The Intersection of Human and Veterinary Medicine-A Possible Direction towards the Improvement of Cell Therapy Protocols in the Treatment of Perianal Fistulas.

The effective treatment of perianal fistulizing Crohn's disease is still a challenge. Local administration of mesenchymal stromal cells (MSCs) is becoming a part of accepted treatment options. However, as a fledgling technique, it still can be optimized. A new trend in translational research, which is in line with "One Health" approach, bases on exploiting parallels between naturally occurring diseases affecting humans and companion animals. Canine anal furunculosis (AF) has been indicated as condition analogous to human perianal Crohn's disease (pCD). This narrative review provides the first comprehensive comparative analysis of these two diseases based on the published data. The paper also outlines the molecular mechanisms of action of MSCs which are likely to have a role in modulating the perianal fistula niche in humans, and refers them to the current knowledge on the immunomodulatory properties of canine MSCs. Generally, the pathogenesis of both diseases shares main determinants such as the presence of genetic predispositions, dysregulation of immune response and the relation to intestine microbiota. However, we also identified many aspects which should be further specified, such as determining the frequency of true fistulas formation in AF patients, elucidating the role of TNF and Th17 pathway in the pathogenesis of AF, or clarifying the role of epithelial-to-mesenchymal transition phenomenon in the formation of canine fistulae. Nevertheless, the available data support the hypothesis that the results from testing cell therapies in dogs with anal furunculosis have a significant translational value in optimizing MSC transplants procedures in pCD patients.

Absceso renal estafilocócico trasforunculosis cutánea / Staphylococcus renal abscess after cutaneous furunculosis

Los abscesos renales son patologías infrecuentes, pero de alta morbi-mortalidad si no son diagnosticados temprano y tratados precozmente. Su vaga e inespecífica sintomatología: dolor abdominal o lumbar, fiebre o mal estado general hacen que su diagnostico sea a veces tardío. La ecografía y/o la TAC dan el diagnóstico en el 100 por ciento de los casos lo que hace posible su tratamiento temprano. El objetivo de este artículo es poner de relieve que el absceso renal es una causa de urgencia urológica a tener presente en pacientes fundamentalmente del sexo femenino, con síntomas de dolor abdominal o fiebre sin clara focalidad urológica.MATERIAL Y MÉTODOS: Se presenta el caso de una adolescente de 16 años con antecedente reciente de forunculosis cutánea supurada en rodilla derecha, que acudió a urgencias por dolor en flanco derecho y fosa iliaca derecha de 10 días de evolución sin fiebre ni síntomas miccionales. Se nos consultó para su valoración, siendo la ecografía el método diagnóstico que se utilizó para la localización de un absceso renal derecho subcapsular de 44 mm en polo superior, y posteriormente para su drenaje percutáneo al no responder porcompleto al tratamiento antibiótico i.v. El cultivo del material purulento del drenaje percutáneo aisló un Staphyloccocus aureus no meticilin resistente. El tratamiento antibiótico i.v asociado a drenaje percutáneo seguido de cloxacilina oral a su alta, curó a la paciente. A raíz de este caso se revisan las series y revisiones sobre abscesos renales de los últimos 10 años, con un total de 179 pacientes, y las publicaciones sobre abscesos renales por Staphyloccocus aureus con tan sólo 13 casos. CONCLUSIONES: Los abscesos renales han de tenerse en cuenta entre las urgencias urológicas. Su diagnóstico y tratamiento percutáneo es mayormente radiológico, reservándose la cirugía abierta o la nefrectomía para abscesos > de 5 cm o pacientes sépticos...

Renal abscesses are infrequent pathologies, but with a high morbidity-mortality if they are not diagnosed and treated early. Its vague and unspecific symptomatology: abdominal or lumbar pain, fever or poor general state, make its diagnosis late sometimes. The ultrasound and/or TAC provide a 100 percent diagnosis of the cases where its early treatment is possible. The objective of this article is to give importance to the fact that renal abscess is a cause of an urological emergency to keep in mind in patients, particularly females with symptoms of abdominal pain or fever without a clear urological focus. MATERIAL AND METHODS: The case of a 16-year-old adolescent is presented with a recent history of festered cutaneous furunculosis on the right knee. She went to the emergency room due to pain on the right side and right illiac fosa with 10 days evolution without fever or urinary symptoms. She came to us for its evaluation, an ultrasound was used for diagnosis to locate a right subcapsular renal abscess of 44 mm on the superior pole, and later for its percutaneous drainage when it did not completely responded to I.V. antibiotic treatment. The culture of the purulent material of the percutaneous drainage isolated a resistant non-methicillin Staphyloccocus aureus. The I.V. antibiotic treatment associated to percutaneous drainage followed by oral cloxacillin upon release cured the patient. CONCLUSIONS: Renal abscesses have to be taken into account among the urological emergencies. Their diagnosis and percutaneous treatment is mainly radiological, leaving open surgery or nephrectomy for abscesses > 5cm or with septic patients...

