Combined endolymphatic and surgical treatment of a leaking central conducting lymphatic malformation in a neonate

Lymphatic malformations are congenital alterations of normal embryonic lymphatic development. We present a case of a premature 7-week-old male with a large central conducting lymphatic malformation and significant abdominal chylorrhea. He was successfully treated with combined endolymphatic and surgical approaches. To the authors’ knowledge, this is the first case to be described.

Chylous effusion presenting in a 37-year-old woman with severe hypothyroidism: a case report

Introduction

We report what is to the best of our knowledge the second adult case of chylothorax clearly associated with severe hypothyroidism in the English-language medical literature. To the best of our knowledge, this is the first case of its kind reported without a prior history of malignancy.

Case presentation

A 37-year-old Hispanic woman with no reported significant past medical history initially presented with shortness of breath and inability to lose weight. She was found to have a large chylous effusion requiring chest-tube drainage, as well as severe hypothyroidism. After several weeks of thyroid hormone-replacement therapy, the formation of chylous pleural fluid in the patient greatly diminished, and the chest tube was removed. Upon long-term follow-up her minimal residual effusion remains stable on serial chest radiographs.

Conclusion

Although the exact pathophysiologic relation between low thyroid hormone levels and chyle formation remains to be elucidated, hypothyroidism should be a diagnostic consideration in patients with chylous effusions, especially those refractory to conventional treatments.

Blood concentrations of amitriptyline and its metabolite in rats after acute oral administration of amitriptyline

Amitriptyline (AMT), a tricyclic antidepressant that is a dibenzocycloheptadine derivative, is frequently used. However, the case reports of AMT-related fatalities are increased, nowadays, due to the low levels of toxic and fatal concentration in blood. So, this study was carried out to determine the concentrations of AMT and its demethylated metabolite, nortriptyline (NTR), after acute single oral administration of AMT in rats. Blood samples were collected five times from the ophthalmic venous plexus at 0, 1, 2, 4, and 8 h after acute single oral administration of AMT in toxic doses of 10 (Group I) or 20 mg/kg (Group II), and the concentrations of AMT and NTR and the mean ratios of AMT to NTR (AMT/NTR) in the blood were periodically determined at designated times. The blood concentrations of AMT and NTR were identified and quantitated by gas chromatography with thermionic specific detection and gas chromatography-mass spectrometry after solid-phase extraction with a Clean Screen DAU column. The peak blood concentrations of AMT and NTR in Group I were 0.34 and 0.28 microg/mL, respectively, and those of AMT and NTR in Group II were 0.59 and 0.43 microg/mL, respectively, and were reached at 1 h after single oral administration.

Levels of paraquat in fatal intoxications

We describe here fatal levels of paraquat in plasma of victims due to the ingestion of the herbicide, paraquat, and the relationship between those levels and survival times after ingestion. We determined paraquat levels in plasma of 106 paraquat poisoning cases in Korea between June 1992 and December 1996 using a visible spectrophotometric method based on the alkali-dithionite reaction. Among 55 cases with known survival times, plasma paraquat levels of victims who died within one day of ingestion ranged from 2.3 to 636.6 microg/ml (average 127.6 microg/ml) while those of the victims who died between 1 approximately 4 days ranged from 0.9 to 25.1 microg/ml (average 7.0 microg/ml). Since preparations containing 24.5% paraquat dichloride are still used in Korea, our data for Korean victims who died within one day were 8.5 times higher than those in Baselt and Cravey's report for the same survival times. Our data also suggest that victims in whom a plasma paraquat concentration of more than 30 microg/ml was detected are likely to have died within 24 h after ingestion.

Acute fatal poisoning cases due to furathiocarb ingestion

Seven cases involving acute fatalities due to ingestion of furathiocarb, a carbamate insecticide, are presented. Furathiocarb was detected in the gastric contents using thin layer chromatography (TLC) and gas chromatography/mass spectrophotometry (GC/MS), and quantified in the blood using a gas chromatograph equipped with a nitrogen-phosphorus detector (NPD). The fatal levels of furathiocarb in the blood ranged from 0.1 to 21.6 micrograms/ml.

Multiple primary lung cancers

From November 1957 to June 1984 at Shanghai Chest Hospital, 30 cases of multiple primary lung cancers were confirmed, based on clinical characteristics, diagnostic process, histologic type, treatment, and prognosis. Out of 3,815 cases of resected primary lung cancer, the incidence of multiple primary lung cancers was 0.8 percent. There were ten synchronous cases and 20 metachronous cases. Seventeen cases were unilateral, and 13 cases were bilateral, of which only one case was synchronous, and the remaining 12 cases were postoperative resection of an opposite lesion. Among the ten synchronous cases, four cases of multiple primary lung cancers were definitely diagnosed before surgery by chest x-ray films or fiberoptic bronchoscopy. Among the 20 metachronous cases, 11 cases were definitely diagnosed before surgery as the second primary lesion by chest x-ray films taken during periodic follow-ups after the initial resection, while nine cases were proven by thoracotomy. All of the 15 cases definitely diagnosed before surgery as multiple primary lung cancers were according to our criteria. Histologically, adenocarcinoma was relatively scarce, at a rate of 13 percent (4/30); but epidermoid carcinoma was predominant, at a rate of 87 percent (26/30), of which 11 cases were accompanied by adenocarcinoma or large-cell undifferentiated carcinoma. The average postoperative survival in the ten synchronous cases was 29 months and in the 20 metachronous cases was 26.2 months, counting from the time of the second operation. The criteria of clinicopathologic findings, early diagnostic procedure, and surgery for multiple primary lung cancers were also discussed.

Critical evaluation of results of extension of indication for surgery for primary bronchogenic carcinoma

Among 3,120 surgically resected cases (1957-1983) in Shanghai Chest Hospital, 1,476 resections (47.3%) were performed under extended indication. Six categories--(1) aged 70-87 years (102), (2) associated with severe impairment of pulmonary function (25), (3) small-cell anaplastic type (143), (4) stage III lesion (1,145), (5) invading carina (29), (6) with disseminated pleural metastasis and effusion (32)--were critically evaluated. For the first four categories, long-term survival rates were very encouraging, whereas only technical advancement and short-term results were discussed for the last two. The authors present strategic points significant in availing higher overall operability and hence the overall survival rate, shedding light on the increase of curative potential for lung cancer.