| Characteristics of thoracic duct lymph in multiple organ dysfunction syndrome. | |
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MedLine Citation:
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PMID: 9006547 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 alpha, interleukin-1 beta, 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-1 beta. 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. |
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Authors:
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M Sánchez-García; A Prieto; A Tejedor; A Martin-Duce; F J Fernandez-Sánchez; J Granell; M Alvarez-Mon |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Archives of surgery (Chicago, Ill. : 1960) Volume: 132 ISSN: 0004-0010 ISO Abbreviation: Arch Surg Publication Date: 1997 Jan |
Date Detail:
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Created Date: 1997-02-24 Completed Date: 1997-02-24 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9716528 Medline TA: Arch Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 13-8 Citation Subset: AIM; IM |
Affiliation:
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Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Female Humans Lymph / chemistry* Male Middle Aged Multiple Organ Failure* / blood, immunology Thoracic Duct* |
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