Ecthyma gangrenosum and ecthyma-like lesions: review article.

The generally accepted definition of ecthyma gangrenosum (EG) states that this condition is pathognomonic of Pseudomonas septicemia (Pseudomonas aeruginosa) and that it should usually be seen in immunocompromised patients, particularly those with underlying malignant disease. The cases described in the literature present a somewhat different picture. Our objective was to analyze this controversy. The review analyzes 167 cases of EG that were described in the literature from 1975 to 2014. All articles on EG cases with EG-specific tissue defect that had signs of general and/or local infection and skin necrosis were included and analyzed, whatever the etiology detected. Necrotic lesions of the skin diagnosed as EG have various microbiological etiology, can occur in immunocompetent or even healthy persons, and are not necessarily connected with septicemia. In published cases, P. aeruginosa was detected in 123 cases (73.65%); of them, there were only 72 cases (58.5%) with sepsis. Other bacterial etiology was detected in 29 cases (17.35%) and fungi were detected in 15 cases (9%). While the clinical picture of the disease and the treatment strategy remain the same, there is no need to invent two separate definitions for Pseudomonas and non-Pseudomonas cases. We suggest accepting a broader definition of EG.

Pantoea agglomerans as an indicator of a foreign body of plant origin in cases of wound infection.

OBJECTIVE: To investigate the role of Pantoea agglomerans as an infectious agent that causes infection in a wound even after the wound was managed at the emergency department. METHOD: A retrospective cohort study, reviewing the medical records of patients with traumatic wounds that were admitted to the emergency department from 2007-20 12 and had signs of wound infection for more than I 0 days after the wound was managed. Bacteriological results, clinical picture,and treatment results were obtained. RESULTS: Nine cases were identified. Pantoea agglomerans was detected in all cases. After 1-2 months of ineffective treatment, patients were hospitalised and surgical revisions of the wounds were performed.In all cases, small foreign bodies of plant origin were detected. After surgical revision, wounds were healed in 2-3 days. CONCLUSION: In cases of prolonged healing of post-traumatic wounds, the presence of foreign bodies of plant origin infected with Pantoea agglomerans should be taken into account. Removal of such foreign bodies leads to rapid healing of the wounds.

The endoscopic Draf II frontal sinusotomy: non-navigated approach.

OBJECTIVE: Endoscopic endonasal Draf II frontal sinusotomy is indicated for a variety of pathologies such as mucocele and non-responsive chronic frontal sinusitis. However, this approach is challenged and controversial. The objectives were to evaluate the advantages, disadvantages, indications, and rate of complications of this approach, without the use of a navigation system. METHODS: The files and computed tomography (CT) scans of 25 patients who underwent endoscopic endonasal Draf II sinusotomy at Assaf Harofeh Medical Center between 1999 and 2002 were reviewed. RESULTS: Thirty-one frontal sinuses were operated on and follow-up was between 18 and 62 months (average 30.3). Twenty-two sinuses (71%) had previous surgery. The Draf II procedure was used in 3.7% of all cases during the survey period. The most frequent indication for surgery was inflammation (48%) followed by mucocele (28%). In all but 2 sinuses (93%), the frontal floor between the lamina papyracea and the middle concha was drilled out. Twenty-four patients (96%) were successfully ventilated. No major complications were noted. CONCLUSIONS: The Draf II approach can be used safely and successfully without a navigation system, including cases of revision endoscopic sinus surgery. Correct interpretation of the surgical field and a CT scan are crucial for success. Careful patient selection is essential for this procedure.

Characterization of a polymorphic heat shock protein 70 gene in swine outside the SLA major histocompatibility complex.

