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PubMed2006

Diagnostic value of IgG isotype responses against Brugia malayi antifilarial antibodies in the clinical spectrum of brugian filariasis.

To study the diagnostic significance of antifilarial IgG subclasses in the clinical spectrum of brugian filariasis, IgG1, IgG3 and IgG4 antifilarial antibodies were determined in an exposed population comprising 74 asymptomatic amicrofilaraemics, 30 microfilaraemics, 20 lymphangitis and 16 elephantiasis patients resident in Narathiwart province, an area endemic for Brugia malayi lymphatic filariasis in southern Thailand. The dominant isotype of antifilarial antibody was IgG4. A significantly higher percentage of individuals were positive for IgG1 in the microfilaraemic and lymphangitis groups compared with the elephantiasis and endemic normal patients, while a significantly higher positive rate of IgG3 was found in those with lymphangitis. The possible role of these isotypes for diagnostic purposes and the pattern of antibody response in various clinically manifesting groups are discussed.

Adolescent↗
PubMed2006

Circulating fibrosis markers, eosinophil cationic protein and eosinophil protein X in patients with Wuchereria bancrofti infection: association with clinical status.

We measured the concentrations of several circulating fibrosis markers (type I collagen I, type III procollagen, hyaluronan) and eosinophil granule proteins (ECP and EPX) in lymphatic filariosis patients to investigate their relationship with clinical, parasitological and immunological data. This study was conducted in Polynesian patients with various stages of the disease (acute lymphangitis, chyluria, hydrocoele, elephantiasis), a closely related microbial lymphangitis and endemic controls. We observed modifications of the different markers in this pathology. Serum type I collagen and PIIINP were decreased. Serum hyaluronan, linked to perilymphatic granulomatous inflammation, was significantly increased in acute lymphangitis and elephantiasis patients. Serum ECP was also increased, at the limit of significance in our sample, in elephantiasis patients. These two last markers, already validated in another helminth disease, schistosomiasis, have potential interest in terms of follow-up of morbidity in these parasitic diseases.

Adult↗
PubMed2006

Risk factors for primary major amputation in diabetic patients.

CONTEXT AND OBJECTIVE: Diabetic patients present high risk of having to undergo minor or major amputation during their lifetimes, because of ischemia or infection. The aim of this study was to identify and quantify risk factors for major amputation in diabetic patients with foot infections. DESIGN AND SETTING: Retrospective clinical-surgical trial at the Vascular Surgery Service of Santa Casa de São Paulo. METHODS: Ninety-nine patients with diabetic foot infections who underwent 129 hospitalizations in the Vascular Surgery Unit were analyzed in accordance with a pre-established protocol to compare two groups of diabetic patients: one that underwent major amputations and the other that underwent minor amputations or debridements. The patients were predominantly male, in their sixth decade of life, and had type 2 diabetes mellitus. Chronic arterial insufficiency, age, diabetes mellitus duration, ascending lymphangitis, calcaneal lesions, Wagner's classification, laboratory tests and different microorganisms in deep tissue cultures were the risk factors evaluated in all patients. RESULTS: The statistically significant risk factors for major amputation included age, ascending lymphangitis (odds ratio, OR: 2.5), calcaneal lesions (OR: 10.5), Wagner grade 5 lesions (OR: 3.4), chronic arterial insufficiency without possibility of revascularization (OR: 5.4) and diabetes duration. Presence of Gram-positive microorganisms was associated with the need of major amputation. The serum urea, creatinine, glucose and white blood cell levels were not significant risk factors for major amputation. CONCLUSIONS: The risk factors for major amputation were: age, ascending lymphangitis, calcaneal lesions, Wagner grade 5 lesions, arterial insufficiency, diabetes duration and Gram-positive microorganisms in cultures.

Adult↗
PubMed1987

[Roentgenologic diagnosis and differential diagnosis of carcinomatous lymphangiosis of the lungs].

