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PubMed1990

[Epidemiological survey on patients with advanced filariasis in Shandong Province with bancroftian filariasis basically eliminated].

This paper reports on the incidence of advanced filariasis after basic elimination of bancroftian filariasis since 1983 in Shandong Province. Investigation was carried out in a population of 166,776 between 1984 and 1988 in 252 villages of Teng Xian and other 5 counties/cities, the erstwhile highly endemic areas. A total of 1,038 filariasis patients were found with an average incidence of 0.6%. Among them, 383 were with elephantiasis, 357 with chyluria and 298 with hydrocele. 902 cases (86.9%) who suffered the disease before the elimination of filariasis and 136 cases (13.1%) after it, 125 (91.9%) being chyluria cases. The oldest of the 1,038 cases was 86 years of age and the youngest, 6 years of age. The course of duration as 8-74 years in elephantiasis cases, 82.8% of them (317 cases) had previously lymphangitis and/or lymphadenitis. In the past three years 16.4% (52 cases) suffered from prolonged or intermittent acute lymphangitis and/or lymphadenitis. The results of this survey indicated that, after the basic elimination of filariasis in Shandong Province together with thorough clearance of infection source, elephantiasis and hydrocele persisted while new cases of chyluria continued to develop. Therefore, in such areas more emphasis should be put on the treatment of clinical patients. New patients should be surveyed and old patients be treated actively so as to reach the goal of eradicating filariasis.

Adolescent↗
PubMedDate not supplied

[The role of thermography in the diagnosis of testicular diseases].

Combined clinical and thermovision investigation was carried out in 104 patients with various scrotal diseases. Acute epididymitis and orchidoepididymitis (42 patients) were associated with the following thermographic signs: thermo-asymmetric intensity of infrared emission with hyperthermia (0.6 to 2 degrees C) on the affected side, a greater glow area, as compared to actual anatomical size of the organ, "truncal" inguino-iliac hyperthermia in cases of ascending lymphangitis. Asymmetry of heat pattern diminished or disappeared altogether in cases of successful treatment. Hydrocele (32 patients) was associated with enlarged heat outlines on the affected side of the scrotum, without any apparent heat pattern asymmetry. Malignant testicular tumors (30 patients) were associated with enlarged outline of the affected scrotal side with a temperature difference of 1.2 degrees C and more, as compared to the normal side, persistent hyperthermia at repeated examinations, small- and medium-sized hyperthermic foci over the projected liver, lungs, mediastinum, meso- and hypogastrium, lumbar region and in the area of lateral neck surface in cases of metastatic growth. A clear-cut homogeneous hyperthermia over the anterior abdominal wall and in the lumbar region is registered as a post-gamma teletherapy condition. Thermovision is an effective instrument for the diagnosis of benign and malignant scrotal diseases; it makes possible early detection of complications (lymphangitis, lymphadenitis, metastases) providing for an objective assessment of treatment efficiency. The accuracy of thermovision diagnosis was 100% in cases of hydrocele and acute orchidoepididymitis, and 89.6% in cases of testicular tumors.

Adolescent↗
PubMed1988

Herpes simplex virus infection of the hand. Clinical features and management.

Herpes simplex virus (HSV) infection of the hand occurs predominantly in three different population groups. Young adults with a recurrent HSV II infection of the hand account for the majority of cases. A prodromal phase of up to 72 hours and a recurrence of seven to 10 days' duration occasionally associated with lymphangitis, lymphadenopathy, and lymphedema are characteristic. HSV I infection of the hand classically occurs in children with herpetic stomatitis and in health care workers infected during patient care delivery. In health care workers, the infection may last 21 to 28 days and be associated with severe pain and lymphangitis. Recurrences appear uncommon in HSV I infections. Primary infection is usually managed conservatively. Vesicle drainage for pain relief and antiviral therapy with acyclovir may be of value. For recurrent infections, acyclovir, 800 mg orally, twice daily, initiated during the prodrome in an open study of eight patients appeared effective in aborting the attack. Evaluation of long-term suppression in recurrent HSV infection of the hand is in progress.

