RESUMEN

The clinical manifestations of non-Hodgkin's lymphomas (NHL) are unspecific and may vary with their location, growth rate or organs involved. Chylothorax consists of an accumulation of chyle in pleural space. galiLymphoproliferative diseases represent the main non-traumatic aetiology. The authors report the case of an 81-year-old woman admitted with right pleural effusion and lower limbs oedema, initially interpreted as decompensated heart failure. The thoracocentesis revealed a chylothorax and the aetiological study exposed a mantle cell lymphoma. The authors aim to alert to a less frequent presentation of NHL and remind that a low suspicion may delay the diagnosis

No disponible

Asunto(s)

RESUMEN

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.

Asunto(s)

RESUMEN

El quilotórax es una manifestación infrecuente de la enfermadad tuberculosa. En la literatura se han descrito casos anecdóticos de quilotórax producido por Mycobacterium tuberculosis. Describimos un caso clínico de quilotórax de etiología tuberculosa y revisamos los casos publicados en la literatura médica. En ningún caso el diagnóstico etiológico se realizó mediante la aplicación de la reacción en cadena de polimerasa (PCR) en el líquido de quilotórax. Esta técnica ha demostrado una alta sensibilidad y especificidad cuando se aplica a distintos especímenes; por este motivo, el uso sistemático de esta técnica poco agresiva podría ser de gran utilidad para establecer el diagnóstico precoz del quilotórax tuberculoso especialmente en aquellos casos sin evidencia radiológica de afectación pulmonar

Chylothorax is an inusual manifestation of tuberculous disease. Anecdotal cases of chylothorax due to Mycobacterium Tuberculosis have been reported in the literature. We describe a case of tuberculous chylothorax and review the previously published cases. None of these cases was diagnosed by the aplication of polymerase chain reaction in pleural effusion. This test applaied to different specimenes has shown a high especificity and sensitivity; for this reason, the routin use of this test, on pleural effusion, could be very useful, quick, and few agressive in the diagnosis of tuberculous chylothorax, especially when chest X-ray is normal

Asunto(s)

RESUMEN

A-19-year old male patient complained of shortness of breath. Aspiration of the pleural fluid revealed chylothorax. Right chest tube was inserted. His ABG showed hypoxaemia with relative hypercarbia. He underwent right thoracotomy and thoracic duct ligation under general anaesthesia and double lumen endobroncheal intubation. During surgery he lost 1.5 L of blood and 4 L chyle. He was transferred to the SICU intubated and on mechanical ventilation. On the subsequent days chyle leak was reduced to a minimum of 10 ml/hr. On the 9th postoperative day the patient was extubated. He was receiving TPN 2600 kcal/day. He was transferred to the normal floor on the 15th day. After 7 day he was readmitted, his chest showed severe lung fibrosis and consolidation. His ABG showed severe hypercarbia (PaCO2 = 126 mmHg). The patient was intubated. His condition deteriorated and he was considered for lung transplantation. No donor was available. Later he arrested and died. Anaesthesia and surgical management of spontaneous chylothorax is challenging. The mortality rate is high.

Asunto(s)

RESUMEN

BACKGROUND: This article aims to make a contribution to the present knowledge of the diagnosis and therapy of chylous reflux pathologies, based largely on the authors' clinical experience in the microsurgical treatment of these disorders. METHODS: In 47 patients affected by chylostatic disorders the diagnosis was based on the clinical history, physical examination, lymphoscintigraphy, lymphography, ultrasound, CT scanning and lymphangio-MR. In cases of chylous reflux towards the external genitalia or the lower limbs, the puncture of one of the lymphostatic verrucae which may be part of the symptomatology, can be sufficient for the clinical diagnosis. If patients suffer from hypoproteinaemia and/or an intestinal malabsorption syndrome, this should be dealt with to ensure them at least temporary metabolic compensation before surgical treatment, if any. In patients affected by chylous ascites, antigravitational ligatures of incompetent collectors, sometimes associated with lymphovenous shunts, can be a therapeutic solution. RESULTS: We have found that CO2 laser irradiation at very low power achieved full section closure of lymphatic and chylous vessels as complete as if they had been tied. In the case of chyloedema of the external genitalia and of/or the lower limbs, reductive plastic treatment completes the result after antigravitational ligatures and derivative microsurgery. CONCLUSIONS: A laser-microsurgical technique used to manage chylous reflux pathologies achieved positive and permanent results, especially after an accurate preoperative diagnostic study to determine the site and nature of the lymphatic and chylous leakage and associated disorders.