A case of common variable immunodeficiency presenting with furunculosis.

Common variable immunodeficiency (CVID) is the most prevalent of the primary immunodeficiencies, and is characterised by low IgG and IgA, and sometimes IgM. There is some evidence of genetic susceptibility, with 20% of patients having a dominantly inherited disorder with variable expression. It is a heterogeneous disorder with protean manifestations, and as a result diagnosis is often delayed until the second or third decade, with resultant irreversible organ damage, in particular bronchiectasis. Effective treatment is available with regular 3-4-weekly infusions of immunoglobulin. The mechanism of the immunodeficiency has not yet been fully elucidated. The majority of patients present with recurrent sinopulmonary infection, however, this is a multisystem disorder and thus presents to physicians in diverse specialties including dermatology. Other clinical features of the disorder include gastrointestinal problems, granulomatous inflammation, cutaneous features, unusual presentations of enteroviral and mycoplasma infection, an increased incidence of autoimmunity, and a predisposition to lymphoma and stomach cancer. Therefore a knowledge of the disorder and appropriate suspicion by all clinicians of the possibility of such rare problems and a consequent low threshold for performing relevant investigations is imperative in allowing early recognition and instituting effective treatment. We describe a case of CVID identified when the patient developed widespread skin infection, fever and malaise. This case is an important example of a possible presentation of CVID within the dermatology clinic and demonstrates that maintaining a high level of clinical suspicion is essential for the diagnosis of the rare primary immunodeficiencies.

[Septic metastatic complications in facial furuncles and carbuncles]. / Septico-metastaticheskie oslozhneniia pri furunkulakh i karbunkulakh litsa.

According the information of Maxillo-Facial Surgery Clinic of Moscow Medical Academy the percentage of the patients with face furuncles and carbuncles from all the hospitalised is the following: 1994--4.5%, 1995--7.9%, 1996--11.4%, 1997--17.0%. That gives about 3.7 times during the last 2 years. The rate of dangerous for life septic metastatic complications in the course of such diseases considerably exceeds those at phlegmons. This figure has increased 2 to 2.5 times during the last 2 years. Two clinical cases which demonstrate possibility of bacterial thromboemboli spreading in face furuncles and carbuncles not only through small, but also through large blood circulation with formation of septic centres in organs are described. The treatment tactics for such patients requires a strictly individual approach. At slightest suspicion of the complication urgent hospitalisation of the patients for active conservative therapy is necessary. In case of purulent process extension surgery is indicated.

Metastatic staphylococcal lung abscess due to a cutaneous furuncle.

A seemingly trivial infection of the skin can lead to fulminant staphylococcal pneumonia and death. This case history describes the evolution of a fatal Staphylococcus aureus sepsis complicated by the development of multiple lung abscesses in a 17-year-old patient. A pre-existing cutaneous furuncle was the only identifiable cause. Early bacteraemic symptoms are described. Multiple cavitory lesions could be seen on a CAT-scan. The authors would like to stress the importance of early and adequate antibiotic treatment.

Isotopic response.

BACKGROUND: The occurrence of a new skin disorder exactly at the site of another one, already healed and unrelated, was first described in 1955. In 1985, Wolf et al. recognized that we are dealing with a dermatologic phenomenon and established a precise definition for this phenomenon. Fifty-eight cases corresponding to the definition of this phenomenon have been reported until now. METHODS: The new phenomenon, for which the term "isotopic response" has been suggested, has been defined. Cases corresponding to the definition have been analyzed with special emphasis on the diseases involved, the time intervals, and the locations of the diseases. Eight new cases are described. RESULTS: A total of 58 cases of isotopic response have been described. The first disease in most of the patients was herpes zoster; in three cases it was herpes simplex, in two varicella, and in one, thrombophlebitis. The second disease, which appeared exactly at the site of the first, already healed disease, was in most reported cases a carcinoma (26 cases, in particular 15 cases of breast carcinoma, 5 basal cell carcinomas (BCC), 4 squamous cell carcinomas (SCC), 2 basosquamous carcinomas), or granuloma annulare (16 cases). Additional diseases were Kaposi's sarcoma (2 cases), pseudolymphoma (2 cases), sarcoid (2 cases), tinea (2 cases), tuberculoid and vasculitis granuloma (1 case), angiosarcoma, metastasis, Bowen's disease, lymphoma, leukemia cutis, and acne (1 case each). The diseases did not show any predilection for a particular location. The interval between the first and second disease was extremely variable (ranging from days to years) and showed no particular features. In the eight additional cases described in the present report, the first disease was herpes simplex (6 cases) or herpes zoster (2 cases). The second disease was viral warts (3 cases) or squamous cell carcinoma (2 cases). Additional diseases were furunculosis, contact dermatitis, and molluscum contagiosum (1 case each). CONCLUSIONS: The new term, "isotopic response," describes the occurrence of a new skin disorder at the site of another, unrelated, and already healed skin disease. It is suggested that the term "isotopic response" be included in the lexicon (glossary) of dermatology. Introducing the new term and classifying all the cases under a single key word, will make it possible to locate and collect them easily and to search for the mechanism underlying this phenomenon.

