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PubMed2001

[Pancreas as one of the targets of "auto-enzyme explosion" in pancreatitis].

The authors consider pancreatitis not as a nosological unity but as a clinical manifestation of enzymatic or autoenzymatic aggression. Based on clinical, histopathomorphological examinations, the authors describe pancreatogenous enzymatic injury of organs and tissues (pancreas, heart, kidneys, liver, gastrointestinal tract, etc). For 4-8 days to 2-10 years the syndrome may damage not only pancreatic parenchyma, but also vascular structures with formation of general vasculitis, lymphangitis and subsequent thrombotic microangiopathy. The authors regard pancreas as one of the target organs--of general disease, in which serious injuries of other organs and tissues may prevail over changes in the primary zone of aggression.

Adult↗
PubMed2001

[Orf in urban surroundings and religious practices: a study over a 3-year period].

BACKGROUND: Orf is a sheep disease, due to a parapox virus. Men in close contact with these animals may be contaminated. This generally occurs during professional activities. In our clinic, located in the heart of Brussels, we were surprised by the number of orf cases encountered each year, grouped during a short three-week period. PATIENTS AND METHODS: We decided to set up a prospective study of three years. Forty-four cases (14 to 64 years of age) were observed: 14 in 1998, 18 in 1999 and 12 in 2000. There were 29 men and 15 women. RESULTS: Only one patient had professional contact with sheep; 42 were muslims. Forty-two lesions out of 44 developed in the same time span, 10 days earlier each year. Complications observed were: erythema multiforme (7 cases), lymphangitis (3 cases), axillary adenitis (3 cases), eyelid edema (2 cases), generalized maculopapular eruption (2 cases) and contact dermatitis to the cream applied (1 case). DISCUSSION: This peculiar epidemiology can easily be explained: patients are contaminated during a religious feast, Aid el Kebir (the Feast of Sacrifice). On this occasion, they slaughter sheep, which they manipulate with bare hands. Small trauma often occur at that time. We conclude that orf is not only a professional disease but particuliar habits may cause epidemic-type contamination.

Adolescent↗
PubMed2001

7. Management of advanced breast cancer.

Approximately half the patients with breast cancer relapse with locally recurrent or metastatic disease. This disease is incurable but can often be controlled, sometimes for many years. Careful clinical evaluation and restaging provides a baseline reference against which response can be judged. Investigations are selected but may include biochemical screens, blood counts, chest X-ray, isotopic bone scan and radiographs of abnormal regions. Selection of systemic treatment is based on three key factors: the extent, pattern and aggressiveness of the disease; hormone sensitivity; and menstrual status. Chemotherapy is used for rapidly progressing visceral disease such as lymphangitis carcinomatosa or hepatic metastases with deranged liver biochemistry where death ensues rapidly unless disease progression can be reversed. With less aggressive disease, treatment is planned around the oestrogen and progesterone status of the tumour. Those with low tumour receptor levels are unlikely to respond to endocrine treatment and chemotherapy should be considered. For patients with steroid receptor-positive tumours, endocrine treatment is used before chemotherapy is needed and consideration of menstrual status can assist in the selection of the precise approach.

Antineoplastic Agents↗
PubMed2002

[A case of effective paclitaxel therapy for adriamycin resistant metastatic breast cancer with brain metastases].

A 36-year-old woman was referred to our hospital because of a right breast lump. Chest computed tomography revealed pulmonary metastases with lymphangitis carcinomatosa. Additional examination revealed liver metastases and axillary and cervical lymph node metastases. The patient was started on CA therapy (cyclophosphamide 900 mg, adriamycin 90 mg). A minor response was observed in the pulmonary metastases after two courses but new brain metastases were detected. We then tried paclitaxel administration (260 mg). A partial response was observed in the brain and pulmonary metastases. Thus, paclitaxel administration was continued on a weekly basis (120 mg) and the brain and pulmonary metastases continued to diminish. The primary breast cancer, liver metastases and axillary and cervical lymph node metastases were disappeared. Whole brain radiation was done with weekly paclitaxel administration and the brain metastases were diminished even more. Paclitaxel is as a radiosensitizer and seems to have a strong antineoplastic effect with concurrent radiation.

Adult↗
PubMed1975

[Heat production by breast neoplasms. IV. Influence of growth rate and probability of lymphatic dissemination during spontaneous development].

