Primary infection of dogs with Echinococcus granulosus: systemic and local (Peyer's patches) immune responses

Local and systemic lymphocyte proliferation and antibody production were tested in five dogs 35 days after primary experimental infection with Echinococcus granulosus. A significant cell proliferation was demonstrated by [3H] thymidine incorporation in mesenteric, popliteal and/or Peyer's patches (PPs) cells in response to E. granulosus protoscolex or adult worm antigen in three of five infected dogs, but not in five control animals. In contrast, blood mononuclear cells responded very weakly in only two of the infected dogs to parasite antigens. Elevated levels (compared with preinfection status) of protoscolex- and adult worm antigen-specific serum IgG were detected (ELISA) in four of the five dogs 35 days after infection. Furthermore, slightly elevated levels of parasite-specific IgE and IgA were observed in the sera of three and four in four infected dogs, respectively. Specific serum IgM was not significantly higher 35 days after infection than before infection. Local antibody production was studied in vitro using PPs, mesenteric and popliteal cells isolated from three infected and three uninfected dogs by ELISA using adult worm antigen. In two of three cultures of unstimulated PPs cells of infected dogs, parasite-specific IgG was detectable. Parasite-specific IgA and IgM were detected in one of the unstimulated PPs cell culture derived from an infected dog. Following in vitro stimulation with parasite antigen, PPs cells from two infected dogs showed increased parasite-specific IgG and PPs cells of all three infected dogs produced parasite-specific IgA. PPs cells from uninfected dogs did not produce significant quantities of parasite-specific antibodies and cells from mesenteric and popliteal lymph nodes of infected or uninfected dogs neither produced antibodies whilst in in vitro cultures.     

IS system for internists

Fibrodysplasia is a generalized arterial dysplasia of unknown etiology. We report a case involving both popliteal arteries. The patient presented with microemboli of the toes of both feet originating in the dysplastic popliteal arteries. The clinical significance of popliteal artery fibrodysplasia is briefly discussed.     

Western blot monitoring of disseminated Nocardia nova infection treated with clarithromycin, imipenem, and surgical drainage

A case of disseminated infection due to Nocardia nova with subcutaneous popliteal and retrosternal abscesses and lung involvement in an immunocompromised patient is reported. The patient did not respond to sulfonamide therapy. Clinical recovery was obtained upon treatment with imipenem then clarithromycin. Western blot studies revealed an antibody response to a known Nocardia-specific 55-kDa antigen in four successive sera samples collected in the period from the time of admission to seven months later. The resolution of the disseminated nocardiosis and efficacy of the clarithromycin treatment were assessed on the basis of disappearance of the antibodies to the 55-kDa antigen, without invasive sampling.     

Fetal cells in maternal blood: recovery by charge flow separation

PURPOSE: To screen patients with abdominal aortic aneurysm for popliteal aneurysm and investigate cardiovascular and genetic risk factors associated with aneurysmal disease at more than one site (generalised aneurysmal disease). SUBJECTS, DESIGN AND SETTING: All patients referred to the Regional Vascular Surgical Service at Charing Cross Hospital with unruptured abdominal aortic aneurysm between 1989 and 1993 were screened for popliteal aneurysms, using ultrasonography. MAIN OUTCOME MEASURES: Palpation of a popliteal aneurysm or ultrasonographic detection of popliteal dilatation, where the ratio maximum popliteal fossa diameter/suprageniculate popliteal diameter was > or = 1.5, in relation to cardiovascular and genetic risk factors. RESULTS: Clinical examination detected popliteal aneurysms in only 11/232 patients (5%), but ultrasonography demonstrated the presence of popliteal aneurysm in a further 13 patients, 24/232 in total (10%). Multivariate regression identified four independent factors associated with popliteal dilatation disease: age (p = 0.046), height (p = 0.006), systolic hypertension (p = 0.037) and triglyceride concentration (p = 0.009). Generalised aneurysmal disease and systolic blood pressure were associated with polymorphic variation in the fibrillin-1 gene, but not with variations in the apolipoprotein B and type III collagen genes. CONCLUSIONS: Few patients with abdominal aortic aneurysm (10%) also have popliteal aneurysms: the risk of popliteal dilatation increases with age, height, systolic blood pressure, triglyceride concentration and fibrillin genotype. The strong interaction between fibrillin genotype and blood pressure may contribute to the familial tendency to aortic aneurysm.     

