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Query: UMLS:C0020505 (hyperphagia)
 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case is presented in which a unique combination of events occurred as a complication of subclavian vein catheterization. Extravasation of intravenous hyperalimentation solution occurred, resulting in mediastinitis and venous obstruction of the jugulosubclavian confluence bilaterally. Bilateral chylothorax resulted which was successfully managed by conservative means. The methods used and the rationale for their employment are discussed.
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PMID:Chylothorax: a complication of subclavian vein catheterization and parenteral hyperalimentation. 81 71

Persistent loss of chyle, rich in metabolites, water and electrolytes, can be quickly devastating, particularly in debilitated patients and children. Chylothorax of traumatic origin, especially when loss of chyle is rapid, is most effectively arrested with direct closure of the fistula or ligation of the thoracic duct. Thoracic duct ligation is indicated when a controlled fat diet or parenteral hyperalimentation without oral intake and closed chest drainage are not effective in arresting chylous pleural effusions.
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PMID:Chylothorax: therapeutic alternatives. 86 Aug 60

A 34-year-old woman was admitted with an abnormal shadow on a chest X-ray film. Under a preoperative diagnosis of benign bronchogenic cyst, operation was carried out and the tumor was found to be originating from the right main vagal nerve in the mid-superior mediastinum. The vagal nerve was transected to remove the tumor. Pathological diagnosis was a neurinoma. Postoperative complication was chylothorax which was successfully treated with thoracic drainage and intravenous hyperalimentation.
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PMID:[A case of mediastinal neurinoma originating from right intrathoracic vagal nerve]. 231 24

Chylothorax is an unusual complication after transhiatal esophagectomy (THE) and in the past 10 years has occurred in 11 of 320 patients (3%) undergoing this operation for diseases of the intrathoracic esophagus. Four patients had benign esophageal disease: scleroderma reflux esophagitis (1), caustic stricture (1), and achalasia (2), and each had undergone at least one previous esophageal operation. Seven patients had intrathoracic esophageal carcinoma--two upper-third, two middle-third, and three distal-third lesions. Excessive chest tube drainage more than 72 hours after THE was the standard presentation, and the diagnosis of chylothorax was confirmed by the administration of cream through the jejunostomy feeding tube placed routinely at operation. The character of the chest tube drainage changed from serous to opalescent. Aggressive treatment of this complication was the rule, and every patient underwent a thoracotomy between 2 to 14 days (average, 6 days) after the diagnosis was established. Cream was administered through the jejunostomy tube before operation, and in each case the thoracic duct injury was readily identified and controlled with suture ligatures. There were no deaths in this group, and there was one recurrence of the fistula that required reoperation; all patients were discharged from the hospital within 3 to 29 days (average, 10 days) after thoracic duct ligation. It is concluded that early recognition of a chylothorax after transhiatal esophagectomy with prompt transthoracic ligation of the injured duct results in a shorter overall hospitalization and lower morbidity and mortality from this complication. The traditional conservative management of chylothorax with intravenous hyperalimentation and no or low-residue enteral feedings has little place in this nutritionally depleted patient population.
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PMID:Aggressive treatment of chylothorax complicating transhiatal esophagectomy without thoracotomy. 317 69

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.
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PMID:Chylothorax and chylous ascites in a patient with uterine cancer. 328 82

Ligation of the thoracic duct has previously been recommended for adults with traumatic chylothorax when average daily chyle loss exceeds 1,500 mL/day over five days since such cases are usually refractory to medical management. We describe a case of traumatic chylothorax where chyle output exceeded 2 L/day for a week despite cessation of oral intake and institution of intravenous hyperalimentation. The chylothorax rapidly resolved when mechanical ventilation with positive end-expiratory pressure was begun for treatment of an acute respiratory distress syndrome. The artificial ventilation may have promoted tamponade of the injured lymphatic duct thereby accounting for the abrupt decrease in chyle flow the occurred.
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PMID:Resolution of chylothorax after positive end-expiratory pressure ventilation. 698 92