Growth rate and heat production of breast carcinomas have been investigated during the natural evolution of 21 untreated cancers, all with small tumour size (greater than or equal to 3 cm) and most of them were treated by surgery (excision of growth, mastectomy). Three original facts have thus been discovered : a) the specific heat power 1 (i.e. the heat quantity generated by the tumour per untis of volume and time, computed from from intramammary temperature and thermal conductivity measurements made using of fluvographic needle probes), is typical of each cancer and re7ains remarkably constant during the growth in spite of themorphological and of the morphological and circulatory changes; b) the tumour doubling time tau2v (calculated from measurements of the tumour size effected at various stages of the evolution by assuming an exponential growth), is univocally related to 1 by a hyperbolic law so that the faster the tumour is growing themore heat generates; c) q is significanty higher and tau2v shorter in all cases where the histological examination has revealed signs of lymphatic dissemination (carcinomatous lymphangitis, lymph node metastases,...). Practically q represents a quantitative criteria useful for setting with objectivity the pre-therapeutical prognosis of cancers clinically classified T1 or T2 and of circumscribed no palpable cancers. Similar but less accurate prognostic information may also be obtained by cutaneous thermography (infrared, liquid crystals) considering the intensity, extent and topography of the skin hyperthermia frequently elicited by the cancer. Thid aid to prognosis of the thermal methods is all the more valuable as the tumour doubling time cannot be evaluated under the customary clinical conditions.

Adult↗
PubMed1975

Fallibility of the clinical diagnosis of venous thrombosis.

Doppler ultrasound examination confirmed the diagnosis of acute venous thrombosis in only 194 (37%) of 527 patients. Of the remaining 333 patients, 245 (74%) had some other evident cause of the limb complaints. The postphlebitic stasis syndrome; symptomatic varicose veins; congestive heart failure; leg trauma; venous or lymphatic obstruction by malignancy; cellulitis or lymphangitis; arthritis; and pregnancy were etiologic factors in these patients. The proved inaccuracy of the bedside diagnosis of leg vein thrombosis stresses the need for accurate objective verification of venous disease before committing the patient to a full course of anticoagulant therapy. For most clinicians, a contrast phlebogram is the most available and reliable diagnostic procedure.

Acute Disease↗
PubMed2003

Micro-magnetic resonance lymphangiography in mice using a novel dendrimer-based magnetic resonance imaging contrast agent.

Major advances in cancer biology and immunology have been gained using mouse models. However, very few methods are currently available to visualize the deep lymphatic system. A new micro-magnetic resonance lymphangiography (MRL) method in mice, which uses dendrimer-based magnetic resonance imaging contrast agents, was developed. Micro-MRL imaging clearly visualized most of the mouse lymphatic system, including both lymphatics and lymph nodes. This method could detect and distinguish among dilation of lymphatic vessels in a lymphangitis model, proliferative or neoplastic lymph node swellings in a lymphoproliferative model, and inflammatory lymph node swellings in an infection/inflammation model. Changes in the lymphoid system of transgenic mice overexpressing interleukin-15 could be visualized. Abnormal enlarged lymph nodes identified by micro-MRL were selectively removed and analyzed to demonstrate their cell type, receptor expression, and clonality in individual mice. We conclude that the enhanced resolution of this noninvasive micro-MRL can detect and classify lymphatic and lymph node abnormalities in mice, which should have wide applicability to the study of immunology and cancer in both experimental animals and clinical medicine.

Animals↗
PubMedDate not supplied

A case of pulmonary adenocarcinoma associated with hypertrophic osteoarthropathy due to vascular endothelial growth factor.

A 62-year-old male patient was admitted, because a chest X-ray examination revealed an abnormal shadow (4 cm in diameter) in the left upper lobe. A transbronchial lung biopsy showed the features of adenocarcinoma. Chest and abdominal computed tomography (CT) scan showed the features of lymphangitis carcinomatosa, and bilateral metastatic adrenal tumors. After effective chemotherapy, he complained of arthralgia and a bone scintigram showed abnormal uptakes in his bilateral shoulder, knee and wrist. He was diagnosed with pulmonary hypertrophic osteoarthropathy (PHOA). The serum level of vascular endothelial growth factor (VEGF) was elevated to 424 pg/ml, while serum growth hormone (GH) and GH-releasing hormone were normal. Immunohistochemical analysis showed positive features of VEGF in the pulmonary tumor cells. He died of cachexia on May 2nd, 2001, more than 2 years after the diagnosis of pulmonary adenocarcinoma at stage IV.

