Granuloma Tissue Formation Research Articles

Comparative performance of video-otoscopy and CT in the diagnosis of external ear disease in cats.

The aim of the study was to compare CT with video-otoscopy for detecting external ear canal masses in cats and to describe CT features of feline external ear disease. This retrospective study evaluated the external ear canals of cats that underwent both CT and video-otoscopy. Two blinded observers reviewed the CT scans and their findings were compared with video-otoscopy results evaluated by one blinded observer. Of the 32 examined ears, 13 had an external ear canal mass detected by both CT and video-otoscopy. No false positives were identified. All 19 ears without masses were correctly identified as true negatives, resulting in perfect agreement for mass detection (kappa = 1.000). On histopathology, 9/13 masses were diagnosed as polyps, 1/13 masses was diagnosed as carcinoma, 2/13 did not undergo histopathology and 1/13 masses seen on video-otoscopy was diagnosed as otitis externa with granulomatous tissue formation. Of the 16 cats examined, 12 had a mass in the external ear canal diagnosed by video-otoscopy: six domestic shorthairs, five Maine Coons and one Oriental Shorthair cat. Of these cats, 11 had a unilateral mass and one had a bilateral mass. There was very low agreement between CT and video-otoscopy for ear canal wall enhancement and erythema (kappa = 0.033), as well as for ear canal thickening and stenosis (weighted kappa = 0.056). There was no significant difference between chronic and non-chronic clinical signs in terms of the presence of ear canal wall mineralisation (P = 0.223). There is high agreement between video-otoscopy and CT in detecting external ear canal masses in cats. However, there is very low agreement between CT and video-otoscopy for ear canal wall enhancement, erythema, thickening and stenosis. The presence of external ear canal mineralisation did not correlate with the chronicity of clinical signs.

Utilizing mechatronic agilent gas chromatography to validate therapeutic efficacy of Combretum paniculatum against oxidative stress and inflammation

The quest for novel antioxidant and anti-inflammatory medications from medicinal plants is crucial since the plants contain bioactive compounds with a better efficacy and safety profile than orthodox therapy. This study harnesses the capabilities of mechatronics-driven Agilent Gas Chromatography, deploying in vitro, in vivo, and in silico models to unravel the antioxidant and anti-inflammatory attributes within Combretum paniculatum ethanol extract (CPEE). Employing gas chromatography-mass spectroscopy (GC-MS), our analysis efficiently segregates and evaluates volatile compound mixtures, a technique renowned for identifying organic compounds, as exemplified by its success in detecting fatty acids in food and resin acids in water. Using gas chromatography-mass spectrometry (GC-MS) and GC-FID analyses, this paper ascertains the comprehensive phytochemical composition of CPEE. Also, Molecular interactions of identified compounds with cyclooxygenase (COX-2) implicated in inflammatory urpsurge is verified. GC-MS and GC-FID analyses unveil 41 phytoconstituents within CPEE. Based on the in vitro research, CPEE demonstrated potential in inhibiting thiobarbituric acid-reactive substances, nitric oxide, and phospholipase lipase A2 with inhibition rates of 2.284, 6.547, and 66.8 μg/mL respectively. In vivo experiments confirm CPEE's efficacy in inhibiting granuloma tissue formation, lipid peroxidation, and neutrophil counts compared to untreated rats. Moreover, CPEE elicited a significant (P < 0.05) increase in the activities of SOD, CAT, and GSH concentrations while decreasing C-reactive protein, signifying promising therapeutic potential. Highlighting interactions between top-scoring phytoligands (epicatechin, catechin, and kaempferol) and COX-2, the findings underscore their drug-like characteristics, favorable pharmacokinetics, and enhanced safety toxicity profiles. Results from in vitro, in vivo, and in silico studies, highlights CPEE remarkable antioxidant and anti-inflammatory potentials.

