Thoracic Duct Fistula Research Articles

Metabolism of cerebroside in the intestinal tract of the rat

[3- 3H]Sphingosin- or [9,10- 3H 2]palmitoyl-labeled glucosyl-ceramide and [6- 3H]-galactosyl-labeled galactosyl-ceramide were fed to intact rats and to rats with a thoracic duct fistula. The data obtained from analyses of the thoracic duct lymph, of the small intestine and intestinal contents and of the feces indicated that to a large extent the substrates were absorbed and metabolized in the small intestine. 20–42% of the fatty acid portion was recovered in lymph triglycerides and lecithin, and labeled hexose was transported in a water-soluble form by the portal vein. The low recoveries of radioactivity in lymph lipids in experiments with [3- 3H]sphingosin-labeled glucosyl-ceramide and earlier data indicated that 55–60% the sphingosin portion was absorbed and metabolized to fatty acids in the mucosal cells. The remainder appeared in the feces as intact cerebroside and ceramide. Rat pancreatic juice and human intestinal contents did not hydrolyze glucosyl-ceramide. The analyses of the small intestine and intestinal contents 2–3 h after feeding the substrates also indicated that the hydrolysis of dietary cerebroside occurs in the mucosal cells after absorption. An active biosynthesis of cerebroside, in which dietary sphingosin bases take part, occurs in the mucosal cells.

Experimental pancreatitis. Treatment by colloid replacement and adrenocorticosteroid therapy combined with thoracic duct drainage.

In a previous study we have shown that acute experimental pancreatitis is associated with an increase in the volume and enzyme concentration of lymph collected from thoracic duct fistulas. 1 Following the initial high flow rate, there was a precipitous reduction of lymph volume which coincided with appearance of hematochylia. Duprez, in a discussion we had with him in 1965, stated that he infused this sanguineous lymph into the pancreatic ducts of normal dogs and found that recipient animals developed severe pancreatitis. When no replacement therapy was given, dogs with thoracic duct fistulas all died early in the course of acute pancreatitis, while some of the animals given parenteral colloid survived. Thus, thoracic duct drainage appeared to offer a method for removal of potentially toxic fluid from the inflamed pancreas and prevent its entry into the general circulation. Severe pancreatitis causes an acute depletion of circulating blood and plasma volume.

A modified Bollman's technique for cannulation of the rat's thoracic duct: lymph flow standardization.

SummaryA modification of Bollman's technique for the cannulation of the abdominal thoracic duct in the rat has been reported. A preparation is described in which three fistulas are made in the same animal, the thoracic duct fistula and two fistulas in the upper part of the common bile duct. One of these catheters in the bile duct drains pure bile and the other is used to infuse isotonic saline at a constant rate into the duodenum. Data are presented which demonstrate that lymph-flow rate is quantitatively related to the infusion rate of isotonic saline. The modified Bollman's technique can be used for assessment of small differences in the rate of absorption of fat-soluble materials.

Absorption and lymphatic transport of cholesterol in the rat

Rats with thoracic duct fistulae were fed triolein and triolein containing various amounts of labeled cholesterol. The analysis of the lymph lipids gave the following results. In the fasting state the cholesterol transported via the thoracic duct was 0.87 micromole/hr. Feeding 800 micromoles of triolein gave a maximum rate of transport of cholesterol of 1.65 micromoles/hr. Addition of cholesterol to the triolein further increased the cholesterol transport to a maximal rate of almost 5 micromoles/hr when 50 micromoles of cholesterol were fed per 800 micromoles of triolein. The exogenous fraction of the cholesterol transported increased linearly with increasing cholesterol load, constituting at the highest dose almost 90% of the total cholesterol transported. An almost constant fraction (about 0.4) of the dietary cholesterol was recovered in the thoracic duct lymph in 24 hr irrespective of the dose fed, from a trace up to 100 micromoles in 800 micromoles of triolein. Cholesterol absorption has the characteristics of a passive diffusion process.

Five years' experience in renal transplantation with immunosuppressive drugs: survival, function, complications, and the role of lymphocyte depletion by thoracic duct fistula.

