Thoracoscopic Thoracic Duct Ligation for Persistent Cervical Chyle Leak: Utility of Immediate Pathologic Confirmation

ObjectiveChylous fistulas can occur after neck surgery. Both nonoperative measures and direct fistula ligation may lead to fistula resolution. However, a refractory fistula requires upstream thoracic duct ligation. This can be accomplished minimally invasively. Success depends on lymphatic flow interruption where the duct enters the thorax. We report on the utility of frozen section confirmation in achieving this goal.MethodsPersistent chylous fistulas occurred in 2 patients after left cervical operations. In the first patient, attempted direct fistula ligation and sclerosant application failed. Fasting, parenteral nutrition, and somatostatin-analog provided no benefit. For the second patient, nonoperative treatment was also ineffective. Prior radiation therapy and multiple cervical operations militated against attempted direct fistula ligation. Both patients underwent thoracoscopic thoracic duct interruption.ResultsIn both cases, a duct candidate was identified between the aorta and azygos vein. Frozen section analysis of tissue resected between endoclips verified it as thoracic duct. Fistula resolution ensued promptly in both instances.ConclusionsThis report lends further credence to the efficacy of minimally invasive thoracic duct ligation in treating postoperative cervical chylous fistulas. Frozen section confirmation of thoracic duct tissue is useful. It allows one facile with thoracoscopy, but less familiar with thoracic duct ligation, to confidently terminate the operation

Modern optical astronomy: technology and impact of interferometry

The present `state of the art' and the path to future progress in high spatial resolution imaging interferometry is reviewed. The review begins with a treatment of the fundamentals of stellar optical interferometry, the origin, properties, optical effects of turbulence in the Earth's atmosphere, the passive methods that are applied on a single telescope to overcome atmospheric image degradation such as speckle interferometry, and various other techniques. These topics include differential speckle interferometry, speckle spectroscopy and polarimetry, phase diversity, wavefront shearing interferometry, phase-closure methods, dark speckle imaging, as well as the limitations imposed by the detectors on the performance of speckle imaging. A brief account is given of the technological innovation of adaptive-optics (AO) to compensate such atmospheric effects on the image in real time. A major advancement involves the transition from single-aperture to the dilute-aperture interferometry using multiple telescopes. Therefore, the review deals with recent developments involving ground-based, and space-based optical arrays. Emphasis is placed on the problems specific to delay-lines, beam recombination, polarization, dispersion, fringe-tracking, bootstrapping, coherencing and cophasing, and recovery of the visibility functions. The role of AO in enhancing visibilities is also discussed. The applications of interferometry, such as imaging, astrometry, and nulling are described. The mathematical intricacies of the various `post-detection' image-processing techniques are examined critically. The review concludes with a discussion of the astrophysical importance and the perspectives of interferometry.Comment: 65 pages LaTeX file including 23 figures. Reviews of Modern Physics, 2002, to appear in April issu

Thoracoscopic thoracic duct ligation for persistent cervical chyle leak: utility of immediate pathologic confirmation.

ObjectiveChylous fistulas can occur after neck surgery. Both nonoperative measures and direct fistula ligation may lead to fistula resolution. However, a refractory fistula requires upstream thoracic duct ligation. This can be accomplished minimally invasively. Success depends on lymphatic flow interruption where the duct enters the thorax. We report on the utility of frozen section confirmation in achieving this goal.MethodsPersistent chylous fistulas occurred in 2 patients after left cervical operations. In the first patient, attempted direct fistula ligation and sclerosant application failed. Fasting, parenteral nutrition, and somatostatin-analog provided no benefit. For the second patient, nonoperative treatment was also ineffective. Prior radiation therapy and multiple cervical operations militated against attempted direct fistula ligation. Both patients underwent thoracoscopic thoracic duct interruption.ResultsIn both cases, a duct candidate was identified between the aorta and azygos vein. Frozen section analysis of tissue resected between endoclips verified it as thoracic duct. Fistula resolution ensued promptly in both instances.ConclusionsThis report lends further credence to the efficacy of minimally invasive thoracic duct ligation in treating postoperative cervical chylous fistulas. Frozen section confirmation of thoracic duct tissue is useful. It allows one facile with thoracoscopy, but less familiar with thoracic duct ligation, to confidently terminate the operation

Multivariate linear regression analysis: Associations of the KT ratio (dependent variable) with CD4+ and CD8+ T cells, and the CD4/CD8 ratio (independent variables) in SOCA cohort.

<p>Because of colinearity, we fitted one model to calculate the coefficients of CD4+ and CD8+ T cells, and a different model for the CD4/CD8 ratio.</p><p>Variables CD4+ and CD8+ T cells, and the CD4/CD8 ratio were log transformed.</p><p>Coefficients are adjusted by age, gender, nadir CD4+ T cell count and duration of viral suppression.</p><p>To interpret the logarithmically transformed coefficients, we applied the following formula: <i>Beta*log(1.10)</i>, resulting in the % of change in the odds of the outcome predicted by each 10% increase in the independent variable.</p

Percentages and absolute counts of CD8+ activation phenotypes among HIV-/CMV+ individuals and ART-suppressed HIV-infected patients with CD4 counts >500 cells/mm³ stratified by a normal (4th quartile, ≥1, in green) or low (1st quartile, ≤0.4, in red) CD4/CD8 ratio.

<p>Subjects with low CD4/CD8 ratio showed higher percentages (<b>A</b>) and absolute counts (<b>B</b>) of HLADR+, CD28− and CD28−CD57+, and higher absolute counts of PD1+ cells (<b>B</b>). There were no differences in HIV-infected individuals in the proportion of CD28−CD8+ T cells expressing CD57, being significantly lower in both groups compared to HIV-/CMV+ controls.</p

Correlations with biomarkers of T cell activation and senescence in SOCA cohort.

<p>“%CD57 of CD28−” refers to the percentage of CD28−CD8+ T cells expressing CD57.</p

Correlations with biomarkers of innate immune activation and epithelial integrity in SOCA cohort.

<p>Correlations with biomarkers of innate immune activation and epithelial integrity in SOCA cohort.</p