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PubMed2003

Dramatic effect of ZD1839 ('Iressa') in a patient with advanced non-small-cell lung cancer and poor performance status.

We describe the case of a 52-year-old Japanese woman with advanced adenocarcinoma of the lung, in whom once-daily treatment with 250 mg ZD1839 ('Iressa') demonstrated a marked antitumour effect. She had initially achieved a partial response with cisplatin-based combination chemotherapy, but had subsequently progressed and had failed to respond to salvage chemotherapy. She had also received whole-brain irradiation for brain metastases. On admission, the patient was confined to bed due to dyspnoea and had rapidly progressing hypoxia secondary to lymphangitis carcinomatosa and a massive right pleural effusion. She was treated with oxygen supplementation and oral ZD1839, which, within a week, led to marked tumour regression and gradually improving dyspnoea. The main adverse event observed was a grade 2 rash. A month after starting ZD1839 treatment, the patient was discharged without the need for oxygen supplementation and had since returned to full-time work. This is a demonstration of ZD1839 producing a dramatic clinical response when administered to a patient with poor performance status who had received extensive prior treatment with cytotoxic agents.'Iressa' is a trademark of the AstraZeneca group of companies.

Adenocarcinoma↗

PubMed1996

[The so-called malignant pleural effusion: a new review of direct data obtained with diagnostic pleuroscopy].

We analyze a series of 896 thoracoscopies for pleural effusion, of which 78% (662/896) were due to pleural carcinomatosis, primary or metastatic. Pleural malignancy was observed mainly, in the right hemithorax (65%), arising from tumors within the diaphragm. The likelihood of finding pleural metastasis in lung cancer was 77%. When the pleural effusion is slight (less than 500 ml) the likelihood falls to 22%. We therefore advise thoracoscopy in the former and thoracotomy in the latter. Blood-stained effusion continues to have the worst prognosis (84% stemming from metastasis) and signifies an advanced stage of pleural metastasis. The pleura parietal is involved in 69% of pleural carcinomatosis cases, and in 80% when the lower hemithorax or the area around breast or lung tumors are involved. The cytology yield was 45.9%, though always depending on extent of metastasis. When metastasis was slight, the likelihood of positive cytology was less (19%) and when metastasis was generalized throughout the entire pleura the likelihood increased to 73%. We found no reason to think that the cells in most pleural liquids are able to nest and form tumoral niches. The origin of such cell nests was rather found to be in shedding from the metastases themselves, from lung tumors or from carcinomatous lymphangitis by lymphatic obstruction. The diagnostic yield of thoracoscopy once again proved to be superior to that of pleural biopsy.

Adult↗

PubMed1979

Epidemiologic and clinical aspects of animal bite injuries.

During 1975, 332 animal bite injuries accounted for 1.2% of all surgical problems treated at the UCLA Hospital Emergency Department. Data on 307 bite injuries were available and analyzed for environmental, animal, human, interaction, and clinical factors. More than half of the dog bites and almost three fourths of the cat bites-scratches happened at or near the victims' homes. Dog bites were almost twice as common among men, while cat bites-scratches were twice as common among women. Of the incidents in which ownership information was available, 85% of dog bites and 80% of cat bites-scratches were from an animal belonging to the victim, his family or friends, or another known person. Forty-three percent of dog bites, and 52% of cat bites-scratches were provoked, that is, happened while the victim was interacting with the animal. Of bites of the head and/or neck, 38% injured the upper lip; 17% of dog bites injured the eye or adjacent tissues; 48% were in children less than ten-years-old. On fifth of cat bites-scratches involved the head and/or neck, 60% of these injured orbital or periorbital tissues. Over 2% of patients were hospitalized. Five percent of dog bite victims and 29% of cat bite-scratch victims returned with complications, mostly cellulitis or lymphangitis. Pasteurella multocida was the most common pathogen cultured, as evidenced by the 50% and 80% culture-positive rates for dog and cat bite-scratches respectively in this series.

Adolescent↗

PubMed1982

Pasteurella multocida--the major cause of hand infections following domestic animal bites.

