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M Chand, D S Keller, H M Joshi, L Devoto, M Rodriguez-Justo, R Cohen
BACKGROUND: In colon cancer, appropriate tumour excision and associated lymphadenectomy directly impact recurrence and survival outcomes. Currently, there is no standard for mesenteric lymphadenectomy, with a lymph node yield of 12 acting as a surrogate quality marker. Our goal was to determine the safety and feasibility of indocyanine green (ICG) fluorescence imaging to demonstrate lymphatic drainage in colon cancer in a dose-escalation study. METHODS: A prospective pilot study of colon cancer patients undergoing curative laparoscopic resection was performed...
March 17, 2018: Techniques in Coloproctology
Edmund Burke, Sanjeev A Datar
PURPOSE OF REVIEW: The essential role of the lymphatic system in fluid homeostasis, nutrient transport, and immune trafficking is well recognized; however, there is limited understanding of the mechanisms that regulate lymphatic function, particularly in the setting of critical illness. The lymphatics likely affect disease severity and progression in every condition, from severe systemic inflammatory states to respiratory failure. Here, we review structural and functional disorders of the lymphatic system, both congenital and acquired, as they relate to care of the pediatric patient in the intensive care setting, including novel areas of research into medical and procedural therapeutic interventions...
March 13, 2018: Current Opinion in Pediatrics
Rajiv N Srinivasa, Jeffrey Forris Beecham Chick, Joseph J Gemmete, Anthony N Hage, Ravi N Srinivasa
INTRODUCTION: To report the technical and clinical success of performing minimally invasive endolymphatic embolization in neonates presenting with a chylothorax or chylous ascites. MATERIALS AND METHODS: 3 neonates, 2 males and 1 female, with a mean age of 28 days (range: 19-39 days) presented with a chylothorax (2) or chylous ascites (1) which was refractory to conservative management. All 3 patients (1 previously reported) underwent intranodal lymphangiography followed by thoracic duct embolization with 1 patient undergoing additional sclerosis of the retroperitoneal abdominal lymphatics...
March 7, 2018: Annals of Vascular Surgery
Elizabeth O Kenworthy, Jonas A Nelson, Richa Verma, JeanJacques Mbabuike, Babak J Mehrara, Joseph H Dayan
BACKGROUND AND OBJECTIVES: Orthotopic vascularized lymph node transplant has been successfully used to treat lymphedema. A second, heterotopic lymph node transplant in the distal extremity may provide further improvement. The vascularized omentum lymphatic transplant (VOLT) provides adequate tissue for two simultaneous flap transfers to one limb. The purpose of this study was to review our experience with this technique. METHODS: We conducted a retrospective study of patients who underwent VOLT, with a subgroup analysis of patients who underwent double VOLT...
March 8, 2018: Journal of Surgical Oncology
Jimmy Yu Wai Chan, Stanley Thian Sze Wong, William Ignace Wei
BACKGROUND: To investigate the role of indocyanine green (ICG) lymphangiography in the reduction of drainage after neck dissection. METHODS: Patients with oral cavity squamous cell carcinoma were randomized into Group A (study group) and Group B (control). In the study group, upon the completion of neck dissection, a total of 2.5 mg of ICG was injected submucosally at the four quadrants around the tumour. Another 2.5 mg of ICG was injected subdermally in the groin bilaterally...
March 2018: Oral Oncology
Jian Dong, Jianfeng Xin, Wenbin Shen, Xiaobai Chen, Tingguo Wen, Chunyan Zhang, Rengui Wang
OBJECTIVE: The objective of our study was to investigate the clinical value of diagnostic lymphangiography followed by sequential CT examinations in patients with idiopathic chyluria. MATERIALS AND METHODS: Thirty-six patients with idiopathic chyluria underwent unipedal diagnostic lymphangiography and then underwent sequential CT examinations. The examinations were reviewed separately by two radiologists. Abnormal distribution of contrast medium, lymphourinary leakages, and retrograde flow were noted, and the range and distribution of lymphatic vessel lesions were recorded...
February 22, 2018: AJR. American Journal of Roentgenology
Hisako Hara, Makoto Mihara, Masayoshi Yamamoto
Chylothorax is a challenging disease. We present a case of traumatic chylothorax that was successfully treated using lymphangiography through intranodal injection of contrast agent. A 17-year-old girl had chylothorax. It did not improve despite medical treatment. We performed lymphangiography through intranodal injection of an oil contrast agent (Lipiodol). The amount of chylothorax was reduced from 1000 to 120 mL/d, and we could remove the thoracotomy tube. Thereafter, although she had a small amount of pleural effusion, she has not demonstrated aggravation for 19 months...
