Conservative versus surgical management of chylothorax

Marts, Boyd C.; Naunheim, Keith S.; Fiore, Andrew C.; Pennington, D. Glenn

doi:10.1016/s0002-9610(05)81195-x

Cited by 175 publications

(109 citation statements)

References 12 publications

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“…[6][7][8][9] Dietary management of infants with chylothorax has included TPN to a low-fat (or medium-chain triglycerides), high-protein diet. Special cow-based formulas with medium-chain triglycerides such as Pregestimil and Portagen have been used.…”

Section: Discussionmentioning

confidence: 99%

“…5 Once drainage is accomplished, infants are placed on formulas containing medium-chain triglycerides, rather than long-chain fats, to reduce thoracic duct lymph flow and the rate of reaccumulation of chyle. [6][7][8] Human milk has not been used with infants with chylothorax because of its high long-chain fatty acid content. 9 However, infants with chylothorax may benefit from using human milk because of its immunologic qualities that are not present in cow's milk-based formulas.…”

Section: Introductionmentioning

confidence: 99%

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The use of fat-free human milk in infants with chylous pleural effusion

Chan

Lechtenberg

2007

J Perinatol

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Objective: The purpose of this study is to describe the processing of human milk to remove its fat content and its use in seven infants with chylothorax.Study design: The mother's milk was centrifuged at 3000 r.p.m. for 15 min at 21C. After centrifugation, the milk separated into a solidified-fat top layer and a lower liquid portion. The fat-free liquid portion was then poured into collection cups and frozen for the patient's use at a later date. A sample of the mother's milk before and after processing was stored and analyzed for fat, sodium, potassium, calcium and zinc.Results: The mean fat removed was 5±1 g/dl (mean±s.d.), which was the same as the pre-fat content of the mother's milk. Seven infants with chylous pleural effusions used the fat-free human milk. All infants started on the fat-free milk after a month of age for an average of 16 days duration (7 to 34 days range). There was no reaccumulation of the chylous pleural effusions with the use of the fat-free mother's milk. Mother's milk electrolytes were similar before and after processing. Conclusion:Fat-free human milk may be an important additional dietary therapy for infants with chylothorax and may add the immunologic properties of human milk that other feedings cannot provide.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The use of fat-free human milk in infants with chylous pleural effusion

Chan

Lechtenberg

2007

J Perinatol

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“…Many follow guidelines that Selle and associates [14] suggested. They propose surgery in trauma, daily loss of chyle exceeds 1,500 mL in adults or > 100 mL/ kg body weight per day in a child, when the output of chyle is not diminished over a 14-day period, or when nutritional complications seem imminent [15]. Graham et al recommend that surgical intervention is highly effective and seems warranted if the chylothorax has not responded after 5-7 day trial of medical therapy in both adults and children [16].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Chylothorax. An Unusual Presentation in the Course of Immune Reconstitution Inflammatory Syndrome, HIV Infection and Kaposi’s Sarcoma: A Case Report

Boultadakis

2014

J Med Cases

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Immune reconstitution inflammatory syndrome (IRIS) is a term used to describe the paradoxical worsening of a pre-existing infection or the presentation of a previously undiagnosed condition in HIV-infected patients soon after commencement of antiretroviral therapy (ART). We report a case of a patient with HIV infection and Kaposi sarcoma, who developed bilateral chylothorax as a manifestation of IRIS, after the initiation of highly active antiretroviral therapy. Bilateral chylothorax is extremely rare and has been associated with significant morbidity and mortality. We present here the successful management with bilateral video-assisted thoracic surgery.

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“…Hicieron plantear la posibilidad de quilotórax traumático bilateral secundario a lesión del conducto torácico (vaso linfático) Quilotórax es una complicación no muy frecuente de cirugía esofágica y torácica, que se asocia a traumatismos torácicos leves o moderados (3,4) , y también se asocia a neoplasias como linfomas o metástasis a ganglios regionales. Su manejo debe ser siempre el drenaje en primera instancia, pero luego considerar la intervención quirúrgica en casos de drenaje prolongado (5,6). Nosotros presentamos un caso asociado a punción percutánea repetida de la vena subclavia, también comentada por otros autores (7), pensamos que la lesión directa del vaso linfático puede explicar su formación.…”

Section: Discussionunclassified

Efusión pleural secundaria a cateterización venosa central: Quilotórax e hidrotórax. A propósito de dos casos.

Hermoza¹,

Chiarella²,

Aguirre³

et al. 2013

Rev Med Hered

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INTRODUCCIÓNEl acceso vascular de venas centrales se ha constituido en una ayuda invalorable, principalmente, en las Unidades de Cuidados Intensivos (UCI), para infusión de líquidos, presión venosa central, nutrición parenteral (1). No obstante, este procedimiento tiene ciertos riesgos y/o complicaciones, que pueden ser inaparentes al inicio y manifestarse luego de algunas horas.El propósito de esta comunicación es mostrar dos de sus complicaciones: quilotórax e hidrotórax. CASO 1Paciente mujer de 14 meses de edad, y 9170 gr de peso, que ingresó por cuadro de diarrea y edemas, catalogada con desnutrida severa (K washiokor) y sepsis a punto de partida gastrointestinal. La paciente recibió tratamiento antibiótico de amplio espectro: en su evolución, presentó hemorragia digestiva alta y malabsorción intestinal, por lo que se inició nutrición parenteral total, mediante flebotomía.A los 26 días de su hospitalización se decide colocar catéter central percutáneo por vía subclavia, en varios intentos por cada lado, resultando fallidos. Treinta y seis horas después del último intento la paciente inició distres respiratorio en forma paulatina, a los 48 horas la radiografía de tórax evidenció derrame pleural bilateral (Ver figura Nº 1).

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Conservative versus surgical management of chylothorax

Cited by 175 publications

References 12 publications

The use of fat-free human milk in infants with chylous pleural effusion

The use of fat-free human milk in infants with chylous pleural effusion

Bilateral Chylothorax. An Unusual Presentation in the Course of Immune Reconstitution Inflammatory Syndrome, HIV Infection and Kaposi’s Sarcoma: A Case Report

Efusión pleural secundaria a cateterización venosa central: Quilotórax e hidrotórax. A propósito de dos casos.

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