Congenital chylothorax in siblings

We describe two cases of congenital chylothorax in siblings with important differences from previously described familial cases. Our findings support the likelihood of an autosomal recessive inheritance in some cases of this condition, rather than X-linked recessive inheritance, which has also been suggested. Autopsy findings from one of these cases and others previously described suggest that the pathophysiological mechanisms involved may be variable.     

Bilateral chylothorax following neck dissection

Deviations between simulation and first check films were quantitatively assessed for 95 unselected head and neck cancer patients. All measured deviations--calculated on the basis of a total of 190 simulation and 380 verification films--were normally distributed, with mean values of 0-3 mm and standard deviations of 3-5 mm. Of the absolute deviations, 50% and 95% were within 3 mm and 9 mm, respectively. These results should be considered in clinical practice when prescribing safety margins and adequate cut off doses for sparing critical organs in head and neck cancer.     

Lymphoscintigraphy in chyluria, chyloperitoneum and chylothorax

Lymphoscintigraphy allows functional assessment of lymphatic transport and depiction of regional lymph nodes, is fast and nontraumatic and has no known side effects. We retrospectively analyzed lymphoscintigraphic studies to determine their efficacy in the investigation of chyluria, chyloperitoneum and chylothorax. METHODS: Twenty-one whole-body lymphoscintigrams using 99mTc-antimony sulfide colloid or dextran were acquired in 18 patients with chyluria, chyloperitoneum and/or chylothorax. The images were reviewed to assess the rate of tracer transport and number, size and distribution of lymph vessels and nodes as well as the presence of collateral, fistula or lymph reflux. RESULTS: Lymphoscintigraphy was normal (5 of 11 patients) or showed lymphatic obstruction (6 of 11 patients) in chyluria associated with filariasis. Lymphatic obstruction was demonstrated in chyloperitoneum and/or chylothorax associated with liver cirrhosis (2 patients), postoperative (1 patient) or congenital (1 patient) lymphatic dysplasia, inferior vena cava obstruction (1 patient) and nephrotic syndrome (1 patient). Enhanced lymph flow was seen in systemic lupus erythematosus (1 patient). Follow-up lymphoscintigrams showed patency of lymphovenous anastomosis (1 patient), improvement (1 patient) or no change (1 patient) in lymphatic drainage after treatment. CONCLUSION: Lymphoscintigraphy can demonstrate abnormal lymphatic drainage in chyluria, chyloperitoneum and chylothorax. It is useful for selecting patients for surgery and assessing the effect of treatment.     

Treatment of a persistent postoperative chylothorax with somatostatin

Chylothorax is a rare but potentially serious complication of pediatric cardiac operations. We report the case of a 4-month-old boy who underwent a Senning procedure for correction of D-transposition of the great vessels. A persistent postoperative chylothorax developed, necessitating continuous drainage, despite conservative treatment over 3 weeks. Thereafter, continuous somatostatin infusion for 14 days led to the reduction and finally cessation of chyle production. This treatment allowed early enteral feeding and avoided further surgical intervention.     

The changes in lymphocytes subpopulations of a patient with postoperative chylothorax

A case of 64-year-old male who developed chylorrhea at 2 days post coronary artery by-pass grafting, is reported. He was managed conservatively for 3 weeks. But chylothorax was not improved, he was treated operatively. Analysis of his lymphocyte subpopulations in peripheral blood were performed during the course of chylothorax. Lymphocytepenia became apparent and subpopulation of T cell were decreased gradually. The subpopulation of CD 4(+) cell decreased, while the subpopulation of CD 8(+) increased. The CD 4(+) cell/CD 8(+) cell ratio decreased consequently till 7th day after 2nd operation. Although the replenishment of nutritional deficiencies using TPN allows prolonged conservative management for chylothorax patient, the deterioration in cellular immunocompetence can not be prevented at present. It is necessary to take great care about infection for chylothorax patient.     

Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy

BACKGROUND: The management of chylothorax complicating oesophagectomy remains controversial. Even if medical management alone can be successful, some authors advocate early reoperation. The aim of this retrospective study was to identify the clinical variables associated with a high probability of full recovery with medical treatment. METHODS: Among 850 Lewis procedures performed for oesophageal carcinoma, 23 patients (2.7 per cent) developed postoperative chylothorax despite systematic preventive ligation of the main thoracic duct. Patients who responded to conservative management were compared with those requiring reoperation for preoperative radiotherapy, unilateral versus bilateral pleural effusion, delay of occurrence of the chylothorax, and ratio of mean chylous output to body-weight 1 and 5 days after its onset. RESULTS: Conservative management was successful in 14 patients with a mean(s.d.) delay of 12(5) (range 7-21) days and there were no hospital deaths. Reoperation was necessary in nine patients; there were two postoperative deaths and no recurrence of the chylothorax. The only significant difference between reoperated and medically treated patients was the mean(s.d.) chylous output at day 5: 23.5(16.6) versus 6.7(5.5) ml per kg body-weight (P< 0.001). At this time, the output was less than 10 ml/kg in 12 of 14 patients in whom medical treatment was successful (sensitivity 86 per cent), and equal to or greater than this cut-off value in all the patients who underwent reoperation (specificity 100 per cent). CONCLUSION: The ratio of chylous output to body-weight on the fifth day after the onset of a chylothorax complicating oesophagectomy seems to reliably predict the success of continuing medical treatment.     

Congenital pulmonary lymphangiectasis with chylothorax: a heterogeneous lymphatic vessel abnormality

We describe the generation of a new antipeptide antibody that binds to the centromeric region of human mitotic chromosomes. This antibody was raised against a synthetic peptide corresponding to the 481-493 amino acid sequence of the human CENP-B autoantigen. Immunofluorescence analysis revealed that this anti-CENP-B serum showed an identical pattern to the human CREST anticentromere autoantibody in both mitotic cells and interphase nuclei. Immunoblotting showed that this antibody reacts with the recombinant human CENP-B autoantigen, indicating that it is directed to the 80-kDa centromere polypeptide. We have used this serum to determine, by indirect immunofluorescence, whether CENP-B is conserved in different mammalian species. Surprisingly, the human antipeptide antibody does not react with the centromeric proteins of cultured mouse, hamster, or Indian muntjac cells. Because the CENP-B gene has been cloned in human and mouse, our results suggest that the CENP-B epitope used as an immunogen in this study is not ubiquitous in mammalian cells, and that we have most probably established a monospecific antibody to the human centromere.     

Adams-Oliver syndrome: a case with juvenile chronic myelogenous leukemia and chylothorax

We report on a patient with Adams-Oliver syndrome and report new findings: a chylous pleural effusion and juvenile chronic myelogenous leukemia. Also, our patient had congenital heart disease, confirming that heart lesions are a manifestation in this syndrome. The major manifestations of this disorder are summarized. Included are cases not previously recognized as having Adams-Oliver syndrome identified in a literature survey. Distal limb deficiency is commonest with more frequent and more severe involvement of the lower limbs. Scalp defects are the second commonest manifestation, while an underlying skull defect is not infrequent. Cutis marmorata telangiectatica and dilated scalp veins are significant signs of this condition. This review highlights unresolved questions about Adams-Oliver syndrome.     

Iatrogenic chylothorax. Etiologic and therapeutic considerations, with presentation of two clinical cases

A case of mediastinal sclerosis after radiotherapy is presented as a curiosity in iatrogenic etiologies of chylothorax. After 7 weeks of conservative treatment, an operative pleurodesis was successful. In a second clinical case, the hazardous intra-thoracic coagulation of the chyle is illustrate. Etiology and therapeutic mangements of iatrogenic chylothorax in the literature are briefly reviewed.     

