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PubMed1975

[Changes in thoracic duct lymph in allotransplantation of the liver in dogs].

In 8 dogs simultaneous orthotopic liver allotransplantation and external drainage were performed. During and after surgery lymph and blood plasma were examined. The lymph flow increased considerably, due to blood stasis in the gut. Concentrations of total protein and potassium decreased in blood and in lymph. Levels of glucose and lactate in lymph were significantly elevated, compared with plasma levels. Examination of thoracic duct lymph improves the possibilities to assess the blood stasis in the splanchnic system and the corresponding metabolic cell alterations. It is presumed that external drainage of thoracic duct might improve the course immediately after liver transplantation.

Animals↗
PubMed1984

Transvascular fluid shift and thoracic duct lymph: analysis of lymph formation in the rat.

To analyze the effect of changes in interstitial fluid on lymph production, intravascular infusions of saline were given to splenectomized rats under pentobarbital anesthesia at 3 different rates (2, 3, and 4 ml/100 g of body weight) over 10 min. Change of blood volume was continuously monitored and, simultaneously, thoracic duct lymph was collected during and after the infusion. Equilibrium was attained approximately 40 min after the infusion; regardless of the infusion rate, 10% of the infused volume was incorporated into the vascular space and 90% was filtered into the extravascular space. Thus, the amount of transvascular fluid shift showed a linear relationship with the infused volume. However, the drainage from thoracic duct lymph amounted to 5.9%, 11.4%, and 17.8% of the infused saline volume when given at the rate of 2, 3, and 4 ml/100 g, respectively. The relation of lymph flow and infused volume could be regarded as a nonlinear system. By means of a simulation study, this relation was found to be attributed to the nonlinearity of conductance for fluid movement from tissue to lymph duct, which was only one sixth of that determined for the capillary membrane. The drainage of lymph protein following the infusion was only about 50% of that expected from the interstitial protein concentration in even distribution of the infused saline. These characteristics of interstitial fluid space play an important role in absorbing water and, hence, buffering changes in circulating blood volume after volume loading.

Animals↗
PubMed1987

Vascular endothelial markers of the human thoracic duct and lacteal.

Factor VIII-related antigen (F8) and Ulex europaeus lectin (UEL) are accepted markers for human blood vessel endothelium. However, disagreement exists as to whether lymphatic vessels stain for F8, and accordingly this study was undertaken to address this issue. Moreover, another vascular endothelial marker, angiotensin converting enzyme (ACE) was also examined in lymphatics. Segments of human thoracic duct and portions of small bowel containing lacteals with post-mortem intervals of less than 15 hours, were removed at autopsy and fixed in B5 or formalin. The specimens were processed routinely and sections examined by indirect immunohistochemical techniques for F8 (Dako Corp.), ACE and for UEL (EY Lab). F8, UEL, and ACE positivity was uniformly found in thoracic ducts and lacteals; however, the staining intensity was less in lymphatic vessels with F8 and UEL than with comparable arteries or veins. ACE staining intensity, on the other hand, was similar in blood vessels and lymphatics. Both formalin and B5 fixation preserved antigenicity; however, background staining was greater with B5 fixation whereas tissue staining was slightly more intense with formalin fixation.

Antigens↗
PubMed1976

Selective elimination of the delayed-type hypersensitivity response by extracorporeal thoracic duct filtration.

Calves were sensitized to tuberculin and histoplasmin. The delayed-type hypersensitivity skin response to these antigens was produced and the diameter of induration measured. Repeated skin tests prior to filtration demonstrated that the amount of induration produced by these skin tests was closely reproducible. Histoplasmin or tuberculin-coated columns were then introduced into a closed circuit extracorporeal thoracic duct circulation. A significant (P is less than 0.01) reduction or ablation of the delayed-type hypersensitivity response was obtained to the antigen used to coat the column. In contrast, no significant reduction occurred in the skin test response to the other antigen. Repeated skin tests to both antigens after the cessation of filtration showed a gradual rise toward prefiltration levels in the skin test to the filtered antigen. The results of these experiments indicate that a selective population of T lymphocytes can be removed from an in vivo system. The removal of these cells can selectively reduce a delayed-type hypersensitivity skin test response to a particular antigen. These results are consistent with the hypothesis that a type of in vivo selective immunosuppression can be produced by antigen-coated columns when they are placed in an extracorporeal thoracic duct lymph circulation system.