Generalised lymphatic carcinosis, also known as lymphangitis carcinomatosa, cannot be diagnosed by just one x-ray film of the thoracic organs. However, if an enhanced reticular striated pattern is seen, possibly associated with miliar stippling or hilar masses it is recommended to perform short-term follow-ups and comparisons with previous x-ray films. Lymphangitis carcinomatosa becomes probable if rapid progression of the findings or development of new lesions is seen besides the already existing ones and if this is associated with rapidly increasing dyspnoea. Pulmonary tomography will not yield highly significant results, but it can substantiate the diagnosis, the same applies to computed tomography of the thorax. CT is particularly important in differential diagnosis. Earliest possible diagnosis of lymphangitis carcinomatosa is of great importance for therapy, since it may be a first pointer towards an unknown metastasising primary tumor or haematogenous dissemination of already known tumours.

Adenocarcinoma↗
PubMed1995

[Multiple cutaneous carcinoma and chronic lymphoid leukemia].

INTRODUCTION: Skin cancer occurs more readily in more aggressive forms in immunodepressed subjects. We report the case of a patient with chronic lymphoid leukaemia and multiple skin carcinomas complicated with carcinomatous lymphangitis. CASE REPORT: A 63 year-old man with chronic lymphoid leukaemia, stage A in the Binet classification, had multiple epidermoid carcinomas on the trunk and face. The skin tumours were complicated with cervical lymph mode metastases, then a prethoracic carcinomatous lymphangitis with a rapidly fatal clinical course. DISCUSSION: Chronic lymphoid leukaemia and lymphomas are associated with a high incidence of skin carcinoma. The immunodepression inherent in the haematologic disease would appear to favor aggressive skin cancers. Our case was particularly severe since the carcinomatous lymphangitis was rapidly fatal.

Basal Cell Carcinoma↗
PubMed1996

A study of the advantages of elastic stockings for leg lymphedema.

To assess the efficacy of compression therapy alone, we report herein the long-term results of leg lymphedema using elastic stockings. Between January 1965 and March 1993, 41 primary lymphedema and 74 secondary lymphedema of the lower extremities have been treated at our hospital. Ten patients had recurrence of cancer, and 5 patients had surgical therapy. The remaining 100 patients were analyzed for the clinical results following treatment with elastic stockings. During the follow-up period of 5 +/- 0.2 years, 3 of 39 limbs (8% or 30 patients) with primary lymphedema wearing elastic stockings experienced enlargement of limb circumference and 36 limbs (92% or 27 patients) showed decrease or no change. Without elastic stockings, 1 out of 13 limbs (8% or 8 patients) with primary lymphedema showed worsening of their symptoms. In contrast, only 1 of 61 limbs (1.7%) in 46 patients with secondary lymphedema who wore elastic stockings showed deterioration of their symptoms. Although elastic stockings did not influence the incidence of the lymphangitis, their effect in maintaining limb circumference was apparent in all the patients with inflammation caused by secondary lymphedema. Among 20 patients with secondary lymphedema who had recurrent lymphangitis, only 1 out of 19 limbs (5%) in 16 patients experienced deterioration of the symptom with the use of elastic stockings while 1 out of 4 limbs (25%) in 4 patients showed improvement or no change without elastic stockings. Our data demonstrate that compression stockings are associated with long-term maintenance of reduced limb circumference, especially in secondary lymphedema regardless of the association with recurrent lymphangitis.

Adolescent↗
PubMed1993

Radiographic patterns of intrathoracic disease in breast carcinoma: prognostic implications.

