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Qualitative and quantitative changes in thoracic duct lymph during canine experimental shock.

Changes of the body fluid exchange and of the composition of metabolites in the hepatosplanchnic area in canine hemorrhagic and endotoxin or septic shock models were studied by investigating the qualitative and quantitative changes in thoracic duct lymph draining from abdominal organs. In the present study, it might be summarized that the changes in the flow rate and composition of thoracic duct lymph were put forward to much more directly and apparently indicate the degree of hepatosplanchnic cellular impairment in canine experimental shock than in the circulating blood.

Animals↗

The in vitro differentiation of mast cells. Cultures of cells from immunized mouse lymph nodes and thoracic duct lymph on fibroblast monolayers.

When cells from lymph nodes or thoracic duct of mice hyperimmunized with protein antigens are cultivated on embryo monolayers in the presence of the antigen, numerous clones of mast cells appear. The histochemical and ultrastructural characteristics of the cells permit their identification as mast cells and distinguish them from the phagocytic histiocytes that usually arise in abundance in similar cultures from unimmunized mouse cells or from immunized mouse cells cultured in the absence of the antigen. Only a few colonies of mast cells appeared in the latter cultures. The basis for the induction of mast cell differentiation is not known.

Animals↗

[Mediastinal localisation of a thoracic duct lymphocele--account of a surgical case].

INTRODUCTION: Lymphocele of the thoracic duct is a rare pathological entity occurring as a consequence of deterioration and cystic dilation wall of this vessel. It may be of congenital or degenerative origin. OBSERVATION: We report the case of a 47 year old patient, operated on for a symptomatic cyst localised by CT scan to the inferoposterior mediastinum. At postero-lateral thoracotomy it was identified as a lymphocele and completely resected. Chemical analysis of the liquid and histopathology study of the cystic wall confirmed the diagnosis. The patient's post operative course was uneventful. CONCLUSION: This case demonstrates the clinical characteristics of this entity and describes diagnostic techniques and surgical management.

Follow-Up Studies↗

Effects of biological response modifier on thoracic duct lymphocytes in recurrent gastric cancer. Evaluation of OK-432, a hemolytic streptococcus preparation.

In 9 patients with recurrent gastric carcinoma treated with intracutaneous injections of a hemolytic streptococcal preparation of OK-432 (PIC), the T/B cell ratio, the number of IgG-Fc receptor positive (T gamma) cells, the degree of blastoid transformation of lymphocytes in response to concanavalin-A (Con-A) and phytohemagglutinin (PHA), and the activity of natural killer cells (NK) in the thoracic duct lymphocytes (TDL) and peripheral blood lymphocytes (PBL) were measured. In thoracic duct lymph, the T cell to B cell ratio was higher than that found in peripheral blood. The proportion of T gamma cells and the natural killer cell activity was found to be considerably lower in TDL than PBL, though there was a higher degree of blastoid transformation of lymphocytes in response to Con-A and PHA in TDL. After the administration of PIC, there was no significant difference in T/B cell ratios and T gamma cell proportion between TDL and PBL, though the lymphocytic blastoid transformation in response to Con-A and PHA decreased in TDL but not in PBL. PIC administration appeared to augument natural killer cell activity in both TDL and PBL.

Aged↗

Thoracic duct injuries.

Chylous fistulas are an infrequent result of injury to the thoracic duct during radical neck dissection. Leakage of lymph from a fistula which is allowed to persist will cause such serious postoperative problems as metabolic deficiencies, flap elevation, suture breakdown with hemorrhage, and infection. There appears to be no valid justification for extended conservative management if it fails to slow the leak within 48 hours. We recommend prompt exploration of the wound with an operating microscope and microsurgical ligation of the lacerated duct with nonabsorbable sutures.

Aged↗

[Resuscitation from experimentally induced hemorrhagic shock with hypertonic saline (effects on thoracic duct lymph flow and tissue oxygen tension)].

