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PubMed1991

Quantitative cellular cytotoxicity to Brugia malayi microfilariae: in vitro studies of sera from an area endemic for filariasis in Andhra Pradesh, India.

The extent of eosinophil and neutrophil cell-mediated cytotoxicity on Brugia malayi microfilariae by sera from an area endemic for bancroftian filariasis in Andhra Pradesh, India, has been studied in vitro in terms of the clinical status of the subjects. At physical examination, 66 serum samples were collected. Group "A" included patients with various disease manifestations like lymphoedema, hydrocoele, lymphangitis and elephantiasis. Group "B" had microfilaraemia ranging from 1-300/ml of blood. Subjects with no history of infection past or present (endemic normals) were studied as Group "C". Out of 38 sera tested individually with eosinophils, 14/18 of Group A, 10/11 of Group B and 7/9 of Group C promoted higher (21-97%), moderate (18-88%) and highest (51-95%) range of cytotoxicity, respectively. The age, clinical status and duration of disease among the infected subjects appeared to correlate with the microfilarial mortality. In Group B, we observed the highest microfilarial count (16-300/ml) in lower (1-20 yrs) age groups. These individuals promoted higher (77-83%) cytotoxicity compared to the older age group (21-40 or 41-60) with low (1-36/ml) microfilaraemia. Group C sera were highly toxic to microfilariae. All those that were positive promoted greater than 50% mortality. Eighteen nonendemic normal sera had no effect on microfilariae. The overlapping but differential toxicity of the sera indicates that various clinical manifestations are associated with different types of cellular and humoral responses. These studies should help focus identification of the target epitopes of various immune responses of the host.

Adolescent↗
PubMed1990

[Cat-scratch disease].

Cat scratch disease is an infectious disorder caused by a Gram-negative bacterium. The classical form is heralded by a scratch, subsequently red papules develops at the place of the inoculation. After an incubation period of one to two weeks lympadenopathy without lymphangitis occurs, with tender, red, warm and indurated skin as well as fever and general malaise. In the atypical form, different organs may be involved. Specific treatment is not indicated and the overall prognosis is good. The diagnoses of cat scratch disease can be sustained by a skin test.

Cat-Scratch Disease↗
PubMed1990

[A survey of the French-speaking Association of Lymphology on the use of pressotherapy in France during the treatment of lymphedema].

116 physicians out of the 1000 who were questioned use pressure-therapy in the treatment of lymphedema of the extremities. Another 170 are interested in the technique and await this report before possibly adopting it. Overall, the devices utilized are compartmented and use discontinued pressure that is asynchronous in relations to heart beat; each session lasts 30 minutes, on average, with compression and resting phases lasting 45 seconds and 15 seconds, respectively. The usual schedule is one session daily, three days per week, in two series clustered within a single year. Although manual drainage of lymphatics is combined with pressure-therapy in 71.55% of the times, only 43.47% of physicians use elastic support following the treatment. Results are good or very good in 64.4% of cases, and the incidence of post-therapeutic events is rather low (polyuria, pain recrudescence of lymphangitis, etc.). Aside from lymphedema, venous insufficiency, hypodermitis and leg ulcers may also benefit from pressure-therapy.

Clinical Protocols↗
PubMed1990

[Pulmonary microvascular cytology in critical patients].

Cytology in blood drawn through a wedged Swan-Ganz catheter appears as a sensitive method for the diagnosis of carcinomatous lymphangitis in patients in whom transbronchial biopsy is considered dangerous or who refuse to undergo the latter procedure. However, its usefulness has not been assessed in critical patients with acute respiratory failure of unknown etiology in whom malignant disease is suspected. We report our experience in two patients admitted to the Intensive Care Unit with acute respiratory failure of unknown etiology: they were a female with breast carcinoma and a male with lymphoma in whom the cytological study of pulmonary capillary blood disclosed malignant cells. The clinical evaluation and the subsequent histological studies confirmed the pulmonary involvement by malignant disease in both cases.

Acute Disease↗
PubMed1989

Selective up-regulation of endothelial cell class I MHC expression by cytokines from patients with lymphatic filariasis.

