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Watanabe A, Koyanagi T, Nakashima S, Higami T. Supradiaphragmatic thoracic duct clipping for chylothorax through left-sided video-assisted thoracoscopic surgery. Eur J Cardiothorac Surg 2006; 31:313-4. [PMID: 17194599 DOI: 10.1016/j.ejcts.2006.11.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 11/23/2006] [Accepted: 11/27/2006] [Indexed: 10/23/2022] Open
Abstract
Chylothorax is a life-threatening clinical entity. Traditional surgical management for cases refractory to conservative treatment is thoracic duct ligation through a right open thoracotomy or closure of the site of duct laceration through an open thoracotomy. We report herein two patients with left chylothorax successfully treated by supradiaphragmatic thoracic duct (STD) ligation through left-sided video-assisted thoracoscopic surgery (VATS). This approach offers optimal exposure for the thoracic duct ligation and is useful for treatment of left chylothorax after left-sided thoracic surgery and idiopathic left chylothorax.
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102
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Simosa HF, Aquino M, Hirsch EF. Chylous retroperitoneum: a rare presentation of blunt thoracic duct injury. THE JOURNAL OF TRAUMA 2006; 61:1280-2. [PMID: 17099546 DOI: 10.1097/01.ta.0000244166.55451.0a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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103
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Hwang HS, Shin SW, Kim EH, Do YS, Choo SW, Cho SK, Park KB. Iatrogenic Aorto-Cisterna Chyli Fistula During Percutaneous Balloon Aortoplasty in a Patient with Takayasu’s Arteritis: A Case Report. Cardiovasc Intervent Radiol 2006; 30:324-7. [PMID: 17031726 DOI: 10.1007/s00270-006-0003-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We present a case of iatrogenic aorto-cisterna chyli fistula that developed during percutaneous transluminal aortoplasty in a 16-year old girl with Takayasu's arteritis. The aorto-cisterna chyli fistula was angiographically confirmed and treated using a stent-graft, which successfully occluded the fistula. Her claudication then improved, although follow-up CT angiography at 10 months revealed mild recurrent aortic stenosis.
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104
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Allaham AH, Estrera AL, Miller CC, Achouh P, Safi HJ. Chylothorax Complicating Repairs of the Descending and Thoracoabdominal Aorta. Chest 2006; 130:1138-42. [PMID: 17035448 DOI: 10.1378/chest.130.4.1138] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Chylothorax occurring during thoracic aortic surgery is an infrequent but serious complication. The purpose of this study was to analyze our experience with this complication and the resulting outcomes. METHODS From January 1991 to July 2005, we performed 1,233 descending thoracic and thoracoabdominal aortic surgical procedures. A retrospective review was performed to analyze and identify preoperative and operative risk factors as well as management outcomes of postoperative chylothorax (PCT). RESULTS PCT developed in five patients (0.4%). All five cases occurred with descending thoracic aortic aneurysm repair, and 80% (four of five patients) were undergoing aortic reoperation. All patients were managed successfully with no mortality. Risk factors for the development of chylothorax were descending thoracic aortic repair (p = 0.006) and thoracic aortic reoperations (p = 0.0003). Nonoperative management was successful in 60% (three of five patients). Two patients required left thoracotomy with direct ligation. Mean hospital length of stay was 35 days (range, 15 to 60 days). Mean follow-up was 33 months (range, 3 to 69 months) with no recurrence of chylothorax or additional morbidity or mortality. CONCLUSIONS Chylothorax is more likely to occur with reoperations and repairs involving the descending thoracic aorta. Although PCT is associated with longer hospital length of stay, it is not associated with increased infectious complications. Early identification and prompt treatment may decrease both early and late morbidity and mortality.