Acyclovir↗
PubMed1987

[Stewart-Treves pseudo-syndrome caused by cutaneo-lymphatic metastases of contralateral breast carcinoma].

The pathogenesis of Stewart-Treves syndrome remains controversial: angiosarcoma or epithelial cell metastases from a mammary carcinoma? The case reported here, with clinical signs of Stewart-Treves syndrome on one side and mastectomy for carcinoma on the other side of the body, revives the debate. Case-history. The patient was an 89-year old woman whose left breast had been removed in June, 1981 for carcinoma with lymph node involvement. One year after the operation, multiple lymphadenopathy developed in her right armpit and subclavian region. In December, 1984, her right arm became swollen by lymphoedema, while Kaposi-like and nodular skin lesions appeared on her right upper chest and upper back and on her right shoulder and arm. Radiography of the chest showed right pleural effusion, bronchial lymph node enlargement and a reticulate image in the right lung. In spite of chemotherapy, the patient died in April, 1985. Pathology. Pathological examinations included standard histology (HPS, PAS and Gordon-Sweet staining), immunohistochemistry, using anti-factor VIII, anti-keratin KL1 and anti-EMA antisera, and electron microscopy. Results. Irrespective of the skin area biopsied, the histological images were always the same, showing carcinomatous lymphangitis with a varying degree of invasion of the surrounding dermis. Staining of the reticulum enhanced the vascular basal membranes but did not mark the intraluminal tumoral cell population. Post-mortem examination confirmed that the malignant lymphangitis extended to the lung tissue, the oesophageal wall and the adrenal glands, and that the axillary and subclavian lymph nodes were invaded by metastases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1980

[Metastatic pulmonary emboli: clinical types and incidence (author's transl)].

Pathological examinations during autopsy of 1457 cases of cancer demonstrated the presence of metastatic pulmonary emboli in 10 p. cent (148 cases). The were divided, as a function of their site and histological type of the primary neoplasm, as follows: hepatoma 33 p. cent, chorioepithelioma 25 p. cent, endocrine glands 19 p. cent, biliary tract 17.6 p. cent, hypernephroma 15.6 p. cent, sarcoma 13 p. cent, and various other tumors such as cancer of the pancreas, and breast. Two anatomical types of these emboli can be distinguished: one mixed type associated with a pulmonary cancerous lymphangitis (90 cases), and observed at a later stage in the disease. This may be latent or cause a subacute cor pulmonale. The other type is not associated with lymphangitis (58 cases), results from hematogenic cancers (hepatoma, hypernephroma, etc...), is often seen at an early stage, and causes sudden death. Histological examination enabled the consequences of any infarct developing as a result of the emboli to be demonstrated, and the origin of the emboli from neoplasmatic thromboses in the primary cancer drainage routes or from metastases in the liver to be determined.

Breast Neoplasms↗
PubMed1995

[The pathomorphological aspects for the classification of pneumoconioses].

The present national classification of pneumoconioses was adopted 15 years ago. During this time span clinical morphology, a new branch of medical science, was formed and developed. So, the new approaches inspired classic pathologic anatomy and experimental pulmonology to assemble more precise and somehow refined knowledge of pneumoconioses, including the classification. Pneumoconiosis as diffuse pneumonitis can develop 2 main types: interstitial and granulomatous. Both types are characterized by progressive stages of morphogenesis, which are different in various loci of lungs. Those stages are: alveolar lipoproteinosis, serous and desquamative alveolitis, coniotic lymphangitis, coniotic pneumosclerosis. First three of them compose alteration and dystrophic period of the disease, the last one demonstrates pulmonary fibrosis. During the coniotic lymphangitis granulomas could be formed of either macrophages, or epithelioid cells.

Biopsy↗
PubMed1997

African tick-bite fever. An imported spotless rickettsiosis.

