Elephantiasis Of Legs Research Articles

Assessment of the clinical outcomes and patient satisfaction when using bilateral radial artery as surgical conduits in coronary artery bypass grafting

IntroductionThe need for use of the bilateral radial artery has emerged since we faced patients in our institute with severe uncontrolled diabetes, bilateral leg elephantiasis, and left main disease that needs surgical revascularization.Patients and methodsWe reviewed the outcomes from our institute with retrospective analysis of prospectively collected clinical data from our local clinical database and identified 30 consecutive patients who underwent coronary artery revascularization requiring the use of bilateral radial harvest. Patient satisfaction was assessed using a quality-of-life questionnaire with the descriptors on a Likert Scale (table A). The patients were followed up both clinically and by ECG and echocardiography every 6 months for 2 years postoperatively to follow up their ejection fraction and for the assessment of any new segmental wall motion abnormalities.ResultsOnly three (12.5%) patients out of 24 reported 'rarely' or sometimes arm pain or discomfort, while all the others (87.5%) were asymptomatic. The median score for arm and sensory and neurological complications was 5. Three (12.5%) patients reported long-term permanent sensory deficit, while six (25%) patients had some other less-significant sensory loss. Only one (4.2%) patient reported significant motor dysfunction, while five (20.8%) patients reported milder forms of motor deficit. Thirteen (54.1%) patients considered the appearance of radial harvest site as excellent, while 23 (95.8%) patients considered it to be at least acceptable. One (4.2%) patient reported a 'moderate' functional change otherwise, the remaining patients reported 'minimal' (12.5%) or 'no change' (83%). The functional outcomes from our series of patients remain favorable with minimal functional decline in the majority of our patients. Both clinical ECG and echocardiographic follow-up revealed stability of all followed patients without the need for CCU admission or repeat revascularization in this time period.ConclusionsUsing bilateral radial artery as surgical conduits in coronary artery bypass grafting is acceptable to patients when alternatives are not favorable for surgical revascularization.

Assessment of disease and infection of lymphatic filariasis in Northeastern Cambodia.

We assessed the filariasis disease burden in four northeastern provinces of Cambodia by using and validating a key-informant questionnaire, consisting of four questions, with pictures of patients with leg elephantiasis and hydrocoele. The questionnaire was distributed and collected through the school, health and administrative systems. Validation surveys included clinical examination, a card test for W. bancrofti (ICT Filariasis card test, AMRAD) and night blood finger prick examination of patients reported with clinical elephantiasis. Only 48.0% of questionnaires were returned. A total of 220 patients were reported, mostly from Stung Treng (36.8%) and Rattanakiri provinces (35.0%). Key-informants reported patients with lymphatic filariasis with a sensitivity of 85.7% for leg and 97.0% for scrotum morbidity, and with a specificity of 95.6%. However, substantial over-reporting resulted in very low positive predictive values for elephantiasis of 19.4% for legs and of 23.7% for the scrotum. As 97.4% of patients with clinical lymphatic filariasis were older than 40 years, the diagnostic performance of the questionnaire would be improved by restricting its use to that age group. About 0.7% of 3490 W. bancrofti card tests were positive; the prevalence was 1.94% (12/618) in Rattanakiri, 0.38% (4/1055) in Stung Treng and 0.22% (2/919) in Preah Vihear. W. bancrofti microfilaria were identified in blood from two patients in Rattanakiri (0.32%) and from one patient in Stung Treng (0.09%). Brugia malayi microfilaria were identified in blood from five patients in Rattanakiri (0.81%) only. No patients with microfilariaemia were identified in Preah Vehear. In Mondulkiri province all investigations (card test, night blood examination, clinical examination) for lymphatic filariasis were negative. Our findings confirm the usefulness of key-informant questionnaire for the identification of filariasis patients provided that high adherence can be achieved. Lymphatic filariasis infection and disease is present in northern Cambodian provinces but the burdens of disease and infection are relatively low. These results are being used in the implementation of the national control programme for lymphatic filariasis.

