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Asian Journal of Surgery Jul 2023
Topics: Humans; Thoracic Duct; Dilatation; Dilatation, Pathologic
PubMed: 37173246
DOI: 10.1016/j.asjsur.2023.03.194 -
World Journal of Clinical Cases Apr 2024Central venous catheter insertion in the internal jugular vein (IJV) is frequently performed in acute care settings, facilitated by its easy availability and increased...
Central venous catheter insertion in the internal jugular vein (IJV) is frequently performed in acute care settings, facilitated by its easy availability and increased use of ultrasound in healthcare settings. Despite the increased safety profile and insertion convenience, it has complications. Herein, we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.
PubMed: 38660082
DOI: 10.12998/wjcc.v12.i10.1714 -
JACC. Basic To Translational Science Nov 2021
PubMed: 34869952
DOI: 10.1016/j.jacbts.2021.10.003 -
Indian Journal of Surgical Oncology Jun 2022Near-infrared (NIR) fluorescence imaging with indocyanine green dye (ICG) is an emerging technology in detecting the anatomy of the thoracic duct; hence, it can be... (Review)
Review
Near-infrared (NIR) fluorescence imaging with indocyanine green dye (ICG) is an emerging technology in detecting the anatomy of the thoracic duct; hence, it can be useful for the identification of the thoracic duct in real time and prevention of its injury during thoracic surgery. It helps to localize thoracic duct injury, identifying chyle leaks in difficult, recurrent, and refractory cases. This review paper provides insights regarding the current applications, advantages, and potential developments of NIR fluorescence imaging with ICG in recognizing thoracic duct during thoracic surgery.
PubMed: 35782807
DOI: 10.1007/s13193-022-01493-y -
Cureus Oct 2022Schwannomas are tumors derived from Schwann cells of the peripheral nerve sheath that are usually benign; nonetheless, they can cause significant morbidity. When...
Schwannomas are tumors derived from Schwann cells of the peripheral nerve sheath that are usually benign; nonetheless, they can cause significant morbidity. When indicated, surgical resection is the gold standard of treatment for schwannomas. However, chylothorax is a rare postoperative complication of thoracic surgery. We present a case of chylothorax after thoracic schwannoma resection. A 61-year-old woman underwent a computed tomography (CT) scan for suspected nephrolithiasis, which instead found a right mediastinal mass that was confirmed to have features consistent with a schwannoma on thoracic spine magnetic resonance imaging (MRI). Right thoracotomy and schwannoma resection were performed, resulting in the complete removal of the schwannoma without capsular invasion. Two chest tubes were also inserted. On postoperative day 1 (POD1), the patient presented with a chylothorax that was initially treated with chest tube suctioning and total parenteral nutrition (TPN). However, a repeat right thoracotomy with thoracic duct ligation and dry talc chemical pleurodesis was subsequently performed on POD15 due to a lack of clinical improvement, which saw the resolution of the chylothorax without recurrence. Chylothorax is a rare but severe postoperative complication of thoracic surgeries, including those that involve tumor resections. We present a case of chylothorax after thoracic schwannoma resection that initially failed conservative management but eventually resolved after thoracic duct ligation and chemical pleurodesis. This case highlights the need for effective non-surgical treatments for chylothorax, the importance of remaining vigilant for rare postoperative complications, and the need for randomized controlled trials (RCTs) to develop a standardized chylothorax management algorithm.
PubMed: 36381836
DOI: 10.7759/cureus.30112 -
Nature Communications Oct 2019Cranial lymphatic vessels (LVs) are involved in the transport of fluids, macromolecules and central nervous system (CNS) immune responses. Little information about...
Cranial lymphatic vessels (LVs) are involved in the transport of fluids, macromolecules and central nervous system (CNS) immune responses. Little information about spinal LVs is available, because these delicate structures are embedded within vertebral tissues and difficult to visualize using traditional histology. Here we show an extended vertebral column LV network using three-dimensional imaging of decalcified iDISCO-clarified spine segments. Vertebral LVs connect to peripheral sensory and sympathetic ganglia and form metameric vertebral circuits connecting to lymph nodes and the thoracic duct. They drain the epidural space and the dura mater around the spinal cord and associate with leukocytes. Vertebral LVs remodel extensively after spinal cord injury and VEGF-C-induced vertebral lymphangiogenesis exacerbates the inflammatory responses, T cell infiltration and demyelination following focal spinal cord lesion. Therefore, vertebral LVs add to skull meningeal LVs as gatekeepers of CNS immunity and may be potential targets to improve the maintenance and repair of spinal tissues.