OBJECTIVES: To characterize the clinical presentation and course of African tick-bite fever, a recently rediscovered rickettsiosis caused by Rickettsia africae (a new species within the spotted fever group of rickettsiae), to establish its relationship with Amblyomma tick species, and to discuss its role in the etiology of fever in patients who are returning from the tropics. PATIENTS: Seven patients who returned from Zimbabwe of the Republic of South Africa and presented with fever. METHODS: Cases were recognized clinically by the presence of multiple taches noire and were diagnosed as having a rickettsial infection by identification of the organisms in circulating endothelial cells. The causative role of R africae was further demonstrated using cross-absorption and immunoblotting of patients' serum samples and isolation of the agent from blood and skin biopsy specimens. Isolates were characterized using the restriction fragment length polymorphism-polymerase chain reaction and sequence analysis of the gene that encodes for the 190-kd Rickettsia-specific antigen. RESULTS: All 7 patients presented with fever and multiple taches noire. Further physical examination of patients revealed lymphadenopathy, lymphangitis, and edema, but there were virtually no signs of a rash. These findings are characteristic of R africae-infected patients and are distinct from those observed in patients with Rickettsia conorii-induced Mediterranean spotted fever. All 7 patients were infected with R africae as demonstrated by immunoblotting or isolation of the agent, and all were cured. CONCLUSIONS: With increasing international travel, a need for the recognition of rickettsial diseases by physicians is becoming more important. Tick-bite fever, a disease caused by R africae and transmitted by Amblyomma ticks, is characterized by multiple taches noire, lymphadenopathy, lymphangitis, and edema, but no rash or a discrete rash. It is a frequent but benign disease that physicians should consider when presented with febrile patients returning from southern Africa.

Adult↗
PubMed1976

[False basalnomas and false cutaneous metastasis of visceral cancer. Apropos of 7 observations of eccrine carcinoma].

After a review of the bibliography on the subject of eccrine sweat gland carcinomas, the authors emphasize the confusing terminology used for the designation of these cases and the difficulties for a correct clinical and histological diagnosis of these tumors. According to the data obtained from the study of 7 personal cases, the most characteristic features of the eccrine carcinomas could be the following: 1) From the clinical standpoint--Appearance of a single tumour, lasting unmodified for a long period of time.--Tendency to reccurrence of the neighbouring areas after tumour excision, and to a slow progression through the superficial lymphatic channels.--Appearance of distant metastasis a long time after the original lesion. These metastases are observed, a) on the regional lymph nodes, b) on the superficial lymphatic channels and c) in some cases in the skin by intraepidermal growth. 2) From the histological point of view--Localisation in the deep dermis of the tumoral masses in the original lesion.--Acinar or tubular structures. Abundant nitoses and considerable indifferntiation of the cellular elements.--Tendency to the formation of empty peritumoral spaces separating the tumoral masses from the connective tissue by the retraction caused by the fixative.--Styloid or trabecular growth surrounding the main mass of the tumor.--Two types of cells can be observed in some tumours; large cells with a clear cytoplasm and small deeply-stained cells resembling the mioepithelial cells.--Tendency to the formation of clear cell tumoral masses.--Squamous metaplasia of isolated cells or groups of cells.--Presence of PAS-positive cytoplasmatic granulations in some cellular elements.--Degenerative changes with secondary cystic formations.--Frequent features of tumoral lymphangitis. 3y From theions.--Frequent features of tumoral lymphangitis. 3) From the cytological standpoint Staining in yellow of the cytoplasms of the tumour cells with the Panpanicolau method. 4) From the ultrastructural standpoint--Impossibility of classifiying the cells into serous or mucous due to the considerable anaplasia.--Absence of eccrine-apocrine differentiation, of ductal formation and of embrionary sweat cell features.

Basal Cell Carcinoma↗
PubMed2000

Melkersson-Rosenthal syndrome: new clinicopathologic findings in 4 cases.

