Minimally Invasive Treatment of Chyle Leak After Thyroidectomy and Cervical Lymph Node Dissection in Patients with Thyroid Carcinoma: Results of a Study Involving 36 Patients.

Objective: Chyle leak (CL) after head and neck surgery is a rare but well-known complication. In patients with high-output leakage, the treatment can be complicated. This study aims to report on a recent innovation in lymphatic intervention for treating such patients. Materials and Methods: A retrospective review of 36 patients with chyle leak after neck surgery for thyroid cancer was conducted to assess the efficacy of percutaneous lymphatic embolization and thoracic duct (TD) disruption. Results: Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1-7 days). There was no complication intra and after procedures. Conclusion: TDE, selective TD branches embolization and TDD are safe and effective minimally invasive treatments for CL post-surgery for thyroid carcinoma. Sclerosing cervical fluid collection contributes to clinical success.

Chylous ascites after donor nephrectomy: MR lymphangiography and lymphatic embolization treatment.

Chylous ascites results from the leakage of lipid-rich lymphatic fluid into the peritoneal cavity. Most postsurgical chylous ascites occurs following abdominal aortic surgeries. However, rarely, it is a complication after laparoscopic donor nephrectomy. Postsurgical chylous ascites are often managed with conservative treatment or surgery, but lymphatic embolization may be required. Here, we presented a 45-year-old male patient who was referred for abdominal distension for 1 week after left donor nephrectomy. The drain fluid was milky and fluid analysis revealed high concentrations of triglycerides and chylomicron, confirming diagnosis of chylous ascites. The patient was treated with conservative therapy including a low-fat diet and fluid drainage but continued to have high draining output (up to 1500-2000 mL/24 h). He underwent magnetic resonance lymphangiography and intranodal lymphangiography, revealing extravasation of contrast into the abdomen and the left renal fossa. We embolized the interstitial lymphatic of the left retroperitoneal and lymphatic vessels leak. The patient was discharged from hospital at the fifth day after intervention. In this article, we demonstrate lymphatic lesions, the safety, and success of this technique.

TiO2-Based Hybrid Nanocomposites Modified by Phosphonate Molecules as Selective PAH Adsorbents.

A robust sol-gel process was developed for the synthesis of surface-functionalized titania nanocrystallites bearing unsaturated groups starting from molecular heteroleptic single-source precursors. Molecules and nanomaterials were thoroughly characterized by multinuclear liquid and solid-state nuclear magnetic resonance (NMR), infra-red (FT-IR, DRIFT) spectroscopies. Nitrogen adsorption-desorption (BET), thermogravimetric (TG) and elemental analyses demonstrated the reliability and the fine tuning of the surface functionalization in terms of ratio TiO2:ligand. The as-prepared materials were used as nano-adsorbents to remove mixture of 16 polycyclic aromatic hydrocarbon (PAHs) from aqueous solutions. Adsorption kinetic experiments were carried out for 24 h in solutions of one PAH [benzo(a)pyrene, 220 ppb] and of a mixture of sixteen ones [220 ppb for each PAH]. Most kinetic data best fitted the pseudo-second order model. However, in PAHs mixture, a competition process took place during the first hours leading to a remarkable high selectivity between light and heavy PAHs. This selectivity could be fine-tuned depending on the nature of the unsaturated group of the phosphonate framework and on the nanomaterial textures.

Enhancement of muscle contraction in the stomach of the crab Cancer borealis: a possible hormonal role for GABA.

Gamma-aminobutyric acid (GABA) is best known as an inhibitory neurotransmitter in the mammalian central nervous system. Here we show, however, that GABA has an excitatory effect on nerve-evoked contractions and on excitatory junctional potentials (EJPs) of the gastric mill 4 (gm4) muscle from the stomach of the crab Cancer borealis. The threshold concentration for these effects was between 1 and 10 micromol l(-1). Using immunohistochemical techniques, we found that GABA is colocalized with the vesicle-associated protein synapsin in nearby nerves and hence is presumably released there. However, since these nerves do not innervate the muscle directly, we conclude that these release sites are not the likely source of the GABA responsible for muscle modulation. We also extracted hemolymph from the crab pericardial cavity, which contains the pericardial organs, a major neurosecretory structure. Through reversed-phase liquid chromatography-mass spectrometry analysis we determined the concentration of GABA in the hemolymph to be 3.3 +/- 0.7 micromol l(-1), high enough to modulate the muscle. These findings suggest that the gm4 muscle could be modulated by GABA produced by and released from a distant neurohemal organ.

Characteristic differences in modulation of stomatogastric musculature by a neuropeptide in three species of Cancer crabs.

Stomatogastric musculature from crabs in the genus Cancer provides a system in which modulatory roles of peptides from the FLRFamide family can be compared. The anterior cardiac plexus (ACP) is a neuroendocrine release site within the Cancer stomatogastric nervous system that is structurally identical in C. borealis, C. productus, and C. magister but that appears to contain FLRFamide-like peptide(s) only in C. productus. We measured the effect of TNRNFLRFamide on nerve-evoked contractions of muscles that were nearby, an intermediate distance, or far from the ACP. We found the spatial pattern of FLRFamidergic modulation of muscles in C. productus to be qualitatively different than in C. borealis or C. magister. In C. productus, muscles proximal to the ACP were more responsive than distal muscles. In C. borealis, FLRFamidergic response was less dependent on muscle location. These results suggest that functionally different roles of FLRFamides in modulating stomatogastric muscle movements may have evolved in different Cancer species.

Patient’s knowledge, attitude and practice in the health care for their school age children

By oral questions, an investigation was performed on 911 subjects, concerning their children’s hygiene problems, some stomatological, nasopharyngeal diseases, trachoma, position of seat as well as the school-family inter-relation and their proposals for improving the services of health care at school. Good knowledge, behavior were noted, but efforts should be paid to improve the practice of hygiene. Results also shows some differences between subjects’ ages, genders, and occupations as regard the above mentioned problems.