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Lagarde SM, Omloo JMT, de Jong K, Busch ORC, Obertop H, van Lanschot JJB. Incidence and management of chyle leakage after esophagectomy. Ann Thorac Surg 2006; 80:449-54. [PMID: 16039184 DOI: 10.1016/j.athoracsur.2005.02.076] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Revised: 02/15/2005] [Accepted: 02/28/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative chyle leakage is a rare but well-recognized complication after esophageal surgery. The aim of this study was to identify its incidence and potentially predisposing factors and to assess the consequences and management. METHODS A consecutive series of 536 patients who underwent esophagectomy for malignant disease of the esophagus or gastroesophageal junction was reviewed. RESULTS There were 20 patients (3.7%) with chyle leakage. After transthoracic esophagectomy the risk for the development of chyle leakage was higher than after transhiatal resection (p = 0.006). Chyle leakage was associated with more positive nodes (p = 0.041). Patients with chyle leakage had significantly more pulmonary complications (p < 0.001) and longer intensive care unit (p = 0.015) and hospital stays (p = 0.001). No patient with chyle leakage died. Conservative management, consisting of no enteral feeding and total parenteral nutrition, was instituted in all patients, but was abandoned in 4 patients (20%) because of persistence of high chyle output through the chest tube. In contrast to patients who were successfully treated with conservative measures, patients who eventually needed a reoperation had a drain output of more than 2 L on the day conservative therapy was started and 1 and 2 days later. CONCLUSIONS Chyle leakage is seen more often in patients who undergo transthoracic esophagectomy and in patients who have more positive nodes. Patients with chyle leakage have more pulmonary complications. Conservative therapy is often successful, but operative therapy should be seriously considered in patients with a persistently high daily output of more than 2 L after 2 days of optimal conservative therapy.
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Talwar S, Choudhary SK, Airan B. Diaphragmatic fenestration for resistant chylothorax. Ann Thorac Surg 2006; 82:767-8. [PMID: 16863820 DOI: 10.1016/j.athoracsur.2006.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 01/04/2006] [Accepted: 01/06/2006] [Indexed: 11/27/2022]
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Tanaka R, Shimizu M, Hirao H, Kobayashi M, Nagashima Y, Machida N, Yamane Y. Surgical management of a double-chambered right ventricle and chylothorax in a Labrador retriever. J Small Anim Pract 2006; 47:405-8. [PMID: 16842279 DOI: 10.1111/j.1748-5827.2006.00079.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 22-month-old, male Labrador retriever was presented with anorexia, dyspnoea, and fainting. The dog was diagnosed with a double-chambered right ventricle and tricuspid valve dysplasia using echocardiography and cardiac catheterisation. A marked bilateral pleural effusion was also present and chemical analysis of the fluid confirmed the diagnosis of chylothorax. Using echocardiography, a pressure gradient of 87.1 mmHg was found between the proximal and distal chambers of the double-chambered right ventricle. Initiation of cardiopulmonary bypass allowed the anomalous muscle bundle that divided the right ventricle into two chambers to be resected via a right ventriculotomy. The fainting completely resolved postoperatively, and this treatment seemed quite effective in the reduction of pressure overload ascribable to ejection disturbance. Because the tricuspid dysplasia was not corrected in the first operation, the postoperative chyle effusion was reduced but did not cease. A combination of thoracic duct ligation and passive pleuroperitoneal shunting was effective in the resolution of the chyle effusion.
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108
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Shah SSA, Drinkwater DC, Christian KG. Plastic Bronchitis: Is Thoracic Duct Ligation a Real Surgical Option? Ann Thorac Surg 2006; 81:2281-3. [PMID: 16731170 DOI: 10.1016/j.athoracsur.2005.07.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Revised: 06/29/2005] [Accepted: 07/05/2005] [Indexed: 11/15/2022]
Abstract
Plastic bronchitis is an unusual clinical scenario of unknown cause and occurs in multiple clinical settings. The disease is characterized by the development of arborizing, thick, tenacious casts of the tracheobronchial tree that results in airway obstruction. Patients with congenital heart disease who have undergone a Fontan operation are at high risk for having this problem develop. Management of this distressing situation is difficult with only palliative options being available, such as repeated bronchoscopies, inhaled heparin, tissue plasminogen activator, inhaled bronchodilators, or azithromycin. The patients with Fontan circuits have a myriad of unique complications develop, such as atrial arrhythmias, recurrent pleural effusions, chylothoraces, protein-losing enteropathy, and plastic bronchitis. High intrathoracic lymphatic pressures with nondemonstrable lympho-bronchial fistulas were believed to be the cause for the development of these recurrent bronchial casts in plastic bronchitis. Faced with recurrent plastic bronchitis resistant to medical management in 2 Fontan patients with normal Fontan pressures on cardiac catheterization, we decided to explore a surgical solution by performing a thoracic duct ligation. This resulted in complete resolution of the formation of casts in both patients, who were discharged home and remain asymptomatic on continued follow-up. Thoracic duct ligation provides a surgical cure for plastic bronchitis by decreasing intrathoracic lymphatic pressure and flow.
