Extensive extraaxial blastomycosis granuloma at the skull base--case report

A 37-year-old female presented with a rare case of intradural, extraaxial Blastomyces dermatitidis granuloma involving a large part of the skull base. She had the principal complaint of worsening vision, but was otherwise healthy. The lesion mimicked an en-plaque meningioma on radiological examination and in gross appearance during surgery. This is a very unusual presentation for a blasto-mycosis granuloma.

Schistosoma mansoni: influence of infection on mouse behavior

Schistosoma mansoni infection in humans and animals induces abnormal neurobehavioral responses following granuloma formation. In mice, granulomas in the liver are observed 8 weeks after infection, while after 15-20 weeks, the presence of eggs and granulomas in the brain has been reported. In this study, outbred CD-1 female mice were infected with S. mansoni and examined in several behavioral tests (open field, novel object investigation, black/white box, and hot plate) 8 and 15 weeks after infection. The detected effects of schistosome infection were a reduction of body weight in 8-week infected mice, marked changes in exploration/activity, rearing, and wall-rearing in 8- and 15-week infected mice, an enhancement of sniffing and grooming in 8-week infected mice, and finally an increase in the threshold of pain response to the hot plate in 15-week infected mice. The results of the present study indicate that S. mansoni infection markedly alters exploratory behavior of mice, affecting particularly the vertical movements of the animals, and suggests that the differences in behavioral abnormalities between 8- and 15-week infected mice might be associated with modifications in the levels of nerve growth factor and cytokines induced by granulomas.

Selective kallikrein-kinin system activation in inbred rats differentially susceptible to granulomatous enterocolitis

BACKGROUND & AIMS

Crohn's disease is characterized by unrestrained inflammation with a genetic component. Genetic susceptibility and activation of the kalli-krein-kinin (contact) system were investigated in experimental enterocolitis and extraintestinal inflammation induced by bacterial polymers.

METHODS

Kinetics of inflammation in inbred Lewis and Buffalo rats injected subserosally with peptidoglycan-polysaccharide polymers were correlated with in vivo and in vitro activation of the contact system.

RESULTS

Lewis rats had a biphasic course of enterocolitis. Acute inflammation peaked 1 day after injection, gradually decreasing until day 14 when intestinal inflammation spontaneously reactivated and persisted for 16 weeks, accompanied by arthritis, granulomatous hepatitis, anemia, and leukocytosis. Self-limited acute enterocolitis in Buffalo rats resolved by 24 days without extraintestinal involvement. Consumption of the precursor proteins prekalli-krein and high-molecular-weight kininogen indicated activation of the plasma contact system in Lewis rats and closely correlated with chronic intestinal inflammation. Contact system activation did not occur in Buffalo rats, even during acute inflammation. In vitro studies showed a decreased rate of kininogen cleavage in Buffalo plasma.

CONCLUSIONS

Selective in vivo and in vitro activation of the contact system in susceptible Lewis rats suggests that this pathway is one determinant of genetic susceptibility to granulomatous enterocolitis and systemic complications.

Vocal fold submucosal infusion technique in phonomicrosurgery

Phonomicrosurgery is optimized by maximally preserving the vocal fold's layered microstructure (laminae propriae). The technique of submucosal infusion of saline and epinephrine into the superficial lamina propria (SLP) was examined to delineate how, when, and why it was helpful toward this surgical goal. A retrospective review revealed that the submucosal infusion technique was used to enhance the surgery in 75 of 152 vocal fold procedures that were performed over the last 2 years. The vocal fold epithelium was noted to be adherent to the vocal ligament in 29 of the 75 cases: 19 from previous surgical scarring, 4 from cancer, 3 from sulcus vocalis, 2 from chronic hemorrhage, and 1 from radiotherapy. The submucosal infusion technique was most helpful when the vocal fold epithelium required resection and/or when extensive dissection in the SLP was necessary. The infusion enhanced the surgery by vasoconstriction of the microvasculature in the SLP, which improved visualization during cold-instrument tangential dissection. Improved visualization facilitated maximal preservation of the SLP, which is necessary for optimal pliability of the overlying epithelium. The infusion also improved the placement of incisions at the perimeter of benign, premalignant, and malignant lesions, and thereby helped preserve epithelium uninvolved by the disorder.

Effect of policosanol on foam-cell formation in carrageenan-induced granulomas in rats

Policosanol is a new cholesterol-lowering drug isolated and purified from sugar-cane wax, which prevents the development of lipofundin-induced lesions and foam-cell formation in New Zealand rabbits and Wistar rats. This study was conducted to examine the effects of policosanol on foam-cell formation in carrageenan-induced granulomas in rats. Eighteen Wistar rats were randomly distributed in three experimental groups which received orally for 20 days Tween 20 H2O as vehicle (control group) or policosanol at 2.5 or 25 mg kg-1. At the 11th day, lipofundin was injected intraperitoneally for 8 days to induce formation of foam cells in the granuloma. At day 13, carrageenan was injected subcutaneously for granuloma induction and seven days later animals were killed. A significant reduction of the foam-cell formation in granulomas of policosanol-treated rats was observed. It is concluded that policosanol prevents the development of foam cells in carrageenan-induced granulomas (extravascular medium) in rats.

Small cavity mastoidectomy--5 year review

It has been recognized that the traditional method of open mastoid surgery often produces a larger mastoid cavity than necessary. Small cavity mastoidectomy is advocated to reduce the size of the mastoid cavity by exteriorizing the cholesteatoma from the epitympanum backwards. When this operation is performed in a sclerotic mastoid bone, the resulting cavity is very small. The 5 year review of 39 ears with small cavity mastoidectomy is presented. Not only were the mastoid cavities small, they remained stable and trouble-free. It also enabled the patients to enjoy swimming and minimizing wax accumulation within the cavities. The hearing results after 5 years were comparable to that of the closed technique. Formation of cholesterol granuloma behind the concho-meatal flap was an uncommon complication.

