-01

    Full Text Available Obstruction of the thoracic duct may lead to accumulation of a lymphatic fluid rich in triglycerides named chyle. When chyle accumulates in the pleural cavity, it becomes a chylothorax. Malignancy, particularly lymphoma, is the most common cause of chylothorax; however, any pathology leading to obstruction or destruction of the thoracic duct can lead to a chylothorax. This particular case investigates an incidence of chylothorax in sarcoidosis. A 54-year-old African American woman with a medical history of sarcoidosis, congestive heart failure, and smoking presented to the emergency department with complaints of bilateral foot swelling and exertional shortness of breath 3 days in duration. Physical examination was positive for bilateral crepitations with decreased air entry, abdominal ascites, and bilateral 2+ pitting edema. Both chest X-ray and chest CT were positive for stable bilateral pleural effusions (when compared to imaging done 3 years previously, and thoracocentesis and paracentesis were positive for chylous fluid accumulation. Chylothorax was diagnosed, and based on the previous medical history, the lymphadenopathy of sarcoidosis was determined to cause the occlusion of the thoracic duct. Lymphoscintigraphy and surgical intervention were advised; however, the family decided on conservative management and the patient expired intubated in the ICU. Chylothorax is a rare manifestation of sarcoidosis and high index of suspicion should be there to diagnose this, as there is high morbidity and mortality associated with it.

  19. Analytical performances of Hemoclot Protein C Reagent on ACL TOP analyzer.

    Science.gov (United States)

    Calmette, Leyla; Charpentier, Nicole; Tircot, Caroline; Bigot, Delphine; Dunois, Claire; Amiral, Jean; Tetegan, Marcelle; Sep Hieng, Sonnthida; Peltier, Jean-Yves

    2016-12-01

    Our study aimed to evaluate and validate according to standard NF EN ISO 15189 the original protocol ajustement of Hemoclot Protein C (PC) (Hyphen BioMed), clotting-based assay of PC on ACL TOP analyzer (Werfen/Instrumentation Laboratory). We evaluated the performance in terms of imprecision and we validate additional parameters in range B required by the SH GTA 04 (COFRAC): repeatability, reproducibility, detection and quantification limits, limits of linearity, stability, inter-samples and inter-reagents contamination, inaccuracy, evaluation of interferences (hemolysis, bilirubinemia and chyles). A comparison with Hemoclot PC on STA Compact analyzer (Stago) was performed. Coefficients of variation were lower than 5 %. Detection and quantification limits were respectively 8.3 % and 9.3 %. Superior limit of linearity was 140 %. The test didn't diplay any inter-samples and inter-reagents contamination. Reagent after reconstitution was stable 6 hours on ACL TOP. No interferences were observed for hemoglobin lower than 500 mg/dL, for bilirubin lower than and for chyles lower than 300 mg/dL. Comparison with Hemoclot PC on STA analyzer (Stago) was satisfactory. Hemoclot PC adjusted on ACL TOP analyzer showed satisfactory analytical performances with criteria chosen in our study. These data allow a better knowledge of the performances of this test and were useful to make a validation file in range B as recommended by SH GTA 04.

  20. 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.

  1. 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.

  2. Spilt Milk

    Directory of Open Access Journals (Sweden)

    Sara Matani MD

    2015-04-01

    Full Text Available We report a case of bilateral chylothorax without evidence of chylous fistula in a 62-year-old man following total laryngectomy and bilateral selective neck dissection for laryngeal cancer. Chylous fistulae, a well-known complication of neck dissection, occurs following 1% to 2% of these surgeries. On rare occasions, the chyle leak may communicate with the pleural space, resulting in chylothorax. This is a rare but potentially life-threatening complication. Bilateral chylothorax following neck dissection is even rarer, with less than 25 cases reported in the literature. Early diagnosis is essential to prevent complications. Physicians should have a high index of suspicion, especially when the postoperative effusions do not respond to diuretics. Though no evidence-based treatment guidelines exist, expert opinion recommends conservative management as first-line therapy. Our patient was effectively treated by conservative management. We postulate a mechanism whereby bilateral chylothorax occurred in our patient without a chylous fistula.

  3. Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (Betadine).

    Science.gov (United States)

    Brissaud, O; Desfrere, L; Mohsen, R; Fayon, M; Demarquez, J L

    2003-11-01

    Chylothorax is defined as an accumulation of chyle in the pleural space. This condition usually occurs after an operation, the congenital idiopathic form being rare (1/15000 births). Recovery is observed within four to six weeks of diagnosis in most cases. Treatment is either conservative or surgical. Four cases are reported of congenital chylothorax (three idiopathic, one accompanied by diffuse lymphangectasia) managed by chemical pleurodesis (intrapleural injection of povidone-iodine). Tolerance was satisfactory: unaltered thyroid function in the three cases explored; one case of transient generalised oedema. Treatment was deemed successful in three of the four cases. One child died from renal failure (unrelated to the chemical pleurodesis). Pleurodesis by povidone-iodine appears to be well tolerated and may represent a good alternative to mechanical abrasion or surgery for congenital idiopathic chylothorax. Its use for refractory chylothorax may also decrease the morbidity related to prolonged hospital stay.

  4. 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.

  5. From red to white urine: a patient's nightmare with a rather benign outcome

    Directory of Open Access Journals (Sweden)

    Knier Benjamin

    2012-02-01

    Full Text Available Abstract Background Chyluria is a medical condition with presence of chyle in the urine. The disease is most prevalent in endemic regions of Africa and the Indian subcontinent where it is mostly caused by parasitic infections, particularly lymphatic filariasis due to wucheria bancrofti. Non-parasitic chyluria, however, is a very rare finding. Case Presentation We report the case of a 48 year old woman who developed a lymphorenal fistula with chyluria following ureterrenoscopy with biopsies taken for urological work-up of persistent macrohematuria. Renal biopsy confirmed the diagnosis of benign familial hematuria due to thin basement nephropathy, a condition frequently associated with episodes of macrohematuria. Conclusions This case highlights a rare case of non-parasitic chyluria as a complication of urological work-up for macrohematuria of benign nature.

