Ileitis-associated tertiary lymphoid organs arise at lymphatic valves and impede mesenteric lymph flow in response to tumor necrosis factor

Lymphangitis and the formation of tertiary lymphoid organs (TLOs) in the mesentery are features of Crohn's disease. Here, we examined the genesis of these TLOs and their impact on disease progression. Whole-mount and intravital imaging of the ileum and ileum-draining collecting lymphatic vessels (CLVs) draining to mesenteric lymph nodes from TNF^ΔARE mice, a model of ileitis, revealed TLO formation at valves of CLVs. TLOs obstructed cellular and molecular outflow from the gut and were sites of lymph leakage and backflow. Tumor necrosis factor (TNF) neutralization begun at early stages of TLO formation restored lymph transport. However, robustly developed, chronic TLOs resisted regression and restoration of flow after TNF neutralization. TNF stimulation of cultured lymphatic endothelial cells reprogrammed responses to oscillatory shear stress, preventing the induction of valve-associated genes. Disrupted transport of immune cells, driven by loss of valve integrity and TLO formation, may contribute to the pathology of Crohn's disease.

[Bilateral chylothorax in a case of metastatic adenocarcinoma of unknown primary]

We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax.

Soluble cellular adhesion molecules, selectins, VEGF and endothelin-1 in patients with Wuchereria bancrofti infection and association with clinical status

Lymphatic filariasis, a mosquito-transmitted disease commonly known as Bancroftian filariasis, is characterized by debilitating pathology linked to the progression of lymphoedema to a chronic state of elephantiasis. We performed longitudinal measurements of endothelial adhesion and angiogenic molecules in 63 Polynesian patients living in an hyperendemic focus of Wuchereria bancrofti. Decreased serum concentrations of soluble (s-) L selectin (CD62L) were noticed in sera of of patients with chronic conditions (hydrocele and elephantiasis). Chyluria was associated with increased vascular endothelial growth factor (VEGF) levels, whereas elephantiasis presented a high endothelin-1 (ET-1) profile. By contrast, increased serum concentrations of soluble intercellular (sICAM-1, CD54), but not of vascular cell (sVCAM-1, CD106), adhesion molecules were observed in sera of patients with bacterial lymphangitis used as controls. These trends are consistent with the increased permeability of vascular structures, a major clinical feature observed in acute lymphatic pathology (of bacterial or filarial origin), and of fundamental differences in the pathogenesis of hydrocele and elephantiasis. Using markers correlated with the clinical status (high ET-1 and VEGF levels for elephantiasis and chyluria, respectively; low CD62L levels for hydrocoele and elephantiasis) it should be possible to monitor disease progression in lymphatic filariasis.

Lymphangitis carcinomatosa: a literature review

Intrathoracic metastases occur in 30-40% of patients with malignant disease. In this group 6-8% have lymphangitis carcinomatosa. This review examines the pathogenesis, investigation and treatment of lymphangitis carcinomatosa. The 40-49 years age group is most commonly affected. In 46% of patients respiratory symptoms are the initial presentation of the underlying carcinoma. The most common underlying primary tumours are breast (33%), stomach (29%) and lung cancers (17%). Approximately 50% die within 3 months of their first respiratory symptoms but those with a prostatic primary carcinoma may have good remission with adjuvant hormonal therapy.

A ten-year observation on experimental infection of periodic Brugia malayi in man

This paper reports the results of 10 years of observations on the clinical manifestations, pathology and 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. The changes in clinical symptoms and signs were recorded systematically. Microfilariae were first detected at 41 and 46 weeks after inoculation in two subjects and remained detectable in small numbers until 8-8.5 years after infection. The microfilarial density fluctuated at 1-2 mf 120 microliters-1. Thereafter no microfilariae were detected in 12 blood sample examinations, suggesting that the adult reproductive period of periodic B. malayi could last up to 8-9 years in the human body. Eosinophilia occurred mainly before and at the initial stage of microfilaraemia. An increase in the lymphocytes was observed to some extent at 2-156 weeks after infection. Biopsy at the inoculation site 6 weeks after inoculation showed infiltration of the lymph node by inflammatory cells, mainly eosinocytes, lymphocytes and monocytes. Lymphangiectasis and lymphostasis were observed in both limbs and pelvic regions by lymphangiogram taken 11 weeks after inoculation. Antibodies against B. malayi first appeared at 2-5 weeks after infection, peaked at 12-56 weeks and thereafter declined gradually. Subjects A and C became antibody free but subject B remained positive to antibody against B. malayi 10 years after infection. E-rosette forming lymphocytes became lower than normal at 11 weeks and recovered to normal within 10 years after infection.

Observations on the clinical manifestations and treatment of an experimental infection with Brugia malayi in man

This paper reports clinical observations made during experimental Brugia malayi infection in man. This was induced by 52 infective larvae-carrying mosquitoes, Anopheles sinensis. A monkey, Maccaca mulatta, was inoculated with infective larvae from the mosquitoes infected with nocturnally periodic type of B. malayi from patients. Six months later, the monkey became a microfilaria carrier. Nine days later, the subject was experimentally bitten by mosquitoes infected from biting the monkey, with an estimated delivery of over 200 infective larvae. Seven days after the infection, general (but fluctuating) pruritus developed, followed by lymphadenitis and swelling of the hand and forearm, with a mild pyrexia for nearly 3 months. The eosinophil counts continuously increased. There were four separate attacks of lymphangitis. On day 142, microfilaraemia was first detected. After two more weeks, the subject was treated with a total dose of 15 g diethylcarbamazine (DEC) over 30 days. During this period, 28 small tender subcutaneous nodules appeared on his arms. After treatment, microfilaraemia gradually disappeared and the swelling of his arms improved. Three months later, the eosinophil count of his blood returned to normal but some temporary and scattered small pruritic erythematous patches still persisted over his left forearm. Lymphangitis has not recurred.

Common and uncommon infections of the hand

Most serious hand infections are preventable at this time if proper prophylaxis is maintained with regard to the hands and if the precursor conditions-mild inflammations and infections-are quickly and appropriately treated. In those few serious hand infections that still occur, a judicious combination of medical, surgical, and rehabilitative measures should preserve normal or at least reasonable function in practically all instances.

Nonvenereal sclerosing lymphangitis of the penis

Sclerosing lymphangitis of the penis with a purplish, cord-like structure, singular or multiple around the coronal sulcus, appears 24 to 48 hours after sexual relations. There is edema of the glans penis and coronal area, which is doughy and plastic. The condition is self-limited.