Simultaneous presence of massive chyloperitoneum and chylothorax and its successful management

The incidence of massive chylous ascites and chylothorax after aortofemoral bypass grafting (AFBG) procedure is unknown. Leakage of chyle results in severe malnutrition and infection which can be life threatening. Because of the rarity of disease, the definitive guideline on management of such extensive accumulation of chyle is lacking. We present a case of a 68- year-old gentleman who developed large chylous ascites and chylous pleural effusions causing respiratory distress. His history was significant for aortofemoral bypass graft procedure 8 weeks prior to index presentation. He was successfully managed with chylous fluid drainage, judicious use of diuretics, adherence to a low-fat diet, and supplementation with medium-chain triglycerides.

Treatment of an incarcerated inguinal hernia associated with abdominal tuberculosis in an adult patient

The incidence of tuberculosis is increasing worldwide, especially in developing countries. The prevalence of abdominal tuberculosis has been found to be as high as 12% in people with extrapulmonary tuberculosis. Peritoneal thickening and intestinal adhesions can occur in patients with abdominal tuberculosis. Inguinal hernias are extremely rare in people with abdominal tuberculosis; only 11 cases have been reported in the English-language literature, half of which involved pediatric patients. No definitive guideline on the management of such cases is available. In this report, we describe the unusual finding of an incarcerated inguinal hernia in an adult with abdominal tuberculosis and propose a therapy to treat this complicated disease based on our successful experience.

Abstract P190: Associations of 24-h Urinary Sodium/potassium (Na/K) Ratio with Recommended Intakes of Na and K: The INTERMAP Study

Background: High dietary sodium (Na), low dietary potassium (K) and high dietary sodium/potassium (Na/K) ratio are associated with adverse blood pressure levels and excess risks of cardiovascular diseases. 24-h urine collection is the gold standard for measuring dietary Na, K and Na/K ratio. Recommended levels of Na and K intakes are suggested in WHO guidelines; less than 85 mmol/day for Na; at least 90 mmol/day for K; there is no definitive guideline for Na/K ratio. Objective: Our primary aim was to compare the level of urinary Na/K ratio with the current recommended levels of Na and K intakes suggested in WHO guidelines. Methods: INTERMAP is an international study on associations of multiple dietary variables with blood pressure (BP), based on two timed 24-hr urine collections and dietary data from 4 in-depth 24-h dietary recalls in 4,680 men and women ages 40-59 years in China, Japan, United Kingdom and United States (US). Na/K ratio of 24-hr urine stratified in 1 unit intervals was compared with the current recommended levels of Na and K intakes suggested in WHO guidelines. Na intake was evaluated by urinary Na excretion; K intake by dietary K intake. Results: Thirty-one of the 4,680 INTERMAP participants (0.7%) had urinary Na/K ratio less than 1. The proportions of participants with Na excretion less than 2 g/day (85 mmol/day) among all 4,680 individuals were 77% (n=24), 19% (n=117), and 0.2% (n=11) in those with urinary Na/K ratio less than 1, 1 to 2, and more than 4, respectively. In US samples (n=2,195) the proportions were 88% (n=15), 19% (n=70), and 0.3% (n=6), respectively. The proportions of participants with dietary K intake more than 3.51 g/day (90 mmol/day) among all 4,680 individuals were 71% (n=22), 38% (n=233), and 2.4% (n=111) in those with urinary Na/K ratio less than 1, 1 to 2, and more than 4, respectively. In US samples the proportions were 59% (n=10), 38% (n=138), and 2.1% (n=47), respectively. Conclusions: WHO recommends Na intake less than 85 mmol/day, and K intake more than 90 mmol/day. Urinary Na/K ratio less than 1 is needed to ensure reasonable compliance with these recommendations. Currently, very few people satisfy urinary Na/K ratio less than 1, so population-wide efforts are needed to reduce salt (sodium chloride) and increase K intake.