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[Substantiation of optimal combination of external drainage of the thoracic duct, lymphosorption and hemosorption in the complex treatment of patients with destructive pancreatitis].

The results of treating 147 patients with acute destructive pancreatitis are summarized. In the complex treatment of 48 patients, the external drainage of the thoracic duct (EDTD) was used, 36--EDTD in combination with lymphosorption (LS), 23--EDTD, LS, hemosorption (HS). It is established that the level of oligopeptides precisely reflects the severity degree of endogenous intoxication in patients with destructive pancreatitis, and can serve as one of the indications for the performance of the methods of acute detoxication. In patients with destructive pancreatitis, the combined use of LS and HS is the most effective.

Adult↗

[External drainage of the thoracic duct with and without lymphosorption in the endotoxic phase of phalloid mushroom poisoning].

For the first time in Bulgaria and maybe in the world is reported very good therapeutic effect of the application of external drainage of the thoracic duct with and without lymphosorption in two consecutive cases of phalloid mushroom poisoning. Concrete indications are suggested for application of the method in this type of poisoning - in the late endotoxic phase of the poisoning when all other methods have been used with no effect.

Amanita↗

Thoracic duct drainage in SLE with cutaneous vasculitis. A case report.

A 25-year-old woman had systemic lupus erythematosus manifested primarily by severe cutaneous vasculitis that was unresponsive to oral prednisone and azathioprine. She was treated with thoracic duct drainage (TDD). Her course was followed by serial photographs, skin biopsies, and serum immunoglobulin, antinuclear antibody, and complement levels. After 1 week of drainage there was obvious clinical improvement. During the remainder of her drainage, the vasculitis continued to improve. It was possible to taper oral corticosteroids and to discontinue azathioprine during TDD without any clinical or laboratory evidence of exacerbation. The patient had no recurrence of vasculitis 22 weeks after the termination of TDD.

Adrenal Cortex Hormones↗

The effect of BCG on thoracic duct lymphocytes.

Adoptive immunotherapy is becoming increasingly more important in the management of advanced malignancies. This report describes the results of immunomodulation therapy with BCG in the Dunning tumor. In addition it describes new techniques in the harvesting of lymphocytes. Thoracic duct lymphocytes from 34 rats were evaluated for the effect of the presence of the Dunning R-3327 AT-3 tumor as well as for the response to bacillus Calmette Guerin (BCG). Both tumor and BCG resulted in significant changes in the helper/suppressor T cell ratios.

Animals↗

Effect of interferon on thoracic duct lymphocyte output: induction with either poly I:poly C or vaccinia virus.

Systemic inoculation of the interferon (IFN) inducer polyinosinic-polycytidylic polyribonucleotide (poly I:poly C) into CBA/J mice produces a significant decrease in the number of thoracic duct lymphocytes (TDL) collected 6 to 22 hr after injection. The number of TDL is restored to normal levels by 48 to 64 hr. Residual TDL collected during the inhibition period of poly I:poly C treatment showed a phenotypic profile similar to phosphate-buffered saline- (PBS) treated control groups when examined for Lyt-1.1, Lyt-2, Thy-1.2 and Iak surface markers. Interferon is implicated as the mediator of this phenomenon since: 1) Inoculation of exogenous IFN can induce a similar suppression in the number of recoverable TDL. 2) Pretreatment of mice with sheep anti-murine IFN serum can block this effect of poly I:poly C. Similar experiments with vaccinia virus demonstrate that although live virus can partially suppress the TDL output, almost complete suppression is achieved with ultraviolet (UV)-inactivated virus. Vaccinia virus-induced suppression of the number of TDL also appears to be caused by IFN since: 1) UV-inactivated virus induces significantly higher serum levels of IFN in comparison to live virus. 2) The suppression of TDL output by either live or UV-inactivated vaccinia virus can be blocked by pretreatment with anti-murine IFN. These findings suggest that the immunosuppression often associated with viral infections may be at least partially due to a decrease in lymphocyte recirculation mediated by the IFN initially released in response to the virus.

Animals↗

Lymphocyte recognition of lymph node high endothelium. III. Enhancement by a component of thoracic duct lymph.

The first step in the entry of blood lymphocytes into lymph node is the binding of these cells to venules lined by high endothelium (HEV). This recognition event has been studied using a model system in which rat thoracic duct lymphocytes (TDL) adhere selectively to HEV when overlaid onto lymph node sections. We now report that this binding is increased by a lymph fraction designated adherence enhancing factor (AEF). Lymph depleted of cells and chylomicra was fractionated with (NH4)2SO4. Material that precipitated between 60 and 80% saturation was dissolved in buffer and extracted with chloroform/methanol; the aqueous phase was used as the source of AEF. The factor was nondialyzable, trypsin sensitive, and heat stable (70 degrees C, 30 min). Lymph node sections pretreated with AEF showed a 2- to 3-fold increase in the number of TDL bound to HEV and a 5 to 10-fold increase in the number of HEV with more than 5 adherent lymphocytes. The effect of AEF was specific: 1) No increase in lymphocyte binding to non-HEV areas of the tissue section occurred. 2) The binding of both TDL and spleen lymphoid cells to HEV was enhanced, but thymocyte attachment was not promoted. We conclude that AEF has biologic properties that might enable it to play a physiologic role in lymphocyte recirculation.

Animals↗

Enzyme activities in thoracic duct lymph and plasma of anaesthetized, conscious resting and exercising dogs.

