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August 1981, Vol 116, No. 8 >
ARTICLE | August 1981

The Lymphatic System: Title and subTitle BreakSome Surgical Considerations FREE

William W. L. Glenn, MD
[+] Author Affiliations

Accepted for publication Feb 2, 1981.

Read as the presidential address at the seventh annual meeting of the New England Society for Vascular Surgery, Durham, NH, Sept 25, 1980.

Reprint requests to Department of Surgery, Yale University School of Medicine, 333 Cedar St, PO Box 3333, New Haven, CT 06510 (Dr Glenn).


Arch Surg. 1981;116(8):989-995. doi:10.1001/archsurg.1981.01380200007001
Text Size: A A A
Published online
Article
References
Comments

• This article on the lymphatics was undertaken for three reasons: The first is to recount the story of the rediscovery of these vessels in the 17th century and briefly review the subsequent events leading up to our present knowledge of the lymphatic system. The second is to emphasize the role of the lymphatics in maintaining extracellular fluid balance, in the removal of protein, fat, and other substances of large molecular size from the tissue spaces, and in the circulation of the lymphocytes from their germinal centers and storage depots to all parts of the body via lymphaticovenous connections. The third reason is to suggest that the responsibility for maintaining the transport function of the lymphatics properly belongs to the vascular surgeon.

(Arch Surg 1981;116:989-995)