We compared the effect of hypertonic salt solution (7.2%, HS) with that of normal saline (NS) and lactated Ringer's solution (LR) for the treatment of hemorrhagic shock. We monitored hemodynamic parameters, thoracic duct lymph flow, and tissue oxygen tension over 3 hours after hemorrhage. Twenty-seven anesthetized mongrel dogs (0.5% halothane) were bled to an aortic pressure of 60 mmHg for 90 min following 40 mmHg for 30 min and then they were resuscitated with each solution. In NS group, the volume transfused was twice the bled volume, and in other two groups, each solution was transfused providing equal amounts of sodium as NS group. We found that hemodynamics were restored in HS group as well as in other two groups. On the other hand, thoracic duct lymph flow and tissue oxygen tension of renal cortex and liver increased significantly over other two groups. We conclude that small volume resuscitation with 7.2% NaCl may be effective in the initial treatment of hemorrhagic shock from the view of tissue circulation in vital organs.

Animals↗

The velocity of lymph flow in the canine thoracic duct.

1. The velocity and pattern of movement of lymph in the thoracic duct of anaesthetized and conscious dogs has been studied by observing the movement of droplets of ultrafluid lipiodol in the duct.2. The velocity of flow when anaesthetized varied from 0.1-2.0 cm/sec, to 5.0 cm/sec when conscious.3. The pattern of flow was affected by respiration and the cardiac cycle. Most movement occurred at the end of inspiration.4. The duct of five autopsy preparations was perfused with saline to assess the volume and velocity of flow produced by the level of pressure gradients previously observed in the duct. These studies show that the small gradients (2-5 mmHg) observed during life are more than sufficient to produce the normal volume and velocity of flow measured. The mean resistance of the duct was 0.5 mmHg/ml. min.

Animals↗

Local intestinal immune responses to infections with Trichinella spiralis. Real-time, continuous assay of cytokines in the intestinal (afferent) and efferent thoracic duct lymph of rats.

Levels of IL-4, IL-5, TNF-alpha, and IFN-gamma were quantitated in the intestinal (afferent) and efferent thoracic duct lymph of rats during the course (0 to 289 h) of an infection with Trichinella spiralis. Intestinal lymph was collected by cannulating thoracic ducts of mesenteric lymphadenectomized animals. These studies showed that cytokines typical of a Th2 type (IL-4 and IL-5) and a Th1 type (IFN-gamma) were simultaneously detected in the intestinal lymph during the first 8 days after infection. Worm expulsion (day 11 to 12) was associated with increased levels of IL-4 and IL-5 in the intestinal lymph. IL-5 levels rose as early as 15 to 20 h and remained elevated throughout the infection. IL-4 activity appeared in intestinal lymph 60 h after infection and reached peak levels during worm expulsion. Despite the predominantly Th2 nature of cytokine response, IFN-gamma levels showed several cycles of high and low production during the course of infection. A comparison of cytokine levels between intestinal and efferent lymph values showed no significant differences in IL-4 or IL-5 levels suggesting no contribution by the mesenteric node to efferent lymph. However, IFN-gamma and TNF-alpha levels were lower in efferent lymph compared with intestinal lymph suggesting mesenteric node consumption. Adoptive transfer experiments showed that protective CD4+CD45RC- cells primed the gut for a more rapid TH2-type response that was faster than in a primary infection. In contrast, adoptive transfer of CD4+CD45RC+ cells primed the gut for a more rapid Th1-type(IFN-gamma) response. These studies demonstrate a novel method for measuring real-time changes in cytokine levels in the gut during the course of an active infection.

Animals↗

Percutaneous transabdominal embolization of thoracic duct lacerations in animals.

PURPOSE: To develop percutaneous techniques for lacerating the thoracic duct (TD) and to assess the efficacy of percutaneous TD embolization. MATERIALS AND METHODS: The TD was catheterized by means of antegrade or antegrade-retrograde techniques after the lymphographically opacified cisterna chyli (CC) was punctured in five swine and one dog. The TD was lacerated by fluid overdistention (n = 1), perforated with stiff guide wires (n = 3) or a 5-F styletted catheter (n = 1), or macerated by rotational guide-wire trauma (n = 1). The TD was percutaneously embolized in five animals with steel (n = 2) and platinum (n = 3) coils. The CC containing a metal target was recatheterized 2-7 days after embolization. RESULTS: All types of TD trauma led to mediastinal extravasation. The one chylothorax was induced by the 5-F styletted catheter. The TD of four animals was promptly thrombosed with coils. In the fifth animal, the TD failed to thrombose 3 days after embolization, probably because of the use of an undersized platinum are coil. There were no immediate or delayed complications. Necropsy in five animals was unremarkable. The sixth animal was alive and well at 4 months. CONCLUSIONS: Percutaneous transcatheter TD trauma led to mediastinal extravasation in all six animals, but chylothorax occurred in only one animal. TD coil embolization led to duct thrombosis in four of five animals with no early or late complications. The technique has potential clinical applications for localization and selective embolization of TD leaks in debilitated patients.