  6. 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.

  7. The fluid mechanics of nutrition: Herman Boerhaave's synthesis of seventeenth-century circulation physiology.

    Science.gov (United States)

    Orland, Barbara

    2012-06-01

    This paper investigates the theory of nutrition of Herman Boerhaave, the famous professor of medicine and chemistry at the university of Leyden. Boerhaave's work, which systematized and synthesized the knowledge of the time, represents a shift from a humoral to a hydraulic model of the body in medicine and culture around 1700. This epistemological reconfiguration of early modern physiological thinking is exemplified with respect to the changing meanings of milk. While over centuries the analogy between blood and milk played an essential role in understanding the hidden workings of the nutritional faculties, following the discovery of the blood circulation the blood-milk analogy was transformed into a chyle-milk analogy. Yet Boerhaave's interpretations show that the use of new knowledge tools did not simply displace the old ways of reasoning. Instead, analogies continued to serve as epistemic instruments. Old theories and new insights overlapped, and contemporary knowledge assimilated past ideas.

  8. Congenital chylothorax in newborn with trisomy 21.

    Science.gov (United States)

    Lomauri, Kh

    2014-11-01

    Neonatal chylothorax results from the accumulation of chyle in the pleural space and may be either congenital or an acquired condition. Congenital chylothorax is most likely due to abnormal development or obstruction of the lymphatic system. It is often associated with hydrops fetalis. It can be idiopathic or may be associated with various chromosomal anomalies including Trisomy 21, Turner syndrome, Noonan syndrome, and other genetic abnormalities. Congenital pulmonary lymphangiectasia and generalized lymphangiomatosis have also been reported to be associated with congenital chylothorax. Several case reports indicate that congenital chylothorax can recur in subsequent offspring, suggesting a possible underlying genetic etiology. It is important to identify infants with chylothorax, as there are specific issues that need to be addressed in the management of these patients. We present a case of newborn with trysomy 21 (trisomy 21 was diagnosed antenatally by amniocentesis with support of Association "Perinatology"), who developed moderate Respiratory Distress Syndrome, chest X-ray and US reveal pleural effusion on right side rapid intervention was made before deterioration, requiring intensive life-saving measures. In the neonate, chylous effusion is not a common cause of pleural effusions. It is characterized as an exudate because of the high protein and lipid content once the infant is fed. The fluid will be clear/yellow to slightly cloudy in the unfed state and will quickly become milky following feeding, as chylomicrons appear in the fluid. Lymphocytes predominate in the differential cell count of chyle. The volume of fluid output can be high, and management can be challenging. We review the common manifestations of congenital chylotoraxes and emphasize the importance of early diagnosis and intervention in preventing devastating outcomes from this condition.

  9. 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.

  10. 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.

  11. Post-mastectomy chylous fistula: anatomical and clinical implications.

    Science.gov (United States)

    Purkayastha, Joydeep; Hazarika, Sidhartha; Deo, S V S; Kar, Madhabananda; Shukla, N K

    2004-07-01

    A chylous fistula after a modified radical mastectomy is a rare occurrence; however, major anatomical variations in the termination of the thoracic duct may occur, rendering it susceptible to injury. High output chylous fistulae are difficult to manage and have local, metabolic, and immunologic complications with a mortality rate varying from 12.5-50%. Herein such a case of postmastectomy chylous fistula and its management are discussed. A 56-year-old postmenopausal woman with invasive duct carcinoma of the left breast underwent modified radical mastectomy with complete axillary clearance (Level I, II, III nodes). The operative procedure was uneventful. On the commencement of a normal diet, however, the patient started exuding milky fluid from the axillary drain and analysis of the fluid revealed biochemical features compatible with chyle. After 2 weeks of failed conservative management, the axilla was re-explored. A continuous flow of clear fluid was observed originating from a single major lymphatic trunk inferior to the axillary vein in the region of the former Level II nodes. The leak was controlled by the application of multiple mass ligatures using 2-0 silk suture. A part of the pectoralis major muscle was rotated and sutured over the area of the leak as additional reinforcement. Suturing a muscle flap over the leak has been described previously and functions theoretically by causing fibrosis. The chylous fistula in the present case was managed successfully with mass ligatures and muscle flap reinforcement.

  12. 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.

  13. 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.

  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. 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.

  16. Chylothorax in dermatomyositis complicated with interstitial pneumonia.

    Science.gov (United States)

    Isoda, Kentaro; Kiboshi, Takao; Shoda, Takeshi

    2016-11-24

    Chylothorax is a disease in which chyle leaks and accumulates in the thoracic cavity. Interstitial pneumonia and pneumomediastinum are common thoracic manifestations of dermatomyositis, but chylothorax complicated with dermatomyositis is not reported. We report a case of dermatomyositis with interstitial pneumonia complicated by chylothorax. A 77-year-old woman was diagnosed as dermatomyositis with Gottron's papules, skin ulcers, anti-MDA5 antibody and rapid progressive interstitial pneumonia. Treatment with betamethasone, tacrolimus and intravenous high-dose cyclophosphamide was initiated, and her skin symptoms and interstitial pneumonia improved once. However, right-sided chylothorax began to accumulate and gradually increase, and at the same time, her interstitial pneumonia began to exacerbate, and skin ulcers began to reappear on her fingers and auricles. Although her chylothorax improved by fasting and parenteral nutrition, she died due to further exacerbations of dermatomyositis and interstitial pneumonia in spite of steroid pulse therapy, increase in the betamethasone dosage, additional intravenous high-dose cyclophosphamide and plasma pheresis. An autopsy showed no lesions such as malignant tumors in the thoracic cavity. This is the first report of chylothorax complicated by dermatomyositis with interstitial pneumonia.