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Fu JH, Hu Y, Huang WZ, Yang H, Zhu ZH, Zheng B. [Evaluating prophylactic ligation of thoracic duct during radical resection of esophageal carcinoma]. AI ZHENG = AIZHENG = CHINESE JOURNAL OF CANCER 2006; 25:728-30. [PMID: 16764769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND & OBJECTIVE Prophylactic ligation of thoracic duct during the radical resection of esophageal carcinoma is usually used to prevent and treat chylothorax, but there is dispute about the effect. Its correlation to other complications and prognosis of esophageal carcinoma patients after operation has seldom been reported. The study was to evaluate its preventive effect on chylothorax and its influences on other complications and prognosis of esophageal carcinoma patients. METHODS Clinical data from 389 patients who underwent radical transthoracic esophagectomy from Jun. 1991 to Jun. 1996 in Cancer Center of Sun Yat-sen University were retrospectively analyzed. Of the 389 patients, 171 received thoracic duct ligation (ligation group), and 218 had thoracic duct preserved (preservation group). The occurrence rates of chylothorax and other complications, and the survival rates were compared between the 2 groups. RESULTS The occurrence rates of chylothorax were 1.17% in ligation group and 0.46% in preservation group (P<0.001). The occurrence rates of complication were 18.2% in ligation group and 11.5% in preservation group (P=0.063). Perioperative mortalities were 1.75% in ligation group and 0.92% in preservation group (P=0.658). The 1-, 2-, 3-, and 5-year survival rates were 74.3%, 52.1%, 42.1%, and 29.2% in ligation group, and 74.3%, 53.2%, 43.1%, and 29.8% in preservation group (P=0.992, 0.819, 0.841, 0.902). CONCLUSION Prophylactic ligation of thoracic duct during esophagectomy for patients with esophageal carcinoma could not prevent chylothorax effectively, and has no obvious influence on the occurrence of other complications and survival of the patients after operation.
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Raco A, Russo N, Landi A, Dazzi M, Carlesimo B. Lymphatic fluid fistula: an extremely rare complication of posterior lumbar transpedicular screw fixation. J Neurosurg Spine 2006; 4:421-3. [PMID: 16703912 DOI: 10.3171/spi.2006.4.5.421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors describe the unique case of a patient who had undergone posterior stabilization of the lumbar spine complicating the course of a lymphatic fistula. A lymphatic fistula is a rare complication of posterior lumbar surgery. Predisposing factors include individual anatomy, scarring adherences due to previous abdominal operations or surgical maneuvers deep in the plane of the transverse processes. Because the onset of lymphatic fistulas is subtle, and because they are associated with a high mortality rate and require multidisciplinary treatment, care is needed to avoid misdiagnosing these lesions as the more common cerebrospinal fluid fistula.
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111
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Attias D, Ou P, Souillard P, Boudjemline Y, Sidi D, Bonnet D. [Spontaneous idiopathic chylopericardium in childhood]. ARCHIVES DES MALADIES DU COEUR ET DES VAISSEAUX 2006; 99:529-31. [PMID: 16802750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Here we report a case of a primary idiopathic chylopericardium in a 13 years old child. Pericardial effusion was diagnosed because the child suffered chest pain and fatigue. Pericardial drainage was performed and 800mL of chylous fluid was evacuated. Extensive investigations were performed but no cause could be found. Thoracic CT scan, lymphoscintigraphy and MRI did not evidence any communication between the thoracic duct and pericardium. After 2 recurrences of pericardial effusion while the child was on a medium chain triglycerides regimen, it was decided to ligate the thoracic duct and to do a partial pericardectomy. The result was excellent with complete resolution of the pericardial effusion and no recurrence since 3 years.