To characterize a hitherto unidentified swine Hsp70 gene, a cDNA library was prepared from total RNA isolated from swine lymphocytes and heat-shocked at 42 degrees C for 2 h. One positive clone with a 2.6 kb insert was found. Its sequencing revealed a maximum homology with the human inducible Hsp70B' gene. The genomic polymorphism of this insert was investigated by restriction fragment length polymorphism (RFLP) in an informative family for the major histocompatibility complex SLA. Digestion with PvuII generated 8 bands which were common to both parents, and for the male two extra bands at 0.69 and 0.64 kb. After digestion with PstI, there was also an extra band at 1.6 kb for the male in addition to the seven bands common to both parents. The eleven offsprings' RFLP patterns exhibited all the common parental bands, but four piglets displayed the male's specific bands in addition. All the polymorphic bands belonged to the same locus and segregated independently of SLA. Restriction mapping of the Hsp70 gene indicated the absence of introns, and showed that the polymorphic PstI site was located upstream of the gene's 5' coding region, and the PvuII site inside its coding region.

Sequences of the swine 21-hydroxylase gene (CYP21) and a portion of the opposite-strand overlapping gene of unknown function previously described in human.

We sequenced a 4.8 kb BamHI swine genomic fragment comprising the entire 21-hydroxylase gene (CYP21) and its 5' and 3' flanking segments. The CYP21 coding sequence spanned 3050 bp and as in other species, comprised 10 exons separated by the corresponding introns. The deduced protein corresponded to 492 amino acid residues, 8 of which differed from a previously sequenced swine CYP21 enzyme. The 5' flanking region displayed several putative cis-acting elements which may be involved in either constitutive or cyclic adenosine 3',5'-monophosphate (cAMP) dependent transcriptional expression. We also characterized within the 5' region a 139 bp repetitive element of the short interspersed nucleotide element (SINE) family located on the opposite strand. In addition, we characterized the last five exons of a human-like opposite strand gene (OSG/X) located in the swine at the 3' end of CYP21. The sequenced part of this OSG/X displayed a very strong homology with its human counterpart.

Role of plasma and platelet von Willebrand factor in arterial thrombogenesis and hemostasis in the pig.

To evaluate the relative role of plasma and platelet von Willebrand factor (vWF) pools in hemostasis and arterial thrombogenesis, pigs with vW disease (vWD) were injected with vWF concentrate and/or grafted with bone marrow from a normal pig. Hemostasis was assessed by measurement of ear immersion bleeding time, factor VIII (FVIII) activity, and plasma and platelet vWF antigen levels. The thrombotic process was explored at 650 s(-1) and 1600 s(-1) in an ex vivo cylindrical perfusion chamber. Pigs with vWD exhibited a prolonged bleeding time (>30 minutes) compared with normal pigs (<5 minutes); in addition, they showed normal platelet adhesion and thrombus formation at 650 s(-1) but profoundly reduced platelet adhesion and thrombus formation at 1600 s(-1). Each experiment was performed before and 3 and 24 hours after injection of vWF concentrate. In our bleeding time study, only plasma vWF restoration induced a partial but delayed correction (24 hours postinjection), which was correlated with the highest measured level of FVIII activity. In the perfusion chamber model, restoration of plasma or platelet vWF pools resulted in similar partial correction of platelet adhesion and average thrombus size. In the perfused pigs, the maximum correction occurred 3 hours postinjection. Platelet deposition reached normal values after vWF concentrate was injected into a grafted pig. The present results suggest that when both plasma and platelet vWF levels are restored in vWD pigs, bleeding time and the thrombotic process are normalized according to different kinetics and with differing degrees of effectiveness.

An experimental model for testing von Willebrand factor function: successful SLA-matched crossed bone marrow transplantations between normal and von Willebrand pigs.

