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PubMed1982

[Topographo-anatomical substantiation of the choice of a rational approach to the terminal region of the thoracic duct].

With the aim to state the dependence between the projection of the place where the thoracic duct flows into and the superior part of its arc with the position of its external reference marks in order to choose a rational approach to the terminal part of the thoracic duct, an investigation on 50 embalmed human corpses has been performed by the method of graphic reconstruction and quantitative estimation of the planimetric images obtained. Certain regularities have been revealed in the interconnection of the terminal part of the thoracic duct with the elements of the cervical vascular-neural fasciculi, the sternocleidomastoid muscle, the clavicle, etc. There is a correlative dependence between the position of the external reference points and topographic peculiarities of the cervical part of the thoracic duct. A technique is suggested to calculate the projection zone of the cervical part of the thoracic duct in every case with the aim to choose a rational approach for the external drainage.

Adult↗
PubMed1986

Redistribution of regional lymph to the thoracic duct in rats during heat stress.

The protein concentration of the thoracic duct lymph and the amount of protein transported by the thoracic duct decreased during an acute heat stress in rats. The changes in regional lymph flow into the thoracic duct were calculated and the ratio of the lymph from the skin increased 13% and that from the visceral organs decreased 6% during heat stress.

Animals↗
PubMed1990

Effects of vasoconstrictive and vasodilative agents on lymphatic smooth muscles in isolated canine thoracic ducts.

A study was made of the isometric responses of isolated canine thoracic ducts to several physiological vasoactive substances. Contractions of the lymphatic smooth muscles were induced by epinephrine, norepinephrine, 5-hydroxytryptamine, histamine (HIS) and prostaglandin F2 alpha in a dose-dependent manner. The decreasing order of potency in the contractile responses was as follows: epinephrine greater than norepinephrine greater than 5-hydroxytryptamine much greater than HIS not equal to prostaglandin F2 alpha. There were no significant regional differences in the responses to vasoconstrictive agents. Phenylephrine, xylazine and clonidine caused a dose-dependent contraction in the lymphatic preparations. Prazosin (10(-8) to 10(-7) M) inhibited the phenylephrine-induced vasoconstriction in a competitive manner. Xylazine-induced responses were inhibited competitively by yohimbine (10(-8) to 10(-7) M). These results suggest that both alpha-1 and alpha-2 adrenoceptors are located on the lymphatic smooth muscles of canine thoracic ducts. On the other hand, acetylcholine, isoproterenol, HIS, adenosine and ATP caused dose-dependent relaxations in canine thoracic ducts precontracted by 10(-5) M norepinephrine. The decreasing order of potency in the relaxant responses was as follows: acetylcholine much greater than isoproterenol much greater than adenosine not equal to HIS not equal to ATP. There were no significant regional differences in the relaxant responses to the agents. Procaterol, salbutamol, dobutamine and denopamine caused a dose-dependent relaxation of isolated canine thoracic ducts. Propranolol (10(-9) to 10(-8) M) inhibited procaterol- and dobutamine-induced vasorelaxations in a competitive manner. Metoprolol (10(-8) to 10(-7) M) inhibited only the dobutamine-induced vasorelaxation, but did not significantly influence the procaterol-induced response.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1998

Treatment of chronic thoracic duct fistula with the sternocleidomastoid muscle flap.

Thoracic duct fistula is a rare but potentially serious complication of head and neck surgery. The fistulae can be difficult to treat, and several techniques, both operative and nonoperative, are advocated. We present a simple technique for the treatment of chronic thoracic duct fistula where other procedures have failed. After identification and ligation of the duct, the area is covered with the clavicular head of the sternocleidomastoid muscle.

Chronic Disease↗
PubMed2003

Influences of thoracic duct blockage on early enteral nutrition for patients who underwent esophageal cancer surgery.