REFERENCES

1 +
Asellius G: De Lactibus sine lacteis venis . Milan, Italy, 1627;.
2 +
Fulton JF:  The early history of the lymphatics with particular reference to Bartholin, Rudbeck and Joyliffe . Bull Hennepin County Med Soc 1938;;9:5-10.
3 +
Pecquet J: Experimenta nova anatomica . Paris, Carmoisy S & G, 1651;, p 21.
4 +
New Anatomical Experiments of John Pecquet . London, printed by T.W. for Octavian Pulleyn, 1653;, pp 7-8.
5 +
Mascagni P: Vasorum Lymphaticorum Corporis Humani Historia Ludovicus et Heermanuus Ichnographic auctore . Siena, Italy, P Carli, 1787;.
6 +
Hunter W: Two Introductory Lectures to His Last Course of Anatomical Lectures at His Theatre in Windmill-Street . London, J Johnson, 1784;, pp 58-59.
7 +
Sabin FR:  A critical study of the evidence presented in several recent articles on the development of the lymphatic system . Anat Rec 1911;;5:417-446.
8 +
Ludwig C: Lehrbuch der physiologie des Menschen . Leipzig and Heidelberg, Germany, Winter, 1858;.
9 +
Starling E: The Fluids of the Body . Chicago, Keener & Co, 1908;.
10 +
Field ME, Drinker CK:  Conditions governing the removal of protein deposited in the subcutaneous tissues of the dog . Am J Physiol 1931;;98:66-69.
11 +
Drinker CK, Yoffey JM: Lymphatics, Lymph and Lymphoid Tissue: Their Physiological and Clinical Significance . Cambridge, Mass, Harvard University Press, 1941;.
12 +
Hudack SS, McMaster PD:  The lymphatic participation in human cutaneous phenomena: A study of the minute lymphatics of the living skin . J Exp Med 1933;;57:751-774.
13 +
Funaoka S:  Mechanismus der Lymphbewegung , in Untersuchungen über die Physiologie der Lymphbewegung. Heft. 1. Die Rontgenographie des Lymphgefässes , Series D. Kyoto, Japan, Imperial University of Kyoto, 1930;, p 1.
14 +
Shdanow DA:  Röntgenologische Untersuchungsmethoden des Lymphgefässystems des Menschen und der Tiere . Fortschr Rontgen 1932;; 46:680-691.
15 +
Gimbel N, Riegel C, Glenn WWL:  Metabolic and cardiovascular studies of prolonged intravenous administration of human serum albumin . J Clin Invest 1950;;29:998-1009.
16 +
Servelle, Deysson:  Reflux of the intestinal chyle in the lymphatics of the leg . Ann Surg 1951;;133:234-239.
17 +
Kinmonth JB:  Lymphangiography in man . Clin Sci 1952;;11:13-20.
18 +
Kinmonth JB:  Lymphangiography in clinical surgery and particularly in the treatment of lymphoedema . Ann R Coll Surg Engl 1954;;15:300-315.
19 +
Kinmonth JB: The Lymphatics: Diseases, Lymphography and Surgery . Baltimore, Williams & Wilkins Co, 1972;.
20 +
Charles H:  Elephantiasis scroti , in Latham A, English TC (eds): A System of Treatment . London, Churchill, 1914;, vol 3, pp 504-516.
21 +
Thompson N:  Buried dermal flap operation for chronic lymphedema of the extremities: Ten year survey of results in 79 cases . Plast Reconstr Surg 1970;;45:541-548.
22 +
Nielubowicz J, Olszewski W:  Surgical lymphaticovenous shunts in patients with secondary lymphoedema . Br J Surg 1968;;55:440-442,
23 +
Sakulsky SB, Schirger A, Harrison EG, et al: Lymphedema:  Results of surgical treatment in 64 patients (1936-1964) . Lymphology 1977;;10:15-26.
24 +
Battezzati M, Donini I: The Lymphatic System , rev ed, Cameron-Curry V (trans). New York, John Wiley & Sons Inc, 1973;, pp 234-240.
25 +
Kinmonth JB, Taylor GW:  Chylous reflux . Br Med J 1964;;1:529-532.
26 +
Kinmonth JB, Taylor GW, Jantet GH:  Chylous complications of primary lymphoedema . J Cardiovasc Surg 1964;;5:327-345.
27 +
Johnson WT:  Cutaneous chylous reflux: 'The weeping scrotum.' Arch Dermatol 1979;;115:464-466.
28 +
Vasko JS, Tapper RI:  The surgical significance of chylous ascites . Arch Surg 1967;;95:355-368.
29 +
Weber HP, Emons D, Knöpfle G, et al:  Congenitaler chylöser ascites . Klin Paediatr 1975;;187:370-376.
30 +
Meinke AH, Estes NC, Ernst CB:  Chylous ascites following abdominal aortic aneurysmectomy . Ann Surg 1979;;190:631-633.
31 +
Morag B, Hertz M, Rubinstein ZJ:  The value of lymphangiography in chyluria: A report of three cases . Lymphology 1977;;10:5-9.
32 +
Crane DB, Wheeler WE, Smith MGU:  Chyluria . Urology 1977;;9:429-432.