Popliteal venous aneurysm: report of two cases and review of the world literature

Two new cases of popliteal venous aneurysm are reported and added to the 22 other cases of popliteal venous aneurysm available for review. Both patients were first seen with acute pulmonary embolism and were treated with thrombolytic therapy followed by anticoagulation. Each had recurrent venous thromboembolism before discovery of the popliteal venous aneurysm. One popliteal venous aneurysm was diagnosed with phlebography and the second with venous duplex imaging, confirmed with phlebography. Both were surgically corrected with tangential aneurysmectomy and lateral venorrhaphy. Twenty-four cases of popliteal venous aneurysm are now available for review. Seventy-one percent (17 of 24) presented with pulmonary embolism, 88% (21 of 24) were saccular, and 96% (23 of 24) were located in the proximal popliteal vein. All but two were diagnosed by ascending phlebography. Three patients received no treatment: in two of these the outcome was not documented and the third had occasional pain. Two patients received anticoagulation without subsequent operative repair and both died of recurrent pulmonary emboli. Operative correction resulted in a 75% patency rate with 21% complications, most of which were related to postoperative anticoagulation. No patient who was operated on had subsequent pulmonary embolism, and there were no operative deaths. We suggest that all patients who have pulmonary embolism have lower-extremity venous duplex imaging. All popliteal venous aneurysms should be surgically repaired, inasmuch as nonoperative therapy results in recurrent thromboembolism and an unacceptably high mortality rate. Tangential aneurysmectomy with lateral venorrhaphy is the recommended procedure.     

Lymph flow disorders following arterial surgery of the leg

In a series of 342 arterial reconstructions of the iliacolic to popliteal arteries 24 patients with lymph vessel damage were observed. The diagnosis of lymphedema was established in 18 patients by clinical findings and in 2 of them the diagnosis was confirmed by lymphography with followup of 1 year. Three patients developed an internal lymphogenic cyst, 3 showed an external lymph fistula, and 1 patient developed an infection of a dacron bifurcation graft. The infection occurred when an additional occlusion of the left femoral artery was bypassed with an autologous saphenous vein graft and a lymph cyst in the groin, which was excised several times, became infected. The patient was treated successfully by excising the graft and performing an axillofemoral bypass. Although cases of surgical damage to lymph vessels following arterial reconstructions are rare in the literature, it is assumed that this complication occurs more often than reported, because of lack of lymphographic information.     

Effect of medical record audit and feedback on residents'' compliance with preventive health care guidelines

BACKGROUND: Location of the sapheno-popliteal junction (SPJ) is highly variable and therefore often difficult to identify correctly at operation. The anatomy is often complicated by associated pathology in the popliteal fossa, which makes clinical examination unreliable. OBJECTIVE: The purpose of our study was to quantify this variability and record other concomitant pathology in patients with sapheno-popliteal junction incompetence. METHODS: We retrospectively reviewed duplex scans of 544 patients with 638 legs showing SPJ incompetence, from a total of approximately 4000 patients attending our laboratory between August 1993 and August 1995. RESULTS: We found that 51% of sapheno-popliteal junctions were located within 2 cm above the popliteal skin crease and a further 36% within 4 cm, with the remaining situated anywhere between 4 and 10 cm above the popliteal skin crease. Additionally 18% of patients had either Giacomini or gastrocnemius vein incompetence in addition to SPJ incompetence, further complicating the clinical picture. CONCLUSION: When SPJ incompetence is suspected, duplex scanning identifies the exact location of the junction and other associated pathology in the popliteal fossa, and allows the position of the junction to be marked on the leg preoperatively.     