Tumoral form of cerebral schistosomiasis mansoni. A report of four cases and a review of the literature

We describe four cases of the tumoral form of cerebral schistosomiasis mansoni. The patients had symptoms of increased intracranial pressure and focal neurological signs that varied according to the site of the lesion. Computerized tomography showed a hyperdense, enhancing lesion located in the cerebellum (2 patients), frontal lobe and thalamus (1 patient), and temporal subdural region (1 patient), with associated mass effects. The lesion was resected in three patients and a stereotactic biopsy was performed in one. Histopathologic specimens of all four patients revealed multiple schistosomal granulomas in various evolutive phases. Two of these patients differ from previously described cases; one because of the subdural location of the lesion, mimicking a meningioma, and the other one because two lesions were present.

Tinea incognito: an update on Majocchi granuloma

Majocchi granuloma was described naturally in situations of occlusion and later from superficial trauma such as shaving. More recently, the disease has occurred in the immunocompromised patient. Iatrogenic disease (tinea incognito) is a new and more subtle form.

Sociodemographic variables of a German sample of patients with contact granuloma

We report 28 German patients with contact granuloma (27 male, 1 female). Their mean age was 52 years (ranging from 35 to 70). Thirty-two percent were retired. The occupations of the others represented a wide range of different jobs. The majority of the sample had a middle educational level. Most patients lived with their family or with a partner. According to self-assessments, 68% had average daily strain on their speaking voice. All patients were nonsmokers. The patients felt themselves more disturbed by somatic troubles as the general population. Heartburn was felt by nearly half of the patients. A little more than half of the patients suffered from globus sensation. Thus, it is not possible at present to explain the laryngeal contact granuloma by sociodemographic data, vocal stress, or special somatic complaints in this sample. Therefore a multifactorial etiology should be supposed.

[Logopedic rehabilitation of laryngeal granulomas]

Posterior laryngeal granuloma is an infrequent pathology of multidisciplinary interest. Actually, its real prevalence is difficult to quantify because in some cases it is asymptomatic and in other instances it may either be reabsorbed or eliminated spontaneously. It is located at the vocal apophysis of the arytenoid or, less frequently, above it or on the laryngeal side of the arytenoid. The many etiologic factors (laryngeal intubation, gastro-esophageal refluxes, blunt trauma of the larynx, vocal dysfunction), sometimes concomitant and with the possible addition of enhancing circumstances (upper aerodigestive tract inflammation, naso-gastric tube, smoking and alcohol abuse), converge to a single pathogenetic mechanism: an ulceration of the mucosa and the pericondrium, sometimes complicated by an infection, which does not heal but instead produces a typical granulation tissue with capillaries oriented radially from the center of the lesion. Post intubation granulomas, extremely rare in children, are more frequent in females. It appears that there is no correlation with duration of intubation in that granulomas, can also occur after short general anesthesia. Idiopathic or contact granulomas are more frequent in the males. They are the result of vocal laryngeal hyperfunction, habitual throat clearing or cough-like throat clearing. Gastro-esophageal reflux of gastric juice, coughing or throat clearing may injure the mucosa. A blunt trauma of the larynx may cause a granuloma if the cartilage of the vocal process is exposed. Symptoms, when present, are dysphonia, tiredness during or after voicing, bolus, laryngeal unilateral pain, sensation of something in the throat which is mobile during breathing and swallowing, traces of blood in the expectoration. Therapeutic options are surgical, medical or logopedic. Surgery, although followed by frequent recurrences, is mandatory when the granuloma causes dispnea or if a pathologic essay is needed. Medical treatment aims at solving gastroesophageal reflux and/or inflammations of the district. Logopedic rehabilitation is the most successful therapy. Since January 1992 the Authors have been adopting the rehabilitation protocol planned by the French phoniatrician Brigitte Arnoux-Sindt for post-intubation granulomas, which, moreover, is utilyzed for all type of granulomas, including those arising during the early postoperative period after cordectomy. This protocol is analytically presented and discussed. In the cases of contact granulomas, and when there is concomitant vocal dysfunction, logopedic treatment is prolonged after granuloma dissapearance with some sessions aiming at restoring correct vocal behaviour. In all the ten patients rehabilitated up to now, granulomas disappeared after a mean of 16.3 sessions held twice a week. After several months of follow-up we had no recurrences. This clinical experience, while limited in number, seems to confirm the good results already reported in French Literature.

An overview of treatment options for lower airway obstruction

Effectively treating airway stenosis is a challenging problem for the otolaryngologist-head and neck surgeon. A number of options are available. The most effective management requires an approach that is flexible and individualized for each patient. This article outlines the available options and highlights the indications, techniques, results, and potential complications of each.

Eosinophilic granuloma presenting as chronic otitis media: pitfalls in the diagnosis of aural polyps in children

The case of a 7-year-old boy with multifocal eosinophilic granuloma, initially presumed to be chronic otitis media, is presented. A review of other similar cases in the literature reveals that a delay in diagnosis is not uncommon, and a high index of suspicion is necessary to avoid an unfavourable outcome. Early in the evaluation of an aural polyp, sufficient biopsies should be performed and computerized tomography scanning should be considered.

Plant bacterial spores, active systemically as a separate entity, play a significant role in human illnesses such as cancer, granulomas, AIDS, and milky white abdominal ascites that currently defies recognition

There is currently an unrecognized chapter in medical illnesses, occurring in living human beings, that defies recognition in explaining the diseases' origin and growth, and failing accurately to account for the pathophysiology involved. It is pertinent, therefore, to alert medical science, based upon facts as uncovered by my research studies (1-5), that plant bacterial spores can exist as a separate entity systemically. Being totally devoid of the presence of their adult origin, they can survive with a degree of viability. Ultimately, they may become embedded within, or nearby, a network of cells, consisting of the reticuloendothelial, squamous, or epithelial group. With an ensuing adequate but compatible circulating flow of blood by the host to the specific tissue site as muscles, bone, or bone marrow, it can thus lead to the various pathophysiological changes and illnesses that currently defy an accountable recognition.