Pasteurella multocida is a common cause of infection following bites or scratches caused by dogs and (especially) cats. It is rarely reported, however, and apparently often overlooked as a pathogen. The typical clinical manifestation is a rapidly developing cellulitis at the site of injury. The infection is potentially dangerous and can cause a chronic local infection of deep tissues and osteomyelitis. It responds well to several antimicrobials, with penicillin being drug of choice. Fifty-five patients are reported--72% with cat bites and/or scratches and 28% with dog bites. Ninety-two percent of the wounds went deeply through the skin. All patients presented for treatment 12 to 72 hours after receiving the animal wounds to their hands. Drainage from all wounds was serosanguineous or purulent, and cultures taken were positive for P. multocida. All of the wounds responded to surgical drainage and penicillin. One patient developed osteomyelitis. The acute onset of cellulitis, lymphangitis, and serosanguineous or purulent drainage from hand wounds 12 to 24 hours after cat or dog bites should suggest P. multocida as the predominant etiologic agent. Immediate surgical drainage and penicillin therapy is the treatment of choice.

Adolescent↗

PubMed2003

Diagnosis of histoplasmosis by detection of the internal transcribed spacer region of fungal rRNA gene from a paraffin-embedded skin sample from a dog in Japan.

The lesions of histoplasmosis in dogs in Japan differ from those in dogs in North America. Affected dogs in Japan have had multiple granulomatous or ulcerated foci in skin or gingiva and have not had pulmonary or gastrointestinal lesions. The present report introduces a polymerase chain reaction (PCR) diagnosis of canine histoplasmosis and the characteristic of disease in Japan. The surgically removed skin ulcerate samples from a 5-years-old female Shiba-inu native to Japan without traveling out of the country were evaluated. Tissue samples had many yeast-like organisms in the macrophages. DNA was extracted from paraffin-embedded tissue samples. A nested PCR technique was applied. The detected sequence of the internal transcribed spacer of ribosomal RNA gene had 99.7% in homology with Ajellomyces capsulatus (the teleomorph of Histoplasma capsulatum). Clinical manifestations, historical background of equine epizootic lymphangitis in Japan, and a human autochthonous case of histoplasmosis farciminosi indicated that this dog might have been infected with H. capsulatum var. farciminosum as a heteroecism.

Animals↗

PubMed1998

Tularemia in a common marmoset (Callithrix jacchus) diagnosed by 16S rRNA sequencing.

We report a case of tularemia in a common marmoset (Callithrix jacchus) diagnosed by determination of the isolate's 16S ribosomal RNA (rRNA) gene sequence. Pathological examination of the animal revealed a multifocal acute necrotizing hepatitis, interstitial nephritis, splenitis, and lymphangitis of the mandibular, retropharyngeal, and cervical and mesenteric lymph nodes. Moreover, multiple foci of acute necrosis were found in the epithelium of the jejunum and the interstitium of the lung. Bacteriological investigations revealed a septicemia. The isolated infectious agent was uncommon, not routinely diagnosed in our laboratory and therefore difficult to identify by conventional tools in a reasonable time and effort. thus, we decided to perform a genetic analysis based on the 16S rRNA gene sequence. Thereby, an infection with Francisella tularensis, the causative agent of tularemia, was unambiguously diagnosed. This shows the great advantage 16S rRNA gene sequencing has as a general identification approach for unusual or rare isolates.

Animals↗

PubMed1998

Comparative molecular characterization of Corynebacterium pseudotuberculosis of different origin.

Ribotyping and susceptibility to 17 antimicrobial agents were used to compare 37 isolates of Corynebacterium pseudotuberculosis (28 from horses, 1 from cattle, 3 from sheep and 5 from goats) derived from various types of lesions, and different geographic locations. According to the presence of nitrate reductase, all but one isolate from horses reduced nitrate (nitrate-positive), whereas all isolates from sheep and goats were unable to reduce nitrate (nitrate-negative). The ribotype of the nitrate-negative isolate from a horse with ulcerative lymphangitis was identical to all the other isolates from horses, and different than the ribotype of nitrate-negative isolates from sheep and goats. Ribotyping with one of the restriction endonucleases, Apa 1, revealed differences between, but not within, the two biotypes. However, ribotyping with Pst 1 endonuclease revealed one variant within the equine biotype and one variant within the ovine biotype. The minimum inhibitory concentration (MIC; microgram/ml) of antimicrobial agents against isolates from nitrate-negative and nitrate-positive groups was very similar, with the exception of isolates from sheep and goats which had a higher MIC for amikacin than isolates from horses and cattle.

