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PubMed1990

Acute primary cutaneous nocardiosis.

An acute localized, purulent skin lesion developed on the right knee of an 8-year-old girl and was subsequently diagnosed as a primary cutaneous Nocardia brasiliensis infection. It was soon accompanied by intense lymphangitis and regional adenopathy. The patient had a history of a minor abrasion contaminated by soil at the site of infection 8 days before the infection became evident. The infection was successfully treated with a combination of minocycline and dapsone.

Acute Disease↗
PubMed1991

Pulmonary tumour embolism from squamous cell carcinoma of the oesophagus.

Pulmonary tumour embolism and subacute "cor pulmonale" have been reported in association with tumours of different origins. Even though these features were first described in a patient with carcinoma of the oesophagus, the frequency and importance of oesophageal tumours as the source of pulmonary tumour embolism have not been studied. In the present investigation, the lungs of 16 autopsied patients with squamous cell carcinoma of the oesophagus were studied prospectively. The lungs were removed as a block and 15 sections (3 from each lobe) were analysed. Pulmonary tumour embolism was detected in 7 cases. The lymphatic vessels were involved in all of them, and were associated with arteries and arterioles in 2. 2 patients presented a classical picture of subacute cor pulmonale, and dyspnoea was present in 3 other cases. The present study permitted us to conclude that carcinomas of the oesophagus frequently evolve toward carcinomatous lymphangitis and that pulmonary tumour embolism should be included in the differential diagnosis of the dyspnoea presented by the patients.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Acute lymphatic filariasis in an American traveler.

Acute lymphatic filariasis developed in an American traveling recreationally to Asia. The illness was characterized by fatigue, eosinophilia, and lymphedema of the arm and chest wall, but no lymphangitis, lymphadenitis, or pain. Complete resolution occurred over 1-2 years. We discuss this syndrome and describe the use of new diagnostic tests in its diagnosis and management.

Arm↗
PubMed2006

Wuchereria bancrofti: effect of single and multiple larval inoculations on infection dynamics and development of clinical manifestations in non-human primate Presbytis entellus.

We earlier reported the successful experimental transmission of Wuchereria bancrofti from humans to the Indian leaf monkey (Presbytis entellus) [Misra, S., Tyagi, K., Chatterjee, R.K., 1997. Experimental transmission of nocturnally periodic Wuchereria bancrofti to Indian leaf monkey (Presbytis entellus). Experimental Parasitology 86,155-157.; Dube, A., Murthy, P.K., Puri, S.K., Misra-Bhattacharya, S., 2004. Presbytis entellus: a primate model for parasitic disease research. Trends in Parasitology 20(8), 358-360.] using a small number of animals. The present study, involving 27 langur monkeys, found the development of pathological manifestations ranging from filarial fever, lymphangitis, lymphadenitis, hydrocoele, and limb edema to minor histopathological changes in tissues after single, double, triple, or multiple inoculations of infective larvae of W. bancrofti recovered from Culex quinquefasciatus fed on human microfilaraemic blood. Thirty-eight percent of the infected langurs developed detectable microfilaraemia in their blood. Single or double larval exposure resulted in better worm establishment than multiple exposures with small numbers of larvae. All of the langurs receiving a single large inoculum and 85.71% of those receiving two inoculations harbored adult parasites. Worm establishment decreased with increasing number of larval inoculations. In all, 60% of infected langurs developed classical gross-pathological symptoms of lymphatic filariasis. Of these, 29.16% developed thickening of the lymphatics, 25% suffered from periodic rise in rectal temperature, and 16.66% developed scrotal swelling with presence of microfilariae in the hydrocoele fluid. Only one out of 25 langurs (4%) developed acute limb edema. It appeared that a single inoculum of a large number of infective larvae was able to induce maximum pathology. Fifty-six percent of the infected langurs acquired a peculiar sitting posture, retracting both the hind limbs, usually after 4-5 months of larval inoculation and eventually resulting in reduced mobility. Oral administration of diethylcarbamazine (citrate) at 12mg/kg for 12 consecutive days to one langur caused 80% suppression in microfilaraemia on day 8, killing all the adult parasites. Of the two immunosuppressed (cortisone- or prednisolone-treated) male rhesus monkeys included in the study, neither developed any of the above lymphatic symptoms or parasites after receiving larval inoculations on two or three occasions; however, a rise in rectal temperature in one of the animals was noticed. The present study thus reveals that the Indian leaf monkey, P. entellus, may serve as an ideal non-human primate model of human bancroftian filariasis for carrying out longitudinal studies on pathology, host-parasite interactions, and preclinical evaluation of candidate anti-filarial drugs or vaccines.

