Routine use of mupirocin at the peritoneal catheter exit site and mupirocin resistance: still low after 7 years.

OBJECTIVE: The purpose of this study (the third in a series of similar studies) is to evaluate the prevalence of Staphylococcus aureus (SA), methicillin-resistant SA (MRSA) and mupirocin-resistant SA (MuRSA) carriers in a peritoneal dialysis centre where patients have been instructed to use prophylactic mupirocin ointment at the catheter exit site over the last 7 years. METHODS: Swabs were taken from catheter exit site, nares, axillae and groin in 147 chronic peritoneal dialysis out-patients between November 2003 and January 2004. Axillae/groin and nasal samples were pooled and cultured in the same medium, whereas exit site swabs were cultured separately. All SA isolated were tested for methicillin and mupirocin resistance using oxacillin screening plates and E-test strips. RESULTS: Sixteen of 147 patients (10.9%) were found to be SA carriers: of these 13 (8.8%) had a positive nasal/axillae/groin culture; two (1.4%) had both nasal/axillae/groin- and exit site-positive culture; and one (0.7%) had only exit site-positive culture. In these 16 SA carriers, we found mupirocin-resistant strains (MuRSA) in four patients (25%) and MRSA in two patients (12.5%). Among the four MuRSA carriers, one had both nasal/axillae/groin- and exit site-positive culture and three had only nasal/axillae/groin-positive culture. Three high-level resistance and one low-level resistance MuRSA carriers were isolated. One MuRSA strain was also methicillin resistant. All MRSA strains were sensitive to vancomycin and rifampicin. CONCLUSION: After 7 years' routine use of prophylactic mupirocin ointment at the catheter exit site in non-selected chronic peritoneal dialysis patients, MuRSA was found in 25% of SA strains isolated or in 2.7% of the patients. Compared with our previous study, 3 years earlier, there is no significant increase in the MuRSA prevalence in peritoneal dialysis patients who routinely apply mupirocin ointment at the catheter exit site.     

Genetics: Familial blepharophimosis with ovarian dysfunction

Three cases including two sisters and one brother with blepharophimosisare described. Their father also had blepharophimosis. Moreover,the elder sister initially presented with resistant ovary syndromeand thereafter true premature menopause, while the younger onepresented with resistant ovary syndrome. The explanation forthe association of blepharophimosis with primary ovarian dysfunctionis unknown, but the possibility of a microdeletion of geneticmaterial containing two geographically associated, but independentgenes could not be confirmed or excluded. All families affectedby blepharophimosis should be counselled about the high incidenceof ovarian dysfunction and female infertility, at least in oneform of the syndrome.     

Spontaneous perirenal hemorrhage: A 10-year experience at our institution

Objective: To report our experience in patients with spontaneous perirenal hemorrhage (SPH) seen at our institution over a 10-year period. Material and patients: Over the years from 1992 to 2002, 13 patients with SPH without a history of trauma, were treated at our hospital. There were 5 male and 8 female patients with a mean age of 55.7 years (range 36–79 years). The patients' records were reviewed retrospectively with respect to etiology, clinical presentation, radiologic findings and therapeutic management of SPH. Results: All patients were presented with flank or abdominal pain. Radiological evaluation included ultrasonography (U/S) in 7 cases and computed tomography (CT) in 13 cases. An underlying renal mass was indentified employing U/S in 2 cases and using CT in 10 cases respectively. The etiology of SPH was determined in 12 cases. The most common causes were angiomyolipoma (5 patients) and renal cell carcinoma (4 patients). Out of the remaining 4 cases with SPH, one was associated with anticoagulant therapy; polyarteritis nodosa and Wegener angeitis were the underlying diseases in 2 cases respectively; finally, the etiology could not be determined in 1 case. All but two patients were managed surgically. Complete nephrectomy was performed in 6 cases, partial nephrectomy in 4 and simple evacuation of the haematoma was performed in 1 case. Conclusions: SPH presence should arouse suspicions concerning its etiology, since the most common cause is a renal tumor and approximately 50% of such tumors are malignant. CT scanning is a useful imaging modality for the initial evaluation of SPH, permitting identification of the underlying cause in most instances. This revised version was published online in August 2006 with corrections to the Cover Date.     

Localization of molluscan R15α2 peptide immunoreactivity in the mammalian brain

The R15 neuropeptides have been identified in the marine molluscAplysia californica. They compose a new family of neuropeptides acting on the cardiovascular, digestive, respiratory, reproductive and nervous system. In this report we show that one of the members of the R15 neuropeptide family, the α2 peptide is conserved in lower mammals. We have identified R15α2 immunoreactive neurons in the neurosecretory cell groups of the hypothalamus and in the brainstem of the hedgehog (Erinaceus europaeus). The majority of labeled cells were localized to the anterior periventricular part of the paraventricular nucleus and the accessory neurosecretory cell groups in the lateral hypothalamus as well as to the dorsal part of the nucleus tractus solitarii. In the paraventricular nucleus, R15α2 immunoreactive neurons also exhibit immunoreactivity for oxytocin, cortocotropin releasing factor, vasoactive intestinal polypeptide and for the FMRFamide-related peptide which we found to be conserved in the hedgehog brain as well. No complete colocalization of R15α2 with any of the neuroactive substances tested, is observed. The highest degree of coexistence occurs with FMRFamide-related peptide, followed by vasoactive intestinal polypeptide, oxytocin and corticotropin releasing factor.     

Retinal projections in the hedgehog (Erinaceus europaeus). An autoradiographic and horseradish peroxidase study

Summary The retinal projections of the hedgehog were studied using tritiated leucine and horseradish peroxidase as orthograde tracers. In both series of experiments labeling was seen bilaterally in the suprachiasmatic nucleus, the dorsal and the ventral lateral geniculate nucleus, the superior colliculus, and the pretectal area and contralaterally in the terminal nuclei (dorsal, lateral and medial) of the accessory optic system. A retino-intergeniculate leaflet projection is described for the first time in this species, and its significance is discussed.