OBJECTIVE: To define the clinicopathologic features of eyelid involvement in Melkersson-Rosenthal syndrome (MRS). METHODS: Four patients with eyelid edema consistent with MRS were evaluated clinically, including diagnostic imaging in 2 patients. Eyelid tissue from these patients was examined by light microscopy and immunohistochemistry. Polymerase chain reaction for herpes simplex virus was performed in 1 case. RESULTS: The 3 men and 1 woman ranged in age from 33 to 74 years. All patients had insidious, painless, nonpitting eyelid edema. Three patients had unilateral edema; one had bilateral, asymmetric involvement. Ipsilateral lip edema was present in 1 case. Computed tomography demonstrated periorbital heterogeneous thickening that corresponded to the microscopic finding of scattered granulomas. All 4 patients demonstrated epithelioid granulomas inside and adjacent to dilated lymphatic vessels. Polymerase chain reaction testing was negative for herpes simplex virus. CONCLUSIONS: Isolated eyelid swelling that mimics thyroid-associated ophthalmopathy may occur in MRS. Computed tomography may be useful in the diagnosis. Biopsy should be performed in all cases of unexplained nonpitting eyelid edema. In the eyelid, MRS is characterized histopathologically by a granulomatous lymphangitis, a finding that seems to be unique to this condition.

Adult↗
PubMed1977

Intralymphatic BCG in the treatment of gynecologic malignancies: a phase I study.

Thirteen patients with a variety of advanced gynecologic malignancies were administered BCG via the dorsal lymphatics of the lower extremity in addition to standard accepted forms of therapy. Prolonged febrile courses, lymphangitis and suppurative adenitis were observed along the lymphatic pathway of the injected lower limbs. There was no correlation between reaction to a standard anergy panel and survival. There was also no correlation between reaction to a standard anergy panel and the inflammatory response to intralymphatic BCG (ILP-BCG). There was, however, a positive correlation between the inflammatory response to ILP-BCG and survival. Intralymphatic administration of immunostimulants may conceivably be of value as ancillary therapy for use in gynecologic malignancy. However, complications of this approach to immunotherapy are significant and the method should not be used until complications are decreased.

Adult↗
PubMed2004

Antibiotics / anti-inflammatories for reducing acute inflammatory episodes in lymphoedema of the limbs.

BACKGROUND: Lymphoedema is a chronic and progressive condition and current debate revolves around the best course of management for infective/inflammatory episodes. OBJECTIVES: To determine whether antibiotic/anti-inflammatory drugs given prophylactically reduce the number and severity of infective/inflammatory episodes in patients with lymphoedema. SEARCH STRATEGY: We searched the Cochrane Breast Cancer Group register in September 2003, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), CINAHL, MEDLINE, PASCAL, SIGLE, UnCover, reference lists produced by The British Lymphology Society, the National Research Register (NRR) and the International Society of Lymphology congress proceedings. SELECTION CRITERIA: Types of studies considered for review were randomised controlled trials testing an antibiotic or anti-inflammatory drug against placebo (with or without physical therapies). DATA COLLECTION AND ANALYSIS: Eligibility for inclusion was confirmed by two blinded reviewers who screened the papers independently using a checklist of criteria relating to the randomisation and blinding of a trial. Both reviewers extracted data from the eligible studies using a data extraction form. MAIN RESULTS: Overall, four studies (364 randomised patients) were included. Two of these studied the effects of intensive physical treatment plus selenium or placebo in preventing AIE, and two studied the effects of Ivermectin, Diethylcarbamazine (DEC) (anti-filarial agents) and penicillin as prophylactic treatment for adeno lymphangitis(ADL) versus placebo. Both selenium trials reported no inflammatory episodes during the trial period in the treated group but one case of infection in the two placebo groups respectively during the first three weeks of each trial. Seven additional cases of infection in trial one and 14 cases in trial two required treatment in the three month follow up period. One anti filarial trial reported a total of 127 ADL episodes for all groups during the treatment year (compared with 684 episodes reported for the same participants during the pre-treatment year). Another 228 ADL episodes were reported during the trial follow-up year but no significant differences were found between the three groups. No apparent link was found between the grade of oedema and the frequency of ADL episodes. However, there was a significant link between increased episodes and the rainy season. In the penicillin group the mean number of inflammatory episodes was reduced from 4.6 to 0.5 after treatment and increased to 1.9 at the end of the follow-up year. REVIEWERS' CONCLUSIONS: The effectiveness of selenium in preventing AIE in lymphoedema remains inconclusive in the absence of properly conducted randomised controlled trials. Anti-filarials (DEC and Ivermectin) do not appear to reduce ADL episodes in filarial lymphoedema. Foot care may be important in reducing ADL episodes, and penicillin appears to contribute to a significant reduction in ADL, when combined with foot-care. It seems reasonable to emphasise the importance of foot-care to patients and practitioners in preventing infection and this may also apply to care of the arm in women who develop lymphoedema following breast cancer treatment. However, properly conducted trials are needed to demonstrate any efficacy of these interventions.