Simultaneous generation of nitric oxide and superoxide by inflammatory cells in rats

It has recently been shown that peroxynitrite anion is a powerful oxidant than can initiate lipid peroxidation. As this oxidant is the product of the reaction between nitric oxide and superoxide, we have studied whether cells isolated from an inflammatory exudate can release both radicals simultaneously under physiological conditions. The carrageenin-induced granuloma model in rats was used. Cells from the inflammatory pouch were stimulated with opsonized zymosan in the absence or in the presence of exogenous L-arginine. Nitric oxide production without exogenous L-arginine was detectable after 15 min (0.29 nmol NO2-) and increased with time (1.65 nmol NO2- at 4 h). When nitrite released from cells was expressed as a rate a burst was shown in the first few minutes. Between 0 and 15 min, cells produced NO2- at the following rates: 20 pmol NO2-/1 x 10(6) cells/min without exogenous L-arginine and 83 pmol NO2-/1 x 10(6) cells/min with exogenous L-arginine. Production was further stimulated with opsonized zymosan (92 pmol NO2-/1 x 10(6) cells/min), and inhibited by L-NMMA and L-NIO. The production of superoxide increased for up to 2 h and then stabilized. A significant increase in nitrite was observed in the presence of SOD, whereas L-NIO increased superoxide generation. These results suggest that peroxynitrite anion may be formed by inflammatory cells.

Role of cyclooxygenase inhibition and hyperoxia in regulating pulmonary perfusion in dogs

To assess the roles of cyclooxygenase inhibition and hyperoxia in regulating pulmonary perfusion, we studied 13 dogs with diffuse granulomatous lung disease (DGLD) and 13 normal dogs. Baseline observations were obtained at fractional inspired O2 (FIO2) 0.21 and 1.0 and repeated after infusion of meclofenamate (Mec; n = 8) or saline (n = 5). Resistance to flow was evaluated from the pulmonary end-diastolic gradient (PDG) and by ohmic pulmonary vascular resistance (PVR). Distribution of blood flow was evaluated with sulfur hexafluoride in DGLD and with multiple inert gas alveolar ventilation-perfusion (VA/Q) plots in normal dogs. Before infusion, there were no differences between the saline and Mec groups at either FIO2. Saline induced no significant changes at either FIO2. After Mec in DGLD, PDG at FIO2 0.21 rose from 4 +/- 2 to 6 +/- 4 mmHg (P < 0.04), PVR increased from 297 +/- 98 to 484 +/- 181 dyn.s.cm-5.m-2 (P < 0.01), whereas shunt flow (Qs/Qt) fell form 13.6 +/- 12.0 to 6.2 +/- 5.3% (P < 0.03). At FIO2 1.0 PDG rose from 3 +/- 2 to 4 +/- 3 mmHg (P < 0.02), PVR increased from 262 +/- 78 to 374 +/- 139 dyn.s.cm-5.m-2 (P < 0.01), whereas Qs/Qt fell from 14.5 +/- 13.3 to 6.4 +/- 5.2% (P < 0.02). After Mec in normal dogs, PDG at FIO2 0.21 rose from 3 +/- 1 to 4 +/- 1 mmHg (P < 0.015) and PVR increased from 256 +/- 92 to 340 +/- 101 dyn.s.cm-5.m-2 (P < 0.05); at FIO2 1.0 PDG and PVR were unchanged from preinfusion levels. In normal dogs, no parameters of VA/Q changed significantly with hyperoxia or Mec. These data suggest that perivascular inflammation enhances perfusion in DGLD by elaboration of vasodilator prostaglandins (PG). By inhibiting PG synthesis, Mec selectively increases resistance in diseased lung at FIO2 0.21 and lowers Qs/Qt. In contrast, there was vasoconstriction without flow redistribution in normal dogs, suggesting that vasodilator PGs contribute to the low tone in the normal pulmonary bed. The vasodilation without flow redistribution in both models during hyperoxia after Mec suggests an effect of O2 that is related neither to PG synthesis nor to hypoxic vasoconstriction.

[The 69th annual meeting symposium. II: Mechanism of necrotizing granuloma formation and its function]

Histological features of tuberculosis are caseation necrosis and epithelioid cell granuloma formation. Both phenomena are interpreted as expression of cellular immunity. Caseation necrosis is thought to be immunopathology and epithelioid cell granuloma formation is considered to be expression of protective immunity. Recently roles of cytokines for granuloma formation are gradually elucidated. In this symposium, mechanisms and functions of necrosis and granuloma formation Dr. Akagawa reported differentiation of two types of phenotypically different macrophages from human monocytes by GM (granulocyte-macrophage)-CSF or M (macrophage)-CSF. Interestingly such a basic differentiation induced by CSF was affected by IL-4 (interleukin-4). Langerhans-like dendritic cells were generated by cooperation of GM-CSF and IL-4, and multinucleated cells were generated by cooperation of IL-4 and M-CSF. Dr. Fukuda reported human Langerhans cell granulomatosis (LCG) from the pathological and immunohistochemical standpoints. In situ proliferation of LCs in the LCG was demonstrated by immunohistochemistry using antibody to PCNA (proliferating cell nuclear antigen) which is used to detect proliferating cells. In the course of granuloma formation, damage and disruption of lung structure such as alveolar basement membrane and elastic tissue framework, and reactive intraluminar fibrosis was observed. Mechanism of cystic dilation was also reported. Cytokines might play important roles in these events. Dr. Ina demonstrated experimental epithelioid cell granuloma formation. Extract (granuloma inducing factor, GIF) from Schistosoma mansoni Egg-induced granuloma, TNF -alpha, or IL-1 beta were coated, individually on the surface of beads, then these beads were inoculated to rat's skins or cultured with rat's monocytes. Four weeks later, epithelioid cell granuloma was demonstrated histologically and electronmicroscopically around beads in vitro and in vivo. GIF-induced granuloma was more organized than cytokine-induced ones. In vitro using human monocytes, activated macrophages accumulated around beads of which cytokines or GIF were coated. It was suspected that many cytokines or other factors are needed to make epithelioid cell granuloma. Dr. Sakamoto showed the presence of acid fast bacilli and various inflammatory cells including lymphocytes and macrophages in the tuberculous caseous necrosis after exudative reaction (E-necrosis) by immunohistochemistry. But no acid fast bacilli or inflammatory cells were found in the caseous necrosis after productive reaction (P-necrosis). TNF-alpha (tumor necrosis factor-alpha) and IL-4 were stained in the E-necrosis and IL-4 and ICAM-1 (intercellular adhesion molecule-1) were positively stained in the cytoplasm of epithelioid cells by immunohistochemistry. It was suspected that many cells and cytokines were involved in epithelioid cell granuloma formation and caseous necrosis formation.(ABSTRACT TRUNCATED AT 400 WORDS)

