Indications, techniques, and clinical outcomes of thoracic duct interventions in patients: a forgotten literature?

Wang, Hsiang-Wei; Escott, Alistair B.J.; Phang, Kian Liun; Petrov, Maxim S.; Phillips, Anthony R. J.; Windsor, John A.

doi:10.1016/j.jss.2016.04.050

Cited by 19 publications

(12 citation statements)

References 86 publications

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“…Since 1987, we have introduced an original access for sampling the thoracic duct lymph which works with no failure. Moreover, the ongoing studies in thoracic duct cannulation and lymphatic fl uid collection in animals [23] and humans [24] are performed over last years, thus allowing to take lymph samples and to perform lymph drainage, e.g., for in vivo T cell exhaustion in human patients [25].…”

Section: Discussionmentioning

confidence: 99%

Mitotic activity of thoracic duct cells in rabbits correlates with age and total lymphocyte numbers

Kuznetsov¹,

Fakhradiyev²,

Almabayev³

et al. 2019

CTT

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Th e aim of this study was to assess correlations between rabbit mitotic thoracic duct (TD) cells, rabbit's age, and TD lymphocytes. Th e experiments were carried out in 27 intact male Chinchilla rabbits weighing 120-2.500 g (at the age of 1.5 weeks to 36 weeks). TD lymph specimens were drawn from the cisterna chyli of anaesthetised rabbits. Th e numbers of mitotic cells from TD per 100 cells, and absolute numbers of TD lymphocytes were counted in the Giemsa-stained cell smears by means of routine light microscope methods, and routine hemocytometric counts. We have performed statistical evaluation of the data by Microsoft Offi ce Excel 2007 soft ware. Correlations between the TD mitotic cell ratio, lymphocyte numbers, and animal age was estimated by Pearson's criteria. Th e mitotic cell number in TD lymph decreased from the age of 1.5 weeks (infant animals) to 36 weeks (young adult rabbits). Maximal mitotic activity was found in rabbits at 1.5 week of age (23.0 ± 0.14, P=0.02) in comparison with appropriate indexes in rabbits at 4.5 and 13.5 weeks of age (11.0 ± 0.14*, P<0.05 and 6.3 ± 0.08**, P<0.001 respectively). In contrast to mitotic cell amounts, the absolute TD lymphocyte numbers were increased in older rabbits. Th e minimal TD; lymphocyte number in the 1.5-week old rabbits aged was 2.8 ± 0.03, being signifi cantly diff erent (P=0.04) against the lymphocyte numbers in rabbits aged 36 week (5.9 ± 0.05, P=0.03). Hence, strong negative correlations were found between the TD mitotic activity and age, mitotic cells and total TD lymphocyte numbers, as well as positive correlation between the TD lymphocytes and age (respectively, R 2 =0.7, R 2 =0.96 and R 2 =0.8) in immature rabbits (age from 1.5 weeks to 36 weeks). To our knowledge, these interrelations for TD lymph cells in the very young animals were detected for the fi rst time. We conclude that the age-related correlation between mitotic activity and total lymphocyte amounts in TD allows presume optimal combinations of cytokines and other bioactive factors that regulate mitotic activity of thoracic duct cells with advancing age.

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Section: Discussionmentioning

confidence: 99%

Mitotic activity of thoracic duct cells in rabbits correlates with age and total lymphocyte numbers

Kuznetsov¹,

Fakhradiyev²,

Almabayev³

et al. 2019

CTT

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show abstract

“…This intervention requires judicious fluid and electrolyte replacement and can be complicated by infection and lymph leak. Another reason for the lack of interest in thoracic duct interventions is likely to be because the results from the studies in a wide range of acute diseases have been largely equivocal, most likely reflecting inferior and under‐powered clinical trial design . On the basis of this literature and the experimental evidence, it has been considered that equipoise still exists and that further studies are warranted.…”

Section: External Drainage Of Thoracic Duct Lymphmentioning

confidence: 99%

“…It is hypothesized that diverting toxic gut‐lymph by external drainage of thoracic duct lymph during the first week will likely yield clinical benefits in severe and critical AP. Of possible concern with this approach is the risk of immunodepletion, but this does not occur until after 3–4 weeks of thoracic duct lymph drainage . It is now important to evaluate external drainage of thoracic duct lymph in the context of a randomized clinical trial to determine whether it can reduce the systemic inflammatory response, mitigate multiple organ dysfunctions, and improve clinical outcome in patients with severe and critical AP.…”