Adenocarcinoma↗
PubMedDate not supplied

[Lymphedema secondary to breast cancer treatment: possibility of diagnostic and therapeutic prevention].

We performed a prospective randomized study upon 50 patients who had undergone a breast cancer treatment, considering particularly the possibility of appearance of arm secondary lymphedema. The patients were divided in two groups of 25 patients each. In the 1st group, we performed only a clinical follow-up, whilst in the 2nd one, we used also lymphoscintigraphy. The aim of the study was to compare the incidence of arm secondary lymphedema in the two groups, and relate the data with those of the international literature, in order to identify diagnostic procedures indicative of the risk of development of lymphedema and find proper therapeutic preventive measures. It is certainty complex to foresee the appearance of arm lymphedema due to breast cancer treatment. No specific preventive therapeutic methods based upon particular diagnostic investigations were ever reported. Patients had undergone surgery and radiation for breast cancer in the period between April 1992 and June 1994, and controlled at over 5 years after operation. Upper limb lymphoscintigraphy was performed only in one of the two groups of 25 patients, before operation and, furthermore, after 1-3-6 months and 1-3 years from the treatment. Patients who presented lymphoscintigraphic alterations (dermal back flow, diffused or delayed transit of the tracer, etc.), before edema appeared clinically, underwent physical and rehabilitative therapy (bandages, manual lymphatic drainage, mechanical lymph drainage, elastic garments, etc.) and microsurgery (lymphatic-venous anastomoses at the arm), performed early (stages Ib and II) in patients not responsive to physical therapy. In the first group followed only clinically, secondary arm lymphedema occurred in 9 cases (36%), and appeared after a period variable from 1 week to 2 years (3-6 months averagely). In the second group, lymphoscintigraphy, performed preoperatively, permitted to find lymphatic impairment (absence of deltoid way, reduced axillary lymph nodal tracer uptake, delayed transit of the tracer) at the upper limb in 4 patients (15%). After breast cancer surgery, lymphoscintigraphy pointed out alterations of lymphatic circulation in 5 patients (20%) after 1 month, in other 6 cases (56%) at 6 months, other 5 (76%) after 1 year and 3 (88%) at 3 and 5 years. Physical preventive therapy performed in patients with positive lymphoscintigraphy, even before the clinical appearance of edema, allowed to find a clinically evident lymphedema only in 2 cases (8%). The last two patients underwent early (at stage Ib and II) microsurgical operation of lymphatic-venous anastomoses, with complete regression of edema and improved lymphatic drainage of the arm controlled by lymphoscintigraphy (appearance of preferential lymphatic pathways, absence of dermal back flow). Secondary arm lymphedema due to breast cancer treatment appears in 20-25% of cases till 35% when surgery is associated with radiotherapy. Lymphoscintigraphy allows to pointout alterations of lymphatic drainage before the clinical appearance of edema. Preventive physical and rehabilitative measures allows to reduce the clinical appearance of lymphedema significantly. Microsurgical operation performed precociously, at the early stages of the disease, permits to obtain the complete regression of the pathology thanks to the repair of preferential lymphatic pathways before of fibrosclerotic tissural alterations occur, which cause progressive worsening of clinical conditions, together with recurrent attacks of acute lymphangitis.

Adult↗
PubMed2003

[Cutaneous lymphangitic carcinomatosis and acquired ichtyosis associated with prostatic carcinoma].

BACKGROUND: Prostatic adenocarcinoma is exceptionally associated with cutaneous lesions. We describe a patient with cutaneous lymphangitis and paraneoplastic ichtyosis related to prostatic cancer. CASE REPORT: A 92 year-old man had been treated for five years for a prostatic carcinoma. An angiomatous lesion developed with in 3 months near the right breast. Physical examination revealed axillary node enlargement, a large skin angiomatous lesion, and ichtyosis. The skin biopsy of the angiomatous skin lesion demonstrated its prostatic origin with carcinomatous metastases in the lymphatic vessels. The ichtyosis was considered as paraneoplastic. DISCUSSION: Cutaneous metastases from prostatic carcinoma are rare. Less than 1 p. 100 of cutaneous metastases are of prostate origin despite the high frequency of this cancer in the general population. The clinical aspects - angiomatous lesion and paraneoplastic ichtyosis - are exceptional.

