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PubMed1987

Effects of oral administration of streptococcal preparation OK-432 on thoracic duct lymphocytes.

One KE of streptococcal preparation OK-432 (PIC) was given orally to 6-week old male Wistar-Imamichi rats twice weekly, and control animals received comparable volumes of saline alone. Samples of thoracic duct lymph and posterior vena caval blood were collected prior to and 4 and 8 weeks following PIC. The T cell count of thoracic duct lymphocytes was about three times greater than that of venous blood specimens, and increased significantly in animals following PIC. Controls showed only a slight increase followed by a decrease, so that by 8 weeks of treatment with PIC, the thoracic duct T cell count revealed a significantly greater number in the PIC group than in the controls. In addition, after 8 weeks the per cent T cell subpopulation in thoracic duct lymph increased significantly in the treated group, but it declined in the control group. Concerning T cell subsets in thoracic duct lymphocytes, the percentage of suppressor/cytotoxic T cells showed a significant elevation in the control group after 4 weeks compared with the treated group. No other blood or lymph variables reached statistical significance in this respect.

Administration, Oral↗
PubMed1997

[Anatomic characteristics of relatively inaccessible zones of thoracic duct and principles for improving surgical approaches].

The analysis of data obtained from investigation of 158 cadavers of adults with the use of complex of anatomic methods and from experiments on video-endosurgical installation revealed that the following ways should be combined to expose thoracic duct relatively inaccessible zones: a method of opened access to thoracic duct using high traumatism elements (clavicotomy and pericardium dissection), video-endosurgical method of access to thoracic duct regions located on the bottom of infundibular recess and use of mechanical clipping for faster block of thoracic duct lumen.

Adult↗
PubMed1986

Catalytic enzyme activity concentration in thoracic duct, liver, and intestinal lymph of the dog, the rabbit, the rat and the mouse. Approach to a quantitative diagnostic enzymology, II. Communication.

In the mixed body lymph of the thoracic duct and in the defined organ lymph of the liver and the intestine, the catalytic activity concentrations of up to sixteen enzymes and the concentrations of albumin and protein were determined, as well as the transport rate of these substances and their lymph/plasma ratio. Thoracic duct lymph specimens were obtained from an extracorporeal lymph shunt in anaesthetized and conscious dogs and from short-term fistulas in anaesthetized rabbits, rats and mice. Additionally, rabbits and rats underwent passive motion of the hind limbs in another experimental trial. Thoracic duct flow in anaesthetized dogs is only half that seen in conscious dogs, due to bypassed muscular lymph. A similar flow change is seen during passive motion of hind limbs in anaesthetized rabbits and rats. From a literature review of flow in the four main lymphatics of the body, it is concluded that the thoracic duct flow should account for 50-70% of total body lymph flow. In the anaesthetized state, flow is mainly of visceral origin. In the conscious state and during passive motion the increased flow is of muscular origin. In the latter case, the catalytic activities of enzymes like lactate dehydrogenase, malate dehydrogenase, creatine kinase, aldolase and phosphohexose isomerase, increase in lymph as does their lymph/plasma ratio. These enzymes have high catalytic activities in muscle. Their transport into the blood increases 2-3-fold, due to a doubling of lymph flow. Reported data for anaesthetized and immobile animals therefore far underestimate the significance of thoracic duct enzyme transport. Liver lymph was obtained from anaesthetized dogs and rabbits. Our finding that lymph catalytic activity for several enzymes is higher than in plasma is not compatible with the proposed delivery of plasma proteins directly into the sinusoidal space without prior mixing with the Space of Disse. Enzymes in liver lymph should derive from parenchymal and endothelial lining cells. Their site of delivery from the hepatocyte seems different from that of proteins. Liver lymph is an important transport route of enzymes into the blood. Intestinal lymph was sampled from anaesthetized dogs, rabbits and rats. It was shown that most enzymes from the intestine are primarily released into the interstitial space and from there are transported via the lymph into the blood.

Anesthesia↗
PubMed1986

Long-term continuous intralipid infusion in the thoracic duct in rats.

Intralipid was continuously infused into the thoracic duct for 12 days in rats. All remained clinically fit and had satisfactory weight gain only for the first week. Autopsy showed significantly increased lung weight in all rats and in some there were lymphatic fistulas and dilated thoracic duct. Microscopy revealed fat droplets, vascular changes and thickening of alveolar septa in the lungs. Epithelioid cell clusters were found in liver and spleen in some of the rats and Kupffer cell increase in most. Thus commercially available fat emulsion for parenteral use, when delivered by the natural route for natural chylomicrons, caused undesirable derangements in rats.