Animals↗
PubMed2006

A forensic case of Munchausen's syndrome.

The case of a 37-year-old cleaning worker, who applied to the court with a claim of being fired from her job due to permanent functional loss of her left arm triggered by a stroke following a work accident, is presented. The court has forwarded the case to the forensic medicine department for further evaluation and documentation of the judicial report. Examination of the medical files has revealed that the person applied to our and other hospitals with various symptoms simulating urologic, neurological, musculoskeletal, cardiovascular, and pulmonary disorders. The person had been hospitalized for extensive, costly, and often invasive medical examinations and/or treatment, and deceived the physicians into carry out unnecessary diagnostic procedures. No objective signs or evidence related to a work accident or stroke was obtained from the medical records. She has been followed up with the diagnosis of lymphangitis, thrombophlebitis and repeated cellulities since 2001, and the infection had been caused by intentional insertion of glass pieces into her left arm. The reason why she was unable to use her left arm was because of contraction related to the repeated soft tissue infection rather than the claimed work accident. This case was not only trying the medical personnel to make errors and confusion, but also attempting to mislead the judgment. Therefore, in forensic cases, medical history of patient must be evaluated carefully.

Accidents, Occupational↗
PubMed2004

Dyspnea and its correlates in taiwanese patients with terminal cancer.

This study prospectively assessed dyspnea and related bio-psycho-social-spiritual factors--including severity, cause, psychological distress, and fear of death--that were possibly related to dyspnea in 125 terminal cancer patients at admission and two days before their death. At admission, 74 patients had dyspnea, which improved but later worsened. Causes included cachexia, anemia, pleural effusion, and lymphangitis. Quality of life, anxiety, depression, and fear of death improved after admission; anxiety was correlated with dyspnea before death (r = 0.211, P < 0.05, univariate analysis). Lung infection (odds ratio = 2.29, 95% confidence interval = 0.68-3.90; multiple regression), airway obstruction (2.27, 1.41-3.13), acidemia (1.82, 0.72-2.98), and pericardial effusion (1.38, 0.44-2.32) were independent correlates of dyspnea severity at admission (42.8% of explained variance). Before death, airway obstruction, esophageal cancer, pericardial effusion, lung infection, and mediastinal mass were independent correlates of severity (42.7% of explained variance). Comprehensive care, including improved psychospiritual status, can help in controlling dyspnea and enhancing patients' quality of life.

Adolescent↗
PubMed2005

Tissue microcircumstances for leukocytic infiltration into the testis and epididymis in mice.

Spermatozoa do not appear in the seminiferous epithelium until puberty, when immune tolerance has already been established. Therefore, they contain various autoimmunogenic materials which are recognized as foreign by the self immune system. However, the testis and epididymis are known as immunologically privileged organs. In particular, the blood-testis barrier (BTB) formed by Sertoli cells and the blood-epididymal barrier formed by epididymal epithelial cells protect autoimmunogeneic spermatozoa from attack by the self immune system. The immune privileged circumstances in the testis and epididymis have been demonstrated by many studies to involve a local transplantation system. We review here the immune privileged status of these organs from the viewpoint of induction of inflammatory cell responses in mice. The testicular interstitium in mice is resistant to vasculitis, lymphangitis, spermatic granuloma and polymorphonuclear cell infiltration: however, the epididymal interstitium is vulnerable to them. Therefore, the testicular tissue outside BTB is also protected from inflammatory cell infiltration, although many resident macrophages are normally present in the testis. In sharp contrast, subcutaneous injection of viable syngeneic testicular germ cells (TGC) alone induces autoimmune orchitis with no involvement of the epididymitis in mice. In the testes of TGC-immunized animals, severe lymphocytic infiltration with aspermatogenesis was seen in spite of no use of adjuvants. Unexpectedly, injections of viable epididymal spermatozoa (ES) did not evoke any autoimmune inflammation in the epididymides. Therefore, the testis rather than the epididymis may easily become an unprivileged organ as to autoimmunity under some special conditions.

Animals↗
PubMed2005

A case of exposure to Bancroftian filariasis in a traveller to Thailand.

A New Zealander travelling recreationally to Asia became exposed to Bancroftian filariasis. The traveller had presented incidentally with gastrointestinal illness. In addition to diarrhoea, the traveller's symptoms were non-specific and there was no eosinophilia, lymphoedema, lymphangitis, lymphadenitis, or pain. The immunochromatographic test for Wuchereria bancrofti was positive indicating that there was or had been an adult filarial worm. The illness resolved completely following treatment with ivermectin.

