Revue médicale suisse
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Chylothorax is characterized by a milky pleural effusion that results from the injury to the thoracic duct, causing leakage of chyle into the pleural space. Its diagnosis relies primarily, on the determination of triglycerides and/or the identification of chylomicrons in the pleural fluid. ⋯ Conservative treatment is based on pleural drainage with a low fat diet and appropriate etiological approach. In case of failure, occlusion of the thoracic lymph duct should be considered, either by a surgical approach or interventional radiology.
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The year 2015 was marked by several publications questioning the practice of emergency medicine. The systematic administration of oxygen in STEMI patients offers no benefit. Similarly, medical expulsive therapy in patients with ureteric stones was questioned. ⋯ Several studies have demonstrated the benefit combining intraarterial and intravenous thrombolytic therapy for ischemic stroke. However, studies assessing optimal management strategy for patients hospitalized with community acquired pneumonia, showed conflicting results. Finally, these developments occur in the context of an aging population and increase of pre-hospital management for the elderly, raising the question of how to reduce hospital admissions in this population.