  17. 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.

  18. [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.

  19. 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.

  20. 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

  1. 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.

  2. Changes over time in milk test results following pancreatectomy

    Institute of Scientific and Technical Information of China (English)

    Hideki Aoki; Masashi Utsumi; Kenta Sui; Nobuhiko Kanaya; Tomoyoshi Kunitomo; Hitoshi Takeuchi; Norihisa Takakura; Shigehiro Shiozaki; Hiroyoshi Matsukawa

    2016-01-01

    AIM: To investigate changes over time in, and effects of sealing technology on, milk test results following pancreatectomy. METHODS: From April 2008 to October 2013, 66 pancreatic resections were performed at the Iwakuni Clinical Center. The milk test has been routinely conducted at the institute whenever possible during pancreatectomy. The milk test comprises the following procedure: A nasogastric tube is inserted until the third portion of the duodenum, followed by injection of 100 mL of milk through the tube. If a chyle leak is present, the patient tests positive in this milk test based on the observation of a white milky discharge. Positive milk test rates, leakage sites, and chylous ascites incidence were examined. Liga Sure?(LS; Covidien, Dublin, Ireland), a vessel-sealing device, is routinely used in pancreatectomy. Positive milk test rates before and after use of LS, as well as drain discharge volume at the 2nd and 3rd postoperative days, were compared retrospectively. Finally, positive milk test rates and chylous ascites incidence were compared with the results of a previous report.RESULTS: Fifty-nine milk tests were conducted during pancreatectomy. The positive milk test rate for all pancreatectomy cases was 13.6%(8 of 59 cases). One case developed postoperative chylous ascites(2.1% among the pancreatoduedenectomy cases and 1.7% among all pancreatectomies). Positive rates by procedure were 12.8% for pancreatoduodenectomy and 22.2% for distal pancreatectomy. Positive rates by disease were 17.9% for pancreatic and 5.9% for biliary diseases. When comparing results from before and after use of LS, positive milk test rates in pancreatoduodenectomy were 13.0% before and 12.5% after, while those in distal pancreatectomy were 33.3% and 0%. Drainage volume tended to decrease when LS was used on the 3rd postoperative day(volumes were 424 ± 303 mL before LS and 285 ± 185 mL after, P = 0.056). Both chylous ascites incidence and positive milk test

  3. 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.

  4. Chylothorax of a very low birth weight infant and literature review%极低出生体重儿乳糜胸1例并文献复习

    Institute of Scientific and Technical Information of China (English)

    罗立倩; 郭金珍; 于西萍; 李占魁

    2014-01-01

    目的探讨新生儿乳糜胸的临床特点,诊疗方法,提高对本病的认识。方法整理分析本科自开科以来收治的第一例新生儿乳糜胸的临床表现、实验室检查、影像学检查、诊疗过程等资料,并进行相关文献学习。结果该患儿临床表现为呼吸急促、肤色发绀、心率增快,X线胸片及心脏B超提示左侧胸腔积液,胸腔穿刺积液乳糜实验阳性,经呼吸机辅助通气、禁食、胸腔穿刺术后病情好转,乳糜胸未再复发。结论新生儿乳糜胸若能及时发现,患儿可通过内科保守治疗治愈,预后良好。%ObjectiveThis study was aimed to explore the clinical characteristics and diagnosis methods of newborns with chylothorax and raise awareness of the disease.Method The clinical manifestations, laboratory tests, imaging changes, and treatment process of the first case of neonatal chylothorax in our hospital were collected and analyzed.Result The clinical manifestations were tachypnea, cyanosis and high heart rate.The chest X‐ray and echocardiography showed a left pleural effusion.The chyle test was positive. By treatment of mechanical ventilation, fasting, and thoracocentesis, the baby got better and the chylothorax did not relapse.ConclusionThe majority of cases with neonatal chylothorax can be cured with medical conservative treatments and have good prognosis if they get early diagnosis and treatment timely and effectively.

  5. Primary intestinal lymphangiectasia (Waldmann's disease

    Directory of Open Access Journals (Sweden)

    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

  6. Disorders of lymph flow.

    Science.gov (United States)

    Witte, C L; Witte, M H

    1995-04-01

    Disturbances in blood capillary exchange of fluid, macromolecules, and cells across intact and abnormal microvessels and deranged lymphatic transport are integral, interacting components in disorders of tissue swelling. Lymphedema or low-output failure of the lymph circulation is often indolent for many years before lymphatic insufficiency (failure) and tissue swelling emerge and persist. Superimposed occult or overt infection (lymphangitis) are probably major contributors to progressive limb deformity (elephantiasis). Long-standing lymphedema is characterized by trapping in the skin and subcutaneous tissue of fluid, extravasated plasma proteins, and other macromolecules: impaired immune cell trafficking; abnormal processing of autologous and foreign antigens; heightened susceptibility to superimposed infection; local immunodysregulation; defective lymphatic (lymphangion) propulsion from an imbalance of mediators regulating vasomotion; soft-tissue overgrowth; scarring and hypertrophy; and exuberant angiogenesis occasionally culminating in vascular tumors (Fig. 8). In contrast to the blood circulation, where flow depends primarily on the propulsive force of the myocardium, lymph propulsion depends predominately on intrinsic truncal contraction, a phylogenetic vestige of amphibian lymph hearts. Whereas venous "plasma" flows rapidly (2-3 l/min) against low vascular resistance, lymph flows slowly (1-2 ml/min) against high vascular resistance. On occasion, impaired transport of intestinal lymph may be associated with reflux and accumulation and leakage of intestinal chyle in a swollen leg. Although the term "lymphedema" is usually reserved for extremity swelling, the pathogenesis of a wide variety of visceral disorders also may be traceable to defective tissue fluid and macromolecular circulation and impaired cell trafficking of lymphocytes and macrophages. Thus, lymph stasis, with impaired tissue fluid flow, underlies or complicates an indolent subclinical course with

