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PubMed2002

Somatostatin analog treatment of a cervical thoracic duct fistula.

BACKGROUND: Reoperation for recurrent thyroid cancer poses an increased risk of complications, including thoracic duct fistula. Treatment of this complication is controversial. A survey of thoracic literature reports the use of somatostatin analog, whereas no cases have reported the use of this therapy in cases arising from neck dissection. METHODS: We report a 16-year-old girl with recurrent papillary thyroid cancer who had a persistent lymphatic-cutaneous fistula develop after repeat modified left neck dissection. Despite conservative management, drainage persisted for 2 months. A regimen was begun that included TPN and injections of a somatostatin analog. RESULTS: Treatment with a somatostatin analog resulted in an immediate attenuation of drainage and subsequent closure of the fistula after 16 days of treatment. CONCLUSION: The use of somatostatin analog can increase the success of conservative management of thoracic duct fistulae.

Adolescent↗
PubMed1999

[The structure of the thoracic duct wall in newborn pigs].

Architectonics of thoracic duct wall was studied in newborn pigs by means of transmission electron microscopy. The detailed description of three coats: internal medium (muscular) and external (connective tissue) is given. Specific structure of each coat is discussed.

Animals↗
PubMed1989

Lipoperoxide in dog thoracic duct lymph.

Lipoperoxide levels were examined in thoracic duct lymph (TDL) of 11 dogs. In four dogs with sodium citrate added in vitro to prevent coagulation, TDL had notably higher levels than in serum. After centrifugation, however, lymph supernatant levels of lipoperoxide closely approximated that in serum suggesting that the bulk of lipoperoxide remained in the sediment and derived from circulating cells. Interstitial accumulation of lipoperoxide, a breakdown product of cell membranes, may be a potent "toxic factor" responsible for trophic changes associated with chronic lymph-edema.

Animals↗
PubMed1972

Identification of marrow-derived and thymus-derived small lymphocytes in the lymphoid tissue and thoracic duct lymph of normal rats.

These experiments show that small lymphocytes from the thoracic duct of rats are normally a mixture of thymus-derived and marrow-derived cells, and define the traffic areas in lymphoid tissues through which the two populations recirculate. Thoracic duct lymphocytes were labeled in vitro with uridine-(3)H and their histological distribution in the lymphoid tissues of normal recipients was demonstrated by radioautography. Labeled lymphocytes occupied two adjacent areas distinguished by a marked difference in the intensity of labeling; heavily labeled cells were found in thymus-dependent traffic areas of lymphocyte recirculation, while lightly labeled cells localized in the thymus-independent follicular areas around germinal centers. A corresponding heterogeneity of uridine uptake among small lymphocytes from normal donors was demonstrated by sedimentation at 1 g; slowly sedimenting cells incorporated little uridine and localized in follicular areas after transfusion while rapidly sedimenting cells incorporated more uridine and localized in thymus-dependent areas after transfusion. Experimentally prepared marrow-derived small lymphocytes behaved in sedimentation studies and after transfusion like a pure population of the lightly labeled small lymphocytes in normal lymph. Artificially reconstituted mixtures of marrow-derived and thymus-derived lymphocytes were qualitatively indistinguishable from normal lymphocyte populations.

Animals↗
PubMed1988

[Microrelief of the internal surface of the thoracic duct in dogs (based on scanning electron microscopy data)].

The investigation has been performed on 17 mature dogs. With the aim to investigate the internal surface of the thoracic duct, the methods of scanning electron microscopy of native, impregnated and corrosive preparations have been used. The analysis of the scannograms obtained demonstrates that the valves of the thoracic ducts are mainly bicuspid, have a typical infundibular form, their cuspides are fused, forming a mesentery-like fold on the duct wall. It plays the main role in ensuring unilateral transport of lymph. The microrelief of the thoracic duct endothelium possesses a rather complex organization. The following relief formations are distinguished in endotheliocytes: 1. nuclei-containing eminence, 2. marginal processes, 3. separate microvilli. The dependence of the microrelief on arrangement of endothelial cells in the valvular area or intervalvular fragments is noted. This is also concerned orientation of endotheliocytes; therefore, predominance of stretched endotheliocytes of the postvalvular fragment can be connected with demonstration of viscous friction force in the lymph stream, that produces deforming and orienting influence on the endotheliocytes.