Absorption↗
PubMed1980

Lymphangiographic demonstration of thoracic duct cyst.

We describe the first reported case of a cyst of the thoracic duct which was diagnosed prior to surgery by bipedal lymphangiographic studies. The differential diagnosis of posterior mediastinal masses should include this pathologic entity.

Adult↗
PubMed1999

[Thoracic duct cyst].

Patient aged 48 with the cyst of the cervical part of thoracic duct was described. Cyst appeared as the result of inflammation. Histopathological examination excluded the cystic lymphangioma.

Cervical Vertebrae↗
PubMed1976

[Indirect lymphography of the retrosternal lymphatics and of the thoracic duct (author's transl)].

Successful demonstration of the retrosternal lymphatics and of the thoracic duct after infradiaphragmatic injection is reported, using a contrast medium developed by the author. The lymphatics opacify after 45 minutes. After fourteen days the substance can no longer be seen radiogically. Following some preliminary investigations, it is proposed to try the method in humans. The importance of the lymphatic pathways in medial carcinomas of the breast and in the movement of carcinoma cells from the peritoneal cavity and the liver is stressed.

Animals↗
PubMed1981

Renal transplantation after thoracic duct drainage.

Forty-seven patients treated by at least 28 days of thoracic duct drainage (TDD) before cadaveric renal transplant are compared with 63 patients treated with standard immunosuppression. The TDD patients were begun on half the dosage of steroids, and at 30 days were receiving approximately two-thirds the dose that the non-TDD patients received. Acute rejection occurred in 35% of the TDD group, as compared with 61% of the non-TDD group. Graft survival in the TDD patients was twice as good as the non-TDD patients at all time intervals. The patient survival rates were not significantly different between the two groups. TDD pretransplant favorably affects cadaveric renal allograft survival for at least five years.

Adult↗
PubMed1973

Cholesterol feeding alters the metabolism of thoracic-duct lymph lipoprotein cholesterol in rabbits but not in rats.

1. Labelled thoracic-duct lymph was collected from rats and rabbits after test meals containing [(14)C]cholesterol and [2-(3)H]glyceryl trioleate. 2. The metabolism of labelled cholesterol and triglyceride was studied in normally fed and cholesterol-fed rats and rabbits injected with radioactive lymph from the same species. 3. In normally fed animals of both species, 10min after intravenous administration, about 80% of lymph cholesteryl ester but only about 10% of triglyceride was recovered in the liver after clearance from the plasma. This distribution is consistent with participation of ;remnant' particles in the metabolism of dietary lymph particles. 4. The metabolism of cleared lymph lipoprotein constituents was unchanged in cholesterol-fed rats, but the recovery of cholesteryl ester in the livers of the cholesterol-fed rabbits was decreased to 30% of the cleared dose. 5. The low recovery in cholesterol-fed rabbits was accounted for mainly by increased hydrolysis of cholesteryl ester. 6. It is proposed that differences between rats and rabbits in metabolism of dietary cholesterol might be partly due to the observed enhancement of hydrolysis of lymph lipoprotein cholesteryl ester in rabbits.

Animals↗
PubMed1990

Effects of outflow pressure and vascular volume loading on thoracic duct lymph flow in adult sheep.

