The Role of the Subclavian-Vein Thoracic Duct Junction in Experimental Ascites

Abstract Background Chyle leak after esophagectomy for carcinoma esophagus is a rare but life threatening condition with reported an incidence of 1–6%. Mortality rate of up to 50% have been reported. Management of chyle leak is controversial. We reviewed our experience with iatrogenic chylothorax after esophagectomy for carcinoma esophagus. Methods From 2003 to 2017, 560 patients underwent esophagectomy for cancer at our department of oncosurgery. Eight patients developed post operative chyle leak. Transthoracic or transabdominal ligation of duct was done in six patients with in first week. 100 ml of cream was given 30 min before induction to visualize the leak intraoperatively. We used 4–0 prolene pledgeted suture to ligate the duct. Results Six patients who underwent early ligation could be salvaged and the two who were managed conservatively succumbed. Oringer et al. pointed towards conservative treatment having little place in the management of chylothorax in nutritionally depleted patients. Hence, prompt ligation of thoracic duct decreases morbidity and mortality of chylothorax. Thus the role of early surgery needs to stressed. There is a wide difference of mortality rate of conservative management of 82% with respect to the mortality rate of surgery of 10–16%. Though no conclusion data are available regarding the indication and time point of surgical ligation of the thoracic duct, it is important not to procrastinate while the condition deteriorates to a level at which surgery would be detrimental.Administration of cream to the patient (through feeding jejunostomy) around half an hour before surgery makes identification of site of leak simpler.The importance of pledgeted sutures cannot be denied as the thoracic duct is paper thin and chyle contains no fibrin. Thus non pledgeted sutures will tear it further. Infact, stitching should not be done through the duct but into the surrounding tissue around the duct and should allow the pledgets to close the duct. Conclusion Disclosure All authors have declared no conflicts of interest.

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The role of lymphocytes in antibody formation I. Restoration of the haemolysin response in X -irradiated rats with lymphocytes from normal and immunologically tolerant donors

Proceedings of the Royal Society of London Series B Biological Sciences ◽

10.1098/rspb.1967.0063 ◽

1967 ◽

Vol 168 (1012) ◽

pp. 229-243 ◽

Cited By ~ 20

Keyword(s):

Thoracic Duct ◽

Immunological Tolerance ◽

Whole Body ◽

Sheep Erythrocytes ◽

X Irradiation ◽

Additional Support ◽

Immunological Deficiency ◽

Donor Lymphocytes

The haemolysin response of rats to an intravenous dose of 10 8 sheep erythrocytes was abolished by pretreatment with 500 rad of whole body X-irradiation. The immunological deficiency in such animals could be corrected equally well by either an injection of thoracic duct cells or by an inoculum consisting almost exclusively of small lymphocytes, obtained in each case from normal (non-immune) rats. The reversal of unresponsiveness depended upon the survival of the donor lymphocytes in the X-irradiated recipients and was not due to a non-specific restoration of the hosts’ own capacity to form antibody. Evidence for this conclusion came from experiments in which the X-irradiated recipients were themselves immunologically tolerant of sheep erythrocytes; additional support came from the inability of lymphocytes from immunologically tolerant donors to restore specific responsiveness in X-irradiated (non-tolerant) recipients. In a proportion of trials the immunological tolerance to sheep erythrocytes exhibited by thoracic duct lymphocytes from tolerant donors could be broken by incubating the cells in vitro before their injection into X-irradiated recipients. This points to the existence of individual tolerant cells in the tolerant populations of lymphocytes. Taken as a whole the experiments suggest strongly that small lymphocytes are the precursors of the cells which produce haemolysin against sheep erythrocytes in the rat.

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Corrections to: “Coodley EL, Matsumoto T: Case report: Thoracic duct-subclavian vein anastomosis in management of cirrhotic ascites. Am J Med Sci 279(3):163-167 (May/June) 1980.”

The American Journal of the Medical Sciences ◽

10.1097/00000441-198005000-00014 ◽

1980 ◽

Vol 279 (3) ◽

pp. 186

Keyword(s):

Case Report ◽

Thoracic Duct ◽

Subclavian Vein

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Role of anesthesiologists in early recognition of traumatic injury of the thoracic duct: case report

10.26226/morressier.58f5b032d462b80296c9d85a ◽

2017 ◽

Author(s):

Marjana Burmuzoska

Keyword(s):

Case Report ◽

Thoracic Duct ◽

Early Recognition ◽

Traumatic Injury

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THE ROLE OF LYMPHOCYTES IN THE SENSITIZATION OF RATS TO RENAL HOMOGRAFTS

Journal of Experimental Medicine ◽

10.1084/jem.122.2.347 ◽

1965 ◽

Vol 122 (2) ◽

pp. 347-360 ◽

Cited By ~ 78

Author(s):

S. Strober ◽

J. L. Gowans

Keyword(s):

Lymph Nodes ◽

Thoracic Duct ◽

Femoral Vein ◽

F1 Hybrid ◽

Duct Cells ◽

Degree Of Sensitization ◽

Spleen And Lymph Nodes

In order to study the role of blood-borne small lymphocytes in the sensitization of rats to renal homografts 2 techniques for the perfusion of isolated rat kidneys were employed: (a) the in vitro perfusion of kidneys with thoracic duct cells suspended in either an artificial medium or in blood; the perfusates were then injected into rats syngeneic with the lymphocyte donors; (b) the in vivo perfusion of kidneys with blood issuing from the femoral artery and returning to the femoral vein of living rats. The degree of sensitization conferred on the recipients by the perfusates was assessed by applying a skin homograft from the kidney donor and scoring the epithelial necrosis at 6 days. The in vitro experiments indicated that parental strain thoracic duct cells, which had passed through an F1 hybrid kidney could confer upon a parental rat sensitivity to an F1 skin graft. Several perfusions with radioactively labelled lymphocytes showed that the injected cells migrated to the lymph nodes and spleen of the recipients Labelled large pyroninophilic cells were occasionally seen in the spleen and lymph nodes of recipients, and it was suggested that these had arisen from the injected cells. Although the in vitro perfusions with blood indicated that renal homografts might sensitize their hosts within 1 hour, the in vivo perfusions suggested that about 5 to 12 hours were required. The more rapid sensitization in vitro was possibly due to the more frequent opportunity for contact between lymphocytes and kidney vascular endothelium which was afforded by the conditions in vitro.

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