Chyle is a fluid rich in triglycerides and is characterized by the presence of chylomicrons. Chylous effusions are unusual complications of malignant neoplasms, usually lymphomas. The combination of chyloperitoneum and chylothorax is very rare. When abdominal lymphatics are obstructed, chylous ascites results and eventually leads to a chylothorax. We present the case of a 68-year-old woman with a chyloperitoneum and a right-sided chylothorax due to an underlying malignant B-cell lymphoma. After thoracocentesis and replacement therapy with medium chain triglycerides, she was treated with a combination of cyclophosphamide, vincristine and prednisone. This has resulted in a regression of the chylous effusions. A short review of the literature describes causes, diagnosis and therapy of chylous effusions.

The objective of this study was to investigate, through a patient chart analysis, the average and the variation in the medical resource use in pulmonary embolism (PE) patients in Belgium, and to find explanatory variables for the possible variation. A sample of patients with confirmed PE (n = 54) from 5 centres was selected. The centres were representative for size and region. The charts were selected at random after applying a set of exclusion criteria, in order to avoid heterogeneity of the sample characteristics. Charts were analysed using a standardised case report form, and medical resource use was collected by an independent researcher. Only medical resources related to the PE were included. On average, it appeared that the management of PE was fairly consistent between the different centres. The total average cost of PE was [symbol: see text] 3394 (St. Err. = [symbol: see text] 323). Nevertheless, large differences were found in the number of diagnostic and follow-up tests. Also, a wide variation in duration of hospital stay was found (average = 14.6, p75-p25 = 9.0), but this effect was not explained by the type of centre nor the region. The two factors that explain duration of hospital stay are the number of days of IV heparin use and the intensity of diagnostic follow-up, as expressed by the number of VQ-scans.

We report a rare case of symptomatic adverse local tissue reaction in a patient with a ceramic-on-ceramic total hip bearing surface and review the literature. Probably, ceramic wear debris is not entirely inert and may lead to adverse local tissue reactions.

Outside of cobalt-chromium alloy articulations, the development of adverse local tissue reaction (ALTR) after total hip arthroplasty (THA) is uncommon but remains a significant complication [1]. ALTR is used to describe a granulomatous or destructive cystic lesion that develops around a THA [1,2]. The patient often describes the first sign of the development of ALTR and pseudotumor formation as discomfort and pain. ALTR causes soft tissue mass, osteolysis, bone erosion, and significant damage to periarticular soft tissues, leading to total joint failure and instability [1]. In THA, ALTR may develop around metal-onpolyethylene implants due to taper corrosion and around metal-on-metal (MoM) bearing surfaces [3-6].