Abstract We067: A meta-analysis of RNA sequencing data to characterize immune cell activation among patients with cardiac sarcoidosis

Introduction: Cardiac sarcoidosis (CS) is a life-threatening auto-immune disorder that causes the formation of non-caseating granulomas in cardiac tissue. Th17.1 cell have been found to be upregulated in patients with pulmonary sarcoidosis (PS) although data is lacking among CS patients. This meta-analysis integrates all publicly available granuloma single-cell and single-nuclei RNA sequencing data to identify patterns in immune cell activation across different granulomatous diseases while focusing on CD4+T cell activation among CS patients. Methods: Five studies were included, spanning cardiac tissue from healthy controls and DCM (Koenig 2022, PMID:35959412), cardiac tissue from ICM and cardiac sarcoidosis (Liu 2022, PMID:36111531), BAL from beryllium sensitized, chronic berylliosis, and PS (Liao 2021, PMID: 33602861), peripheral blood samples from sarcoidosis (Garman 2020, PMID: 33363531), and lesional and nonlesional skin tissue from sarcoidosis (Krausgruber 2023, PMID: 36750099) for a total of 122 patients. All integrative analysis was performed using the R package Seuratv5 on Stanford’s computing cluster, Sherlock. After quality control filtering, a total of 127,335 cells were integrated using Seurat’s reference-based integration. After labeling the UMAP with general immune cells (figure 1A), we subsetted T cells into CD4+ and CD8+ and examined the landscape of CD4+ T cells (figure 1B). Results: We found significantly more Tregs in CS than PS (P=0.013, figure 1C). Additionally, patients with CS had significantly more Th17.1 cells in CS in comparison to PS (P=0.0041). However, significantly less Th2 cells were found in CS than PS patients (P=0.0152). These differences remained statistically significant across various analyses comparing Tregs and Th17.1 cell as a proportion of CD4+, CD3+, and CD45+ cells. Conclusions: In comparison to patients with PS, pathways which differentiate naive CD4+ cells into TH17.1 and Tregs are upregulated among CS patients while the TH2 differentiation pathway is downregulated. Our findings indicate distinct CD4+ T cell patterns among CS and PS patients. Our ongoing work aims to further evaluate T cell proliferation and expression to elucidate mechanistic pathways as potential drug targets for CS.

Persicaria lanigera (Polygonaceae) leaf extract exhibits antiulcerogenic and antiproliferative activities against acetic acid-induced ulcerative colitis and cotton pellet-induced granuloma tissue in rats

Objective: To assess the effect of leaf extract of Persicaria lanigera on cotton pellet-induced granuloma tissue formation and acetic acid-induced ulcerative colitis. Methods: Rats were randomly divided into six groups: normal control, negative control, positive control (dexamethasone or sulfasalazine) as well as Persicaria lanigera (100-600 mg/kg)-treated groups. The effects of the extracts on body weight, antioxidant, and hematological parameters, as well as mast cell proliferation, were assessed. In addition, a histological evaluation was conducted. Results: Persicaria lanigera extract significantly decreased the mean exudate amount and suppressed granuloma tissue formation in a concentration-dependent manner in rats (P&lt;0.05). Additionally, the extract significantly increased body weight, improved hematological profile, reduced the disease activity index score and malondialdehyde level, as well as enhanced catalase and superoxide dismutase activities (P&lt;0.05). Histological evaluation showed Persicaria lanigera extract alleviated acetic acid-induced colonic damages, as evidenced by decreased cell necrosis, edema, and inflammatory cell infiltration. Conclusions: Persicaria lanigera extract possesses antiproliferative, antioxidative, and anti-colitis activities. However, its underlying mechanisms of action need further investigation.