In vivo administration of a monoclonal antibody against the type I IL-1 receptor inhibits the ability of mice to eliminate Mycobacterium paratuberculosis

The purpose of this study was to determine the influence of endogenous interleukin-1 (IL-1) on resistance to paratuberculosis infection in experimentally infected gnotobiotic mice. Following a 6-month treatment with prednisolone to facilitate bacillary multiplication, control mice substantially reduced the numbers of M. paratuberculosis in the liver and ileum. In contrast, mice injected with a monoclonal antibody against the type I IL-1 receptor failed to reduce the numbers of M. paratuberculosis in the liver and ileum and exhibited more liver granulomas, which contained numerous acid-fast bacilli. These results indicate a significant role for endogenous IL-1 in host defense against experimental M. paratuberculosis infection in mice.

Free radical bombing of spermatozoa in spermatic granuloma: an attempt to prevent autoimmune switch-on

Even though vasectomy-associated reactions in subjects are established, the biochemical attributes of the granuloma cells enabling them to potently dispose of the accumulating spermatozoa remain unelucidated. This study demonstrates a careful "free-radical bombing" within the granuloma interior to efficiently disintegrate all the structural elements of the sperm cells, especially the proteins. A free radical triggered and instantaneous protein-disposal could be important in avoiding early post-vasectomy autoimmune triggering.

From granuloma to fibrosis in interstitial lung diseases: molecular and cellular interactions

Granuloma is a feature of many chronic interstitial lung diseases, and may serve as a focus for subsequent fibrosis. Granulomas are composed of structured masses of cells of the macrophage lineage, which adopt an epithelioid aspect, interspersed with lymphocytes. They are formed around local centres of irritation. During their resolution, fibroblasts congregate around the structures and may penetrate the interior. In many cases, granulomas can disappear without leaving lasting traces. However, especially when damage has occurred to the surrounding tissue, permanent scarring and fibrosis may occur. Both types of cell present in the granuloma are capable of secreting a number of factors influencing the accumulation and proliferation of fibroblasts, both positively and negatively. The possible roles played by the different factors and, especially, interactions between them are discussed in the light of fibrosis formation. Possible therapeutic interventions are summarized.

The role of cytokines in the pathogenesis of hepatic granulomatous disease in Schistosoma mansoni infected mice

Cytokines are important in the cell-mediated response to Schistosoma mansoni eggs. We have found that Th2 cytokine responses (e.g. IL-4 and IL-5) are augmented after egg laying begins while Th1 responses (IL-2 and IFN-gamma) are down regulated in S. mansoni infected mice. Treatment of mice with anti-IL-5 monoclonal antibodies (Mab) suppressed the eosinophil response almost completely but did not affect granuloma size and slightly increased hepatic fibrosis. Anti-IL-4 treatment abolished IgE responses in infected mice and decreased hepatic fibrosis slightly. Anti-IFN-gamma treatment had no effect on hepatic pathology. Anti-IL-2 treatment decreased granuloma size significantly and decreased hepatic fibrosis markedly. Anti-IL-2 treatment dramatically decreased IL-5 secretion by splenic cells in vitro and decreased peripheral blood and tissue eosinophilia. In contrast IL-4 secretion was unaffected and serum IgE was normal or increased. IL-2 and IFN-gamma secretion by splenic cells of treated mice were slightly but not significantly increased suggesting that anti-IL-2 treatment is affecting Th2 rather than Th1 responses.

Sex differences in inflammation induced cartilage damage in rodents. The influence of sex steroids

OBJECTIVE

To investigate sex differences in granulomatous inflammation and its effects upon articular cartilage and to assess the potential role of sex steroids in the process.

METHODS

The cotton-pellet cartilage implant model was used with male and female mice in the presence and absence of gonadectomy and hormone replacement. The effects of granulomatous tissue upon articular cartilage was assessed and tissue content of interleukin 1 (IL-1) was determined. The expression of sex hormone receptors in inflammatory tissue was investigated by immunocytochemistry.

RESULTS

Female mice showed a higher ability than males to degrade cartilage irrespective of the sex of the cartilage implanted. Gonadectomy resulted in a significant acceleration of cartilage damage in both sexes, which was reverted by estrogen replacement in females and androgen replacement in males. Female granulomata had significantly higher IL-1 content than those from males. Gonadectomy was associated with an increased IL-1 content in males but not in females, the effects being abolished by androgen replacement in males. Estrogen and androgen receptors were identified in inflammatory cells from the granulomatous tissue.

CONCLUSION

Our data demonstrate that sex hormones affect inflammation induced cartilage degradation in male and female mice probably through the modulation of cytokine production and release in the granulomatous tissue. Further investigation on the effects of sex steroids in inflammation induced cartilage degradation may help elucidate their pathogenic role and therapeutic potential in human disease.

Cell-matrix interactions modulate interstitial collagenase expression by human keratinocytes actively involved in wound healing

We reported that interstitial collagenase is produced by keratinocytes at the edge of ulcers in pyogenic granuloma, and in this report, we assessed if production of this metalloproteinase is a common feature of the epidermal response in a variety of wounds. In all samples of chronic ulcers, regardless of etiology, and in incision wounds, collagenase mRNA, localized by in situ hybridization, was prominently expressed by basal keratinocytes bordering the sites of active re-epithelialization indicating that collagenolytic activity is a characteristic response of the epidermis to wounding. No expression of mRNAs for 72- and 92-kD gelatinases or matrilysin was seen in keratinocytes, and no signal for any metalloproteinase was detected in normal epidermis. Immunostaining for type IV collagen showed that collagenase-positive keratinocytes were not in contact with an intact basement membrane and, unlike normal keratinocytes, expressed alpha 5 beta 1 receptors. These observations suggest that cell-matrix interactions influence collagenase expression by epidermal cells. Indeed, as determined by ELISA, primary cultures of human keratinocytes grown on basement membrane proteins (Matrigel; Collaborative Research Inc., Bedford, MA) did not express significant levels of collagenase, whereas cells grown on type I collagen produced markedly increased levels. These results suggest that migrating keratinocytes actively involved in re-epithelialization acquire a collagenolytic phenotype upon contact with the dermal matrix.