Aged↗
PubMed1992

[Roxithromycin in dental infections].

Roxithromicin is a semisynthetic macrolide antibiotic, with similar antibacterial activity to erythromycin. It is characterized by an excellent pharmacokinetic profile and a good tissue penetration. Particularly at the dose of 300 mg per day the dental tissue diffusion is extremely good, and this is important to oppose the oral cavity infections. Oral cavity infections can be either odontogenic or non odontogenic. Odontogenic infections are typically primary and are caused by commensal bacteria (oral Streptococci, Bacteroides sp., Veillonella sp. and Fusobacterium sp.). The antibacterial spectrum of roxithromycin is very large and includes many of the most frequent strains responsible for oral cavity infections. A very interesting characteristic of roxithromycin is its penetration in macrophages (uptake) that allow a more rapid inhibition of bacterial activity. To evaluate the clinical efficacy and tolerance of roxithromycin in the treatment of odontogenic infections, an open study was performed. This study evaluated both the microbiological and clinical aspects. Thirty patients (21 females and 9 males) who had not been previously treated with antibiotic or antibacterial drugs, affected by infective dysodontiasis, gingivitis and periodontal diseases, received 300 mg per day (once a day) of roxithromycin for an average period of 6 days. The symptomatology considered was: intumescence, redness, pain, lymphangitis and presence of trismus. Clinical symptomatology was assessed at the start and at the end of the treatment. The symptomatological improvement due to roxithromycin was rapid and very effective. After 6 days of therapy, the improvement was statistically significant (p < 0.01) compared to basal conditions. No adverse reactions or side-effects were complained during the study. No changement were detected in laboratory parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Vascular complications in intravenous drug addicts].

Twenty patients with complications of drug addiction were admitted to the Department of Vascular Surgery of the Santa Catarina University Hospital, from January 1986 to September 1990. Most of these patients were male, aged between 20 and 35 years. The most common drug used was propoxiphene, followed by cocaine. Swelling, ulcers and pain in the inferior extremities were the most common signs and symptoms. Six patients presented deep venous thrombosis, four had acute lymphangitis, all of them in the lower limbs. Five patients had acute arterial occlusions, one presented common femoral artery mycotic aneurysm and another had a false aneurysm of the superficial femoral artery. Venous and lymphatic complications were clinically treated with antibiotics, heparin and local care. Six patients were submitted to surgical procedures. One was treated by aneurysmectomy and vascular reconstruction, another with aneurysmectomy and arterial ligation. On one patient forearm fasciotomy was performed. Two amputations and one drainage of abscess were carried out.

Adult↗
PubMed1992

Cutaneous nocardiosis associated with insect bites.

We report the first case of cutaneous nocardiosis associated with insect bites. The patient received these insect bites while camping a few days before he presented to the emergency room. The patient was a healthy twenty-six-year-old man, who was asplenic as a result of a motor vehicle accident. He presented to the emergency room with fever, multiple insect bites to his left lower extremity with pustules, lymphangitis, and left inguinal adenopathy. He was hospitalized but his condition failed to improve despite treatment with intravenous nafcillin for three days. Wound and blood cultures subsequently grew Nocardia brasiliensis. Treatment with intravenous amikacin (5 mg/kg every eight hours) was instituted along with oral trimethoprim-sulfamethoxazole double strength twice a day. The patient recovered with minimal scarring of the extremity. The amikacin was stopped after seven days and the patient was discharged to receive oral trimethoprim-sulfamethoxazole. This disease should be kept in mind when cutaneous infections do not respond to standard antibiotics, especially in the southwestern United States.

Adult↗
PubMed1992

Necrotizing soft-tissue infections.