Animals↗
PubMed1999

Bacterial translocation to the thoracic duct in a setting of ischemia, partial resection and reperfusion of the porcine liver.

BACKGROUND/AIMS: Bacterial translocation is postulated as a risk factor in the development of a systemic inflammatory response syndrome (SIRS). Research on this topic has focused on the detection of bacteria and endotoxin in blood or mesenteric lymph nodes (MLNs). We investigated whether bacterial translocation occurs beyond the MLNs into the thoracic duct in a setting of ischemia, partial resection and reperfusion of the porcine liver. METHODS: A porcine model of severe, extra-intestinal tissue injury, consisting of prolonged hepatic ischemia and reperfusion, in combination with hemihepatectomy, was used (experimental group, n = 5 pigs). To prevent venous congestion of the gut during ischemia, a temporary portal-caval shunt was created. In 5 animals (sham group) a sham portal-caval shunt was constructed while liver ischemia, partial resection and reperfusion were not induced. Thoracic duct lymph, portal blood and systemic blood were collected, and analyzed for the presence of bacteria and endotoxin. RESULTS: In the experimental group, the incidence of bacterial translocation to the thoracic duct was significantly higher during early reperfusion compared to the sham group (5/5 animals versus 1/5 animals, p < 0.05). CONCLUSION: This study demonstrates bacterial translocation into the thoracic duct. Translocation at this level leads to direct discharge of bacteria and endotoxin into the systemic circulation and therefore, may potentially enhance the development of SIRS.

Animals↗
PubMed1997

Improved technique for cannulation of the murine thoracic duct: a valuable tool for the dissection of immune responses.

Several experimental approaches have been used in the past for the cannulation of the thoracic duct in mice. Most, however, are characterized by a modest reproducibility and a low lymph yield. Here, we describe a cannulation technique modified with respect to the anesthesia, the use of a silicone cannula and a simple and efficient intraabdominal fixation of the drain. Surgery averaged 45 min with an intra- and postoperative mortality rate of zero. Postoperatively, mice were given access to an exercise wheel allowing increased mobility and consequently a good lymph flow, thus maintaining the function of the cannula. The mice yielded a mean of 29.3 ml/24 h (range 8-40 ml) thoracic duct lymph, which contained a mean of 2.2 x 10(6) lymphocytes/ml during the first 24 h, decreasing to 0.1 x 10(6) lymphocytes/ml on the 2nd day after cannulation. Patency of the cannulae was 100% after 3 days. Interestingly, we have detected strain dependent differences in the anatomy of the thoracic duct in the mouse and these need to be considered when cannulation procedures are attempted.

Animals↗
PubMed2002

Inhibition of the active lymph pump by flow in rat mesenteric lymphatics and thoracic duct.

There are only a few reports of the influence of imposed flow on an active lymph pump under conditions of controlled intraluminal pressure. Thus, the mechanisms are not clearly defined. Rat mesenteric lymphatics and thoracic ducts were isolated, cannulated and pressurized. Input and output pressures were adjusted to impose various flows. Lymphatic systolic and diastolic diameters were measured and used to determine contraction frequency and pump flow indices. Imposed flow inhibited the active lymph pump in both mesenteric lymphatics and in the thoracic duct. The active pump of the thoracic duct appeared more sensitive to flow than did the active pump of the mesenteric lymphatics. Imposed flow reduced the frequency and amplitude of the contractions and accordingly the active pump flow. Flow-induced inhibition of the active lymph pump followed two temporal patterns. The first pattern was a rapidly developing inhibition of contraction frequency. Upon imposition of flow, the contraction frequency immediately fell and then partially recovered over time during continued flow. This effect was dependent on the magnitude of imposed flow, but did not depend on the direction of flow. The effect also depended upon the rate of change in the direction of flow. The second pattern was a slowly developing reduction of the amplitude of the lymphatic contractions, which increased over time during continued flow. The inhibition of contraction amplitude was dependent on the direction of the imposed flow, but independent of the magnitude of flow. Nitric oxide was partly but not completely responsible for the influence of flow on the mesenteric lymph pump. Exposure to NO mimicked the effects of flow, and inhibition of the NO synthase by N (G)-monomethyl-L-arginine attenuated but did not completely abolish the effects of flow.