Evaluation of occlusive dressings for management of full-thickness excisional wounds on the distal portion of the limbs of horses

Two 2.5-cm2 full-thickness skin wounds were created surgically over the lateral aspect of the cannon bone of each limb of 6 horses (n = 48 wounds). Dressings evaluated were a nonadherent gauze pad (group 1); a synthetic semiocclusive dressing, (group 2); equine amnion (group 3); and a synthetic fully occlusive dressing (group 4). Wounds were assessed subjectively at each dressing change, and total wound area, area of granulation tissue, and area of epithelium in each wound were determined by computerized digital analysis of photographs of the wounds. Complete healing time (wound covered by epithelium) also was determined for each wound. Statistical comparisons were made, using Kruskal-Wallis analysis and a Mann-Whitney U test. Median time to complete healing was: group 1, 53 days; group 2, 71 days; group 3, 63 days; and group 4, 113 days. Time to complete healing was significantly longer for wounds of group-4 horses than all other groups, and wounds of group-1 horses healed faster than did those of group-2 horses (P < 0.05). Wounds in group-4 horses required significantly (P < or = 0.05) more excisions of granulation tissue (median, 11.5 times) than did those in group-1 (median, 3.5), group-2 (median, 5.5) or group-3 (median, 2.5) horses. Epithelial tissue was detected later in wounds of group-4 horses (median, 27 days) than in wounds of horses in groups 1, 2 or 3 (median, 17 days); however, this difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulmonary granuloma formation in the rat is partially dependent on monocyte chemoattractant protein 1

BACKGROUND

We have examined the role of MCP-1 (monocyte chemoattractant protein 1; also known as monocyte chemotactic and activating factor or the murine JE gene product) in the pathogenesis of glucan-induced granulomatous vasculitis in the rat. While in vitro studies indicate that MCP-1 possesses monocyte chemotactic and activating activities, little is known about its biologic role in pathologic processes. Glucan-induced pulmonary granulomatous vasculitis is an ideal model in which to study the role of MCP-1, because the granulomas develop rapidly and synchronously and are monocyte/macrophage-rich.

EXPERIMENTAL DESIGN

The purpose of this study was to define the topographic distribution and temporal pattern of MCP-1 expression in the lungs of rats with evolving glucan-induced granulomatous vasculitis and to determine the effect of neutralization of MCP-1 activity on granuloma formation. Glucan-induced pulmonary granulomatous vasculitis was induced in rats by the intravenous infusion of yeast cell wall glucan. At the indicated time points after glucan infusion, rats were sacrificed and the lungs processed for Northern, immunohistochemical and in situ hybridization analyses of MCP-1 production. Morphometric analysis was used to quantify the effect of neutralization of MCP-1 activity on granuloma formation.

RESULTS

Granuloma formation was accompanied by a biphasic increase in steady-state whole lung MCP-1 mRNA levels that peaked at 1 and 6 to 24 hours. In situ hybridization and immunohistochemical analyses revealed that components of the bronchial and vascular walls are responsible for the early rise (1 hour) in MCP-1 mRNA and protein expression, whereas granuloma-associated alveolar macrophages are the predominant source of MCP-1 later (6 to 24 hours) in the evolution of these lesions. Intravenous infusion and/or intratracheal instillation of neutralizing concentrations of anti-rat MCP-1 antibody raised against recombinant rat MCP-1 resulted in a dramatic decrease in the number and size of glucan-induced granulomas as well as in the numbers of mononuclear phagocytes retrieved in bronchoalveolar lavage fluid.

CONCLUSIONS

These studies demonstrate that glucan-induced granulomatous vasculitis is accompanied by increased local expression of MCP-1 mRNA and protein, that there is a coordinated production of MCP-1 by different cell types within the lung during evolving glucan-induced pulmonary vasculitis, and that MCP-1 plays a requisite role in pulmonary granuloma formation.

Changes in the threshold of pentylenetetrazol-induced seizures in cats with a chronic granuloma in brain amygdala

A parenchymal brain granuloma is the final consequence of a localized inflammatory reaction against an infectious agent, particularly parasites. In humans, these lesions are frequent causes of epilepsy. We studied the pattern of seizures induced by pentylenetetrazol (PTZ) in cats with a chronic granuloma induced 1 year earlier by injection of silicates into the brain amygdala. Compared with controls, the seizure threshold to myoclonic seizures was significantly decreased in cats with granuloma, while the threshold for tonic-clonic seizures was not altered. Thus, the difference in PTZ doses between the initial and final components of the seizure became significantly enlarged (P < 0.001). Our results indicate that a granulomatous lesion in amygdala facilitates the generation and propagation of myoclonic seizures, whereas other components of PTZ-induced seizures are not affected.

[The dermal dendrocyte]

Dermal dendrocytes represent a population of resident cells of the dermis identified recently by virtue of the immunohistochemical expression of the coagulation factor XIIIa (fXIIIa). These dendritic cells of bone-marrow origin bear particular histoenzymatic and immunohistochemical features, some of which are shared with antigen-presenting cells; however, they are clearly distinct from epidermal Langerhans cells. Dermal dendrocytes could act as macrophages, antigen-presenting cells or participate in the homeostasis of macromolecules of the dermis. These cells give rise to some cutaneous tumours and seem involved in inflammatory dermatoses where they act by means of cytokine production; they could even represent targets of HIV infection. Future functional studies will hopefully lead to a better understanding of their precise role in normal and diseased skin, which remains presently partly speculative.

