An intermittent method for drainage of the thoracic lymphatic duct in chronic lympholeukemia

The authors presented the results of treatment of patients with chronic lymphocytic leukemia complicated by cytolysis with the help of an intermittent method of external thoracic lymphatic duct drainage (ETLDD). The method was as follows. A temporary external lymphovenous shunt was created between a siliconized catheter placed surgically in the terminal part of the thoracic lymphatic duct and a subclavicular catheter using a sterile rubber adapter from a drop glass. The use of the method in 7 patients with chronic lymphocytic leukemia has shown that this therapeutic approach results in a considerable decrease in the level of peripheral blood leukocytes and substantial improvement of the production of red blood cells and platelets.     

CELL TO CELL INTERACTION IN THE IMMUNE RESPONSE : I. HEMOLYSIN-FORMING CELLS IN NEONATALLY THYMECTOMIZED MICE RECONSTITUTED WITH THYMUS OR THORACIC DUCT LYMPHOCYTES

An injection of viable thymus or thoracic duct lymphocytes was absolutely essential to enable a normal or near-normal 19S liemolysin-forming cell response in the spleens of neonatally thymectomized mice challenged with sheep erythrocytes. Syngeneic thymus lymphocytes were as effective as thoracic duct lymphocytes in this system and allogeneic or semiallogeneic cells could also reconstitute their hosts. No significant elevation of the response was achieved by giving either bone marrow cells, irradiated thymus or thoracic duct cells, thymus extracts or yeast. Spleen cells from reconstituted mice were exposed to anti-H2 sera directed against either the donor of the thymus or thoracic duct cells, or against the neonatally thymectomized host. Only isoantisera directed against the host could significantly reduce the number of hemolysin-forming cells present in the spleen cell suspensions. It is concluded that these antibody-forming cells are derived, not from the inoculated thymus or thoracic duct lymphocytes, but from the host. Thoracic duct cells from donors specifically immunologically tolerant of sheep erythrocytes had a markedly reduced restorative capacity in neonatally thymectomized recipients challenged with sheep erythrocytes. These results have suggested that there are cell types, in thymus or thoracic duct lymph, with capacities to react specifically with antigen and to induce the differentiation, to antibody-forming cells, of hemolysin-forming cell precursors derived from a separate cell line present in the neonatally thymectomized hosts.     

Albumin to ascites: demonstration of a direct pathway bypassing the systemic circulation

The transport of plasma albumin and newly made albumin into ascitic fluid was studied in eight patients with cirrhosis and ascites. The thoracic duct was cannulated in two patients and lymph collected over a period of 2 hr. Simultaneously albumin-(131)I and carbonate-(14)C were injected intravenously. The albumin-(131)I measured the transfer of plasma albumin into ascites and into thoracic duct lymph. The carbonate-(14)C, by labeling newly formed albumin, permitted the estimation of the transfer of newly formed albumin into plasma, ascites, and lymph.If the newly synthesized albumin entering ascites and thoracic duct lymph is delivered initially into the plasma, then the ratios of the albumin-(14)C and -(131)I in ascites and lymph compared with the content of albumin-(14)C and -(131)I in plasma would be identical. However, if some newly formed albumin is delivered directly into ascites or lymph, the ratio for albumin-(14)C would be higher than that for albumin-(131)I in lymph or ascites.The ratios of both labeled albumins found in ascites or lymph are expressed as per cent of the total plasma pool. In the eight patients studied 4.2-11.7% of the albumin-(14)C in plasma was found in ascites in 2 hr whereas only 0.4-2.2% of plasma albumin-(131)I entered in this same period. In the two patients studied during thoracic duct lymph drainage 6.1 and 13.5% of newly made albumin-(14)C appeared in lymph in 2 hr whereas only 2.8 and 3.8% of plasma albumin-(131)I was found in the lymph.In cirrhosis with ascites some newly formed albumin entered ascites and thoracic duct lymph by a direct pathway from the liver bypassing the systemic circulation.     