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Christodoulou M, Ris HB, Pezzetta E. Video-assisted right supradiaphragmatic thoracic duct ligation for non-traumatic recurrent chylothorax. Eur J Cardiothorac Surg 2006; 29:810-4. [PMID: 16626966 DOI: 10.1016/j.ejcts.2006.01.064] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Revised: 01/28/2006] [Accepted: 01/31/2006] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chylothorax is an uncommon disorder with respiratory, nutritional and immunological manifestations. Surgical management is indicated in case of recurrence or failure after conservative treatment. We report our experience with video-assisted right-sided supradiaphragmatic thoracic duct ligation for non-traumatic, non-postoperative persistent or recurrent chylothorax. PATIENTS AND METHODS The medical records of six patients operated at our institution between 1999 and 2004 were retrospectively reviewed. A right-sided chylothorax was found in four patients, a left-sided in one, and a bilateral in one. Three patients developed chylothorax after chemotherapy and chest irradiation for malignant diseases (lymphoma in two patients and breast cancer in one), one in the context of lymphangioleiomyomatosis, one due to a non-diagnosed lymphoma, and one after heart transplantation. RESULTS The mean operative time was 102 min, with an average length of hospital stay of 14 days. Persistent cessation of chylous effusion within 7 days after surgery was observed in 5/6 patients without recurrence during a mean follow-up time of 41 months. One patient with undiagnosed mediastinal lymphoma required re-operation and thoracic duct ligation on day 8 by right-sided thoracotomy due to persistent chylothorax. No 30-day mortality was recorded. Two patients presented postoperative complications including respiratory insufficiency requiring mechanical ventilation in one, and chylous ascites development requiring peritoneo-venous LeVeen shunting in one patient. CONCLUSIONS Recurrent or persistent non-traumatic chylothorax may be successfully treated by video-assisted right supradiaphragmatic thoracic duct ligation.
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Smati B, Sadok Boudaya M, Marghli A, Mestiri T, Baccari S, Hantous T, Djilani H, Kilani T. Prise en charge des chylothorax post opératoires. Rev Mal Respir 2006; 23:152-6. [PMID: 16788440 DOI: 10.1016/s0761-8425(06)71479-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A chylothorax can occur following any intrathoracic procedure. It is generally straightforward to make the diagnosis but optimal management can be problematic. METHODS Between 1995 and 2002, three women and one man aged from 13 to 58 years were treated for chylothorax after thoracic surgery. Their initial illnesses were a right pulmonary hydatid cyst associated with hepatic disease, a tumour of the posterior mediastinum, an oesophageal carcinoma and metastases in the left lung. RESULTS These patients had: a pulmonary and hepatic cystectomies, a resection of the mediastinal tumor, an Akyama oesophagectomy and a resection of four left pulmonary metastases. Chylothorax became apparent post operatively between the 1st and the 4th day. All patients were treated with a medium-chain triglyceride diet. Two patients were re-explored with ligation of lymphatic vessels. One woman who did not have further surgery was treated with etilefrine. In the patient who had had an oesophagectomy, chylothorax persisted after re-operation. He was successfully treated by talc pleurodesis via a chest drain, which prevented further recurrence. CONCLUSIONS In the management of postoperative chylothorax, medical treatment must be started early but surgery should not be delayed as operative risk is increased by the development of malnutrition and immune deficiency.