Isolated ocular sarcoidosis

A rare clinical case of a patient with isolated sarcoidosis of the eyes is presented. Sarcoidosis is a polyethological disease, the morphological feature of which is the formation of epithelioid cell granulomas in various organs and tissues, which is accompanied by a violation of their structure and function. Both congenital and adaptive immune systems are involved in the pathogenesis of sarcoidosis, with damage to lymph nodes, lungs, skin, organ of vision, etc. Risk factors for the development of sarcoidosis have not been definitively established. Environmental factors and genetic predisposition play a crucial role in the development of the disease. The above clinical observation demonstrates the polymorphism of the clinical picture of isolated ocular sarcoidosis. In addition to standard ophthalmic examination methods, the genetic method of reverse transcription and quantitative polymerase chain reaction (RT-PCR, English qRT-PCR) was also used to determine the expression profile of signature microRNAs as potential diagnostic markers of sarcoidosis of the organ of vision.An increase in the expression level of hsa-miR-455-3p, hsa-miR-4663, hsamiR68063p, hsa-miR-450b-5p, hsa-miR-6716-3p, hsa-miR-5000-5p, hsa-miR150-5p can be considered as potential diagnostic biomarkers of sarcoid lesion of eye structures. With sarcoidosis, the involvement of the lacrimal gland is possible. In the presented clinical observation, this was indicated by the results of a functional examination, sonographic signs: revealed multiple linear tubular hyperechoic structures and a decrease in blood flow velocity in the ocular and lacrimal arteries, as well as an increase in the expression activity of hsa-miR150-5p (p &lt; 0.05). In order to prevent possible damage to the ocular surface due to the development of lacrimal gland dysfunction, it is advisable to prescribe local tear replacement therapy with hyaluronic acid preparations. Such effective drugs include tear substitutes of the Optinol® line: “Optinol® Express Moisture” and “Optinol® Deep Moisture”.

Analgesic and Anti-Inflammatory Activity: A Comprehensive Review on Invitro and In Vivo Screening Methods

Modern pharmacotherapy includes analgesic and anti-inflammatory medicines as essential components to relieve pain and inflammation brought on by a variety of medical diseases. Robust screening techniques are essential for the identification of possible candidates with appropriate safety and effectiveness profiles in the search and development of new analgesic and anti-inflammatory medications. This study looks at the many screening methods used in preclinical studies to assess new drugs' analgesic and anti-inflammatory quality. Conventional techniques like the tail flick, hot plate, and writhing’s tests measure analgesic activity by having animals respond to unpleasant stimuli. Comparably, anti-inflammatory activity is frequently assessed using assays like the cotton pellet granuloma test, which gauges tissue granuloma formation, and the carrageenan-induced paw edema model, which measures inflammation. These traditional techniques offer insightful information about the pharmacological effects of test substances. Despite the wide range of screening techniques available, each strategy has advantages and disadvantages. Preclinical studies are more reliable and have higher predictive value when various assays and techniques are integrated into a tiered screening strategy. Furthermore, the successful translation of preclinical findings to human applications depends on taking into account translational variables including species differences and clinical relevancies. As a result, choosing the right screening techniques is critical to the effective identification and characterization of new analgesic and anti-inflammatory drugs.

Pulmonary dimorphic fungal infections among HIV/AIDS non-TB patients with chronic cough in Kampala, Uganda.

Dimorphic fungi cause infection following the inhalation of spores into the pulmonary system. In the lower respiratory tract, the conidia transform into yeasts, which are engulfed by alveolar macrophages and may be destroyed without disease manifestation. However, in some immunocompromised individuals, they may persist and cause active fungal disease characterized by formation of granulomas in the infected tissues, which may mimic Mycobacterium tuberculosis (MTB). To determine the prevalence of pulmonary dimorphic fungal infections among HIV/AIDS patients with non-TB chronic cough at Mulago National Referral and Teaching Hospital in Kampala, Uganda. Sputum samples were collected from 175 consented HIV/AIDS patients attending the immuno-suppression syndrome (ISS) clinic at the hospital. Upon Xpert MTB/RIF sputum testing, 21 patients tested positive for MTB, and these were excluded from further analysis. The other 154 sputum negative samples were then subjected to PCR for dimorphic fungi at MBN Clinical Laboratories. Singleplex PCR was used to detect the target sequences in selected respective genes of each dimorphic fungal species of interest. DNA amplicons were detected based on gel electrophoresis. Dimorphic fungi were detected in 16.2% (25/154) of the studied population. Of these 9.1% (14/154) had Blastomyces dermatitidis and 7.1% (11/154) had Talaromyces marneffei. The remaining 84% of the studied participants had no dimorphic fungi. Histoplasma capsulatum, Coccidioides immitis and Paracoccidioides brasiliensis were not detected in any of the participants. Dimorphic fungi (B. dermatitidis and T. marneffei) were found in 16.2% of the HIV/AIDS patients with non-TB chronic cough in Kampala, Uganda. We recommend routine testing for these pathogens among HIV/AIDS patients with chronic cough.

