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PubMed1979

Thoracic duct fistula and renal transplantation.

Thoracic duct drainage (TDD) was established for 21-115 days in 40 kidney recipients with an average removal per patient day of 4.7 1 lymph and 1.88 billion cells. Cellular and humoral immunity were depressed. TDD and immunosuppressive drugs were started at transplantation in 35 recipients of cross-match negative grafts. Although the results were better than in precedent non-TDD controls, eight patients rejected their grafts before a full TDD effect, and three of the eight developed predominantly anti-B lymphocyte cytotoxic antibodies which were probably responsible for positive cross-matches with their next donors. With continuing TDD, all eight patients had good initial function after early retransplantation. In five more "nontransplantable" patients with performed cytotoxic antibodies, TDD was started 30-56 days before transplantation. In these five pretreated patients, antibodies persisted with positive antidonor cross-matches. Hyperacute rejection occurred repeatedly in two patients with high anti-T (and anti-B) titers, but was surmounted in three patients with lower titers. From the clinical and immunologic data, we have concluded that TDD should be used for pretreatment of all cases with or without prior antibodies, and have suggested an adjustable management plan that takes into account new developments in antibody monitoring.

Adolescent↗
PubMed1999

Mechanical characteristics of the canine thoracic duct: what are the driving forces of the lymph flow?

This study is designed to better understand the mode of lymph transport, particularly through the extrinsic pumping by external compression of the lymph vessel. The pressure-diameter relationship of lymphatic segments isolated from the canine thoracic duct was examined using a laser optical micrometer measurement system. Results revealed that the thoracic duct displayed a high extensibility or compliance in the physiological pressure range, yet became progressively less so with increasing internal pressure. The calculated incremental circumferential modulus of the thoracic duct under physiological pressure (range of 2 to 6 cm H2O) showed values ranging from 1.2 x 10(4) to 3.61 x 10(5) dyn/cm2. At a pressure of 35 cm H2O, the modulus reached a limiting value of approximately 6.0 x 10(6) dyn/cm2. In the physiological pressure range, the relative wall thickness (h/R0) of the canine thoracic duct was approximately 3.5%, which was much lower than that reported for canine arterial segments and similar in value to that of the canine jugular vein. In conclusion, the pressure-diameter curve of the canine thoracic duct was shown to resemble that of venous vessels. However, the circumferential elastic modulus of the thoracic duct wall was lower than the moduli of veins, proving that lymphatics are more compliant than veins. This suggests lymph flow in the thoracic duct may be better promoted by external compression of the lymphatic vessel.

Animals↗
PubMed1998

Electrical stimulation-induced alpha1- and alpha2-adrenoceptors-mediated contraction in isolated dog thoracic ducts.

The electrical stimulation-induced responses of isolated dog thoracic ducts were investigated using an organ bath technique. Electrical stimulation (0.7 ms in pulse width, 25 V in nominal voltage, 10 s in duration time, 1-32 Hz at frequency) produced frequency-related contractions in the lymphatic preparations. The contractions were abolished by pretreatment with tetrodotoxin (10(-7) M), guanethidine (10(-7), 10(-6) M), and bretylium (10(-7), 10(-6) M). Cocaine (10(-6) M) significantly potentiated the electrical stimulation-induced contractions. Phentolamine (10(-8)-10(-5) M), prazosin (10(-8)-10(-5) M), bunazosin (10(-6), 10(-5) M), yohimbine (10(-8)-10(-6) M) and rauwolscine (10(-8)-10(-6) M) also dose-dependently reduced the contractions. On the other hand, propranolol (10(-8)-10(-6) M), atropine (10(-6) M), hexamethonium (10(-6) M), aspirin (3 x 10(-5) M), N(omega)-nitro-L-arginine methyl ester (L-NAME) (3 x 10(-5) M) and L-NAME (3 x 10(-5) M) + L-arginine (10(-4) M) caused no significant effect on electrical stimulation-induced contractions. No significant difference in the electrical stimulation-induced responses was observed between the lymphatic preparations with and without an intact endothelium. The electrical stimulation caused only a small contraction with no relaxation in the thoracic duct preparation precontracted with 10(-8) M U46619. The small contraction was abolished by 10(-5) M phentolamine. These findings suggest that there exists alpha1- and alpha2-adrenoceptors-mediated excitatory innervation, but no NO-ergic inhibitory nerve fiber in dog thoracic ducts.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMed1993

Ultrastructure of the monkey thoracic duct and the cisterna chyli.

