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PubMed1994

Evaluation of mesenteric lymphangiography and thoracic duct ligation in cats with chylothorax: 19 cases (1987-1992).

Mesenteric lymphangiography and thoracic duct ligation were performed on 19 cats with chylothorax between 1987 to 1992. Chylothorax was diagnosed on the basis of detection of chylomicrons in the pleural effusion or determination of a cholesterol concentration:triglyceride concentration ratio of < 1 in the pleural fluid. Preoperative medical treatment consisted of thoracentesis (19 of 19 cats) and feeding a fat-restricted diet (14 of 19 cats). Positive-contrast mesenteric lymphangiography was performed before thoracic duct ligation to identify an underlying cause for the effusion. Lymphangiectasia was diagnosed by use of radiography in 17 cats, none of which had evidence of a thoracic duct rupture. Thoracic duct ligation was performed via an incision made through the left 10th intercostal space. Lymphangiography was repeated immediately after ligation of the thoracic duct to document occlusion of all branches. Follow-up monitoring was done for 12 to 47 months (median, 28 months) and consisted of physical examination, evaluation for clinical signs related to pleural effusion, and thoracic radiography. Ten of 19 (53%) cats had complete resolution of pleural effusion. Nonchylous effusion, localized in the right hemithorax, was detected in 1 cat 2 months after thoracic duct ligation, but resolved after thoracotomy, breakdown of thoracic adhesions, and expansion of the right cranial lung lobe. Chylous effusion resolved 3 to 7 days (mean, 5.4 days) after surgery in the 10 cats that survived > 12 months after surgery. Four cats died between 2 and 13 days after thoracic duct ligation, but pleural effusion had resolved in 3 of these 4 cats at the time of death.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Transdiaphragmatic approach to thoracic duct ligation in the cat.

An approach combining ventral midline celiotomy with transdiaphragmatic thoracotomy was evaluated in eight healthy cats for ligation of the thoracic duct system. Evans Blue solution was injected into the right colic lymph node to outline the intestinal lymphatic trunk and the thoracic duct system. Three cats (group 1) had mesenteric lymphangiograms and three (group 2) had only lymph node dye injection before thoracic duct ligation. The thoracic duct system was ligated with hemostatic clips just cranial to the aortic hiatus of the diaphragm, through a left transdiaphragmatic thoracotomy. Two cats (group 3) had prethoracotomy mesenteric lymphangiograms and thoracic duct isolation without ligation. Mesenteric lymphangiography was performed immediately after the surgery. In all of the cats, an absence of contrast medium in the thoracic duct system cranial to the surgical site was interpreted as complete obstruction. Four weeks after ligation, there was complete obstruction of the thoracic duct system with alternate lymphaticovenous communications in four of the six cats with ligated thoracic duct systems. Partial obstruction of the thoracic duct system with alternate lymphaticovenous communications was present in the other two cats. Both cats without thoracic duct ligation had patent thoracic duct systems. At necropsy of the six cats with ligated thoracic ducts, there was mild focal lymphadenitis of injected lymph nodes in three cats. The wall of the aorta adjacent to the hemostatic clips was normal in all six cats. The surgical technique was simple and provided excellent exposure. Vital staining with Evans Blue helped visualize the thoracic duct system, but mesenteric lymphangiography did not. Postligation lymphangiography was not of value in identifying incomplete ligation.

Animals↗
PubMed1993

Thoracic duct lymph. Relative contribution from splanchnic and muscle tissue.

