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At least 343 records · Page 19Linked to original sources
PubMed1992

Hemodynamic changes after resection of thoracic duct for en bloc resection of esophageal cancer.

An en bloc resection of esophageal cancer is one of the most radical forms of esophagectomy, and includes the resection of the thoracic duct, but a relatively high hospital mortality rate has been reported. There is very little knowledge on the pathophysiological changes after resection of the thoracic duct. We examined 24 patients who underwent en bloc resection. Some patients developed severe tachycardia or shock postoperatively which subsided after a massive infusion of plasma. Analysis of the fluid balance revealed that much more fluid was necessary during surgery and the postoperative 24 h than in patients treated by a standard esophagectomy. Postoperative lymphangiography or CT revealed abnormal collateral lymphatics around the kidneys or in the pelvic cavity. This suggests the development of the lymphaticovenous shunts, which differed depending on the anatomy of each patient. One patient with chronic hepatitis developed uncontrollable ascites. These are important findings which can hopefully reduce the high rate of hospital death after this operation.

Aged↗
PubMed1986

[Injuries of the thoracic duct during neck surgery].

Although rarely published, operative injuries to thoracic duct in neck are by no means exceptional, and can occur during all types of surgery to lower cervical and supraclavicular regions. A case is reported and used as a basis for an analysis of diagnostic means and therapeutic possibilities of injuries detected during operation or those developing manifestations at a later stage. In the case reported, long-term medical treatment resulted in arrest of lymphorrhea within 37 days.

Adult↗
PubMed1998

Basic fibroblast growth factor-mediated lymphangiogenesis of lymphatic endothelial cells isolated from dog thoracic ducts: effects of heparin.

We have attempted to evaluate whether, similar to the angiogenesis of blood vessels, cultures of lymphatic endothelial cells (LEC) isolated from dog thoracic ducts have an ability to induce lymphangiogenesis in response to basic fibroblast growth factor (bFGF), then to examine the effects of heparin on the bFGF-mediated morphogenesis. The effects of bFGF and/or heparin on the proliferation and migration of the LEC were evaluated by changing the number of the subconfluent cells and by wound migration assay, respectively. The effects of the agents on invasion and tube formation of the LEC into a three-dimensional collagen gel and on collagen gel induced tube formation of the LEC were also investigated by a phase-contrast microscope and an electron microscope. The bFGF (10 ng/ml) caused a significant induction of proliferation and migration of the LEC, the induction of which was augmented dose-dependently by an additional treatment with heparin ranging from 1 to 100 microg/ml. The bFGF produced invasion and tube formation of the LEC into a three-dimensional collagen gel. The bFGF also facilitated to form capillary-like tubes of the LEC between two layers of collagen gels. Heparin (10 microg/ml) accelerated both processes of bFGF-mediated lymphangiogenesis of the LEC. These findings suggest that the cultured LEC isolated from dog thoracic ducts have an ability to form lymphatic capillary-like tubes in response to bFGF and that heparin accelerates dose-dependently the process of the bFGF-mediated neovascularization of lymph vessels.

Animals↗
PubMed1981

Effect of plasma exchange and thoracic duct drainage on immunological status in glomerulonephritis.

The effect of thoracic duct drainage (16 patients treated) and plasmapheresis (15 cases) on immunological status has been studied in patients suffering from immunological glomerular disease. Lymph drainage proved to affect mostly cellular immunity. Besides a marked reduction in peripheral lymphocyte count and changes in behaviour of E(T-RFC) and E(A-RFC), different functional behaviour was observed in lymphocytes from drainage and blood lymphocytes after mitogen stimulation. Plasmapheresis was associated with changes mainly in humoral parameters, i.e. rapid disappearance of circulating immune complexes. Some increased T suppressor activity was also documented in patients with active lupus nephritis.

Adult↗
PubMed1995

The morphology of valves and valve-like structures in the canine and feline thoracic duct.