A 76-year-old female was referred to our hospital for examination of milky pleural effusion. We diagnosed her illness as chylothorax because of the high concentration of triglyceride in the effusion. There was neither obstruction nor damage of the thoracic duct. Systemic evaluation disclosed an abdominal mass in the umbilical region. Fasting with intravenous hyperalimentation followed by pleurodesis with minocycline successfully eliminated the effusion. On the other hand, the abdominal mass was diagnosed as mesenteric panniculitis by open biopsy. Since she also had chylous ascites, the tumor could have obstructed the intestinal lymphatics. Chylothorax was probably caused by damage to collateral lymph circulation.
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PMID:[A case of chylothorax caused by mesenteric panniculitis]. 750 May 56

Indications of rethoracotomy after esophagectomy for esophageal cancer are reviewed in this paper. Hemothorax, pneumothorax, pyothorax and chylothorax are the main causes of rethoracotomy. Complications indicating rethoracotomy are summarized as follows: 1) Hemothorax; emergency rethoracotomy is indicated in cases of bleeding through the chest drain over 100ml/hr, which is continuing over 5 hours or in cases when normal blood pressure cannot be maintained without blood transfusion. In many cases the bleeding point is the chest wall, from the branches of the intercostal artery. 2) Pneumothorax; reoperation for pneumothorax is rare. But rethoracotomy and bullectomy or closure of fustula is indicated when a large volume of air leakage and lung collapse continues over a week. 3) Pyothorax; old pyothorax with bronchial fistula is treated by closure of fistula and plombage with omentum or muscle flap. 4) Chylothorax; chylothorax is not a frequent complication of esophageal surgery but when it occurs reoperation is not rare. In cases with 1,500ml/day or more of chyle drainage for over 5 days under fasting with intravenous hyperalimentation, rethoracotomy and ligation of thoracic duct is indicated.
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PMID:[Indications of rethoracotomy after esophagectomy for esophageal cancer]. 877 13

Between July 1987 and May 1995, 11,315 patients underwent general thoracic surgical procedures at our institution. In 47 of these patients (0.42%), postoperative chylothorax developed. There were 32 men and 15 women with a median age of 65 years (range 21 to 88 years). Initial operation was for esophageal disease in 27 patients, pulmonary disease in 13, mediastinal mass in six, and thoracic aortic aneurysm in one. All patients were initially treated with hyperalimentation, cessation of oral intake, medium chain triglyceride diet, or a combination. Nonoperative therapy was successful in 13 cases (27.7%), and oral intake was resumed a median of 7 days later (range 2 to 15 days). Reoperation was required in the remaining 34 cases. The reoperation rate varied according to the type of initial operation. Twenty-four of the 27 patients (88.9%) who had undergone an esophageal operation required reoperation, versus only five of 13 patients (38.5%) who had undergone pulmonary resection (p < 0.001). Lymphangiography was performed in 16 patients and identified the site of the leak in 13. The thoracic duct was ligated in 32 of the 34 patients who required reoperation (94%). The remaining two patients were treated with mechanical pleurodesis and fibrin glue. Reoperation was successful in 31 of the 34 patients (91.2%). The single death among the 47 patients (2.1%) occurred in the reoperated group. Complications occurred in 18 patients (38.3%). Factors that predicted the need for reoperation were initial esophageal operation and average daily postoperative drainage greater than 1000 ml/day for 7 days. We conclude that postoperative chylothorax is an infrequent complication. Some cases can be managed without operation; however, we recommend early reoperation when drainage is greater than 1000 ml/day or if the chylous fistula occurs after an esophageal operation. The fistula can usually be controlled by ligation of the thoracic duct.
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PMID:Postoperative chylothorax. 891 35

Hemothorax and chylothorax remain perplexing medical problems. The primary cause of hemothorax is trauma, whereas the primary cause of chylothorax is cancer. Most patients with hemothorax can be treated with chest tube drainage only. Early thoracotomy with thoracic duct ligation is recommended for patients with chylothorax when conservative treatment with chest tube drainage and hyperalimentation fails. Radiation therapy is the mainstay of treatment for chylothorax related to cancer. Video-assisted thoracoscopy may play an increasing role in the surgical treatment of both hemothorax and chylothorax.
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PMID:Hemothorax and chylothorax. 926 19


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