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Aerts NR, Erling N, Fontes PRO. Thoracoscopic thoracic duct ligation for chylothorax after traumatic subclavian artery injury. J Thorac Cardiovasc Surg 2006; 131:752-3. [PMID: 16515942 DOI: 10.1016/j.jtcvs.2005.10.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Revised: 10/09/2005] [Accepted: 10/26/2005] [Indexed: 10/25/2022]
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115
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Underwood J, Buckley J, Manning B. Gorham disease: an intraoperative case study. AANA JOURNAL 2006; 74:45-8. [PMID: 16483068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Gorham disease is a rare chronic disorder that is characterized by the abnormal proliferation of thin-walled capillaries and small lymphatic vessels that results in the massive osteolysis of adjacent bone. Clinical manifestations are determined by the area of involvement, which may include the chest and ribs. The case presented involves a 47-year-old man with Gorham disease complicated by unilateral chylothorax who was treated with thoracic duct ligation. The anesthetic implications associated with Gorham disease are discussed, and nonsurgical primary and adjunctive treatments for chylothorax are summarized.
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Mehrotra S, Peeran NA, Bandyopadhyay A. Idiopathic chylopericardium: an unusual cause of cardiac tamponade. Tex Heart Inst J 2006; 33:249-52. [PMID: 16878639 PMCID: PMC1524687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Chylous pericardial effusion is an uncommon condition, and the treatment is difficult. We report a case of massive chylous pericardial effusion with tamponade in a 22-year-old man, managed successfully. Lymphoscintigraphy confirmed the communication between the lymphatic trunk and the pericardial space, which was surgically ligated. There are relatively few published reports of idiopathic chylopericardium, and its pathogenesis remains unknown. The most effective treatment is surgical ligation of the thoracic duct and creation of a pericardial window.
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Lespine A, Chanoit G, Bousquet-Melou A, Lallemand E, Bassissi FM, Alvinerie M, Toutain PL. Contribution of lymphatic transport to the systemic exposure of orally administered moxidectin in conscious lymph duct-cannulated dogs. Eur J Pharm Sci 2006; 27:37-43. [PMID: 16198549 DOI: 10.1016/j.ejps.2005.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 07/20/2005] [Accepted: 08/05/2005] [Indexed: 11/18/2022]
Abstract
Moxidectin, a macrocyclic lactone (ML), is a potent parasiticide widely used in veterinary medicine and currently under development for use in humans. The contribution of the lymphatic route to the intestinal absorption and transport of moxidectin to the systemic circulation was evaluated in lymph duct-cannulated dogs. Beagle dogs were operated for lymph duct cannulation and were orally dosed with 38g of corn oil and moxidectin (0.2mg/kg, n=3). The lymph and plasma were collected over 24h and moxidectin and triglyceride concentrations were measured. Similarly, control dogs (n=5) were dosed orally with moxidectin and oil and subsequently with moxidectin intravenously. Pharmacokinetic parameters were calculated for moxidectin in the plasma of the dogs. Moxidectin readily accumulated in the lymph and reached a plateau 8h post-administration, paralleling triglyceride appearance. The percentage of moxidectin recovered in lymph was 22+/-3% of the total administered dose with 92% being associated with triglyceride-rich particles. The systemic bioavailability of oral moxidectin coadministered with lipid was only 40% in the lymph duct-cannulated dogs compared with 71% in the controls. Our data clearly indicate that the lymphatic transport process contributes significantly to the post-prandial intestinal absorption of moxidectin and subsequently to its systemic bioavailability. The lymphatic transport of moxidectin offers potential strategies based on lipid formulations to improve the bioavailability of MLs when administered orally.
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Kamiyoshihara M, Kakegawa S, Kawashima O, Otani Y, Morishita Y. [Thoracoscopic clipping of the thooracic duct for chylothorax following esophagectomy: report of a case]. KYOBU GEKA. THE JAPANESE JOURNAL OF THORACIC SURGERY 2005; 58:1189-91. [PMID: 16359025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Thoracoscopic clipping of the thoracic duct was successfully performed for the treatment of postoperative chylothorax. Chylothorax occurred in a 67-year-old man following an esophagectomy for esophageal cancer. Following unsuccessful conservative therapy for 3 weeks, we performed thoracoscopic surgery to examine the thoracic duct and found a leaking point of chylous fluid. The thoracic duct was successfully clipped resulting in complete elimination of the effusion immediately after surgery. Generally, chylothorax complicated by an esophagectomy has been managed by medical treatment first, followed by surgical intervention in case of uncontrollable pleural effusion. We think you should try this method at first in case chylothorax was able to be treated with not thoracotomy but thoracoscopic surgery: minimal invasiveness.