Local host immune responses to the lymphatic-dwelling filarial parasite Wuchereria bancrofti are important in the pathogenesis of the lymphangitis that leads to filarial elephantiasis. That the lymphatic endothelial cells may be important in this inflammatory process was shown by the ability of supernatants generated from filarial Ag-driven PBMC of individuals with filarial elephantiasis caused by W. bancrofti infection to up-regulate class I MHC expression on human umbilical vein endothelial cells when compared to unstimulated control supernatants from the same individual (relative fluorescence intensity = 159% +/- 13.5; p less than 0.001). In contrast, individuals with the same filarial infection but manifesting no lymphatic disease were unable to generate, in response to filarial Ag the cytokines required for this activation (relative fluorescence intensity = 93% +/- 2.6). Supernatants induced by a non-filarial Ag (purified protein derivative) were able to effect class I MHC up-regulation in both patient groups. The same filarial Ag-driven supernatants did not cause detectable class II MHC staining on human umbilical vein endothelial cells. These results suggest a likely role for parasite Ag-driven, cytokine-mediated endothelial cell activation in the pathogenesis of lymphatic inflammatory/obstructive filarial disease.

Adult↗
PubMed1989

[The studies on clinical efficacy of Tomiron in the surgical patients: skin and soft tissue infection].

We studied the clinical efficacy and prophylactic effect of Tomiron (cefteram pivoxil; CFTM-PI), a new oral cephalosporin, in the surgical patients. CFTM-PI was administered at a daily dose of 300 or 600 mg after meals. Infectious diseases in 151 patients consisted of infected atheroma, wound infection, subcutaneous abscess, furuncle, phlegmon, mastitis, lymphangitis, periproctal abscess and biliary tract infection. Fifty patients were administered CFTM-PI to prevent secondary wound infection. The clinical efficacy rate was 75.5% in the treatment of infection and 86.0% in the prophylactic use. The clinical efficacy for skin and soft tissue infection was regarded as excellent in 25, good in 74, fair in 17 and poor in 8 out of 124 cases, with a clinical efficacy rate of 79.8%. The eradication rate in 40 cases of monomicro-bial infection was 97.4%, and in 12 cases of polymicrobial infection it was 72.7%. For biliary tract infection, the clinical efficacy was excellent in 1, good in 5, fair in 1 and poor in 1, with a clinical efficacy rate of 75.0%. Adverse effects were observed in 4 (2.0%) of 201 cases: allergic reaction in 3, and sleepiness in 1. Abnormal laboratory findings were observed in 2 cases, but it is not clear if these were due to this drug. These results indicate that Tomiron is a useful oral antimicrobial agent in the treatment and prophylaxis of surgical infection, mainly skin and soft tissue infection.

Adolescent↗
PubMed1989

[Recurrent thrombophlebitis, weakness].

The 46-year-old woman was admitted with an acute inflammatory swelling of the left forearm. During the previous six months the patient had suffered from recurrent thromboses of the superficial veins associated with generalized physical weakness. The gynaecological history was remarkable for hypermenorrhea and metrorrhagia. On examination, the signs of an acute thrombophlebitis with concomitant lymphangitis were observed. In the lower right abdomen there was a palpable tumor. Laboratory findings showed a mild anemia and indices of inflammation. Subsequent procedures (abdominal sonography, gynaecological examination) further substantiated the suspicion of an underlying malignant process. Hysterectomy and histological examination revealed two different carcinomas of the right ovary and of the uterine cave. Already during the uncomplicated postoperative period the thrombophlebitis completely regressed.

Adenocarcinoma↗
PubMed1989

[Pathogenesis, diagnosis and therapy of thrombophlebitis and varicophlebitis].

