Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “THORACIC DUCT”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed2007

Transabdominal ligation of the thoracic duct as treatment of choice for postoperative chylothorax after esophagectomy.

Postoperative chylothorax after injury of the thoracic duct during esophagectomy is a rare but severe complication which may lead to serious problems such as loss of fat and proteins, and immunodeficiency. Without treatment mortality can rise to over 50%. From 1988 to 2005, we treated 10 patients with postoperative chylothorax after 409 resections of the esophagus (2.4%). Of these 10 patients nine underwent transthoracic esophagectomy with gastric pull-up to enable an intrathoracic (n = 7) or cervical (n = 2) anastomosis and one patient received a transhiatal esophagectomy with gastric pull-up and cervical anastomosis. The average amount of postoperative chylus was 2205 mL (200-4500 mL) per day. After a median postoperative interval of 10 days, relaparotomy and transhiatal double ligation of the thoracic duct was performed in nine out of 10 patients. One patient could be managed conservatively. The average amount of chylus was reduced to 151 mL per day (90.5%). Seven patients had no complications, and three suffered from postoperative pneumonia. Two of the patients with pneumonia recovered, and one died. Discharge from hospital, after ligation of the thoracic duct, was possible after a median time of 18 days (11-52). Ligation of the thoracic duct via relaparotomy appeared to be a simple and safe method to treat postoperative chylothorax.

Aged↗
PubMed1990

[Thoracic duct cyst--a case report].

A case of thoracic duct cyst was reported. The patient, 72 year old man, was admitted with chief complaint of dysphagia. Chest X-ray film demonstrated an ovoid mass at the right upper mediastinum and the esophagus pressed by the tumor to the right. CT scan showed a round tumor with obscure margin located at the right upper mediastinum. Other laboratory data were almost within normal limits. Thoracotomy was performed on March 26, 1987 under diagnosis of leiomyoma of the esophagus. A fluid containing cyst covered with pleura was found at the upper mediastinum. The tumor was connected to the thoracic duct at its upper and lower portion. The cyst was isolated by sharp and blunt dissection without difficulties and removed. The cyst measured 7.5 X 4.5 X 4.5 cm and contained chyle. Pathological examination revealed no evidence of malignancy. Postoperative course of this patient was uneventful, and dysphagia was disappeared.

Aged↗
PubMed1976

Extracorporeal irradiation of thoracic duct lymph as immunosuppressive treatment in rheumatoid arthritis.

Thoracic duct drainage and re-infusion of the irradiated lymph was carried out as immunosuppressive treatment in 2 patients with progressive, therapy-resistant rheumatoid arthritis. In both patients, a marked clinical improvement was achieved even during the first days of treatment. A reduced number of T cells in the blood was seen 3 days after onset of drainage, whereas no significant change in the number of B cells was observed. No recirculation of the infused cells could be detected, nor was the radiation removal of T cells accompanied by rapid proliferation of "new" T cells. As clinical improvement and reduction in T cells occurred simultaneously, there is probably a connection between these two events. The beneficial clinical response and the achievement of T cell suppression by thoracic duct drainage--the result of irradiation and re-infusion of irradiated lymph--encourage further clinical trials with this type of treatment in severe therapy-resistant rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed2002

Videoscopic supradiaphragmatic thoracic duct division using ultrasonic coagulator.

Three consecutive male patients underwent videoscopic supradiaphragmatic thoracic duct division using the Harmonic Scalpel with a hook blade (Ethicon Endo-Surgery, Cincinnati, OH, USA) for treatment of chyle leaks that developed after left upper lobectomy, graft replacement of a descending aortic aneurysm and thyroidectomy with concomitant partial sternal resection. The thoracic duct was exposed and divided using just the Harmonic Scalpel. The operations lasted 40, 20 and 18 min. No mortality, morbidity or recurrence occurred during follow-up periods of 27, 17 and 9 months. The Harmonic Scalpel with a hook blade can facilitate supradiaphragmatic exposure of the thoracic duct.

Aged↗
PubMed2001

Thoracic duct scintigraphy by orally administered I-123 BMIPP: normal findings and a case report.

