Chylothorax caused by acupuncture

Chylothorax, the accumulation of fatty fluid within the chest cavity, is associated with multiple etiologies including surgical injuries. A rare complication of acupuncture in a 37-year-old woman who developed left pneumothorax and pleural fluid collection after acupuncture was performed on the neck and upper back is described. Chest tube drainage resulted in complete lung expansion, and analysis of the milky fluid revealed chyle leakage. Conservative treatment with a diet low in lipids and rich in medium-chain triacylglycerols allowed extubation. Acupuncture-induced thoracic duct injury, although extremely rare, should be considered as a cause of chylothorax.     

Chylothorax following median sternotomy

Reports of chylothorax (CT) following median sternotomy are rare, amounting so far to 16 cases in the English literature, of which 6 were cases of postcoronary artery bypass grafting (CABG). This report deals with an additional case of a 70-year-old woman who developed left pleural chylous effusion following CABG. It is suggested that the incidence of this type of pleural effusion is considerably greater than the few cases hitherto reported. Moreover, as CT may produce serious pulmonary and/or pleural functional impairment, it is proposed that a diagnostic tap be performed more often in cases of post CABG pleural effusion and that preventive drainage be instituted when CT is diagnosed.     

Chylothorax caused by Paragonimus westermani in a native Californian

Paragonimiasis is a parasitic infection endemic in Asia but uncommon in the United States. It presents most frequently with cough and hemoptysis. Pleural effusions are common and can manifest occasionally as a pseudochylothorax, but a true chylothorax has, to our knowledge, never been reported. We report a case of a chylothorax from infection with Paragonimus westermani. The case is also unique because it occurred in a native Californian who had not traveled to Asia and was infected by eating raw crabs at a local sushi restaurant. The freshwater crabs had been imported from Asia.     

Septic arthritis caused by Corynebacterium xerosis following vascular surgery

A case of septic arthritis due to Corynebacterium xerosis occurred after vascular surgery and was successfully treated with intravenous cefotaxime followed by oral erythromycin. The only previously reported case of C. xerosis arthritis developed in a patient with a history of similar recent surgery. The possible association of this infection with such a postsurgical setting is discussed.     

Acute diverticulitis following cardiac surgery

Gastrointestinal complications requiring surgical correction following cardiopulmonary bypass most frequently involve the upper gastrointestinal tract. Surgical diseases of the colon are quite unusual in this setting. We recently performed cardiac surgery on three patients who developed acute diverticulitis requiring laparotomy in the early postoperative period. The presentation and management of this disorder after open heart surgery are discussed.     

Cardiopulmonary complications following cardiac surgery

Opinion statement There are numerous cardiac and pulmonary complications that can occur after operations that involve the use of cardiopulmonary bypass (CPB). We have chosen to focus on perioperative myocardial ischemia, left ventricular (LV) dysfunction, ventricular arrhythmias, atrial arrhythmias, and inflammation and pulmonary dysfunction as the most important. If left untreated, these complications can be life-threatening. Moreover, their presence is associated with higher hospital expenses due to therapies and longer inpatient stays.     