We have shown previously that thoracic duct lymph insulin dynamics are well correlated with tracer-determined whole-body glucose uptake and have suggested that thoracic duct lymph insulin is representative of insulin concentration in muscle interstitial fluid. However, thoracic duct lymph is comprised of interstitial fluid from all sub-thoracic tissue beds. To investigate the relative contribution of muscle interstitial fluid to total thoracic duct lymph flow, the distribution and elimination of [14C]inulin was investigated in eight experiments with conscious dogs. Both plasma and thoracic duct lymph were measured, and a three-compartment model that was hypothesized to consist of plasma, splanchnic interstitial fluid, and muscle interstitial fluid was identified. Identifications were performed with either a bolus protocol (n = 4) or an infusion protocol (n = 4), and the predicted [14C]inulin dynamics in the splanchnic and muscle interstitial fluid compartments were compared with measured values in thoracic duct lymph. Neither compartment predicted the thoracic duct [14C]inulin dynamics; however, a model based on a percentage contribution from each tissue bed fit the thoracic data well. The relative contribution of splanchnic interstitial fluid to the total thoracic duct lymph flow averaged 78 +/- 5% for the bolus protocol and 54 +/- 5% for the infusion protocol. Thus, we conclude that in the conscious animal, approximately 25-50% of thoracic duct lymph originates from muscle interstitial fluid.

Animals↗
PubMed1996

Thoracic duct function in fetal, newborn, and adult sheep.

We measured thoracic duct lymph flow rate versus outflow pressure in 7 chronically catheterized adult sheep and in 6 newborn lambs and compared our results to data previously obtained from 10 fetal sheep. In fetal sheep the thoracic duct lymph flow rate was 34.5 +/- 17.2 ml/hr or 11.7 +/- 6.0 ml/kg/hr. Fetal thoracic duct lymph flow deviated from baseline between 8 and 12 torr outflow pressure and lymph stopped at 18 +/- 2.5 torr. In newborn lambs the thoracic duct lymph flow rate was 49.5 +/- 22.0 ml/hr or 7.4 +/- 2.5 ml/kg/hr. The range of outflow pressures over which newborn lymph flow deviated from baseline was between 15 and 18 torr and lymph flow stopped at 26.2 +/- 6.4 torr. Adult sheep thoracic duct lymph flow rate was 130 +/- 74 ml/hr or 2.3 +/- 1.3 ml/kg/hr. Adult lymph flow deviated from baseline between 25 and 35 torr and stopped at an outflow pressure of 41.7 +/- 6.7 torr. The ability of the thoracic duct to return lymph against an outflow pressure improves with maturation. However, lymph flow rate corrected for body weight is greatest in immature animals. The higher corrected lymph flow rate in conjunction with the decreased ability to pump against an outflow pressure may help account for immature animals predisposition for edema.

Animals↗
PubMedDate not supplied

Thoracoscopic visualization and ligation of the thoracic duct in dogs.

OBJECTIVE: To develop a technique for thoracoscopic visualization and ligation of the thoracic duct in dogs. STUDY DESIGN: In vivo experimental study. ANIMALS: Five mature, healthy dogs. METHODS: Dogs were normal based on physical examination, negative occult heartworm test, normal complete blood count and biochemical profile, and normal thoracic radiographs. The dogs were anesthetized, and a ventral midline laparotomy was performed for catheterization of a mesenteric lymphatic. Lymphangiography was performed to determine thoracic duct anatomy. Thoracoscopy was performed in the caudal, right hemithorax after single lung intubation or bronchial blockade. At least two 10-mm clips were placed across the thoracic duct in each dog. Lymphangiography was repeated to assess duct ligation. If complete duct occlusion was not achieved, thoracoscopy was repeated for additional clip placement. After surgery the dogs were euthanatized, and necropsies were performed. RESULTS: Lymphangiography showed that multiple branches of the thoracic duct were present in every dog; bilateral thoracic duct branches were most common. Thoracoscopic identification and ligation of the thoracic duct was successful in all five dogs. Two dogs required a second thoracoscopic procedure to completely occlude flow of contrast through the thoracic duct. Surgery time for thoracoscopy averaged 59 plus minus 9.6 minutes. Retroperitoneal contrast accumulation after thoracic duct ligation occurred in two dogs. One dog required bilateral pulmonary ventilation. CONCLUSION: Thoracoscopy can be used to visualize the thoracic duct for ligation in normal dogs. CLINICAL RELEVANCE: Thoracoscopic ligation of the thoracic duct may be a therapeutic option for management of chylothorax in dogs.