Animals↗
PubMed1996

[Mediastinal thoracic duct cyst--a case report].

The patient, a 55-year-old asymptomatic man, was referred to our hospital in October 1995 for further investigation of a chest ++roentogenographic abnormality found during a "physical check-up". His chest X-ray showed a round shadow over the hilus of the left lung. Computed tomography revealed a homogeneous, low density mass bordering the esophagus, vertebral column, left lower pulmonary vein and descending aorta. Roentogenography after swallowing barium sulfate showed that the esophagus was compressed and displaced to the right in the anterior direction. Endoscopic ultrasound scan demonstrated a cystic mass. The preoperative findings were suggestive of an esophageal cyst or a thoracic duct cyst. On December 12, 1995, the patient was operated on. The mass was 2 x 3 x 6 cm in size, and was easily separated from the left pulmonary vein, esophagus and vertebral column by blunt and sharp dissection, but it was strongly adhered to the aorta. The wall of the cyst was incised and a chylous fluid was found inside. The mass was diagnosed as a thoracic duct cyst and was removed after clipping and cutting the thoracic duct above and below the cyst. Histopathological features of the wall of the cyst was that the luminal surface was lined by a monolayer of flat endothelium and composed of loose fibrous tissue with scattered bundles of smooth muscle. It differed from that of veins. The postoperative course was uneventful and he was discharged on the 12th postoperative day. Mediastinal thoracic duct cysts are rare and only 25 operated cases have been reported in the literature. We review and discuss these cases.

Humans↗
PubMed2006

Renal lymphatic drainage and thoracic duct connections: implications for cancer spread.

Studies on renal lymph drainage have generally described lymph nodes without further investigation of the lymph vessels. Our purpose was to revisit this organ to study the vessel drainage pattern. This investigation was performed on 16 refrigerated adult cadavers. After both kidneys were injected with a blue modified Gerota mass, lymph vessels were dissected until their termination. From the right kidneys (n = 13), lymphatics (n = 8) traveling on the anterior aspect of the inferior vena cava were dissected, reaching interaortocaval and more distant nodes, aorta bifurcation (n = 1) and left lateroaortic (n = 1); posterior lymphatics were observed in all subjects, uniformly connecting to the thoracic duct, either after crossing nodes (n = 8) or directly (n = 5). From the left kidneys (n = 13), anterior efferents (n = 16) were dissected, reaching left lateroaortic and also celiac (n = 4) and iliac (n = 1) nodes; posterior lymphatics were also demonstrated, always connecting to the thoracic duct (3 directly). Renal lymphatics have been found to reach very distant nodes as well as always connecting to the origin of the thoracic duct. This feature suggests an important role in both the formation of the thoracic duct and in the spread of renal cancer.

Adult↗
PubMed1996

Subcutaneous accumulation of chyle after thoracic duct ligation in a dog.

A 3.5-year-old female German Shepherd Dog developed subcutaneous accumulation of chyle in a hind limb after ligation of the thoracic duct for treatment of chylothorax. Lymphangiography revealed severe lymphangiectasia in the abdomen and left inguinal region. Although the pleural effusion resolved, the subcutaneous accumulation of chyle continued even after medical and surgical treatment, which included transplantation of the greater omentum into the subcutaneous tissues of the affected limb. Alternate lymphaticovenous pathways usually develop in dogs after thoracic duct ligation. These apparently did not develop in this dog, resulting in retrograde flow of chylous fluid into the hind limb. To the authors' knowledge, this is a previously unrecognized complication of thoracic duct ligation for treatment of chylothorax in dogs.

Animals↗
PubMed1991

Comparison of IgD+ and IgD- thoracic duct B lymphocytes as germinal center precursor cells in the rat.