Thrombophlebitis is defined as thrombotic inflammation of a previously healthy superficial vein, varicophlebitis as that occurring in varicosities. The latter appears responsible for the majority of thrombotic venous occlusions. In contrast to venous thrombosis, the thrombotic involvement of deep veins, thrombophlebitis usually resolves without sequel and, in general, thrombophlebitis nor varicophlebitis are associated with the risk of pulmonary embolism. The clinical presentation of thrombophlebitis is that of a tender, hardened superficial vein which, in the presence of inflammation, may be very painful. The lower extremities are most frequently involved. Differential diagnostic considerations include bacterial cellulitis and lymphangitis. The cause of thrombophlebitis, which is rare without precipitating factors, may be a mechanical lesion such as kinking of the vein or trauma to the wall of the vein as well as other primary disease such as auto-immune afflictions, endangiitis obliterans or malignancy; in particular, with localization in the area of the rump, with concomitant occurrence in various regions or extending phlebitis, paraneoplastic syndromes and hemoblastoses should be ruled out. Rarely, phlebitis may be associated with tuberculosis and syphilis. Thrombophlebitis may be caused iatrogenically by improper application of chemical substances which cause damage to the venous walls as well as by indwelling catheters or cannulas. This form can progress to sepsis and pulmonary embolism may be incurred. Varicophlebitis, in contrast, accounts for about 90% of all cases of phlebitis and can be regarded as a typical late complication of varicosities in the superficial venous system.(ABSTRACT TRUNCATED AT 250 WORDS)

Bandages↗
PubMed1989

[Neonatal pleuropulmonary staphylococcal infection with multiple abscesses of the liver].

We report the case of a neonate who developed septicemia due to a methicillin-susceptible Staphylococcus aureus strain at six days of age. At eight days of age, physical evaluation revealed a tense, tender abdomen and further enlargement of the liver, and abdominal ultrasonography demonstrated multiple liver abscesses. On the following day, pleuropulmonary lesions developed and required mechanical ventilation. Recovery was achieved using parenteral vancomycin and fosfomycin for 15 days followed by oral pristinamycin for ten days. This case is unusual in that the infection was acquired by the digestive route probably as a result of lymphangitis of the breast in the mother, and multiple liver abscesses were associated with the pleuropulmonary localization. It provides further evidence of the value of ultrasonography for the diagnosis and monitoring of liver abscesses, including multiple abscesses.

Female↗
PubMed1989

[Significance of the presence of mastocytes in bronchoalveolar lavage in the diagnostic evaluation of diffuse interstitial lung diseases].

The cell preparations of 199 bronchoalveolar lavages (BAL) were reviewed to evaluate the meaning of the presence of mastocytes for the diagnosis of diffuse interstitial lung diseases. The study population consisted of 41 control individuals, 10 with extrinsic allergic alveolitis (EAA), 55 with sarcoidosis 38 with asbestosis, 25 with pulmonary fibrosis associated to collagen diseases, 18 with idiopathic pulmonary fibrosis and 12 with carcinomatous lymphangitis. Mastocytes were predominantly found in patients with EAA (8 of 10 cases) and in some cases of sarcoidosis and idiopathic pulmonary fibrosis. The rate of mastocytes in the patients with EAA was significantly higher than in the other groups (p less than 0.001). The presence of mastocytes in the BAL is particularly suggestive of EAA; rates higher than 3% are only found in this condition.

Alveolitis, Extrinsic Allergic↗
PubMed1989

Preoperative correlates of impaired wound healing after saphenous vein excision.

Although major wound complications after saphenous vein excision are infrequent, we have found broadly defined impairment in leg wound healing to be relatively common. Wound healing impairment is defined in this study as inflammation, separation, cellulitis, lymphangitis, drainage, necrosis, or abscess necessitating dressing, antibiotics, or débridement before wound healing with complete epithelialization without eschar. Healing was impaired in 245 of 1047 patients (24.3%). Significant correlations were found between impaired wound healing and female sex (p less than 0.005), body mass index (obesity) (p less than 0.005), diabetes mellitus (p less than 0.005), left ventricular end-diastolic pressure greater than 15 mm Hg (p = 0.0074), arterial occlusive disease of the legs (p = 0.0124), and preoperative hematocrit value (p = 0.0491).

Arterial Occlusive Diseases↗
PubMed1988

[A case of Mondor's disease of the penis].

A case of Mondor's disease of the penis in a 40-year-old man is reported. The patient complained of a small subcutaneous induration (0.5 x 1.0 cm) with slight tenderness in the dorsal region of the penile shaft. On examination, the linear cord was palpated running both distally and proximally from the induration. This lesion was removed under local anesthesia, and the induration and the cord were found to be part of the superficial dorsal vein of the penis. The venous wall was thick and the thrombus was packed in it. Histological findings showed the proliferation of connective tissue of the vessel wall and partially granulating thrombus in the canal. From these findings, we confirmed the diagnosis of Mondor's disease of the penis. The etiology of this disease, especially in comparison with non-venereal sclerosing lymphangitis of the penis (N.S.L.P.) is discussed.