Animals↗

Lysozyme concentrations in synovial fluid, pleural fluid and thoracic duct lymph in rheumatoid arthritis.

Lysozyme (LZM) concentrations in synovial fluid were determined in patients with seropositive and seronegative rheumatoid arthritis (RA) and in patients whose arthritic exudates had been caused by Reiter's disease, a Yersinia enterocolitica infection, osteoarthritis, or trauma. Patients with rheumatoid disease had significantly higher levels of lysozyme in synovial fluid than patients with non-rheumatic diseases. The concentration of lysozyme correlated with the number of polymorphonuclear leukocytes in synovial fluid in seronegative--but not in seropositive--rheumatoid arthritis. In patients with rheumatic arthritis the lysozyme level correlated inversely with the concentration of glucose in synovial fluid. In patients with rheumatoid pleural effusion, lysozyme levels in pleural fluid were comparable to those in serum. The concentration of LZM in thoracic duct lymph was roughly the same as in serum. During drainage of thoracic duct lymph, the lysozyme level in serum decreased.

Adult↗

[Kinetics of protein metabolism in the thoracic duct wall. II].

Endothelial, muscular cells and fibroblasts of the albino rat thoracic duct show a great similarity in localization and functioning intensity of the protein-synthesing apparatus. The main by the mass of production protein syntheses occur in cytoplasm. The nucleus is also of great importance in protein production: a relatively high level of proteinosynthesis is registered radioautographically in it.

Animals↗

Effects of hypotonic, isotonic, and hypertonic fluids on thoracic duct lymph flow.

To test whether whole-body lymph flow responses to vascular volume loading depend on osmolality, we measured left thoracic duct lymph flow rate and protein concentration, plasma protein concentration, plasma osmolality, hematocrit, and arterial and venous pressures in pentobarbital-anesthetized, acutely nephrectomized dogs. Hypo- (100 mosmol), iso- (309 mosmol), and hypertonic (600 mosmol) saline, isotonic lactated Ringer solution, and 5% glucose in lactated Ringer solution (580 mosmol) were infused into the jugular vein (20 ml/kg per infusion over 5 min at 30-min intervals). Changes in blood, interstitial, and cellular volumes were calculated from the infused volume and from the hematocrit and plasma osmolality. The hypotonic fluid increased lymph flow about half as much as the isotonic fluid, whereas the hypertonic fluids increased lymph flow about twice as much as the isotonic infusions. Responses appeared independent of the osmotic agent, because hypertonic NaCl was as effective as hypertonic glucose in increasing lymph flow. Responses were not altered appreciably after lowering arterial pressure by 25 mmHg. The major finding of this study is that for every condition we explored, the excess lymph flow over 30 min (ELF in ml X kg-1 X 30 min-1) correlated with the change in interstitial fluid volume (delta ISFV in ml/kg); ELF = 0.076 delta ISFV (r = 0.909). These data suggest that cellular fluid that enters the interstitium is equally effective in increasing thoracic duct lymph flow as is vascular fluid that filters into the interstitium.

Animals↗

[Direct approach to the site of injury of the thoracic duct in treatment of chylothorax after pulmonary resection].

Chylothorax, a rare complication after pulmonary resection, has no single established treatment. Generally, conservative therapy is tried first, but surgery should be done without delay if chyle leakage is severe. A 73-year-old woman underwent upper left lobectomy for lung cancer. Two days later, chylothorax was diagnosed, and because chyle leakage was great, emergency re-thoracotomy was done on day 4 after the first operation. With the preoperative ingestion of 200 ml of milk and 20 g of margarine, chyle leakage from the injured thoracic duct was readily located in the upper mediastinum. Closure of the trunk of the thoracic duct may be undertaken, but a direct approach to the site of injury is more preferable, because the trunk may have collateral.

Aged↗

Weibel-Palade bodies in endothelial cells of normal thoracic ducts and deep cervical lymphatics in rabbits.

