Chylothorax: report of a case complicating ductus ligation through a median sternotomy, and review

An unusual case of chylothorax is described in a 4-year-old child after repair of a ventricular septal defect and ligation of a patent ductus arteriosus through a median sternotomy. Left chylothorax developed after a latent period of six days and was treated initially with continuous drainage and parenteral supplementation of proteins and lipids. Operative intervention with oversewing of the site of the leak in the anterior mediastinum proved necessary after three weeks. The anatomical variations of the thoracic duct are outlined to explain the occurrence of chylothorax after diverse intrathoracic operations. The physiological effects of a thoracic duct fistula and various aspects of management are reviewed.

Review lecture. Bayliss-Starling Memorial Lecture 1976. Lymph formation by secretion or filtration?

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Plasma enzyme levels in the anaesthetised dog during drainage of thoracic duct lymph

The effect of continuous removal of thoracic duct lymph on plasma activities of creatine phosphokinase (PCK), glutamic-oxaloacetic transaminase (PAST); and lactic dehydrogenase (PLDH), uas examined in pentobarbital-anaesthetised dogs over a 5.5-hour period. PCK and PAST declined relative to levels in control dogs while PLDH was unaltered. Lymph/plasma (L/P) ratios for AST and CPK were greater, and for LDH less, than the L/P ratio for total protein. It was concluded that PCK, and to some extent PAST, are normally maintained by introduction of enzyme, escaping from the intracellular compartment, into the circulating blood via the lymphatic system. PLDH and PAST appear to be maintained principally by introduction of enzyme directly from the intracellular to the plasma compartment.

Technic of chronic thoracic duct "side fistula" for immunologic evaluation of patients with cancer

A technic suitable for long-term study of the human thoracic duct circulation under physiological conditions is described. The results and observations obtained in ten patients studied for three to twenty-one days are presented.

[The contractile and electrical activity of the smooth muscles of the major lymph vessels]

In rats, catecholamines were found to increase the rate of the muscles spontaneous rhythmic contractions while the alpha- and beta-blocking agents suppressed them. The spontaneous contractions were blocked in the uncalunm medium. Rhythmic electrical stimulation evoked contracture-like responses the uncalunm of which depended on the strength, frequency, and duration of the stimulation. In spontaneoulsy active preparations, single electrical stimuli evoked contractions according to the "all or nothing" rule. The membrane potential magnitude varied within the limits of 25-37 mV, and action potentials were related to the contractions. The data obtained suggest that the functional unit of conduction of spontaneous or evoked excitation waves is represented by a group of smooth muscle cells within a single lymphangion.

Concentration and transport of different sugars in the lymph of the thoracic duct and in blood of the portal vein in dogs after enteral and parenteral administration

The uptake and distribution of glucose, galactose, fructose and inulin in dogs was investigated in the lymph of the thoracic duct and in different blood vessels after enteral and parenteral administration. Whereas inulin could be detected neither in the lymph nor in portal venous blood after enteral administration, all other sugars were found in different concentrations in blood and lymph. Although the concentration of different sugars in the lymph after enteral and parenteral application can be compared to that in serum, the amount of sugars transported via the lymphatics is so small that it can be neglected.

The velocity of lymph flow in the canine thoracic duct

1. The velocity and pattern of movement of lymph in the thoracic duct of anaesthetized and conscious dogs has been studied by observing the movement of droplets of ultrafluid lipiodol in the duct.2. The velocity of flow when anaesthetized varied from 0.1-2.0 cm/sec, to 5.0 cm/sec when conscious.3. The pattern of flow was affected by respiration and the cardiac cycle. Most movement occurred at the end of inspiration.4. The duct of five autopsy preparations was perfused with saline to assess the volume and velocity of flow produced by the level of pressure gradients previously observed in the duct. These studies show that the small gradients (2-5 mmHg) observed during life are more than sufficient to produce the normal volume and velocity of flow measured. The mean resistance of the duct was 0.5 mmHg/ml. min.