Animals↗

PubMed2001

Pediatric observation medicine.

Observing pediatric patients in an OU (whether a pediatric or combined or hybrid unit) has many advantages: better patient care, a decrease in missed diagnoses and acuity, better risk management, decreased malpractice liability, cost effectiveness, increased patient and family satisfaction, and psychosocial benefits. Key principles of observation medicine (purpose, time frame, general patient inclusion and exclusion criteria, administration, CQI, and so forth) are equivalent for pediatric and adult observation patients, but there are important differences. Unique characteristics of pediatric observation patients include specific diagnosis, decreased length of stay, less need for cardiac monitoring, a highly variable admission rate, and a decreased percentage or admission rate to the OU from the ED. Whereas the adult OU is primarily a cardiac-monitoring unit, the pediatric OU is a respiratory and infectious disease unit with a frequent need for an i.v. therapy and hydration. Types of pediatric patients commonly treated in an OU include respiratory illnesses (asthma, croup, bronchiolitis, pneumonia), gastrointestinal disorders (gastroenteritis, abdominal pain), dehydration, infections (fever, cellulitis, lymphangitis, pyelonephritis or UTI), overdoses or poisonings, and seizures.

Adult↗

PubMed2002

Descriptors of breathlessness in patients with cancer and other cardiorespiratory diseases.

The objective of this study was to examine the relationship between descriptors of breathlessness and its underlying cause in patients with lung cancer and cardiopulmonary diseases to see whether descriptors might be used to help determine the cause of breathlessness, particularly in patients with lung cancer. We studied 131 patients with primary or secondary lung cancer, whose breathlessness was attributed to tumor mass, pleural effusion, lung collapse, metastases, pleural thickening or lymphangitis carcinomatosis, and 130 patients with breathlessness attributed to asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease or cardiac failure. Patients selected statements (descriptors) that described the quality of their breathlessness from a 15-item questionnaire and the relationship between the descriptors and the attributed cause of breathlessness was evaluated by cluster analysis. All patient groups were characterized by more than one cluster and several clusters were shared between groups. Specific sets of clusters were associated with breathlessness due to asthma, COPD and cardiac failure, and to cancer causing collapse, metastases or pleural thickening. The association of different sets of clusters with the different diagnostic groups suggests that patients are describing qualitatively different experiences of breathlessness, but the relationship does not appear to be sufficiently robust for the questionnaire to aid differential diagnosis.

Aged↗

PubMed2000

Adherence characteristics and susceptibility to antimicrobial agents of Staphylococcus aureus strains isolated from skin infections and atopic dermatitis.

We examined the adherence characteristics and susceptibility to various antimicrobial agents of 130 strains of Staphylococcus aureus isolated from infective skin lesions and 135 strains of S. aureus isolated from non-infective eczematous lesions of atopic dermatitis (AD) patients. The isolation rate of methicillin-resistant S. aureus (MRSA) was 27.7% in strains from clinical sources excluding AD and 31.1% in those from AD. Coagulase type II strains were most frequently observed in MRSA strains isolated from all sources excluding AD, and coagulase type III strains were most frequently observed in those isolated from AD. We proposed that antimicrobial treatment for AD patients should be carefully designed to prevent MRSA infection. Plasma coagulation ability was lowest in S. aureus strains isolated from abscesses, suggesting that the lower production of fibrin observed in abscesses may assist the infiltration of neutrophils into skin tissues and that a decrease in plasma coagulation ability may enable abscess formation. Adherence to polypropylene tubes with slime production was most evident in S. aureus strains isolated from felon and least evident in those isolated from cellulitis and lymphangitis. Tube adherence was characteristic of the S. aureus strains attached to superficial skin tissues, but not necessarily for strains that had infiltrated the deep skin tissues. Fusidic acid demonstrated significant antimicrobial activity against the MRSA strains, but rifampicin was the strongest antimicrobial agent.