Animals↗
PubMed1994

Variations in the thoracic duct of the Japanese monkey (Macaca fuscata).

Variations in the thoracic duct of Japanese monkeys were compared with previous reports on the human (Japanese) thoracic duct. The most striking difference between man and the Japanese monkey was that in the majority of the monkeys examined the right thoracic duct ascended without crossing to the left side whereas in man the upper portion of the right duct crosses over to the left. Although most thoracic ducts in man, other primates and domestic animals reportedly enter the left venous angle, about half of the ducts of Japanese monkeys enter the right venous angle. A ring configuration in the thoracic duct was found in 24.4% of Japanese monkeys. This was less frequent than human Japanese. Three out of 41 monkeys had an intercalated lymph node, situated between the 10th and 11th and 12th thoracic vertebrae; this has only occasionally been reported in man.

Animals↗
PubMed1978

[Controlled drainage of the thoracic duct (author's transl)].

The technique of the thoracic duct drainage is described. The importance of preserving the natural lymph outflow is emphasized. A method of controlled thoracic duct drainage is introduced that permits dosaged exteriorization of the lymph and additional internal drainage of the lymph into the veins via an external bypass for a long period of time. The results of the employment of controlled thoracic duct drainage in 33 patients are presented. A clear clinical effect was received in 65% of the cases. The authors conclude that controlled drainage of the thoracic duct is an effective method of treatment.

Acute Disease↗
PubMed1989

[A case report of thoracic duct cyst].

A case of mediastinal thoracic duct is described. A 27-year-old female patient was referred to our hospital for abnormal finding of her chest X-ray film, which revealed a mediastinal mass. CT scan, endoscopic ultrasonography, MRI showed that the mass was cystic in the posterior mediastinum. Intra operative ultrasonography demonstrated a thin-walled ovoid cyst containing some high echoic parts inside, which suggested condensed milky fluid. The small pedicle entered the upper pole of cyst was found at surgery and the cyst contained chyle about 300 ml. Histopathological specimen of resected cyst showed a structure of thoracic duct with some lymphoid tissue. Postoperative course was smooth. The characteristic finding of ultrasonography seemed to be valuable in the diagnosis of thoracic duct cyst.

Adult↗
PubMedDate not supplied

Thoracoscopic ligation of the thoracic duct.

OBJECTIVE: When nonoperative treatment of chylothorax fails, thoracic duct ligation is usually performed through a thoracotomy. We describe two cases of persistent chylothorax, in a child and an adult, successfully treated with thoracoscopic ligation of the thoracic duct. METHODS: A 4-year-old girl developed a right chylothorax following a Fontan procedure. Aggressive nonoperative management failed to eliminate the persistent chyle loss. A 72-year-old insulin-dependent diabetic man was involved in a motor vehicle accident, in which he sustained multiple fractured ribs, a right hemopneumothorax, a right femoral shaft fracture, and a T-11 thoracic vertebral fracture. Subsequently, he developed a right chylothorax, which did not respond to nonoperative management. Both patients were successfully treated with thoracoscopic ligation of the thoracic duct. RESULTS: The child had significant decrease of chyle drainage following surgery. Increased drainage that appeared after the introduction of full feedings five days postoperatively was controlled with the somatostatin analog octreotide. The chest tube was removed two weeks after surgery. After two years' follow-up, she has had no recurrence of chylothorax. The adult had no chyle drainage following surgery. He was maintained on a medium-chain triglyceride diet postoperatively for two weeks. The chest tube was removed four days after surgery. After six months' follow-up, he has had no recurrence of chylothorax. CONCLUSIONS: Thoracoscopic ligation of the thoracic duct provides a safe and effective treatment of chylothorax and may avoid thoracotomy and its associated morbidity.

Aged↗
PubMed1977

Protein content of thoracic duct lymph in patients with bilharzial hepatic fibrosis.