The microanatomy and ultrastructure of the feline and canine thoracic duct and afferent lymphatics were studied by scanning and transmission electron microscopy. We found that the lymphatic vessels were always terminated by ostial valves of two shapes, crescent- and navicular-like, in a ratio of 4:1. Specific regulatory structures along the free edges of the valves, including marginal thickenings and buttresses, are described. The tissue and cellular organization of the valve endothelium showed distinct peculiarities, particularly in the orientation and shape of the cells and their microrelief. We found that valvular endothelial cells, especially ¿tip cells¿, which are situated in unfavourable lymphodynamic conditions, were characterized by an increased volume density of intermediate (probably vimentin-based) filaments, suggesting an accommodative mechanism involving such filaments.

Animals↗
PubMedDate not supplied

Effect of preoperative thoracic duct drainage on canine kidney transplantation.

Chronic drainage of the thoracic duct to the esophagus was developed in dogs, and its efficacy in immunomodulation was tested using kidney transplantation. Compared to 9.7 days in the control, the mean animal survival was prolonged to 9.9 days, 17.8 days, and 18.5 days when TDD was applied preoperatively for 3 weeks, 6 weeks, and 9 weeks, respectively. Prolongation was significant after 6 weeks. Patency of the fistula was 93.5, 80.4, and 76.1% at respective weeks. Number of peripheral T-lymphocytes determined by a new monoclonal antibody diminished after 3 weeks. All animals were in normal health, requiring no special care for fluid, electrolyte, or protein replacement.

Animals↗
PubMed1990

Anti-thoracic duct lymphocyte globulin stimulates human megakaryocytopoiesis in vitro.

Anti-thoracic duct lymphocyte globulin (ALG) therapy is effective in patients with aplastic anemia. We examined the effect of ALG on human megakaryocyte progenitor cells (colony-forming unit-megakaryocyte, CFU-Meg) in vitro. Normal human bone marrow mononuclear cells (MNC) were cultured in plasma clots with varying concentrations of ALG or non-immunized horse IgG. After 12 days of culture, significant megakaryocyte colony formation was observed in cultures containing ALG but not in cultures containing non-immunized horse IgG. The peak stimulatory effect seemed to occur with 10-25 micrograms/ml of ALG. When marrow MNC, depleted of adherent and T cells, were cultured in plasma clots with ALG, its stimulatory effect on megakaryocytopoiesis decreased markedly. Finally, it was demonstrated that ALG stimulated marrow MNC to produce a factor stimulatory for CFU-Meg. The in vitro megakaryocytopoietic stimulatory effect of ALG may be related to its clinical efficacy in some patients with aplastic anemia.

Antilymphocyte Serum↗
PubMed1979

Variations in the canine thoracic duct system and the effects of surgical occlusion demonstrated by rapid aqueous lymphography, using an intestinal lymphatic trunk.

An alternative method for lymphography was developed in an attempt to improve the outlining of the thoracic duct system. Lymphograms obtained on 20 normal dogs demonstrated a large extent of anatomic variation. A complete obstruction of the thoracic duct was created in six dogs through transpleural resection and ligation. The lymphatic system responded by opening lymphaticovenous anastomoses proximal to the site of obstruction.

Animals↗
PubMed1990

Immigration of thoracic duct B lymphocytes into established germinal centers in the rat.

Immigration of B lymphocytes into established germinal centers in the rat was studied by transferring genetically marked thoracic duct B cells to non-irradiated congenic hosts at various times between 3 days before and 6 days after host immunization. Seven days after host immunization, the distribution of donor B cells to lymph node germinal centers (relative to their distribution to non-germinal center lymph node areas) was measured by two-color flow cytometry in which (a) donor and host B cells were distinguished by their Ig kappa chain allotypes, and (b) germinal center B cells were distinguished by their lack of labeling with the monoclonal antibody HIS22. Thoracic duct B cells from long-term antigen-primed rats were found to immigrate into host germinal centers much better than B cells from unprimed donors. This effect was antigen specific: primed B cells only immigrated well into host germinal centers induced by the priming antigen. Although B cells localized in germinal centers most efficiently when injected before immunization, specifically primed donor B cells injected after immunization were still found to be at least as evenly distributed to germinal centers as to other lymph node areas, whereas unprimed B cells transferred after immunization localized poorly in host germinal centers. These findings are discussed in light of recent suggestions that memory B cell clones are maintained by continued antigenic stimulation within secondary lymphoid follicles.