OBJECTIVES: We have previously reported the beneficial effects of immediate enteral nutrition (EN) after esophageal cancer surgery. This randomized control study was conducted to determine whether immediate EN is beneficial or not for patients whose thoracic ducts were ligated, as well as those whose thoracic ducts were preserved. PATIENTS AND METHODS: Thirty-nine patients who underwent radical resection of the esophageal cancer entered this trial. After stratifying into two groups--patients whose thoracic ducts were preserved [D(+)] and those whose thoracic ducts were ligated [D(-)], they were randomly divided into two groups--the patients who received early EN and those who received parenteral nutrition (PN) followed by delayed enteral feeding. Thus, the number of patients in the D(+)-EN group, D(+)-PN group, D(-)-EN group and D(-)-PN group were 13, 12, 7 and 7, respectively. The mortality and morbidity rates, and several blood chemistries were compared between the EN groups and the PN groups. RESULTS: Total lymphocyte count showed a significant early increase and serum c-reactive protein (CRP) was significantly decreased in the D(+)-EN group compared to the D(+)-PN group. However those differences were not observed between the D(-) groups. Serum total bilirubin was significantly decreased in the both EN groups compared to the PN groups. The mortality and morbidity rates were not different between the EN group and the PN group in the D(+) patients and also in the D(-) patients. CONCLUSIONS: Patients whose thoracic ducts were ligated did not obtain any other benefit from early enteral feeding except for bilirubin metabolism. Early enteral feeding is not recommended for patients whose thoracic ducts are ligated during radical resection of a cancer in the thoracic esophagus.

Aged↗
PubMed1998

Thoracic duct injury during anterior cervical discectomy: a rare complication. Case report.

Chylous fistula resulting from intraoperative injury to the cervical thoracic duct is well described as a complication of neck dissection. However, injury to the thoracic duct during spinal surgery is rarely reported. The authors present the first case of thoracic duct injury occurring during cervical discectomy and fusion via an anterior approach. The anomalous location of the terminal arch of the thoracic duct in this patient contributed to the complication. The morbidity of chyle leakage is minimized by its early recognition, a thorough understanding of lymphatic system anatomy, and aggressive management of the thoracic duct injury.

Adult↗
PubMed1992

Reduction in biliary IgA after burn injury. Role of diminished delivery via the thoracic duct and of enhanced loss from the systemic circulation.

The concentration of biliary IgA is greatly reduced after scald burn injury in the rat, thereby contributing to a deficiency in upper intestinal immune defense. This reduction in biliary IgA might have several explanations, including failure of the transhepatic transport of polymeric IgA (pIgA) from the circulation, decreased delivery of pIgA to the hepatocyte, or decreased local synthesis of IgA in the liver. The authors examined whether burn injury reduces circulating pIgA available for delivery to the hepatocyte. In initial studies, they demonstrated that burn injury induces a decrease in circulating pIgA in bile-duct-ligated rats. They then sought to determine whether this decrease in pIgA was due to increased loss from the circulation or to a decreased supply of pIgA to the circulation through the thoracic duct. After injection of purified 125I-pIgA into bile duct-ligated rats, radioactivity was removed more rapidly from the circulation of burn-injured compared with control rats. The radioactivity localized in the skin and muscle at the site of burn injury. In another group of rats with patent bile ducts, the thoracic duct was cannulated and lymph collected for 12 hours. The total amount of IgA protein in lymph was found to be reduced in burn-injured compared with control animals. Thus, burn injury is accompanied by reduced circulating pIgA, which may be attributed to its enhanced loss from the circulation and to decreased delivery of pIgA from the intestinal mucosa to the systemic circulation via the thoracic duct.

Animals↗
PubMed1976

The origin and significance of macrophages in thoracic duct lymph.

Efferent lymph collected from a thoracic duct fistula initially contains no macrophages. However, the surgical procedures used to insert plastic cannulae into efferent lymphatics incite a vigorous foreign body reaction leading to the contamination of collected lymph with significant numbers of these cells. A sensitive and specific assay for the presence of macrophages in lymphocyte populations was used to quantitate the degree of contamination in rats bearing thoracic duct cannulae. The origin of some of these contaminant cells from the peritoneal macorphage population was established by adoptive transfer of labelled peritoneal cells to cannulated recipients.

Animals↗
PubMed1976

In vitro response of bovine thoracic duct lymphocyte to phytohaemagglutinin following adult thymectomy.

The effect of adult thymectomy on the thoracic duct lymphocyte population of yearling calves has been investigated. Four to 6 weeks after thymectomy animals showed significantly reduced thoracic duct lymphocyte concentrations when compared to non-thymectomized controls. In addition, phytohaemagglutinin responsiveness of thoracic duct lymphocytes, measured by (3H) thymidine uptake, was significantly decreased following adult thymectomy. However, this decreased response to PHA was not accompanied by a change in spontaneous isotope incorporation. It is concluded that adult thymectomy in the bovine probably leads to a reduction in the number of PHA responsive T cells in the thoracic duct lymph.

Animals↗
PubMed2001

Lymphocele of the thoracic duct presenting as a left supraclavicular mass: a case report and review of the literature.