33 +
Kausel HW, Reeve TS, Stein AA, et al:  Anatomic and pathologic studies of the thoracic duct . J Thorac Surg 1957;;34:631-642.
34 +
Ross JK:  A review of the surgery of the thoracic duct . Thorax 1969;; 16:12-21.
35 +
Bessone LN, Ferguson TB, Busford TH:  Chylothorax . Ann Thorac Surg 1971;;12:527-550.
36 +
Maier HC:  Chylous reflux in the lungs and pleurae . Thorax 1968;; 23:281-296.
37 +
Holm AL, Söderlund S:  Experiences of postoperative chylothorax in children . Pediatr Radiol 1975;;4:10-13.
38 +
Kosloske AM, Martin LW, Schubert WK:  Management of chylothorax in children by thoracentesis and medium-chain triglyceride feedings . J Pediatr Surg 1974;;9:365-371.
39 +
Peitersen B, Jacobsen BB:  Medium chain triglycerides for treatment of spontaneous, neonatal chylothorax . Acta Paediatr Scand 1977;;66:121-125.
40 +
Machleder HI, Paulus H:  Clinical and immunological alterations observed in patients undergoing long-term thoracic duct drainage . Surgery 1978;;84:157-165.
41 +
Maloney JV, Spencer FC:  The non-operative treatment of traumatic chylothorax . Surgery 1956;;40:121-128.
42 +
Cushing H:  Operative wounds of the thoracic duct: Report of a case with suture of the duct . Ann Surg 1898;;27:719-728.
43 +
Lampson RS:  Traumatic chylothorax . J Thorac Surg 1948;;17:778-791.
44 +
Rubin JW, Moore HV, Ellison RG: Chylothorax:  Therapeutic alternatives . Am Surg 1977;;43:292-297.
45 +
Dumont AE:  The thoracic duct , in Ellis FH Jr (vol ed): Thoracic Surgery, in Practice of Surgery . Hagerstown, Md, Harper & Row Publishers Inc, 1978;, pp 1-13.
46 +
Roy PH, Carr DT, Payne WS:  The problem of chylothorax . Mayo Clin Proc 1967;;42:457-466.
47 +
Dyckner T, Jacobbson SI, Schildt B, et al:  Bilateral chylothorax: Complication in malignancy . Lymphology 1975;;8:90-94.
48 +
Thawley SE:  Chylous fistula prevention and management . Laryngoscope 1980;;90:522-525.
49 +
Glenn WWL, Bauer FX, Cresson SL:  Experimental thoracic duct fistula: Observations on lymphocyte output . Blood 1949;;4:1338-1345.
50 +
Dumont AE, Witte MH:  Clinical usefulness of thoracic duct cannulation , in Stollerman G (ed): Advances in Internal Medicine . Chicago, Year Book Medical Publishers, 1969;, pp 51-70.
51 +
Van Wyck DB, Lucas DO:  Immune function in disorders of the lymph circulation . Vase Surg 1977;;11:152-159.
52 +
Dunn RP:  Primary chylopericardium: A review of the literature and an illustrated case . Am Heart J 1975;;89:369-377.
53 +
Fonkalsrud EW:  Surgical management of congenital malformations of the lymphatic system . Am J Surg 1974;;128:152-159.
54 +
Noonan JA, Walters LR, Reeves JT:  Congenital pulmonary lymphangiectasis . Am J Dis Child 1970;;120:314-319.
55 +
Chang CK, Viseskul C, Opitz JM, et al:  Generalized lymphangiectasis associated with chylothorax: A possible dysplasia of the lymphatic system . Eur J Pediatr 1974;;118:9-24.
56 +
Wagenaar SJSC, Swierenga J, Wagenvoort CA:  Late presentation of primary pulmonary lymphangiectasis . Thorax 1978;;33:791-795.
57 +
Henzel JH, Pories WJ, Burget DE, et al:  Intra-abdominal lymphangiomata . Arch Surg 1966;;93:304-308.
58 +
Tsuchiya R, Sugiura Y, Ogata T, et al:  Thoracic duct cyst of the mediastinum . J Thorac Cardiovasc Surg 1980;;79:856-859.
59 +
Dalaker K:  Chylous cyst of the mesentery of the transverse colon . Acta Chir Scand 1979;;145:207-208.
60 +
Cornog JL, Enterline HT:  Lymphangiomyoma, a benign lesion of chyliferous lymphatics synonymous with lymphangiopericytoma . Cancer 1966;;19:1909-1930.
61 +
Frack MD, Simon L, Dawson BH:  The lymphangiomyomatosis syndrome . Cancer 1968;;22:428-437.
62 +
Miller SU, Pruett J, Long A:  Fatal chylopericardium caused by hamartomatous lymphangiomatosis . Am J Med 1959;;26:951-956.
63 +
Calabrese PR, Frank HD, Taubin HL:  Lymphangiomyomatosis with chylous ascites: Treatment with dietary fat restriction and medium chain triglycerides . Cancer 1977;;4:895-897.
64 +
Kinmonth JB, Taylor GW:  Lymphatic circulation in lymphedema . Ann Surg 1954;;139:129-136.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Asellius G: De Lactibus sine lacteis venis . Milan, Italy, 1627;.
