title: Characteristics of thoracic duct lymph in multiple organ dysfunction syndrome.
abstract: 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.
  
  
  METHODS
  Convenience sample.
  
  
  METHODS
  General intensive care unit of a university hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  The thoracic duct was cannulated with a 7F catheter and samples of lymph and peripheral blood were obtained.
  
  
  METHODS
  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.affiliation: Intensive Care Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sánchez-García
authors.forename: A
authors.initials: A
authors.lastname: Prieto
authors.forename: A
authors.initials: A
authors.lastname: Tejedor
authors.forename: A
authors.initials: A
authors.lastname: Martin-Duce
authors.forename: F J
authors.initials: FJ
authors.lastname: Fernandez-Sánchez
authors.forename: J
authors.initials: J
authors.lastname: Granell
authors.forename: M
authors.initials: M
authors.lastname: Alvarez-Mon
mesh_terms: D005260:Female; D006801:Humans; D008196:Lymph / Q000737:chemistry*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000276:immunology; D013897:Thoracic Duct