Surgical injuries and blunt trauma are the main causes of thoracic duct lesions. Cervical chylous fistula and chylothorax occur frequently after lesions of the cervical portion of the thoracic duct. On the other hand, thoracic duct cyst is a very rare entity, especially in its cervical portion. The authors reported a case of thoracic duct cyst, presenting as an asymptomatic left cervical mass. Diagnosis was suggested by computerized axial tomography and confirmed by histological analysis, after surgical removal of the cyst. After review of the literature, the authors recommended surgical treatment of cervical thoracic duct cysts in order to prevent potential complications as traumatic or spontaneous rupture.

Clavicle↗
PubMed1999

Thoracic duct in patients with multiple organ failure: no major route of bacterial translocation.

OBJECTIVE: To determine whether translocation of bacteria or endotoxin occurred into the thoracic duct in patients with multiple organ failure (MOF). SUMMARY BACKGROUND DATA: Translocation of bacteria or endotoxin has been proposed as a causative factor for MOF in patients without an infectious focus, although it has rarely been demonstrated in patients at risk for MOF. Most studies have investigated the hematogenic route of translocation, but it has been argued that lymphatic translocation of bacteria or endotoxin by the thoracic duct is the major route of translocation. METHODS: The thoracic duct was drained for 5 days in patients with MOF caused either by generalized fecal peritonitis (n = 4) or by an event without clinical and microbiologic evidence of infection (n = 4). Patients without MOF who were undergoing a transthoracic esophageal resection served as controls. In lymph and blood, concentrations of endotoxin, proinflammatory cytokines, and antiinflammatory cytokines were measured. RESULTS: Endotoxin concentrations in lymph and blood of patients with MOF ranged from 39 to 63 units per liter and were not significantly different from concentrations in patients without MOF. The quantity of endotoxin transported by the thoracic duct in the study group was small. In patients with MOF, low levels of proinflammatory cytokines and high levels of antagonists of these cytokines were found. CONCLUSION: This study provides evidence that translocation (especially of endotoxin) occurs into the thoracic duct. However, these data do not support the concept that the thoracic duct is a major route of bacterial translocation in patients with MOF.

Aged↗
PubMed2000

Octreotide in the treatment of thoracic duct injuries.

Anecdotal reports support the use of octreotide in the treatment of traumatic thoracic duct injuries and chylothorax, but no prospective studies have proved its efficacy. We evaluated the effects of octreotide in treating thoracic duct transection in a canine model. Eight mongrel dogs (27.8+/-5.1 kg) were fed one pint of 10.5 per cent milkfat 2 hours before operation. Through a left supraclavicular neck incision, the thoracic duct was identified and transected, producing free flow of chyle. A quarter-inch drain was tunneled subcutaneously from the wound and attached to closed suction. After wound closure dogs were randomized to a control group (n = 4) receiving sham injections of saline subcutaneously three times per day, or a treatment group (n = 4) given 3 microg/kg octreotide three times per day. Postoperatively all dogs were fed a standard low-fat (5-7%) crude fat diet. Drain output was measured each day, and on odd-numbered postoperative days the drainage was analyzed for cholesterol, triglycerides, albumin, and total protein. Fistula closure was defined as drainage <10 ml/24-hour period. Treated dogs achieved fistula closure significantly faster than controls: 3.5+/-1.3 days versus 7.8+/-1.0 days (P = 0.0037). Whereas equivalent amounts of drainage occurred on the day of surgery and on postoperative day one in both groups, by postoperative day 2 the treatment group had significantly less drainage over 24 hours: 63+/-69 ml versus 195+/-79 ml (P = 0.046); this significant difference persisted through postoperative day 5 when drainage began to decrease in the control group. No significant differences between groups were seen in levels of cholesterol, triglycerides, albumin, or protein in the drainage at any time point. We conclude that octreotide is effective in treating thoracic duct injury, leading to an early decrease in drainage and early fistula closure. The mechanism for this effect remains to be clarified.

Animals↗
PubMed1973

The role of thoracic duct lymph in gastrin transport and gastric secretion.

The effect of thoracic lymph diversion on gastric secretion has been studied in dogs. In addition, the concentration of gastrin in thoracic duct lymph of nine dogs and two patients has been measured before and during antral stimulation with either food or acetylcholine. The secretory studies do not support the concept that there is a significant gastric secretagogue in thoracic duct lymph. The amount of gastrin carried in thoracic duct lymph as determined by radioimmunoassay is far less than that necessary to evoke a gastric secretory response.

