1/15. Management of postoperative chylothorax with nitric oxide: a case report.OBJECTIVE: To describe the use of inhaled nitric oxide in the management of refractory postoperative chylothorax. DESIGN: Case report. SETTING: A pediatric intensive care unit of a tertiary care children's hospital. PATIENT: A neonate with refractory chylothoraces complicated by moderate pulmonary hypertension after a complicated arterial switch operation. INTERVENTIONS: Administration of inhaled nitric oxide through a ventilator circuit. MEASUREMENTS AND MAIN RESULTS: The institution of inhaled nitric oxide at 20 ppm resulted in a marked reduction in chest tube drainage and a decrease in echocardiographically estimated pulmonary artery pressure from 50%-75% systemic to 30%-50% systemic. Chest tube drainage doubled when the nitric oxide was decreased to 10 ppm and, again, dramatically decreased after raising nitric oxide back to 20 ppm. After 8 days of nitric oxide therapy, the chest tube drainage ceased. nitric oxide therapy was successfully discontinued 19 days after initiation, with no recurrence of chylothorax. There was no effect of nitric oxide on systemic blood pressure. methemoglobin levels while on NO remained <1.7%. CONCLUSION: Consideration may be given to the use of inhaled nitric oxide in the therapy of refractory chylothoraces complicated by central venous hypertension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/15. chylothorax: a novel therapy.OBJECTIVE: To report a novel therapy for chylothorax. DESIGN: Case report. PATIENT: Severely ill neonate with congestive heart failure and high surgical risk. INTERVENTIONS: Standard therapy for chylous effusion with the addition of pressure control ventilation and positive end-expiratory pressure (high mean airway pressure). RESULTS: Rapid resolution of effusion with elimination of excessive fluid needs and correction of coagulation profile. CONCLUSION: Increasing mean airway pressure by pressure control ventilation and positive end-expiratory pressure should be considered as a therapeutic intervention in patients with persistent chylous effusions.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
3/15. Refractory chylothorax in hepatic cirrhosis: successful treatment by transjugular intrahepatic portosystemic shunt.patients with cirrhosis and portal hypertension have increased thoracic duct lymph flow. Correction of portal hypertension is associated with decreases in thoracic duct flow. The authors present a case of rapid resolution of refractory chylothorax caused by thoracic duct injury proven by lymphangiography and helical CT scan in a patient with cirrhosis of the liver by using a transjugular intrahepatic portosystemic shunt to decrease portal pressure and thereby reduce thoracic duct lymph flow.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/15. Treatment of severe fetal chylothorax associated with pronounced hydrops with intrapleural injection of OK-432.We describe a case of a 25-week fetus with severe bilateral pleural effusion, marked ascites, skin edema, an anterior thick (hydropic) placenta and polyhydramnios in which the most probable diagnosis was congenital chylothorax. Treatment with a pleuroamniotic shunt was planned, however the location of the fetus just below the anterior placenta made the placement of the shunt too dangerous. We therefore decided to use intrapleural injection of OK-432. From week 29, the lungs looked normal, the pleural effusion had resolved and the thoracic circumference was within normal limits. The severe ascites persisted throughout the pregnancy and a total volume of 3680 mL was removed on several occasions. A cesarean section was performed at 38 weeks and a normal male was delivered. continuous positive airway pressure was needed on the first 4 days but after a week the situation was stable. On day 8, an X-ray showed normally developed lungs. OK-432 appears to have prevented pulmonary hypoplasia in our patient.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/15. somatostatin treatment of massive lymphorrhea following excision of a lymphatic malformation.Postoperative lymphorrhea is a serious and occasionally lethal complication of neck dissection and cardiothoracic surgery. Management is not standardized, but usually centers around diet modification, drainage, pressure dressings, and reoperation. We report the successful use of the long acting somatostatin analogue octreotide in the management of massive lymphorrhea complicating excision of a large cervicomediastinal lymphatic malformation in an infant. Based on this report and a review of the available literature, we advocate the early consideration of somatostatin and its analogues in the control of lymphorrhea.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/15. Bilateral chylothorax.A 2.5-kg female developed bilateral chylothoraces 10 days after surgery for coarctation of the aorta. Initial conservative management consisted of intermittent positive pressure ventilation, drainage of chylous fluid and enteral feeding, but there was no diminution in loss of chyle. ligation of the thoracic duct and pleurectomy were performed subsequently to reduce the large daily losses of chyle, amounting to nearly three times the child's circulating blood volume. Brawny oedema of the right upper quadrant of the body developed rapidly after the duct ligation and right pleurectomy. A further period of conservative treatment was required before the latter complication resolved. The literature relating to this iatrogenic complication and to fluid and nutritional losses in paediatric chylothorax is reviewed and discussed.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/15. chylothorax after childbirth.We report a case of chylothorax which appeared in a mother after childbirth. Disruption of the thoracic duct occurred with the high intrathoracic pressures generated by the valsalva maneuver used by the patient during labor to "push." No evidence of other trauma or malignancy were found and the patient did well after use of total parenteral nutrition, thoracotomy with thoracic duct ligation, and pleurodesis.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/15. Massive primary chylopericardium: a case report.A large pericardial effusion was discovered in an asymptomatic 12-year-old boy admitted for an elective orthopedic procedure. On physical examination, heart rate was 96 and blood pressure was 130/70 without paradox. The neck veins were not distended, but heart tones were distant. Chest roentgenogram (CXR) showed an enlarged cardiac silhouette. Echocardiogram showed a massive pericardial effusion compressing the right atrium, with depressed ventricular contractility. pericardiocentesis yielded 450 mL of chylous fluid. A percutaneous pericardial drain was placed and drained another 400 mL of chyle. Pericardial fluid reaccumulated even though the patient was on a low-fat diet, and 1 week after admission left thoracotomy was performed with partial pericardiectomy and pericardial window. There was 1 L of chyle in the pericardial sac; frozen section of the pericardium showed lymphangiectasia. Chest tube drainage diminished rapidly and the patient was discharged. Follow-up CXR at 1 week showed fluid in both pleural spaces requiring bilateral tube thoracostomies again draining chyle. Even with total parenteral nutrition (TPN), 500 mL/d of chyle drained from the pleural tubes. Right thoracotomy with ligation of the thoracic duct was performed after 1 week of TPN. Pleural drainage abruptly dropped, and there has been no reaccumulation in either the pleural spaces or pericardium at 6-month follow-up. This case dramatically supports early thoracic duct ligation and partial pericardiectomy as the treatment of choice for primary massive chylopericardium.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/15. dyspnea resulting from accumulation of pleural effusion after radical neck dissection. A case report.The patient became dyspneic 3 days after radical neck dissection on the left side. A chest radiography showed bilateral pleural effusion.During the operation, a lymphatic leak was noted. In this case, the factor of an associated perforation of the pleural had not been demonstrated. Fresh frozen plasma was administered and positive end-expiratory pressure was applied.The patient had no residual pulmonary sequelae.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
10/15. chylothorax after gastric resection.Traumatic chylothorax has been described as an uncommon complication of various thoracic and cervical surgical procedures. No previous reports have been made of chylothorax following gastric resection for malignancy. Two cases of chylothorax following damage to the thoracic duct during gastric resection for malignancy are presented and the literature is reviewed. The condition was successfully managed by conservative means. Pleural aspiration, combined with total parenteral nutrition in one case and positive end-expiratory pressure ventilation in the other, resulted in complete resolution of the chylous effusions.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
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