Parasitic chyluria in a 72-year-old Sierra Leonean woman: A case report.

Although Sierra Leone lies within the worldwide filarial belt, chyluria (the passage of milky coloured urine) is a rare presenting symptom in clinical practice. This report describes a confirmed case of parasitic filariasis presenting in a 72-year-old woman. After treatment with a combination of ivermectin and albendazole, her symptoms resolved within 48 h and she was symptom free at 6 months.

Chyle Fistula After Neck Dissection: An 8-Year, Single-Center, Prospective Study of Incidence, Clinical Features, and Treatment.

BACKGROUND: Chyle fistula is a relatively rare complication of neck dissection, and there is a lack of consensus regarding its incidence, risk factors, and management. METHODS: Between 2007 and 2014, a total of 472 cases of neck dissection involving the level IV compartment were included in the study. The incidence, risk factors, and clinical course of chyle fistula were investigated, as well as the outcomes of conventional management and the use of octreotide injection in high-output chyle fistula. RESULTS: The overall incidence of chyle fistula was 4.7 % (22/472), with an incidence of 3.0 % and 6.2 % after right and left neck dissection, respectively. The presence of a metastatic lesion around the junction of the internal jugular vein and subclavian vein was the only factor significantly associated with the development of chyle fistula (approximately fourfold higher risk) in univariate and multivariate analyses. In 22 cases of chyle fistula, the mean total drainage volume was 3226 mL during a mean 15.4 days of drain placement. Total parental nutrition for the management of chyle fistula was required in 16 cases. Nine (40.9 %) of 22 cases experienced additional complications related to chyle fistula. Of the six high-output cases, four were managed with conservative methods plus octreotide injection, and three did not require surgery. CONCLUSIONS: The incidence of chyle fistula after neck dissection was higher than expected, especially on the right side. Surgeons should pay greater attention to chyle fistula from preoperative evaluation to postoperative management.

Gefitinib leads to complete resolution of postoperative cervical chyloma and chylothorax in a lung cancer patient.

Cervical chyloma is a not uncommon complication after neck surgery, especially following diagnostic excision of supraclavicular lymph nodes. Conservative treatment remains the standard approach but is inevitably distressful. We describe the case of a 60-year-old Asian woman who was diagnosed as having adenocarcinoma of the lung with cervical and supraclavicular node involvement. She developed persistent cervical chyle leak after excisional biopsy of the supraclavicular nodes and proved refractory to all management. Subsequent gefitinib therapy led to rapid resolution of chyloma and tumor regression. This case provided a unique experience of managing intractable postoperative chyloma in a cancer patient.

The community management of chylous fistula using a pancreatic lipase inhibitor (orlistat).

We describe two innovative ideas in the treatment of iatrogenic chyle leak. The first is the early use of a pancreatic lipase inhibitor (Orlistat) to reduce fat absorption and chyle production, with consequent faster fistula healing. The second is the treatment of these patients at home in the community by district nurses backed by the hospital staff. This domiciliary approach has a positive psychological effect on the patient, permits the patient to take responsibility for their treatment, and reduces hospital length of stay minimising patient exposure to nosocomial infections.

Octreotide in the treatment of thoracic duct injuries.

Anecdotal reports support the use of octreotide in the treatment of traumatic thoracic duct injuries and chylothorax, but no prospective studies have proved its efficacy. We evaluated the effects of octreotide in treating thoracic duct transection in a canine model. Eight mongrel dogs (27.8+/-5.1 kg) were fed one pint of 10.5 per cent milkfat 2 hours before operation. Through a left supraclavicular neck incision, the thoracic duct was identified and transected, producing free flow of chyle. A quarter-inch drain was tunneled subcutaneously from the wound and attached to closed suction. After wound closure dogs were randomized to a control group (n = 4) receiving sham injections of saline subcutaneously three times per day, or a treatment group (n = 4) given 3 microg/kg octreotide three times per day. Postoperatively all dogs were fed a standard low-fat (5-7%) crude fat diet. Drain output was measured each day, and on odd-numbered postoperative days the drainage was analyzed for cholesterol, triglycerides, albumin, and total protein. Fistula closure was defined as drainage <10 ml/24-hour period. Treated dogs achieved fistula closure significantly faster than controls: 3.5+/-1.3 days versus 7.8+/-1.0 days (P = 0.0037). Whereas equivalent amounts of drainage occurred on the day of surgery and on postoperative day one in both groups, by postoperative day 2 the treatment group had significantly less drainage over 24 hours: 63+/-69 ml versus 195+/-79 ml (P = 0.046); this significant difference persisted through postoperative day 5 when drainage began to decrease in the control group. No significant differences between groups were seen in levels of cholesterol, triglycerides, albumin, or protein in the drainage at any time point. We conclude that octreotide is effective in treating thoracic duct injury, leading to an early decrease in drainage and early fistula closure. The mechanism for this effect remains to be clarified.