Acetylcholine↗
PubMed2005

Thoracic duct cysts: a rare differential diagnosis.

OBJECTIVE: Cysts of the thoracic duct located in the supraclavicular region are uncommon. To date only 12 cases in this topographic area have been described in the literature. Between 1998 and 2002, 5 patients presented to our department with the primary symptom of a palpable soft left-supracavicular swelling that could be displaced relative to adjacent structures. SETTING: In each case, sonography showed a hypoechogenic, almost echo-free, distinctly outlined polycyclic structure with distal echo enhancement at the junction of the left internal jugular vein and the subclavian vein. All 5 patients underwent surgery, the cysts were extirpated, and the numerous communicating lymph vessels localized and meticulously ligated. Pathohistologic analysis of the milky, yellowish fluid obtained by intraoperative puncture confirmed the initial suspicion of a thoracic duct cyst in all patients. CONCLUSION: In the case of left supraclavicular masses, the rare differential diagnosis of a thoracic duct cyst must be considered as a possibility. Sonography as the imaging method of choice is sufficient for primary diagnosis. In addition, a thorax x-ray should be performed in order to exclude an intrathoracic involvement. Surgical extirpation marks the therapy of choice in treating such cysts.

Adult↗
PubMed1971

Pressure waves and gradients in the canine thoracic duct.

1. Pressures have been measured in the thoracic duct of anaesthetized and conscious dogs to ascertain the mean pressures, the nature of the pressure waves and the pressure gradients along the duct and between it and the great veins.2. The average mean pressure in the thoracic duct of ten anaesthetized dogs was 1.4 mm Hg. The pressure waves were secondary to respiration and the pulsations of the aorta. No waves were transmitted from the great veins.3. Pressures in conscious dogs varied from day to day, sometimes being positive, sometimes negative. They were increased by panting and by drinking.4. The pressure gradients along the duct were small, no more than 0.5-2.0 mm Hg along its whole length.5. No evidence was found of spontaneous contractions of the duct.

Anesthesia↗
PubMed1995

Sonographic assessment of the distal end of the thoracic duct in healthy volunteers and in patients with portal hypertension.

OBJECTIVE: Our study assessed the feasibility of detecting and measuring by sonography the diameter of the thoracic duct in healthy subjects and in patients with cirrhosis and portal hypertension. We also evaluated the relationship of thoracic duct size with age and with clinical, endoscopic, and sonographic signs of portal hypertension. SUBJECTS AND METHODS: The left supraclavicular area of 24 patients with cirrhosis and 23 healthy subjects was examined with high-frequency probes using transverse and oblique scans to visualize the distal end of the thoracic duct. All patients with cirrhosis, diagnosed by liver biopsy or clinical and biochemical data, had endoscopic or sonographic signs of portal hypertension. The severity of the liver disease was determined by Child-Pugh's criteria; the diameter of portal vessels and the size of esophageal varices were also considered. RESULTS: The thoracic duct was visualized in 19 of 24 patients with cirrhosis and in 18 of 23 control subjects (percent of visualization was 79% and 78%, respectively). The diameter of the duct was larger in patients with cirrhosis than in healthy subjects (3.1 +/- 1.2 mm versus 1.9 +/- 0.5 mm; p < .0001), but no relationship was found among clinical, endoscopic, and sonographic signs of portal hypertension. A direct relationship between age and the size of the thoracic duct was found only among healthy subjects. CONCLUSION: This is the first report of the sonographic visualization of the distal end of the thoracic duct. Its diameter is small in healthy young subjects, whereas in patients with cirrhosis its increased diameter seems to be associated only with the presence of portal hypertension and not with its severity.

Humans↗
PubMed1984

Thoracic duct drainage in rheumatoid arthritis.

Thoracic duct drainage (TDD) led to major improvement of disease in two of five patients with severe rheumatoid arthritis and lesser improvement in two others. This improvement was maintained as long as 10 months, but reassertion of disease activity was seen despite use of azathioprine in standard immunosuppressive doses. A consistent fall in the mitogen-induced proliferative responses of blood lymphocytes occurred during TDD, along with a shift in the ratio of OKT4/T8 to a higher proportion of OKT8. However, there was minimal effect on B cell function and no demonstrable influence on complement activating events in the disease, and there was an inverse relationship between responsiveness to TDD and the degree to which in vivo complement activation was occurring. We suggest that it may be important to assess the candidacy of RA patients for given apheresis procedures by sensitive measures of the degree of activation of complement proteins.

Adult↗