Arterial injuries of the extremities

Fifty-eight patients with arterial injuries of the extremities were treated during the past 8 years. Fifty-one had acute injuries and seven had nonacute injuries. Blunt trauma or shotgun wounds caused 74% of the injuries, and 55% were associated with skeletal trauma. All the acute injuries endangered the limb; the average ischemic time was 8.5 hours. Brachial, popliteal, and superficial femoral arterial injuries were seen most frequently. Repair was accomplished with autogenous saphenous vein grafts in 47% and end-to-end anastomosis in 41%. Six patients died, four due to injuries of other organs. The most alarming complication of arterial repair was secondary hemorrhage which occurred in three patients and was caused by local infection. Six patients (13.3% required amputations; the highest number (three) after injuries of the popliteal artery. The injuries leading to amputations had associated prolonged ischemia, severity of injury, and associated venous, soft tissue, and skeletal injury. The nonacute injuries were in the form of false aneurysms, pulsating hematomas, AV fistula, and delayed bleeding. These were easily managed without any significant complication.     

Campylobacter fetus endocarditis manifested by a popliteal mycotic aneurysm

BACKGROUND: Campylobacter fetus endocarditis is uncommon and may be life-threatening. CASE REPORT: A 91-year-old patient with rectal villous adenocarcinoma was admitted with fever and recent complaints of popliteal pain. The definite diagnosis of endocarditis and mycotic aneurysm related to C. fetus infection were accepted on the basis of clinical, radiological and microbiological data. Cure was achieved with antibiotics and surgery of the aneurysm without valvular replacement. DISCUSSION: C. fetus endocarditis was probably secondary to the iterative laser treatment of the rectal tumor that had been performed during the past weeks without antibiotic prophylaxis.     

Bilateral aneurysms of the popliteal artery

INTRODUCTION: Popliteal artery aneurysms are the most common of peripheral arterial aneurysms. Popliteal aneurysms are bilateral in 42% of patients. Atherosclerosis and bacterial invasion of the arterial wall are the predominant etiologic factors of popliteal artery aneurysms. CLINICAL CASE: A male of 67 years old was referred to our institution for bilateral claudication and 150 m. free interval. The angiogram showed a partial occluded aneurysm of the right popliteal artery and a complete thrombosis of the left popliteal artery aneurysms. The left aneurysm was resected and a femoral popliteal by-pass was performed, using the inverted saphenous vein graft, associated with left lumbar sympathectomy. Six months later the contralateral aneurysm was excised and a Dacron femoro-popliteal by-pass graft was performed. Two years later Arteriographic and Doppler examination showed patent by-pass bilaterally. CONCLUSION: Popliteal artery aneurysms can be a threaten for the lower limbs, because of thromboembolic phenomena and occasional rupture. Surgery is the best treatment before the appearance of an acute complication and a by-pass with an autogenous vein graft or a Dacron graft are the most common surgical procedures performed. Thrombolytic therapy offers good results where an acute complication appears.     

The incidence of iliac, femoral, and popliteal artery aneurysms in hospitalized patients

