Accumulation of 99m-Tc Phytate in the pyelocalyceal system in a patient with chylous ascites - a pitfall resolved by SPECT/CT.

We reported 99m-Tc phytate accumulation in the pyelocalyceal system of the kidney in the lymphoscintigraphic images of a 3.5 months-old male infant with chylous ascites, which was mistaken with the site of lymph leakage. SPECT/CT localized activity in the para-aortic region to the renal pelvis and on delayed images, this was disappeared. Our case illustrates the added value of SPECT/CT for the differentiation of possible false-positive findings in lymphoscintigraphy.

Idiopathic chylous ascites treated with total parenteral nutrition and octreotide. A case report and review of the literature.

Chylous ascites is the accumulation of lipid-rich lymph in the peritoneal cavity. The usual cause in adults is lymphatic obstruction or leakage caused by malignancy. Non-malignant causes include postoperative trauma, cirrhosis, tuberculosis, pancreatitis and filariasis. A variety of treatment options have been proposed for the management of chylous ascites; however, their effectiveness in idiopathic or primary form is unknown. Here we report a case of chylous acid rapidly resolved with the treatment of fasting, total parenteral nutrition and somatostatin analogue.

Negative pressure in pharyngo-oral cavity can treat lymphedema and related disorders.

With the finding of specific markers and growth factors for lymphatic vessels, more and more attentions were paid to research on lymphatic vascular system. But the treatment of lymphedema and related disorders is still difficult. Waldeyer's ring is the lymphoid tissues that form a ring around the opening of the throat including tonsils laterally, adenoids superiorly, and lingual tonsil at the base. We hypothesized that negative pressure in pharyngo-oral cavity can improve lymphatic system circulation by affect Waldeyer's ring. And this treatment is proved to be useful in the therapy of lymphedema and chyloperitoneum. So we came to the conclusion that negative pressure in pharyngo-oral cavity was helpful in the treatment of lymphedema and related disorders. But the mechanism of this treatment still need further study. The future of this field of research is very promising and may eventually lead to better treatment of lymphedema and related disorders.

Chylous ascites after pancreatico-duodenectomy cholangiocarcinoma xenografts in nude mice.

BACKGROUND: Chylous ascites (CA) following pancreatico-duodenectomy (PD) is a rare complication secondary to disruption of the lymphatics during extended retroperitoneal lymph node dissection. The majority of cases do not develop CA, possibly due to patency of the proximal thoracic duct and good collaterals. CA may be due to a consequence of occult obstruction of the proximal thoracic duct by malignant infiltration or tumor embolus. This study was to report the incidence of CA and its outcomes of management. METHODS: A retrospective search of our liver database was performed using the key words "pancreatico-duodenectomy", "chylous ascites" from January 2000 to December 2005. The medical records of CA patients and their management and outcome were reviewed. RESULTS: In 138 patients who had undergone PD in our centre for pancreatic malignancy, 3 were identified with CA and managed by abdominal paracentesis. CA resolved in 2 patients with low fat medium chain triglyceride diet alone and 1 patient had total parenteral nutrition (TPN) for persistent CA. Resolution of CA occurred in these 3 patients at a median follow-up of 4 weeks (range 4-12 weeks). Histologically, resected specimen confirmed pancreatic adenocarcinoma in all the patients. Two patients developed loco-regional recurrences at a median follow up of 8 months (range 6-10 months). And the other was currently disease free at a 10-month follow up. CONCLUSIONS: CA as an uncommon postoperative complication requires frequent paracentesis, prolonged hospital stay, and delayed adjuvant chemotherapy. CA is treated with low fat medium chain triglyceride diet or occasionally TPN is required.

Antithrombin activity in children with chylothorax.

OBJECTIVE: To determine whether increased antithrombin loss is present in children with chylothorax after cardiac surgery. METHODS: Plasma and pleural effusion samples of children with chylous and non-chylous pleural effusion were assayed for antithrombin activity. RESULTS: Ten children with chylothorax and five children with non-chylous pleural effusion were investigated. There was statistically significant increase in mean antithrombin activity in chylous samples (32.2+/-11.4%) compared to non-chylous samples (14.4+/-13.9%), and significant decrease in plasma of children with chylothorax (44.6+/-15.4%) compared to children with non-chylous pleural effusion (69.9+/-22.4%). Seven of 10 children with chylous and none of the children without chylous developed thrombosis (p<0.007). CONCLUSIONS: Increased loss of antithrombin is present in children with chylothorax, potentially predisposing these children to an increased risk of thrombosis. Repeated antithrombin substitution should be considered in critically ill children with chylothorax.

[Chylous ascites in cirrhotic and non-cirrhotic patients]. / Ascitis quilosa en pacientes cirróticos y no cirróticos.

Chylous ascites is an accumulation of lymph in the abdominal cavity. The diagnosis is established when the concentration of triglycerides in plasma is greater than in ascitic fluid over a level of 200 mg/dl. The clinical and biochemical characteristics of 22 patients with chylous ascites (11 cirrhotics and 11 non cirrhotics) were studied in order to assess differences between patients with and without hepatic cirrhosis. The cirrhotic patients with chylous ascites showed lower protein (1.3 +/- 0.74 mg/dl, p = 0.002) and cholesterol concentration (46.0 +/- 45.2 mg/dl, p = 0.02) in ascitic fluid than non cirrhotic patients (3.1 +/- 1.09 mg/dl, and 100.85 +/- 41.7 mg/dl, respectively). In addition, the cellularity in the ascitic fluid was also lower in cirrhotic patients (209.09 +/- 113.96 cel/mm3) versus (831.8 +/- 945.08 cel/mm3; p < 0.05). Four patients (18.18%) presented high adenosine deaminase levels (ADA) in the ascitic fluid in the absence of tuberculous peritonitis. The authors conclude that the biochemical differences observed in the ascitic fluid of the cirrhotic patients with chylous ascites may be explained by a dilutional mechanism due to the combination of "clear" ascites secondary to portal hypertension and chylous ascites. Furthermore, chylous ascites could be the cause of an elevation in ADA in the absence of tuberculous peritonitis.

Chylothorax and chylous ascites in a patient with uterine cancer.

A 63-year-old woman, who had undergone radical hysterectomy and radiation therapy for cervical cancer of the uterus three years previously, was found to have pleural effusion and ascites. A diagnosis of chylothorax and chylous ascites was made on the basis of these fluids' characteristics. She received medium-chain triglyceride (MCT) in her diet and intra-venous hyperalimentation to decrease the leakages of chyle into the pleural and peritoneal cavities, but she died of respiratory and renal failures after six months. At autopsy, metastases from the cervical cancer of the uterus to the lymph nodes in the mediastinum and around the abdominal aorta were proved histologically. Lymph node swelling due to metastasis had caused a rupture of the thoracic duct, leading to chylothorax and chylous ascites. The diagnosis, evaluation and therapeutic modalities of the condition are outlined and the literature reviewed.