Chylothorax - multidisciplinary solution.

Surgical treatment is not commonly used in the management of chylothorax. We describe a complicated algorithm that we used in treating a 70-year-old lady with Bechterev disease, who suffered from a blunt chest injury with subsequent right-sided serial ribs fracture with hemothorax and thoracic vertebral body fracture. Because of Bechterev disease, hyperextension of the ossified thoracic spine caused an injury of the thoracic lymphatic duct. Simultaneous thoracic spine stabilisation with surgical revision of the thoracic lymphatic duct from an anterior approach was indicated. Despite the urgency of thoracic spine stabilisation, the procedure was postponed due to an acute coronary syndrome, which implied drug eluting stent insertion with a subsequent need of dual anti platelet therapy. Thus, the procedure was done 16 days after stent insertion. The diagnosis of chylotorax must be considered in case of thoracic injury with continuing waste to the chest tube and the finding of well expanded pulmonary parenchyma. Biochemical investigation of the effusion is the cornerstone in establishing the diagnosis of chylothorax (Tab. 2, Fig. 1, Ref. 14).

[Role of percutaneous vertebroplasty and kyphoplasty in the treatment of oncology disorders of the spine]. / Postavení perkutánní vertebroplastiky a kyfoplastiky v lécbe onkologického onemocnení pátere.

BACKGROUND: The aim of the study is to present results of a prospective uncontrolled clinical study. Percutaneous vertebroplasty or kyphoplasty are minimally invasive methods based on polymethylmethacrylate (PMMA) bone cement application into the damaged vertebra. This leads to decrease of the pain and vertebral body stabilisation. Oncology disorders of the spine are relatively common, having a wide alternative of various methods of treatment. Patients, according to their findings and indication criteria, are treated surgically or conservatively, oncological treatment is usually based on radiotherapy. Authors discuss the role of these invasive procedures in the treating algorithm of patients with spinal metasthases and multiple myeloma. METHODS AND RESULTS: From September 2003 to December 2005, 21 percutaneous vertebroplasties in 14 patients, mean age 68.7 (47-80) year, were performed in our department. During one treatment session 1-2 vertebrae (total of 21 vertebrae) in level Th9 - L5 were treated. Vertebroplasties and kyphoplasty were performed under fluoroscopy guidance. Transpedicular acces was used. Totally, 3 asymptomatic complications were proved. As first, a bone cement leaked paravertebrally during L5 body treatment, as second, a bone cement leaked into paravertebral veins, and as third, a bone cement leaked into the intervertebral space. Visual analog scale (VAS) was 8.9 points before procedure, 1.9 point 3 months after procedure and 2.6 points 6 months after procedure. We did not prove a symptomatic or total complication. CONCLUSIONS: According to our experience, percutaneous vertebroplasty is an effective alternative treatment of painful oncologic spine disease.

[Percutaneous vertebroplasty]. / Perkutánní vertebroplastiky.

Percutaneous vertebroplasty is a therapeutic, interventional radiologic procedure originally developed in France by Galibert, Deramond et al. (1987). The technique consists of the percutaneous puncture of the affected vertebral body, followed by injection of bone cement into a vertebral body for the relief of pain, and the strengthening of the bone. The procedure was used initially to treat aggressive hemangiomas, but it then was extended to the treatment of osteolytic metastases, multiple myeloma and osteoporotic compression fractures refractory to medical therapy. In this article we review the current techniques, indications for this procedure, preoperative and postoperative evaluations.