Time-course of phospholipase A2, eicosanoid release and cellular accumulation in rat immunological air pouch inflammation

Phospholipase A2 activity in the rat air pouch cavity was determined after induction of a reverse passive Arthus reaction. Time-course of phospholipase A2 activity appeared to correlate with increased prostaglandin E2 levels in inflammatory exudate and with the influx of mononuclear inflammatory cells. Local administration of anti-inflammatory drugs such as dexamethasone, indomethacin, or a PLA2 inhibitor such as p-bromophenacyl bromide significantly inhibited exudate volume, cellular influx, granuloma formation, exudate PGE2 levels and PLA2 activity, to varying degrees. Dexamethasone treatment significantly reduced all parameters determined, whereas p-bromophenacyl bromide had a significant inhibitory effect on PLA2 activity and PGE2 release, and indomethacin only restored PGE2 levels. These results show that PLA2 is neither the only nor the most important factor involved in the development of subchronic inflammation.

Granuloma formation in severe combined immunodeficient (SCID) mice in response to progressive BCG infection. Tendency not to form granulomas in the lung is associated with faster bacterial growth in this organ

Intravenous inoculation of Mycobacterium bovis, strain bacillus Calmette-Guerin caused infection in the lungs, livers, and spleens of severe combined immunodeficient (SCID) mice and in the same organs in immunocompetent co-isogenic C.B17 mice. However, whereas infection in the latter mice was stabilized and partly resolved, it was progressive in SCID mice and eventually lethal, with the most rapid bacterial growth occurring in the lungs. Histological examination of infected organs showed that well-developed, compact epithelioid granulomas formed at sites of bacterial multiplication in livers, spleens, and lungs of C.B17 mice. Granulomas also formed in the livers and spleens of SCID mice, despite their inability to generate immunity. However, in the lungs of SCID mice, bacillus Calmette-Guerin was regionally distributed mostly in isolated alveolar macrophages and in aggregates of macrophages resembling small granulomas. The possibility that this tendency not to form granulomas in the lung is the reason for the more rapid growth of bacillus Calmette-Guerin in this organ is discussed.

[Physiology of granulomas]

Granulomas are a local formation of specific cells including macrophages and lymphocytes revealing a chronic inflammatory reaction against infection, often due to intracellular agents. Granulomas can be composed of macrophages (foreign body reaction), epithelioid cells (immune granulomas of sarcoidosis, tuberculosis), or Langerhans' cells (histiocytosis X). In immune granulomas, the epithelioid cells derived from activated macrophages are found at the centre of the granuloma associated with CD4+ T-lymphocytes, while the periphery is mainly populated with CD8+ T-lymphocytes. Granulomas are not static formations, the rate of cell turnover is high. Different cytokines have been identified as mediators involved in the formation and maintenance of these granulomas: IL2, interferon gamma, TNF alpha, 1,25(OH)2D3, IL1. Major questions, especially concerning antigens involved in granulomatous reactions, remain to be answered for a better understanding of these events.

Human bilharzial ureters. II. Cellular dynamic against deposited eggs

The cellular dynamic against deposited Schistosoma haematobium eggs was studied in the submucosa and muscularis of the lower ureteral segments of Saudi patients with chronic urinary schistosomiasis. This dynamic activity was greatly affected by the damaged phase of the egg embryo. Freshly deposited eggs with "healthy" embryos were entirely surrounded by long cytoplasmic extensions of fibroblasts. Eggs with partially damaged embryos were surrounded by plasma cells which were focally adhered to spines of egg-shells and releasing their granular contents over their surface. Eggs with "dead" embryos, or empty egg-shells, were surrounded by actively mobile macrophages possessing numerous lysosomes, phagocytic vacuoles, and convoluted surface projections. After "peeling" off the outer and intermediate shell layers, macrophages invaded into eggs and fused together forming multinucleate giant macrophages. This study showed that the fibroblastic extensions acted as barriers between the parasite eggs or their products, and the host tissue; the plasma cell secretion over the egg surface may be involved in the migration of macrophages towards deposited eggs; and macrophages were the only dynamic cells responsible for the egg-shell invasion possibly for elimination.

Alpha-naphthyl acetate esterase-1 (ANAE-1) secreted by epithelioid cells from induced rabbit lung granuloma showed MIF activity

The function of alpha-naphthyl acetate esterase-1, whose isoelectric point values range from 5.15 to 5.45, was examined. A higher value of alpha-naphthyl acetate esterase-1 was detected in the extracts of epithelioid cells isolated from rabbit lung granuloma at 4 weeks after injection of Freund's complete adjuvant, compared to those values of alveolar macrophages isolated from the same lungs described above and of the normal lungs. Additionally, this enzyme activity was observed to be prominent in the culture supernatants of epithelioid cells. alpha-Naphthyl acetate esterase-1 was purified from lung granuloma as a single 62-kDa band by SDS-PAGE analysis. The purified enzyme showed a macrophage migration inhibition activity at concentrations over 20 nM, and its activity was dose-dependent. Moreover, when various amounts of the purified enzyme were added to lymphocyte-derived macrophage migration inhibitory factor, macrophage migration inhibition was significantly enhanced with a dose-dependent manner. The results suggest that alpha-naphthyl acetate esterase-1 secreted by granuloma macrophages, particularly by epithelioid cells, contributes to granuloma formation.

Fibroblast stimulation in schistosomiasis. XII. Identification of CD4+ lymphocytes within schistosomal egg granulomas as a source of an apparently novel fibroblast growth factor (FsF-1)

Granulomas that form around Schistosoma mansoni eggs deposited in the liver secrete a variety of fibrogenic factors that may provide a molecular link between chronic inflammation and hepatic fibrogenesis in schistosomiasis. We recently isolated from conditioned medium of egg granuloma cultures a approximately equal to 60-kDa heparin-binding growth factor for fibroblasts. Because this protein is distinct from other defined heparin-binding growth factors, we designated it "fibroblast stimulating factor-1" (FsF-1). We now report that FsF-1 is a lymphokine. We prepared IgG antibody against purified FsF-1 and determined that it did not cross-react with a variety of growth factors or recombinant interleukins. Using two-color flow cytometry of dissociated granuloma cell suspensions, we observed that approximately 20% to 25% of granuloma CD4+ lymphocytes express surface FsF-1. We isolated CD4+ granuloma lymphocytes by FACS and observed that these cells spontaneously secrete into culture supernatant a fibroblast mitogen that is neutralized by anti-FsF-1 antibody. Furthermore, anti-FsF-1 can specifically immunoprecipitate a metabolically labeled protein produced by the granuloma CD4+ lymphocytes. The labeled protein has the same apparent molecular mass (approximately equal to 60 kDa) as FsF-1 purified from granuloma culture supernatants. These findings define CD4+ lymphocytes as a source of FsF-1. Because FsF-1 has biologic and chemical features distinct from most other defined lymphokines and from other heparin-binding growth factors, FsF-1 appears to be a novel lymphokine.

