Minimally Invasive Treatment of Chyle Leak After Thyroidectomy and Cervical Lymph Node Dissection in Patients with Thyroid Carcinoma: Results of a Study Involving 36 Patients.

Objective: Chyle leak (CL) after head and neck surgery is a rare but well-known complication. In patients with high-output leakage, the treatment can be complicated. This study aims to report on a recent innovation in lymphatic intervention for treating such patients. Materials and Methods: A retrospective review of 36 patients with chyle leak after neck surgery for thyroid cancer was conducted to assess the efficacy of percutaneous lymphatic embolization and thoracic duct (TD) disruption. Results: Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1-7 days). There was no complication intra and after procedures. Conclusion: TDE, selective TD branches embolization and TDD are safe and effective minimally invasive treatments for CL post-surgery for thyroid carcinoma. Sclerosing cervical fluid collection contributes to clinical success.

Occlusion of thoracic duct stent resulting in recurrent chyluria: role of renal-lymphatic fistula embolization.

BACKGROUND: Thoracic duct (TD) stenting is considered a treatment option for certain pathological conditions caused by TD obstruction, such as chyluria. Several studies have reported on the efficacy of TD stent treatment for both obstructive and leakage condition of TD, but few have evaluated the stent patency. This report aims to describe the patency of TD stent and the effectiveness of renal-lymphatic fistula embolization in the treatment of chyluria. CASE PRESENTATION: We report a case of chyluria treated by TD stent previously, stent was placed at the TD venous junction four months before the symptoms recurred. At the second intervention we found the stent was obstructed by debris. We recanalized the stent and successfully catheterised the microcatheter through the stent retrograde into the TD then into the renal-lymphatic fistula branch. After embolization of that abnormal branch, the recurrent chyluria was treated and no further episode of chyluria was occurred during 12 months follow up. CONCLUSION: Stent in the TD may be occluded by debris. Embolization of renal-lymphatic fistula might be the most important treatment for spontaneous chyluria.

Thoracic duct stent treatment for chyle leak after nephrectomy.

Chyle leak is a rare and serious condition caused by damaged lymphatic vessels. It can occur after retroperitoneal surgery involving extensive lymphadenectomy for kidney cancer. Besides lymphatic channel damage, the obstruction of the thoracic duct worsens the leakage. Managing patients with thoracic duct obstruction and postsurgical chyle leakage is challenging due to limited data on how to handle this condition. In this case report, a 28-year-old female patient underwent left nephrectomy for left kidney cancer. Three days after the surgery, milky fluid drained from the left renal fossa. Conservative treatment failed, and further examination through magnetic resonance lymphangiography revealed the absence of the thoracic duct and contrast extravasation at the left renal fossa. Lymphangiography confirmed distal thoracic duct obstruction. The patient's condition was successfully managed by using thoracic duct stenting. This report contributes to the understanding that thoracic duct obstruction can lead to lymphatic collateral circulation within the abdomen, thereby increasing the risk of postoperative chylous leak.

Review of the epidemiology, diagnosis and management of invasive meningococcal disease in Vietnam.

Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, is life-threatening with a high case fatality rate (CFR) and severe sequelae. We compiled and critically discussed the evidence on IMD epidemiology, antibiotic resistance and disease management in Vietnam, focusing on children. PubMed, Embase and gray literature searches for English, Vietnamese and French publications, with no date restrictions, retrieved 11 eligible studies. IMD incidence rate (/100,000 population) was 7.4 [95% confidence interval 3.6-15.3] in children under 5 years of age; driven by high rates in infants (e.g. 29.1 [8.0-106.0] in 7-11 month-olds). Serogroup B IMD was predominant. Neisseria meningitidis strains may have developed resistance to streptomycin, sulfonamides, ciprofloxacin, and possibly ceftriaxone. There was a lack of current data on diagnosis and treatment of IMD, which remain challenging. Healthcare professionals should be trained to rapidly recognize and treat IMD. Preventive measures, such as routine vaccination, could help address the medical need.

A 44-Year-Old Man With Chronic Lower Chest Pain.

CASE PRESENTATION: A 44-year-old man was admitted to the hospital because of chest pain located around his lower thoracic spine with deep inspiration for 6 months. He denied having any cough, dyspnea, fever, or weight loss. He had no history of trauma. He was a nonsmoker, without any other personal or familial medical history. He had been examined at some hospitals, but the cause had not been determined.

Chylous ascites after donor nephrectomy: MR lymphangiography and lymphatic embolization treatment.