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Watanabe K, Miyamoto Y, Kinouchi K, Kagawa K, Kitamura S. [Anesthetic management of a 1.7-kg premature infant undergoing thoracoscopic thoracic duct ligation]. MASUI. THE JAPANESE JOURNAL OF ANESTHESIOLOGY 2005; 54:1165-7. [PMID: 16231777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We report successful anesthetic management of a 1.7-kg premature infant who underwent thoracoscopic thoracic duct ligation under general anesthesia. She was born at 30 weeks gestation with birth weight of 1,546 g and was suffering from respiratory distress due to persistent right chylothorax for two months after birth. Chest tube drainage, fasting and intrapleural fibrin glue did not reduce her right chylothorax. Thoracoscopic thoracic duct ligation was scheduled on her day 64 under general anesthesia. The tracheal tube end was placed in the midtrachea and carbon dioxide was insufflated into the operative side of the thorax. During thoracoscopy her left lung was ventilated with the right lung pressed with spatulaes, but her respiratory status did not deteriorate so much despite of unilateral ventilation. We speculate that, due to massive right chylothorax, her pulmonary blood flow had already shifted to the left lung, therefore intraoperative substantial left unilateral lung ventilation exerted minimal effect on her respiratory status. The operation was successful and she was weaned from the ventilator on the following day.
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Hayashi K, Sicard G, Gellasch K, Frank JD, Hardie RJ, McAnulty JF. Cisterna Chyli Ablation with Thoracic Duct Ligation for Chylothorax: Results in Eight Dogs. Vet Surg 2005; 34:519-23. [PMID: 16266346 DOI: 10.1111/j.1532-950x.2005.00078.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report use of combined cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) for treatment of spontaneously occurring chylothorax in dogs. STUDY DESIGN Retrospective study. ANIMALS Eight dogs with chylothorax. METHODS TDL was performed through a right caudal intercostal thoracotomy and CCA through a left flank paracostal approach or ventral median celiotomy. Long-term outcome (range, 2-48 months; median, 11.5 months) was evaluated by telephone communication with owners. RESULTS Seven dogs were free of clinical signs related to chylothorax at last follow-up (range, 4-48 months; median, 15.5 months). One dog was euthanatized 2 months after surgery because of lack of improvement. No major complications occurred from CCA. CONCLUSION CCA and TDL resolved chylothorax in most dogs (88%). CLINICAL RELEVANCE CCA combined with TDL may improve the outcome of chylothorax in dogs.
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Binkert CA, Yucel EK, Davison BD, Sugarbaker DJ, Baum RA. Percutaneous Treatment of High-Output Chylothorax with Embolization or Needle Disruption Technique. J Vasc Interv Radiol 2005; 16:1257-62. [PMID: 16151069 DOI: 10.1097/01.rvi.0000167869.36093.43] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Surgical ligation of the thoracic duct is associated with a high degree of morbidity; therefore, a minimally invasive approach is desirable. Herein, eight percutaneously treated patients are described. In four patients, the thoracic duct was embolized with use of coils and glue. In the other four patients, lymphatic ducts were disrupted by multiple needle punctures. The median chest tube drainage substantially decreased in both patient groups from more than 1,300 mL the day before the procedure to less than 300 mL 2 days after the procedure. The median times to chest tube removal were 7 days in the embolization group and 3.5 days in the needle disruption group.