March 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Masayoshi Yamamoto, Kentaro Yamada, Masahiro Horikawa, Hiroshi Kondo, Hiroshi Oba, Shigeru Furui
PURPOSE: To report embolization of the thoracic duct by direct injection of N-butyl-2-cyanoacrylate (NBCA) glue via a puncture needle. MATERIALS AND METHODS: Two cases of high output chylothorax were successfully treated with direct injection of N-butyl-2-cyanoacrylate (NBCA) glue via a puncture needle. In them, conventional thoracic duct embolization (TDE) was attempted, but the cisterna chyli was absent on intranodal lymphangiography, and probably for this reason catheterization of the thoracic duct was unsuccessful...
February 7, 2018: Cardiovascular and Interventional Radiology
Dingyi Liu, Boke Liu, Weimu Xia, Qi Tang, Haidong Wang, Jian Wang, Yanfeng Zhou, Jiashun Yu, Wenmin Li, Mingwei Wang, Wenlong Zhou, Sang Hu, Yuan Shao
BACKGROUND: To identify the value of unilateral pedal lymphangiography (LPG) plus computed tomography angiography (CTA) in accurate depiction of persistent idiopathic chyluria undetectable by ordinary contrast CT. METHODS: Eighteen patients 44-63 years of age with persistent idiopathic chyluria who failed conservative management were included. Ordinary CT had not revealed a chyle leak. Cystoscopy, unilateral LPG, and post-LPG CT angiography (CTA) were sequentially performed...
February 6, 2018: BMC Urology
Colette R Pameijer, Anna Leung, Rogerio I Neves, Junjia Zhu
BACKGROUND: Infrared fluorescence imaging with indocyanine green (ICG) is a novel method for sentinel node localization. Our objective was to assess ICG and fluorescence imaging for preoperative and intraoperative utility. METHODS: 87 eligible patients participated in this prospective study. All patients received injection of ICG dye in addition to both methylene blue and 99mTc. Each sentinel node was assessed for the presence of each dye. RESULTS: ICG was visible prior to incision in 44% of subjects...
January 23, 2018: American Journal of Surgery
Yoshihiro Ota, Shingo Tachibana, Kosuke Takahashi, Takafumi Watanabe, Takeshi Suda, Sumito Hoshino, Yoshiaki Osaka, Kazuhiko Kasuya, Kenji Katsumata, Akihiko Tsuchida
A 65-year-old man was diagnosed as having middle thoracic esophageal cancer(c-T3N2M0, stage III ), and neoadjuvant chemoradiotherapy was performed.We performed surgical therapy.However, tumor and #113 lymph node invasion into the aortic arch was observed; therefore, it was judged that curative resection was difficult, and R2 surgery was performed instead. Postoperative diagnosis was Mt, CRT-type 5b, s-T4(aortic arch)N4(#113)M0, stage IV a.After surgery, pleural effusion was abundant and was diagnosed as chylothorax...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Xue Yu, Na Jia, Sanxia Ye, Min Zhou, Deping Liu
Primary chylopericardium (CP) is a rare clinical condition in which chylous fluid containing high concentrations of triglyceride accumulates in the pericardial cavity. The present study reports a case of CP that was successfully treated by reconstruction surgery of thoracic duct. To improve the ability to diagnosis and treat this rare disease, the current study also systematically extracted 104 reported cases of primary or idiopathic CP from the past 60 years (January 1950 to December of 2015), and reviewed the clinical manifestation, etiology, diagnosis and treatment of these cases...
January 2018: Experimental and Therapeutic Medicine
Xuming Luo, Zhuhua Zhang, ShiQiang Wang, XianDong Gu, Xiongbiao Wang
BACKGROUND: Chyloptysis is reflux of chyle into the lungs and is a rare manifestation of primary chylous disorders. CASE PRESENTATION: Over 29 months, on the basis of x-rays, a 33-year-old female was repeatedly misdiagnosed with recurrent right-sided pneumonia; her symptoms included a recurrent cough, the appearance of cheese-like sputum, and diffuse pulmonary exudates. There was a history that abundant fluid in the pericardium was confirmed with echocardiography to have been present and asymptomatic for 4 years...
January 29, 2018: BMC Pulmonary Medicine
Ravi N Srinivasa, Joseph J Gemmete, Matthew L Osher, Jeffrey Forris Beecham Chick
PURPOSE: To describe endolymphatic balloon-occluded retrograde abdominal lymphangiography (BORAL) and embolization (BORALE) for diagnosis and treatment of chylous ascites in patients with previously unidentifiable leakage site or failed lymphatic embolization. MATERIALS AND METHODS: Two (66%) men and one (33%) woman with mean age of 52 years (range: range: 14-79 years) presented with chylous ascites and underwent BORAL or BORALE between March 2016 and February 2017...
