Treatment of Chylothorax with Elemene

Abstract

Background: Chylothorax is a disorder with a variety of causes and is often difficult and complex to manage. There are two treatment options for chylothorax: conservative management or surgical intervention. Conservative management of chylothorax consists of pleural fluid drainage, supportive ventilation, supplementation of fluid loss, and elemental diet or total parenteral nutrition. Surgical repair often results in significant morbidity and mortality. Pleurodesis is also an appropriate method of treatment. Elemene, an extract of the ginger plant, is also a sclerosing agent and can be used for pleurodesis. Methods: In this study, 23 consecutive patients were treated for high-output chylothorax. 0.5 % elemene emulsion injection (40 ml) was injected into the pleural cavity. The injection can be repeated if necessary. Results: All patients experienced resolution of symptoms. 7 patients received sclerotherapy with elemene once, 11 patients received it twice and 4 patients received it three times. 1 patient required five applications of elemene. The side effects included chest pain and fever but were considered sustainable. Conclusion: Elemene is an effective and safe treatment for patients with chylothorax.

Key words

thoracic surgery - chylothorax - elemene

References

• 1 Dugue L, Sauvanet A, Farges O. et al . Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy.  Br J Surg. 1998;  85 1147-1149
• 2 Cerfolio R J, Allen M S, Deschamps C. et al . Postoperative chylothorax.  J Thorac Cardiovasc Surg. 1996;  112 1361-1366
• 3 Merigliano S, Molena D, Ruol A. et al . Chylothorax complicating esophagectomy for cancer: a plea for early thoracic duct ligation.  J Thorac Cardiovasc Surg. 2000;  119 453-457
• 4 Chamberlain M, Ratnatunga C. Late presentation of tension chylothorax following blunt chest trauma.  Eur J Cardiothorac Surg. 2000;  18 357-359
• 5 McCormick III J, Henderson S O. Blunt trauma-induced bilateral chylothorax.  Am J Emerg Med. 1999;  17 302-304
• 6 Lopez Espadas F, Iribarren Sarrias J L, Martinez Jimenez C. et al . Chylothorax secondary to blunt thoracic trauma: report of 6 cases.  Arch Bronconeumol. 1997;  33 168-171
• 7 Vallieres E, Shamji F M, Todd T R. Postpneumonectomy chylothorax.  Ann Thorac Surg. 1993;  55 1006-1008
• 8 Shimizu K, Yoshida J, Nishimura M. et al . Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer.  J Thorac Cardiovasc Surg. 2002;  124 499-502
• 9 Vallieres E, Shamjj F M, Todd T R. Postpneumonectomy chylothorax.  Ann Thorac Surg. 1993;  55 1006-1008
• 10 Izbicki J R, Thetter O, Habekost M. et al . Radical systemic mediastinal lymphadenopathy in non-small cell lung cancer: a randomized controlled trial.  Br J Surg. 1994;  81 229-235
• 11 Beghetti M, La Scala G, Belli D. et al . Etiology and management of pediatric chylothorax.  J Pediatr. 2000;  136 653-658
• 12 van Straaten H LM, Gerards L J, Krediet T G. Chylothorax in the neonatal period.  Eur J Pediatr. 1993;  152 2-5
• 13 Alexiou C, Watson M, Beggs D. et al . Chylothorax following oesophagogastrectomy for malignant disease.  Eur J Cardiothorac Surg. 1998;  14 460-466
• 14 Wang G, Li X, Huang F. et al . Antitumor effect of beta-elemene in non-small-cell lung cancer cells is mediated via induction of cell cycle arrest and apoptotic cell death.  Cell Mol Life Sci. 2005;  62 881-893