Chylous ascites results from the leakage of lipid-rich lymphatic fluid into the peritoneal cavity. Most postsurgical chylous ascites occurs following abdominal aortic surgeries. However, rarely, it is a complication after laparoscopic donor nephrectomy. Postsurgical chylous ascites are often managed with conservative treatment or surgery, but lymphatic embolization may be required. Here, we presented a 45-year-old male patient who was referred for abdominal distension for 1 week after left donor nephrectomy. The drain fluid was milky and fluid analysis revealed high concentrations of triglycerides and chylomicron, confirming diagnosis of chylous ascites. The patient was treated with conservative therapy including a low-fat diet and fluid drainage but continued to have high draining output (up to 1500-2000 mL/24 h). He underwent magnetic resonance lymphangiography and intranodal lymphangiography, revealing extravasation of contrast into the abdomen and the left renal fossa. We embolized the interstitial lymphatic of the left retroperitoneal and lymphatic vessels leak. The patient was discharged from hospital at the fifth day after intervention. In this article, we demonstrate lymphatic lesions, the safety, and success of this technique.

Management of chyluria using percutaneous thoracic duct stenting.

BACKGROUND: Thoracic duct stenosis or obstruction is one of the causes of chyluria. Although the diagnosis of chyluria is not difficult, treatment is still challenging. Although there have been no standard guidelines for the treatment of chyluria, interventional techniques now offer minimally invasive treatment options for chyluria such as interstitial lymphatic embolization, ductoplasty with balloon, or thoracic duct stenting. CASE PRESENTATION : Here, we report a case of chyluria due to obstruction of the junction between the thoracic duct and subclavian vein in a 64 -year- old female patient. The patient was treated with balloon plasty for lymphovenous junction obstruction and interstitial lymphatic embolization for chyluria. However, chyluria was recurrent after 6 months so intranodal lymphangiography was performed. Anterograde thoracic duct was accessed through a transabdominal to the cisterna chyli which showed that the thoracic venous junction was re-obstruction. The patient was successfully treated by placing a uncovered drug-eluting stent with the size of 2.5 mm x 15 mm in length for resolving the thoracic occlusion. CONCLUSION: This report demonstrates the feasibility of using thoracic duct stenting in the treatment chyluria due to lymphovenous junction obstruction.

A case report of primary pulmonary artery intimal sarcoma.

Primary pulmonary artery sarcoma is a rare tumor that mimics pulmonary embolism. Patients may present with cough, dyspnea, chest pain, and weight loss. The diagnosis is challenging. Herein, we report a case of 29-year-old female patient who had presented with dyspnea, fatigue for 2 weeks. Computed tomography pulmonary angiography scan suggests pulmonary embolism. We decided to perform surgical embolectomy. The histopathological results, however demonstrated primary pulmonary artery intimal sarcoma. The patient died 1-month post-surgery because of respiratory and circulatory failure.

A 32-Year-Old Man With Dyspnea and Stridor.

CASE PRESENTATION: A 32-year-old man was admitted to the hospital because of dyspnea on exertion for 2 months. Dyspnea occurred in both inspiration and expiration with an associated wheeze that was more pronounced with exertion. He had no other medical history or allergies. The patient was a current one-pack-a-day smoker for the past 5 years. He denied any close personal contact or recent exposure to any patients with active TB. He denied any current symptoms of chest pain, cough, fever, or changes in weight. On a prior admission for similar symptoms, the patient had been diagnosed with asthma and treated with an inhaled corticosteroid/long-acting beta-agonist with no change or improvement in symptoms.

A Rare Case of Kikuchi-Fujimoto Disease in a Young Female Patient.

BACKGROUND Kikuchi-Fujimoto disease (KFD) is a rare benign and usually local lymphadenopathy that typically occurs in young women. Patients with it usually have non-specific symptoms, such as fever in the afternoon, cervical lymphadenitis, and weight loss. Posterior cervical lymphadenopathy is the most common manifestation of KFD. The symptoms often last for a few weeks and then resolve spontaneously. The cause of KFD is unknown; however, it is considered to be related to some infectious agents, as well as several autoimmune diseases. Because of the non-specific symptoms and the rarity of KFD, the cervical lymphadenopathy associated with it can be misdiagnosed as coming from a more common condition. Making a correct diagnosis requires histology of the affected lymph nodes. CASE REPORT Here, we describe the case of a 25-year-old Vietnamese woman who presented with mild fever in the afternoons and enlarged cervical lymph nodes with no local sign of inflammation. She was initially believed to have tubercular lymphadenitis because of her symptoms and the high prevalence of tuberculosis in Vietnam. However, she had no respiratory symptoms and tested negative on QuantiFERON-TB Gold. Pathology from the patient's lymph node specimen showed an abnormal inflammatory reaction in the tissue. Her lesions were suspected to have been caused by KFD and she was treated successfully with nonsteroidal anti-inflammatory drug (NSAID) therapy. CONCLUSIONS KFD is a benign disease that manifests with common symptoms. The diagnosis is based on biopsy of a specimen and pathology results. No treatment is required in patients who have no symptoms. Patients with symptoms usually respond well to a short course of NSAID therapy.