Aprindine-induced hepatic granulomata

Aprindine is a very effective antiarrhythmic agent with a narrow therapeutic ratio. We report a patient who suffered from granulomatous hepatitis probably due to the administration of aprindine. Evidence of hepatitis appeared within 6 weeks of initiating aprindine therapy and resolved rapidly when the drug was withdrawn. Six months later, fibrosis but no granulomata were found in the expanded portal tracts. Our observations suggest that granulomatous hepatitis can occur during aprindine therapy.

Kupffer cells express type I TGF-beta receptors, migrate to TGF-beta and participate in streptococcal cell wall induced hepatic granuloma formation

Intraperitoneal injection of Group A streptococcal cell wall (SCW) fragments into female Lewis rats results in the induction of an acute hepatic inflammation that progresses to granulomatous lesions. Kupffer cells have been shown to rapidly clear circulating SCW which triggers production of TGF-beta. In this study, we examined Kupffer cells for the expression of TGF-beta receptors to determine if these cells might be modulated in an autocrine/paracrine fashion by TGF-beta during SCW-hepatic inflammation. By receptor crosslinking and subsequent SDS-PAGE analysis we demonstrate that Kupffer cells express Type I TGF-beta receptors, but not Types II and III. Scatchard analysis indicated a receptor density of approximately 1100 receptors per cell. Functionally, TGF-beta was found to be chemotactic for Kupffer cells in vitro and this chemotactic response was higher in cells isolated from rats 1-21 days post SCW-injection. Although TGF-beta 1 mRNA is constitutively expressed by Kupffer cells, in vitro stimulation of the cultures with purified TGF-beta augments the expression of TGF-beta 1 mRNA and protein synthesis suggesting autocrine/paracrine regulation. These results indicate that TGF beta secreted by Kupffer cells during SCW-induced hepatic inflammation may amplify its own expression and regulate Kupffer cell functions relevant to the formation of granulomatous lesions within the liver.

The role of egg antigens, cytokines in granuloma formation in murine schistosomiasis mansoni

The induction of granuloma formation by soluble egg antigens (SEA) of Schistosoma mansoni is accompanied by T cell-mediated lymphokine production that regulates the intensity of the response. In the present study we have examined the ability of SDS-PAGE fractionated SEA proteins to elicit granulomas and lymphokine production in infected and egg-immunized mice. At the acute stage of infection SEA fractions (< 21, 25-30, 32-38, 60-66, 70-90, 93-125, and > 200 kD) that elicited pulmonary granulomas also elicited IL-2, IL-4 lymphokine production. At the chronic stage a diminished number of fractions (60-66, 70-90, 93-125, and > 200 kD) were able to elicit granulomas with an overall decrease in IL-2, IL-4 production. Granulomas were elicited by larval-egg crossreactive and egg-specific fractions at both the acute and chronic stage of the infection. Examination of lymphokine production from egg-immunized mice demonstrated that as early as 4 days IL-2 was produced by spleen cells stimulated with < 21, 32-38, 40-46, 93-125, and > 200 kD fractions. By 16 days, IL-2 production was evoked by 8 of 9 fractions. IL-4 production at 4 days in response to all fractions was minimal while at 16 days IL-4 was elicited with the < 21, 25-30, 50-56, 93-125, and > 200 kD fractions. The present study reveals differences in the range of SEA fractions able to elicit granulomas and IL-2, IL-4 production between acute and chronic stages of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Temporal study of carrageenan-induced PMN migration in mice

The time course of polymorphonuclear neutrophil (PMN) migration in an experimental inflammatory granuloma induced by carrageenan in the mice was studied at 6 different times of the day. Compared to saline, the number of PMN increased as soon as 240 min and reached high level at 480 min when migration was induced by carrageenan. The data showed circadian variations in the time course of cell migration. After 240 and 360 minutes of migration, the number of PMN was highest in the cell trap implanted at 09.00 whereas minimum values were obtained at 01.00. After 480 minutes of implantation, the PMN migration was maximal when the carrageenan experiment was performed at 05.00 and minimum values were obtained at 13.00. Thus, a significant rhythm was demonstrated in the time course of PMN migration.

Modulation of exudate inflammation parameters in rat carrageenan-induced granuloma by modification of exudate iron levels

We have used the carrageenan-induced pouch-granuloma in rats to investigate how changes in low-molecular-mass iron chelate levels in the exudate, induced by iron loading (iron-dextran) or chelation (desferrioxamine) influence cellular and systemic inflammatory parameters. In the iron-treated group we observed a rapid decrease in the number of leukocytes and exudate volume; there was also an increase in ferritin iron and low-molecular-mass iron chelates, and on the eighth day a systemic response. In the desferrioxamine-treated group we detected a decrease in low-molecular-mass iron chelates, ferritin iron, and an increase in the number of leukocytes. We describe the protective effects of desferrioxamine against the deleterious effects of ferrous iron and relate this to its chelating and scavenging activity. The results suggest that the levels of low-molecular-mass iron chelates modulate the inflammatory response, possibly through their contribution to the oxygen free radical generation, which is responsible for the cell membrane damage and subsequently its death. The modulatory action of iron-dextran and desferrioxamine support our hypothesis.