Necrotizing soft-tissue infections have been widely recognized for over a century, but they remain a challenging problem in clinical infectious disease. Patterns of disease are clearly apparent, but most are polymicrobial and derive increased virulence from synergy between bacteria. Early recognition and prompt surgical drainage are the keys to successful treatment. Edema extending beyond the area of erythema, skin vesicles, crepitus or air in the subcutaneous tissues, and absence of lymphangitis and lymphadenitis are markers of necrotizing infections, particularly when they occur in patients with serious underlying disease. Empiric broad-spectrum antibiotics, prophylactic heparin, and nutritional therapy are important adjuncts to aggressive "stepwise" surgical debridement. A knowledge of patterns of disease can aid in fine-tuning treatment to decrease morbidity.

Gangrene↗
PubMed1965

LINCOMYCIN IN DERMATOLOGIC PRACTICE.

In clinical studies with a new oral antibiotic, lincomycin, excellent results were obtained in the treatment of carbuncles, furuncles, folliculitis, cellulitis, lymphangitis, lymphadenitis, pyonychias and dermatitis infectiosa eczematoides due to coagulase-positive Staphylococcus aureus and to Streptococcus hemolyticus Type A. Encouraging results were noted in a small series of acne conglobata (cystic acne). Loose stools and diarrhea were frequently encountered but these symptoms abated when the dosage was reduced.

Acne Vulgaris↗
PubMed1992

[Reliability of bronchial tumor typing base on fibroscopically obtained biopsies].

This study is based on the bronchial tumors biopsied and later examined between 1971 and 1986 at the Institute of Pathology, Lausanne. In each case the diagnosis based on the initial biopsy material is compared with the final surgical or autopsy diagnosis (Reference: Histological typing of lung tumours, second edition, WHO, 1981, 2). The series studied is constituted by 163 cases: 144 men (88.3%) and 19 women (11.7%). In 136 cases (83.4%), the biopsy diagnoses are identical to the diagnoses based upon surgical or autopsy material; in 27 cases (16.6%) these diagnoses differ. The positive predictive value of bronchial biopsy appears to be excellent (100%) for small cell and epidermoid carcinoma (CA). It is satisfactory for adenocarcinoma (85.7%) but insufficient for large cell CA (42.3%) and the tumors grouped under "others" (50%). The diagnosis of large cell CA, in situ CA, papillary tumor, undifferentiated CA, or carcinomatous lymphangitis should be considered with caution and in some cases it is advisable to repeat the biopsy. The discrepancies between the initial and final diagnoses can, in all cases, be attributed either to the biopsy specimen being too small and therefore nonrepresentative or, less frequently, to crushing and necrosis of the tissues.

Autopsy↗
PubMed2003

[Skin complications of stonefish envenomation in 6 travellers returning from the Indo-Pacific maritime region].

Stonefish (Synanceja verrucosa) sting has been known for a long time to be a medical hazard. It is a common cause of severe marine envenomation. Immediate complications (collapsus, pulmonary oedema) have been described extensively. Late complications (oedema, tissue necrosis) have not been studied in details although they are common and a cause of invalidity and pain. We have observed six travellers with complications of stonefish sting over a 10 year-period in our department. All the patients were coming back from the Indo-Pacific maritime region. They presented with cutaneous abcess (in one) or necrotic complications (foot ulcers in two, cellulitis in three) associated with painfull oedema in two and lymphangitis in three. Surgery has been performed in four patients, two of them undergoing many operations. Two had long term sequelae. Such complications could be avoided. Appropriate initial treatment (i.e., neutralization of the venom by hot water, disinfection, antivenom and antibioprophylaxis) seems to be able to reduce late complications. Antivenom is indicated in severe systemic manifestations which are life threatening and in case of crucial pains. Prevention is the most important part of therapy and relies on appropriate information of the travellers.

Adult↗
PubMed2004

[A case of quadruple cancer arising in the stomach, lung, liver and prostate].

A 75-year-old man was admitted to our hospital because of severe dyspnea and pollakiuria in October 2001. We diagnosed his illness as carcinomatous pericarditis caused by the recurrence of primary lung cancer and prostatic hypertrophy. He had undergone surgery for gastric cancer in 1986, and for lung cancer in 1996. Furthermore, he had been treated for hepatocellular carcinoma in 1997. He finally died in February 2002 of respiratory failure due to the carcinomatous lymphangitis that followed the lung cancer. After autopsy, a microscopic view of the prostate revealed that he had prostatic carcinoma. Such a case is rare.

Adenocarcinoma↗