Anti-Bacterial Agents↗
PubMed2005

Fish vaccine injection injuries of the hand.

High pressure injection of oil-based substances can cause devastating injuries of the hand and the necessity for urgent surgical debridement has been well established. We present three cases of injection injury caused by vaccines used in the fish farming industry. Patients presented with pain, swelling and lymphangitis. The marked vascular changes often associated with such injuries were absent. All patients were treated with intravenous antibiotics combined with early surgical debridement and irrigation. We report full recovery in all three patients.

Accidents, Occupational↗
PubMed2003

Microbiology and management of human and animal bite wound infections.

This article describes the microbiology, diagnosis, and management of human and animal bite wound infections. Various organisms can be recovered from bite wounds that generally result from aerobic and anaerobic microbial flora of the oral cavity of the biting animal, rather than the victim's own skin flora. The role of anaerobes in bite wound infections has been increasingly appreciated. Anaerobes were isolated from more than two thirds of human and animal bite wound infections, especially those associated with abscess formation. This article describes several of the organisms found in the bites of various species. In addition to local wound infection, other complications may occur, including lymphangitis, local abscess, septic arthritis, tenosynovitis, and osteomyelitis. Rare complications include endocarditis, meningitis, brain abscess, and sepsis with disseminated intravascular coagulation, especially in immunocompromised individuals. Wound management includes the administration of proper local care and the use of proper antimicrobial agents when needed.

Abscess↗
PubMed1992

Comparison of a new pressurized saline canister versus syringe irrigation for laceration cleansing in the emergency department.

STUDY OBJECTIVE: Studies have documented the efficacy of normal saline irrigation in decreasing wound infection rates. Wounds traditionally are irrigated using a syringe and needle with manual injection of fluid, a time- and labor-intensive method. We compared irrigation times and infection rates for wounds cleansed with syringe irrigation versus a new, single-use canister of pressurized (8 psi) sterile normal saline. DESIGN: Prospective, randomized, controlled. SETTING: Two Level I emergency departments in tertiary care hospitals, both with emergency medicine residency programs. PARTICIPANTS: Patients with lacerations requiring closure were eligible. Exclusion criteria were wounds above the clavicle more than ten hours old, wounds below the clavicle more than six hours old, insulin-dependent diabetes mellitus, or antibiotic or steroid therapy. Patients (550) were entered between August 1, 1990, and January 31, 1991. Characteristics of the two treatment groups were similar for patient age, age of the wound, size and depth of the laceration, and number of sutures. INTERVENTIONS: Lacerations were irrigated with 250 mL saline in a syringe or 220 mL saline in a pressurized canister for each 5 cm of laceration. At follow-up or suture removal, patients were evaluated for signs of wound complications (cellulitis, ascending lymphangitis, purulent discharge, or dehiscence). MAIN RESULTS: The mean irrigation time for the pressurized canister group (281) was 3.9 minutes versus 7.3 minutes in the syringe irrigation group (254) (P < .0001). The complication rate for the pressurized canister group was 5.0% compared with 3.6% for the syringe irrigation group (not significant, P = .50). Only three of the 20 total complications required antibiotics (two in the pressurized canister group, one in the syringe irrigation group). CONCLUSION: Syringe irrigation times were nearly twice as long as the pressurized canister irrigation times. Use of the pressurized canister facilitates ease of irrigation and markedly decreases the time involved in this traditionally labor-intensive activity. In addition, delivery of the saline is no longer operator dependent, ensuring generation of pressures appropriate for wound cleansing. The pressurized canisters may be useful in standardizing irrigation in wound management research.