2 +
Fulton JF:  The early history of the lymphatics with particular reference to Bartholin, Rudbeck and Joyliffe . Bull Hennepin County Med Soc 1938;;9:5-10.
3 +
Pecquet J: Experimenta nova anatomica . Paris, Carmoisy S & G, 1651;, p 21.
4 +
New Anatomical Experiments of John Pecquet . London, printed by T.W. for Octavian Pulleyn, 1653;, pp 7-8.
5 +
Mascagni P: Vasorum Lymphaticorum Corporis Humani Historia Ludovicus et Heermanuus Ichnographic auctore . Siena, Italy, P Carli, 1787;.
6 +
Hunter W: Two Introductory Lectures to His Last Course of Anatomical Lectures at His Theatre in Windmill-Street . London, J Johnson, 1784;, pp 58-59.
7 +
Sabin FR:  A critical study of the evidence presented in several recent articles on the development of the lymphatic system . Anat Rec 1911;;5:417-446.
8 +
Ludwig C: Lehrbuch der physiologie des Menschen . Leipzig and Heidelberg, Germany, Winter, 1858;.
9 +
Starling E: The Fluids of the Body . Chicago, Keener & Co, 1908;.
10 +
Field ME, Drinker CK:  Conditions governing the removal of protein deposited in the subcutaneous tissues of the dog . Am J Physiol 1931;;98:66-69.
11 +
Drinker CK, Yoffey JM: Lymphatics, Lymph and Lymphoid Tissue: Their Physiological and Clinical Significance . Cambridge, Mass, Harvard University Press, 1941;.
12 +
Hudack SS, McMaster PD:  The lymphatic participation in human cutaneous phenomena: A study of the minute lymphatics of the living skin . J Exp Med 1933;;57:751-774.
13 +
Funaoka S:  Mechanismus der Lymphbewegung , in Untersuchungen über die Physiologie der Lymphbewegung. Heft. 1. Die Rontgenographie des Lymphgefässes , Series D. Kyoto, Japan, Imperial University of Kyoto, 1930;, p 1.
14 +
Shdanow DA:  Röntgenologische Untersuchungsmethoden des Lymphgefässystems des Menschen und der Tiere . Fortschr Rontgen 1932;; 46:680-691.
15 +
Gimbel N, Riegel C, Glenn WWL:  Metabolic and cardiovascular studies of prolonged intravenous administration of human serum albumin . J Clin Invest 1950;;29:998-1009.
16 +
Servelle, Deysson:  Reflux of the intestinal chyle in the lymphatics of the leg . Ann Surg 1951;;133:234-239.
17 +
Kinmonth JB:  Lymphangiography in man . Clin Sci 1952;;11:13-20.
18 +
Kinmonth JB:  Lymphangiography in clinical surgery and particularly in the treatment of lymphoedema . Ann R Coll Surg Engl 1954;;15:300-315.
19 +
Kinmonth JB: The Lymphatics: Diseases, Lymphography and Surgery . Baltimore, Williams & Wilkins Co, 1972;.
20 +
Charles H:  Elephantiasis scroti , in Latham A, English TC (eds): A System of Treatment . London, Churchill, 1914;, vol 3, pp 504-516.
21 +
Thompson N:  Buried dermal flap operation for chronic lymphedema of the extremities: Ten year survey of results in 79 cases . Plast Reconstr Surg 1970;;45:541-548.
22 +
Nielubowicz J, Olszewski W:  Surgical lymphaticovenous shunts in patients with secondary lymphoedema . Br J Surg 1968;;55:440-442,
23 +
Sakulsky SB, Schirger A, Harrison EG, et al: Lymphedema:  Results of surgical treatment in 64 patients (1936-1964) . Lymphology 1977;;10:15-26.
24 +
Battezzati M, Donini I: The Lymphatic System , rev ed, Cameron-Curry V (trans). New York, John Wiley & Sons Inc, 1973;, pp 234-240.
25 +
Kinmonth JB, Taylor GW:  Chylous reflux . Br Med J 1964;;1:529-532.
26 +
Kinmonth JB, Taylor GW, Jantet GH:  Chylous complications of primary lymphoedema . J Cardiovasc Surg 1964;;5:327-345.
27 +
Johnson WT:  Cutaneous chylous reflux: 'The weeping scrotum.' Arch Dermatol 1979;;115:464-466.
28 +
Vasko JS, Tapper RI:  The surgical significance of chylous ascites . Arch Surg 1967;;95:355-368.
29 +
Weber HP, Emons D, Knöpfle G, et al:  Congenitaler chylöser ascites . Klin Paediatr 1975;;187:370-376.
30 +
Meinke AH, Estes NC, Ernst CB:  Chylous ascites following abdominal aortic aneurysmectomy . Ann Surg 1979;;190:631-633.
31 +
Morag B, Hertz M, Rubinstein ZJ:  The value of lymphangiography in chyluria: A report of three cases . Lymphology 1977;;10:5-9.
32 +
Crane DB, Wheeler WE, Smith MGU:  Chyluria . Urology 1977;;9:429-432.