Animals↗
PubMed1979

Thoracic duct drainage before and after cadaveric kidney transplantation.

Twenty-seven consecutive recipients of cadaveric kidneys, including five with pre-existing warm cytotoxic antibodies, were treated with thoracic duct drainage before and after transplantation. Fourteen patients who had lymph drainage for 26 to 58 days before transplantation had minor cytotoxic antibody responses after grafting, even if the antibodies had been present before therapy. Only one of the 14 recipients had any rejection during the follow-up periods of one to six months. There were two deaths. The 13 patients pretreated for 17 to 23 days exhibited stronger cytotoxic antibody responsiveness, and five of these recipients had significant rejections of which four were reversible. One of the latter 13 patients died. These clinical and immunologic studies have established the value and have defined the appropriate timing of preoperative thoracic duct drainage in kidney transplantation. They have also directed attention to the rationale andthe probable value of using other immunosuppressive methods for preparatory host conditioning instead of beginning such therapy at the time of transplantation.

Adolescent↗
PubMedDate not supplied

Lymphocyte involvement in rheumatoid arthritis. Studies during thoracic duct drainage.

Grip strength, ring size, duration of morning stiffness, and the number of tender joints improved significantly in 9 patients with severe rheumatoid arthritis during prolonged continuous removal of thoracic duct lymphocytes through a surgical fistula. There was no improvement in 4 subjects in whom surgery failed to establish satisfactory lymph drainage. Reinfusion of unlabeled or 51Cr-labeled autologous lymphocytes resulted in transient exacerbation of disease activity in 3 subjects. Following reinfusion, some 51Cr-labeled lymphocytes could be found in the inflamed synovium and synovial fluid by autoradiography, and radioactivity was detected over the joints by surface counting of gamma radiation. Active rheumatoid arthritis recurred in all subjects at variable intervals after cessation of lymph drainage. These findings are compatible with the hypothesis that some of the lymphocytes in the thoracic duct lymph are essential for the continued activity of the inflammation associated with rheumatoid arthritis.

Adult↗
PubMed1987

Lymphocyte and erythrocyte turnover in thoracic duct lymph in patients with schistosomal hepatosplenomegaly and portal hypertension.

In 60 patients with hepatosplenic schistosomiasis and portal hypertension and in 20 control subjects, the turnover of erythrocytes and lymphocytes circulating in thoracic duct lymph was compared. Despite slight anemia in most patients with schistosomiasis, there was a greatly accelerated extravascular splanchnic circulation rate of erythrocytes. Lymphocytes also circulated more rapidly, but in contrast to erythrocytes, the peripheral blood lymphocyte count was elevated in schistosomal patients. Although thoracic duct lymph flow was increased at all stages of schistosomiasis, it was less rapid in "ascitic" and "varix bleeders" and thus the extravascular circulation turnover of erythrocytes and lymphocytes appeared to decline with chronicity of disease. The more rapid lymphocyte and erythrocyte "turnover," however, was almost entirely due to increased formation of interstitial fluid (greater lymph flow) suggesting that a prime regulator of splanchnic cellular migration was "solvent drag." These findings may derive from deranged portal microvascular dynamics (e.g., increased microvascular pressure, collagen deposition in Disse's space, capillarization of hepatic sinusoids, presinusoidal obstruction) as well as generalized host immunoresponsiveness to schistosomal infection.

Erythrocytes↗
PubMed2001

The successful management of thoracoscopic thoracic duct ligation in a compromised infant with targeted lobar deflation.

IMPLICATIONS: We describe the successful management of thoracoscopic thoracic duct ligation in a 2.5-kg compromised infant by using selective lobar-bronchial blockade. The technique reduces the risk of intraprocedural physiologic impairment, allowing the benefits of otherwise minimally invasive thoracoscopic procedures, even when the conditions of children are severely compromised.