  7. 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

  8. Analytical performance of three cysteine proteinase inhibitor c reagents applied in the automatic biochemistry analyzer%三种应用于自动生化分析仪的半胱氨酸蛋白酶抑制剂C试剂的分析性能验证

    Institute of Scientific and Technical Information of China (English)

    国秀芝; 邱玲; 刘荔; 寿玮龄; 王亚静; 任凤琴; 张麟

    2011-01-01

    Objective To validate the analytical performance of three Cys C reagents with particle-enhanced turbidimetric immunoassay(PETIA) method used on the automatic biochemistry analyzer for preliminary clinical application.Methods The performance of three Cys C reagents (labeled as A, B, C) with PETIA method from Shanghai Jing Yuan Co., Beijing Leadman Co. and Beijing Jiuqiang Co. on OlympusAU2700 automatic biochemistry analyzer were assessed.According to the standard of CLSI EP6-A, EP15-A and EP7-P, the precision, linearity range, disturbance (bilirubin, hemoglobin, chyle) were assessed, and compared with those of Cys C reagent based on particle-enhanced nephelometric immunoassay(PENIA) from Dade Behring Co.. The reference ranges for Cys C in serum of 120 healthy individual were evaluated.Results The within-run CVs of the three reagents (A, B and C) were 3.08%-3.2%, 2.3%-4.15% and 1.38%-1.53% respectively.The total CV in A, B and C were 3.29%-3.44%, 2.65%-5.18% and 1.67%-1.69% respectively, lower than the stated.Limits of quantitative determination (LOQ) of the three reagents were 0.41, 0.23 and 0.07 mg/L, basically meeting the testing requirement.The linearity range was 0.22-7.26 mg/L(r=0.996), 0.20-7.72 mg/L(r=0.999)and 0.20-7.62 mg/L(r=0.997)in the three reagents, which demonstrated a sound linear correlation. For interference tests, no remarkable interference (<±10%) of reagent C was detected when bilirubin≤684 μmol/L, hemoglobin≤9.7 g/L and Chyle turbidity≤6 200 FTU; and no significant interference of reagent B was found when bilirubin≤684 μmol/L, hemoglobin≤6.79 g/L and Chyle turbidity≤6 200 FTU; when bilirubin≤684 μmol/L, hemoglobin≤4.85 g/L and Chyle turbidity≤1 240 FTU reagent A was not interfered significantly. The comparison afte and before the high-speed centrifugation reveals that the average percentage of bias for reagents A, B, C measured Cys C in chylous serum samples of patients was -8.31%, 1.52%, 1.32%, respectively.In method

  9. Investigation of the etiology,treatment,and preventive experience of the chylous fistula after radical resection of colon carcinoma plus D3 lymph node dissection%结肠癌D3清扫术后腹腔乳糜漏的病因预防及治疗分析

    Institute of Scientific and Technical Information of China (English)

    杨东东; 武雪亮; 何琨; 王立坤

    2013-01-01

    Objective To summarize the etiology, treatment and preventive experience of the chylous fistula after radical resection of colon carcinoma plus D3 lymph node dissection. Methods 628 cases of the chylous fistula after radical resection of colon carcinoma plus D3 lymph node dissection were analyzed retrospectively. The incidence of the chylous fistula in different surgical methods( the Laparotomy Group and the laparoscopy group ) and different surgical sites( left colon cancer and right colon cancer )was compared. Results Chylorrhea occurred in 22 patients( 3.5% ),including 2. 8%( 8/286 )in the Laparotomy Group and 4. 0%( 14/342 )in the Laparotomy Group,and the differences were no statistical significance( P >0.05 ). Incidence of the chylous fistula in radical resection of right -colon carcinoma plus D3 lymph node dissection was 7. 8%( 16/207 ),while incidence of the chylous fistula in radical resection of right - colon carcinoma plus D3 lymph node dissection was 1.4%( 6/421 ). There was statistical significance( P 0. 05 ). Twenty - one patients received conservative treatment abrosia, total parenteral nutrition, somatostatin infusion, anti - infection, delaying removing drainage tubes ) were successfully cured,and one patient required re - operation. No patients had recurrence and died. Conclusion There is no statistical significance between the Laparotomy Group and the laparoscopy group. Radical resection of right - colon carcinoma plus D3 lymph node dissection is associated with higher risk for chyle leak. Conservative treatment is effective in early stage of chyle leak after radical resection of colon carcinoma plus D3 lymph node dissection.%目的总结结肠癌D3清扫术后腹腔乳糜漏的病因、治疗及预防经验.方法 对628例行结肠癌D3清扫术后发生乳糜漏病例进行回顾性分析,比较不同术式(开腹组与腹腔镜组)、不同部位(右半结肠与左半结肠)乳糜漏的发生率.结果 22例结肠癌患者(3.5%)术后发生

  10. 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.