Murray, Joseph E. M.D.†; Wilson, Richard E. M.D.††; Tilney, Nicholas L. M.D.†††; Merrill, John P. M.D.††††; Cooper, William C. M.D.*; Birtch, Alan G. M.D.**; Carpenter, Charles B. M.D.***; Hager, Edward B. M.D.****; Dammin, Gustave J. M.D.***†; Harrison, J. Hartwell M.D.*†† Author Information

Chronic thoracic duct fistula: operative technic and physiologic effects in man

Chronic thoracic duct fistula: operative technic and physiologic effects in man

The intestinal absorption of glycerol trioctadecenyl ether

1. 1. Glycerol tri- cis-9-octadecenyl ether is used as a model substance for triolein in studying the intestinal absorption of non-hydrolysed triglycerides. 2. 2. [ 14C]Glycerol trioctadecenyl ether was fed to rats provided with a thoracic duct fistula and to non-operated rats. The radioactivity of the lipids of lymph, some organs and the whole carcass was determined. 3. 3. The very poor absorption of [ 14C]glycerol trioctadecenyl ether confirms the suggestion of others that the absorption of intact triglycerides must be very poor.

Treatment of Renal Allograft Rejection in Dogs

A previous study in this laboratory suggested that an external thoracic duct fistula could prolong the survival of canine renal allografts. 1 The mechanism for this apparent interference with the transplant immunity might be the depletion in the population of immunologically competent lymphocytes resulting from uninterrupted drainage of the thoracic duct. Gowans has shown that lymphopenia can be brought about by prolonged drainage of the thoracic duct in rats. 2 Others have reported similar findings in dogs. 3 Although the role of the lymphocytes in transplant immunity has not been ascertained, it seems only reasonable to implicate them because of their consistent involvement in the antigen-antibody reaction. Their well documented presence at the site of the tissue graft rejection marks them teleologically as an intermediary in this phenomenon, specifically as carriers of antibodies. For this reason immunosuppressive drugs have been tested according to their ability to produce lymphopenia. Even some

Metabolism of Lysolecithin by Rat Small Intestine

Summary Lysolecithin, the chief phospholipid in the lumen of the human jejunum, is also present in the contents of the rat small intestine. In this study, lysolecithin (labeled in fatty acid and in glycerol moieties) was infused intraduodenally into rats with thoracic duct fistulas to determine whether it is metabolized in the small bowel. During the following 24 hr, lysolecithin was completely absorbed, although less than half of the absorbed radioactivity was recovered in the lymph. Labeled water-soluble metabolites were found in portal venous blood. Part of the hydrolysis of fed lysolecithin occurred within the small intestinal lumen. Most of the lymph radioactivity was present in triglyceride and lecithin. The labeling of both these lipids was maximal within 0 to 2 hr after an infusion. About 3 to 14% of the fed lysolecithin may have been directly acylated to lymph lecithin. Approximately 70% of radioactive lymph lecithin was associated with chylomicrons and very low density lipoproteins. Furthermore, the incorporation of radioactivity into lymph lecithin was enhanced by increasing the amount of triolein in the intraduodenal infusion. These data indicate that luminal lysolecithin and its metabolites may be precursors of lymph lecithin during the absorption of dietary triglyceride.

The effect of bile on vitamin A absorption in the rat.

SummaryTwo groups of 11 Sprague-Dawley rats were fed vitamin A-14C in corn oil, both had thoracic duct fistulas, one group in addition had bile fistulas. There was a poor total recovery of vitamin from the animal tissue and gastrointestinal contents of both groups of animals and this was less in the bile fistula animals where less vitamin A was absorbed. This is most likely explained by the degradation of lipid soluble vitamin A into water soluble metabolites by bacteria in the large intestine. In the control animals more radioactivity was recovered from the intestinal lymph than the liver and other tissues, suggesting that most of the absorbed vitamin A was transported by the lymphatic route. In the absence of bile, however, when the absorption of vitamin A was grossly impaired, there was a tendency for more to be recovered from the liver than the lymph, suggesting that an alternative route of transport of the absorbed vitamin was used.