PURPOSE: To investigate the use of orally administered iodine-123-labeled 15-(4-iodophenyl)-3(R,S)-methyl-pentadecanoic acid (I-123 BMIPP) for thoracic duct imaging in normal and pathologic states and to study the tracer distribution and dynamics in healthy participants. METHODS: The radiotracer was administered with solid (in three healthy persons and one patient) or liquid meals (in three other healthy persons). Solid meals contained relatively more fat content than did the liquid meal. Images were acquired to trace the passage of radiotracer from the intestine to the systemic venous circulation via the lymphatic route. Multiple static planar images were acquired in the anterior and posterior views. Blood samples were analyzed for radioactivity and serum triglyceride levels. RESULTS: In the healthy participants, I-123 BMIPP was absorbed from the intestine and reached the venous circulation through the thoracic duct. The thoracic part of the duct was visualized successfully in all healthy persons within 80 minutes. The radiotracer dynamics varied according to the type of meal administered. The patient had chylomediastinum and right chylothorax and underwent thoracic duct ligation. In the patient, marked stasis in the collateral lymphatic channels was seen, as was chylous leakage into the mediastinal space and right pleural cavity. Passage of tracer to the general venous circulation was delayed. A normal thoracic duct was not seen in this patient. CONCLUSIONS: Scintigraphy by orally administered I-123 BMIPP is a simple method to image the thoracic duct and to monitor its lesions. Meals with a higher fat content result in better BMIPP absorption and may be used as a standard method.

Administration, Oral↗
PubMedDate not supplied

Sealing the thoracic duct with ultrasonic coagulating shears.

BACKGROUND/AIMS: Ultrasonic coagulating shears were developed as an endosurgical device that allows cutting of vessels without ligation. In this study, we obtained basic data on the feasibility of dividing and sealing the thoracic duct by using ultrasonic coagulating shears. METHODOLOGY: We obtained the thoracic duct and the left gastric artery from surgical specimens of 27 patients. After one end of each vessel was sealed using ultrasonic coagulating shears, we recorded the bursting pressure. The sealed ends of the vessels were also examined histopathologically. RESULTS: The mean bursting pressure of the thoracic duct was high enough to support the clinical use of this device, and was significantly higher than that of the left gastric artery (p<0.001). Microscopic examination of the sealed vessels showed that degenerated collagen fibers were more homogeneous and covered a significantly larger area in the thoracic duct than in the left gastric artery (p<0.001). CONCLUSIONS: The present study provides a basis for using ultrasonic coagulating shears to seal the thoracic duct and possibly lymph node dissection.

Electrocoagulation↗
PubMed1981

[Frequency and ways of filling lymph nodes above the diaphragm with contrast medium during anterograde lymphography of the thoracic duct].

The data on contrast radiography of the lymph nodes situated above the diaphragm have been obtained in 246 out of 342 patients subject to the investigation of their normal thoracic ducts. It has been stated that the contrast picture of the lymph nodes situated far from the thoracic duct (peritracheal, bronchopulmonary, bifurcational and anterior mediastinum) is the most difficult to obtain. Retrograde filling of the supraclavicular, posterior inferior diaphragmal intercostal nodes with the contrast material occurs more often via the deferent lymphatic vessels which get into the thoracic duct. Besides, the frequency on simultaneous filling with the contrast material of various groups of the lymph nodes along the course of the thoracic duct has been studied. It has been stated that in 46.7% of the patients only one group of the lymph nodes become contrasted, less often--2 (23.1%) and still less often--3-4 groups (14.2% and 10.2% respectively). For the first time the intercalated lymph nodes along the course of the thoracic duct have been described; they are filled with the contrast substance anterogradelly via short connective branches.

Adult↗
PubMed2006

Lymphography of the thoracic duct by percutaneous injection of iohexol into the popliteal lymph node of dogs: experimental study and clinical application.

OBJECTIVE: To evaluate the efficacy of percutaneous administration of iohexol into the popliteal lymph node as a non-invasive technique for thoracic duct lymphangiography in dogs. STUDY DESIGN: Experimental study and clinical report. ANIMALS: Normal adult dogs (n=4) and 1 dog with recurrent chylothorax. METHODS: For the experimental study, 4 dogs (weight, 8.4-12.3 kg) had 5-10 mL iohexol injected percutaneously into 1 popliteal lymph node and then thoracic radiographs were taken. Popliteal lymph nodes were examined by histopathology 8 days later. One 25-kg dog with recurrent chylothorax had 25 mL iohexol injected into the right popliteal lymph node followed by thoracic radiography. RESULTS: In experimental dogs, the thoracic duct was best visualized on thoracic radiographs after administration of 10 mL iohexol. Clinically, no abnormalities were identified in the injected limb and except for 1 dog that had large numbers of siderocytes and erythrophagocytic macrophages in the injected lymph node, the histopathologic findings in the other injected popliteal lymph nodes were not different from contralateral nodes. In the clinical case, the thoracic duct was visualized, but there was leakage of iohexol around the node. CONCLUSION: The thoracic duct in dogs can be visualized by lymphography after percutaneous injection of iohexol (1 mL/kg at 2 mL/min) into the popliteal lymph node. CLINICAL RELEVANCE: Percutaneous popliteal lymph node administration of iohexol should be considered as an alternative to mesenteric lymph node injection for radiographic identification of the thoracic duct in dogs.