33 +
Kausel HW, Reeve TS, Stein AA, et al:  Anatomic and pathologic studies of the thoracic duct . J Thorac Surg 1957;;34:631-642.
34 +
Ross JK:  A review of the surgery of the thoracic duct . Thorax 1969;; 16:12-21.
35 +
Bessone LN, Ferguson TB, Busford TH:  Chylothorax . Ann Thorac Surg 1971;;12:527-550.
36 +
Maier HC:  Chylous reflux in the lungs and pleurae . Thorax 1968;; 23:281-296.
37 +
Holm AL, Söderlund S:  Experiences of postoperative chylothorax in children . Pediatr Radiol 1975;;4:10-13.
38 +
Kosloske AM, Martin LW, Schubert WK:  Management of chylothorax in children by thoracentesis and medium-chain triglyceride feedings . J Pediatr Surg 1974;;9:365-371.
39 +
Peitersen B, Jacobsen BB:  Medium chain triglycerides for treatment of spontaneous, neonatal chylothorax . Acta Paediatr Scand 1977;;66:121-125.
40 +
Machleder HI, Paulus H:  Clinical and immunological alterations observed in patients undergoing long-term thoracic duct drainage . Surgery 1978;;84:157-165.
41 +
Maloney JV, Spencer FC:  The non-operative treatment of traumatic chylothorax . Surgery 1956;;40:121-128.
42 +
Cushing H:  Operative wounds of the thoracic duct: Report of a case with suture of the duct . Ann Surg 1898;;27:719-728.
43 +
Lampson RS:  Traumatic chylothorax . J Thorac Surg 1948;;17:778-791.
44 +
Rubin JW, Moore HV, Ellison RG: Chylothorax:  Therapeutic alternatives . Am Surg 1977;;43:292-297.
45 +
Dumont AE:  The thoracic duct , in Ellis FH Jr (vol ed): Thoracic Surgery, in Practice of Surgery . Hagerstown, Md, Harper & Row Publishers Inc, 1978;, pp 1-13.
46 +
Roy PH, Carr DT, Payne WS:  The problem of chylothorax . Mayo Clin Proc 1967;;42:457-466.
47 +
Dyckner T, Jacobbson SI, Schildt B, et al:  Bilateral chylothorax: Complication in malignancy . Lymphology 1975;;8:90-94.
48 +
Thawley SE:  Chylous fistula prevention and management . Laryngoscope 1980;;90:522-525.
49 +
Glenn WWL, Bauer FX, Cresson SL:  Experimental thoracic duct fistula: Observations on lymphocyte output . Blood 1949;;4:1338-1345.
50 +
Dumont AE, Witte MH:  Clinical usefulness of thoracic duct cannulation , in Stollerman G (ed): Advances in Internal Medicine . Chicago, Year Book Medical Publishers, 1969;, pp 51-70.
51 +
Van Wyck DB, Lucas DO:  Immune function in disorders of the lymph circulation . Vase Surg 1977;;11:152-159.
52 +
Dunn RP:  Primary chylopericardium: A review of the literature and an illustrated case . Am Heart J 1975;;89:369-377.
53 +
Fonkalsrud EW:  Surgical management of congenital malformations of the lymphatic system . Am J Surg 1974;;128:152-159.
54 +
Noonan JA, Walters LR, Reeves JT:  Congenital pulmonary lymphangiectasis . Am J Dis Child 1970;;120:314-319.
55 +
Chang CK, Viseskul C, Opitz JM, et al:  Generalized lymphangiectasis associated with chylothorax: A possible dysplasia of the lymphatic system . Eur J Pediatr 1974;;118:9-24.
56 +
Wagenaar SJSC, Swierenga J, Wagenvoort CA:  Late presentation of primary pulmonary lymphangiectasis . Thorax 1978;;33:791-795.
57 +
Henzel JH, Pories WJ, Burget DE, et al:  Intra-abdominal lymphangiomata . Arch Surg 1966;;93:304-308.
58 +
Tsuchiya R, Sugiura Y, Ogata T, et al:  Thoracic duct cyst of the mediastinum . J Thorac Cardiovasc Surg 1980;;79:856-859.
59 +
Dalaker K:  Chylous cyst of the mesentery of the transverse colon . Acta Chir Scand 1979;;145:207-208.
60 +
Cornog JL, Enterline HT:  Lymphangiomyoma, a benign lesion of chyliferous lymphatics synonymous with lymphangiopericytoma . Cancer 1966;;19:1909-1930.
61 +
Frack MD, Simon L, Dawson BH:  The lymphangiomyomatosis syndrome . Cancer 1968;;22:428-437.
62 +
Miller SU, Pruett J, Long A:  Fatal chylopericardium caused by hamartomatous lymphangiomatosis . Am J Med 1959;;26:951-956.
63 +
Calabrese PR, Frank HD, Taubin HL:  Lymphangiomyomatosis with chylous ascites: Treatment with dietary fat restriction and medium chain triglycerides . Cancer 1977;;4:895-897.
64 +
Kinmonth JB, Taylor GW:  Lymphatic circulation in lymphedema . Ann Surg 1954;;139:129-136.

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