Genetically marked thoracic duct B cell subpopulations rich in either IgD+ or IgD- B cells were transferred to non-irradiated, congenic rats in order to compare the capacities of IgD+ versus IgD- B cells to form germinal centers (GCs). This comparison was made quantitatively based on flow cytometric analyses of lymph node cells prepared from chimeric rats 7 days after s.c. immunization. Donor-origin and host-origin B cells were distinguished using anti-Igk antibodies, and GC B cells were distinguished from other B cells in suspension by their lack of labeling with the mAb HIS22. IgK+ HIS22- lymph node cells corresponded well to GC B cells: they contained many large cells, were IgM+ but mostly IgD-, expressed relatively lower levels of IgM than HIS22+ B cells, and increased in number and frequency in response to antigen. Results from flow cytometric analyses, corroborated by immunofluorescence histochemical studies, showed that cell-for-cell, IgD- B cells from GCs much more efficiently than IgD+ cells. B cell populations enriched for IgD- cells became relatively more distributed to GCs than to other lymph node B cell areas and gave rise to many more GC B cells of donor origin per transferred B cell than whole, unseparated thoracic duct B cells (for which greater than 97% were IgD+). IgD- B cells from rats primed deliberately with antigen also became relatively more distributed to GCs and gave rise to more GC B cells of donor origin than either IgD+ B cells from primed donors or IgD- B cells from unprimed donors.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Last-intercalated node and direct lymphatic drainage into the thoracic duct from the thoracoabdominal viscera.

OBJECTIVE: We clarified the configuration of the mediastinal lymphatics, focusing on the last intercalated lymph node and the direct drainage vessel to the thoracic duct, based on recent anatomical findings. METHODS: We macroscopically observed the lymphatics during dissections of 205 cadavers in combination with routine histology. We also review the results of injection by other researchers. RESULTS: Efferent vessels draining directly into the thoracic duct or venous angle were frequently found in the following node groups: the right paratracheal node group corresponding to the last intercalated node in 98% of cadavers (201); the brachiocephalic angle node group in 85% of cadavers (174); the right recurrent nerve group in 46% (94); the left superior phrenic node group in 73% (150); the node group at the origin of the left common carotid artery (the preaortico-carotid node) in 37% (76); the pretracheal node group in 25% (51) and the left tracheobronchial node group in 36% (74). Last intercalated nodes appeared common for multiple drainage routes or regional lymphatics. These results were mostly consistent with injection studies by Riquet et al. Direct lymphatic drainage from the esophagus to the thoracic duct was observed in 19% of cadavers (39). Direct lymphatic drainage of lung segments to distant mediastinal nodes is also reviewed. The sentinel node concept is discussed in relation to the above observations. CONCLUSIONS: We hypothesize that the most critical sentinel node, if such usage is allowed, is situated as a guard for a limited specific route and for a common drainage route. We term it the "common terminal node".

Humans↗
PubMed2000

Thoracic duct lymph flow and its driving pressure in anesthetized sheep.

We examined the relationship between thoracic duct lymph flow (TDF) and its driving pressure (DP) in six anesthetized sheep. DP was determined as the thoracic duct pressure (TDP) minus the innominate vein pressure (VP). TDF was measured using an ultrasound transit-time flow meter, placing a flow probe beside the caudal mediastinal lymph node. TDP was measured with a fine needle inserted near the flow probe. TDP increased linearly together with an increase in VP after balloon inflation in the cranial vena cava with a TDP/VP ratio of 0.79. DP decreased, therefore, with an increase in VP and this decrease in DP correlated directly with a fall in TDF. After rapid i.v. fluid infusion, TDF increased but DP varied among the six sheep. Nonetheless, after balloon inflation with expanded volume (i.e., i.v. fluid infusion), DP and TDF were positively correlated. We conclude that DP is the main factor determining TDF when VP rises in conjunction with increased lymph production.

Animals↗
PubMed2006

Video-assisted right supradiaphragmatic thoracic duct ligation for non-traumatic recurrent chylothorax.