A survey of Brugia malayi infection on the Heugsan Islands, Korea.

Lymphatic filariasis due to Brugia malayi infection was endemic in several areas of South Korea. The infection was controlled, or disappeared, in most areas, with the exception of the remote southwestern islands of Jeonranam-do, including the Heugsan Islands. To discover its current situation, a small-scale survey was performed on the Heugsan Islands in September 2000. A total of 378 people, 151 male and 227 female, living in 8 villages (6 on Daeheugsan-do, 1 on Daejang-do, and 1 on Yeongsan-do) were subjected to a night blood survey for microfilaremia, and physical examination for elephantiasis on the extremities. There were 6 (1.6%) microfilaria positive cases, all in females aged 57-72 years, and from only two villages of the Daeheugsan-do area. There were 4 patients with lower leg elephantiasis, but they showed no microfilaremia. The results show that a low-grade endemicity of filariasis remains on the Daeheugsan-do.

Lymphatic filariasis in Lower Shire, southern Malawi

Surveys for lymphatic filariasis were carried out for the first time in Lower Shire (Nsanje and Chikwawa Districts) of southern Malawi, in April–June 2000. There were 3 phases. In phase I, questionnaire surveys in 48 randomly selected villages indicated that chronic manifestations of lymphatic filariasis (‘swollen scrotum’ and ‘swollen legs’) were common and widespread in the area. In phase II, volunteers from 10 of the villages reporting frequent manifestations of filariasis in phase I were examined with the ICT whole-blood test for Wuchereria bancrofti-specific circulating filarial antigen (CFA). The observed prevalence of CFA positivity was very high (range, 38·8–79·1% for the villages). In phase III, a more detailed parasitological, CFA and clinical investigation was carried out in 2 of the high CFA prevalence villages identified in phase II (1 in each district). Overall, 18·1% and 22·2% were positive for microfilariae, and 62·3% and 64·6% were positive for CFA in the 2 villages. Among those aged ≥ 15 years, 3·7% and 1·3% had leg elephantiasis, and 17·9% and 13·0% (of males only) had hydrocoele. In both phase II and III, CFA prevalences were unexpectedly high, especially in children. This was probably related to a recent increase in transmission of filariasis as a result of extensive flooding in the area prior to the study. The study indicated that lymphatic filariasis is highly endemic in the Lower Shire area of Malawi, and calls for action towards its control.

A review of the present status of lymphatic filariasis in Vietnam

Establishing the current status of an infectious disease forms the starting point of any attempt at parasite control. Although data on the prevalence and distribution of lymphatic filariasis exist for Vietnam from the early 1900s, the present situation regarding the disease is less well-known. Here, we review the results of recent surveys conducted by the Institute of Malariology, Parasitology and Entomology, Hanoi, to update the existing information on filariasis epidemiology and distribution for this country. The present results are from surveys carried out on some 135 000 individuals in 24 provinces of Vietnam. The highest prevalences of microfilaraemia (primarily Brugia malayi) are observed in lowland areas of the Red River Delta and in Quang-binh Province where the survey results show microfilaraemia (mf) prevalences in the range of 0.9–5.5%. The most common type of chronic clinical manifestation is shown to be leg elephantiasis. A significant finding is that an overall decrease in mf prevalence was observed to occur in five communities which were surveyed twice over an 11–21-year period, even though no interventions were carried out between the two surveys. The changes are probably caused by environmental changes, such as increased standards of housing and drainage. Studies on the effect of selective chemotherapy and mass chemotherapy using diethylcarbamazine showed reductions in community mf prevalences of 69 and 72–88%, respectively. Furthermore, cats do not appear to represent significant reservoirs of infection. These findings of geographical restriction of infection, effective and well-tolerated drug therapy, low significance of animal reservoirs, together with the existence of an effective national health network, suggest a good prognosis for the control of filariasis in this country.