The endothelial cells of normal thoracic ducts and deep cervical lymphatics were examined by electron microscopy using conventional staining methods and acid-phosphatase and ruthenium red (RR) reactions. The endothelial cells contained rod-shaped, circular and elliptical bodies of moderate density. The shape and structure of all these bodies were the same as those of the Weibel-Palade bodies (WPB) in the endothelial cells of blood vessels. They were usually found near the Golgi complex in groups, and the long axis of the rods paralleled the Golgi saccules. In addition, a peculiar vacuolated rod with a bulge was found adjacent to the WPB. Single coated vacuoles were occasionally located next to the WPB. Acid-phosphatase activity and RR positive material were not seen in the WPB and the vacuoles. Our observations suggest that the WPB have a close relationship, morphological as well as functional, to the Golgi complex in lymphatic endothelial cells.

Animals↗

Studies on lymph humoral factor. Biological characteristics of a lymphocytopoietic factor in rat thoracic duct lymph.

The biological characteristics of a lymphocytopoietic factor obtained from rat thoracic duct lymph (Yamashita, Fukumoto & Miyamoto, 1976) were further investigated. The lymph extract from normal rats failed to stimulate both large pyroninophilic cell-proliferation and mitotic response in the spleen and lymph node of the thymectomized, irradiated and marrow reconstituted rat (B rat). This suggests that target or responsive cells for the factor are not marrow-derived (B) cells, but thymus-derived (T) cells. On the other hand, the lymph extract from the lymphopenic lymph-drained B rats showed similar high lymphopoietic activity to those of normal rats, indicating that the existence of a thymus is not essential for the production or secretion of the factor. The fact that lymphocytotic rats produced by syngeneic lymphocyte transfusion are most sensitive to the lymph extract suggests that liver endogenous level of this factor and the responsiveness of target cells are regulated by the number of circulating T lymphocytes.

Animals↗

Computer analysis of defined populations of lymphocytes irradiated in vitro: I. Evaluation of murine thoracic duct lymphocytes.

Computer-assisted morphometric analysis of murine lymphocytes obtained by thoracic duct cannulation demonstrates two populations of cells; the larger population (73 percent) appears to be thymus-derived and the remaining 27 percent is of bone marrow origin. Following exposure to varying amounts of x-radiation, morphologic alterations in both populations are evident. The smaller cell populations are evident. The smaller cell population exhibits some of these changes at lower dose levels than does the larger population. In addition, the character of the radiation-induced changes appears to be different for the two populations of lymphocytes. After 500 rad, the nuclei of the larger population appears unchanged; the nuclei of the population representing 27 percent of the cells have become enlarged and vacuolated and are thought to be edematous. After 2000 rad, the nuclei of the larger population appear pyknotic with coarsely clumped chromatin. In the examined set of cells, the smaller population could no longer be detected after 2000 rad. Such disparate responses to radiation-induced injury may correlate with known differences in immunologic function which serve to distinguish thymic-dependent and bone marrow-derived small lymphocytes.

Animals↗

Prospective evaluation of thoracic-duct drainage in the treatment of respiratory failure complicating severe acute pancreatitis.

Thoracic duct drainage (TDD) may be of value for removing toxic substances released by the inflamed pancreas and which are responsible for lung damage. We have prospectively assessed the efficacy of TDD in improving pulmonary gas exchange in 12 patients with severe acute pancreatitis (SAP) complicated by persistent respiratory failure despite standard conservative treatment including peritoneal dialysis in 8 patients. In group A were 6 patients (mean Ranson score = 7.3) with adult respiratory distress syndrome (ARDS) and in group B were 6 hypoxemic patients (mean Ranson score = 6.6) judged to be at risk of developing ARDS. The duration of TDD ranged from 3 to 10 days and the total amount of drained lymph (L) varied from 770 to 15,600 ml. Immunoreactive trypsin levels were significantly higher in L when compared to blood in both groups. Leukocyte myeloperoxidases in L (normal value less than than 332 +/- 82 ng/ml in plasma) were increased in 5 of 5 group A patients (830 +/- 317 ng/ml) and in 3 of 6 patients in group B (671 +/- 467 ng/ml). After TDD pulmonary gas exchange as measured by median PaO2/FiO2 (mmHg) improved from 148 +/- 60 to 285 +/- 42 in group A and from 192 +/- 37 to 330 +/- 42 in group B (p less than 0.05). All patients were weaned after ventilation for a mean of 8 days in group A and 4 days in group B. All patients survived apart from 1 group B patient who died of sepsis on day 34.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