The ultrastructure of the thoracic duct and cisterna chyli was studied in the Formosan rock monkey. This duct is approximately 40% of the crown-rump length. Bicuspid valves ensure one-way drainage of the lymph and prevent reflux of lymph. Ultrastructural variations between the 2 sides of the valves and the functional significance of the different types of valve are discussed. The muscular organisation in the tunica media is similar to that of the human thoracic duct. The abdominal and thoracic parts of the duct contain smooth muscle and probably exhibit active peristalsis, while the cervical part is less muscular and functions like a vein.

Animals↗
PubMed1972

The life-span and recirculation of marrow-derived small lymphocytes from the rat thoracic duct.

These experiments describe the preparation of pure marrow-derived lymphocyte suspensions from the thoracic duct of thymectomized, irradiated rats reconstituted with bone marrow cells. The majority of marrow-derived cells were small lymphocytes morphologically indistinguishable from small lymphocytes in thoracic duct lymph of normal donors. Marrow-derived small lymphocytes (B lymphocytes) were a predominantly long-lived population; the frequency of short-lived B lymphocytes in the thoracic duct was not significantly higher than the frequency of short-lived small lymphocytes in normal lymph. B lymphocytes transferred to normal recipients recirculated from blood to lymph. The first appearance of intravenously injected B lymphocytes in the thoracic duct was delayed relative to lymphocytes from normal donors and there was no clear cut modal recirculation time. Nevertheless their recirculation over a 48 hr period after transfusion was of the same order of magnitude as that of lymphocytes from normal donors.

Animals↗
PubMed1987

The beneficial effects of thoracic duct drainage in HLA-1 haplotype identical kidney transplantation.

The beneficial effects of pre-treatment thoracic duct drainage on graft survival in living related kidney transplantation are presented. Since July 1980 lymphocyte depletion through thoracic duct drainage has been used as pre-treatment therapy in 39 HLA-1 haplotype identical living related kidney transplant patients. Thoracic duct drainage was maintained for 29 to 49 days (mean 36 days) before transplantation and 52 to 215 times 10(9) cells (mean 130 times 10(9) cells) were removed. Postoperative immunosuppression consisted of azathioprine and steroids. Actuarial graft survival was 100 per cent at 3 months, 97 per cent at 6 months through 2 years, 92 per cent at 3 years and 57 per cent at 4 years after transplantation. Patient survival was 100 per cent at 3 months, 97 per cent at 6 months through 3 years and 86 per cent at 4 years. Pre-treatment thoracic duct drainage maintained for more than 28 days could have a significant role on the improvement of the graft survival in HLA-1 haplotype identical kidney transplantation.

Actuarial Analysis↗
PubMedDate not supplied

Thoracoscopic ligation of the thoracic duct.

Traditional operative management for chylous drainage refractory to conservative therapy is thoracic duct ligation via right open thoracotomy. This case report details successful thoracoscopic ligation of the thoracic duct for a chylous leak following a left neck dissection. Since the thoracoscopic approach is less morbid than open thoracotomy, early operative management is recommended for thoracic duct injuries.

Adult↗
PubMed1999

Analysis of thoracic duct flow waves using fast Fourier transform in sheep.

We measured the lymph flow of the thoracic duct using an ultrasound transit-time flowmeter and then analyzed the obtained flow signals by fast Fourier transform. We found that the wave form included a low frequency component (approximately 0.1 Hz) as well as high frequency components which represented cordiac pulsation and respiratory movement. The low frequency component signified an intrinsic thoracic duct pulsation. When venous outflow pressure was increased, the frequency of the thoracic duct pulsation increased, whereas the frequencies of cardiac pulsation and respiratory movement were unchanged. These findings suggest that thoracic duct pulsation is independent of cardiac pulsation and respiratory movement.

Animals↗
PubMed1989

Thoracic duct lymph in a patient with chylous ascites and a carcinoid tumor.

An adult patient with both intraabdominal carcinoid tumor and chylous ascites underwent thoracic duct drainage in an attempt to relieve accumulation of intraabdominal fluid. After cannulation of the left cervical thoracic duct, lymph flow rate was normal (1.4ml/min) and 24 hours of drainage was without effect on the ascites. In contrast to the chylous nature of the ascitic fluid, however, thoracic duct lymph was non-chylous and its protein content was lower than that of the ascitic fluid. The administration of secretin intravenously increased both the flow and amylase content of thoracic duct lymph. These observations signify that the chylous ascitic fluid neither leaked from nor had access to thoracic duct lymph but originated instead from obstructed mesenteric lacteals.