Non-specific granulomas of the pituitary: report of six cases treated surgically

Granulomatous lesions of the pituitary gland are very rare. In our department, six patients with these lesions have been operated on since 1988. The records of these patients were analysed and are reported in the following. Three of the patients were admitted because of severe and rapid development of visual disturbances caused by a suprasellar extending lesion. Endocrinological examination most often found posterior lobe insufficiency, was followed by anterior lobe dysfunction. CT and MRI demonstrated a cystic lesion with semiliquid content, where mild contrast enhancement of the walls of the tumor was observed in all cases. Surgery was performed using the transphenoidal approach. Rapid relief of visual impairment was observed in the three patients with chiasmal compression. In one patient, recurrent chiasm syndrome due to lesion regrowth required additional surgery with transcranial resection of the capsule. Unfortunately, visual impairment persisted postoperatively in one eye. Endocrinological follow-up demonstrated unchanged or even worsened pituitary functions in all cases. Our study revealed no consistent predictive preoperative finding. Therefore, we consider an indication for decompression surgery to be given in all patients with chiasmal syndrome and for diagnostic surgery for all patients with intrasellar lesions.

Epithelial macrophages secrete a deactivating factor for superoxide release

The release of superoxide anion (O2-) by inflammatory macrophages, multinucleated giant cells, and epithelioid cells, obtained by the insertion of round glass coverslips into the subcutaneous tissue of mice, was investigated. O2- was shown to be spontaneously released by cells on the surface of glass coverslips implanted up to 7 days, but not by cells obtained 14 or 21 days after coverslip implantation. The former showed increased O2- release when stimulated by phorbol myristate acetate, whereas cells harvested after 14 or 21 days implantation did not. The induction of delayed type hypersensitivity around coverslips implanted for 5 days increased spontaneous O2- release by these cells by 40%. On the other hand, when the same protocol was used with coverslips implanted for 14 days, O2- release was not detected. These results were viewed in regard to the composition of the cell population at each time point. When coverslips were removed after 14 days of implantation and the cells incubated for 30 minutes in vitro, the medium so conditioned inhibited O2- release by cells of 5 day old preparations. This indicates the release by cells on the longer term coverslips of a substance that inhibits O2- production by cells of coverslips implanted for 5 days only. This inhibitory activity could be suppressed by treating the conditioned medium with proteases. The factor was, however, heat stable and exerted its effects even when the test cells were exposed to phorbol myristate acetate.

Anti-inflammatory activity of some copper(II) complexes

Anti-inflammatory activity of some copper(II) neutral complexes and complexated salts on different animal models of inflammation has been investigated. In a preliminary screening 5 complexes were selected for a more extensive study based on their capacity inhibiting the rat hind paw edema induced by carrageenin. These selected complexes showed inhibitory action on acute and subacute inflammation with an activity degree higher than that of indometacin. They were also effective inhibitors of primary and secondary lesions in the adjuvant-induced arthritis, with an activity similar to phenylbutazone. These complexes had no topical anti-inflammatory effect.

[Course of the visual evoked potentials in intracranial tuberculous granuloma]

The case in study is a 13-year-old male with tubercular granuloma in the optic chiasma, affecting the right optic nerve and causing temporary loss of vision in that eye. Evoked visual potentials are performed and a first examination reveals that loss of vision was preceded by an alteration of response through the right optical path. The physiopathology is discussed and an evolutionary study of the lesion is made, evaluating the usefulness of EVPs in the diagnosis and follow-up in these patients.

Talc granulomatosis in the rat. Involvement of bone in the acute-phase response

We investigated the dynamics of the acute-phase response (APR) and osteoblast trabecular surface in rats with subcutaneous inflammation provoked by magnesium silicate (talc). The first visible indicator of the APR was a rapid and profound hypozincemia, paralleled by a decrease in metaphyseal trabecular surfaces covered with osteoblasts in long bones. Both the intensity of serum APR and the decrease in osteoblast trabecular surface were directly proportional to the number of granulomas. Alterations in bone metabolism were specific for the inflammation, whereas mild hypozincemia and decrease in mononuclear and increase in polymorphonuclear peripheral white blood cell fractions developed in animals pair-fed with rats bearing two or four granulomas. Rats with talc granulomatosis had high serum ACTH and corticosterone levels, but neither adrenalectomy nor high doses of hydrocortisone could revert bone alterations in talc-injected animals. Glucocorticoids were necessary for the development of hypozincemia and hypercupremia seen in talc granulomatosis, as well as for normal bone metabolism. Inhibition of prostaglandin synthesis had no effect on bone alterations and serum APR in rats bearing talc-induced granulomas. We conclude that the decrease in bone formation constitutes an important aspect of the host acute-phase response in a rat model of talc granulomatosis.

Physiologic oxygen tensions limit oxidant-mediated killing of schistosome eggs by inflammatory cells and isolated granulomas

Explanted hepatic granulomas, eosinophils obtained from the peritoneal cavity of schistosome-infected mice, schistosome egg granuloma macrophages, alveolar macrophages, and activated peritoneal macrophages obtained from Listeria-infected mice were miracidicidal when cultured at 21% oxygen. This activity was markedly attenuated at physiologic oxygen concentrations (1-15%). Catalase and superoxide dismutase blocked the miracidicidal activity of inflammatory cells but did not prevent granuloma-mediated egg killing. However, the biomimetic superoxide dismutase, copper (II) [diisopropyl salicylate]2, inhibited granuloma-mediated egg killing in a dose-dependent, apparently nontoxic manner. Thioglycollate-elicited macrophages did not kill schistosome egg miracidia even when cultured in 21% oxygen, unless pretreated with lipopolysaccharide. Isolated schistosome eggs initiated an oxidative burst in macrophages, as measured by superoxide anion production. This burst was suppressed at reduced oxygen concentrations. Thus schistosome egg miracidia can be killed nonspecifically by macrophages through the release of cytotoxic reactive oxygen intermediates triggered by the egg. This activity is not supported by the oxygen concentrations found in most tissues, with the possible exception of the lung. Schistosoma mansoni eggs, injected intraveneously and lodged in the pulmonary vasculature of mice, were killed rapidly, with a half life of 3.5 days. Eggs, injected into the mesenteric veins and lodged in the liver, remained fully viable for several weeks. The data suggest that the high oxygen tension of the lung allows for the increased production of reactive oxygen intermediates (ROI) by local inflammatory cells, which in turn increases their miracidicidal efficiency. Conversely, the relatively hypoxic environment of the liver decreases ROI production by local inflammatory cells and decreases their miracidicidal efficiency.