ABSTRACT
Chylothorax, an uncommon cause of pleural effusion, results from the accumulation of lymph in the pleural space due to damage or obstruction of the thoracic duct. Chylothorax can be due to several aetiologies, many of which are rare, and it is often a diagnostic challenge to identify the cause. This case report refers to a patient with rapid recurrent episodes of bilateral pleural chylothorax due to damage of the thoracic duct after external electrical cardioversion treatment. The diagnosis took place by the method of exclusion, when all known causes of chylothorax, both non-traumatic and traumatic, were ruled out. A review of the literature on chylothorax was performed using PubMed to assess the different aetiologies, investigations, and treatments usually performed. Chylothorax is usually secondary to malignancy, trauma, congenital diseases, and infections. However, even non-invasive thoracic procedures, such as the one described in our case report, can be the cause.
ABSTRACT
PURPOSE: To assess whether preoperative transcatheter arterial embolization of spinal metastases reduces blood loss, the need for transfusion with allogeneic red blood cells (RBCs), and surgery time in the surgical treatment of patients with symptomatic metastatic spinal cord compression. MATERIALS AND METHODS: This single-blind, randomized (1:1), controlled, parallel-group, single-center trial was approved by the Danish National Committee on Biomedical Research Ethics and was conducted from May 2011-March 2013. Participants (N = 45) were scheduled for decompression and posterior thoracic/lumbar spinal instrumentation and randomly assigned to either preoperative embolization (n = 23) or a control group (n = 22). The primary outcome was intraoperative blood loss. Secondary outcomes were perioperative blood loss, allogeneic RBC transfusion, and surgery time. Analyses were performed by intention-to-treat. RESULTS: The intention-to-treat analysis included 45 patients. Mean intraoperative blood loss did not differ significantly (P = .270) between the embolization group (618 mL [SD, 282 mL]) and the control group (735 mL [SD, 415 mL]). There was also no significant difference in allogeneic RBC transfusion (P = .243). Surgery time was significantly shorter in the embolization group (P = .031): median 90 minutes (range, 54-252 min) versus 124 minutes (range, 80-183 min). The subanalysis of hypervascular metastases revealed a significant (P = .041) reduction in blood loss in the embolization group: 645 mL (SD, 289 mL) versus 902 mL (SD, 416 mL). CONCLUSIONS: Preoperative embolization in patients with symptomatic spinal metastasis independent of primary tumor diagnosis did not reduce intraoperative blood loss and allogeneic RBC transfusion significantly but did reduce the surgery time. A small reduction of intraoperative blood loss was shown in hypervascular metastases.
Subject(s)
Embolization, Therapeutic/methods , Laminectomy/methods , Postoperative Hemorrhage/prevention & control , Spinal Neoplasms/secondary , Spinal Neoplasms/therapy , Female , Humans , Laminectomy/adverse effects , Male , Middle Aged , Operative Time , Postoperative Hemorrhage/diagnosis , Postoperative Hemorrhage/etiology , Preoperative Care/methods , Single-Blind Method , Spinal Neoplasms/complications , Treatment OutcomeABSTRACT
The transjugular intrahepatic portosystemic shunt (TIPS) is a percutaneous, minimally invasive method of creating a portosystemic shunt for the treatment of portal hypertension. These guidelines define indications and contraindications for referral of candidate patients to Danish TIPS-centres and are in accordance with international recommendations and local experience. TIPS will prevent re-bleeding from varices and decrease the need for repeated large volume paracentesis in patients with refractory ascites.