PURPOSE: Previous studies have attempted to determine the incidence and mortality rate of abdominal aortic aneurysms in a variety of populations; however, the incidence of iliac, femoral, and popliteal artery aneurysms have not been established. The objective of this study was to determine the incidence of lower extremity aneurysms in hospitalized patients in the state of Utah, which has a population at low risk for cardiovascular disease, atherosclerosis, and smoking, and to compare the results with the incidence in the United States. METHODS: Incidences of iliac, femoral, and popliteal artery aneurysm in Utah were determined over a 6-year period, with data obtained via diagnostic codes from the Utah Hospital Association. The incidence of iliac, femoral, and popliteal artery aneurysms in the United States hospital population was calculated by use of National Hospital Discharge Summary 1990 data, a complex sample of nonfederal short-stay hospitals in the United States, which provides the most comprehensive database of health statistics in the United States. RESULTS: The incidence of iliac femoral/popliteal artery aneurysms in hospitalized Utah men is 3.76 and 4.85 per 100,000 population, respectively. In American men, iliac and femoral/popliteal artery aneurysm incidences are 6.58 and 7.39 per 100,000 population, respectively. Incidences among hospitalized women in Utah are 0.24 and 1.07 per 100,000; incidences in women in the United States are 0.26 and 1.00 per 100,000, respectively. The incidence of nonaortic peripheral aneurysms among hospitalized patients in Utah is lower than in the United States. The rate ratios (Utah/United States) for incidences of iliac, femoral, and popliteal artery aneurysms in men are 0.57 and 0.66, respectively (p < 0.05). No statistical difference is seen between incidences in women in Utah and the United States (p > 0.05)-ratios of 0.93 and 1.06, respectively. CONCLUSION: This study validates the traditional belief that iliac, femoral, and popliteal artery aneurysms are much less frequent, at least in hospitalized patients, than previously published incidences of abdominal aortic aneurysms.     

The treatment of osseous rupture of the posterior cruciate ligament (author's transl)

3 cases are reported of successful surgical treatment of isolated osseous rupture of the posterior cruciate ligament. Fixation was undertaken with 2 crossed wires leading from the popliteal fossa to the anterior aspect of the tibia. The advantage of this method is that the popliteal fossa does not have to be reopened 6 to 8 weeks later when the wires are removed.     

Improved treatment of popliteal arterial injuries using anticoagulation and extra-anatomic reconstruction

Management of popliteal arterial injuries remains a challenging problem. Early recognition and treatment, arteriography, fasciotomy, and repair of concomitant popliteal venous injuries are modalities that have contributed to improved results. Systemic heparin sodium anticoagulation and selected extra-anatomic vein graft bypass of the popliteal area are two additional measures that have contributed to a 91% success rate in treatment of popliteal arterial injuries and five of six blunt injuries were treated successfully in this time period. A limb salvage rate of only 46% was attained in the previous five-year period. There were no operative deaths. No complications attributable to systemic anticoagulation or extra-anatomic bypass graft occurred. These adjuncts are recommended to all who manage vascular injuries.     

Popliteal pterygium syndrome in a 74-year-old woman

The case of a 74-year-old woman with the rare popliteal pterygium syndrome is presented. This syndrome is inherited as an autosomal dominant trait with incomplete penetrance and varying expression and consists of cleft lip and palate, lip pits, genital anomalies, popliteal pterygium, and malformations of the extremities. The various treatments our patient underwent over the years are reported. Treatment of popliteal pterygium involves special problems whem removing the skin fold because the nerve and vascular cords lie immediately anterior to the posterior fibrous cord. In the present case there are widespread arthrotic changes, both in the extremity joints and in the spine. These patients are short in stature. This, together with the general arthropathy, suggests a hereditary metabolic disturbance in the cartilaginous tissue.     

Investigation and significance of short saphenous vein incompetence

In this study, 186 limbs with varicose veins or venous skin changes were examined using duplex ultrasonography. Limbs were classified on the basis of short saphenous or popliteal venous incompetence and the number of limbs with venous ulceration (active or healed) recorded. Short saphenous incompetence did not produce a significant increase in the incidence of ulceration, whereas popliteal reflux produced an increase in the risk of ulceration which was statistically significant when compared with limbs without reflux in these two veins (chi 2 = 4.55, P = 0.003). There was no significant difference in the proportion of limbs with concomitant long saphenous reflux between these two groups. Short saphenous reflux is not important in the pathogenesis of venous ulceration. Popliteal reflux is an important factor in the pathogenesis of venous ulceration. More attention should be paid to the surgical correction of popliteal reflux when present in limbs with venous ulceration that fail to heal by conservative measures.     

