Characteristics of thoracic duct lymph in multiple organ dysfunction syndrome
| Autor: | Melchor Alvarez-Mon, F. Javier Fernandez-Sánchez, Alberto Tejedor, Javier Granell, Miguel Sánchez-García, Antonio Martín-Duce, Alfredo Prieto |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Male
medicine.medical_specialty Pathology Necrosis medicine.medical_treatment Multiple Organ Failure Thoracic duct Thoracic Duct Blood plasma medicine Humans business.industry Organ dysfunction Middle Aged medicine.disease Surgery Cytokine medicine.anatomical_structure Lymphatic system Female Lymph medicine.symptom business Multiple organ dysfunction syndrome |
| Zdroj: | Archives of surgery (Chicago, Ill. : 1960). 132(1) |
| ISSN: | 0004-0010 |
| Popis: | Objective: To investigate the presence of endotoxin, bacteria, and potential humoral and cellular mediators in thoracic duct lymph and peripheral blood in patients with severe refractory multiple organ dysfunction. Design: Convenience sample. Setting: General intensive care unit of a university hospital. Patients: Two men and 2 women were studied after a mean of 7.25 days (range, 6-9 days) of multiple organ dysfunction syndrome. The primary injury was thoracic in 1 patient and abdominal in 3 patients. Intervention: The thoracic duct was cannulated with a 7F catheter and samples of lymph and peripheral blood were obtained. Main Outcome Measures: Simultaneous lymph and serum levels of lipopolysaccharide, tumor necrosis factor α, interleukin-1β, and interleukin-6, and activation markers on T lymphocytes. Results: Lipopolysaccharide and cytokine levels were low in lymph and serum, except for a mean lymph-to-serum ratio of 53.4 for interleukin-1β. There was phenotypical evidence of intense polyclonal T-lymphocyte activation in both lymph and peripheral blood with increased lymph-to-peripheral blood ratios. Increased percentages in lymph of CD45RA+CD45RO+ lymphocytes were observed. In 1 patient, Proteus mirabilis grew simultaneously in lymph, pancreatic necrosis fluid, and a central venous catheter tip. All simultaneous blood cultures were negative. Conclusions: Our results provide evidence of the participation of the gut-associated lymphatic tissue in the pathogenesis of the multiple organ dysfunction syndrome, suggesting that T-cell activation and cytokine production occur at the gut level. Future studies are needed to confirm and extend our findings. Arch Surg. 1997;132:13-18 |
| Databáze: | OpenAIRE |
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