To assess the relative in vivo roles of von Willebrand factor (vWF) of different origins, we performed crossed bone marrow transplantations (BMTs) among normal pigs and pigs with the von Willebrand disease(vWF). The two groups were fully compatible immunologically according to typing by swine leukocyte antigen (SLA). After total-body irradiation (8-10 Gy), all pigs received 0.5X10(9) to 10(10)/kg mononuclear bone marrow cells without any immunosuppression. The nadir of aplasia occurred between days 5 and 7 after irradiation (white blood cell [WBC] count 0.6X10(9)/L, platelet [Plt] count 76X10(9)/L. Three weeks after the graft, WBC and Plt counts had returned to normal levels. Animals were followed for at lease 50 days, during which no bone marrow rejection occurred; no evidence of graft-vs-host disease (GVHD) was observed. Each BMT was confirmed by karyotype analysis. In the six homozygous pigs with vWD grafted with normal marrow, platelet vWF antigen (vWFAg) and platelet vWF activity rose from <3 to 450 U/dl with a normal multimeric pattern; plasma vF increases slightly. No correction of bleeding time was observed. In the five normal pigs grafted with bone marrow form pigs with vWD, platelet vWFAg and platelet vWF activity decreased from >100 U/dl to undetectable levels; bleeding time and plasma vWFAg remained unchanged. A derivative of normal porcine plasma, a concentrate containing factor VIII and vWF, was infused into a homozygous vWD pig before and after BMT from a normal pig. Co correction of bleeding time was obtained, even though plasma nd platelet vWFAg levels were normal. W concluded that crossed BMT among SLA-identical pigs is a feasible model of studying the synthesis and the roles of vWF in hemostasis and thrombosis.

A method of purifying sheep sIg+ lymphocytes as a tool for class II MHC antigen analysis.

A method is described for the purification of sheep lymphocytes carrying class II MHC antigens. After incubation of purified blood lymphocytes on anti-IgM-coated petri dishes, the adherent fraction contained 95% sIg-positive cells determined by immunofluorescence. When tested with cross-reacting anti-class II (bovine and human) monoclonal antibodies, more than 95% of these cells were positive either by immunofluorescence or cytotoxicity. This technique will permit studies of the polymorphism of sheep class II antigens.

Expression of beta 2-microglobulin on preimplantation pig embryos.

The expression of beta-2 microglobulin (beta 2m), a protein associated with the histocompatibility antigens of the pig complex (SLA), was studied in preimplantation embryos between the segmentation stage and the beginning of elongation (day 12). The antigen was visualized at the ultrastructural level by immunocytochemical techniques using peroxidase or colloidal gold particles as labels. beta 2m expression appeared to parallel trophoblast differentiation. No positive reaction was obtained before the early blastocyst stage. From this stage on, labelling was observed on the apical surface of the trophectoderm cells.

Unlike tenascin-X, tenascin-C is highly up-regulated in pig cutaneous and underlying muscle tissue developing fibrosis after necrosis induced by very high-dose gamma radiation.

Fibrosis is characterized by proliferation of fibroblasts and deposition of extracellular matrix (ECM). As alterations in the composition of ECM may account for its chronic extension, we studied the expression of the tenascin-C (TN-C) and tenascin-X (TN-X) ECM glycoproteins in our pig model of the effects of accidental exposures to radiation, in which cutaneous and muscle fibrosis developed after the induction of necrosis after a high single dose (160 Gy at the skin surface) of gamma rays. We found that, in the healed fibrotic dermis and underlying muscle fibrosis, the amount of TN-C mRNA was increased up to 18- and 39-fold, respectively, compared to normal dermis, whereas the level of TN-X mRNA remained almost unchanged. In analyses by Western blotting, the two main TN-C isoforms of 235-240 and 190-200 kDa increased up to 45- and 105-fold in fibrotic tissues, respectively. The large isoform was expressed more strongly than the smaller, although in healed fibrotic scar tissues their ratio was lower in protein than in RNA. Compared to unirradiated skin, an immunohistological study revealed stronger TN-C staining at the dermo-epidermal junction and in areas of remodeling in healed skin. An intense extracellular staining was observed around myofibroblasts in muscle fibrosis. Therefore, the gene encoding TN-C is highly up-regulated in fibrotic tissues, and mechanisms regulating the levels of TN-C variants occur at both the RNA and protein levels. Each isoform might play a distinct role in the chronic activation of fibrosis by differentially regulating mechanisms like cell adhesion, migration or proliferation.

Individual differences in cell-mediated and humoral immunity in pigs.