Animals↗
PubMed1994

[Substantiation of the thoracic duct drainage in diseases of the liver and biliary tract].

Morphological study of the hepatic lymph vessels in 16 patients with diseases of the liver and biliary tract and the thoracic duct in individuals of different ages showed that the number and diameter of the lymphatic vessels and the diameter of the thoracic duct increase in the phase of inflammation, Proliferation of connective tissue in cirrhosis reduces the number of lymph vessels, induces valvular incompetence in the thoracic duct attended by ascites. Sixteen patients with diseases of the liver and biliary tract underwent operation for drainage of the thoracic duct. Biochemical parameters and the flow of lymph indicated that the diminished lymph issue is attended on the second day by decrease of the intoxication indices by one third, which is revealed by endotoxin--bile acids, bilirubin, the liver reduces in size and pruritus disappears. The results of the study substantiate the operation for drainage of the thoracic duct and show its importance as a method for the prevention of hepatic insufficiency and for detoxification.

Adult↗
PubMed1975

Rabbit gut-associated lymphoid tissue. Major pathway for thoracic duct lymphocyte circulation.

The demonstration of a preponderance of T cells in the thoracic duct lymph of rabbits prompted us to initiate cytokinetic studies using both uridine- and thymidine-labeled thoracic duct lymphocytes (TDL). Rabbits received intravenous injections of 8 to 11 X 10(8) autologous or allogeneic TDL, 95 per cent of which had incorporated 3H-uridine during a 1-hour in vitro incubation. Autoradiographs of tissues collected 24 hours after injection of TDL failed to demonstrate any trapping of label in liver or in vivo reutilization of 3H-uridine. No differences in the distribution of labeled cells were noted between recipients of autologous and allogeneic TDL. The paracortical areas of lymph nodes and periarterial areas of splenic follicles contained many heavily labeled cells; these areas therefore appear to correspond to thymus-dependent areas as in other rodents. The tonsils contained densely packed sheets of labeled cells. In the tonsillar but not in other germinal centers, evenly distributed, lightly labeled cells were seen. Small clusters of heavily labeled cells were seen in the bronchus-associated lymphoid tissue. In the appendix, sacculus rotundus, and Peyer's patches (GALT) densely packed, heavily labeled cells were seen in the interfollicular areas; fewer, heavily labeled cells were scattered throughout the dome and corona of GALT. In the dome and corona, however, there were many lightly labeled cells. The germinal centers of GALT were lacking totally in uridine-labeled cells. Some 20 per cent of TDL collected 24 hours after injection of uridine-labeled TDL were labeled, thereby reflecting considerable recirculation of TDL. Injection of 24 to 48 X 10(6) thymidine-labeled immunoblasts, obtained from TDL incubated with 3H-thymidine in vitro, into autologous or allogeneic recipients killed 24 hours later, revealed heavily labeled cells in the intestinal lamina propria, the dome, corona, and interfollicular areas of GALT, as well as throughout the spleen, lymph nodes, and tonsils. There was a 2- to 3-fold higher concentration of labeled cells in the appendiceal and mesenteric lymph nodes than in respective popliteal nodes. The potential significance of this differential distribution together with the homing-circulation patterns of these cells in GALT are discussed with regard to differentiation of IgA-producing cells. It is concluded that rabbit GALT contains a substantial number of cells belonging to the pool of recirculating lymphocytes and that B and T cells in the thoracic duct may have different rates of uridine incorporation as has been shown in other rodents.

Animals↗
PubMed2006

Bilateral thoracic ducts with coexistent persistent left superior vena cava.

A case of bilateral thoracic ducts with coexistent persistent left superior vena cava (SVC) was identified in a 77-year-old Japanese female cadaver during dissection in a gross anatomy course. The persistent left SVC began at the lower surface of the left brachiocephalic vein, descended in front of the aortic arch, and drained into the right atrium through the coronary sinus. The right SVC was normal both in size and in position. The azygos vein, receiving the hemiazygos vein, opened into the right SVC. The accessory hemiazygos vein and the left superior intercostal vein united to form a common trunk, which drained into the left SVC. The left and right thoracic ducts began at the level of the 1st lumbar vertebra, ran upwards parallel and anterior to the vertebral column, and terminated at the venous angles of their corresponding sides. There was an anastomotic branch between them. The present case was considered to be very rare, since the persistent left SVC and bilateral thoracic ducts coexisted. The embryologic basis and clinical importance of this case are discussed.

