Development of a contaminated ischemic porcine wound model and the evaluation of bromelain based enzymatic debridement.

OBJECTIVES: There are no well accepted animal models of chronic wounds, limiting advances in understanding and treatment of chronic ulcers. We developed a porcine wound model which combines multiple factors involved in chronic wounds to create a contaminated necrotic eschar and evaluated the debriding efficacy of a novel bromelain based enzymatic debriding agent (EscharEx). METHODS: Contaminated ischemic wounds were created on the flanks of domestic pigs by 'sandwiching' the skin between 2 'O' rings (1 placed on the surface of the skin and the other underneath the skin) for 24h prior to dermatomal excision of the necrotic eschar and its contamination with Staphylococcus aureus and Candida albicans. After confirming the development of infected eschars, additional animals were used to compare the effects of daily application of topical EscharEx or its hydrating vehicle on eschar debridement as a control. RESULTS: In all cases, application of the 'O' rings resulted in full thickness necrotic ecshars with invasive infections, which did not reepithelialize and sloughed off spontaneously within 14-21 days. All wounds reepithelialized within 28-42 days forming contracted scars. All EscharEx treated eschars were completely debrided within 7-9 days, while no debridement was evident in eschars treated with the control gel. CONCLUSIONS: Our model simulates the initial phase of chronic wounds characterized by a contaminated necrotic eschar allowing evaluation of wound debriding agents, and that a bromelain-based debriding agent completely debrides the contaminated necrotic eschars within one week in this model.

In situ photoimmunotherapy for cutaneous granuloma caused by itraconazole-resistant Candida guilliermondii.

Cutaneous granulomas caused by Candida guilliermondii are difficult to cure. In situ photoimmunotherapy (ISPI) is a novel method composed of local photothermal therapy and immunoadjuvant. In this study, ISPI was used the first time clinically for cutaneous granuloma caused by itraconazole-resistant C.guilliermondii. A 10-week cycle of ISPI was composed of (1) 5% imiquimod applied topically every other day and (2) irradiation of lesions with an 808-nm diode laser at Days 14, 28, 42, and 56. Here we report our first case. A patient was treated with ISPI for four cycles. After the treatment, the lesions were eliminated without recurrence during a 12-month follow-up. Our results demonstrate that ISPI can be used as an effective treatment modality for cutaneous fungal granuloma.

Good response in a patient with deep-seated subcutaneous ulcer due to Candida species.

Deep-seated subcutaneous ulcers infected with Candida species are rare. We are reporting a 51-year-old Cantonese woman who had a large, deep-seated subcutaneous ulcer on her right shoulder for more than a year. Direct smears of the purulent extrusion revealed many pseudohyphae and yeast cells. Candida species were isolated from the purulent extrusion and further identified as Candida albicans and C. parapsilosis. A skin lesion biopsy contained yeast cells and pseudohyphae. C. parapsilosis were once isolated from the biopsy specimen. Total healing was obtained with itraconazole (200 mg twice daily for 16 days and then 100 mg twice daily for 14 days) combined with phototherapy.

[The treatment of necrotizing otitis externa with a combination of surgery, antibiotics, specific immunoglobulins and hyperbaric oxygen therapy. Results of the Ulm Treatment Concept]. / Otitis externa necroticans. Kombinierter Einsatz von chirurgischer Therapie, Antibiose, spezifischen Immunglobulinen und hyperbarer Sauerstofftherapie--Ergebnisse des Ulmer Therapiekonzepts.

BACKGROUND: Even today, necrotizing otitis externa is still a life-threatening condition. The standard treatment concepts based on antibiotic therapy, topical treatment and--if necessary--surgical debridement of necrotic tissue, remain ineffective in many cases. In advanced stages, necrotizing otitis externa can therefore be expected to result in severe functional impairment or even a fatal outcome. PATIENTS AND METHODS: We describe our experience with a multimodal treatment concept that we have been using with great success at the Federal Armed Forces Hospital in Ulm since 1987. This treatment is based on four pillars: 1. Surgical debridement, 2. Use of a combination of antibiotics, and 3. Administration of specific immunoglobulins, accompanied by, 4. Hyperbaric oxygen therapy RESULTS: Over a period of more than 5 years 16 of the 22 patients treated on the basis of this multimodal concept remained free of recurrences. In addition, significant reductions in analgesic use and in the insulin doses needed by diabetic patients were possible. CONCLUSIONS: The treatment concept under scrutiny has proved particularly successful. The various modes involved and the results of this combined therapy are discussed.