Colorectal complications following cardiac surgery

PURPOSE: This study was undertaken to assess colorectal complications following cardiopulmonary bypass surgery. METHOD: This is a retrospective review of 5,801 patients who underwent 5,801 cardiopulmonary bypass procedures from 1985 to 1991. Patients were evaluated for type of bypass procedure, postoperative colorectal complications, age, sex, bypass time, aortic cross-clamp time, elective vs.emergency cases, uses of intra-aortic balloon pump, perioperative hypotension, and use of vasopressors. Statistical analysis was performed using chi-squared analysis and Student's t-test. RESULTS: Nineteen of the 5,801 patients developed 19 colorectal complications, a prevalence of 0.3 percent for the initial hospital stay following bypass surgery. Mortality in those with complications was 37 percent (7/19). Of the 19 complications, 9 (47 percent) followed coronary artery bypass grafting, whereas 10 (53 percent) followed valve replacement or combined coronary artery bypass grafting with other cardiac procedures. Five (26 percent) of the complications followed emergency cases, whereas 14 (74 percent) followed elective cases. Average age of those with complications was 698 years, compared with 63.2 years for those without complications. Average aortic cross-clamp time for those with complications was 71 ±25 minutes; pump time was 106±34 minutes. That was significantly higher than in those without complications. Nine (47 percent) patients with complications required vasopressors during the perioperative period, whereas eight (42 percent) suffered prolonged hypotension (systolic blood pressure, <90 mmHg). CONCLUSIONS: It appears that increased age, valve replacement, or combined cardiac procedures, emergency procedures, and prolonged aortic cross-clamp and bypass pump times are risk factors for development of colorectal complications. Hypoperfusion, as suggested by prolonged pump times, clamp times, and emergency procedures may be a possible cause for development of colorectal complications.Supported by William Beaumont Hospital. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Orlando, Florida, May 8 to 13, 1994.     

Obstructive jaundice caused by a blood clot--an unusual complication following endoscopic papillotomy

Endoscopic papillotomy as therapeutic procedure of first choice for common bile duct stones is related with a relatively low complications rate and exhibits a very low method-related mortality. Major complications are cholangitis, pancreatitis, retroduodenal perforation and hemorrhage. In rare cases minor bleedings after papillotomy may lead to coagulation with consecutive obstruction of the papilla. Jaundice without major clinical symptoms will occur. Diagnosis is established by repeated retrograde cholangiography; conservative management is satisfactory and efficient.     

An unusual femoral arteriovenous fistula following cardiac catheterization

The development of an arteriovenous fistula (AVF) is a rare complication of cardiac catheterization. We report a rare case with a femoral AVF following cardiac catheterization, originating from the right deep femoral artery and eventually draining into the right superficial femoral vein through the subcutaneous vein.     

Chylothorax: An unusual complication following coronary artery bypass grafting using the left internal mammary artery

Development of a massive left-sided chylothorax following coronary artery grafting in a 56-year-old man is presented because of its rarity. Management with chest-tube drainage and dietary restrictions of fat with parenteral nutrition were used to treat the patient. Pleural fluid analysis for chyle in presence of massive pleural effusion was the key to early diagnosis and treatment to prevent increased morbidity and mortality. From 1985 to 1997 at this hospital, this complication occurred in 1 out of 18,978 patients who underwent coronary artery bypass graft surgery; in 6,232 patients, the left internal mammary artery was used.     

Right ventricular failure following cardiac surgery

The management of right ventricular failure remains a significant challenge in cardiac surgery. To date, no single clinical study has encompassed all of the principles that can be called upon to manage this problem. This review deals with the physiological management components that may be of value to cardiac medical and surgical clinicians.     

Painful sciatic neuropathy following cardiac surgery

Abstract Ten patients developed bilateral asymmetrical lower limb sensori-motor or motor deficits associated with prominent causalgic pain after cardiac surgery. The clinical and electrophysiological abnormalities indicated bilateral proximal sciatic nerve lesions, although in several cases the distinction from a diffuse ischaemic axonopathy was difficult to make. This pattern of post-cardiac surgery peripheral neurological dysfunction has not been previously described but is likely to relate either to the intra-operative posturing technique for access to the saphenous veins and/or the upright posture used to nurse patients in the immediate post-operative period and is in keeping with the previously demonstrated susceptibility of peripheral nerves to pressure palsy during cardiac surgical procedures.     

Cardiac insufficiency caused by arteriovenous fistula. An unusual complication of spinal surgery

Arteriovenous fistula is one of the main causes of high output cardiac failure. The authors report a case following lumbar disc surgery. There are a number of features which may suggest this complication both during surgery and in the immediate postoperative period which are important because the patient may only become symptomatic a long time after operation with a clinical presentation which leads to a cardiological rather than to a surgical referral.