Chylothorax is a rare condition that results from thoracic duct damage with chyle leakage from the lymphatic system into the pleural space, usually on the right side. It has multiple aetiologies and is usually discovered after it manifests itself as a pleural effusion. Diagnosis involves cholesterol and triglyceride measurement in the pleural fluid. Complications include malnutrition, immunosuppression and respiratory distress. Treatment may be either conservative or aggressive depending on the clinical scenario. In this review, we discuss the aetiology, diagnosis and treatment of chylothorax. English language publications in MEDLINE and references from relevant articles from January 1, 1980 to February 28, 2008 were reviewed. Keywords searched were chylothorax, aetiology, diagnosis and treatment.

In most diseases related to pleural effusion, the fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. The many important characteristics of pleural fluid are described, as are other complementary investigations that can assist with the diagnosis of common and rare pleural effusions. For a systematic review of pleural effusion, a literature search for articles on the practical investigation and diagnosis of pleural effusion was done. Articles included guidelines, expert opinion, experimental and nonexperimental studies, literature reviews, and systematic reviews published from May 2003 through June 2009. The search yielded 1 guideline, 2 meta-analyses, 9 literature reviews, 1 randomized control trial, and 9 clinical studies. On the basis of class IIa or class I evidence from these articles, a step by step approach is recommended for investigating a pleural effusion, beginning with assessment of the medical history, clinical examination, radiology, pleural fluid evaluation, and finally, if no diagnosis is forthcoming, a pleural biopsy under image guidance or thoracoscopy.

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The European Commission (EC) is anxious to increase the innovation, and hence the competitiveness, of small and medium-sized enterprises (SMEs) in the depressed regions of the European Union (EU). To this end, the EC funds education and training for these firms, arguing that education and training will produce the desired innovation. In the north of England, the Yorkshire and Humberside Universities' Association (YHUA) was entrusted to provide appropriate education and training for the region's SMEs. In the year 2000, the YHUA asked the authors to analyse the effectiveness of this provision. The analysis concluded that the universities providing education and training services benefited from the scheme, rather than the participating SMEs. This article stands back from the basic analysis and considers why this was so.

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Moisturizers are recommended to nearly every atopic patient, and should be part of the daily skin care of these patients, as they have the potential to reduce the quantity of topical steroids necessary to keep disease quiescent. The vast array of choices available to consumers is overwhelming, and most patients would like their physicians to recommend specific products. We attempt to provide a review of the newer products available, with special emphasis on those products that contain ceramides.