Spontaneous, post-operative and traumatic chylothorax.

Study of the malformation of the chyliferous vessels, malformations of Pecquet's cistern or of the thoracic duct has brought out the nature of the physiopathology of spontaneous chylothorax: it is the result of a rupture of a lymphatic of the diaphragm, mediastinum, or lung. Post-operative chylothorax is due to a lesion of the thoracic duct or of one of its branches.

[Diagnosis of chyliferous blockage by the hyperlipidemia test (author's transl)].

In our hyperlipidemia test, the total lipids curve, a plateau without a postprandial peak, allows an easy diagnosis of the chyliferous blockage. The malformation of chyliferous vessels produces the congenital forms: exsudative enteropathy, chyloperitoneum, spontaneous chylothorax, chylous cyst of the mediastinum, reflux of chyle in the pulmonary lymphatics, lymphoedema with chyle reflux in the lymphatics of the leg and chyluria. The acquired forms comprise the post-infectious sclerosis of the intestinal lymphatics and the neoplastic invasions of the mesenteric lymph nodes.

[Malformations of the lacteals].

For the diagnosis of malformations of the lymphatics is made by the hyperlipidaemia test, which shows a flat total lipids curve without a post-prandial peak. Malformation of the lymphatics of the small intestine is responsible for exudative enteropathy, chyloperitoneum, chyluria, lymphoedema with reflux of lymph in the lymphatics of the legs and its complications (chylorrhagia, chylarthrosis), chylothorax, chylopericardium and reflux of lymph in the pulmonary lymphatics. This malformation can also be associated with other disorders : such as the syndrome of Klippel and Trenaunay, and simple lymphoedema of the limbs or genital organs.

[The induced hyperlipemia test. 10 years of experience].

The induced hyperlipemia test, which is easly to administer, yields very interesting information for the study of lipidic metabolism in arteriosclerosis patients. Its use, in both the pre- and post-operative phases, has brought out the valuable effect of ligature of the intestinal lymphatics in treating arteritis. It may also enable us to determine whether there is a hereditary factor or family predisposition to arteriosclerosis.