Studies have shown that lymph flow rate from several tissues depends on the pressure at the outflow end of the lymphatics. The left thoracic lymph duct is the largest lymphatic vessel and it transports a majority of the body's lymph. We varied outflow pressure for the left thoracic lymph duct independent of venous pressure in six unanesthetized, nonpregnant adult ewes with chronic lymphatic and venous catheters. When outflow pressure was negative, the thoracic duct lymph flow rate was independent of outflow pressure and averaged 0.040 +/- 0.004 (SE) ml.min-1.kg body wt-1. Lymph flow began to decrease with increasing outflow pressure only when outflow pressure was significantly greater than venous pressure. Above this breakpoint, lymph flow decreased linearly with outflow pressure and ceased at an outflow pressure of 25.6 +/- 4.2 mmHg. After vascular volume loading with lactated Ringer solution, steady-state thoracic duct lymph flow increased to 351 +/- 54% of control and was independent of outflow pressure when outflow pressure was negative. As outflow pressure was elevated, lymph flow began to decrease at the same breakpoint as before volume loading, and lymph flow ceased at the same outflow pressure as before volume loading. Thus this study shows that there is a plateau where thoracic duct lymph flow rate is independent of outflow pressure. In addition venous pressure under normal or volume-loaded conditions is not an impediment to thoracic duct lymph flow in unanesthetized sheep. Large increases in venous pressure are required to totally block thoracic duct lymph flow.

Animals↗
PubMed2006

Plastic bronchitis: is thoracic duct ligation a real surgical option?

Plastic bronchitis is an unusual clinical scenario of unknown cause and occurs in multiple clinical settings. The disease is characterized by the development of arborizing, thick, tenacious casts of the tracheobronchial tree that results in airway obstruction. Patients with congenital heart disease who have undergone a Fontan operation are at high risk for having this problem develop. Management of this distressing situation is difficult with only palliative options being available, such as repeated bronchoscopies, inhaled heparin, tissue plasminogen activator, inhaled bronchodilators, or azithromycin. The patients with Fontan circuits have a myriad of unique complications develop, such as atrial arrhythmias, recurrent pleural effusions, chylothoraces, protein-losing enteropathy, and plastic bronchitis. High intrathoracic lymphatic pressures with nondemonstrable lympho-bronchial fistulas were believed to be the cause for the development of these recurrent bronchial casts in plastic bronchitis. Faced with recurrent plastic bronchitis resistant to medical management in 2 Fontan patients with normal Fontan pressures on cardiac catheterization, we decided to explore a surgical solution by performing a thoracic duct ligation. This resulted in complete resolution of the formation of casts in both patients, who were discharged home and remain asymptomatic on continued follow-up. Thoracic duct ligation provides a surgical cure for plastic bronchitis by decreasing intrathoracic lymphatic pressure and flow.

Airway Obstruction↗
PubMed1977

Thoracic duct lymph in conscious dogs at rest and during changes of physical activity.

In conscious dogs with a thoracic duct-venous shunt, lymph flow (LF), protein concentration (LP), transported protein (LTP), albumin concentration (LA), globulin concentration (LG), albumin to globulin ratio (LAG), plasma disappearance rate of labelled albumin (k), plasma volume (PV) and intravascular protein pool (IVP) were studied at rest, during walking and muscle relaxation induced by guajacolglycerinether. At rest, LF approximated 50 mul/min-kg and LTP 1.55 mg/min-kg. LF and LTP correlated positively with the state of physical activity. LP was 54%, LA 67%, LG 43%, but LAG 156% of the plasma values; k was 0.00228. Relaxation reduced LF by 34%, LTP by 31%, LAG by 7% and the lymph concentration of i.m. applied labelled albumin by 54%. PV, IVP and k were not changed significantly. Walking enhanced LF by 100%, LTP by 50% and LAG by 25%. LP was decreased by 15%. PV, IVP and k were not changed significantly. Control data suggest a significant influence of anaesthesia on thoracic duct lymph flow, composition and protein transport. Spontaneous and experimental changes of thoracic duct lymph may be explained by changes of the activity of the "tissue pump". An extravascular fluid and protein pool would seem to be accumulated at rest and emptied during exercise.

Albumins↗
PubMed1993

Thoracic duct cyst of the mediastinum. Case report.

A mediastinal thoracic duct cyst was incidentally found in an asymptomatic 45-year-old man. The cyst, 6 cm in diameter, was soft and unilocular, with an extremely thin wall, and contained chyle. It was successfully excised.

Humans↗