Abdominal Neoplasms↗
PubMed1984

Cytotoxic effects of polymorphonuclear leukocytes and macrophages in patients undergoing lymph depletion via thoracic duct drainage.

It has been previously reported that both human peripheral blood monocyte derived macrophages and polymorphonuclear leukocytes acquire enhanced cytotoxicity for tumor cells. Lymphocyte depletion by thoracic duct cannulation prior to renal transplantation has been shown to suppress allograft rejection. However, the effects of thoracic duct drainage on macrophage and polymorphonuclear leukocyte function is not known. When the macrophages obtained from thoracic duct drainage patients were studied prior to cannulation, four of the five patients possessed cytotoxic macrophages. At 1 to 2 weeks post thoracic duct drainage, cytotoxicity was significantly depressed whereas by 3 weeks post thoracic duct cannulation most of the patients' macrophages exhibited maximal cytotoxicity. Approximately 3 1/2 weeks after cannulation these five patients received cadaveric renal transplants. The cytotoxic effects of the macrophages were tested again after transplantation and it was found that the macrophages became incapable of killing the tumor targets. In contrast to our findings with macrophage mediated cytotoxicity, the polymorphonuclear leukocytes generally retained their cytotoxic capabilities at all time points tested. However, it was noted that cytotoxic activity reached maximal levels within the first 3 weeks after cannulation but fell to low cytotoxic levels at approximately 4 to 5 weeks after cannulation. When tested several months post cannulation and transplantation, polymorphonuclear leukocyte mediated cytotoxicity increased dramatically in four of the five patients studied.

Adolescent↗
PubMed1975

Drainage of thoracic duct lymph in twelve patients with myasthenia gravis.

The effect of thoracic duct lymph drainage (5-34 days) in 12 patients with myasthenia gravis on muscular function has been followed for 5-43 months. Among the results obtained were: (1) During the drainage the myasthenic symptoms decreased markedly after 1-4 days and remained so during the drainage. (2) The doses of cholinesterase inhibitors had to be markedly reduced during the lymph drainage in eight patients. (3) Discontinuation of the lymph drainage increased the myasthenic symptoms within a few days. However, after a median observation time of 14 months with conventional treatment all but one of the patients had improved. (4) Retransfusion of the patients own cell-free lymph caused a worsening of the myasthenic symptoms. This effect could also be obtained following infusion of IgG preparations from the patients lymph. Three retransfusions of cell suspensions obtained from the thoracic duct lymph from two patients had no effects on their myasthenic symptoms. (5) It is suggested that thoracic duct lymph drainage can be combined with other forms of treatment in severe cases of myasthenia gravis.

Adrenocorticotropic Hormone↗
PubMed1986

The chyloesophageal fistula. A new approach to thoracic duct drainage.

The main reason for the virtual abandonment of external thoracic duct drainage as an immunosuppressive measure is not its lack of efficacy, but the time-consuming technical problems of maintaining cannula patency and replacing the large obligatory losses of fluid and protein. In an effort to overcome these problems we have devised a method of diverting thoracic duct lymph internally into the esophagus of the sheep, our hypothesis being that fluid and protein should be resorbed, but lymphocytes and antibodies destroyed. By isolating that part of the venous system into which the thoracic duct drains and anastomosing this conduit to the cervical esophagus a chyloesophageal fistula was created. A mean patency of 19 days was demonstrated radiologically and there was a reproducible peripheral blood lymphopenia of over 50% of preoperative values at 4 weeks. Although plasma albumin levels fell from 37 g/L to 29 g/L at 1 week, they remained stable thereafter. No parenteral fluid or protein was administered, yet the animals remained well with no significant weight loss or overt signs of dehydration or hypoproteinemia. Skin allograft mean survival time was prolonged from 9 to 11.8 days (P less than 0.01).

Animals↗
PubMed1983

[Development of the thoracic duct in the prenatal period of human ontogeny].