Sarcoidosis of the Skin as an Interdisciplinary Problem

Sarcoidosis is a disease of unknown etiology characterized by the formation of epithelioid cell granulomas in several organs or tissues without caseous necrosis (fibrinoid necrosis may occur). With sarcoidosis, almost all organs and tissues can be affected, which determines the interdisciplinary nature of the problem. Skin sarcoidosis is one of the most common manifestations of systemic sarcoidosis. At the same time, the role of dermatologists in the diagnosis of sarcoidosis is exceptionally large, since skin lesions are often the key to the discovery of systemic sarcoidosis, which allows internists to purposefully and timely diagnose and treat lesions of internal organs. Skin rashes in patients with sarcoidosis may occur secondarily against the background of specific lesions of the lungs, intrathoracic nodes and other internal organs, however, skin sarcoidosis may also develop primarily. All forms of skin sarcoidosis may be the only manifestation of the disease, and it is impossible to distinguish clinically and histologically between skin changes in systemic sarcoidosis and skin lesions alone. Treatment of skin sarcoidosis often presents great difficulties and includes, depending on the prevalence and activity of the process, local (corticosteroids, tacrolimus) and systemic therapy (immunomodulators, immunosuppressors, TNF inhibitors).

Phytochemistry and Anti-Inflammatory Properties of Muntingia calabura L. as a Medicinal Plant: A Review

Inflammation is a normal protective response to tissue injury caused by physical trauma, damaging chemical or microbiological agents. Muntingia calabura L. contains flavonoid compounds that have activities such as anti-inflammatory and antioxidant. This article aims to present the knowledge of the phytochemicals and anti-inflammatory activity of Muntingia calabura L. This review collects various articles related to the phytochemicals and in vitro or in vivo anti-inflammatory activity of Muntingia calabura L. An article search was conducted on electronic databases such as PubMed, Science Direct, and Google Scholar which were published from 2013 to 2023. The keywords “Phytochemistry”, “Phytochemical”, “Anti-inflammatory” and “Muntingia calabura L.”. A total of 19 articles for phytochemicals from Muntingia calabura L. and 12 articles provide anti-inflammatory activity Muntingia calabura L. Muntingia calabura L. inhibits the formation of edema, inhibiting the formation of granulomatous tissue, hypotonicity lysis, protein denaturation, lysosomal enzymes and stabilizing lysosomal membranes. This activity exists because of the phytochemical compounds contained in it Muntingia calabura L. is spread in leaves, stems, fruit, and stem bark such as tannins, flavonoids, terpenoids, coumarins, saponins, phenolic compounds, alkaloids, steroids.

Effect of dietary omega-3-polyunsaturated fatty acid in animal models of experimentally-induced granulomatous inflammatio

Recent advances have shown how polyunsaturated fatty acids (PUFAs) regulate molecular signaling, especially in the context of inflammation. Nutritional intervention/ supplementation with PUFAs in experimental animal models have exhibited anti-inflammatory properties. In this study, chronic inflammation was assayed by cotton pellet-induced granuloma method to evaluate the anti-inflammatory and anti-granuloma effects of omega-3-polyunsaturated fatty acid using experimentally induced inflammatory models in rats. Obtained results indicate that omega-3 oil extract significantly (p&lt;0.05) reduced the granuloma tissue formation (58.36 ± 3.52, 65.40 ± 1.30, 57.78 ± 3.89, 50.93 ± 0.60 and 42.17 ± 0.70 mg) representing 33.78, 25.79, 34.44, 42.21 and 52.15 % inhibition respectively for the proliferative phase when compared to the control. These results showed that omega-3 oil extract studied, possess both anti-inflammatory and anti-granuloma properties.