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Fingeroth JM. Effect of cisterna chyli ablation combined with thoracic duct ligation on abdominal lymphatic drainage. Vet Surg 2005; 34:295; author reply 295. [PMID: 16115090 DOI: 10.1111/j.1532-950x.2004.00044_1.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kajiyama Y, Iwanuma Y, Tomita N, Amano T, Hattori K, Tsurumaru M. Sealing the thoracic duct with ultrasonic coagulating shears. HEPATO-GASTROENTEROLOGY 2005; 52:1053-6. [PMID: 16001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND/AIMS Ultrasonic coagulating shears were developed as an endosurgical device that allows cutting of vessels without ligation. In this study, we obtained basic data on the feasibility of dividing and sealing the thoracic duct by using ultrasonic coagulating shears. METHODOLOGY We obtained the thoracic duct and the left gastric artery from surgical specimens of 27 patients. After one end of each vessel was sealed using ultrasonic coagulating shears, we recorded the bursting pressure. The sealed ends of the vessels were also examined histopathologically. RESULTS The mean bursting pressure of the thoracic duct was high enough to support the clinical use of this device, and was significantly higher than that of the left gastric artery (p<0.001). Microscopic examination of the sealed vessels showed that degenerated collagen fibers were more homogeneous and covered a significantly larger area in the thoracic duct than in the left gastric artery (p<0.001). CONCLUSIONS The present study provides a basis for using ultrasonic coagulating shears to seal the thoracic duct and possibly lymph node dissection.
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Ohtsuka T, Ninomiya M, Kobayashi J, Kaneko Y. VATS thoracic-duct division for aortic surgery-related chylous leakage. Eur J Cardiothorac Surg 2005; 27:153-5. [PMID: 15621490 DOI: 10.1016/j.ejcts.2004.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 09/09/2004] [Accepted: 09/17/2004] [Indexed: 10/26/2022] Open
Abstract
Traumatic chylothorax is a serious morbidity due to aortic surgery. We treated this complication successfully by supradiaphragmatic thoracic-duct division in five adults (three men, two women, aged 61.5+/-19.5 years) and a 3-year-old male infant after an average interval of 4.1+/-1.8 days following initial aortic surgery: graft-replacement of subclavian or descending aortic aneurysm in the adults, and correction of aortic coarctation in the infant. A right thoracoscopic approach was used in the adults and the left thoracotomy was re-used in the infant. Individual exposure and division of the thoracic duct was accomplished using an ultrasonic coagulator. The operating time was 22+/-5.5 min for the thoracoscopy cases, and 70 min for the infant. There was no mortality and no procedure-related morbidity, and chylous leakage ceased immediately in all patients. There was no recurrence of chylothorax during a mean follow-up period of 17+/-9.7 months. Despite our limited experience, we conclude that the present supradiaphragmatic thoracic duct division technique (right thoracoscopy in adults) is safe and perfectly effective, and therefore prompt application of this method is recommendable for treatment of aortic surgery-related traumatic chylo-leakage, particularly in vulnerable elderly or infant patients.
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Gottwald F, Iro H, Finke C, Zenk J. Thoracic duct cysts: a rare differential diagnosis. Otolaryngol Head Neck Surg 2005; 132:330-3. [PMID: 15692550 DOI: 10.1016/j.otohns.2004.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cysts of the thoracic duct located in the supraclavicular region are uncommon. To date only 12 cases in this topographic area have been described in the literature. Between 1998 and 2002, 5 patients presented to our department with the primary symptom of a palpable soft left-supracavicular swelling that could be displaced relative to adjacent structures. SETTING In each case, sonography showed a hypoechogenic, almost echo-free, distinctly outlined polycyclic structure with distal echo enhancement at the junction of the left internal jugular vein and the subclavian vein. All 5 patients underwent surgery, the cysts were extirpated, and the numerous communicating lymph vessels localized and meticulously ligated. Pathohistologic analysis of the milky, yellowish fluid obtained by intraoperative puncture confirmed the initial suspicion of a thoracic duct cyst in all patients. CONCLUSION In the case of left supraclavicular masses, the rare differential diagnosis of a thoracic duct cyst must be considered as a possibility. Sonography as the imaging method of choice is sufficient for primary diagnosis. In addition, a thorax x-ray should be performed in order to exclude an intrathoracic involvement. Surgical extirpation marks the therapy of choice in treating such cysts.
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