Animals↗
PubMed1980

Thoracic duct cyst of the mediastinum.

A case of mediastinal thoracic duct cyst is described. It is believed to be the first to be diagnosed before thoracotomy. Seven surgically treated cases have been reported but in none was the diagnosis made before operation. This case report concerns a 49-year-old woman who was operated upon because of a thoracic duct cyst that had been diagnosed by lymphangiography before the operation. Symptoms were caused by pressure of the cyst on the esophagus. The operation and immediate postoperative course were uneventful. One year later, the patient was doing well and no further investigation was recommended.

Adult↗
PubMed1996

Early thoracic duct ligation for postoperative chylothorax.

Four cases of postoperative chylothorax occurring at this institution over the past 5 years, as well as an extensive review of the world literature, are presented. Of the four cases, three occurred after resection of carcinoma of the lung and one after resection of recurrent chondrosarcoma of the chest wall. These patients were treated nonoperatively for varying periods of time ranging from 2 days to nearly 3 weeks. Subsequently, all patients underwent ligation of the thoracic duct. Early reoperation for ligation of the thoracic duct resulted in no morbidity or mortality. In one case of delayed thoracic duct ligation, after an attempt at ligation of minor lymphatic vessels, the single mortality occurred. In view of the experience with these patients and that reported in the literature, we propose that not only is thoracic duct ligation superior to nonoperative management, but that it should be undertaken without delay.

Adult↗
PubMedDate not supplied

Thoracoscopic pericardial window creation and thoracic duct ligation in neonates.

OBJECTIVE: We describe 2 newborn infants with persistent pericardial effusion treated with thoracoscopic pericardial window and thoracic duct ligation. METHODS: Patient 1 was a premature female newborn who presented with severe cardiac anomalies, including dextrocardia. She was treated with pulmonary artery handing and pacemaker placement for complete cardiac block. Postoperatively, she developed pericarditis with persistent symptomatic pericardial effusion. She did not improve despite pericardial drain placement. She was treated with a thoracoscopic pericardial window. Patient 2 was a newborn male who presented with cardiac tamponade secondary to congenital chylopericardium. He did not respond to pericardial drain placement or medical management with fasting, total parenteral nutrition, and octreotide. He was treated with thoracoscopic pericardial window and thoracic duct ligation. RESULTS: Patient 1 improved rapidly. The pericardial effusion disappeared. The chest tube was removed 5 days following surgery. She died 6 weeks later of a cardiac arrhythmia secondary to pacemaker failure. The pericardial effusion had resolved. Patient 2 responded to the pericardial window and thoracic duct ligation. He was discharged 10 days following the procedure. CONCLUSIONS: Thoracoscopy provides an excellent approach to the pericardium. Pericardial windows and biopsy can be safely performed with this approach. The thoracic duct can be easily identified and ligated even in small babies. Recovery can be fast with minimal postoperative discomfort. Cosmetic results are excellent and length of hospitalization is minimized.

Fatal Outcome↗
PubMed1977

Activities of proscillaridin A in thoracic duct lymph after single oral doses in man.

In order to study the possibility that orally administered proscillaridin after absorption is transported by the lymph to the systemic circulation, the concentrations of the glycoside in thoracic duct lymph were analyzed in two patients with thoracic duct drainage. They received the drug as a single oral dose; plasma and lymph concentrations were measured by 86Rb-technique. Lymph was collected at various intervals for 24 hrs. The proscillaridin activity in thoracic duct lymph was low and followed closely that the plasma. During the sampling period, a total of 300 ng and 240 ng, respectively, was recovered in the lymph, corresponding to less than 0.03% of the administered dose. The results indicate that proscillaridin is not transported by the thoracic duct lymph.

Administration, Oral↗
PubMedDate not supplied

Inadvertent puncture of the thoracic duct during attempted central venous catheter placement.

We report a case of puncture of the thoracic duct during left subclavian vein catheterization on the intensive care unit. Computed tomography and measurement of the triglyceride levels in the aspirated fluid proved the inadvertent penetration of the guidewire into the thoracic duct. Early recognition of central line misplacement avoided serious complications. Inadvertent central venous catheter placement into the thoracic duct may have the potential complications of infusion mediastinum and chylothorax.