Adult↗
PubMed2005

Progression of conservatively treated endometrial carcinoma after full term pregnancy: a case report.

INTRODUCTION: We describe a case of conservatively treated endometrial endometrioid (EE) adenocarcinoma which showed an aggressive clinical outcome after pregnancy. CASE: A 30-year-old woman with a well differentiated EE adenocarcinoma decided to attempt a conservative approach and underwent progestin treatment with subsequent negative ultrasound and hysteroscopic controls. After 3 months, she conceived and at 36 weeks of gestation, a cesarean section was performed with multiple negative biopsies. Eight 8 months after delivery, an exploratory laparotomy documented disseminated poorly differentiated EE adenocarcinoma. Staging work up revealed diffuse metastatic disease. Despite chemotherapy, the patient experienced progression of disease with fatal acute respiratory syndrome due to massive neoplastic pulmonary lymphangitis. CONCLUSION: Conservative medical management of endometrial cancer in young women willing to preserve their reproductive potential, carries on potential risks. Careful selection of cases, informed consent, and strict follow up procedures are mandatory.

Adult↗
PubMed1998

[Laparoscopic treatment of generalized peritonitis with diverticular perforation of the sigmoid colon. Report of 10 cases].

BACKGROUND: The classical treatment of perforated sigmoid diverticulitis with generalised peritonitis is based on the principle of two-stage surgical procedures with a temporary initial defunctioning colostomy. This approach is associated with significant morbidity, concerning mainly the abdominal wall. PATIENTS AND METHODS: Ten consecutive patients, eight female and two male, with a mean age of 54.6 years, underwent an emergency laparoscopy for generalised peritonitis secondary to perforated diverticula. Six had had previous infectious episodes; six were obese; four were diabetic and two had chronic lung disease. After exploration of the abdominal cavity and discovery of a purulent peritonitis (n = 8) or faecal peritonitis (n = 2), an extensive peritoneal lavage was performed (average 15 litres), the contaminating sigmoid lesion was covered with biological glue and a drain inserted at the site of the lesion. In some cases, drainage of dependent zones was also performed. No colostomies were performed. Antibiotic therapy instituted as soon as the diagnosis had been made was continued, on average, for 7 days. RESULTS: There was no mortality. There was a low morbidity: one case of lymphangitis on catheter and one of broncho-pulmonary infection. No cases of abdominal wall sepsis or residual deep collections were observed. The mean duration of hospitalisation was 8 days. Nine patients underwent a sigmoid resection (laparoscopic in eight cases) 3 to 4 months later, with a mean duration of hospitalisation of 6 days. One conversion to laparotomy was necessary. CONCLUSIONS: Laparoscopic treatment of generalised peritonitis secondary to perforated sigmoid diverticulitis constitutes an alternative to classical surgery. It is associated with a decreased morbidity and a marked reduction in duration of the hospitalisation. Colostomy can be avoided and the patient's quality of life is improved during the period previous to secondary colectomy, performed by laparoscopy eight times out of nine. In addition, the cost of this approach is significantly lower.

Adult↗
PubMed1999

Thoracic manifestations of breast carcinoma: metastatic disease and complications of treatment.

Breast cancer, a common malignancy in women, is a major cause of cancer-related deaths. Metastases to the thorax are common in patients with breast cancer. Metastases can manifest radiographically as pulmonary nodules, lymphangitis carcinomatosa, endobronchial masses, intrathoracic adenopathy, pericardial or myocardial masses and pleural effusions. Additionally, pulmonary abnormalities occur after radiotherapy, chemotherapy and autologous bone marrow transplantation. Knowledge of the various intrathoracic manifestations of metastases and complications of therapy is important in staging and evaluating patients with breast cancer and deciding on the most appropriate treatment.

Antineoplastic Agents↗
PubMed1992

Prophylactic use of antimicrobial agents in adult patients.

The prophylactic use of antimicrobial agents is recommended for prevention of numerous infections, including tuberculosis, endocarditis, rheumatic fever, recurrent cellulitis and lymphangitis in patients with lymphedema, meningococcal meningitis, and bite wounds. In addition, the prophylactic use of antimicrobial agents has proved effective in certain surgical procedures such as various abdominal operations, hysterectomy, and major operations that involve the head and neck. Except for oral bowel preparations, antimicrobial prophylaxis should be limited, in general, to the operative period. Prolonged perioperative prophylaxis has not been shown to enhance effectiveness and may result in increased toxicity, resistant superinfections, and inflated costs. The investigation of antimicrobial prophylaxis necessitates adequate evaluation of the potential advantages and disadvantages in a prospective, double-blind fashion.

