[Complications in wearing earrings].
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Pleural effusions are a rare complication of metastatic adenocarcinoma of the prostate and have not been noted to resolve with endocrine therapy. In a patient with massive bilateral pleural effusions as the initial manifestation of underlying prostatic cancer, lung biopsy specimens documented the presence of lymphangitic carcinomatosis and pleural biopsy tissue was normal. The effusions cleared on two occasions after diethylstilbestrol diproprionate therapy was started. We conclude that massive pleural effusions occasionally complicate prostatic lymphangitic carcinomatosis and that they may resolve with endocrine therapy.
The diagnostic results of 125 thoracoscopies in patients aged 17-85 years are analysed retrospectively. The condition for relevant diagnosis by thoracoscopy is an intrapleural space permitting the installation of a pneumothorax of sufficient size for tissue-biopsy under direct vision. The results are largely dependent upon the choice of suitable cases. Macroscopic appearance and histological examination made it possible in 100 of 125 cases to make a definite diagnosis or to exclude it. Thoracoscopy is a suitable diagnostic method especially for the following indications : pleural disorder of uncertain origin (metastatic, tuberculous or of other origin); primary pleural disease (mesothelioma); disseminated pulmonary processes (silicosis, sarcoidosis, miliary tuberculosis, interstitial fibrosis of the lung); peripheral lung disease and spontaneous pneumothorax are other indications. Some representative cases are reported. Biopsy by thoracoscopy is certainly superior to blind pleural biopsy, and is not unpleasant for the patient. The method is even suitable for smaller hospitals, if the technique is careful and indications are well chosen.
Lymphoedema of the upper limb is the most serious and most crippling complication of mastectomy. An account is given of the factors possibly responsible, and a classification of the different forms is proposed. When fibrosis has set in, treatment is followed by very disappointing results, being at best able to bring about a partial, but transitory reduction in limb volume and consistency. Reference is also made to results obtained in 70 cases with two substances, 1-thyroxine and escine (somatoline), applied by massotherapy in postural drainage, ionophoresis, and pressotherapy, according to the requirements of each case. The results were distinctly satisfactory, though the outstanding fact was the maintenance of the response throughout many follow-up controls. It is felt, therefore, that somatoline can be usefully given in cyclic form, both in cases treated in an early stage, and also in all patients were lymphoedema is a likely risk after mastectomy.
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The most frequent complication of primary lymphoedema is streptococcal infection, and in particular erysipelas, and plantar fungal infections. The fungal infection is a portal of entry for erysipelas. Disinfiltration is the basis of treatment of erysipelas.
We described the results of ten-year observations on the clinical manifestations, pathology, immunity to filariasis and aetiological biology of filariae in three volunteers (first author and his family members) who were inoculated experimentally with infective larvae of periodic Brugia malayi in 1981 and without use of any antifilariasis drugs. Microfilariae were first detected at 41 and 46 weeks after inoculation in two subjects and remained detectable in a small number until 8 and 8.5 years after infection. Eosinophilia occurred mainly before and at the initial stage of microfilaremia. The increase in the lymphocytes to some extent was observed at 2-156 weeks after infection. Biopsy at inoculation site 6 weeks after inoculation showed the lymph node with the infiltration of inflammatory cells, mainly eosinocytes, lymphocytes and monocytes. Lymphangiotasis and lymphostasis were observed in both limbs and pelvic regions by lymphangiogram taken 11 weeks after inoculation. Antibody against B. malayi first appeared at 2-5 weeks after infection and reached the highest at 12-56 weeks and thereafter declined gradually. Two subjects turned to be antibody free 10 years after infection. E-rosette forming lymphocytes became lower than normal at 11 weeks and recovered to normal within 10 years after infection.
From 1960 to date, there have been four cases of elephantiasis penis in the urologic clinic of the Katharinenhospital in Stuttgart, which were operated on by skin transplantation. The causes of elephantiasis penis are discussed, and the surgical procedure is presented in detail. Finally, the outcome as far as appearance and function are concerned, is discussed.
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