December 4, 2017: Annals of Vascular Surgery
Jae Seok Bae, Roh-Eul Yoo, Seung Hong Choi, Seong Oh Park, Hak Chang, Minseok Suh, Gi Jeong Cheon
PURPOSE: To validate usefulness of magnetic resonance (MR) lymphangiography for evaluation of peripheral lymphedema in upper extremities by comparison with lymphoscintigraphy. MATERIALS AND METHODS: This prospective study had institutional review board approval and written informed consent was obtained from all patients. Initially, protocol of MR lymphangiography for upper extremity was established in seven healthy volunteers with 3.0T fat-saturated three-dimensional gradient-echo MR after gadobutrol injection...
January 3, 2018: Magnetic Resonance Imaging
Hai-Peng Pan, Qun Lao, Zheng-Hua Fei, Li Yang, Hai-Chun Zhou, Can Lai
Chylothorax is a rare cause of pleural effusion in children, and it is usually difficult to identify the location of chyle leakage due to the small size of the thoracic duct in children. Herein we report an infant case with chylothorax whose leakage of the thoracic duct was successfully located by magnetic resonance lymphangiography (MRL) using pre-contrast MR cholangiopancreatography (MRCP) and gadodiamide-enhanced spectral presaturation inversion recovery (SPIR) T1-weighted imaging, which demonstrate the imaging method is easy and effective for detecting the focal disruption of the thoracic duct in children with chylothorax and younger than 8 months old...
December 30, 2017: Chinese Medical Sciences Journal, Chung-kuo i Hsüeh K'o Hsüeh Tsa Chih
Pyeong Hwa Kim, Jiaywei Tsauo, Ji Hoon Shin
PURPOSE: To perform a systematic review and meta-analysis of published studies to evaluate the efficacy of lymphatic interventions for chylothorax. MATERIALS AND METHODS: The MEDLINE, EMBASE, and Cochrane databases were searched for English-language studies until March 2017 that included patients with chylothorax treated with lymphangiography (LAG), thoracic duct embolization (TDE), or thoracic duct disruption (TDD). Exclusion criteria were as follows: a sample size of less than 10 patients, no extractable data, or data included in subsequent articles or duplicate reports...
December 26, 2017: Journal of Vascular and Interventional Radiology: JVIR
Takeshi Shimakawa, Yoshihiko Naritaka, Miki Miyazawa, Shinichi Asaka, Asako Shimazaki, Kentaro Yamaguchi, Hajime Yokomizo, Kazuhiko Yoshimatsu, Shunichi Shiozawa, Takao Katsube
Postoperative chylothorax after surgery for esophageal cancer is a rare but serious complication. Treatment initially consists of conservative therapy and, if it fails to provide improvement, it is important to perform surgical treatment without delay. We report on a recent case of intractable chylothorax. This report describes a 72-year-old man with Stage III esophageal squamous cell carcinoma. Subtotal esophagectomy, through a right thoracoabdominal approach with two-field lymphadenectomy, and cervical esophagogastric anastomosis via the retrosternal route, were performed...
2017: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
Gregory J Nadolski, Nikunj R Chauhan, Maxim Itkin
PURPOSE: Assess the effectiveness of conventional lymphangiography, MR lymphangiography, and lymphatic embolization for the diagnosis and treatment of refractory chylous ascites. MATERIALS AND METHODS: A retrospective review of 31 patients (M/F:16/15, average age 52) who presented for the management of refractory chylous ascites was conducted to assess the diagnostic value of conventional and MR lymphangiography and outcome of lymphatic embolization. RESULTS: Of the total 31 patients, 25 presented with chylous ascites secondary to iatrogenic trauma and six patients with a non-traumatic etiology...
March 2018: Cardiovascular and Interventional Radiology
Ravi N Srinivasa, Joseph J Gemmete, Matthew L Osher, Anthony N Hage, Jeffrey Forris Beecham Chick
BACKGROUND: To describe endolymphatic balloon-occluded retrograde abdominal lymphangiography (BORAL) and embolization (BORALE) for diagnosis and treatment of chylous ascites in patients with previously unidentifiable leakage site or failed lymphatic embolization. METHODS: Two (66%) men and 1 (33%) woman with mean age of 52 years (range: 14-79 years) presented with chylous ascites and underwent BORAL or BORALE between March 2016 and February 2017. Patients presented with chylous ascites (n = 3) and with renal cell carcinoma after left nephrectomy and lymph node dissection (n = 1), metastatic Merkel cell carcinoma after left nephrectomy and adrenalectomy (n = 1), and heart transplantation after failed Fontan procedure (n = 1)...
December 5, 2017: Annals of Vascular Surgery
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