Clinical and immunological alterations observed in patients undergoing long-term thoracic duct drainage
Machleder, H.I.; Paulus, H.
Surgery 84(1): 157-165
1978
ISSN/ISBN: 0039-6060 PMID: 307281 Document Number: 138715
Patients [20] with various advanced autoimmune diseases were selected to undergo long-term thoracic duct drainage. Clinical responses were dramatic, leading to resolution of joint inflammation in rheumatoid arthritis with reductions in joint counts, gel times, walking times, effusions and nodules; the return of dermal structures; improvement in esophageal motility in scleroderma; reduction of proteinuria in advanced lupus nephritis; restoration of myoelectric and biochemical integrity in dermatomyositis paralleled characteristic serologic and cytologic changes. At the outset of thoracic duct drainage, daily lymphocyte output ranged from 10 .times. 109 to 50 .times. 109, reaching an equilibrium of 1 .times. 109/day at 3-6 wk. Peripheral lymphocyte levels achieved a basal equilibrium at 4 wk and required about 15 wk after drainage to return to normal levels. As drainage progressed the proportion of B[bone marrow-derived]-lymphocytes increased with a concomitant decrease in T[thymus-derived]-lymphocytes. Attenuation of the normal immunologic responses can be substantiated by reduced rejection responsiveness to transplanted tissue, 124 .+-. 86 days, diminution of delayed hypersensitivity to primary and secondary antigens, dinitrochlorobenzene (DNCB) 15.3 .+-. 1.5 mm to 2.3 .+-. 1.5 mm of induration, without concomitant ablation of general inflammatory responses; Trafuril 21.8 .+-. 1.9 mm to 25.6 .+-. 3.8 mm of induration, sodium urate 23.9 .+-. 1.5 mm to 20 .+-. 2.7 mm of induration, and intact granulocyte response to etiocholanolone. Reduction in synthesis of immunoglobulin[Ig]G and IgA while maintaining serum IgM levels was also well documented.