Bancroftian filariasis: analysis of infection and disease in five endemic communities of north-eastern Tanzania.

Clinical and parasitological surveys for bancroftia filariasis were carried out in five endemic communities in north-eastern Tanzania, covering a population of 3086 individuals. High microfilarial (mf) prevalences (17.7%-34.7%) and mf geometric mean intensities (251-1122 microfilariae/ml) were observed in the communities. The mf prevalence generally increased with age, but often levelled out in the older age groups. Larger variability was observed in individual mf intensities and no clear association between mf geometric mean intensity and age or sex was seen. Hydrocele was the most common clinical manifestation (with a prevalence of 30.2%-40.0% in male subjects aged > or = 20 years) followed by leg elephantiasis (with a prevalence of 2.0%-6.8% in all subjects aged > or = 20 years). In four of the five communities, there was no significant difference in mf prevalence in males aged > or = 20 years between those with and without hydrocele. In all the communities, the mf geomtric mean intensities in microfilaraemic males with and without hydrocele were not significantly different. The present study therefore did not indicate any association between hydrocele in males (the most common type of chronic clinical manifestation seen) and presence or absence of microfilaraemia. In contrast, only two (4.4%) of the 45 subjects with leg elephantiasis were microfilaraemic. In children aged 1-15 years, mf prevalence was significantly higher among those with microfilaraemic mothers (18.0%) than among those with amicrofilaraemic mothers (7.9%). The children of microfilaraemic mothers were therefore at 2.3-fold higher risk of becoming microfilaraemic than the children of amicrofilaraemic mothers. No relationship between the mf prevalence of the children and the mf status of their fathers was observed.

A 16-year follow-up study on bancroftian filariasis in three communities of north-eastern Tanzania.

The results of a 16-year, parasitological and clinical, follow-up study on bancroftian filariasis in three villages in north-eastern Tanzania are reported and analysed with respect to the long-term development of microfilaraemia and disease. The study revealed an extraordinary static situation, both at the community level and at the individual level. No significant differences were observed in any of the three villages, with respect to total or age-specific prevalences of microfilaraemia, hydrocele in males aged > or = 20 years or leg elephantiasis in all subjects aged > or = 20 years, when the results from 1975 were compared with those from 1991. Overall, 542 of the subjects (37.2% of the total) examined in 1975 were re-identified and re-examined in 1991. Of those microfilaraeic in 1975, 81.9% were also microfilaraemic in 1991. Similarly, 81.3% of those amicrofilaraemic in 1975 were also amicrofilaraemic in 1991. Thus, most subjects had the same microfilarial (mf) status at both surveys. The low mf loss rate indicates that re-infection of microfilaraemic individuals commonly takes place, and results in repeated sequences of microfilaraemia in the same individuals. The rate of gain of microfilaraemia was independent of age, thus indicating no age-related change in the examined population's susceptibility to develop or sustain microfilaraemia. Individual differences in susceptibility to develop mirofilaraemia therefore appear to be innately determined, or to be acquired in pre-natal or early post-natal life. Neither the presence of hydrocele in 1991, nor the development of new cases of hydrocele over the 16-year period were related to the mf status in 1975 or 1991, and no association between microfilaraemia and this chronic clinical manifestation was observed. The association between leg elephantiasis and mf status could not be analysed because of the small sample size.

Nodular subepidermal fibrosis in non-filarial endemic elephantiasis of the legs.

SUMMARY Nodular subepidermal fibrosis is a common complication of non-filarial elephantiasis of the lower legs. It occurs in the ‘rubbery’ type of elephantiasis only. The sites of predilection correspond to areas exposed to microtraumata; the sole and the leg above the ankle are never involved by nodulation. The microscopic appearances are described. Treatment, which is demanded by the patient for aesthetic reasons, or required as a preparatory measure for footwear, is surgical removal of the nodules.