Document Detail


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

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