Migration of lymphocytes and thymocytes in the rat. I. The route of migration from blood to spleen and lymph nodes.

The cellular deficit in rats thymectomized at birth is primarily one of circulating small lymphocytes. The lymphocyte deficiency is similar to that induced in adult rats by chronic drainage from a thoracic duct fistula. In both cases, the animals show a reduction of small lymphocytes in peripheral blood, thoracic duct lymph, and in circumscribed areas of lymphoid tissue. The lympocyte deficiency in lymphoid tissue can be corrected by an intravenous injection of thoracic duct lymphocytes. The evidence suggests that the deficiency is corrected by small lymphocytes. Small lymphocytes pass from blood to lymphoid tissue along a route which includes the marginal sinus in splenic white pulp and postcapillary venules in the cortex of lymph nodes and Peyer's patches. Neither the ability of small lymphocytes to colonize lymphoid tissue nor their ability to traverse postcapillary venules are thymus-dependent phenomena. However, movement of small lymphocytes across postcapillary venules appears to modify the structure of endothelium. Intravenously injected small thymocytes migrate to lymphoid tissue in smaller numbers than small lymphocytes inoculated by the same route. The few thymocytes which localize in lymphoid tissue follow the same pathway as circulating small lymphocytes.

Chronic thoracic duct fistula: operative technic and physiologic effects in man.

Chronic thoracic duct fistula: operative technic and physiologic effects in man.

Studies on the intestinal absorption of a medium chain fat (trioctanoin) in normal and pancreatectomized dogs.

1. The absorption of intraduodenally administered carboxyl-14C glyceryl trioctanoate (RATO) was studied in 20 normal dogs, in 9 after pancreatectomy and in 4 after pancreatectomy and thoracic duct fistula. 2. The rate of absorption was estimated by continuously monitoring the expired14CO2 after RATO administration. In 20 control animals, an average of 26.7% ± 5.2% of the administered dose of radioactivity was recovered as14CO2 in 150 min. Following pancreatectomy,14CO2 recovery rates diminished significantly in all dogs. 3. The route of absorption was investigated by thin-layer and gas lipid chromatography of lymph collected from 4 of the pancreatectomized dogs after RATO and unlabeled trioctanoin administration. No 8-carbon fatty acids or glycerides were detected in the lymph by these techniques. 4. These results indicate that trioctanoin absorption is retarded in the absence of pancreatic lipase, but that fractional amounts of this lipid are absorbed via the portal route. Probable mechanisms for trioctanoin absorption in pancreatectomized dogs are discussed.

The role of lymphocytes in antibody formation. II. The influence of lymphocyte migration on the initiation of antibody formation in the isolated, perfused spleen.

The aim of these studies was to examine the possible immunological significance of the process of lymphocyte recirculation. For this purpose a technique for perfusing the isolated spleen of the rat was developed. Antigen (sheep erythrocytes) was added to the perfusate and, after 3 to 6 h periods of perfusion, the spleens were cut into fragments and implanted into the peritoneal cavities of X-irradiated syngeneic recipients to determine the magnitude of the haemolysin response. The lymphocyte concentration in the blood perfusing the spleen was varied within wide limits to determine whether a migration of lymphocytes through the spleen influenced its ability to respond to antigenic stimulation. Normal spleens perfused for 3 h with blood containing a normal concentration of lymphocytes gave substantial haemolysin titres in the recipients when sheep erythrocytes had been added initially to the perfusate. Spleens depleted of lymphocytesin vivoby either X-irradiation or chronic drainage from a thoracic duct fistula produced very low titres after perfusion with lymphocyte-free blood and antigen, but their responses were restored by adding lymphocytes to the perfusate. The antibody response of normal spleens was significantly depressed following perfusion for 3 h with lymphocyte-free blood to which antigen had been added initially. However, normal responses were obtained in this experiment if the addition of antigen to the perfusate was delayed for 5 h and perfusion then continued for one further hour. The delay allowed lymphocytes to migrate from the normal spleens into the perfusate and to build up the concentration in the initially lymphocyte-free blood to normal levels. The conclusion drawn from this paradoxical finding was that the magnitude of the haemolysin response depended uponthe concentration of lymphocytes in the perfusate at the time of antigen additionand not upon the total number of lymphocytes in the spleen. The rate of migration of small lymphocytes from the blood into the spleen was found to be directly proportional to the concentration of lymphocytes in the perfusate. The most acceptable explanation of all the data is that the magnitude of the haemolysin response is proportional to the concentration of lymphocytes in a limited compartment of the splenic lymphoid tissue into which lymphocytes have recently migrated from the blood. This compartment is probably located in the central area of the periarteriolar lymphocyte sheath.

