Injury
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Chylothorax is an uncommon occurrence seen most frequently in patients with malignancy. We report a case of chylothorax following fracture-dislocation of the thoracolumbar spine, the ninth reported case in the English literature. ⋯ We have reviewed the literature, and recommend conservative management utilizing closed thoracotomy drainage and total parenteral nutrition for at least 2 weeks. If chyle flow has not diminished by that time then thoracic duct ligation should be considered.
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Recent evidence has shown that there may be leakage of anaesthetic drugs into the systemic circulation during the tourniquet inflation phase of intravenous regional anaesthesia. This, together with increased pressure in forearm vessels during manipulation of fractures, prompted the measurement of arterial levels of local anaesthetic to assess potential toxicity. ⋯ Eleven patients had measurable concentrations of prilocaine in the arterial circulation during the time the tourniquet was inflated, the maximum levels being measured in those patients having fractures manipulated. Considerable vigilance should be ensured during the time of tourniquet inflation in intravenous regional anaesthesia, particularly for fracture manipulation.