Percutaneous sclerosing injection to the thoracic duct under CT guidance for cervical chylous leakage post thyroidectomy: A case report.

Chylous leakage after thyroidectomy is rare, and almost all patients with this complication can be treated conservatively. However, in patients with high-flow leakage, treatments can be complicated. In this study, we report a case that was successfully treated by disrupting the thoracic duct using two sessions of percutaneous interventions. The first intervention was a thoracic duct embolization, and the second intervention was a sclerosing injection to the thoracic duct under computed tomography guidance.

A 69-Year-Old Man With Chronic Cough and Recurrent Pneumonia.

CASE PRESENTATION: A 69-year-old man consulted for a 3-day history of fever, wet cough, and yellow-green phlegm. He denied having any dyspnea, chest pain, hemoptysis, swallowing disorders, choke, chills, asthenia, anorexia, or weight loss. He reported a continuous dry cough and three episodes of pneumonia in the past 4 years. He was a nonsmoker, without any other personal or familial medical history. He had no known professional exposure. He was born and lived in Vietnam but had no known contact with TB in his family or workplace. He was never imprisoned or homeless and did never travel abroad.

A 24-Year-Old Man With Recurrent Hemoptysis.

CASE PRESENTATION: A 24-year-old man was admitted for a new episode of hemoptysis. He reported 3 episodes of hemoptysis in the past 2 years. He had no other medical history and was a nonsmoker. As a Vietnamese person born and living in Vietnam, he was at risk for TB, but had not had contact with those having TB in his family or workplace, was never imprisoned nor homeless, and never traveled abroad. He never experienced pneumonia. He coughed up a small amount of fresh with air red blood (around 5 mL each time) several time for 3 days. He had no dyspnea, no chest pain, no fever, no asthenia, and no anorexia.

School education and childhood obesity: A systemic review.

Childhood obesity prevalence is shooting up at a phenomenal rate worldwide, leading to long-term devastating consequences. A great number of studies have investigated factors contributing to the increase in BMI of children and adolescents. School-based, home-based and clinic-based solutions have been suggested as possible viable strategies, among which school-based interventions is believed to produce a noticeable effect on a massive scale. However, the question of whether school interventions, especially school education exert significant impact on childhood obesity or not, is left with mixing results. This article aims to holistically review the relationship between school education and childhood obesity. Various factors are covered, including health education, nutrition education, school nutrition, physical education, teachers' awareness, teaching practice and school stress, In all, school education is not the answer to childhood obesity but just part of it. More attempts from other stakeholders (parents, community, policy makers, researchers, etc.) should be made in order to solve this complicated puzzle.

An Update on Anti-CD137 Antibodies in Immunotherapies for Cancer.

The selective expression of CD137 on cells of the immune system (e.g., T and DC cells) and oncogenic cells in several types of cancer leads this molecule to be an attractive target to discover cancer immunotherapy. Therefore, specific antibodies against CD137 are being studied and developed aiming to activate and enhance anti-cancer immune responses as well as suppress oncogenic cells. Accumulating evidence suggests that anti-CD137 antibodies can be used separately to prevent tumor in some cases, while in other cases, these antibodies need to be co-administered with other antibodies or drugs/vaccines/regents for a better performance. Thus, in this work, we aim to update and discuss current knowledge about anti-cancer effects of anti-CD137 antibodies as mono- and combined-immunotherapies.

The roles of, activities of, and competencies for, community nursing services in rural Vietnam: Implications for policy decisions.

Community health workforce plays a vital role in providing primary health care services as per the needs of residents; however, few studies have examined how nurses work within commune health centers (CHCs). Using qualitative methods including interviews and focus group discussions with key stakeholders, this study explores the roles, activities, and competencies required of community nursing services in rural districts within Vietnam. Two primary roles were identified: CHC nursing and family nursing. For the latter, in addition to providing people with general health care and health communication, they were expected to also deliver psychological care. CHC nursing fulfilled more roles and required four specific competencies: clinical care, communication, management, and planning/coordination activities. Despite these various roles serving people within a community, few ongoing efforts at either the local or national level are aimed at supporting these nurses. The study highlights the need for policy decisions via either developing a new job position policy or adapting the existing policy by integrating new roles into the existing positions of CHC nurses in Vietnam.

