Eleven (41%) patients showed regression in four or more characteristics; they did not differ significantly from the other 16 patients with respect to sex, age, stage, or duration of lymphedema; duration of participation in the lymphedema program before the first biopsy; interval between biopsies; or ADLA incidence between biopsies (Table 4).
Filariasis elimination programs' increasing adoption of simple, inexpensive measures for lymphedema management has led to reduced ADLA incidence, reduced lymphedema--related illness, decreased stigma, and improved quality of life for women in many filariasis-endemic areas (24,27-29,32).
Chronic infiltrate may have resulted from poor clearance by the lymphatic system of bacteria penetrating the skin surface or a prolonged immune response following an ADLA attack.
Taken as a whole, these observations are consistent with the hypothesis that basic lymphedema management, which reduced microbial load on the skin surface and healed entry lesions, led to a decrease in ADLA incidence and a reduction in chronic inflammation of the skin.
At an individual level, we found no factors, including the absence of ADLA attacks, that were significantly associated with histopathologic regression.
of days between 359 (317-503) 366 (317-656) biopsies (range) Median annual incidence of ADLA 0 (0-2) 0 (0-3) between biopsies (range) Median duration of lymphedema, 11.
Archives Municipales de Saint-Joachim, "Counseil Municipal," 24 December 1882, 14 August 1892; ADLA S1 1712, 18 November 1894.
ADLA 2M207, 2M274, 2M341 Denombrement de la population, Saint-Joachim 1851, 1855, 1881, 1896, 1911; Archives Municipales de Saint-Nazaire, Etat Civil-Actes de Mariages, 1881, 1896, 1911.
ADLA 1M2309, "Sous-prefet," 3 July, 3, 7 August 1861.
La Democratie de l'Ouest, 21, 25 June 1899; Phare de la Loire, 21, 22 June 1899; ADLA 1M2314, 20 June, 18 July 1899.
L'Avenir, 24 December 1882; ADLA 1M2311, "Gendarmerie," 14 December 1893.
324-325; AN BB 18 1932, 16 December 1893; ADLA 1M2311, "Sous-Prefet," 16 December 1893, "Prefet," 16, 18 December 1893, "Commissaire Special," 16, 17 December 1893, "Greve des ouvriers," December 1893; Le Populaire, 15 December 1893.