Anti-Bacterial Agents↗

PubMed2001

[Severe Streptococcus pyogenes cutaneous infections].

Streptococcus pyogenes is the first bacteria encountered in severe cutaneous infections in children. They enclose erysipela (papillar derma concerned more than hypoderma, lymphatic involvement) and necrotising fasciitis NF (focus on fascia and muscles with extension to hypoderma and reticular derma; venous thrombosis; hypodermic and aponevrotic necrosis). A skin lesion is the entrance of infection: varicella lesions are a major factor of NF. In France, sporadic cases in children are observed. The annual incidence of S. pyogenes invasive diseases is 1/100,000 children under 5 years of age and 0.6/100,000 children under 15 years of age. In North America, resurgence has been notified during the past ten years with mortality and morbidity due to NF and toxic shock syndromes. Interaction between bacteria and host, natural reservoir, explains the physiopathology. During the past ten years, some serotypes have become more invasive and virulent. Any cutaneous lesion interrupt the dermal barrier. Bacterial wall, proteins M and adhesins permit colonisation. Four pyrogenic exotoxins are superantigens; some facilitate inflammation, tissular lesions and shock; other participate to bacterial extension. In young children, immune response is immature. Albeit causal link between non-steroids anti-inflammatory drugs and NF in varicella children was not clearly demonstrated, caution should be kept in mind. Diagnosis of erysipela is clinical: sudden appearance of an inflammatory zone, most often on legs, with high fever and pain; sometime peripheral surelevation, lymphangitis, adenopathia. Other aspects open discussion with NF. In NF are in favour, added to high fever, huge pain, erythema and oedema: rapid extension of lesions, cutaneous hypoesthesia appearance, gap between intense severe general status (toxic shock syndrome) and paucity of local signs. NF is a medico-surgical emergency. Early surgery with complete excision of necrotic tissues permit survival. Magnetic resonance is useful in subacute NF. Microbiological diagnosis is possible in 20 to 80% of cases, using combined methods. Blood cultures identify the bacteria in 5 to 20%, skin lesion samples in 30%. Local samples are less useful even with modern techniques. Therapeutic strategy depends on initial diagnosis. Intra-venous antibiotics are necessary: penicillin (G, A or M) is first line therapy. In erysipela, ten days allow a rapid cure without sequellae. In NF, antibiotics are associated with intensive care and surgery. A late diagnosis, a too late surgery explain 16 to 36% of deaths encountered.

Adolescent↗

PubMed1999

Detection of non-infectious conditions mimicking pneumonia in the intensive care setting: usefulness of bronchoalveolar fluid cytology.

The present study investigated the usefulness of bronchoalveolar (BAL) fluid cytology in the identification of non-infectious pulmonary conditions in patients hospitalized in the intensive care unit (ICU) and suspected of pneumonia. A total of 182 BAL fluid samples obtained during a 27-month period from 130 ICU patients with suspected pneumonia were quantitatively cultured and investigated for opportunistic pathogens. Cytocentrifuged preparations stained with the May-Grünwald Giemsa and Perls's methods were reviewed. A non-infectious aetiology was considered when cultures yielded micro-organisms in quantities < 10(3) colony-forming units (CFU) per ml, in the absence of any other pathogen and in conjunction with one or more of the following cytological findings: > 20% haemosiderin macrophages, > 10% lymphocytes, the presence of activated lymphocytes, plasma cells, > 5% eosinophils, a preponderance of foamy macrophages, reactive type II pneumocytes or malignant cells. Patients' clinical records were reviewed to identify a clinical diagnosis for these episodes. In thirty-five (19.2%) BAL fluid samples from 26 patients, the cytological findings pointed to a non-infectious origin. An alternative diagnosis was ascertained in 20 of 26 patients. Diagnoses included: drug-induced pneumonitis (n = 7), aspiration of gastric contents (n = 2), pulmonary emboli (n = 3), adult respiratory distress syndrome (n = 4), lung contusion (n = 1), cardiogenic pulmonary oedema (n = 1), and carcinomatous lymphangitis (n = 2). The BAL fluid cytological findings were readily discernable and proved to be useful in the diagnostic work-up of samples obtained from ICU patients with suspected pneumonia.