Adult↗
PubMed1987

Prophylactic use of antimicrobial agents in adult patients.

Prophylactic antimicrobial agents are recommended for prevention of a variety of conditions, including tuberculosis, endocarditis, rheumatic fever, recurrent cellulitis and lymphangitis in patients with lymphedema, meningococcal meningitis, bite wounds, and herpes virus infections. In addition, prophylactic antimicrobial agents have proved effective in certain surgical procedures such as a variety of abdominal operations, hysterectomy, and head and neck operations for cancer. Except for oral bowel preparations, administration of antimicrobial agents for prophylaxis should be limited, in general, to the perioperative time period. Doses given more than an hour before or 3 hours after a surgical procedure have not been shown to increase effectiveness, and such an approach increases the cost and the probability of toxicity and superinfection. Investigation of antimicrobial prophylaxis necessitates adequate evaluation of potential advantages and disadvantages in prospective double-blind fashion.

Adult↗
PubMed1983

Animal bites.

Animal bites are an extremely common problem in the United States. Dogs are by far the most common offender, closely followed by cats, humans, and rats. Most injuries are trivial, but can become infected, and fatalities do occur. A wide variety of organisms cause a multitude of clinical problems, but cellulitis and lymphangitis caused by Pasteurella multocida are most common. Human bites, especially of the hand, present major problems in management, and staphylococci or streptococci are frequent pathogens. Penicillin is an effective first-line antibiotic for animal bites, while a penicillinase-resistant penicillin, a cephalosporin, or erythromycin should be used for human bites. Attention should always be paid to the potential problems of rabies and tetanus.

Animals↗
PubMed1993

Lymphatic disorders in rheumatoid arthritis.

Lymphedema is a rare complication of rheumatoid arthritis (RA). Diagnosis is clinical: long-standing, painful swelling of a whole limb in association with RA. Cases described in the literature are predominantly of the upper limbs, sometimes bilateral. Diagnosis can be confirmed by biopsy of lymph nodes, lymphography, or preferably lymphoscintigraphy. The etiology of the edema is unknown. Mechanical obstruction and lymphangitis have been suggested. Pharmacological and surgical treatment of the edema have been disappointing, and treatment of the underlying RA does not improve the lymphedema. Physical treatment of the affected limb, such as massage, manual drainage techniques, light compression bandaging, and exercise, has been moderately effective.

Aged↗
PubMed1989

Pulmonary lymphangitic carcinomatosis secondary to cervical carcinoma: a case report.

Pulmonary lymphangitic carcinomatosis is a rare form of metastatic cervical cancer. A patient with persistent squamous cell carcinoma of the cervix presented with symptoms suggestive of pulmonary embolism and right heart failure. Pulmonary lymphangitic spread of the cancer was found postmortem. The pathogenesis of pulmonary lymphangitis carcinomatosis is reviewed and diagnostic evaluation discussed.

Adult↗
PubMed1985

Elephantiasis nostras 1984.

Elephantiasis nostras is a rare condition that usually presents as a persistent swelling of the lower extremity secondary to recurrent lymphangitis. We present a patient, originally referred for "angioneurotic edema of the lip," who presented with a history of several months of persistent swelling of the upper lip. There was probable evidence for recent infection of the lip that is consistent with the diagnosis of elephantiasis nostras. This disease should be included in the differential diagnosis of chronic persistent angioedema of the lip.

Adult↗
PubMed1984

A profile of skin sepsis in meat handlers.

Four hundred and sixty-seven episodes of sepsis associated with meat handling and poultry processing occupations were seen in two Health Districts of North Yorkshire in a period of just over five years. Altogether 389 patients were infected in 16 outbreaks and 24 sporadic incidents; spread of infection was noted in families of nine workers. The variety of skin infections included septic cuts and scratches, paronychia, abscess, lymphangitis as well as infection in pierced ear lobes and in tattoos. Beta-haemolytic streptococci or Staphylococcus aureus were present in 96 per cent of the 303 episodes that yielded positive cultures. These included 203 episodes with Streptococcus pyogenes and 170 with S. aureus. Skin sepsis appears to be common among meat handlers in this part of England.

Abattoirs↗