预防性胸导管结扎与乳糜胸

目的探讨食管手术中预防性胸导管结扎术在预防乳糜胸方面的效果。方法通过对66例食管手术中采取预防性胸导管结扎术的病人,其术后胸腔引流液的分析,了解术后乳糜胸发生的情况。结果64例病人中,术后第1天乳糜定性试验阳性45例,64例病人术后第2～4天引流量少于50ml,拔出胸腔闭式引流管。2例病人引流量较多,于手术后第6天引流量减少至50ml,拔出胸腔闭式引流管。结论在食管手术中,预防性胸导管结扎手术能有效地降低乳糜胸所致的严重并发症,提高乳糜胸的治愈率,降低二次手术的几率。     

原发性乳糜性心包积液淋巴回流障碍的直接淋巴管造影和MSCT表现

目的 探讨直接淋巴管造影(DLG)和MSCT诊断乳糜性心包积液淋巴回流障碍的价值.方法 回顾性分析9例乳糜性心包积液的DLG及造影后MSCT资料;7例伴乳糜胸,其中1例伴乳糜痰;8例接受胸导管梗阻解除术.结果 9例DLG和MSCT均表现为胸导管出口梗阻;5例合并心包区反流,其中4例通过扩张的支气管纵隔干反流.8例接受胸导管出口梗阻解除术,术后病情好转.结论 DLG和MSCT可显示原发性乳糜性心包积液胸导管及属支异常,并能显示心包腔与淋巴系统的异常交通,后者可能是治疗的关键.     

医用生物胶黏合封堵乳糜瘘12例（英文）

背景：针对口腔颌面部肿瘤扩大切除术同时行颈部淋巴结清扫术中并发乳糜瘘的问题。很多专家学者有不同的处理方式,单纯的手术结扎、强负压引流或者是单纯的肌肉组织填塞或者以上方法的组合,在预后及治疗效果上存在或多或少的缺陷。目的：评价颈部淋巴清扫术中采用医用生物胶黏合周围自体肌肉组织封堵胸导管瘘口以预防术后乳糜瘘的疗效。方法：12例口腔癌患者在颈淋巴清扫术中发现并确诊为乳糜瘘后,立即行瘘口缝扎并应用医用生物胶黏合周围自体肌肉组织封堵瘘口。结果与结论：10例患者术中经此方法治疗后术后未出现乳糜瘘及其他严重并发症;2例患者经此法治疗无效后,二次手术探查行瘘口缝扎及应用医用生物胶黏合封堵治疗后有效。术后随访所有12例患者3个月均未发现有乳糜瘘复发,亦未出现局部刺激反应及变态反应。结果表明术中医用生物胶黏合封堵胸导管瘘口是预防颈淋巴结清扫术后乳糜瘘理想、安全的治疗方法。     

医用生物胶黏合封堵乳糜瘘12例

背景:针对口腔颌面部肿瘤扩大切除术同时行颈部淋巴结清扫术中并发乳糜瘘的问题.很多专家学者有不同的处理方式,单纯的手术结扎、强负压引流或者是单纯的肌肉组织填塞或者以上方法的组合,在预后及治疗效果上存在或多或少的缺陷.目的:评价颈部淋巴清扫术中采用医用生物胶黏合周围自体肌肉组织封堵胸导管瘘口以预防术后乳糜瘘的疗效.方法:12例口腔癌患者在颈淋巴清扫术中发现并确诊为乳糜瘘后,立即行瘘口缝扎并应用医用生物胶黏合周围自体肌肉组织封堵瘘口.结果与结论:10例患者术中经此方法治疗后术后未出现乳糜瘘及其他严重并发症;2例患者经此法治疗无效后,二次手术探查行瘘口缝扎及应用医用生物胶黏合封堵治疗后有效.术后随访所有12例患者3个月均未发现有乳糜瘘复发,亦未出现局部刺激反应及变态反应.结果表明术中医用生物胶黏合封堵胸导管瘘口是预防颈淋巴结清扫术后乳糜瘘理想、安全的治疗方法.     

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.     

肝移植术后管腔重建相关并发症的介入治疗

目的：探讨介入技术治疗肝移植术后血管和胆管管腔重建相关性并发症的可行性。方法：肝移植术后共有16例相关并发症患者接受介入治疗,其中肝动脉狭窄4例,肝动脉血栓形成2例,门静脉狭窄并血栓形成1例,胆管吻合口狭窄9例。肝动脉狭窄行球囊扩张（PTA）或内支架治疗,肝动脉血栓形成行导管接触性溶栓治疗,门静脉狭窄并血栓形成行溶栓、支架置入及分流道栓塞治疗,胆管吻合口狭窄行PTA或支架置入治疗。结果：16例患者均获技术成功,治疗均有效,有效率为100%。4例肝动脉狭窄1例单纯PTA有效,3例行支架置入术后有效,血流恢复。2例肝动脉血栓形成术后血栓消失,血流恢复通畅。1例门静脉并发症治疗后血流恢复,灌注增加。9例胆管吻合口狭窄2例行PTA有效,7例置入支架后有效。随访0.5～17个月无复发,5例死于原发病进展或系统并发症,与该并发症或介入治疗无关。结论：介入技术成功率高、并发症少,是治疗肝移植管腔重建相关并发症的有效方法。     