Adult↗

PubMedDate not supplied

Aeromonas hydrophilia infections after penetrating foot trauma.

The bacterium Aeromonas hydrophila is an anaerobic gram-negative bacillus commonly found in natural bodies of water and can cause infection in patients who suffer water-associated trauma or in immunocompromised hosts. The authors present 5 cases of penetrating wound trauma that did not involve any aquatic environment and developed rapidly forming infections. All patients presented with severe pain, cellulitis, ascending lymphangitis, fever, and pain on range of motion of the joint near the traumatic site. Presentation of clinical symptoms mimicked that of a septic joint or of severe streptococcal infection. All patients required surgical incision and drainage, intravenous and oral antibiotics using levofloxacin or bactrim, and local wound care. Results from cultures taken intraoperatively showed only A hydrophilia in every case. Resolution of symptoms occurred rapidly after surgery, and clinical resolution was seen within 72 hours. Each patient healed uneventfully and returned to preinjury status.

Adolescent↗

PubMedDate not supplied

Prospective analysis of postoperative wound infections using an early exposure method of wound care.

The management of operative wounds in most surgical procedures is important in preventing many complications, most notably, infection. Among most surgical subspecialties, postsurgical dressings vary in type of materials utilized as well as duration left in place. The authors propose that the contemporary method of postoperative wound management (i.e., dressings left in place until sutures are removed) is overly conservative when dealing with the uncomplicated patient population. This study involves 100 patients who underwent forefoot, rearfoot, or ankle procedures in which skin incisions were made on nonweightbearing surfaces and percutaneous pins, external fixators, or casts were not utilized. All wounds were considered clean and patients displayed an uncomplicated medical history. Postoperatively, the patients were treated by an early exposure method (i.e., the wounds were left undressed on the 4th postoperative day and patients were allowed to bathe in their usual manner). Patients returned on postoperative day 10-14 at which time sutures were removed. Wounds were inspected up to 12 weeks following surgery. An infected wound was defined by the presence of cellulitis or lymphangitis or by the secretion of purulence from the incision line. The incidence of wound infection was 1.0%. This study also includes analysis via questionnaire of the postoperative care utilized by 495 randomly selected diplomates of the American Board of Podiatric Surgery as well as the surgery department chairs at the seven podiatric medical colleges.

Adolescent↗

PubMed1997

Cellular immune response studies in bancroftian filariasis.

An attempt was made to identify the filarial specific antigens that are capable of inducing immune response in human filariasis. Lymphocytes were taken from three clinically defined groups living in an endemic area in Madras, namely microfilaraemic (MF) subjects with microfilariae in their blood smear without any clinical symptoms, chronic pathology (CP) individuals with lymphangitis or lymphadenitis in combination with a history of recurrent filarial fevers or lymphoedema, and endemic normals (EN) subjects without microfilariae nor any clinical symptoms of pathology. Lymphocytes from the three groups responded with no significant difference (P = 0.21) in their proliferative index to PPD and PHA, although lymphocytes from MF individuals showed significantly (P < 0.001) less proliferative index to Brugia malayi antigen (BMA) than the CP and EN subjects. This antigen specific cellular unresponsiveness seen in MF patients was not reversed by the addition of recombinant IL-1alpha, IL-1beta, and IFN-gamma, but the addition of sera from EN individuals seemed to restore this unresponsiveness (P < 0.001). The peripheral blood mononuclear cells from MF patients secreted more IL-1 in response to BMA induction than the same from CP and EN individuals. A 58 kDa recombinant protein isolated from a Wuchereria bancrofti genomic library (58 kDa) had mounted a higher proliferative response to lymphocytes from all three groups compared to BMA (P < 0.001) indicating the possible use of recombinant filarial protein to mount immunological responses in filarial patients.

