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The authors describe a new technique for the microsurgical cannulation of the thoracic duct. A small silastic tube is utilized which can be joined to a subcutaneously implanted one-way flow, CSF, Ommaya-type reservoir. Extended drainage is avoided. No deletion or alteration of major venous channels occurs. Lymph collection is accomplished by tapping the subcutaneous reservoir with a small-bore needle.
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Fluid and protein flux responses in the left thoracic duct and vasculature were measured in pentobarbital-anesthetized, nephrectomized, adult dogs before and after four successive intravascular saline infusions of 2% of body weight each. We found three main characteristics of the thoracic lymph flow and protein flux responses to the intravenous saline: 1) lymph flow reached a peak and then decreased by approximately 40% after each infusion; 2) the maximum lymph flow occurred 5-7 min after terminating each infusion; and 3) the lymph-to-plasma protein concentration ratio fell more than may be expected from the distribution of the infused saline. We were unable to explain these experimental data with a simple two-compartment mathematical model representing the vascular and interstitial spaces. To adequately explain the data, the model had to be expanded to four compartments representing a vascular compartment, two interstitial compartments each with different capillary protein permeabilities, and a lymphatic compartment. We also found it necessary to include interstitial stress relaxation, a nonlinear function curve for lymph flow versus interstitial fluid pressure, and a complaint lymphatic system.
We present a 17-year-old Caucasian male with congenital pulmonary lymphangiectasia and an absent thoracic duct. This patient is unique as he did not present with the disorder until age 9.5 years. Since his initial presentation he has had recurrent chylothoraces and has been treated symptomatically. We discuss the possible implications of his disorder as well as some of the limited treatment that is available.
Immunoreactive insulin, like inulin, quickly equilibrates with interstitial fluid, as evidenced by recovery in thoracic duct lymph in man. Insulin-like activity not accounted for by immunoreactive insulin behaves as a large protein and is confined to the vascular compartment.
Chylothorax is a rare but potentially serious complication of cardiac operations. We report here a 72-year-old man who underwent replacement of a descending aneurysm with a synthetic graft for dissecting aneurysm (IIIa). A persistent postoperative chylothorax developed, which necessitated continuous drainage, despite conservative treatment more than 12 days. Thoracoscopic high-frequency ultrasonic coagulation of the thoracic duct without clipping finally stopped chyle production. This method may be useful from the standpoint of minimal access, rapid recovery, less pain, and a shorter operation.
Insulin concentration in the peripheral blood and the thoracic duct lymph from male rabbits with CCl4-induced liver cirrhosis was measured using a radioimmunoassay technique. Although insulin concentration in the lymph was lower in the cirrhotic animals than in the control ones, the hourly transport of the hormone by the lymphatic vessel of the cirrhotic animals markedly increased in company with the higher flow rate of the lymph.
The results of reimplantation of the thoracic duct carried out in 22 patients suffering from cirrhotic ascites refractory to medical therapy are presented and analysed. 3-year survival was 54,5% with disappearance of the ascites in 83% of cases. Other conditions being equal, these results are superior to those obtained with porto-systemic shunt.
Reference is made to the anatomy and variant courses of the thoracic duct, as well as to possibilities of surgical and conservative therapy. A chylous fistula developed in a 53-year old man after his left shoulder girdle had been amputated because of a recurrent low grade chondrosarcoma. Nineteen liters of chyle were excreted over a 5-week period. It was possible to achieve a spontaneous occlusion of the fistula by means of repeated punctures, compression bandages, and a low-fat diet.
A patient with lower extremity lymphedema studied with lymphoscintigraphy is described. Radionuclide lymphography demonstrated several thoracic duct malformations that were confirmed by contrast lymphography.
Natural killer (NK) cell activity of thoracic duct lymphocytes (TDL) was examined in normal mice and in mice treated with polyinosinic-polycytidylic acid (poly(I:C) and interferon (IFN). TDL from mice treated with phosphate-buffered saline (PBS) expressed little or no NK cell activity against YAC-1 target cells at effector-to-target ratios of up to 200:1, even after in vitro treatment with murine L-cell IFN. In contrast, TDL from poly(I:C)- or IFN-treated mice expressed significant NK activity, which correlated with the significantly higher NK activity of splenocytes from these mice compared to the NK activity of splenocytes from PBS-treated mice. These data indicate that although TDL from normal mice express no detectable NK cell activity, NK cell activity can be induced in TDL by in vivo treatment with poly(I:C) or IFN.
In these experiments we characterize the protective antibodies in immune serum that interact synergistically with immune thoracic duct lymphocytes (TDL) to induce rapid expulsion (RE) of Trichinella spiralis in adult rats. Antibodies with both reaginic and nonreaginic activity mediated RE upon passive transfer to adult rats that had been adoptively transfused with immune TDL 7 days earlier. In serum collected 28 days after a primary infection, the most important antibody was homocytotropic IgE. Native IgE produced by active infection was isolated from 28-day immune serum by salt precipitation and/or by sequential affinity chromatography. The murine mAb A2 and B5 (anti-rat IgE) were conjugated separately to Sepharose 4B affinity columns for affinity separations. IgE was shown to be pure by gel electrophoresis and Western blots and its m.w. was estimated at approximately 190,000. As little as 183 micrograms of purified IgE could induce RE after passive transfer to adult rats. The IgE was shown to be functional by PCA activity, Ag-binding on Western blots, and skin sensitization; the latter could be blocked by pretreatment with 1R162, a rat myeloma IgE. Monoclonal IgG of any isotype transferred in amounts up to 35 mg/rat could not transfer RE to rats previously transfused with TDL cells. Immune serum collected 3 mo after the primary infection contained insufficient IgE to transfer RE, but complex non-IgE fractions were protective. The data thus demonstrate that IgE is a functional Ig in the rat capable of mediating the rejection of challenge nematode infections of the gut in the absence of other specific Ig. Secondly, other Ig may also play a role, in particular, several weeks after the primary infection when specific IgE levels in serum have declined.