Household trends in access to improved water sources and sanitation facilities in Vietnam and associated factors: findings from the Multiple Indicator Cluster Surveys, 2000-2011.

BACKGROUND: Despite progress made by the Millennium Development Goal (MDG) number 7.C, Vietnam still faces challenges with regard to the provision of access to safe drinking water and basic sanitation. OBJECTIVE: This paper describes household trends in access to improved water sources and sanitation facilities separately, and analyses factors associated with access to improved water sources and sanitation facilities in combination. DESIGN: Secondary data from the Vietnam Multiple Indicator Cluster Survey in 2000, 2006, and 2011 were analyzed. Descriptive statistics and tests of significance describe trends over time in access to water and sanitation by location, demographic and socio-economic factors. Binary logistic regressions (2000, 2006, and 2011) describe associations between access to water and sanitation, and geographic, demographic, and socio-economic factors. RESULTS: There have been some outstanding developments in access to improved water sources and sanitation facilities from 2000 to 2011. In 2011, the proportion of households with access to improved water sources and sanitation facilities reached 90% and 77%, respectively, meeting the 2015 MDG targets for safe drinking water and basic sanitation set at 88% and 75%, respectively. However, despite these achievements, in 2011, only 74% of households overall had access to combined improved drinking water and sanitation facilities. There were also stark differences between regions. In 2011, only 47% of households had access to both improved water and sanitation facilities in the Mekong River Delta compared with 94% in the Red River Delta. In 2011, households in urban compared to rural areas were more than twice as likely (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.9-2.5) to have access to improved water and sanitation facilities in combination, and households in the highest compared with the lowest wealth quintile were over 40 times more likely (OR: 42.3; 95% CI: 29.8-60.0). CONCLUSIONS: More efforts are required to increase household access to both improved water and sanitation facilities in the Mekong River Delta, South East and Central Highlands regions of Vietnam. There is also a need to address socio-economic factors associated with inadequate access to improved sanitation facilities.

Community-based intervention for depression management at the primary care level in Ha Nam Province, Vietnam: a cluster-randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of an intervention including psychoeducation and yoga for depression management at the primary healthcare level in one district in the Hà Nam province, Vietnam. METHOD: The Patient Health Questionnaire-9 (PHQ-9) was used for depression screening and follow-up. Screened patients were further diagnosed with the Mini-International Neuropsychiatric Diagnostic Interview, by a trained general doctor. A linear regression model, adjusted for age, gender and baseline PHQ-9 score was used to assess whether the intervention leads to decreased depression severity compared to standard care in the control communes. RESULTS: Both groups had similar PHQ-9 scores at baseline. The intervention group had on average significantly lower PHQ-9 scores after the intervention than the control group. Almost half of the patients in the intervention group recovered from depression, whereas nobody did in the control group. CONCLUSION: The results indicate that the intervention can be more effective than standard care in treating depression. The mean change of the PHQ-9 score after the intervention is deemed to be of clinical relevance.

Drug use among children under 5 with respiratory illness and/or diarrhoea in a rural district of Vietnam.

OBJECTIVES: To describe the pattern of drug use among the children with respiratory illnesses and/or diarrhoea; and to analyze the association between various socio-economic factors and pattern of drug use. METHODS: A population-based survey of 4087 children under five was conducted within the framework of an epidemiological surveillance site in a rural district of Vietnam. Through interviewing mothers or caretakers, data on self-reported illness, use of drugs, and use of health services during 2 weeks prior to the survey and other background information were collected. RESULTS: Out of 4087 children, 1836 children had respiratory illness and/or diarrhoea during 2 weeks before the interview and drugs were used in the majority of cases. Antibiotics (72.2%) and analgesics/antipyretics (53.5%) were the drugs most commonly reported. Corticosteroids were used in 11.6% of all cases. Among children with diarrhoea, Oral Rehydration Solution (ORS) was used in 9.7%, while anti-diarrhoea drugs were used in 36.1% of all cases. There was a significant association between the family's socio-economic condition and use of corticosteroids, but to a lesser degree regarding other drugs. There was no significant association between pattern of drug use and type of health service consulted. CONCLUSIONS: There are major problems about irrational drug use among children. The treatment guidelines for respiratory illness and diarrhoea are not followed. Urgent actions are needed and should target all actors in the field, mothers, doctors, pharmacy staff, and authorities in order to improve this situation.