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Objective: Investigation of lymph fluid dynamics in thoracic duct during central venous pressure elevation. Background: Lymphatic flow is affected by elevated central venous pressure (CVP) in congestive heart failure. The changes of thoracic duct (TD) lymph flow have not been studied chronically in the setting of elevated CVP. This study is to investigate fluid dynamics and remodeling of the TD in the elevated CVP animal model. Methods: A flow probe was implanted on the swine TD (n = 6) and tricuspid regurgitation (TR) was created by cutting tricuspid chordae percutaneously. Six swine were used as control group animals. The TD flow wasmeasured for 2 weeks (baseline) before TR and 4 weeks postop-TR surgery. Arterial pressure and CVP were measured. The pressure and flow in the TD were measured percutaneously. Histological and morphological analyses were performed. Results: TR resulted in an increase in CVP from 4.2 ± 2.6 to 10.1 ± 4.3 mmHg (p < 0.05). The lymph flow in the TD increased from 0.78 ± 1.06 before TR to 8.8 ± 4.8ml/min (p < 0.05) 2 days post-TR and remained plateau for 4 weeks, i.e., the TD flow remained approximately 8-11 fold its baseline. Compared to the 8.1 ± 3.2mmHg control group, the TD average pressures at the lymphovenous junction increased to 14.6 ± 5.7 mmHg in the TR group (p < 0.05). The TD diameter and wall thickness increased from 3.35 ± 0.37 mm and 0.06 ± 0.01mm in control to 4.32 ± 0.57 mm and 0.26 ± 0.02mm (p < 0.05) in the TR group, respectively. Conclusion: The elevated CVP results in a significant increase in TD flow and pressure which causes the TD's outward remodeling and thickening. Our study implicates that the outward remodeling may result in the TD valve incompetence due to failure coaptation of leaflets. [ABSTRACT FROM AUTHOR]

Local inflammatory reaction at the site of injection of anti-human antilymphocyte serum is a troublesome side effect. In this paper, a simple experimental model is presented for studying the local reaction caused by antilymphocyte serum. Anti- mouse antilymphocyte sera were injected intracutaneously and the intensity of the consequent oedema was estimated by the extravasation of Evans Blue dye solution given intravenously. It was found: (a) that rabbit anti-mouse anti-spleen sera produce consistently stronger local reactions than either anti-lymph node or anti- thymus sera; (b) that there is as yet no correlation between the intensity of the local reaction and the immunosuppressive (graft-protective) activity of the anti- lymphocyte serum pools tested. The possible implications of these findings are also discussed. [ABSTRACT FROM AUTHOR]

Among the different anatomical forms of anomalous pulmonary venous return, that of the inferior vena cava is of particular interest for the following reasons: the special radiological pattern which is referred to as the scimitar sign and the associated anomalies which often occur in the lungs. We have successfully operated on three patients who are reported in this paper, and we have included a review of the literature. [ABSTRACT FROM PUBLISHER]

Pancreatitis, in common with many other upper abdominal diseases, often leads to pleuropulmonary complications. Radiological evidence of pleuropulmonary abnormality was found in 55% of 58 cases examined retrospectively. The majority of such abnormalities are not specific for pancreatitis; but a particular category of pleural effusions, rich in pancreatic enzymes, is a notable exception. A patient with this type of effusion, complicated by a spontaneous bronchopleural fistula and then by an empyema, is reported. The literature relating to pancreatic enzyme-rich pleural effusions (pathognomonic of pancreatitis) is reviewed. Of several possible mechanisms involved in pathogenesis, transdiaphragmatic lymphatic transfer of pancreatic enzymes, intrapleural rupture of mediastinal extensions of pseudocysts, and diaphragmatic perforation are the most important. The measurement of pleural fluid amylase, at present little employed in this country, has considerable diagnostic value. Enzyme-rich effusions are more commonly left-sided, are often blood-stained, are frequently associated with pancreatic pseudocysts, and—if long standing—may be complicated by a bronchopleural fistula. [ABSTRACT FROM PUBLISHER]

A series of skin allografts were carried out in rabbits receiving daily injections of heterologous antilymphocyte serum prepared in four goats, three dogs and three pigs. The most satisfactory prolongation of graft survival was obtained with goat anti-rabbit ALS, although only two of the goats utilized produced an effective anti-serum. A significant overall correlation was established between graft survival time and rosette inhibition titre, but not cytotoxicity or lymphagglutination titre. However, although ineffective sera were poor rosette inhibitors and immunosuppressive sera good inhibitors, a high titre was not always associated with a strong immunosuppressive activity, at least when mixing results obtained with goat and pig ALS. [ABSTRACT FROM AUTHOR]

This paper describes two cases of gastric leiomyoblastoma (bizarre smooth muscle tumour), one of them having evidence of metastases. Both patients remain well after seven years and three and a half years respectively. The literature is reviewed, and the clinical features, diagnosis, and treatment are discussed. The histological appearances are described in detail and an attempt is made to assess the criteria for the diagnosis of malignancy. [ABSTRACT FROM PUBLISHER]