Membranous Vocal Fold Lesions in Patients With Chronic Cough: A Case Series

Trauma related to chronic cough and forceful glottal closure has been associated with lesions of the vocal process; however, there is limited description of cough leading to membranous vocal fold lesions. We present a series of mid-membranous vocal fold lesions in a cohort of patients with chronic cough, with a proposed mechanism of lesion formation. Patients treated for chronic cough with membranous vocal fold lesions affecting phonation were identified. Presentation, diagnosis, treatment strategies (behavioral, medical, and surgical), patient-reported outcome measures (PROMs), and videostroboscopy were reviewed. Five patients are included (four females, one male, aged 56±16 years). Mean cough duration was 2.6±3.5 years. All patients were on acid suppressive medications for existing gastroesophageal reflux disease (GERD) prior to referral. All lesions were identified at the mid-membranous vocal folds and morphologically encompassed a wound healing spectrum between ulceration and/or granulation tissue (granuloma) formation. Patients were treated in an interdisciplinary fashion with behavioral cough suppression therapy, superior laryngeal nerve block, and neuromodulators. Three had persistent lesions requiring procedural intervention (one office-based steroid injection and two surgical excisions). At the completion of treatment, all five patients had improvement in Cough Severity Index with an average decrease of 15.2±4.8. All but one patient had improvement in their Voice Handicap Index-10 with an average decrease of 13.2±11.1. One patient undergoing surgical intervention was noted to have a persistent lesion on follow-up. Mid-membranous vocal fold lesions in patients with chronic cough are uncommon. When they do occur, they represent epithelial change arising in context of shear injury and are distinct from phonotraumatic lesions in the lamina propria. An interdisciplinary approach including behavioral cough suppression therapy, neuromodulators, superior laryngeal nerve block, and acid suppression are reasonable for initial management, reserving surgical intervention for refractory lesions once the inciting source of injury has been controlled.

Impact of systemic health on treatment outcomes in endodontics.

The healing of periapical lesions after root canal treatment (RCT) is not the result of the curative action of the treatment. The process of healing begins with inflammation, and is resolved by the clearance of the immunogen that induces the immune response. Then, the periapical tissue itself carries out the healing of the periapical lesion, by repair or by a combination of repair and regeneration, depending on the host's reparative response working properly. The ultimate objective of RCT is to achieve wound healing by removing the source of bacterial antigens and toxins, allowing chronic inflammatory tissue to become reparative tissue. Some systemic conditions increase the susceptibility of the host to infection or impair the tissue reparative response, maintaining the inflammatory process and periapical bone resorption after RCT. This can cause the failure of RCT and even the need for extraction of the affected tooth. To analyse the scientific literature on the possible influence of systemic conditions on the treatment outcomes in endodontics, as well as to discuss the biological mechanisms that may be involved. The search was carried out in PubMed, SCOPUS and EMBASE. The inclusion criteria established were original scientific articles reporting data about some systemic condition in relation to treatment outcomes in endodontics, including clinical studies and studies carried out in animal models. Systemic factors (age, nutrition, stress, hormones, smoking habits), and systemic diseases, such as diabetes, cardiovascular diseases, osteoporosis, HIV infection, inflammatory bowel disease, and others, can influence or interfere in the repair of periapical tissues after RCT. Some of these systemic diseases can alter bone turnover and fibroblast function, preventing or delaying periapical wound healing. Others can alter the microvasculature, reducing nutrients and oxygen supply to periapical tissues. As a result, these systemic conditions can decrease the success rate of RCT and provoke incomplete wound healing (typically granulomatous tissue formation) in the periapical region. The results of this narrative review show worse success rate of RCT, with higher percentage of postoperative radiolucent periapical lesions and higher proportion of non-retained teeth (RFT), associated with several systemic conditions, such as smoking habits and diabetes.

