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A Typical Case of Thoracic Duct Drainage Surgery in Treatment of Scleroderma

24 mm/h  CK 180.6U/L, CK-MB 40.5U/L£¬AST 32 U/L£¬LDH 124.4U/L¡£
Ms. Liu, 47, was hospitalized for both hands' cyanosis for one year, stiff of skin all over for four months and dysphagia for one month. She was treated with hormone and immunosuppressor for one month and no improvement. Instead, the disease was deteriorated progressively and appeared such symptoms as dysphagia, palpitated after little movement, short breath, and general weakness, going upstairs and crouching with difficulty. For effective treatment, the patient came to our hospital. The following main symptoms were found at admission of our hospital: stiff skin all over, especially at both upper limbs, chest and belly, lift hands with difficulty, pigmentation, wrinkle on part of sweat glands and face vanished, swelling with both hands and upper limbs, restricted crouching movement, intolerance to cold and cold limbs, cough, spitting frequently out white phlegm, choking sensation in chest, short breath especially after body movement, difficulty in swallowing, acid regurgitation and heartburn occasionally; no sense of chilling or headache or dizziness, sleep alright, and normal in excretion. The physical checkup found T: 36.0¡æ, P: 100 C.P.M., R: 21 C.P.M., BP: 110/70 mmHg, and no abnormality with heart, lung and abdomen, ¢ó grade of limbs' muscle strength. Laboratory examination indicated ESR 60 mm/h, CK 509.6U/L, CK-MB 50.5U/L, AST 41 U/L,LDH 240.4U/L. The electromyography reported original abnormality of muscle. She was diagnosed as suffering from systemic scleroderma and polymyositis. Based on the case history and symptoms above, the patient was considered in the swelling stage of the disease. Therefore, a comprehensive treatment combining thoracic duct drainage surgery with Chinese herbal medicine was prescribed. After 15 days' draining operation of liquid and TCM treatment for warming yang, activating the channels, supplementing qi and enriching the blood, the patient's skin condition got close to normal and no more choking sensation in chest, short breath, difficulty in swallowing, cough and expectoration. The muscle strength of limbs resumed to normal too. The laboratory examination showed that: ESR 24 mm/h, CK 180.6U/L, CK-MB 40.5U/L, AST 32 U/L and LDH 124.4U/L.

Systemic scleroderma, as a general desmosis, is widely believed it is an autoimmune disease caused by long-term chronic infection on a hereditary basis. A great variety of autoantibodies in the patients' sero are found. For the untreated patients of systemic scleroderma, the peripheral lymph counting is found normal or slightly decreased; however, a study of the subgroup found that the proportion of helper T lymphocytes (CD4) and B-cells increased while T suppressor cells (CD8) decreased, and the humoral immunity enhanced obviously. Especially, there are plenty of autoantibodies and immune complexes existing, and IgG is higher than the normal limit. 95% of the patients' thoracic duct lymph liquid is found T lymphocyte. In addition, there are plenty of autoantibodies, cell factors, inflammatory factors and immune complex found inside the patients' thoracic duct. After a thoracic duct surgery, the counting of autoantibodies and sensitized lymphocyte, especially memory cells, will decrease while the ratio of T4 to T8 will become lower. Along with the lose of B cells, many immature B cells will get into the circulation system to cause the counting of IgG, circulating immune complexes and receptors of interleukin-2 decreased significantly, which can inhibit the sthenic condition of humoral immunity and affect the immunity cause to systemic scleroderma. Therefore, the patient's skin became soft obviously, the affected internal organs started to recover and the disease appeared a favorable turn.

Thoracic duct drainage surgery is nothing but a treatment means. The patients who had the surgery still need a long-term nursing and treatment with Chinese herbal medicines before get rid of the disease thoroughly.

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