Animals↗

PubMed1993

Filariasis: nutritional interactions in human and animal hosts.

Vector-borne nematodes of the Order Filarioidea produce chronic, debilitating human infections which are usually nonfatal but are associated with a high degree of severe morbidity. Weight loss often accompanies infection and is probably a consequence of the increased energy cost associated with filarial fever, lymphangitis and lymphadenitis. In onchocerciasis, weight loss is associated with heavy worm loads as assessed by abundant nodules and large numbers of skin microfilariae. Experimental infections using rodent filariae have confirmed these observations and have also shown that low protein diets render hosts more susceptible to infection; nevertheless, parasite growth and embryogenesis is retarded in stunted female worms from protein deficient animals. In the absence of appropriate evidence, studies of experimental filariasis suggest that human protein-energy malnutrition may delay the development of stage-specific acquired immunity with a corresponding prolongation of patency. Epidemiological and experimental evidence shows that filarial nematodes acquire certain nutrients directly from their hosts. Of major importance in this respect is vitamin A which is taken up preferentially by human and rodent filariae; in humans, symptoms of hypovitaminosis A often accompany infection and could be an aggravating factor in onchocerciasis. Filariae also appear to require other specific nutrients such as iodine, thiamine and pyridoxine; dietary levels of these nutrients affect the host-parasite relationships in filariasis and pyridoxine seems to be of particular importance in this respect. Filarial parasites obviously compete with their hosts for available nutrients and, in the real world, human filariasis is often associated with a deterioration in the plane of nutrition of infected individuals.

Adult↗

PubMed1998

Wuchereria bancrofti in Kwale District, Coastal Kenya: patterns of focal distribution of infection, clinical manifestations and anti-filarial IgG responsiveness.

A cross-sectional study of bancroftian filariasis was conducted in 2 adjacent communities, Mvumoni and Kilore in Muhaka, Kwale District. Wuchereria bancrofti infection, clinical manifestations and anti-filarial IgG responsiveness were determined before the long rains, a time coinciding with a low transmission season. The prevalence of microfilaraemia increased gradually with age and was significantly higher in Kilore (24%) than in Mvumoni (6.3%, P < 0.001). Similarly, the prevalence of antigenaemia increased with age and also was significantly higher in Kilore, 48.9% than in Mvumoni, 20.5% (P < 0.001). Hydrocele, funiculitis, lymphangitis and lymphadenitis were also significantly more common in Kilore than in Mvumoni. In comparing the 2 communities, levels of IgG4 responsiveness in antigen-positive persons were higher in Kilore than Mvumoni (P = 0.034), but this was related to higher antigen loads in persons in Kilore than in Mvumoni. In antigen-negative persons, anti-filarial antibodies of 3 IgG isotypes were significantly higher in Kilore than Mvumoni (P < 0.001, for IgG1, IgG2, IgG4). These results emphasize the highly focal nature of bancroftian filariasis in this setting and demonstrate that anti-filarial antibody levels are related to transmission intensity.

Adolescent↗

PubMed2000

Lechiguana (focal proliferative fibrogranulomatous panniculitis) in cattle.

Lechiguana is a disease of cattle characterized by large, hard, subcutaneous swellings that grow rapidly and result in death after 3-11 months in untreated animals. Cattle treated with antibiotics recover. The disease has been reported from five states in south and southeastern Brazil. Histologically, the lesion consists of focal proliferation of fibrous tissue infiltrated by plasma cells, eosinophils, lymphocytes and sometimes neutrophils. The primary lesion is an eosinophilic lymphangitis, which results in eosinophilic abscesses, with occasional rosettes containing bacteria in their centres. Much experimental and epidemiological evidence, reviewed in this article, supports the suggestion that lechiguana is caused by an association of Pasteurella granulomatis (syn: Mannheimia granutomatis) and Dermatobia hominis.

Animals↗