CELL TO CELL INTERACTION IN THE IMMUNE RESPONSE : II. THE SOURCE OF HEMOLYSIN-FORMING CELLS IN IRRADIATED MICE GIVEN BONE MARROW AND THYMUS OR THORACIC DUCT LYMPHOCYTES

The number of discrete hemolytic foci and of hemolysin-forming cells arising in the spleens of heavily irradiated mice given sheep erythrocytes and either syngeneic thymus or bone marrow was not significantly greater than that detected in controls given antigen alone. Thoracic duct cells injected with sheep erythrocytes significantly increased the number of hemolytic foci and 10 million cells gave rise to over 1000 hemolysin-forming cells per spleen. A synergistic effect was observed when syngeneic thoracic duct cells were mixed with syngeneic marrow cells: the number of hemolysin-forming cells produced in this case was far greater than could be accounted for by summating the activities of either cell population given alone. The number of hemolytic foci produced by the mixed population was not however greater than that produced by an equivalent number of thoracic duct cells given without bone marrow. Thymus cells given together with syngeneic bone marrow enabled irradiated mice to produce hemolysin-forming cells but were much less effective than the same number of thoracic duct cells. Likewise syngeneic thymus cells were not as effective as thoracic duct cells in enabling thymectomized irradiated bone marrow-protected hosts to produce hemolysin-forming cells in response to sheep erythrocytes. Irradiated recipients of semiallogeneic thoracic duct cells produced hemolysin-forming cells of donor-type as shown by the use of anti-H2 sera. The identity of the hemolysin-forming cells in the spleens of irradiated mice receiving a mixed inoculum of semiallogeneic thoracic duct cells and syngeneic marrow was not determined because no synergistic effect was obtained in these recipients in contrast to the results in the syngeneic situation. Thymectomized irradiated mice protected with bone marrow for a period of 2 wk and injected with semiallogeneic thoracic duct cells together with sheep erythrocytes did however produce a far greater number of hemolysin-forming cells than irradiated mice receiving the same number of thoracic duct cells without bone marrow. Anti-H2 sera revealed that the antibody-forming cells arising in the spleens of these thymectomized irradiated hosts were derived, not from the injected thoracic duct cells, but from bone marrow. It is concluded that thoracic duct lymph contains a mixture of cell types: some are hemolysin-forming cell precursors and others are antigen-reactive cells which can interact with antigen and initiate the differentiation of hemolysin-forming cell precursors to antibody-forming cells. Bone marrow contains only precursors of hemolysin-forming cells and thymus contains only antigen-reactive cells but in a proportion that is far less than in thoracic duct lymph.     

Initiation of antibody responses by different classes of lymphocytes. I. Types of thoracic duct lymphocytes involved in primary antibody responses of rats

Thoracic duct cells and spleen cells were tested for their ability to restore the primary antibody response of X-irradiated rats to bovine serum albumin (BSA), sheep red blood cells (SRBC), horse spleen femtin (HSF), and Salmonella typhi flagella. Spleen cells were at least as efficient as thoracic duct cells in restoring the response to BSA, HSF, and Salmonella typhi flagella. In further experiments thoracic duct cells lacking large dividing lymphocytes were tested for their ability to restore the primary response. Large lymphocytes were eliminated by the in vitro incubation of thoracic duct cells for 24 hr at 37°C or by treatment of thoracic duct cell donors with the mitotic inhibitor vinblastine sulfate 24 hr prior to cannulation of the thoracic duct. Experiments with SRBC show that incubated cells and cells from vinblastine-treated donors are as efficient as normal cells in restoring the primary antibody response. On the other hand, experiments with HSF and Salmonella typhi flagella show that incubated cells and cells from vinblastine-treated donors are about five times less efficient than normal cells in restoring the response. Normal thoracic duct cells were more efficient than incubated cells but less efficient than cells from vinblastine-treated donors in restoring the early response to BSA. The experimental findings indicate that the classes of thoracic duct lymphocytes which initiate the primary antibody response to SRBC differ from the classes which initiate the response to HSF and Salmonella typhi flagella, or BSA.     

THE PATHOGENESIS OF ICTERUS

These experiments indicate that, in obstructive jaundice, the bile which escapes from the liver is absorbed by the hepatic capillaries and carried by the blood to the kidneys. The presence of a thoracic duct fistula influences in no way the development of icterus after total obstruction of the common bile duct. Bile pigments, sufficient to give a Salkowski test, may or may not appear in the lymph of the thoracic duct in such experiments, their appearance possibly depending upon the rapidity of bile secretion and the amount of lymph flow. Chronic icterus developing in an animal with a thoracic duct fistula gives an interesting distribution of bile pigments in the body fluids. The lymph and pericardial fluid contain the same amount, which is much less than the content of bile pigment in the blood serum and urine. It seems clear that in both acute and chronic obstructive jaundice the lymphatic apparatus takes no essential or active part in the absorption of bile pigments from the liver. At best, the lymphatic system is a secondary factor in the mechanism of jaundice.     