Aged↗
PubMed1976

Maturation of b lymphocytes in rates. III. Two subpopulations of memory B cells in the thoracic duct lymph differ by size, turnover rate, and surface immunoglobulin.

We examined the ability of large and small thoracic duct cells obtained from Lewis rats primed to DNP to restore the adoptive secondary anti-DNP response in irradiated syngeneic hosts given an excess of T helper cells. The large cells were four to five times more active on a per cell basis than were the small cells. However, the large cells constitute only 7 to 8% of the thoracic duct cells and, therefore, make a minor contribution to the restorative activity of the unfractionated cells. Pretreatment of thoracic duct cell donors with high specific activity 3H-TdR for 48 hr before cannulation markedly reduced the memory B cell activity of the large cells, but had little effect on that of small cells. In addition, the activity of the large cells diminished with time after primary immunization, but that of the small cells remained stable. Immunofluorescent staining of the large and small cells for surface IgM and IgG, and subsequent sorting on the fluorescence-activated cell sorter (FA CS), showed that surface IgM was present on large memory B cells, and that IgG was present on small memory B cells. The experimental results suggest that two subpopulations of memory B cells in the thoracic duct lymph differ by size, rate of turnover, persistence after primary immunization, and class of surface IgG.

Animals↗
PubMed1979

The effect of thoracic duct drainage on lymphocyte dynamics and clinical symptoms in patients with rheumatoid arthritis.

Thoracic duct drainage (TDD) was performed in 4 patients with severe rheumatoid arthritis. Clinical effects were apparent in all during drainage, but the term of TDD and the cumulative number of lymphocytes drained had no direct relation to the improvement of clinical symptoms. The number of lymphocytes in the peripheral blood increased despite discharge of lymphocytes from the thoracic duct in the very early stage of drainage, suggesting that lymph drainage from thoracic duct accelerates migration of lymphocytes from lymphocyte pools to the blood stream. Biopsy specimens of synovial membranes obtained post-TDD showed marked decrease of mononuclear cell infiltration as compared to the specimens obtained preoperatively. These findings suggest that clinical effectiveness may be due not only to systemic immunosuppression induced by lymphocyte depletion but also to accelerated migration of inflammatory cells from the synovial tissues to the blood stream occurring with dynamic change of lymph flow during TDD.

Adult↗
PubMed1994

Dynamics of glucose production and uptake are more closely related to insulin in hindlimb lymph than in thoracic duct lymph.

We previously reported a striking similarity between the dynamics of both glucose turnover and thoracic duct lymph insulin during euglycemic clamps (J Clin Invest 84:1620, 1989), which suggested that transendothelial insulin transport (TET) is rate-limiting for insulin action in vivo. Thoracic duct lymph, however, is primarily derived from insulin-insensitive tissues, which raises questions as to the physiological significance of this relationship. The relationship between glucose turnover and TET was thus examined in insulin-sensitive tissues by the simultaneous measurement of insulin in plasma, thoracic duct lymph, and hindlimb lymph during euglycemic clamps in normal anesthetized dogs (n = 8). Clamps consisted of two 3-h phases: a 0.6 mU.min-1.kg-1 insulin infusion (activation phase) followed by termination of the insulin infusion (deactivation phase). Lymph insulin was less than plasma insulin during both phases (P < 0.01) with steady-state hindlimb (120 +/- 12 pM) and thoracic duct lymph insulin (138 +/- 12 pM) 38 and 45%, respectively, lower than steady-state plasma insulin (222 +/- 24 pM) at the end of the activation phase (P < 0.05). Also, the rate of increase of lymph insulin was slower than plasma insulin during hormone infusion; half-time to steady-state was 8.8 +/- 2.0 min for plasma insulin, but longer for thoracic (25.8 +/- 3.5) and hindlimb lymph insulin (40.7 +/- 5.7 min). A very close relationship was observed during activation between the rate of increase of glucose uptake (Rd) and the increase in hindlimb lymph insulin (r2 = 0.92); this relationship was weaker for thoracic lymph (r2 = 0.74) and much weaker between glucose uptake and plasma insulin (r2 = 0.35). These data support the concept that interstitial insulin (represented by hindlimb lymph) is the signal that determines glucose uptake by insulin-sensitive tissues and that the rate of increase of glucose uptake is determined by transendothelial insulin transport into insulin-sensitive tissue. Also, during activation, hindlimb lymph insulin was a very strong predictor of the rate of suppression of hepatic glucose output (HGO) (r2 = 0.96), and the correlation with HGO was stronger than that for thoracic lymph (r2 = 0.85). The evidence that the rate of increase of Rd and the rate of suppression of HGO during insulin infusion are very strongly predicted by the time course of insulin in hindlimb lymph is consistent with the single-gateway hypothesis: the insulin transport rate across endothelium in insulin-sensitive tissue (skeletal muscle) determines the rate of glucose utilization and the suppression of hepatic glucose output.(ABSTRACT TRUNCATED AT 400 WORDS)