The chest radiographic appearances of patients with intrathoracic metastases from breast cancer are variable and their relationship to patient outcome is unknown. This study aimed to classify and determine the frequency of various radiographic patterns and, in addition, to establish whether these patterns can be used to predict patient prognosis. A retrospective study was made of the patients of a major breast unit who over a 3 year period were found to have developed intrathoracic metastases. In each case, the earliest plain chest X-ray showing signs of metastasis was reviewed and the frequency of the different radiographic patterns determined. Comparison was made between these patterns and patient mortality. The chest radiographs of 92 patients who developed intrathoracic metastases during a 3 year period were analysed. Pulmonary nodules were found in 66%, pleural effusions in 41% (bilateral in 18%), lymphadenopathy in 25%, lymphangitis in 18% and pleurally-based nodules in 11%. Median survival of the whole group was 13.5 months. Patients with bilateral, but not unilateral, effusions had a significantly poorer prognosis (median survival 3 months). Although the median survival of patients with lymphangitis seemed poor (5.5 months), this difference was not statistically significant. Multivariate analysis showed bilateral effusions to be the only independent predictor of worse outcome. We have found that of the plain radiographic patterns seen in intrathoracic metastasis from breast cancer, only bilateral pleural effusions can be used to predict a worse prognosis than that associated with intrathoracic metastasis as a whole.

Adult↗
PubMed2003

Acute pulmonary oedema: rare causes and possible mechanisms.

Acute pulmonary oedema usually has a fatal outcome. In this clinical report, we present rare cases of pulmonary oedema that were associated with Japanese B encephalitis, lymphangitis in breast carcinoma, fat embolism due to long-bone fracture, and the rupture of cerebral mycotic aneurysms. A total of 18 patients in the four disease categories were collected in two teaching hospitals in Taipei and Hualien. Upon admission, routine and specific examinations were taken and all patients showed clear lungs by chest X-ray; however, signs of acute pulmonary oedema occurred within 7 days. After resuscitation, all patients died of acute pulmonary oedema. In patients with fat embolism, the levels of non-esterified plasma fatty acids, cGMP, 5-hydroxytryptamine (serotonin) and nitrates/nitrites were increased during pulmonary oedema. Immunohistochemical staining revealed virus infection and neuronal death, predominantly in the medial, ventral and caudal medulla in cases of Japanese B encephalitis. The pulmonary oedema due to central sympathetic activation in Japanese B encephalitis may be related to destruction of depressor mechanisms in the medulla. The rupture of mycotic aneurysms is known to cause cerebral compression that results in acute pulmonary oedema. Blockade of lymphatics, capillaries and venules in breast carcinoma with lymphangitis causes the development of rapid lung oedema. The pathogenesis of pulmonary oedema is much more complicated in fat embolism. Mediators such as cGMP, 5-hydroxytryptamine, nitric oxide and presumably other chemical substances may also be involved.

Acute Disease↗
PubMed2000

Association between milk production, somatic cell count and bacterial dermatoses in three dairy cattle herds.

OBJECTIVE: To determine the correlations between three bacterial dermatoses in cattle, milk production and bulk-milk somatic cell count (BMSCC). DESIGN: Field observations in three dairy cattle herds. METHODS: Milk production, BMSCC, fertility and all herd diseases were recorded by computerised dairy management systems. Each herd was visited twice weekly and the clinical signs, course of diseases and morbidity and culling rates were noted. Bulk-tank milk was sampled twice monthly and analysed for somatic cell count. Bacteriological and histological examinations were carried out from samples collected from affected animals in the respective herds. RESULTS: The acute exudative form of dermatophilosis was diagnosed only in first-calving cows. The morbidity rate was 53% and the culling rate was 16% of the affected animals. The BMSCC increased by a factor of 2.4 times, and there was an average loss of milk production of 30%/cow/day in affected animals. Ulcerative lymphangitis was diagnosed in first-calving cows (22%) and older cows (15%). The culling rate was 28%. The BMSCC increased by a factor of 17.3 times, and the average loss of milk production was 5.5%/affected animal/day. Papillomatous digital dermatitis (PDD) was diagnosed in first-calving cows (25%) and in older cows (18%). The culling rate was 8%. The BMSCC increased by a factor of two times, and the average loss of milk production was 1.7%/affected animal/day. CONCLUSIONS: The correlations between three skin diseases (ulcerative lymphangitis, dermatophilosis, papillomatous digital dermatitis), milk production and BMSCC have been found to be unfavourable.