DRAINAGE OF THE THORACIC DUCT IN EXPERIMENTAL PERITONITIS

1. When care is taken to produce a peritonitis, which in itself is almost uniformly fatal, drainage of the thoracic duct in dogs has no favorable influence upon the course or result of the peritonitis. 2. Under the conditions of my experiments the thoracic duct did not serve in any important way as a drainage tract for bacterial contamination of the peritoneal cavity.     

改良中心静脉导管胸腔闭式引流治疗癌性胸水的临床应用

目的：比较改良中心静脉导管胸腔闭式引流后腔内注药和常规胸穿抽液后腔内注药两种方式治疗癌性胸水的疗效。方法：将78例癌性胸水患者随机分成两组,分别进行中心静脉导管闭式引流和常规胸腔穿刺,并均于胸腔内注入力尔凡。结果：引流腔内注药组46例中完全缓解22例,部分缓解19例,无效和进展5例。抽液腔内注药组32例中完全缓解11例,部分缓解7例,无效和进展14例。结论：应用改良中心静脉导管胸腔闭式引流癌性胸水操作安全、简便,能最大限度地排净胸水,对控制癌性胸水有较好的疗效。     

Initiation of antibody responses by different classes of lymphocytes. V. Fundamental changes in the physiological characteristics of virgin thymus-independent ("B") lymphocytes and "B" memory cells

The life-span and migratory characteristics of rat thoracic duct cells which initiate the adoptive primary and secondary antibody response to diphtheria toxoid (DT) and horse spleen ferritin (HSF) were investigated. The experimental results show that thoracic duct lymphocytes from normal (unimmunized) donors are able to restore the adoptive response of irradiated hosts to HSF. Thoracic duct cells passaged through an intermediate host (intravenous injection and subsequent collection in the thoracic duct lymph) showed a marked reduction in their restorative action as compared with unpassaged cells. In addition, the restorative action of cells from donors treated with thymidine-³H for 48 hr before cannulation of the thoracic duct was markedly decreased. This indicates that a population of lymphocytes involved in the adoptive primary response is unable to recirculate from the blood to the lymph and is turning over rapidly (short lived). The nonrecirculating, short-lived lymphocytes are proably "B" cells, since a combination of spleen cells from neonatally thymectomized rats and passaged or thymidine-³H-treated cells restores a vigorous response to HSF. On the other hand, passaged or thymidine-³H-treated thoracic duct cells from donors immunized to DT or HSF are able to restore a vigorous adoptive secondary antibody response. Experiments with the hapten-protein conjugate, DNP-DT, show that the majority of both helper ("T") and precursor ("B") cells are able to recirculate and are slowly turning over (long lived). The findings suggest that T lymphocytes involved in both the primary and secondary antibody response are recirculating, long-lived cells. However, B lymphocytes involved in the primary response are nonrecirculating, short-lived cells ("B₁" cells) which undergo a fundamental physiological change to recirculating, long-lived cells ("B₂" cells) involved in the secondary antibody response.     

电视胸腔镜手术在胸部损伤中的合理应用

目的：探讨电视胸腔镜手术（VATS）在胸部损伤诊断、治疗中的应用价值。方法：选择2001年7月—2010年4月胸部损伤患者34例,应用电视胸腔镜进行探查、诊断,同时进行肺修补、心包修补、膈肌修补、止血等手术治疗。结果：34例经VATS探查以明确脏器损伤情况,肺裂伤10例,右心室穿透伤1例,左下肺静脉撕裂伤1例,胸内异物残留3例,2例可疑乳糜胸皆在VATS联合辅助小切口下完成。合并腹部伤5例行VATS及腹腔镜下修补术。VATS探查及治疗时间45~140 min。术后住院时间5~10d。34例术后半年随访,复查胸片或胸部CT均无胸腔积液、异物、肺不张及其他异常发现。结论：VATS的合理应用能使胸部损伤患者诊断更加及时、准确,在不延误治疗的情况下可使手术创伤尽可能达到最小。     