Effect of thoracic duct fistula on canine renal homografts

Short-term thoracic duct fistula drainage with the addition of low-dose azathioprine therapy appeared to prolong canine renal homograft survival in several animals while short-term thoracic duct drainage alone did not prolong canine renal homograft survival. One animal is a long-term survivor on low-dose azathioprine therapy alone.

Anaesthetic Problems in Renal Transplantation

Patho-physiological problems related to anaesthesia, and in the immediate postoperative period in 21 patients who underwent renal transplantation at Serafimerlasarettet has been examplified and discussed.Major anaesthetics were not only given in connection with renal transplantation, but also for a great number of other operations.The most important complications in this series were related to dehydration and a low blood volume. This can be explained by an excessive withdrawel of fluid during hemodialysis and uncompensated fluid loss via the thoracic duct fistula. Low arterial oxygen tension was seen rather often, pre-and postoperatively.

Thoracic duct laceration: Closure under conservative management based on lymphangiography evaluation

Summary Experimental and clinical evidence is reported which justifies the conservative treatment of thoracic duct lacerations in patients in whom complete severance of the duct has not occurred. Lymphangiography of the lower extremity has proved reliable in demonstrating the extent of the injury of the thoracic duct and the adequacy of the collateral circulation. A case of chylothorax is reported in which conservative treatment based upon lymphangiography permitted the sealing of a traumatic (operative) thoracic duct fistula without surgical intervention.

Studies of a Method of Inducing Specific Lymphopenia in Dogs

The lymphocyte plays a significant role in the development of transplant immunity. Many methods have been used to produce a lymphopenia in animals in order to study the effect of lymphocyte depletion on the homograft response. These methods include total and subtotal body radiation and use of antimetabolites, corticosteroids, antilymphocyte sera, and thoracic-duct fistulae. These methods all produce detrimental general alterations in the host, in addition to the desired lymphopenia. Cronkite¹and his group have produced temporary lymphocyte depletion in calves by extracorporeal radiation of circulating blood. Thomas et al²have shown a similar response to extracorporeal blood radiation in leukemic humans. The marked radiosensitivity of lymphocytes in vitro has been demonstrated in studies by Schrek and Stefani.³β-emitting isotopes have been inserted into arterial prostheses⁴and into the right atrium of the heart⁵in attempts to produce experimental lymphocyte depletion. In this study, an intraarterial

EXTERNAL THORACIC DUCT FISTULA AND CANINE RENAL HOMOGRAFT.

It is well recognized that lymphocytes and lymphopoietic tissue, as a whole, play an important role in antibody formation to antigenic stimuli whether bacterial or transplantation in origin. 1 Methods known to suppress the graft rejection such as irradiation, steroids, and antimetabolites all decrease the leukocyte count, especially the lymphocyte population of the body. Lymphocytes presumably formed in different tissues of the body (lymph nodes, spleen, thymus) are brought to the general circulation at least in part via the thoracic duct and accessory lymphatic channels. Kay commented that presumably, lymphoid stem cells which are constantly poured from the thoracic duct into the blood stream are the active agents (for immune response). 2 Thus, creation of a thoracic duct fistula, thereby preventing the lymphocytes from gaining entrance to the venous circulation, could be utilized to decrease the lymphocyte population of the blood and result in decreasing or preventing their immunologic response.

1963. Prolonged survival of skin homografts in dogs with thoracic duct fistulas

1963. Prolonged survival of skin homografts in dogs with thoracic duct fistulas