Cystic lymphangiomas are uncommon congenital benign tumours of vascular origin with a lymphatic differentiation originating across various anatomical locations. Large intrabdominal cysts may mimic ascites. We report the case of a one-and-a-half-year-old male child with a giant cystic lymphangioma originating in the greater omentum presenting as tubercular ascites. This report aims to highlight the limitations of biochemical investigations such as ascitic adenosine deaminase (ADA) in differentiating the epidemiologically prevalent tubercular ascites from an intrabdominal cyst, especially in a resource-poor nation as ours, where invasive diagnostic procedures pose an economic burden.
Sir,Chylothorax is the most common etiology of fetal and neonatal pleural effusion. 1 We are reporting a case of persisting congenital chylothorax which was difficult to manage and resistant to various conventional therapeutic options.A 2.5 kg female neonate was delivered at home by vaginal route, to second gravida mother at 38 weeks gestation. The antenatal period was uneventful. The baby was apparently well for first 7 days of life, when she developed fast breathing which progressively increased by day 11 of life and was brought to the Referral Neonatal Unit. At admission the skin temperature was 30.8 o C, the infant was hypoxic on room air (SPO 2 78%). The heart rate was 173 per minute, respiratory rate 67 per minute with intercostal and subcostal retractions and nasal flaring. On respiratory examination trachea was shifted to right side with stony dull note and decreased breath sounds on left side. Radiograph of chest showed homogenous opacity with obliteration of costophrenic angle on left side and mediastinal shift to the right. About 300 ml yellow fluid was drained through a chest tube. Biochemical analysis of the aspirate revealed protein 5.6 gm%, sugar133 mg%, cholesterol 112 mg% and triglyceride 708 mg%. Total cell count was 1600 mm 3 , predominantly lymphocytes. Culture for pyogenic organisms was sterile. Sepsis screen was positive. The infant was put on ventilator on SIMV mode, chest tube was inserted and antibiotics were started., Respiratory distress settled with insertion of chest tube and infant was extubated after 14 hours of ventilation. On day 14 of life, infant was started on a medium chain triglyceride formula (SIMYL MCT) which was gradually increased to 120 ml/kg by spoon feeds. Triglyceride level reduced from 708 mg/dl to 360 mg/dl and cholesterol reduced from 112 mg/dl to 56 mg/dl over one month of MCT feeds. After starting the Simyl MCT formula, inter costal drainage gradually stopped within 7 days. Chest tube was removed on day 21 of life when there was no drainage for 48 hours and no respiratory distress. Respiratory distress increased on day 28 and repeat ultrasound examination of chest revealed left sided pleural effusion with maximum width of 6.2 mm. About 90 ml of chyle was aspirated with improvement in respiratory distress. On day 44, Lymphoscintigraphy was done after injecting Tc99m sulfur colloid intradermally. Four hour image showed abnormal accumulation of tracer in the left hemithorax suggestive of abnormality of pulmonary lymphatics. By day 59 of life, 1200 ml chylous fluid had been aspirated over 15 occasions. On day 59 of life injection octreotide was started as I.V. infusion in dose of 3µg/ kg/min which was gradually increased to 10µg/kg/min over the next 7 days.. However, accumulation of chylous fluid in pleura continued unabated and thoracocentesis was required for respiratory distress every 4 th to 5 th day. A total of 1000 ml chyle was drained over 13 occasions during the 4 weeks of octreotide therapy suggestive of poor response. On day 94 of life surgical interventio...
A 5.5 years old Holstein Friesian crossbred cattle was presented with a history of traumatic injury by barbed metallic wire on right fore-teat six hours before. Clinical examination revealed full-thickness, bilateral, longitudinal laceration of the same teat, extending from base of the teat to the distal teat orifice with leakage of milk. Prompt reconstructive surgery was performed under sedation and local anesthesia to repair the laceration. The closure of the teat cistern was performed by suturing the laceration in three layers.Post-operative care included intra-mammary and systemicantibiotic therapy with NSAID for five consecutive days along with daily antiseptic dressing of the wound and regular drainage of milk via the fixed infant feeding tube in the teat cistern. The animal had shown uneventful recovery without any complication with removal of skin sutures on 10th post-operative day and started hand milking from the same teat on 20th post-operative day.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.