Adult↗
PubMed1988

[Cutaneous lymphangitic-nodular sporotrichosis with multiple portals of entry].

A human case of cutaneous sporotrichosis with three chancriform primary lesions and regional lymphangitis is presented in a male patient infected during the hunting of armadillos. The clinical picture shows very well the usual mechanism of infection for the disease in Uruguay, which is a direct contact of man with armadillos and their burrows.

Adult↗
PubMedDate not supplied

The treatment of lymphedema of the extremities with microsurgical lympho-venous anastomoses.

Personal 20-years clinical experience in diagnosis and treatment of various types of lymphedema of the lower limbs with microsurgical lymph node-vein and lymph vessel-vein anastomoses is presented. Optimizing of diagnostic method, improvements in operation technique and results of the follow-up have, during that period of time, modified indications for surgical therapy of lymphedema toward a more conservative approach and applying microsurgical methods to a carefully selected group. At present, lympho-venous shunts are performed in patients with local, segmental obstruction of proximal lymphatics. Peripheral lymph vessels should be patent and have their contractility at least partly preserved. Long-term penicillin therapy is indispensable prior to surgery in cases with a history of lymphangitis. The diagnostic procedures necessary for proper evaluation of the degree of lymph stasis, including the technique of lymph pressure and flow measurements are described. The details of operation of lymphovenous shunts based on personal experience are presented.

Anastomosis, Surgical↗
PubMed1988

Venomous snake bites in Italy: epidemiological and clinical aspects.

From 1980 to 1984, a total of 2,329 people who alleged that they had been bitten by venomous snakes were admitted to 292 Italian hospitals having first aid stations. Three died. Most patients (62%) did not show any symptomatology of envenomation. The epidemiological and clinical aspects of 286 patients, out of 885 exhibiting signs and symptoms of snake bite envenomation, have been studied. The symptoms and signs were: oedema, gastro-intestinal symptoms, pain at the site of the bite, respiratory distress, leucocytosis, CNS depression, shock, fever, cyanosis, exanthema, ecchymoses, incoagulable blood, lymphangitis, melaena, thrombocytopenia, haematuria, and ophthalmoplegia. The bites were located only in the upper or lower limbs. Most were caused by Vipera aspis. The severity of envenomation of the 286 affected patients were: 45% minor, 30% mild, 14% moderate, 8% severe and 1% fatal. Most bites occurred in August. The commonest treatment before and during hospitalization was anti-venin.

Adult↗
PubMed1987

IgE antibodies to Staphylococcus aureus in the hypereosinophilic syndrome.

A 16-year old boy with a 10-year history of circulating eosinophilia was diagnosed having the hypereosinophilic syndrome (HES) based upon the exclusion of other disorders. Eight years after the onset of his condition, he had a subcutaneous staphylococcal abscess followed by lymphangitis, rare clinical features of HES. As measured by radioallergosorbent techniques, there were significantly high serum levels of IgE antibodies to Staphylococcus aureus. The clinical significance of these antibodies is unknown, but their production may be due to persistent antigenic stimulation.

Abscess↗
PubMed1987

Rheumatoid lymphedema.

Edema of the upper limbs is described in 3 men with rheumatoid arthritis. In all cases abnormal lymph vessels were documented on lymphography. Lymphangitis may explain the anomaly.

Arthritis, Rheumatoid↗
PubMed1987

Surgical treatment of lymphedema: a report on 652 cases.

We performed the world's first lymphography, and 2 years later we focused our surgical methods on total superficial lymphangiectomy for the treatment of lymphedema. In the course of 40 years, we have studied the results of this treatment for edemas of lymphatic origin. We surgically treated 600 cases of lymphedema of the lower limb, 48 of the genital organs, and four of the upper limb and have had very promising results. Indications for surgical treatment of these edemas due to lymphatic blockage include the considerable inconvenience caused by the very large size of the extremity affected with lymphorrhagia or chylorrhagia, the severe lymphangitis that occurs in the course of their development, and finally the malignant degeneration of the lymphatic vessels in 1% of the cases.

Arm↗