OBJECTIVE: To report use of combined cisterna chyli ablation (CCA) and thoracic duct ligation (TDL) for treatment of spontaneously occurring chylothorax in dogs. STUDY DESIGN: Retrospective study. ANIMALS: Eight dogs with chylothorax. METHODS: TDL was performed through a right caudal intercostal thoracotomy and CCA through a left flank paracostal approach or ventral median celiotomy. Long-term outcome (range, 2-48 months; median, 11.5 months) was evaluated by telephone communication with owners. RESULTS: Seven dogs were free of clinical signs related to chylothorax at last follow-up (range, 4-48 months; median, 15.5 months). One dog was euthanatized 2 months after surgery because of lack of improvement. No major complications occurred from CCA. CONCLUSION: CCA and TDL resolved chylothorax in most dogs (88%). CLINICAL RELEVANCE: CCA combined with TDL may improve the outcome of chylothorax in dogs.
In acute experiments on 31 dogs, dilatation of the thoracic lymphatic duct on moderate (5--8 V) stimulation of afferents of the sciatic nerve and i. v. administration of noradrenaline (3--5 mcg/kg) was shown to be due to specific effects of excitation of the duct alpha-adrenoreceptors mainly. The alpha-adrenoreceptors seem to be represented in the thoracic duct in a much greater amount that the beta-adrenoreceptors. Stimulation of both types of the duct's adrenoreceptors leads to an increase in its capacity.
Two unique cathepsin D-type proteases apparently present only in rat thoracic duct lymphocytes and in rat lymphoid tissues are described. One, termed H enzyme, has an apparent molecular weight of similar to95,000; the other, termed L enzyme, has an apparent molecular weight of similar to45,000, in common with that of most cathepsins D from other tissues and species. Both enzymes differ from cathepsin D, however, by a considerably greater sensitivity to inhibition by pepstatin and by a smaller degree of inhibition by an antiserum which inhibits rat liver cathepsin D. H enzyme is converted to L enzyme by treatment with beta-mercaptoethanol; the relationship between the two enzymes remains unknown. H and L enzyme have been detected in rat lymphoid tissues and in mouse spleen, but they are not present in other rat tissues (liver, kidney, adrenals), rabbit tissues, calf thymus, bovine spleen, or human tonsils. As measured on acid-denatured bovine hemoglobin as substrate, both enzymes have pH activity curves identical with that of rat liver cathepsin D, with optimal activity at pH 3.6. Activity on human serum albumin is much less and also shows an optimum at pH 3.6; hence, neither enzyme has the properties of cathepsin E. Thiol-reactive inhibitiors have no effect on the activity of H and L enzyme; thus they do not belong to the B group of cathepsins. Additional information, discussed in this paper, leads us to conclude that partially purified H and L enzymes are cathepsin D-type proteases.
Proliferative responses to M locus (Mls) determinants were investigated in vivo by injecting T cell-containing populations intravenously into irradiated H2-identical, Mls-incompatible mice. Responses were studied 1-6 days later by measuring levels of radioactivity in the spleen and lymph nodes of the recipient 45 min after intravenous injection of tritiated thymidine. High responses were observed against Mlsa and Mlsd determinants, i.e. determinants which give strong proliferative responses in vitro. With injection of thoracic duct lymphocytes (TDL), lymph node or thymus cells, the responses, both in the spleen and the lymph nodes, reached a peak at day 3-4 and then fell sharply. This was in marked contrast to the stimulation observed with H-2-incompatible mice where, with TDL or lymph node cells (though not with thymus cells), responses were low at day 3-4 but reached high levels at day 6. Significant responses were also observed against Mlsb and Mlsc determinants, i.e. determinants which stimulate poorly in vitro. The kinetics of this response differed from that against Mlsa or Mlsd determinants in in that proliferation was very low at day 4 but high at day 6. No evidence was found that the responses observed reflected "back-stimulation" by the host. Since congenic resistant strains were not used, the possibility that the stimulation observed was in fact due to minor transplantation antigens rather than Mls determinants could not be excluded. Large numbers of blast cells appeared in thoracic duct lymph of mice sustaining responses to Mlsa or Mlsd determinants. Nearly all of these cells had recently synthesized DNA and entered the lymph after day 3.
Veiled cells (VC), are not normally present in the mouse thoracic duct lymph (TDL). However, TDL from mesenteric lymph-adenectomized (MLNX) mice contained about 1% VC. After exposure to whole body irradiation of 350-500 rads., or 800 rads., 1.5% and 7% VC respectively were present in the TDL. These cells could be enriched further by density gradient centrifugation on 14.5% metrizamide, about 60-70% VC being present in the cells from the interface. The VC had long sweeping cytoplasmic extensions or veils which were continuously extended and retracted when the VC were incubated at 37 degrees C. Electron microscopy revealed that the VC had a lobulated nucleus, and that the cytoplasm contained many mitochondria, a well-developed Golgi zone, rough endoplasmic reticulum and a few lysosomes. The cells were strongly Ia positive and over 70% showed adenosine triphosphatase activity. These features of the mouse VC from the TDL are similar to those described for VC isolated from different sources in other experimental animals and from the afferent lymph in man.