Actinomycetales Infections↗
PubMed2004

[Weekly paclitaxel therapy is useful for gastric carcinoma as second-line chemotherapy].

The patient was a 58-year-old man who suffered from non-resectable gastric cancer, staged intraoperatively for peritoneal dissemination and paraaorta lymph node metastasis at another hospital in December 2002. He was initially treated with TS-1 as an outpatient. However, he was readmitted on March 4, 2003 for hematuria, general fatigue, jaundice and dyspnea. He was diagnosed with gastric cancer duodenum invasion, obstructive jaundice and lymphangitis carcinomatosa, and began weekly TXL as second-line chemotherapy on March 26. TXL (70 mg/ m2) was infused once a week for 3 weeks followed by a 1-week interval as one cycle. One week after the first infusion therapy, the jaundice and dyspnea were greatly improved. CT scan showed the lymphangitis carcinomatosa had disappeared and paraaorta lymph node metastasis was reduced to 60% after one cycle of the treatment. The toxic events were leukopenia (grade 1) and alopecia (grade 1).

Adenocarcinoma, Scirrhous↗
PubMedDate not supplied

Peripheral venous catheter-related inflammation. A randomized prospective trial.

BACKGROUND: Peripheral venous catheter-related inflammation (PVCRI) is a serious health and economic issue. It is mainly linked to peripheral venous catheter (PVC) duration and other risk factors. METHODS: PVCRI was prospectively evaluated in a 3 month-study according to PVC duration. Other risk factors were also studied such as age, gender, diabetes, intravenous steroids and antibiotics. 221 patients admitted to 3 different departments in a university hospital were randomized to undergo a 72 hours versus 96 hours PVC. The primary endpoint was to evaluate if this prolonged duration would increase the incidence of lymphangitis. The secondary endpoints were to evaluate if other risk factors such as age, gender, diabetes, intravenous steroids and antibiotics, have a direct impact on lymphangitis. Fever, local inflammatory signs and date of occurrence have been noted by two different nurses. The Stata 8.0 program, and the Pearson chi-square test to compare percentages (alpha = 0.05) were used. RESULTS: PVCRI occurred in 20.4% of all studied patients. PVCRI incidence did not differ between the patients who kept the catheter for 72 hours and those who kept it for 96 hours, but we found a significantly increasing incidence of PCVRI while comparing 24 hours versus 48 hours duration and 24-48 hours duration versus 72-96 hours duration respectively. Age, as well as intravenous antibiotherapy showed to be a significant risk factor for PVCRI. As for diabetic patients, there was a trend towards a higher incidence of PVCRI. Intravenous steroids showed to have a beneficial effect. It is to be noted that the rate of PVCRI was significantly higher in the internal medicine/infectious diseases department compared to the two other departments. CONCLUSION: No difference on PVCRI risk was found between 72 and 96 hours catheter duration. However the risk seems to increase between the first and the third day of catheterization. We suggest that an adapted duration of the PVC to the patient risks would be more cost-effective.

Adult↗
PubMed1989

Observations on the clinical manifestations and treatment of an experimental infection with Brugia malayi in man.

This paper reports clinical observations made during experimental Brugia malayi infection in man. This was induced by 52 infective larvae-carrying mosquitoes, Anopheles sinensis. A monkey, Maccaca mulatta, was inoculated with infective larvae from the mosquitoes infected with nocturnally periodic type of B. malayi from patients. Six months later, the monkey became a microfilaria carrier. Nine days later, the subject was experimentally bitten by mosquitoes infected from biting the monkey, with an estimated delivery of over 200 infective larvae. Seven days after the infection, general (but fluctuating) pruritus developed, followed by lymphadenitis and swelling of the hand and forearm, with a mild pyrexia for nearly 3 months. The eosinophil counts continuously increased. There were four separate attacks of lymphangitis. On day 142, microfilaraemia was first detected. After two more weeks, the subject was treated with a total dose of 15 g diethylcarbamazine (DEC) over 30 days. During this period, 28 small tender subcutaneous nodules appeared on his arms. After treatment, microfilaraemia gradually disappeared and the swelling of his arms improved. Three months later, the eosinophil count of his blood returned to normal but some temporary and scattered small pruritic erythematous patches still persisted over his left forearm. Lymphangitis has not recurred.