Section: External Drainage Of Thoracic Duct Lymphmentioning

confidence: 99%

“…This is not a new idea, as there are over 70 publications relating to therapeutic thoracic duct interventions, but curiously none in the last 15 years. 50 The reasons for this drop-off include the invasiveness of thoracic duct interventions, which entails a neck incision under general anesthetic for thoracic duct cannulation. This intervention requires judicious fluid and electrolyte replacement and can be complicated by infection and lymph leak.…”

Section: Persistent Organ Failurementioning

confidence: 99%

“…Another reason for the lack of interest in thoracic duct interventions is likely to be because the results from the studies in a wide range of acute diseases have been largely equivocal, most likely reflecting inferior and under-powered clinical trial design. 50 On the basis of this literature and the experimental evidence, it has been considered that equipoise still exists and that further studies are warranted. It is hypothesized that diverting toxic gut-lymph by external drainage of thoracic duct lymph during the first week will likely yield clinical benefits in severe and critical AP.…”

Section: Persistent Organ Failurementioning

confidence: 99%

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Novel strategies for the treatment of acute pancreatitis based on the determinants of severity

Windsor

Escott

Brown

et al. 2017

J of Gastro and Hepatol

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Acute pancreatitis (AP) is a common disease for which a specific treatment remains elusive. The key determinants of the outcome from AP are persistent organ failure and infected pancreatic necrosis. The prevention and treatment of these determinants provides a framework for the development of specific treatment strategies. The gut-lymph concept provides a common mechanism for systemic inflammation and organ dysfunction. Acute and critical illness, including AP, is associated with intestinal ischemia and drastic changes in the composition of gut lymph, which bypasses the liver to drain into the systemic circulation immediately proximal to the major organ systems which fail. The external diversion of gut lymph and the targeting of treatments to counter the toxic elements in gut lymph offers novel approaches to the prevention and treatment of persistent organ failure. Infected pancreatic necrosis is increasingly treated with less invasive techniques, the mainstay of which is drainage, both endoscopic and percutaneous. Further improvements will occur with the strategies to accelerate liquefaction and through a fundamental redesign of drains, both of which will increase drainage efficacy. The determinants of severity and outcome in patients admitted with AP provide the basis for innovative treatment strategies. The priorities are to translate the gut-lymph concept to clinical practice and to improve the design and active use of drains for infected complications of AP.

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The Gut-Lymph Model Gives New Treatment Strategies for Organ Failure

2022

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Organ Failure Remains an Unmet Global ChallengeEach year, more than 20 million people with organ failure (OF) are admitted to intensive care units around the world. 1 With a 30% mortality rate, it remains the leading cause of death in intensive care units. OF is preceded by 2 syndromes, the systemic inflammatory response (SIRS) and multiple organ dysfunction (MODS), which can progress throughout days or weeks to single or multiple OF and death. 2 This patterned sequence is the feared sequelae of many inciting acute and critical diseases (ACDs), which include severe sepsis, hemorrhage, trauma, burns, acute pancreatitis, and most recently, SARS-CoV-2 infection. 3 The heart, lung, and kidney organ systems are most at risk of failing. The failure to translate multiple putative drug treatments to arrest OF is well documented. 2 Current treatment standards for SIRS/MODS/OF are generic, including fluid resuscitation, inotropes, mechanical ventilation, and kidney replacement therapy. While optimizing physiology is a worthy goal, 3 there is an urgent need for a new paradigm to introduce effective treatment strategies that go beyond organ support to target specific disease mechanisms to mitigate SIRS/ MODS/OF and the risk of death.

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Indications, techniques, and clinical outcomes of thoracic duct interventions in patients: a forgotten literature?

Cited by 19 publications

References 86 publications

Mitotic activity of thoracic duct cells in rabbits correlates with age and total lymphocyte numbers

Mitotic activity of thoracic duct cells in rabbits correlates with age and total lymphocyte numbers

Novel strategies for the treatment of acute pancreatitis based on the determinants of severity

The Gut-Lymph Model Gives New Treatment Strategies for Organ Failure

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