Catheterization, Central Venous↗
PubMed1991

Diagnosis and localization of laceration of the thoracic duct: usefulness of lymphangiography and CT.

The usefulness of lymphangiography and CT in the diagnosis and localization of laceration of the thoracic duct was evaluated in 12 patients with chylothorax or chylous ascites after surgery. Bipedal lymphangiography was performed in all 12 patients. The last four patients studied also had CT after lymphangiography. Seven patients had abnormal findings on lymphangiograms; five with leaks from the thoracic duct, one with a lymphocele in a nephrectomy bed, and one with obstructed intestinal lymphatic vessels after thoracotomy. Five patients had no evidence of lymphatic leakage. CT in one patient with evidence of a leak on lymphangiography showed extravasation of contrast medium into the mediastinum and pleural space. CT in three patients with no abnormalities on lymphangiography also showed no abnormalities. Four of the five thoracic duct lacerations and the lymphocele were confirmed surgically. The diagnosis of obstructed intestinal lymphatic vessels was supported clinically. Four of the five patients with normal findings on lymphangiograms had resolution of their pleural effusions and no evidence of recurrence during a follow-up period of 1-27 months. One patient with normal findings on lymphangiography had an alternative diagnosis established at surgery. Laceration of the thoracic duct was accurately diagnosed and localized with lymphangiography, which allowed definitive surgical repair. CT was of little additional value in diagnosing these injuries.

Adult↗
PubMed1995

Thoracoscopic management of thoracic duct injury.

Thoracotomy has long been the conventional surgical approach in dealing with chylothorax due to thoracic duct injury which has been refractory to conservative treatment. The development of thoracoscopic access provides an alternative means of dealing with thoracic duct injuries thereby reducing the morbidity from thoracotomy and prolonged chylous leak. It will encourage earlier intervention in thoracic duct injury.

Adenocarcinoma↗
PubMed1999

Thoracic duct: visualization at nonenhanced MR lymphography--initial experience.

In six healthy volunteers, the thoracic duct was examined at magnetic resonance (MR) lymphography without contrast agent. With a 1.5-T clinical imager, a short echo spacing, three-dimensional, half-Fourier fast spin-echo sequence with electrocardiographic gating was employed to depict the thoracic duct along the thoracic aorta. The images clearly depicted the main duct in the region of the thoracic aorta in all six volunteers, drainage into the left subclavian region in four, and the cisterna chyli in one.

Adult↗
PubMed1989

[Radionuclide diagnosis of disorders of the central lymph dynamics in thoracic duct pathology].

The experience in using radiolymphography in the diagnosis of central lymph dynamics disorders in thoracic duct pathology has been analysed. For the first time in Soviet literature we encounter two observations over the state of lymph dynamics along the thoracic duct by means of lymphoscintigraphy with colloid 113mIn in patients with lymphangiectasia of the thoracic duct and chylothorax. In importance of lymphoscintigraphy in determining the compensatory mechanisms of the lymph flow in primary pathology of the main lymph collector is emphasized.

Adult↗
PubMed1980

[Coagulation properties of the extravascular fluid. I. Coagulation factors in thoracic-duct lymph].

All coagulation factors could be found in the thoracic duct lymph of dogs, but the coagulation activities are significantly lower than that of plasma. Analysis of thoracic duct lymph shows that the activity components are significantly lower for factors I (30%), II (60%), V (20%), VII (50%), VIII (30%), IX (25%), X (70%) and factor XIII (30%). With global (TEG) and group test (PTT, thrombin time) various coagulation properties could be detected in blood and lymph. Antithrombin III reached two third of the plasma concentration. The prothrombin consumption in lymph was markedly reduced. The most remarkable result appears to be a certain quantitative modification of the individual factors in the lymph in comparison to those in blood. Although the lymph does not contain any thrombocytes, thromboplastin formation is sufficient for clot formation.

Animals↗
PubMed1966

Immunologic competence of thoracic duct cells. I. Delayed hypersensitivity.