[Changes in the T-cell component in patients with subleukemic myelosis at various stages of the pathologic process]. / Izmeneniia T-kletochnogo zvena immuniteta u bol'nykh subleikemicheskim mielozom na razlichnykh stadiiakh patologicheskogo protsessa.

T-cell immunity was assessed in 111 patients with subleukemic myelosis. In such patients with large tumor mass and leukemia exacerbation the amount of immunocompetent cells and their functional activity were reduced more prominently. Association of infection and inflammation promoted aggravation of initial immune deficiency.

[Thromboelastography of blood coagulation in patients with complicated nasal furunculosis]. / Tromboélastograficheskii kontrol koaguliatsionnykh svoistv krovi u bolnykh s oslozhnennym furunkulom nosa.

The study of blood coagulation in 50 patients with complicated nasal furuncle using thromboelastogram indicated that such patients have hypercoagulation correctable by intravascular laser radiation. Thromboelastography proved a reliable objective technique in evaluation of blood coagulation this promoting a valid choice of therapeutic policy in complicated nasal furunculi.

Juvenile pityriasis rubra pilaris associated with hypogammaglobulinaemia and furunculosis.

We report a case of follicular keratosis with inflammatory changes, consistent with a diagnosis of atypical juvenile pityriasis rubra pilaris. An unusual feature was the occurrence of severe Staphylococcus aureus folliculitis and furunculosis, a phenomenon rarely encountered in pityriasis rubra pilaris and the other follicular keratoses. Standard antibiotic and antiseptic treatment for chronic S. aureus infection was ineffective. The patient was subsequently found to have hypogammaglobulinaemia, and treatment with human polyvalent immunoglobulin infusions was successful in eradicating the sepsis. It is therefore probable that the hypogammaglobulinaemia played a pathogenic role in the development of cutaneous sepsis.

[Septic metastatic staphylococcal destruction of the lungs in adults]. / Septicheskaia metastaticheskaia stafilokokkovaia destruktsiia legkikh u vzroslykh.

The author analyzes results of diagnostics and treatment of 152 patients with septic metastatic staphylococcal destruction of the lungs. Specific features of the clinical course of the disease are described. Under consideration are questions of the complex pathogenetic treatment of this group of patients by means of using antibiotic and immune therapy, fat emulsions (lipofundin), exchange plasmapheresis, ultraviolet irradiation of blood etc.

[Metastatic lung abscesses]. / Metastaticheskie abstsessy legkikh.

The metastatic origin of abscesses was established in 10 of 142 patients (7%) with acute pulmonary abscesses. The disease was observed to be of severe course, being accompanied by pleural and other complications in all the cases. Thirteen distinctive signs of metastatic abscesses were revealed which determine the curative methods. The main problem in the treatment of such patients is struggle against sepsis, correction of immune processes in the organism, sanitation of the abscess cavity through the tracheobronchial tree and liquidation of pleural complications.

Cyclic neutropenia. Review of clinical manifestations and management.

Human cyclic neutropenia probably represents a rare group of heterogeneous disorders. The disorder most frequently starts in infancy or childhood. During the neutropenic episodes, the most common symptoms are fever and oral ulceration. However, dental and skin manifestations are frequent and require special attention. While the disease is usually benign and the symptoms may ameliorate as the patient grows older, 15 deaths related to neutropenia have been recorded. While many modalities of treatment have been suggested, none have proved to be universally efficacious. Study of cyclic neutropenia may provide insight into the normal control of granulopoiesis and into the genesis of biological rhythms.

Acute bone marrow necrosis caused by streptococcal infection.

An 8 year old boy with a furuncle on the dorsum of the right foot, high fever, severe pain in the right knee joint, slight hepatosplenomegaly, leukopenia and thrombocytopenia was admitted with the working diagnosis of acute leukemia. However, an abundance of necrotic cells, together with clusters of streptococci, could be demonstrated in the bone marrow aspirate. After antibiotic therapy the boy recovered completely.