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

    Institute of Scientific and Technical Information of China (English)

    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

  12. 某三甲医院不同时间段血液报废情况对比分析%Comparative analysis of banked blood scraps between two periods at our hospital

    Institute of Scientific and Technical Information of China (English)

    张立萍; 王燕菊; 张蓉; 陈丽; 刘慧珠

    2016-01-01

    目的:对不同时间段库存血液报废情况进行对比分析,探讨降低血液报废的有效途径,进而采取措施,减少血液浪费。方法对2005年1月—2009年12月和2010年1月—2014年12月2个时间段的血液入库与出库进行逐袋逐项检查,统计血液报废情况。结果2005年1月—2009年12月血液报废原因中排第1位为临床申领未用而报废。2010年1月—2014年12月血液报废原因中排第1位为献血员原因。2个时间段血液报废排第2位均为血袋破裂,第3位均为乳糜血。结论针对第1个时间段排第1位的血液报废原因进行分析并采取应对措施,经过5年再次进行统计,发现临床申领血液未用情况得到很好的控制,减少了血液浪费,节约了宝贵的血液资源。%Objective To analyze the causes of banked blood scrap during the different perio-ds, explore the effective ways to reduce blood scrapped, and then take measures to reduce wastage of blood. Methods Each blood storage bags ( Period one: between January 2005 and December 2009 vs. Period two: between January 2010 and December 2014) to the library and dispatch was checked carefully, and blood scrapped statistical situation item by item was inspected. Results In period one, the first reason of scrapped blood is unused for clinical application. In period two, ranked No. 1 reason is blood donors. Both two stages of blood discarded, ranked second is for broken bags, ranked 3rd for chyle blood. Conclusion For the first phase of blood scrap reasons were ana-lyzed and corresponding measures were put forward. For the next five years of statistics, we found that the blood in clinical applications were well controlled, reduced the blood waste and saved valua-ble blood resources.

  13. 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

  14. Lymphatic fistula in a uremia patient after arteriovenous fistula operation in the upper arm:a case re-port%尿毒症上臂动静脉内瘘术后淋巴瘘一例

    Institute of Scientific and Technical Information of China (English)

    张熙熙

    2013-01-01

    Arteriovenous fistula is a long-term vascular access for treatment of uremia patients in maintenance hemodialysis.The complication of lymphatic fistula after arteriovenous fistula operation is rare.Lymphatic fistula is lymphatic outflow caused by lymph-vessel impairment.The clinical manifestation is the mass or discharge of unknown cause appeared in early postoperative wound.Treatment commonly used for lym-phatic fistula is filling and compression , then it could use lymphatic ligation for those patients who had large volume of lymphatic fistula output and invalid compression therapy.Here we reported a case of treatment of lymphatic fistula in the upper arm of a uremia patient after arteriovenous fistula operation.The diagnosis of lym-phatic fistula was made according to the clinical manifestation , physical sign and leakage chyle test.The pa-tient started with drainage of the lymphatic fistula debridement surgery and local compression therapy which had poor effect, finally the incision healed by use of immersion with 50%glucose, compression bandage by com-pression air sac after local lymphatic fistula cavity exploration drainage surgery and combined with atropine in -jection treatment , follow-up evaluation was good.%动静脉内瘘是尿毒症患者长期维持血液透析治疗的血管通路,术后并发淋巴瘘少见。淋巴瘘是淋巴管受损引起的淋巴液外流,临床表现为术后早期伤口出现不能解释的包块或溢液。淋巴瘘常用的治疗方法为局部填塞、加压包扎,对于渗液量较大、压迫治疗无效的患者,可行手术治疗。该文报道了1例上臂动静脉内瘘术后并发淋巴瘘的尿毒症患者的诊治经过,该例经临床表现、体征结合漏液乳糜试验诊断为淋巴瘘。开始行淋巴瘘清创引流术,用局部加压包扎,效果欠佳,遂再行局部淋巴瘘腔探查引流术并局部使用50%葡萄糖液浸泡冲洗,术后予加压气囊加压包扎,同时联合

  15. 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.

  16. Circulation enzymatic homocysteine reagent performance verification%循环酶法同型半胱氨酸试剂的分析性能验证

    Institute of Scientific and Technical Information of China (English)

    杨云帆

    2015-01-01

    目的:对应用于全自动生化分析仪的同型半胱氨酸(Hcy )试剂进行分析性能验证,并应用于临床。方法在日本Olympus AU‐640全自动生化分析仪上对四川新成公司生产的循环酶法测定 Hcy试剂进行性能验证,参考CLSI EP6‐A、EP15‐A、EP‐7方案对检测方法的精密度、线性范围、干扰因素(胆红素、血红蛋白、乳糜)进行评估,与传统的高效液湘色谱法(HPLC)进行了比对,并对分析前质量控制影响因素进行实验分析。结果精密度实验为批内:CV 2.37%(低值)、3.58%(高值),总 CV :4.52%(低值)、4.85%(高值);该法与 HPLC法相关性良好(r2=0.996,P>0.05);线性范围为2.0~50.0μmol/L ,线性相关良好;试验浓度内的3种干扰物(胆红素小于或等于20 mg/dL ,三酰甘油小于或等于1000 mg/dL ,Hb≤150 mg/dL )对试剂无显著干扰;采血体位对结果有影响;全血标本1 h内分离血清,血清4℃12 h内及-20℃15 d内结果无明显变化;ED T A与肝素防凝血结果无差异。H cy水平与心脑血管病发生呈正相关,其阳性检出率高于传统的血脂指标。结论应用于全自动生化分析仪的循环酶法Hcy试剂具有较高的精密度和灵敏度,与HPLC测定相关良好,可满足临床测试要求,适合血清(浆)Hcy的常规和自动化分析。%Objective To do performance verification for full automatic biochemical analyzer of homocysteine reagent analysis and applied in the clinic .Methods In Japan to push around AU‐640 fully automatic biochemical analyzer in sichuan new into the company′s production cycle enzymatic determination of homocysteine (Hcy ) reagent for performance verification ,reference CLSI EP6‐A ,EP15‐A ,EP‐7 scheme for the precision of the detection method ,linear range ,interference factors (bilirubin ,hemoglobin , chyle) assessed ,and the traditional

