Chyle leak following right axillary lymph node dissection: A case report and review of current literature.

This report discusses the case of a chyle leak following a right axillary lymph node dissection for breast cancer. This presented as a sudden change in drainage character from a right axillary surgical drain from serous to milky white shortly after restarting a diet. The diagnosis of chyle leak was confirmed by laboratory testing of the fluid and managed with closed suction drainage. Chyle leak is a rare, but increasingly recognized complication following axillary clearance for breast cancer and melanoma.

Quantifying the effects of forestry practices on the recovery of upland streams and lochs from acidification.

Trends in long-term chemistry data are presented for 37 acidified upland streams and lochs, located in four areas (A, B, C and D) across Scotland, to provide a comparison between recovery rates of moorland catchments and forest catchments at different stages of the management cycle. For all sites, non-marine sulfate (nm-SO(4)) showed a significant decline in annual median concentrations, the greatest decline being in streams draining felled catchments, which showed a 50% greater decline than catchments with moorland or young, aggrading forests. A similar pattern was found for chloride (Cl) concentrations in Area C, which reflected the reduced interception of sea-salt aerosols following clearfelling. However, high elevation moorland sites in Area D also revealed significant declines in Cl while trends in aggrading forest sites in this area were insignificant. Alkalinity (ALK) and pH increased more at sites where felling had taken place than at moorland or young forest sites while aggrading forest catchments appeared to be most resistant to changes in pH and ALK. Associated with these acid-base changes was a corresponding decline in labile aluminium (Al-L) concentrations. The pattern of nitrate (NO(3)) change was especially affected by the timing of felling in forested catchments. Large negative trends in NO(3) at stream sites were associated with felling during the early part of the study period. This downward trend was further enhanced as NO(3) concentrations fell below pre-felling levels as the second rotation crop became established. Few forest sites showed significant increases in NO(3) due to felling in the latter part of the study period. Most moorland loch sites showed a small but significant increase in NO(3,) probably in response to similar increases in N deposition and/or climatic impacts. Dissolved organic carbon (DOC) increased significantly at both forest and moorland sites, however, the extent of these increasing trends appeared to be positively correlated with absolute DOC concentrations. Despite the complex response of streams and lochs during the various stages of the forest cycle, especially for NO(3), both forest and moorland catchments showed generally similar and rapid responses to reductions in S deposition. Nevertheless, forested sites are still more acid and have higher concentrations of toxic forms of Al than moorland sites. Although the proposed emission reductions in Europe are likely to result in a continuing decline in S and N loadings to catchments, the continuing policy of planting second rotation forests in these acidified catchments may, in the long-term, delay or halt chemical and biological recovery. However, in the short-term, any increase in the uptake of N deposition by aggrading forests should help to counteract the acidifying effects of a small increase in the interception of S and N compounds.

Long-term trends in pH, aluminium and dissolved organic carbon in Scottish fresh waters; implications for brown trout (Salmo trutta) survival.

Over the past 30 years upland streams and lochs in Scotland have shown significant signs of recovery from acidification, particularly in terms of declining concentrations of non-marine sulphate (nm-SO(4)). Long-term index sites in central and southwest Scotland reveal a significant decline in the concentration of biologically important components, notably acidity (H(+)) and labile (toxic) forms of aluminium (Al-L), whilst dissolved organic carbon (DOC) and complexed forms of aluminium (AL-NL) have increased significantly. Although these improvements should increase the probability of brown trout survival, and have resulted in increased acid neutralising capacity (ANC) in fishless streams to values close to current critical limits, there is still a relatively poor correlation between ANC and current fish status. Site to site variability appears to be linked to the relative contribution of (H(+)), Al-L and DOC within the critical ANC (ANC(CRIT)) range. It is proposed that ANC(CRIT) should cover a range of ANC values as a function of Al-L concentration. Based on field studies an empirical range of critical ANC values are suggested which better predict the presence of a sustainable brown trout population.