Micosis superficiales: candidiasis y pitiriasis versicolor / Superficial mycosis: candidiasis and pityriasis versicolor

Se exponen las características clínicas de las lesiones cutáneas en las candidiasis y la pitiriasis versicolor. Se hace hincapié en las medidas de educación, prevención y control de estas afecciones a nivel primario de atención médica. Se exponen además las diferentes maniobras terapéuticas, tanto tópicas como sistémicas, con las que se cuenta para su tratamiento, y se hace referencia a las medidas terapéuticas alternativas que brinda la medicina natural y tradicional para estas afecciones

Micosis superficiales: candidiasis y pitiriasis versicolor / Superficial mycosis: candidiasis and pityriasis versicolor

Se exponen las características clínicas de las lesiones cutáneas en las candidiasis y la pitiriasis versicolor. Se hace hincapié en las medidas de educación, prevención y control de estas afecciones a nivel primario de atención médica. Se exponen además las diferentes maniobras terapéuticas, tanto tópicas como sistémicas, con las que se cuenta para su tratamiento, y se hace referencia a las medidas terapéuticas alternativas que brinda la medicina natural y tradicional para estas afecciones(AU)

Valoración de las propiedades antimicrobianas del agua del Volcán Copahue (Neuquén, Argentina) / Evaluation of the antimicrobial properties of the waters from the Copahue Volcano (Neuquen, Argentine)

El exámen por antibiograma frente a distintas bacterias y hongos patógenos, demuestra que el agua del Volcán Copahue (AVC), Neuquén, Argentina, posee propiedades antibióticas de amplio espectro. Se confirma su uso en balneoterapia como un eficaz agente profiláctico y/o terapéutico, prinicipalmente recomendable en tratamientos a dosificar, en distintas dermatomicosis. Ensayos de antibiosis con diluciones de SO4H2 entre pH 1 y 5 comparados con el efecto del AVC, los análisis cromatográficos y evaluaciones frente a S.aureus y C.albicans permiten descartar como factores primarios del efecto antibiótico, tanto a la extrema acidez del AVC en período de contacto no prolongado, como a posibles compuestos orgánicos de origen vital, no detectados. Se sugiere que la recuperación de tejidos, registrados en diversas afecciones epidérmicas por los dermatólogos, serían debidos a la particular composición inorgánica del AVC (crenoterapia)

Valoración de las propiedades antimicrobianas del agua del Volcán Copahue (Neuquén, Argentina) / Evaluation of the antimicrobial properties of the waters from the Copahue Volcano (Neuquen, Argentine)

El exámen por antibiograma frente a distintas bacterias y hongos patógenos, demuestra que el agua del Volcán Copahue (AVC), Neuquén, Argentina, posee propiedades antibióticas de amplio espectro. Se confirma su uso en balneoterapia como un eficaz agente profiláctico y/o terapéutico, prinicipalmente recomendable en tratamientos a dosificar, en distintas dermatomicosis. Ensayos de antibiosis con diluciones de SO4H2 entre pH 1 y 5 comparados con el efecto del AVC, los análisis cromatográficos y evaluaciones frente a S.aureus y C.albicans permiten descartar como factores primarios del efecto antibiótico, tanto a la extrema acidez del AVC en período de contacto no prolongado, como a posibles compuestos orgánicos de origen vital, no detectados. Se sugiere que la recuperación de tejidos, registrados en diversas afecciones epidérmicas por los dermatólogos, serían debidos a la particular composición inorgánica del AVC (crenoterapia)