联合介入治疗主动脉夹层并冠心病的安全性及临床疗效

目的评价覆膜支架联合PCI介入治疗Stanford B型主动脉夹层并冠心病的安全性及临床疗效。方法2002年1月至2008年6月完成的20例先后行覆膜支架联合PCI治疗Stanford B型主动脉夹层并冠心病患者,观察住院及随防期间覆膜支架内漏、冠状动脉支架血栓形成、心力衰竭、死亡、截瘫、肾功能情况。结果手术成功率100％,术后即刻造影16例近端破口完全封堵,4例少量残余内漏,无截瘫、肾功能不全、心力衰竭、心绞痛、亚急性血栓形成、死亡,随防6个月至2年,复查腹主动脉增强CT示夹层支架封闭良好。结论覆膜支架联合PCI介入治疗Stanford B型主动脉夹层并冠心病安全、有效。     

临床护理路径对食管癌患者术后康复及并发症的影响

目的探讨临床护理路径对食管癌患者术后康复效果及并发症发生率的影响。方法选取我院2018年4月至2019年4月收治的食管癌手术患者100例,随机等分为对照组与试验组,对照组采用常规护理,试验组采用临床路径护理,比较两组术后康复效果及并发症发生率。结果试验组术后首次肛门排气、胸管拔除、首次排便及住院时间明显优于对照组(P<0.05);试验组下肢深静脉血栓、肺部感染、吻合口瘘、吞咽障碍发生率明显低于对照组(P<0.05)。结论临床护理路径在食管癌手术患者中的应用,能促进术后康复,可减少并发症的发生率。     

Estimation of lymphatic conductance. A model based on protein-kinetic studies and haemodynamic measurements in patients with cirrhosis of the liver and in pigs

A model of lymphatic conductivity (i.e. flow rate per unit pressure difference = conductance) based on protein-kinetic and haemodynamic measurements is described. The model is applied to data from patients with cirrhosis and from pigs with different haemodynamic abnormalities in the hepatosplanchnic system. In cirrhotic patients without ascites the estimated thoracic duct conductance (gthd) was three times higher than normal whereas this value was close to normal in patients with tense ascites. The estimated conductance of the right lymphatic duct was ten times below that of the thoracic duct in patients with ascites. In pigs gthd was similar to that in normal humans and no change was seen during acute congestion of the liver. In ascitic pigs gthd was low. The estimated conductance of the liver blood-lymph barrier was similar in normal humans and pigs, but decreased in cirrhosis and was thus compatible with increased sinusoidal wall tightening and fibrosis in the interstitial space of the liver. The model presented supports the so-called 'lymph-imbalance' theory of ascites formation according to which a relatively insufficient lymph drainage is important in the pathogenesis of hepatic ascites.     

Combined Studies of Complement Receptor and Surface Immunoglobulin-Bearing Cells and Sheep Erythrocyte Rosette-Forming Cells in Normal and Leukemic Human Lymphocytes

Human lymphocytes from normal peripheral blood, thymus, spleen, thoracic duct, and peripheral lymphocytes from patients with chronic lymphatic leukemia were studied for complement receptor sites (CRL), surface immunoglobulin (SIg), and for the ability to form rosettes with sheep erythrocytes (TRFC). The two B cell markers (CRL and SIg) were found to be in overlapping, but not totally identical populations, whereas cells that were able to form rosettes were found in a totally unrelated population of lymphocytes; TRFC is therefore probably a reliable marker for T cells. In peripheral blood 24% of lymphocytes had SIg, but only half of these were also CRL. Almost all of the non-SIg peripheral blood lymphocytes were TRFC. In the spleen and thoracic duct only a few lymphocytes were observed that had SIg and were not CRL. On the other hand, in two of three spleens studied 10-20% of cells were CRL that did not have SIg. In the thoracic duct all non-CRL that did not have SIg. In the thoracic duct all non-CRL, non-SIg cells were TRFC. In chronic lymphatic leukemia three findings were made: (a) The presence or absence of CRL was independent of the presence or absence of SIg so that in individuals whose cells were non-SIg. CRL were usually plentiful. (b) Leukemic cells were essentially negative for TRFC. (c) Leukemic cells reacted poorly with human C3 compared to mouse C3, EACmo detecting up to 20-fold more CRL than EAChu. This latter finding was in sharp contrast to normal CRL that reacted somewhat preferentially with EAChu. These data suggest that altered surface Ig receptors and complement receptors are present in chronic lymphatic leukemic cells. Since the cells obtained from all leukemic patients tested in this study had either the complement receptor or surface immunoglobulin in a high percentage of their cells and were essentially negative for TRFC, it is strongly suggested that leukemic lymphocytes are of B cell origin. The finding of lymphocytes with only one of the two B cell markers suggests that these markers are not uniformly present on all B cells and that depending on the source, one or the other may be deficient.