Panhypopituitarism as the first manifestation of sarcoidosis: case report

Sarcoidosis is a systemic inflammatory disease of unknown etiology characterized by the formation of noncaseating granulomas in various organs and tissues and the activation of T-cells at the site of granulomatous inflammation with the release of various chemokines and cytokines [1]. The incidence on average ranges from 10 to 20 per 100,000 population [2]. Most often in patients with sarcoidosis, lesions of the lungs and intrathoracic lymph nodes are detected. Significantly less often (in about 5-20% of patients) damage to the nervous system is noted [6,7,9]. In 9-18% of patients with neurosarcoidosis, involvement of the pituitary gland, pituitary infundibulum and hypothalamus is found, which is manifested by a variety of clinical symptoms [8,10]. We observed a patient with sarcoidosis whose disease debuted with clinical symptoms of hypogonadism, followed by the development of signs of secondary hypothyroidism, adrenal insufficiency, and diabetes insipidus, which was initially regarded as panhypopituitarism against the background of a hypothalamic lesion of unknown origin. Later, additional examination revealed signs of intrathoracic lymphadenopathy and focal changes in the lung parenchyma on CT, as well as skin lesions. Despite the biochemical compensation of hypopituitarism, the clinical efficacy of hormonal therapy with cabergoline, testosterone, hydrocortisone and levothyroxine sodium was insufficient, and the patient's condition improved after the addition of immunosuppressive and anti-inflammatory therapy with methotrexate and methylprednisolone.

Itraconazole, a cytochrome P450 inhibitor, enhanced the efficacy of praziquantel against Schistosoma mansoni infection and alleviated liver injury in mice

Treatment of schistosomiasis is heavily reliant on the single antischistosomal drug praziquantel (PZQ). The use of synergistic drug-drug interactions is one possible solution, which could be used to mitigate PZQ's poor and variable bioavailability. Itraconazole (ITZ), a triazole antifungal agent, is a potent CYP3A inhibitor that can cause significant drug-drug interactions when used with CYP3A substrates. This study investigates the effect of ITZ as adjuvant therapy with PZQ on worm load, egg deposition and maturation, and the consequent histopathology and biochemical abnormalities in the liver during the immature and mature stages of Schistosoma mansoni (S. mansoni) infection. S. mansoni-infected mice were divided into five groups of eight−ten mice each: (I) infected untreated, (II) infected and treated with PZQ 3 weeks PI, (III) infected and treated with both ITZ and PZQ 3 weeks PI, (IV) infected and treated with PZQ 7 weeks PI, and (V) infected and treated with both ITZ and PZQ 7 weeks PI. All mice were killed by rapid decapitation 9 weeks PI. Data revealed that ITZ in combination with PZQ at both immature and mature stages improved the parasitological criteria of cure, and greatly reduced inflammation, granuloma and fibrotic tissue formation, and apoptosis versus PZQ alone. Furthermore, it showed the greatest impact on improving liver injury and oxidative stress markers. Notably, the effect was considerably stronger at the mature stage of S. mansoni infection. These findings support the notion that ITZ increased PZQ's antischistosomal activity by inhibiting CYP450 expression, potentially reducing PZQ metabolism and increasing systemic exposure.

Đặc điểm mô bệnh học bệnh lý hoại tử vô khuẩn chỏm xương đùi được phẫu thuật thay khớp háng

Aseptic necrosis of the femoral head (ANFH) accounts for about 2.24% of common joint diseases. The pathophysiological mechanism of ANFH is a lack of blood supply to the femoral head, leading to the death of bone cells and marrow, leading to the collapse and deformation of the femoral head. Objectives: To characterize microscopic damage to femoral head crest in non-traumatic ANFH.Subjects and methods: The study design was a cross-sectional, descriptive study of 31 femoral heads on 31 patients with ANFH who underwent hip replacement surgery at Viet Duc University. The samples were analyzed, processed, and fixed using the HE-stained histological method. Results: All samples had bone marrow damage, of which bone marrow infarction accounted for 58.1%; granulomatous lesions accounted for 71%, fat necrosis and hematopoietic cells accounted for 80.6%; dead bone accounted for 93.3% and new bone formation on dead bone area accounted for 61.3%. Conclusion: Infarct bone marrow injury, fat necrosis, and hematopoietic cells are associated with the formation of granulomatous tissue surrounding the necrotic area. The loss of bone cells in the trabecular is associated with the formation of dead bone fragments. With age, the formation of new bone on the basis of dead bone decreases. * Keywords: Aseptic necrosis; Femoral head; Histopathology.

