vertigo after epley maneuver dr brian shaffer

Vertigo after epley maneuver dr brian shaffer trial#

Failure of nonoperative management was associated with venous hypertension from increased right-sided cardiac pressures or central venous thrombosis (p < 0.05, Fisher's exact test). The amount of drainage per day was not significantly different between patients treated operatively and those treated nonoperatively. Complications were lymphopenia (2 patients) and fungal sepsis (1 patient). Those for whom operation was chosen drained preoperatively for an average of 29.2 days (range, 25 to 40 days). Spontaneous cessation and cure occurred in 19 (73.1%) of these 26 patients, with an average drainage duration of 11.9 days (range, 4 to 30 days). Chylothorax developed postoperatively in 15 infants and 11 children (18 with a cardiac procedure and 8 with a noncardiac procedure).

All patients were initially treated with total gut rest, with operation reserved for unabated drainage. The type and amount of drainage, data from cardiac catheterization and echocardiography, operative decisions and details, and eventual outcomes have been cataloged. Our experience with postoperative chylothorax over the most recent decade (1980 to 1990) has been reviewed. Questions persist about the management of postoperative chylothorax in infants and children. Management of pediatric postoperative chylothorax.īond, S J Guzzetta, P C Snyder, M L Randolph, J G The prophylactic primary or therapeutic secondary ligature of the thoracic duct is an effective surgical preventive measure and therapy of postoperative chyle leakage. This can be either transthoracic or transhiatal as a selective or mass ligation and has a probability of success of over 90%. If there is any indication of persistent leakage, rapid surgical reintervention appears appropriate.

Vertigo after epley maneuver dr brian shaffer trial#

In the case of postoperative chylothorax, a conservative therapeutic trial may be undertaken with drainage of up to 1000â€‰ml per day for up to one week. Meta-analyses confirm the effectiveness of this measure, with a reduction in the risk to less than 1%.

With this risk, there is the possibility of a prophylactic intraoperative ligature of the thoracic duct, either as a selective or mass ligation.

The risk of chyle leakage after oesophagectomy increases with the difficulty of mediastinal dissection and is reported to be around 3% for oesophagectomy. This article provides an overview of the existing literature on the prevention and surgical therapy of chylothorax. Glatz, Torben Marjanovic, Goran Hoeppner, JensĬhylothorax is a rare complication after thoracic trauma or surgery, especially oesophagectomy, which, if left untreated, can be potentially life-threatening. To our knowledge, this is the first report of postoperative chylothorax successfully treated by the use of a fibrin sealant patch. Fibrin sealant patches (TachoSilÂ®) were placed over the source of leak with complete resolution of chylous effusion. At subsequent surgical re-exploration for persisting chylothorax, accurate inspection of pleural cavity revealed residual chyle leakage. Since conservative measures were not effective, we performed direct ligation of lymphatic vessels and pleurodesis. We report the treatment of postoperative chylothorax after resection of mediastinal ganglioneuroma in a 17-year-old boy. These patients present high risk of malnutrition due to the constant loss of chyle, therefore a suitable nutritional management is essential to avoid more complications.Ĭhylothorax after mediastinal ganglioneuroma resection treated with fibrin sealant patch: a case reportĬhiarelli, Marco Achilli, Pietro Guttadauro, Angelo Vertemati, Giuseppe Terragni, Sabina De Simone, MatildeĬhylothorax is a severe condition resulting from the accumulation of chyle into the pleural space.

The treatment of chylothorax is not standardized and it is necessary a multidisciplinary approach: nutritional, pharmacological, respiratory and even surgery. The pulmonary disease is characterized by dyspnea, pleural effusion, hemoptysis and spontaneous pneumothorax, being the chylothorax a frequent complication in the course of this disease, appearing in up to 30% of cases. Lymphangioleiomyomatosis (LAM) is a rare disease that affects women in fertile age and presents a systemic progressive evolution, being the lung and the mediastinic lymph nodes the most affected organs. Palmeiro, R Arosa, V Cuerda, C BretÃ³n, I Camblor, M RodrÃguez, Ma C GarcÃa Peris, P