Animals↗
PubMed1988

Elephantiasis nostras: an eight-year observation of progressive nonfilarial elephantiasis of the lower extremity.

An eight-year follow-up of a progressive case of nonfilarial elephantiasis affecting the lower extremity and a review of the literature is presented. The natural history and management of this disorder are discussed, together with recommendations to assist the clinician in early identification an treatment. Elephantiasis nostras is characterized by chronic enlargement of a limb, resulting from lymphatic blockage secondary to recurrent attacks of streptococcal lymphangitis. Each subsequent attack results in greater edema of the limb. Without appropriate intervention the cycle continues until the deformity is greatly exaggerated. Control of edema an infection is important in preventing the recurrent lymphangitis that will eventually result in grotesque enlargement of the limb. Photographic documentation and serial circumferential limb measurements are recommended to document progression of the disease and effectiveness of treatment.

Elephantiasis↗
PubMed1984

The lymphatic pathology of Brugia pahangi in nude (athymic) and thymic mice C3H/HeN.

The nude (congenitally athymic) mouse, C3H/HeN is highly susceptible to infection with Brugia pahangi (Nematoda: Filarioidea). Normal, hairy mice show a strong thymus-dependent resistance and usually terminate the infection in the larval stages. The present study examined chronological histopathologic changes in the lumbar lymph nodes and adjacent lymphatic vessels of both hosts. In thymic mice, lymphangitis and perilymphangitis reached a maximum 14 to 17 days PI, about the time of disappearance of live worms. The infiltrate showed characteristics of both acute and chronic inflammation: eosinophils, neutrophils, eosinophilic precipitates, and sometimes necrotizing lymphangitis, as well as macrophages and plasma cells. The cellular infiltrate in nude mice was weaker and developed more slowly. Inflammatory responses to identifiable dead worms were seen in both types of hosts but appeared more frequently in thymic mice. Although variable in both models, the granulomas of thymic mice generally showed more tendency to cavitation, greater macrophage or epithelioid cell infiltration, more granulocytes, and appeared to be more destructive than the foreign body responses of nude mice. Whereas lymphangiectasis was generally progressive in nude mice, it was arrested before the end of the third week in thymic mice. In thymic mice, at maximum lumbar lymph node size (17 days), there were large areas of lymphocyte hyperplasia and heavy infiltration of plasma cells. Most nodes returned to normal mean size by the end of the second month. Little or no reactivity was seen in athymic mouse nodes. Our results suggest that some lesions of lymphatic filariasis are potentially thymus-independent: lymphatic fibrosis, lymphangiectasis, accumulations of macrophages and giant cells around disintegrating worms, calcification of worms, intralymphatic thrombosis, and moderate vascular infiltrates including eosinophils.

Animals↗
PubMed1998

[African tick-bite rickettsiosis: the 1st case of autochthonous infection?].