  17. Modified minimally invasive video-assisted lateral neck dissection for papillary thyroid carcinoma: a series of 130 cases%改良Miccoli手术颈侧区淋巴结清扫术治疗甲状腺乳头状癌130例临床分析

    Institute of Scientific and Technical Information of China (English)

    章德广; 高力; 谢磊; 何高飞; 方亮; 陈剑; 苗滪汶; 王喆喆

    2016-01-01

    Objective To discuss the feasibility,safety and oncologic completeness of modified minimally invasive video-assisted lateral neck dissection (MIVALND) for papillary thyroid carcinoma.Methods Data of 130 patients from Department of Head and Neck Surgery,Sir Run Run Shaw Hospital,Medical School,Zhejiang University undergoing MIVALND from January 2013 to September 2015 were reviewed retrospectively.There were 31 male and 99 female patients with the mean age of (39± 11) years.The thyroidectomy and central compartment dissection were performed under a direct visual field or video-assisted (VA) approach,lateral neck dissection was performed via the VA approach.Serum thyroglobulin and thyroglobulin antibody levels were measured every 6 months after surgery.Ulrasonography was performed to assess the thyroid bed and lateral neck compartment every 6 months after surgery.The mean operation time for MIVALND,mean postoperative hospital stay,size of primary tumor,number of retrieved lymph nodes,complication rates,and postoperative serum thyroglobulin levels were analyzed retrospectively.The patients were followed up by outpatient review and until March 2016.Results Beside 1 case was converted to open procedure,129 (99.2%) patients successfully underwent MIVALND.The mean operative time was (74±17) min (ranging from 40 to 120 rin) for MIVALND.The mean postoperative hospital stay was (4.9±2.1) days (range 2 to 14 days).The mean size of primary tumor was (1.3±0.7) cm (range 0.3 to 4.0 cm).The mean number of lymph nodes removed was 42± 13 (range 15 to 79) in lateral compartment.Postoperative complications included 19 transient hypoparathyroidism,7 transient recurrent laryngeal nerve (RLN) palsy and 3 permanent RLN palsy (tumor invasion and the RLN was resected en bloc with the tumor in 2 cases),2 (1.5%) transient palsy of spinal accessory nerve,1 (0.8%) transient palsy of marginal mandibular branch of the facial nerve,1 (0.8%) seroma,and 4 (3.1%) minor chyle leak

  18. Evaluation of Detection of Serum HCG with BioMérieux VIDAS mini Immunoassay Analyzer%梅里埃VIDAS mini免疫分析仪检测血清HCG实验方法评价

    Institute of Scientific and Technical Information of China (English)

    何宗忠; 龚娅; 林林东; 朱来凤; 史秋霞; 沈雪曼

    2013-01-01

    Objective To evaluate the clinical application of detection for serum HCG with bioMérieux VIDAS mini automated immunoassay analyzer.Methods Precision evaluation was carried out with BIO-RAD control materials.Interference test and recovery test were performed under CLIA88 rules.The β-HCG levels in 26 serum samples were detected by Diasorin LIAISON chemiluminescence immunoassay analyzer,and HCG levels were detected by bioMérieux VIDAS mini automatic immunoassay,and the results were compared and analyzed.Results The detection of serum HCG with VIDAS mini analyzer had qualified precision,the CV of the high and the middle control materials were 5.209% and 5.457%,respectively.The linearity of serum HCG standard was 2 ~ 1500 m IU/mL,and the average recovery rate was 99.50%.The maximum deviation of HCG to hemoglobin,total bilirubin,and chyle blood were 4.41%,5.07%,8.64%,respectively.The serum β-HCG levels detected by Diasorin LIAISON was positively correlated with the serum HCG levels detected by VIDAS mini (Y =1.3484X-132.08,r =0.998,P <0.001).Conclusion Detection of serum HCG level with BioMérieux VIDAS mini automated immunoassay analyzer are sensitive and accurate,and it could be used in the emergency or small hospitals.%目的 对梅里埃VIDAS mini全自动免疫分析仪检测血清HCG进行实验方法评价.方法 应用BIO-RAD质控品评价精密度,并依据CLIA88文件作干扰试验、回收试验,并收集Diasorin LIAISON化学发光免疫分析仪检测血清β-HCG的血清标本26例立即采用梅里埃VIDAS mini全自动免疫分析仪检测HCG作对比性试验.结果 VIDAS mini检测血清HCG的精密度试验表明,重复性好(高、中质控品的CV值分别为5.209%、5.457%),无一失控点;线性范围为2~1500 mlU/mL,灵敏度较高;实测结果与预期值比较,平均回收率达99.50%,在干扰试验中,HCG对血红蛋白、总胆红素、乳糜血的最大偏离分别为4.41%、5.07%、8.64

  19. 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

  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

  1. Amino-terminal pro-brain natriuretic peptide and brain natriuretic peptide measurements under various detection conditions in patients with chronic heart failure%心力衰竭时N末端B型利钠肽原与B型利钠肽检测时受干扰的分析

    Institute of Scientific and Technical Information of China (English)

