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Resumen El quilotórax se produce ante la ruptura, desgarro u obstrucción del conducto torácico o sus afluentes principales, lo que resulta en la liberación de quilo al espacio pleural. Ocurre más frecuentemente asociado a trauma o a lesiones malignas; pero han sido descritas otras causas. El diagnóstico se obtiene mediante toracocentesis y la determinación de las concentraciones de triglicéridos y colesterol en el líquido pleural. Las complicaciones incluyen la desnutrición, inmunosupresión y compromiso respiratorio. El tratamiento puede ser conservador o agresivo en función de la situación clínica.

Abstract Chylothorax occurs when there is rupture, laceration or obstruction of the thoracic duct or its main tributaries, resulting in the release of chyle into the pleural space. It most commonly occurs from trauma or malignancy, but other causes have been described. Diagnosis involves thoracocentesis and cholesterol and triglyceride measurement in the pleural fluid. Complications include malnutrition, immunosuppression and respiratory distress. Treatment may be either conservative or aggressive depending on the clinical scenario.

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Background: Macroscopic identification of the extravasation site of chyle in patients with chylothorax is a major challenge. Current forms of identification are invasive and/or expose patients to radiation, as in computerized tomography and radiography. A prototype device that uses infrared video thermometry images to detect temperature increments of 0.1ºC has been developed. This device can process and show real-time images or video on a monitor during surgeries. Therefore, the aim of this work was to report the first successful case in which this innovative device was tested in the transoperative period to identify the thoracic duct and its tributaries in a chylothorax surgery performed in a dog.Case: A 2-year-old male dog of the Shiba Inu breed was presented to the veterinary hospital with exercise intolerance, cough, emaciation, and no history of trauma. Clinical examination was performed along with complete blood count, biochemical analysis, and thoracic radiography. The patient exhibited dyspnea and had diminished breath sounds on chest auscultation. Radiographic images revealed moderate pleural effusion. The dog was anesthetized and submitted to thoracotomy, which enabled visualization of a chylous effusion. A sample of the effusion was collected for cytological and biochemical analyses. Subsequently, pericardiectomy was carried out, and identification of the thoracic duct and its tributaries was guided by an innovative device that generates infrared video thermometry images in real time. The extravasation site of the chyle was visualized on the images shown on a monitor. Consequently, after ligation of the tributary vessel, interruption of chyle overflow could be noticed on the monitor. Thoracotomy was routinely closed, and a drain was placed through an intercostal space after incision. Thirty days after the surgery, the dog exhibited no signs of recurrence.[...]

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Background: Macroscopic identification of the extravasation site of chyle in patients with chylothorax is a major challenge. Current forms of identification are invasive and/or expose patients to radiation, as in computerized tomography and radiography. A prototype device that uses infrared video thermometry images to detect temperature increments of 0.1ºC has been developed. This device can process and show real-time images or video on a monitor during surgeries. Therefore, the aim of this work was to report the first successful case in which this innovative device was tested in the transoperative period to identify the thoracic duct and its tributaries in a chylothorax surgery performed in a dog.Case: A 2-year-old male dog of the Shiba Inu breed was presented to the veterinary hospital with exercise intolerance, cough, emaciation, and no history of trauma. Clinical examination was performed along with complete blood count, biochemical analysis, and thoracic radiography. The patient exhibited dyspnea and had diminished breath sounds on chest auscultation. Radiographic images revealed moderate pleural effusion. The dog was anesthetized and submitted to thoracotomy, which enabled visualization of a chylous effusion. A sample of the effusion was collected for cytological and biochemical analyses. Subsequently, pericardiectomy was carried out, and identification of the thoracic duct and its tributaries was guided by an innovative device that generates infrared video thermometry images in real time. The extravasation site of the chyle was visualized on the images shown on a monitor. Consequently, after ligation of the tributary vessel, interruption of chyle overflow could be noticed on the monitor. Thoracotomy was routinely closed, and a drain was placed through an intercostal space after incision. Thirty days after the surgery, the dog exhibited no signs of recurrence.[...](AU)

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BACKGROUND: Chyle fistula (CF) is a rare but challenging condition for the surgeon and the patient's health. METHODS: A retrospective review of single surgeon's case load in a 12-year period is presented, reviewing the case of those patients presenting with a CF. RESULTS: Three patients were found during this study period from more than 1,050 surgeries performed due to thyroid cancer. Patients underwent extensive lymph node dissection for advanced, metastatic and infiltrative disease. In all patients, a long hospital stay and surgical re-interventions were required. CONCLUSIONS: A description of the management of CF is presented along with a review of current Literature.