The proteins in the thoracic duct lymph were studied in 46 patients with bilharzial hepatic disease in various stages. The thoracic duct proteins were compared to those of serum and ascitic fluid. Total protein and albumin in thoracic duct lymph were 66 and 69% of the concentration of those in the serum of nonascitic patients. The proteins in the thoracic duct lymph were 29% of the serum level in patients with tense ascites. The lymph to serum and ascitic fluid to serum ratios of the total protein and albumin were similar to each other in moderate and severe ascites, reflecting a low protein content in both the ascitic fluid and thoracic duct lymph. The gamma-globulin concentration was raised in the serum of all patients as well as in the ascitic fluid of those with tense ascites. A contrasting pattern of the proteins is present in the thoracic duct lymph in bilharzial hepatic fibrosis. In the early stages the lymph has a relatively high concentration of protein, which decreases as the disease advances.

Adult↗
PubMedDate not supplied

Transcatheter thoracic duct embolization in the dog. An experimental study.

Thoracic duct embolization was created by injecting an isobutyl 2-cyanoacrylate/iophendylate (IBCA) mixture through a cannulated mesenteric lymphatic vessel in eight normal dogs. Aqueous contrast lymphangiography was repeated at minute 10 and week 6. Six dogs were euthanatized at week 6 and two dogs at month 6. Embolization with 1.5 to 3.9 ml of the mixture resulted in complete obstruction of the thoracic duct in all eight dogs. Results of lymphangiography in six dogs at week 6 showed a persistent, complete obstruction of the thoracic duct in six dogs and alternate lymphaticovenous anastomoses in four dogs. Histologically, there were a sclerosing granulomatous response surrounding the lymphatic embolus, mild congestive changes in the mesenteric lymph nodes, and mild lacteal dilatation in the jejunum. The procedure was well tolerated with only a few complications. One dog suffered partial thrombosis of the cranial vena cava by the injected material with later dislodgement and embolization of a pulmonary artery branch. Modifications have been made in the injection procedure to avoid this complication. This technique for occlusion of the thoracic duct shows potential for clinical use in the management of canine chylothorax. The obstruction appears to be complete and permanent, and surgical/anesthetic time is decreased greatly from previously described procedures.

Animals↗
PubMed1975

End thoracic duct presurres in man.

Thoracic duct end pressures have been measured in a conscious patient undergoing cannulation in an attempt to remove serum blocking activity. Pressures were measured during rest, coughing, straining and laughing during the last-mentioned activity pressures of the order of 85 mm Hg were recorded. It is suggested that formal ligation of the cannula at the termination of treatment.

Adult↗
PubMed1976

Radiation sensitivity of lymphocytes from human blood and from the thoracic duct.

Peripheral blood and thoracic duct lymphocytes are sensitive to irradiation. However, a distinct population of resistant lymphocytes exists, which is characterized by reactivity to a very low dose of lymphocyte-stimulating lectins in vitro. Blood lymphocytes are rapidly eliminated from the circulation after radiation damage. An analysis of the function of blood lymphocytes is thus of little or no use in assessing the therapeutic effect of extracorporeal irradiation. Lymphocyte activation must accordingly also be unsuitable for use as a biologic dosimeter after accidental total body irradiation.

Blood↗
PubMed1981

Germinal centres and the B-cell system. V. Presence of germinal centre-precursor cells among lymphocytes of the thoracic duct in the rat.

Thoracic duct lymphocytes (TDL) were studied with respect to their capacity to give rise to germinal centres (GC) and to form primary antibody in an adoptive transfer system of the rat. Challenge with sheep erythrocytes (SRBC) 24h after lethal irradiation (900 rads) and syngeneic TDL reconstitution (10(8)) lead to conspicuous GC activity already 7 days after transfer. In contrast, using syngeneic bone marrow (BM) in the adoptive transfer system, no GC formation was observed over the period studied (14 days after reconstitution). Reconstitution experiments using in vivo-separated T-TDL (1-5% s-Ig+) and B-TDL (greater than 90% s-Ig+) subpopulations, either separately or in combination, indicated that GC originate from B-TDL but require T-TDL for induction.

