[Variations of internal drainage of the thoracic duct in cirrhosis of the liver]

The experience with 100 operations of the internal drainage of the thoracic lymphatic duct has shown technical difficulties of the procedure. In relation with concrete topographo-anatomical conditions the authors recommend to use reimplantation of the thoracic lymphatic duct and plastic operations on its orifice in addition to the lymphovenous anastomosis. Their technique is described.

[Roentgenomorphological substantiation of drainage of the thoracic duct in patients with liver cirrhosis]

On the basis of an analysis of rentgeno-morphological investigations of the thoracic lymphatic duct (TLD) in 115 patients with complications of hepatocirrhosis and 50 postmortem observations the authors make a conclusion that one of the main factors of the development of insufficiency of TLD in hepatocirrhosis is an excess of lymph resulting in congestion in the duct. It may be considered as a cause for drainage of the TLD in patients with hepatocirrhosis.

Two cases of primary isolated chylopericardium diagnosed by oral administration of 131I-triolein

Two cases of isolated chylopericardium, one idiopathic and the other secondary to the lymphangioma of the pericardium are reported here. In both cases, correct diagnosis was made by radionuclide imaging techniques. When imaging the cardiac pool using 99mTc-in vivo, labeled RBC, a large separation between the heart and surrounding organs was demonstrated; this suggested a presence of massive pericardial effusion. On pericardial imaging taken 24 hours after oral administration of 131I-triolein, a donut-like shape was clearly produced, situated in a gap between the separation, suggesting chylous effusion within the pericardial space. On operating, isolated chylopericardium was confirmed in both cases. To our knowledge, this is the first report of preoperative noninvasive diagnosis of chylopericardium in Japan.

[Topographo-anatomical substantiation of the choice of a rational approach to the terminal region of the thoracic duct]

With the aim to state the dependence between the projection of the place where the thoracic duct flows into and the superior part of its arc with the position of its external reference marks in order to choose a rational approach to the terminal part of the thoracic duct, an investigation on 50 embalmed human corpses has been performed by the method of graphic reconstruction and quantitative estimation of the planimetric images obtained. Certain regularities have been revealed in the interconnection of the terminal part of the thoracic duct with the elements of the cervical vascular-neural fasciculi, the sternocleidomastoid muscle, the clavicle, etc. There is a correlative dependence between the position of the external reference points and topographic peculiarities of the cervical part of the thoracic duct. A technique is suggested to calculate the projection zone of the cervical part of the thoracic duct in every case with the aim to choose a rational approach for the external drainage.

[Indications for lymphovenous anastomosis for ascites in cirrhosis of the liver]

The analysis of outcomes after the lymphovenous anastomosis on the neck of 52 patients with ascites due to cirrhosis of the liver are presented. In 16 cases ascites was arrested, in 15 patients there was a considerable elimination of ascites. In 14 cases the lympho-venous anastomosis resulted in stabilization of the ascitic syndrome, in 7 patients operation proved to be ineffective. In the nearest postoperative period 3 patients died. Two patients died of hemorrhage from the varicose-dilated veins of the esophagus an stomach, and one patients died of acute hepatic insufficiency. In the postoperative period and improvement of the functional state of the liver was noted. The authors propose to divide ascites into three stages which allowed to prognose results of the operation in the postoperative period and make the indications more definite.

Exteriorized lymphatico-venous shunts in conscious rats

Surgical techniques for establishing fistulas of the hepatic and intestinal lymphatics and thoracic duct in conscious rats are described. Continuous recirculation of the lymph into the vena cava inferior is performed by a device which measures flow velocity before returning the lymph to the animal through a permanent venous catheter. Clotting is prevented in all cases by constant infusion of an anticoagulant solution (containing heparin or Na-citrate) into the top of the indwelling catheter.

[Drainage of the thoracic lymphatic duct and lymphosorption in the combined treatment of obstruction of the bile ducts and liver failure]

Results of the application of the method of drainage of the lymphatic duct and lymphosorption in the complex treatment of 108 patients with obstruction of the bile eliminating ducts complicated by mechanical jaundice and hepatic insufficiency are described. Activated charcoal SKN, SUGS and SKT-6A were used for the sorption lymph detoxication. A pronounced detoxication effect of the sorption purification of the lymph with the activated charcoal and its reinfusion to the patient in the pre- and postoperative periods is shown.

Primary chylopericardium

In a 23-year-old man with massive chylous pericardial effusion, oral administration of Sudan III and radio-active 131iodine-labelled triolein revealed an abnormal communication between the lymphatic system and the pericardial sac. Despite partial pericardiectomy and resection of the thoracic duct, the fluid reaccumulated, and a postoperative lymphangiogram showed an obstructed left thoracic duct. Resection of this left thoracic duct resulted in full recovery. This is the first reported case of this disease with a duplicate thoracic duct. Careful attention must be paid to the possibility of this variation before and during surgery.