Previous experiments displayed consistent individual behavioural differences in pigs. Some showed a more active behavioural response (aggressive and resistant; so-called A/R pigs), other a more passive behavioural response (non-aggressive and non-resistant; so-called NA/NR pigs). Moreover, these behavioural coping strategies were associated with different behavioural, physiological and endocrine responses under stress conditions. In the present study we selected 32 A/R and 32 NA/NR individuals and tested their immune reactivity in reaction to stress using several cell-mediated (CMI) and humoral immunological tests. Active A/R pigs had a higher in vivo and in vitro CMI to nonspecific and specific antigens, while after stress CMI reduced more in A/R than in NA/NR pigs. In contrast, humoral immunity was highest in NA/NR pigs. Furthermore, some serologically typed swine lymphocyte antigen (SLA) class I haplotypes were not equally distributed between A/R and NA/NR pigs. In general, these findings show that measurement of immune reactivity is an important tool to define how animals cope with environmental demands.

Porcine major histocompatibility complex.

The major histocompatibility complex in swine (swine leucocyte antigen: SLA) is located on chromosome 7 with the class I and class III regions separated by the centromere from the class II region. The overall molecular organisation of the class I and III regions is well known, but further research is needed to establish that of the class II region. Approximately sixty genes have been characterised to date, including ten tightly packed SLA class I sequences. The exact number of functional polymorphic class I genes, as defined by serology, probably varies from one to four, depending on the haplotype. At least two other distantly class I-related gene families exist. The numerous and significant associations reported between SLA haplotypes and physiological traits are described. These traits include immune responsiveness to a variety of microbes and metazoan parasites, and male and female production and reproduction performance. The results obtained suggest that selection for specific SLA haplotypes may assist in the improvement of porcine production.

[65 orthotopic transplantations of the liver in the pig. Clinical and laboratory results (author's transl)]. / 65 transplantations orthotopiques de foie chez le porc. Résultats cliniques et biologiques

The authors report the clinical and laboratory results of 65 orthotopic allotransplantations of the liver in the pig. The operative mortality (8 cases) was nil in the last 23 transplantations. Vascular filling without blood transfusion, blood alkalinisation and precautions to avoid hypothermia, seem essential to reduce early mortality. The various causes of secondary mortality are studied, using certain preventive measures. Thus, deaths due to gallbladder or hepatic ischemia have become rare by conserving end-to-end anastomosis on the hepatic artery and taking certain precautions. The grafts were rejected only in incompatible pigs in the SLA system, but were not rare in this group (13/43) and sufficient to cause death in one case out of two. Gastric ulcers were frequent, even after vagotomy, but vagotomy protects fairly well against ulcer hemorrhage. However, ulcers almost always accompany a disease which is alone sufficient to cause death. Cholangitis appears less frequent after cholecysto-jejunal anastomosis on an excluded omega loop. The mortality from extra-hepatic causes was severe (12 cases), in particular due to mechanical complications at the level of the small intestine. Laboratory analyses showed a definite rise in SGOT transaminase levels and, above all, alkaline prosphatase levels in cases of rejection compared with cases of biliary obstruction or hepatic necrosis.

[The role of non-clostridial anaerobic infections in the etiology, pathogenesis, clinical aspects and treatment of inflammatory diseases of the paranasal sinuses]. / Rol' neklostridial'noi anaérobnoi infektsii v étiologii, patogeneze, klinike i lechenii vospalitel'nykh zabolevanii okolonosovykh pazukh.

This paper presents the results of clinical and bacteriological examinations of 116 patients with suppurative rhinosinusitis. Bacteriological tests under anaerobic conditions revealed in 53% of the patients nonclostridium anaerobic bacteria that were highly resistant to most antibiotics and sensitive to metronidazole and its derivatives. A protocol of conservative therapy of suppurative rhinosinusitis was developed. The protocol included etiotrophic antianaerobic drugs (metronidazole and its derivatives) and oxygenation of paranasal sinuses. This therapeutic approach yielded positive effects in 92% of the patients.