In 40 series of histological sections performed in human embryos and prefetuses from 4 up to 20 weeks of development, as well as in 20 corpses of fetuses and stillborns, it has been stated that the anlage of the thoracic duct appear in 6-7-week-old fetuses as lymphatic clefts surrounded with mesenchymal cells that are situated near large veins in the areas of the most active morphogenesis. Connecting with each other, the clefts form the jugular and retroperitoneal lymph sacs and a well branching network of canals. From the latter, on the 7th-8th week of development a plexus of lymph vessels appear, and later on (on the 8th-9th week)--bilaterally situating trunks of the thoracic duct. Further development of the thoracic duct is connected with the lymph nodes formation, their germs appear on the 9th-10th week along the course of the left trunk, as well as along the ductal branches and anastomoses. The formation of the lymph nodes results in reduction of some trunks and plexuses of the thoracic duct. Owing to this, its form in 14-15-week-old prefetuses resembles the one in newborns. Disturbances in the formation processes of the lymph nodes along the course of the reducing ductal areas, as well as their formation along the course of its main trunk can result in various structural variants of the thoracic duct in children and grown-up persons. Histogenesis of the thoracic duct wall and formation of the lymph nodes are not completed by birth.

Gestational Age↗
PubMed1980

[Radiology of the thoracic duct in liver cirrhosis (author's transl)].

The authors on the ground of the lymphographic patterns of 54 cirrhotic patients have emphasized the morpho-functional alterations of the thoracic duct of this patients on the basis of three different parameters: 1) morphology of the thoracic duct; 2) dilatation of the thoracic duct; 3) mouth of the thoracic duct.

Humans↗
PubMed2001

Thoracic duct cyst presenting as a left supraclavicular mass.

Thoracic duct cysts may occur either in the mediastinum or in the neck. The majority of such lesions occurring in the neck consist of chylous fistulae and are secondary to surgery on the neck. Fewer than five cases have been reported in the literature of primary thoracic duct cysts occurring in the neck (1).

Biopsy, Needle↗
PubMed1989

[Thoracic duct collaterals of lymphatic and pulmonary origin. Anatomy and chylothorax after pulmonary surgery].

Dye injection of lung segments reveals the existence of lymphatic drainage of the lungs generally into cervical venous confluents and more rarely into the arch of the thoracic duct in the neck and also occasionally into the thoracic duct in the mediastinum. Direct drainage of the lymph into the thoracic duct was observed in 10 cases out of a series of 589 injections of lung segments in adult cadavers. In one half of cases, the thoracic duct was injected from the left suprabronchial lymph node chain, the origin of the left recurrent chain, and in one quarter of cases from the lateral anteroposterior right major azygos and left azygo-aortic lymph node chains, not recognised by the classical authors. More rarely, direct lymphatic collaterals drained certain segments of the lower lobes into the thoracic duct via the triangular ligament. Analysis of cases of chylothorax occurring after lung resection and observed in the authors' department or in the literature reveals that most of them can be attributed to a chyle leak from one of these pulmonary lymph collaterals. These pathways are probably also involved in the development of medical or idiopathic chylothorax.

Adult↗
PubMed1992

Microsurgical approach to the abdominal thoracic duct in the rat: considerations in the collection of lymphocytes.

In experiments involving the collection of thoracic duct lymphocytes the anatomy of the abdominal thoracic duct in the rat has been further defined. In general, the abdominal thoracic duct lies posterior and to the left of the aorta between the renal arteries and the diaphragm. There are variations in the microsurgical approach to the classically described location of this organ that should be noted by investigators attempting to identify and dissect this structure.

Animal Welfare↗
PubMed1996

Management of thoracic duct complex lesions (chylothorax): experience in 16 patients.

From our experience in 16 patients with persistent chylothorax from fistulas of the thoracic duct or its tributaries, we conclude that no standard treatment is uniformly successful and multimodality therapy should be considered. In selected patients, an anastomosis between ectatic lymphatics or hyperplastic lymph nodes and an adjacent vein may be attempted. Chylothorax from "leakage" of the thoracic duct or its tributaries is rare. Rupture of the thoracic duct superior to the sixth thoracic vertebrae generally results in a left-sided chylothorax; below that level, injury usually results in a right-sided chylothorax. The etiology is heterogeneous and includes blunt trauma, penetrating wounds (1), iatrogenic operative injury and lymphatic obstructions due to congenital abnormalities, inflammatory processes or neoplasms. Based on our experience in 16 patients with persistent chylothorax from thoracic duct complex lesions, we review the available treatment options.

Adolescent↗