The significance of changes in lymph flow for the extracellular distribution and transport of cellular enzymes and for the level of enzyme activities in plasma was investigated. Specimens of thoracic duct lymph were obtained from an extracorporal lymph shunt in anaesthetized, conscious resting and treadmill exercising dogs (6 km X h-1 for 1 h) The activity of 10 enzymes and of protein content in lymph and plasma were studied, as well as lymph flow, lymphatic transport, and the lymph-plasma ratio of these compounds. Lactate, pH, and blood gases were monitored in venous blood. Lymph flow of 0.80 ml X min-1 in anaesthetized dogs more than doubled (to 1.86 ml X min-1) when the animals were conscious and resting. In anaesthetized dogs lymph enzyme activity was higher only for enzymes of predominately hepatic origin, such as choline esterase (CHE) and alanine aminoferase (ALAT), and was lower for aspartate aminotransferase (ASAT) and aldolase (ALD). In conscious dogs, due to activation of the skeletal muscle "tissue pump", lymphatic transport of enzymes with rather high activity in skeletal muscle, and of protein, is significantly enhanced. Enzyme activities in plasma, however, did not differ between the groups. Lymph-plasma activity ratios higher than one were found for lactate dehydrogenase (LDH), malate dehydrogenase (MDH), ASAT, creatine kinase (CK), ALD, and phosphohexose isomerase (PHI). Exercise stimulated lymph flow up to 4.9 ml X min-1, and increased the lymphatic activities of those enzymes with a lymph-plasma ratio higher than unity, these enzymes increasing in the plasma due to the highly increased lymphatic transport.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗

Long-term vascular volume expansion maintains elevated thoracic duct lymph flow.

OBJECTIVE: To investigate the mechanisms responsible for edema seen during pregnancy, we tested whether lymph vessels are able to pump high volumes over long periods of time. STUDY DESIGN: In six chronically catheterized nonpregnant ewes, we examined left thoracic duct lymph flow rate and fluid balance responses to the administration of a balanced isotonic solution at a rate of 1 L/hr for 20 hours. Because estrogen administration decreases lymphatic contractility against outflow pressure, we also administered conjugated estrogens (Premarin) during the last 3 hours of the fluid infusion (experimental time 17 to 20 hours). RESULTS: After volume loading for 16 hours, the mean +/- SEM lymph flow rate, blood volume, and arterial pressure rose 100% +/- 26%, 20% +/- 2.3%, and 16% +/- 8.1%, respectively. Vascular compliance decreased significantly and, as evidenced by a lack of body weight changes, interstitial fluid volume failed to change (p < 0.05, analysis of variance). The transcapillary oncotic pressure difference increased by 2 mm Hg; venous pressure increased by 5.2 mm Hg. These data suggest that transcapillary forces favored fluid movement into the interstitium. Lymph flow rate remains elevated after blood volume expansion to a level similar to that described during pregnancy in sheep. A transient decrease in urinary output (approximately 20%) occurred with no changes in lymph flow rate, arterial pressure, or blood volume. CONCLUSION: Lymph flow rate is able to compensate for the increased capillary filtration observed during prolonged blood volume expansion.

Analysis of Variance↗

A comparative study of intravenous versus intralymphatic interleukin-2, with assessment of effects of interleukin-2 on both peripheral blood and thoracic-duct lymph.

Recombinant human interleukin-2 (IL-2) was administered by the intravenous (i.v.) or intralymphatic (i.l.) route to 14 patients with advanced malignancy. IL-2 was given in doses of 600,000 IU/kg or 1,050,000 IU/kg daily x 5. Thoracic duct (TD) catheters were placed, and both TD lymphocytes (TDL) and peripheral blood lymphocytes (PBL) were studied. Five of eight patients at the 600,000 IU/kg dose experienced grade III toxicity as did five of six patients at the 1,050,000 IU/kg dose. Two episodes of grade IV toxicity were seen at the higher dose. The i.l. and i.v. routes had a similar toxicity profile excepting lymphangitis/pedal infection, seen only with i.l. administration. One partial response was seen in a patient with renal cell carcinoma. Lymphopenia was seen early in therapy, with lymphocytosis by day 6. Lymphoid yield of the TD catheter fell early in therapy, then increased over baseline by the end of treatment. Intralymphatic administration resulted in a prolonged serum t1/2 and lower serum levels than did i.v. administration, but resulted in higher TD levels. Antibodies against IL-2 were ubiquitous but had no clear effects. Lymphocyte trafficking studies suggested that IL-2 affected lymphocyte redistribution to liver, spleen, bone marrow, and lymph nodes. NK activity and phenotype and LAK activity increased in response to IL-2, with no advantage for TDL. Tumor necrosis factor-alpha and gamma-interferon levels increased sporadically with treatment. The i.l. route offered no advantage over the i.v. route, and TDL offered no advantage over PBL.

Adult↗

Congenital chylothorax: management by ligature of the thoracic duct.

Congenital chylothorax in a male infant persisted for 10 weeks despite repeated thoracocenteses and dietary regimens which included total parenteral nutrition for 37 days and a peroral semielementary diet with medium-chain triglyceride content for 19 days. Thoracotomy disclosed a small leak in the thoracic duct. The duct was ligated above and below the leak, as attempted repair was unsuccessful. There was no recurrence of pleural effusion after the operation and no distal lymphoedema was observed.

Chylothorax↗

Gastric cancer with carcinoma erysipeloides caused by spontaneous thoracic duct rupture: report of a case.

A case of extensive skin metastasis (carcinoma erysipeloides) resulting from spontaneous rupture of the metastasized Virchow lymph node in a 53-year-old woman is herein reported. Imaging evidence attributing this metastasis to spontaneous rupture of the fragile thoracic duct at the supraclavicular fossa is presented. The patient, who had already undergone gastric resection more than 6 years previously because of advanced gastric cancer, died approximately 4.5 months after the occurrence of lymphorrhea in her neck since the anticancer chemotherapy administered demonstrated little or no effect.

Carcinoma↗