Asunto(s)

RESUMEN

The aim of this study was to describe a system of salvaging and reinfusing chyle which accumulated in the right pleural cavity of a patient after a thoracic duct lesion caused by a closed chest injury associated with amyelic fracture of the dorsal spine D10-D11. The chyle was collected in a reservoir (BT 844 Dideco), transferred by an electronic pump (BT 797 recovery Dideco) to a storage bag, microfiltered and then reinfused to the patient A solution was needed to prevent the patient with severe chylothorax, from having immunological and metabolic imbalance. The long period of conservative treatment with our system was imposed by the onset of acute post-traumatic myocardic infarction which delayed surgery. From experience gained, we can say that using total parenteral nutrition, chyle can not only be salvaged but also reinfused, respecting the strict rules of hygiene.

Asunto(s)

RESUMEN

The management of chylothorax requires a thorough understanding of the anatomy and pathophysiology of the major thoracic lymphatics, prompt diagnosis, and (with rare exception) conservative management, including evacuation of the pleural space, nutritional support, and measures to reduce chyle production. A minority of chylothoraces will fail to resolve with these measures. Surgical intervention is then required to prevent chronic metabolic deterioration and death.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Of 300 congenital malformations of the lymphatics of the small intestine investigated, 120 were operated upon. Intestinal lymphography shows no injection of the cisterna chyli and histology proves that the mesenteric lymph nodes are abnormal. The induced hyperlipidemia test permits a biochemical diagnosis. Modifications of the flow of the chyle secondary to the hypoplasia of the cisterna chyli were studied: (1) in the abdominal cavity, (2) in the extraperitoneal region and the lower limb, (3) in the thorax, especially the chyle drainage channels from the diaphragm towards the cervical region. Our investigations have established that the following diseases are produced by malformation of the lymphatics of the small intestine: protein losing enteropathy, chyloperitoneum, chyluria, lymphedema with chyle reflux, chylothorax, chylopericardium, chyle reflux in the pulmonary lymphatics, hypoproteinemia and food allergies. A better understanding of the pathophysiology of the malformations of the intestinal lymphatics permits a more rational treatment of the diseases produced by this anomaly.

Asunto(s)

RESUMEN

The lymphatic vascular system plays a pivotal role in the control of the interstitial homeostasis. This review illustrates the morphological and ultrastructural features of precollecting, pre- and postnodal collecting and absorbing peripheral vessels. A special attention is devoted to the endothelium of the absorbing lymphatic, its cytological features, kinds of intercellular contact, contractile properties and occurrence of valves. The role of the different mechanisms involved in transendothelial transport, namely membrane diffusion, vesicular route, open junctions and intraendothelial channels, are considered. The morphological reality of "intercellular openings" and "intraendothelial channels" is also discussed. The latter are "dynamic units" which carry on a remarkable task in the drainage, toward the lymphatic lumen, of macromolecules (chylomicra, glycoproteins, etc.) and cellular elements (lymphocytes and polymorphonuclear leukocytes). On the other hand, macrophages follow a transcellular pathway. The factors which possibly underlie these two modes of transendothelial migration are also discussed.

Asunto(s)

Asunto(s)

RESUMEN

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

Asunto(s)

RESUMEN

A series of 15 patients was treated for chylothorax over a 20-year period. The anatomy, physiology, and diseases of the thoracic duct are described, and a plan for the management of chylothorax is presented. If conservative therapy (e.g., aspiration or drainage with restriction of oral intake and intravenous replacement) is not successful after two to three weeks, surgical treatment is necessary and efficacious. The thoracic duct is explored by a full thoracotomy on the side of the effusion. It is readily seen if 6 to 8 oz of a mixture of milk and cream is given to the patient a few hours before operation. The milky fluid drips from the open duct, which is easily oversewn.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)