Chylothorax↗
PubMed1992

[A case of mediastinal lymphatic cyst possibly originating from the right thoracic duct].

A 33-year-old male was admitted to our hospital because of an abnormal shadow in the right superior mediastinum on chest X-ray, which was first noted about half a year before his admission. Several diagnostic procedures, including fiber bronchoscopy, CT scan and MRI; however, no final diagnosis could be made. Thoracotomy was performed with the presumed diagnosis of benign mediastinal cystic tumor. Entry of the right thoracic duct into the cyst was observed at operation. Histological examination revealed that the cyst was lined by mono-layered cuboidal epithelial cells with lymphocytic infiltration in the wall of the cyst. The mono-layered cuboidal epithelium of the thoracic duct gradually changed to the epithelium of the cyst. Twenty ml of colorless transparent fluid was aspirated from the cyst. Analysis of aspirated fluid revealed low concentration of several substances except LDH compared to the values of the previously reported normal standards and other reported cases. From these findings, the cyst was diagnosed as mediastinal lymphatic cyst. Entry of the thoracic lymphatic duct into the mediastinal lymphatic cyst is a rare occurrence, and it is of interest to speculate on its relationship to the origin of the lymphatic cyst.

Adult↗
PubMed2001

Origin of the thoracic duct and pancreaticoduodenal lymphatic pathways to the para-aortic lymph nodes.

We investigated the afferent and efferent connections of the para-aortic lymph nodes (group 16 nodes) relative to the origin of the thoracic duct in 85 postmortem cadavers. The origin was usually restricted to groups 16b1-inter and -latero nodes (type I; 90.6%), regardless of whether the union of their efferents occurred at the abdominal or thoracic level. We also occasionally observed thick collecting vessels originating from the dorsal aspect of the pancreaticoduodenal region, running along the right side of and superficial to the celiac plexus and emptying into group 16b1 nodes. The thoracic duct originated occasionally not only from group 16b1 nodes but also from group 16a2 nodes (type II; 9.4%). Moreover, in all 85 specimens, the group 16a2-inter node often received afferents from the celiac plexus itself or the tight connective tissue between the plexus and diaphragmatic crus, or both. The results support the reliability of the extended D2 lymphadenectomy (D2 + group 16b1 nodes + group 16a2-inter node) for curative cancer surgery in the pancreaticoduodenal region.

Aorta, Thoracic↗
PubMed2002

Thoracic duct injury associated with left internal jugular vein catheterization: anatomic considerations.

Ultrasound (US)-guided cannulation of the internal jugular vein (IJV) has become the preferred approach for venous access as a result of its higher success rate and lower incidence of complications. This report describes a case of thoracic duct injury during US-guided left IJV catheterization. The normal and variant anatomy of the thoracic duct in the neck is illustrated.

Catheterization, Central Venous↗
PubMed1990

[Thoracic duct drainage pretreatment in living related kidney transplantation--long-term results of low dose steroid and azathioprine immunosuppression].

The long term results of 28 HLA 1-haploidentical donor kidney transplant recipients receiving preoperative lymphocyte deletion through thoracic duct drainage and low dose of steroid and azathioprine immunosuppressive treatment were presented. The number of removed lymphocytes was 129.9 +/- 38.1 x 10(9) (mean +/- SD) and the duration of thoracic duct drainage pretreatment was 35 +/- 4 days. Graft survival was 96% at 3 months through 2 years, 89% at 3 years and 84% at 5 years. Patient survival was 100% at 3 months through 2 years and 96% at 3 years through 5 years. Fifteen acute rejection crises were observed in 13 patients within the first 3 months postoperatively. There was no irreversible rejection in the first 3 months. Four chronic rejections were observed in 4 patients. Life-threatening infectious disease was observed in 5 patients, diabetes mellitus in 2 and cataract in 4. These results indicated that the reduction of the dose of steroid in post transplant period might have beneficial effects on the long term graft survival of HLA 1-haploidentical kidney transplant patients receiving TDD pretreatment and the conventional immunosuppressive treatment.

Adolescent↗