    王伟佳; 张秀明; 王前; 温冬梅; 欧阳能良; 崔亚丽; 李飞

    2011-01-01

    Objective To find the potential interference factors for the detection of NT-proBNP and BNP in patients with chronic heart failure. Methods EP15-A2 issued by Clinical and Laboratory Standards Institute (CLSI) was employed to compare the precision and accuracy of commercial NT-proBNP and BNP analyzer electrochemiluminescence immunoassay system Cobas E601 and chemiluminescence system ADVIA Centaur. Moreover, NT-proBNP and BNP were detected in different time interval and in different interfered sampling conditions (haematolysis, choloplania, lipemia). NT-proBNP and BNP of 203 patients with heart failure or heart failure complicated with acute cerebral infarction were analyzed to find the deviation caused by patients' endogenous factors. Results The precision and accuracy were comparable for NT-proBNP and BNP detection using Cobas E601 and ADVIA Centaur (total-CV below 2. 9% and 3.5%, the deviation from definite value below 2. 38% and 3.91% ). The most suitable sample type for NT-proBNP and BNP detection was serum and EDTA- anticoagulant plasma. The detection results of NT-proBNP and BNP were comparable for at least 120 min post sampling and not affected by Hb(2 g/L), DB(428 μmol/L) and chyle(2000FIU). NT-proBNP was significantly higher in heart failure patients complicated with cerebral infarction( P =0. 003) than in heart failure patients. BNP was significantly higher in heart failure grade Ⅲ patients complicated with cerebral infarction ( P < 0. 01 ). Conclusions Cobas E601 and ADVIA Centaur supplied satisfactory detection of NT-proBNP and BNP in patients with chronic heart failure with strong anti-interference capacity. The diagnostic value of NT-proBNP and BNP for chronic heart failure should be analyzed objectively in the presence of complicating diseases.%目的 探讨心力衰竭(心衰)标志物N末端B型利钠肽原(NT-proBNP)与B型利钠肽(BNP)检测结果对心衰评价的潜在干扰因素,为临床医生正确选择分析物与合理分析

  2. Analysis of interference in PCT detection for infectious diseases%降钙素原检测在感染性疾病诊断中的干扰研究

    Institute of Scientific and Technical Information of China (English)

    王伟佳; 张秀明; 阚丽娟; 徐全中; 欧阳能良

    2013-01-01

    OBJECTIVE To find the potential interference factors in the detection of PCT so as to provide basis for the reasonable analysis of the detection result and for the correct use of antibiotics.METHODS EP15-A2 issued by Clinical and Laboratory Standards Institute (CLSI) was employed to evaluate the precision and accuracy of common PCT analyzer electrochemiluminescence immunoassay system Cobas E601,by which we could find out the deviation caused by analyzer itself.Moreover,PCT was detected in different times with different sample types,as well as in different interfered samples (haematolysis,choloplania,lipemia) which EP7-A2 documents could be used in the evaluation.Then the deviation caused by unacceptable samples could be screened out.At last,PCT of 214 samples which were from normal persons,early sepsis patients with positive cultures of blood,and chronic heart failure patients with negative cultures of blood were wed to find the deviation caused by patients endogenous factors.RESULTS The precision and accuracy were good for the PCT detection by using Cobas e601.The total CV was below 3.59% and the deviation from definite value was below 3.38%,which were consistent with clinical requests(10 %).PCT could be stably analyzed in EDTA-anticoagulant plasma(CV =6.37 %),that the results of PCT could be stable in at least 24h when these suitable sample types were used in the detection.Interference could not be observed when the level of interference objectives up to Hb(2 g/L),DB(428 μtmol/L),chyle(2000FIU).There was a significant difference between the three groups (P<0.05).PCT level in sepsis patients was the highest up to (77.37± 59.83)ng/ml,next to which was chronic heart failure patients up to (14.56 ±10.26)ng/ml.CONCLUSION The ability of Cobas e601 is consistent with the clinical request.Although the analyzer has strong anti-interference PCT in normal control was not elevated significantly,the level was only (0.04±0.01ng/ml).ability in the detection of PCT

  3. 根治性顺行模块化胰脾切除术治疗胰体尾癌的临床疗效%Clinical effect of radical antegrade modular pancreatosplenectomy for carcinoma of pancreatic body and tail

    Institute of Scientific and Technical Information of China (English)

    徐冬; 蒋奎荣; 陆子鹏; 郭峰; 陈建敏; 卫积书; 尹杰; 张凯; 吴鹏飞

    2016-01-01

    :overall complications,major postoperative complications [pancreatic fistula,chyle leakage,abdominal bleeding,hemorrhage of digestive tract,delayed gastric emptying,pleural effusion,pulmonary infection,peritoneal effusion,abdominal infection,wound infection,deep venous thrombosis in the lower limbs,multiple organ dysfunction syndrome (MODS)],reoperation,duration of hospital stay,hospital expenses,(3) follow-up:the postoperative survival of patients,tumor recurrence and metastasis.The follow-up using outpatient examination and telephone interview was performed to detect the patients' survival and tumor recurrence and metastasis up to March 2016.Measurement data with normal distribution were presented as (x) ± s and comparison between groups was evaluated with the Student t test.Measurement data with skewed distribution were presented as M(Qn) and comparison between groups was evaluated with the Wilcoxon rank sum test.Count data were analyzed using the chi-square test or Fisher exact probability.The survival time was calculated by the Kaplan-Meier method.Results (1) Surgical situation:operation time,volume of intraoperative blood loss,volume of blood transfusion and number of patients combined with organ resection were 235 minutes (180 minutes,278 minutes),400 mL (350 mL,650 mL),3.1 U (2.5 U,5.6 U),13 in the RAMPS group and 180 minutes (130 minutes,210 minutes),225 mL (200 mL,400 mL),0 (0,2.0 U),10 in the operation group,respectively,with statistically significant differences between the 2 groups (Z =3.529,2.675,3.389,P < 0.05).The number of patients with R0 resection and R1 resection were 19,2 in the RAMPS group and 71,7 in the operation group,showing no statistically significant difference (P > 0.05).(2) Postoperative situation:number of patients with overall complications,pancreatic fistula in grade A,pancreatic fistula in grade B,pancreatic fistula in grade C,chyle leakage,abdominal bleeding,hemorrhage of digestive tract,delayed gastric emptying,pleural effusion