Adult↗
PubMed2002

[Infectious complications of lymphedema].

Erysipelas and lymphangitis are frequent complications of lymphedemas (20 to 30%). The most important risk factor for erysipelas is lymphedema since this is a protein rich edema that contributes to the risk of infection. In case of lymphedema the treatment is the usual consensus treatment for erysipelas. A prophylactic treatment with penicillin is requested as soon as the first recurrence. This prophylactic treatment includes skin care, particularly treatment of injuries and intertrigos. Hyperplastic skin leads to maceration and then mycoses. Physiotherapy does not increase the risk for infection. Moreover an infection needs a complex decongestive physiotherapy which decreases risks of recurrence.

Antibiotic Prophylaxis↗
PubMed1989

Intrathoracic manifestations of disseminated prostatic adenocarcinoma.

Four cases of disseminated adenocarcinoma of the prostate illustrating the clinical spectrum of intrathoracic involvement in this disease are presented. In two cases the presenting features of prostatic cancer were with lymphangitis carcinomatosa and an isolated pleural effusion, whereas two other cases developed intrathoracic metastases in the setting of previously known locally advanced prostatic cancer. In one this took the form of hilar and mediastinal lymphadenopathy and in the other that of pulmonary nodules. An immuno-cytochemical marker for prostatic specific antigen, a highly sensitive and specific tool for identifying prostatic epithelium, identified the prostate as the primary site of malignancy in the first two cases. Symptomatic and radiological responses were noted in all four cases after bilateral orchidectomy. Pulmonary metastases are common in the advanced stages of prostatic cancer but may also be present at the initial presentation with the disease even when the primary tumour is not clinically apparent. We recommend that (i) immuno-cytochemical stains for prostatic specific antigen are applied to all lung, pleural and mediastinal biopsy specimens showing adenocarcinoma in male patients, and (ii) all males with intrathoracic adenocarcinoma have prostatic aspiration cytology performed if the prostatic specific antigen stain is positive.

Adenocarcinoma↗
PubMed1997

Elephantiasis nostras of the lips: a case report.

Elephantiasis nostras (EN) is a clinical entity that usually presents as a persistent swelling of the lower extremities. It has been related to recurrent lymphangitis of bacterial origin that causes a fibrosis and thickening of both epidermal and connective tissue. Although very rare, EN has been previously reported in the lips. This is the first case reported in the oral medicine literature that describes EN involving the lips. We describe the clinical features and a differential diagnosis of the lip lesions and a treatment protocol to which this patient has responded. A diagnosis of EN should be entertained in patients with chronically edematous, scaling lip lesions.

Adult↗
PubMed2005

Management of human and animal bite wounds: an overview.

Serious infections can result from wounds that are caused by bites from animals and humans. Organisms recovered from bite wounds generally originate from the oral cavity of the biting animal, as well as from the patient's skin flora. Anaerobes have been isolated from animal and human bite wound infections, especially those associated with abscess formation. In addition to local wound infections, common complications, such as lymphangitis, septic arthritis, tenosynovitis, and osteomyelitis, and uncommon complications, such as endocarditis, meningitis, brain abscess, and sepsis, may occur. Wound management includes proper local care and, when needed, antimicrobial therapy.

Animals↗