Topics: Animals; Image Processing, Computer-Assisted; Lymph Nodes; Lymphatic Vessels; Male; Mice, Inbred C57BL; Mice, Transgenic; Microscopy, Confocal; Microscopy, Fluorescence; Spinal Cord Injuries; Spine; Thoracic Duct
PubMed: 31597914
DOI: 10.1038/s41467-019-12568-w -
Korean Journal of Radiology Mar 2020To evaluate the technical feasibility of intranodal lymphangiography and thoracic duct (TD) access in a canine model.
OBJECTIVE
To evaluate the technical feasibility of intranodal lymphangiography and thoracic duct (TD) access in a canine model.
MATERIALS AND METHODS
Five male mongrel dogs were studied. The dog was placed in the supine position, and the most prominent lymph node in the groin was accessed using a 26-gauge spinal needle under ultrasonography (US) guidance. If the cisterna chyli (CC) was not opacified by bilateral lymphangiography, the medial iliac lymph nodes were directly punctured and Lipiodol was injected. After opacification, the CC was directly punctured with a 22-gauge needle. A 0.018-in microguidewire was advanced through the CC and TD. A 4-Fr introducer and dilator were then advanced over the wire. The microguidewire was changed to a 0.035-in guidewire, and this was advanced into the left subclavian vein through the terminal valve of the TD. Retrograde TD access was performed using a snare kit.
RESULTS
US-guided lymphangiography (including intranodal injection of Lipiodol [Guerbet]) was successful in all five dogs. However, in three of the five dogs (60%), the medial iliac lymph nodes were not fully opacified due to overt Lipiodol extravasation at the initial injection site. In these dogs, contralateral superficial inguinal intranodal injection was performed. However, two of these three dogs subsequently underwent direct medial iliac lymph node puncture under fluoroscopy guidance to deliver additional Lipiodol into the lymphatic system. Transabdominal CC puncture and cannulation with a 4-Fr introducer was successful in all five dogs. Transvenous retrograde catheterization of the TD (performed using a snare kit) was also successful in all five dogs.
CONCLUSION
A canine model may be appropriate for intranodal lymphangiography and TD access. Most lymphatic intervention techniques can be performed in a canine using the same instruments that are employed in a clinical setting.
Topics: Animals; Dogs; Ethiodized Oil; Lymph Nodes; Lymphography; Male; Models, Animal; Thoracic Duct; Tomography, X-Ray Computed
PubMed: 32090522
DOI: 10.3348/kjr.2019.0313 -
JTCVS Techniques Oct 2022Clinically, recurrent chylothorax is challenging to solve, especially when chylothorax is still present after the thoracic duct is ligated. In this study we explored...
OBJECTIVES
Clinically, recurrent chylothorax is challenging to solve, especially when chylothorax is still present after the thoracic duct is ligated. In this study we explored alternative surgical options to treat complex cases of recurrent chylothorax.
METHODS
Clinical records, laboratory results, and magnetic resonance imaging scans were retrospectively reviewed for 3 patients with recurrent chylothorax who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from August 8, 2016, to October 30, 2019. Evidence from the surgical treatment of thoracic duct-venous anastomosis was assessed using pictures from the operation room, with follow-up until now.
RESULTS
Thoracic duct ligation had failed twice in patient 1, and the other 2 patients each had thoracic duct ligation that failed once again. After undergoing thoracic duct ligation, all 3 patients showed a significant reduction in chest fluid, but their condition soon returned to the same as that before ligation. All 3 patients finally underwent thoracic duct-venous anastomosis. The changes in lymphocyte and granulocyte numbers in the blood system of the patients before and after the operation were not substantial, and the operations had little effect on liver and kidney function. The patients achieved satisfactory treatment results, with follow-up until the present (23-60 months).
CONCLUSIONS
This research shows that thoracic duct-venous anastomosis is a safe and effective alternative surgical approach for complex recurrent chylothorax.