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Obesity is a key risk factor for metabolic and cardiovascular diseases, and although we understand the mechanisms regulating weight and energy balance, the causes of some forms of obesity remain enigmatic. Despite the well-established connections between lymphatics and lipids, and the fact that intestinal lacteals play key roles in dietary fat absorption, the function of the lymphatic vasculature in adipose metabolism has only recently been recognized. It is well established that angiogenesis is tightly associated with the outgrowth of adipose tissue, as expanding adipose tissue requires increased nutrient supply from blood vessels. Results supporting a crosstalk between lymphatic vessels and adipose tissue, and linking lymphatic function with metabolic diseases, obesity, and adipose tissue, also started to accumulate in the last years. Here we review our current knowledge of the mechanisms by which defective lymphatics contribute to obesity and fat accumulation in mouse models, as well as our understanding of the lymphatic-adipose tissue relationship.

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Se expone el caso de un paciente masculino de 59 años con diagnóstico de carcinoma medular de tiroides con metástasis ganglionares, al cual se le realiza una tiroidectomía total bilateral con disección radical de cuello modificada tipo III. En el postoperatorio se documenta fístula del conducto torácico. Se dio un manejo conservador con dieta hiperprotéica sin carbohidratos y rica en triglicéridos de cadena media el cual fue satisfactorio.

We describe the case of a 59-year-old male patient with a diagnosis of medullar thyroid carcinoma with affection of a cervical lymph node surgically managed with total thyroidectomy and bilateral radical neck dissection. It was diagnosed with a thoracic duct fistula. A conservative management with a strict diet of proteins enriched with medium chain triglycerides was performed in a successful way. Because of the case a review of the literature was performed.

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Thoracic duct injury is a well described entity as complication from cardiothoracic surgery. However tension chylothorax is rare, and may become a life-threating condition. Objective: To present 2 pediatric patients who developed hemodynamic and respiratory failures secondary to chylothorax. Patients: The first patient was a 2-month-old boy who developed chylothorax three weeks after a Norwood-Sano surgery; he showed a severe respiratory and hemodynamic collapse. The second patient was a one-month old baby who developed an acute respiratory failure and oliguria two days after a patent ductus arteriosus surgery. In both cases the chest tube placement resulted in the release of chyle under pressure and resolution of the symptoms. Conclusions: These two cases demostrate how chylothorax may provoke severe hemodynamic and respiratory effects. Early recognition and treatment of this condition is important for improved outcome.

El daño del ducto toráxico que ocasiona un quilotórax es una complicación bien conocida y documentada de las cirugías cardiotoráxicas. Sin embargo, el desarrollo de quilotórax a tensión es raramente reportado, siendo un evento que puede poner en riesgo la vida del paciente. Objetivo: Comunicar 2 pacientes, quienes presentaron compromiso hemodinámico y respiratorio de carácter grave, secundario al desarrollo de quilotórax. Casos: El primer paciente, de dos meses de edad, ocurrió luego de tres semanas de efectuarse una cirugía de Norwood-Sano, quien presentó un grave colapso ventilatorio y hemodinámico. El segundo paciente, de 1 mes de edad, desarrolló una falla respiratoria aguda y oliguria dos días posterior al cierre de un ductus arterioso persistente. En ambos casos la instalación de un tubo pleural resultó en la liberación de quilo a gran presión y una rápida resolución de los síntomas. Conclusión: Los dos casos aquí reportados evidencian que el quilotórax puede presentar efectos hemodinámicos y respiratorios deletéreos. El pronto reconocimiento y tratamiento de esta entidad son esenciales para el óptimo pronóstico del paciente.

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PURPOSE: To evaluate the safety and efficacy of a single instillation in a combination of povidone iodine with contrast agent under fluoroscopy guidance for the treatment of chyluria. MATERIALS AND METHODS: From December 1999 to July 2006 a total of 40 patients with chyluria were treated by renal pelvic instillation therapy (RPIS). The sclerosing solution was prepared using povidone iodine with contrast agent diluted with sterile water in a ratio of 1:1:3. It was instilled on the side having chylous efflux using a bulb tip ureteric catheter. Unilateral instillation was done in 26 cases, 10 on the right side and 16 on left. Fourteen patients had bilateral chylous efflux and RPIS was performed on both sides in the same session. Fluoroscopy was used to evaluate the complete filling of the pelvic calyceal system. The sclerosing solution was kept in the system for 5 minutes and the ureteric catheter was then withdrawn. RESULTS: Immediate clearance was observed in 39 patients. Recurrence occurred in five patients. They were treated again using the same procedure with satisfactory results. The longest follow-up was five years and the shortest five months. CONCLUSION: RPIS of chyluria using a single instillation a combination of povidone iodine with contrast agent is safe and effective. Use of fluoroscopy helps to determine the exact amount of sclerosing solution required to completely fill the system and therefore overfilling is avoided. Moreover, the complications, which arise due to pyelointerstitial backflow, are prevented.

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