  4. 免疫透射比浊法和免疫散射比浊法检测特定蛋白的抗干扰能力比较%Comparison on the anti-interference abilities of immune turbidimetry and immune nephelometry for detecting specific proteins

    Institute of Scientific and Technical Information of China (English)

    彭凤; 徐晓萍; 王琳; 应春妹

    2013-01-01

    Objective To compare the anti-interference abilities of immune turbidimetry and immune nephelometry for detecting specific proteins [ immunoglobulin G ( IgG) , immunoglobulin M (IgM ) and C reactive protein ( CRP) ] through the interferers of free bilirubin ( FBil) , conjugated bilirubin ( CBil) , hemoglobin ( Hb) and chyle ( CH ). Methods A total of 6 mixed serum samples were prepared under 2 levels (high/low) of specific proteins (IgG: 8-12 g/L, >16 g/L;IgM:1.0-1.5 g/L, > 2. 0 g/L;CRP:4-10 mg/L, >100mg/L). The 4 interferers were prepared into 5 different concentrations(FBil:656, 1 312, 1 968, 2 624 and 3 280 μmol/L;CBil:688, 1 376, 2 064, 2 752 and 3 440 μmol/L;Hb:9.9, 19.8, 29.8, 39. 7 and 49.6 μmol/L;CH:3 000, 6 000, 9 000, 12 000 and 15 000 FTU) by rules(l: 5 , 2- 5 , 3: 5, 4: 5 and 5: 5) , and the interferers were added to the mixed serum. The concentration of the specific proteins was detected by immune turbidimetry and immune nephelometry respectively, and the interference rate was calculated. The anti-interference abilities of the 2 methods were calculated according to Clinical and Laboratory Standards Institute (CLSI) EP7-A standard. The average concentration of the specific proteins with different interferers ±5% of the control tubes at the same concentration was considered to have interference. Results By the immune nephelometry, the values to detect IgM (high level ) and CRP ( low level) with the interferer of Hb (9. 9 and 29.8 μmol/L)and Hb(9.9, 29.8 and 39.7 μmol/L) respectively, also the values to detect IgM (high level and low level ) with the interferer of CH (9 000, 12 000 and 15 000 FTU)and CH (6 000, 9 000, 12 000 and 15 000 FTU) were all considered to have interference. However, by the immune turbidimetry,the values to detect IgG, IgM and CRP with the 4 interferers were considered to have no interference. Conclusions To 4 interferers (FBil, CBil, Hb and CH) ,the anti-interference ability of immune turbidimetry is better than that of

  5. 肾细胞癌合并下腔静脉癌栓患者发生术后早期并发症的临床分析%Early postoperative complications of renal cell cancer surgery with inferior vena cava tumor thrombus invasion

    Institute of Scientific and Technical Information of China (English)

    刘茁; 马潞林; 王国良; 侯小飞; 赵磊; 张树栋; 田晓军; 肖春雷; 卢剑

    2016-01-01

    Objective To analyze the early postoperative complications in renal cell cancer (RCC) surgery with inferior vena cava tumor thrombus (IVCTT) invasion.Methods The clinical data of 27 patients with RCC and IVCTT from February 2015 to April 2016 were analyzed retrospectively.Of the 27 patients,21 were male and 6 were female.The average age was (61.7 ± 9.8) years old (47 to 84 years).The average body mass index (BMI) was (22.2 ± 2.9) kg/m2 (17.6 to 30.8 kg/m2).Imaging suggested the right renal tumor in 18 cases and left renal tumor in 9 cases.The tumor size ranged from 3.6 to 21.1 cm.The renal vein tumor thrombus or inferior vena cava tumor thrombus was found in all patients,including type 0 thrombus in 6 cases,type Ⅰ thrombus in 6 cases,type Ⅱ thrombus in 8 cases,type Ⅲ thrombus in 5 cases and type Ⅳ thrombus in 2 cases (Mayo Medical Center classification).We completed laparoscopic surgery for RCC with IVCTT in 14 cases and open surgery in 13 cases.Postoperative complications were graded according to the modified Clavien classifications,respectively.Serious complications were defined as grade Ⅲ or higher.Results Among 27 patients,early postoperative complications occurred in 14 cases (51.9%).Chyle leak occurred in 2 cases,they were cured after treated with dietcontrol and subcutaneous injection of somatostatin.Lower extremity venous thrombosis occurred in 3 cases,they were cured after treatment with low molecular weight heparin.Three cases had postoperative pulmonary infection and were cured after antibiotics treatment.Bilateral thigh rash occurred in 1 case.Considering related with antibiotic induced allergy,we stopped the drug and treated with intravenous drip of vitamin C and glucose acid calcium.Serious postoperative complication rate was 18.5% (5 cases).One case had postoperative abdominal distension and peritoneal effusion.He underwent ultrasound guided puncture and drainage.Renal insufficiency and hyperkalemia occurred in 2 cases,they were cured

  6. Investigation on exploring effect of moderate to severe chylemia on 5 detection results in blood donors%中、重度乳糜血对血液5项检验指标检测结果的影响分析

    Institute of Scientific and Technical Information of China (English)

    温秀明; 彭及良; 李丹红; 杨转笑; 叶有玩

    2015-01-01

    different brands.Among different test items,the different degrees of influence were HIV-Ab> HCV-Ab and HBsAg>TP-Ab.Moderate to severe chylemia can improve the S/CO value detected by ELISA,it may lead to some blood waste,but benifit for increasing the risk of blood transfusion.To ensure accurate test results,it is recommended to set aside moderate to severe chylemia samples at low temperature and centrifuge separation of chyle layer before testing.