Analysis of Variance↗
PubMed1985

Mesenteric lymphography and ligation of the thoracic duct in a cat with chylothorax.

Mesenteric lymphography was used to identify and ligate the thoracic duct in a 1-year-old Himalayan cat with chylothorax. Lymphography revealed the thoracic duct to be intact; however, multiple dilated lymphatics, indicative of lymphangiectasia were evident in the cranial portion of the thorax. Hemostatic clips were used to ligate the thoracic duct. The effusion stopped, and 9 months after surgery, effusion has not recurred.

Animals↗
PubMed1986

Thoracic duct lymph flow in pregnant sheep and response to blood volume expansion.

Left thoracic duct lymph flow rate averaged 0.077 +/- 0.003 (SD) and 0.078 +/- 0.003 ml X min-1 X kg-1 in near-term pregnant and nonpregnant sheep (P greater than 0.5). Lymph and plasma protein concentrations were unaltered in the pregnant compared with the nonpregnant animals. The thoracic duct lymph flow responses to three serial intravenous infusions of lactated Ringer solution were essentially the same in the pregnant and nonpregnant animals. Blood volume and vascular pressure changes during and after volume loading were essentially the same in both groups. In addition, terbutaline administration after volume loading caused no change in thoracic duct lymph flow rates. Thus the present study suggests that basal lymph flow rates, lymphatic function, and vascular as well as interstitial compliances are largely unaltered late in pregnancy in the sheep. In addition, beta-mimetic stimulation with terbutaline does not appear to suppress lymph flow rate.

Animals↗
PubMedDate not supplied

The effect on survival of thoracic duct ligation in experimental peritonitis.

BACKGROUND/AIMS: It has been shown that systemic bacteremia and endotoxemia in peritonitis is mainly related to lymphatic transport via the thoracic duct. This study was performed to investigate the effect on mortality of thoracic duct ligation in experimental peritonitis. METHODOLOGY: Thirty dogs were divided into three groups. Groups I, II, and III were control, unligated, and ligated thoracic duct peritonitis groups, respectively. Liver biopsy, blood and peritoneal fluid cultures were taken and survival time was established. RESULTS: Bacteria were determined in peritoneal fluid in all animals in groups II and III. Growing bacteria numbers in group III were two times higher than in group II. While bacterium was grown on blood cultures in all group II animals, growing was determined on blood cultures in only 2 animals in group III. Diffuse necrosis was determined in the liver of 2 animals who died within 72 hours in group II. Another 8 animals had minimal focal necrosis in their livers. Diffuse and progressive necrosis was determined in the liver of all animals in group III. The difference between liver necrosis in group II and group III was found to be statistically significant (p = 0.002). CONCLUSIONS: This experimental study demonstrates that thoracic duct ligation decreases bacteremia rates clearly but that mortality increases significantly.

Animals↗
PubMed1982

Thoracic duct lymph flow after pancreatitis: role in circulatory collapse.

We examined the effects of acute hemorrhagic pancreatitis on thoracic duct lymph flow and its protein concentration. Thoracic duct lymph flow increased and the protein concentration decreased. These changes in the lymph were associated with steady decreases in arterial pressure and cardiac output and increase in systemic vascular resistance. The results suggest that the increased lymph flow and decreased protein concentration were due to either an ultrafiltration causing a dilution of the lymph protein concentration or to the heterogeneous origin of thoracic duct lymph such that redistribution of blood flow to the essential beds (eg, kidneys) after arterial hypotension altered the lymph flow and its protein concentration. The increase in filtration and the absence of a compensatory "autotransfusion" during arterial hypotension may be a mechanism contributing to circulatory shock in acute pancreatitis.

Acute Disease↗