Duplex scanning and light reflection rheography in the assessment of the severity of short saphenous vein incompetence

BACKGROUND: Duplex ultrasound assessment of veins in the popliteal fossa is an accepted alternative to venography. Light reflection rheography provides additional quantitative information on venous reflux in chronic venous insufficiency. OBJECTIVE: To use duplex ultrasound and light reflection rheography to study the venous reflux patterns in the popliteal fossa in a group of patients. METHODS: Duplex ultrasound examination and light reflection rheography were used in the assessment of the severity of short saphenous vein incompetence. RESULTS: The study revealed that any associated deep venous reflux which was detectable beyond the saphenopopliteal junction represented a more advanced stage of superficial venous insufficiency. CONCLUSIONS: Light reflection rheography, as a semiquantitative test, provided useful additional information to duplex scan findings in assessing venous reflux of the popliteal fossa. Short saphenous vein reflux with functional deep venous incompetence was associated with shorter venous refilling times and clinically represented a more advanced stage of primary varicose vein disease.     

The influence of the lymph node on the protein concentration of efferent lymph leaving the node

1. Experiments have been performed in sheep to determine the contribution of lymph formed within a lymph node to the total protein output in lymph leaving the node. 2. The lymphatic duct leaving the popliteal lymph node was cannulated and the protein and lymphocyte output in efferent lymph determined. The afferent lymph flow to the popliteal node was then diverted and lymph formed only within the lymph node collected from the efferent cannula. It appeared from the results that the popliteal lymph node forms lymph at the rate of approximately 1 ml. per hour and may contribute 30-50% of the protein output observed in efferent lymph. 3. The importance of lymph formation within the lymph node varied between nodes found in different regions of the body. This was due in part to the different protein concentrations in the afferent lymph to the different nodes. 4. A positive correlation was found between the protein and lymphocyte concentrations in efferent lymph from the popliteal lymph node in seven out of eleven sheep and in lymph formed within the popliteal lymph node in two out of three sheep. It is suggested that this relationship may be due to an increased transfer of plasma proteins through the post-capillary venules in the lymph node accompanying the continual traffic of lymphocytes across the wall of these vessels. The results indicated that the protein transfer across the post-capillary venules was not an indiscriminate transfer of plasma per se but a selective transport from the blood plasma compartment based on molecular size.     

Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound

BACKGROUND: Two different diagnostic strategies are used to perform compression (real-time) ultrasound for the diagnosis of clinically suspected deep-vein thrombosis. One is to examine the entire proximal venous system from common femoral to distal popliteal vein; the other is a limited examination of only the common femoral and the entire popliteal vein. The latter strategy, which is less time-consuming and requires less expensive equipment, is based on a strong impression from prospective studies using limited compression ultrasound that proximal vein thrombi always involve the common femoral or popliteal vein. This impression, which is supported by the demonstrated safety at long-term follow-up of not treating patients whose limited compression ultrasound is normal at presentation and then repeated within the next week, has not been tested in a formal study. Therefore, we reviewed a large series of venograms performed in consecutive patients with clinically suspected venous thrombosis to determine the distribution of venous thrombosis in symptomatic patients. METHODS: Venograms were performed using 150 mL of radiographic contrast material. Before the study, a panel of experts agreed on the standardized criteria for the assessment of venograms. Venograms were adjudicated blindly for the presence of deep vein thrombosis and to determine the distribution of proximal vein thrombosis and isolated calf-vein thrombosis, the size of proximal thrombi, and whether they were occlusive or nonocclusive. Subsequently, the duration of symptoms was related to the venographic findings. RESULTS: Five hundred sixty-two venograms from consecutive patients with a first episode of clinically suspected deep vein thrombosis were adjudicated. Of these, 20 (3.6%) were inadequate for interpretation. In the remaining 542, venous thrombosis was demonstrated in 189 instances (prevalence, 35%; 95% confidence interval, 31% to 39%) and were located in the proximal veins in 166 (88%; 95% confidence interval, 82% to 92%) venograms. Isolated calf-vein thrombosis was present in the remaining 23 (12%; 95% confidence interval, 8% to 18%) venograms. Proximal with concurrent calf thrombosis was detected in 164 (99%) of the 166 patients. Proximal thrombi involved only the popliteal vein in 16 (10%); the popliteal and superficial femoral veins in 70 (42%); and the popliteal, superficial, and common femoral vein in eight (5%); whereas thrombi involving the entire proximal deep venous system were detected in 58 (35%) venograms. Isolated thrombosis of the superficial femoral, common femoral, and iliac vein was not observed. Proximal venous thrombi were occlusive in 146 (88%) patients. No relation between the duration of symptoms and the extent or the occlusiveness of venous thrombi could be demonstrated. CONCLUSIONS: Most symptomatic patients have extensive occlusive proximal vein thrombosis at the time of presentation. Thrombi isolated to the superficial femoral or iliac vein were not observed in this large sample of consecutive patients. Our data support the use of the relatively simple, inexpensive, and rapid compression ultrasound method that limits the examination of the proximal veins to the common femoral and popliteal veins.     

