Bilateral chylothoraxis an extremely rare complication of modified radical neck dissection. It is a potentially life-threatening condition that can lead to severe respiratory, nutritional, metabolic, and immunologic disorders. Use of a multi-disciplinary approach including drainage of chyle, reduction of chyle formation, adequate nutritional support, use of somatostatin or its analogue, surgical ligation of the thoracic duct, and thoracic duct embolization is the best method for treatment of bilateral chylothorax. We report on a case of bilateral chylothorax following total thyroidectomy with modified radical neck dissection and discuss its management.
Chyle ; Chylothorax* ; Drainage ; Ligation ; Neck Dissection* ; Nutritional Support ; Somatostatin ; Thoracic Duct ; Thyroid Neoplasms* ; Thyroidectomy

Rahnella aquatilis, a saprophytic organism, is a member of the Enterobacteriaceae family. The natural habitat of this organism is fresh water, and it is rarely found in clinical specimens. Clinical conditions ascribed to this organism include bacteremia, respiratory infection, urinary tract infection, wound infection in an immunocompromised host, and infective endocarditis in patients with congenital heart diseases. Here, we report a case of bacteremia due to R. aquatilis in a woman with breast cancer who had received chemotherapy through a chemoport. To our knowledge, this is the second case of bacteremia caused by this organism in a patient with cancer in Korea.

BACKGROUNDS/AIMS: Biliary cystadenoma (BCA) and cystadenocarcinoma (BCCA) are rare cystic hepatic neoplasms. Prior reports concerning the proper surgical treatment and long-term survival are scarce. We report our experience and survival outcome of 30 patients over the last 25 years. METHODS: We retrospectively reviewed the clinicopathologic data of the pathologically confirmed 18 BCA and 12 BCCA patients, who underwent operations from 1983 to 2006, at the Seoul National University Hospital. RESULTS: The patients consisted of 8 men and 22 women with a mean age of 51 years. With abdominal computed tomography scans, 73.3% (n=22) were preoperatively diagnosed as BCA or BCCA, and differentiating BCCA from BCA was accurate in 58.3% patients. R0 resection was achieved in 90% (n=27). The differentiating factors included the presence of mural nodule (4/18 vs. 8/12; p=0.009) and mucinous content (2/9 vs. 8/1; p=0.005), and tumor size tending to be larger in BCCA (11.7 cm vs. 7.9 cm; p=0.067). Overall 5-year and 10-year survival rates of BCCA were 72.9% and 60.9%, respectively. Of patients with BCCA, 4 experienced recurrence. In case of recurrence, patients tended to be younger than 50 years (p=0.061) and the lesions tended to be larger than those without recurrence (p=0.088). CONCLUSIONS: Preoperative differentiations of BCA from simple cyst, and BCCA from BCA are still difficult. Complete removal of the tumor, via major hepatectomy, should be considered, especially in the younger age group with large tumor.
Biliary Tract ; Cystadenocarcinoma ; Cystadenoma ; Female ; Hepatectomy ; Humans ; Liver Neoplasms ; Male ; Mucins ; Recurrence ; Retrospective Studies ; Survival Rate