The immunoregulatory landscape of human tuberculosis granulomas

Tuberculosis (TB) in humans is characterized by formation of immune-rich granulomas in infected tissues, the architecture and composition of which are thought to affect disease outcome. However, our understanding of the spatial relationships that control human granulomas is limited. Here, we used multiplexed ion beam imaging by time of flight (MIBI-TOF) to image 37 proteins in tissues from patients with active TB. We constructed a comprehensive atlas that maps 19 cell subsets across 8 spatial microenvironments. This atlas shows an IFN-γ-depleted microenvironment enriched for TGF-β, regulatory T cells and IDO1+ PD-L1+ myeloid cells. In a further transcriptomic meta-analysis of peripheral blood from patients with TB, immunoregulatory trends mirror those identified by granuloma imaging. Notably, PD-L1 expression is associated with progression to active TB and treatment response. These data indicate that in TB granulomas, there are local spatially coordinated immunoregulatory programs with systemic manifestations that define active TB.

Xanthogranulomatous pyelonephritis: A rare case report of a 54year old female (a potentially fatal infection).

Introduction and importanceXanthogranulomatous pyelonephritis (XPGN) is a rare pathology of the kidneys occurring in 0.6 to 1% of all cases of renal infections, in both men and women. It is characterized by severe inflammation of the renal parenchyma leading to formation of granulomatous tissue containing lipid-laden macrophages. This condition may mimic less aggressive or benign conditions but may worsen or be fatal if not treated aggressively.Case presentationOur patient is a 54 year old Caucasian female who presented with five days of left flank pain, hematuria, chills, nausea and vomiting. Imaging and biopsy results showed that the patient had XPGN.Clinical discussionXPGN is a difficult condition to diagnose as the symptoms are non-specific relative to renal cell carcinoma or other common renal infections. Definitive diagnosis is made with a biopsy; however, clues in various imaging modalities are used to make a tentative diagnosis. It is unclear whether earlier surgical intervention would have improved overall patient outcomes. Currently, a partial or complete nephrectomy is the only effective treatment.ConclusionAggressive management including early diagnosis, antibiotics and nephrectomy appears to be critical in preventing progression and complications of XPNG.

Granulomatous Mastitis: Manifestation of Primary Sarcoidosis Masquerading as Tubercular Mastitis

Sarcoidosis is a multisystem disease of unknown etiology that affects young to middle aged adults, characterized by granuloma formation in various tissues, most commonly the lungs, lymphatics, skin and eyes. Involvement of the breast in sarcoidosis is rare. The breast is involved in less than 1% of cases and can be defined into three subsets, including granulomas localized to the breast, referred to as breast sarcoidosis. Breast can be either a primary or a secondary site of presentation. Breast sarcoidosis often mimics carcinomas at clinical examination. It may present with systemic findings such as erythema nodosum, arthritis, and uveitis, and unlike typical sarcoidosis, commonly manifests during pregnancy. We report a case of breast Sarcoidosis in a 35-year-old lady presenting as recurrent breast abscess with polyarthralgia. On histology, it was characterized by non-caseating giant cell granulomas. Differential diagnoses included idiopathic granulomatous mastitis, tuberculosis, fungal infection, cat-scratch disease, and sarcoid-like reactions to cancer. She was started anti tubercular therapy but responded poorly. Further clinical and laboratory investigations were consistent with a diagnosis of sarcoidosis. Specifically, serum levels of angiotensin-converting enzyme (ACE) were elevated. The patient received treatment with corticosteroid and immunosuppressive, methotrexate and is presently asymptomatic. Breast involvement by sarcoidosis, although rare, should be considered when dealing with granulomatous lesions of the breast.