Animals↗
PubMed1982

Antigen transport. I. Demonstration and characterization of cells laden with antigen in thoracic duct lymph and blood.

Thoracic duct lymph (TDL) of nonimmune rats and mice was examined for the presence of antigen-carrying cells immediately following a single injection of 125I-labelled or fluorescence-labelled serum protein antigens. Small numbers of cells laden with antigen (approximately 1/2000 to 1/5000) were identified in TDL and blood by autoradiography or fluorescence microscopy. The antigen-laden (Ag-L) cells resembled macrophages in that a large number adhered to plastic, they phagocytosed bacteria or a particulate dye, were non-specific esterase positive, radioresistant and could take up more than one antigen at one time in vivo. Surface phenotyping using monoclonal antibodies against rat cell markers established that Ag-L cells did not express Ia determinants. The results suggest the existence of a subpopulation of macrophage-related cells that may be involved in the transport of antigen and in stimulation of antibody responses.

Animals↗
PubMed2006

Thoracic duct variations may complicate the anterior spine procedures.

The aim of this study is to localize and document the anatomic features of the thoracic duct and its tributaries with special emphasis on the spinal surgery point of view. The thoracic ducts were dissected from nine formaldehyde-preserved male cadavers. The drainage patterns, diameter of the thoracic duct in upper, middle and lower thoracic segments, localization of main tributaries and morphologic features of cisterna chyli were determined. The thoracic duct was detected in all cadavers. The main tributaries were concentrated at upper thoracic (between third and fifth thoracic vertebrae) and lower thoracic segments (below the level of ninth thoracic vertebra) at the right side. However, the main lymphatic tributaries were drained into the thoracic duct only in the lower thoracic area (below the level of the tenth thoracic vertebra) at the left side. Two major anatomic variations were detected in the thoracic duct. In the first case, there were two different lymphatic drainage systems. In the second case, the thoracic duct was found as bifid at two different levels. In formaldehyde preservation, the dimensions of the soft tissues may change. For that reason, the dimensions were not discussed and they may not be a guide in surgery. Additionally, our study group is quite small. Larger series may be needed to define the anatomic variations. As a conclusion, anatomic variations of the thoracic duct are numerous and must be considered to avoid complications when doing surgery.

Aorta, Thoracic↗
PubMedDate not supplied

Popliteal and mesenteric lymph node injection with methylene blue for coloration of the thoracic duct in dogs.

OBJECTIVE: To describe and compare the time of onset and intensity of thoracic duct coloration after injection of methylene blue into a mesenteric or popliteal lymph node. STUDY DESIGN: Experimental study. ANIMALS: Twenty adult dogs. METHODS: A right tenth intercostal thoracotomy, a right paracostal laparotomy, and an approach to the right popliteal lymph node were performed on each dog. Methylene blue (0.5 mg/kg of a 1% solution, maximum 10 mg) was injected into either a mesenteric (group M, 10 dogs) or popliteal (group P, 10 dogs) lymph node. Thoracic duct color was graded (0 to 3) every 5 minutes for 60 minutes. Statistical analysis was performed on mean thoracic duct color grade data, on number of successful outcomes between groups M and P, and between weight groups. RESULTS: Coloration of the thoracic duct occurred in all group M dogs and 6 group P dogs. Coloration was first recorded 0 to 10 minutes after injection in all dogs and persisted for 60 minutes in 15 dogs. Mean thoracic duct color grade was significantly increased postinjection compared with preinjection at all times in group M. More successful outcomes occurred in group M (P =.03). CONCLUSIONS: Methylene blue injected into mesenteric or popliteal lymph nodes was successful in coloring the thoracic duct, but both mean grade and number of successful outcomes were significantly higher after mesenteric injection. CLINICAL RELEVANCE: Thoracic duct coloration after lymph node injection occurred within 10 minutes and persisted for 60 minutes. This information is useful in planning thoracic duct ligation in cases of chylothorax when observation of the duct is desired. Injection of both lymph node sites was successful, but mesenteric node injection was a more reliable technique.

Animals↗