Staphylococcal scalded-skin syndrome complicating wound infection in a preterm infant with postoperative chylothorax

The course of infection in a 3-week-old premature newborn suffering from extensive dermatitis with flaccid blisters is described. Staphylococcus aureus was recovered from a local wound infection around a chest tube inserted to drain a postoperative chylothorax. The strain isolated tested positive for the eta gene for exfoliative toxin A, the causative agent of staphylococcal scalded-skin syndrome (SSSS). In this case, prematurity and loss of chylus with consecutive lymphopenia may have contributed to development of SSSS.     

Postesophagectomy mediastinal chylothorax causing upper airway obstruction misdiagnosed as asthma: a report of two cases

Injury to the thoracic duct resulting in chylothorax is an uncommon but well-documented complication of esophagectomy. In two cases, which were associated with signs of life-threatening upper airway obstruction, an initial diagnosis of asthma was made. It appears that this complication of esophagectomy has not been reported previously.     

Clipping of the thoracic duct with video-assisted thoracic surgery in the treatment of chylothorax after pulmonary resection

We describe a procedure for video-assisted thoracoscopic clipping of the thoracic duct to treat postoperative chylothorax. This technique was successfully performed on a 62-year-old man who developed chylothorax following right lower lobectomy and partial resection of the 11th and 12th vertebral bodies for squamous cell lung cancer. Because conservative therapy for 7 days failed to reduce the amount of pleural effusion, we performed thoracoscopic examination of the thoracic duct and found a site leaking chylous fluid. The thoracic duct was successfully and easily clipped resulting in complete elimination of the effusion in 2 days. Generally, chylothorax complicating pulmonary resection has been managed by medical treatment first, followed by surgical intervention in case that fail to respond to initial therapy. The newly designed video-assisted thoracic surgery procedure reduces the trauma, shortens the drainage period and hospital stay, and provides better exposure of the thoracic duct. We believe that this procedure can be carried out shortly after the occurrence of chylothorax.     

Direct approach to the site of injury of the thoracic duct in treatment of chylothorax after pulmonary resection

Chylothorax, a rare complication after pulmonary resection, has no single established treatment. Generally, conservative therapy is tried first, but surgery should be done without delay if chyle leakage is severe. A 73-year-old woman underwent upper left lobectomy for lung cancer. Two days later, chylothorax was diagnosed, and because chyle leakage was great, emergency re-thoracotomy was done on day 4 after the first operation. With the preoperative ingestion of 200 ml of milk and 20 g of margarine, chyle leakage from the injured thoracic duct was readily located in the upper mediastinum. Closure of the trunk of the thoracic duct may be undertaken, but a direct approach to the site of injury is more preferable, because the trunk may have collateral.     

On the possible role of positive end-expiratory pressure ventilation in the treatment of chylothorax caused by blunt chest trauma

Recent reports on the treatment of chylothorax postulate a benefit to ventilator therapy, especially using positive end-expiratory pressure (PEEP). This report describes the use of mechanical ventilation with PEEP in the management of a 24-year-old male motorcyclist who sustained a ligamentous Chance fracture of the thoracic spine at the T6-7 level with bilateral traumatic chylothorax. Treatment of the chylothorax consisted of high PEEP ventilation, bilateral chest tube thoracostomies, and total parenteral nutrition. The chylothoraces resolved within 4 days of treatment and mechanical ventilation was stopped. Ventilator therapy of traumatic chylothorax and the physiologic grounds for its use are discussed. A review of the literature and experimental evidence seem to suggest that ventilator treatment of traumatic chylothoraces is effective.     

财务管理在企业管理中的作用

随着我国市场经济体制改革的深入,我国传统的企业财务管理已经不能够适应现代企业发展的要求,现代企业的财务管理必须全面强化资金管理、建立财务监督制度,建立科学严谨的成本管理机制从而提高企业经济效