Partial Penectomy in a Horse with Paraphimosis

Background: In horses, an increase in the volume of penis and foreskin can be caused by trauma. The resultant edema interferes with the retraction of the penis and cause paraphimosis. Surgical intervention through penectomy is indicated in cases wherein an alternative treatment is not feasible. Partial penectomy can prolong the life and reproductive function of many stallions. The present study aims to report on the methodological, functional, and economic feasibility of a successful case of the use of Williams technique for partial penectomy performed in the field in a horse with paraphimosis, preserving urinary, productive, and reproductive functions.Case: A 10-year-old horse weighing 500 kg had clinical signs of paraphimosis due to the formation of granulomatous tissue following trauma to the glans region. A surgical intervention, namely a partial penectomy was decided to be performed to prevent injury from priapism. Due to the limited resources provided by the owner and the impossibility of moving the animal to a surgical center in a veterinary hospital, the procedure was performed in the field, with prior sanitization and preparation of the environment used to perform surgery. The horse was tranquilized with intravenous xylazine hydrochloride and acepromazine, with subsequent induction of anesthesia with ready-to-use (RTU) guaifenesin bolus and maintenance of anesthesia with an intravenous association of RTU guaifenesin, xylazine hydrochloride, and ketamine. The distal third of the penis was amputated using the recommended Williams technique. Although the complications like dehiscence and emergence of granulation tissue occurred after surgery, these were controlled in the daily follow-up of the animal and post-surgical treatment.Discussion:Paraphimosis predisposed the horse to abrasions and edema of the exposed portion of the penis. However, there was no urine retention, which suggested that the urethral ostium and the urethra had no lesions. Because the granulomatous lesions were located in the distal third of the penis and the extent of penile exposure was small, the partial penectomy technique proved effective in solving the permanent exposure of the penis. The anesthetic protocol used was inexpensive, easy to execute, and effective, and no anesthetic complications occurred, proving this protocol to be efficient for the anesthetic induction of animals in the field.In addition to being reliable and widespread, the Williams technique was recommended to prevent possible urethral stenosis and the development of contact dermatitis by urine. This technique makes a rapid recovery of the animal possible, with improvement of its physiological parameters, and due to ease of being able to be done in the field, it is also inexpensive. The edema and the granulation tissue that occurred after surgery were controlled with medication. In general, post-penectomy animals are not used for reproduction. This makes the present report an important contribution, because in cases in which the lesions present a distal disposition and the penile exposure is small, stallions have a chance of maintaining reproductive function after surgery, even with a long period of evolution before surgical treatment. This was demonstrated in the present case, as the animal in this case later impregnated a mare, with the pregnancy confirmed by ultrasound examination. Partial penectomy is a resolution technique for cases of traumatic paraphimosis, in which exuberant granulation tissue is formed in the distal third of the penis, with a long period of evolution. The surgery can be done in the field, with a low surgical cost to the owner, and a good productive and reproductive prognosis for the animal.Keywords: partial penectomy, paraphimosis, Williams technique, horse.Descritores: penectomia parcial, parafimose, técnica de William, equino.Título: Penectomia em equino com parafimose

Postoplasty in Nellore bull affected with acrobustitis: Case report

The objective of this work was to describe a case of acrobustitis, characterized by inflammation of the foreskin tip in bulls, causing infertility, reproductive and economic losses. It is considered as one of the main pathologies of the reproductive system of zebu bulls, given its anatomical and morphological characteristics. This study describes a case of acrobustitis diagnosed in a Nellore bull. In the clinical examination, an increase in volume and size in the foreskin was observed, with firm consistency on palpation with the formation of granulomatous tissue, stenosis of the preputial ostium, the tip of the penis turned tail, and with the impossibility of exposing the penis. Postoperative treatment was chosen, with partial amputation of the affected preputial portion. In the postoperative period cleaning the wound, shower with cold water, antibiotic therapy based on penicillin associated with Piroxicam, healing ointment, and Bactrovet Silver. Thus, the surgical procedure was successfully performed, obtaining a fast recovery of the animal, allowing it to return to reproductive life 60 days after the surgical procedure.