BACKGROUND: Chylothorax is an uncommon disorder with respiratory, nutritional and immunological manifestations. Surgical management is indicated in case of recurrence or failure after conservative treatment. We report our experience with video-assisted right-sided supradiaphragmatic thoracic duct ligation for non-traumatic, non-postoperative persistent or recurrent chylothorax. PATIENTS AND METHODS: The medical records of six patients operated at our institution between 1999 and 2004 were retrospectively reviewed. A right-sided chylothorax was found in four patients, a left-sided in one, and a bilateral in one. Three patients developed chylothorax after chemotherapy and chest irradiation for malignant diseases (lymphoma in two patients and breast cancer in one), one in the context of lymphangioleiomyomatosis, one due to a non-diagnosed lymphoma, and one after heart transplantation. RESULTS: The mean operative time was 102 min, with an average length of hospital stay of 14 days. Persistent cessation of chylous effusion within 7 days after surgery was observed in 5/6 patients without recurrence during a mean follow-up time of 41 months. One patient with undiagnosed mediastinal lymphoma required re-operation and thoracic duct ligation on day 8 by right-sided thoracotomy due to persistent chylothorax. No 30-day mortality was recorded. Two patients presented postoperative complications including respiratory insufficiency requiring mechanical ventilation in one, and chylous ascites development requiring peritoneo-venous LeVeen shunting in one patient. CONCLUSIONS: Recurrent or persistent non-traumatic chylothorax may be successfully treated by video-assisted right supradiaphragmatic thoracic duct ligation.

Adult↗
PubMedDate not supplied

[The formation of definitive variants in the organization of the rudimentary portion of the thoracic duct in the prenatal period of human ontogeny].

The aim of the investigation was to find out the anatomo-topographic parallels in the development of the initial part of the thoracic duct, organs of the abdominal cavity and branches of the abdominal aorta which takes place due to taxis of the physiological umbilical hernia and secondary adhesion of the peritoneum. Specificity of these processes determines variability of branching of the abdominal artery and the formation of the duodenum, the increasing pressure to the posterior wall of the abdomen and mesentery where the presumptive lymph collectors are found. The degree of their separation by invaginations of blood vessels, the rate and spread of the development of lymph nodes are responsible for the structure and position of the initial part of the thoracic duct in human fetuses. The results obtained may be taken as a morphogenetic ground for search of the local reference points for the initial part of the thoracic duct.

Abdomen↗
PubMed2001

Percutaneous translymphatic thoracic duct embolization for treatment of chylothorax.

A modified technique for transabdominal, translymphatic occlusion of the thoracic duct is described. During unilateral lymphangiography an abdominal lymph vessel was punctured with a fine needle under fluoroscopic guidance, and a 4 French access to the lymph system established. The thoracic duct was successfully embolized with coils and tissue adhesive in a patient with postoperative high output chylothorax. Chylous drainage immediately decreased after the intervention, the intercostal drain could be removed after seven days. Long term follow up over a ten months period confirmed the clinical success; the patient is still free of pleural effusions.

Aged↗
PubMed1976

Drainage of thoracic duct lymph in renal transplant patients.

Lymphocyte depletion by drainage of lymph via a thoracic duct fistula was accomplished in 51 renal transplant recipients as an adjunct method for immunosuppression. The duration of lymph flow varied between 2 and 53 days and the total drained lymph volume between 1 and 168 liters. The graft survival of these patients was compared to that of a control group of patients undergoing transplantation during a similar period. The followup period was 2-6 years. In patients receiving transplants from living related donors, no beneficial effect of lymphocyte depletion was demonstrated, probably because of the satisfactory graft survival among the control patients (84% at 1 year). However, in recipients of cadaveric kidneys, a significantly higher 1-year graft survival was achieved in the lymph-drained patients. Drainage for more than 30 days and of more than 20 liters improved the results. Additional suppression by thymectomy and institution of antilymphocyte globulin suggested that the best treatment would be a combination of both these measures with lymph drainage continuing for more than 30 days. Infection around the thoracic duct cannula occurred in 5 patients, necessitating removal of the cannula in 2. Two patients developed septicemia. In one of them the infection originated from an infected incisional wound and in the other probably from reinfusion of contaminated lymph plasma. Two other patients developed malignant tumors 23 and 58 months after transplantation, respectively. It is felt that lymphocyte depletion by lymph drainage is an effective supplementary method of immunosuppression to enhance graft survival in recipients of cadaveric renal transplants.

Adult↗