BACKGROUND: African tick-bite fever is caused by R. africae. All cases reported to date in France have occurred among patients who came from southern Africa, the endemic zone. We report the first case, to our knowledge, of a patient infected in France. CASE REPORT: A 69-year-old white man who had never left France developed fever and 3 "black spots" on the legs with lymphangitis and enlarged nodes. The clinically suspected diagnosis was confirmed by positive serology reactions to R. africae. As cross immunity with R. conorii can occur, the diagnosis was further confirmed by western blot for R. africae and by the persistence of the reaction after adsorption of the R. conorii serum. DISCUSSION: African tick-bite fever was identified as a clinical entity different from Mediterranean spotted fever by Kelly in 1992 who demonstrated the causal role of R. africae. The typical clinical presentation associates fever, several black spots, lymphangitis and multiple node enlargement. The serological diagnosis is difficult owing to cross immunity with R. conorii. Western blot and polymerase chain reaction are required for definitive diagnosis. In our case, the infection was probably due to a R. africae imported into France in the luggage of the patient's daughter who had spent 3 months in Zimbabwe.

Aged↗
PubMed1991

Prognostic factors in papillary carcinoma of the thyroid.

In a retrospective study of 119 patients, followed for 1 to 30 years after treatment of a papillary carcinoma of the thyroid, the authors searched for possible prognostic factors of the risk of recurrence. Microcarcinomas, anaplastic tumors and Hürthle cell carcinomas were excluded from the study. In a univariate analysis, age (greater than 45 years), sex (male), loss of histologic differentiation, size (greater than 3 cm), presence of carcinomatous lymphangitis, extrathyroid extension, and presence of metastasis at diagnosis were associated with a higher recurrence rate; type of growth and multifocality were not significant. In a multivariate analysis (logistic regression), age, size, and carcinomatous lymphangitis were significant predictors for women, whereas metastasis at diagnosis and cystic growth were significant for men.

Adult↗
PubMed1985

Pathology of the human pulmonary paracoccidioidomycosis.

Lungs of twelve patients with chronic paracoccidioidomycosis (Pb) were studied in an attempt to understand the pathogenesis of the pulmonary disease. Ribbons of the lung parenchyma including the hilar region and directed towards apical, basal and lateral regions were subdivided into sections from the hilar, intermediate and peripheral segments. The following histopathological reactions directly or indirectly related to P. brasiliensis were described and analysed in relation to the number of slides studied and the pulmonary region involved: pneumonic reaction; early granulomatous formation; mature and healed granulomata; mixed pattern (early and mature granuloma in the same pulmonary area visualized in the slide); pulmonary fibrosis. It was concluded that chronic pulmonary Pb is a recurrent disease affecting equally both lungs. Fibrosis was connected mainly with the progressive evolution of the granulomata towards cicatrization and to a lesser degree probably to a direct induction by the fungi. Based chiefly on the tendency of the fibrosis to run around bronchi and to make up septa interconnecting bronchi and vessels it was hipothesized that these findings were the result of a previous chronic specific lymphangitis by the fungi. Hilar fibrosis would be the result of this lymphangitis and/or of the progression of the specific granulomatous reaction seen in the hilar lymph nodes. Non specific forms of arteritis and areas of destructive emphysema related to granulomatous inflammation and fibrosis were described. Three cases developed pulmonary hypertension.

Arteritis↗
PubMed1986

Thickening of pelvic fascia in carcinoma of the rectum. Perirectal fascia or Waldeyer's fascia?

Computed tomography (CT) scan of the pelvis unreliably detects metastases to lymph nodes from rectal carcinoma. Alternative features of tumor spread visualized on pelvic CT scan may aid preoperative evaluation. Two patients in a series had thickened perirectal fascia due to tumor involvement. The perirectal fascia was recently described by others from CT scans of the pelvis. The extent of the perirectal fascia shown on CT scan correlated with descriptions of Waldeyer's fascia that stress its expansive nature enveloping internal iliac vessels and lymphatics. The perirectal fascia and Waldeyer's fascia are proposed to be synonymous, and lymphangitis carcinomatosa is proposed to account for a thickened perirectal/Waldeyer's fascia in rectal carcinoma. The fascial thickening also is found in inflammatory pathology of the rectum (probably due to inflammatory lymphangitis), and fascial thickening on pelvic CT scan is thus not an absolute indicator of carcinoma.

Fascia↗