Delayed hypersensitivity was produced in donor Lewis rats by sensitization with soluble protein antigens emulsified in complete Freund's adjuvant. Cells of their thoracic duct lymph were collected for varying periods of time and transferred intravenously to isogenic Lewis recipients. With this model the following conclusions were reached: 1. Delayed hypersensitivity was transferred by thoracic duct cells. 2. The longer the drainage of the thoracic duct, the fewer cells were needed to achieve a successful transfer. With continuing drainage the proportion of small lymphocytes decreased and large cells increased. There was, therefore, a better correlation between successful transfer of delayed hypersensitivity and the number of large cells transfused than between positive skin reactions and transfer of small lymphocytes. 3. Prolonged fistula of the thoracic duct did not diminish the skin reaction of sensitized donors to specific antigen. 4. Delayed hypersensitivity was elicited in recipients 3 wk after transfer of sensitized cells. There was evidence that delayed hypersensitivity was enhanced in recipients, possibly because of prior skin testing. 5. Total body X-irradiation abolished the lesions of passively transferred delayed hypersensitivity. Recovery of positive skin tests was observed 19 to 20 days later. 6. The lesions of delayed hypersensitivity were probably mediated by cells. There was no evidence that a circulating high affinity antibody played a role in this type of immunologic reaction.

Animals↗
PubMed1983

The migration of lymphocytes across specialized vascular endothelium. VI. The migratory behaviour of thoracic duct lymphocytes retransferred from the lymph nodes, spleen, blood, or lymph of a primary recipient.

Thoracic duct lymphocytes labelled with 51Cr were injected into a primary recipient and then were transferred for a second time from the lymph nodes (cervical and/or mesenteric), spleen, lymph, or blood into a series of final recipients. Measurement of the organ distribution of labelled lymphocytes in the final recipients enabled three main conclusions to be drawn. (1) Lymphocytes that had localized in the spleen, mesenteric lymph nodes (LN), or cervical LN of the first recipient showed no tendency to return in increased numbers to the same organ in the final recipient. (2) Lymphocytes that had recently entered the spleen or LN were temporarily impaired in their ability to reenter LN. This capacity was recharged when the cells returned to the lymph and the blood. (3) Lymphocytes that had been passaged from blood to lymph and collected for up to 4 hr at room temperature entered the LN of a recipient much faster than did nonpassaged thoracic duct lymphocytes collected overnight at 0 degree C. Supplementary experiments indicated that the different migratory behavior of thoracic duct lymphocytes under these two circumstances was mainly a consequence of their handling in vitro during the collecting and the labelling procedures. This functional impairment was not associated with a diminished ability to enter the spleen and bone marrow or to survive in recipients for up to 24 hr.

Animals↗
PubMed1984

Characterization of recirculating lymphocytes in rheumatoid arthritis patients: selective deficiency of natural killer cells in thoracic duct lymph.

Five patients with rheumatoid arthritis (RA), who were treated by lymphocyte depletion by using thoracic duct drainage (TDD), provided an opportunity to characterize the phenotype and function of their recirculating lymphocytes. We found that: a) thoracic duct lymphocytes (TDL) were similar in their proportion of T cells (83% +/- 6 OKT3+), OKT4+ subset (65% +/- 8), and OKT8+ subset (22% +/- 6) to peripheral blood lymphocytes (PBL): b) fewer natural killer-like cells were present in TDL (5% +/- 4 Leu-7+; 2% +/- 2 Leu-11+: 8% +/- 2 OKM -1+) than in PBL (20% +/- 10 Leu-7+: 11% +/- 6 Leu-11+; 18% +/- 5 OKM -1) (p less than 0.01); c) TDL differed from synovial fluid lymphocytes ( SFL ) and synovial membrane lymphocytes ( SML ) in that TDL lacked a high percentage of activated lymphocytes (T cells bearing Ia antigen, OKT10 , and transferrin receptor): d) immature T cells (expressing either OKT6 antigen or reactive with peanut agglutinin) were not found in TDL even late in the course of TDD: and e) in vitro functional studies demonstrated that TDL were similar to PBL in their ability to synthesize immunoglobulin after mitogen stimulation and to generate cytotoxic T lymphocytes capable of lysing autologous EBV-transformed B cells. However, natural killer activity, as measured by lysis of K562 cells was significantly lower in TDL than PBL (p less than 0.05). These results demonstrate that natural killer cells defined by phenotype and function are excluded from thoracic duct lymph and thus have a circulation pattern different from most T cells.

Adult↗
PubMed1995

Thoracic duct injury in penetrating neck trauma.

Thoracic duct laceration from penetrating neck trauma is a rare injury associated with significant morbidity. Seventy-one cases published in the English literature in the last 50 years, along with one new case, were reviewed in an attempt to characterize the clinical profile, treatment, and outcome.

Adult↗