Reconstructive surgery in atherosclerosis of the femoral-popliteal- tibial segment

Results of surgical treatment of 368 patients with atherosclerotic occlusions of popliteal-tibial segment are analyzed. The operation method choice was based on classification, discerning five types of lesion: I type--isolated a. femoris superficialis (AFS) occlusion; II type--AFS occlusion, a. femoris profunda stenosis; III type--extended occlusions of superficial, popliteal, deep arteries and shin arteries; IV type--the lesion of distal part of a. femoris communis and a. poplitea; V type--the popliteal artery occlusion with the process transient on shin arteries.     

Differential induction of apoptosis in activated and resting T cells by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and its repercussion on T cell responsiveness

TCDD is well known for its immunotoxic effects on T cells, although the exact mechanism of toxicity remains unknown. In the current study, we investigated the effect of TCDD administration on resting and activated T cells within the same animal. To this end, C57BL/6 mice were injected intraperitoneally with either TCDD (50 microg/kg body weight) or the vehicle and were injected with anti-CD3 mAbs into the rear footpads to polyclonally activate T cells in the popliteal lymph nodes (LN). Axillary LN cells harvested from the same groups of mice served as a source of resting T cells. When the LN cells were tested for their proliferative responsiveness to stimulation with anti-CD3 mAbs in vitro, the activated popliteal LN, but not the resting axillary LN cells from TCDD-treated mice exhibited a significant decrease in responsiveness when compared to the vehicle controls. Inasmuch as TCDD has been shown to induce apoptosis in thymocytes, we addressed whether TCDD triggered apoptosis in LN cells, using the terminal deoxynucleotidyl transferase (TdT)-mediated FITC-dUTP nick end labeling (TUNEL) method. The axillary and popliteal LN cells from TCDD-treated mice failed to exhibit significant levels of apoptosis when freshly harvested. However, upon in vitro culture for 24 h with either tissue culture medium alone or with anti-CD3 mAbs, activated popliteal LN cells from TCDD-treated mice showed a significant increase in apoptosis when compared to similar cells from vehicle-treated mice. In contrast, resting axillary LN cells from TCDD-treated mice, similarly cultured in vitro, exhibited decreased levels of apoptosis when compared to the controls. Using a double-staining technique, the activated popliteal LN cells undergoing increased apoptosis in TCDD-treated animals were confirmed to be CD3+ T cells. Together, these data demonstrate that TCDD exerts differential effects on activated and resting T cells, even within the same animal, by inhibiting the proliferative responsiveness of activated, but not resting, T cells. Furthermore, this effect may be mediated by the ability of TCDD to induce increased apoptosis in activated, but not resting, T cells.