PubMed: 36276678
DOI: 10.1016/j.xjtc.2022.07.015 -
Journal of Thoracic Disease Jul 2017Since 1995, video-assisted thoracoscopic oesophagectomy (VATS), according the same surgical principles as the Japanese open surgery, has been completed in 700 patients... (Review)
Review
Since 1995, video-assisted thoracoscopic oesophagectomy (VATS), according the same surgical principles as the Japanese open surgery, has been completed in 700 patients with oesophageal cancer. Our indication for VATS is (I) no extensive pleural adhesion; (II) no contiguous tumor spread; (III) pulmonary function capable of sustaining single-lung ventilation, and (IV) non radiated patients. We use 4 ports around a 5 cm mini-thoracotomy on 5th intercostal space. We laid emphasis on utilizing magnifying effect of video (5 to 20 magnifications), obtained by positioning the camera at close vicinity to the dissection. Magnified view facilitates recognizing the fine layer structure of the mediastinum. The dissection should be performed following this layer structure just like open the page of a book. Tearing the layer makes the dissection irrational and cause unnecessary bleeding and invasiveness. The microanatomies we recognize during upper mediastinal dissection are (I) the most outer layer below the mediastinal pleura are branches from the vagus nerve and thoracic sympathetic trunk; (II) there is no vessel flow in the nerves or out, in the field of dissection; (III) the ideal layer of dissection along the nerve is exposing the epineurium; (IV) the strongest fixing structures in the mediastinum are the vagal nerves and nerves form thoracic sympathetic trunk; (V) the stump of thoracic duct shows particular appearance because of the intramural smooth muscle; (VI) the lymphonodes in the mediastinum are fixed strongly with nerves and gently with vessels; (VII) the aorta is covered with fine fibrous membrane consisting of branches form thoracic sympathetic trunk, etc. Magnified view shows the microstructure of the lymph node such as the afferent lymphatics penetrating the capsule and the hilum structure consisting the efferent lymphatics, artery, vein and nerve. The direction of the hilum of nodes is defined in each region. Therefore, understanding the hilum direction facilitates rational dissection. The hospital mortality was four patients (0.6%). The rate of regional control was 95%. The 5-year survival rates of the patients with pStage 0, 1, 2, 3, 4 were 92%, 88%, 69%, 52% and 24%, respectively, which were favorably compared with open surgery.
PubMed: 28815070
DOI: 10.21037/jtd.2017.05.25 -
Diseases of the Esophagus : Official... Sep 2023Despite advances in multidisciplinary treatment, esophagectomy remains the main curative treatment for esophageal cancer. The advantages and disadvantages of thoracic...
Despite advances in multidisciplinary treatment, esophagectomy remains the main curative treatment for esophageal cancer. The advantages and disadvantages of thoracic duct (TD) resection have been controversial for decades. We have herein reviewed relevant published literature regarding 'thoracic duct,' 'esophageal cancer,' and 'esophagectomy' describing the anatomy and function of the TD, and incidence of thoracic duct lymph nodes (TDLN) and TDLN metastases, as well as the oncological and physiological effects of TD resection. The presence of lymph nodes around the TD, referred to as TDLN, has been reported previously. The delineation of TDLNs is clearly defined by a thin fascial structure covering the TD and the surrounding adipose tissue. Previous studies have examined the number of TDLNs and the percentage of patients with TDLN metastasis and revealed that each patient had approximately two TDLNs. The percentage of patients with TDLN metastasis was reported to be 6-15%. Several studies have been conducted to compare the survival after TD resection with that after TD preservation. However, no consensus has been reached because all studies were retrospective, precluding firm conclusions. Although the issue of whether the risk of postoperative complications is affected by TD resection is still unclear, resecting the TD has been shown to have a long-term impact on nutritional status after surgery. In summary, TDLNs are quite common and present in most patients, while metastasis in the TDLNs occurs in a minority. However, the oncological value of TD resection in esophageal cancer surgery remains controversial due to varying findings and methodological limitations of previous comparative studies. Considering the potential but unproven oncological benefits and possible physiological drawbacks of TD resection, including postoperative fluid retention and disadvantages in the long-term nutritional outcome, clinical stage, and nutritional status should be considered before deciding whether to perform TD resection or not.
Topics: Humans; Thoracic Duct; Lymph Node Excision; Retrospective Studies; Esophageal Neoplasms; Lymph Nodes; Postoperative Complications; Lymphatic Metastasis; Esophagectomy
PubMed: 36950928
DOI: 10.1093/dote/doad015