Aspergillus peritonitis in peritoneal dialysis: case report and a review of the literature

Aspergillus peritonitis is a rare complication of continuousambulatory peritoneal dialysis. The case is described of a 68-year-oldman in whom Aspergillus fumigatus was isolated from the peritonealdialysate after recurrent peritonitis with Gram-negative rodsin association with diverticulosis. Treatment consisting ofremoval of the catheter and intravenous administration of amphotericinB followed by oral itraconazole was successful. A review of the sparse literature (12 cases) displays uncertaintiesregarding diagnostic awareness, culture diagnosis, and therapeuticmanagement. Next to institution of appropriate antifungal therapy,early removal the peritoneal dialysis catheter is recommended,as delayed removal of the catheter appears to be associatedwith increased mortality and morbidity.     

Branching neurons in the cervical spinal cord: a retrograde fluorescent double-labeling study in the rat

Summary Branching neurons giving rise to ascending and descending collaterals were studied in the cervical spinal cord of the rat. After unilateral injection of two retrograde fluorescent tracers, i.e. DY.2HCl at T2 or more caudal levels and TB at C1 or more rostral levels, many DY-TB double-labeled neurons were found in C3 to C8. These neurons were located bilaterally throughout the spinal grey matter, as well as in the lateral spinal nucleus (LSN). However, no double-labeled neurons could be detected in the laminae I and II on either side. The double-labeled neurons must represent branching neurons giving rise to a collateral ascending to the rostral injection-site or above, and another collateral descending to the caudal injection-site or below. The descending collaterals were found to extend to various spinal levels, including the lumbosacral cord. However, most of them terminated at shorter distances from their parent cell bodies; thus 20% of the C3–C8 neurons projecting to C1 or above had a descending collateral reaching T2, 8% had a collateral reaching T9, and 3% a collateral reaching L2/L3. The ascending collaterals of the majority of the branching neurons passed into the most caudal part of the medulla oblongata, and about half of these collaterals reached the level of the rostral part of the inferior olive. In regard to the neurons located in the segments C5–C8, about 13% of those projecting to T2 or below distribute an ascending collateral restricted to C2–C4, while 29% of those had an ascending collateral to C1 or above.     

Listeria peritonitis in patients on peritoneal dialysis: two cases and a review of the literature

Two cases are reported of patients on continuous ambulatory peritoneal dialysis who presented with peritonitis caused by Listeria monocytogenes. They were successfully treated with intraperitoneal and intravenous administration of amoxicillin. In patients on peritoneal dialysis, Listeria monocytogenes is a very rare cause of peritonitis, with only 11 cases reported to date, and mainly occurring in immunocompromised patients. In contrast to the majority of the reported cases, neither of our patients had received immunosuppressive drugs. To our knowledge, these are the first two cases of Listeria peritonitis reported in the Netherlands.     

Spinocerebellar neurons and propriospinal neurons in the cervical spinal cord: a fluorescent double-labeling study in the rat and the cat

Summary In the cervical spinal cord of the rat and the cat, the distributions of spinocerebellar and of descending propriospinal neurons were investigated using the retrograde fluorescent double-labeling technique. Moreover, a search was made for the presence of neurons with both ascending spinocerebellar and descending propriospinal axoncollaterals. Diamidino Yellow Dihydrochloride (DY) was injected at T2, while True Blue (TB) (in rats) or Fast Blue (FB) (in cats) was injected in the cerebellum. The distributions of labeled neurons were very similar in the rat and the cat. DY-labeled propriospinal neurons, projecting to T2 or below, were most numerous in lamina I and laminae IV to VIII. In the rat, such neurons were also present in the lateral spinal nucleus (LSN). TB- or FB-labeled spinocerebellar neurons were concentrated in the central cervical nucleus (CCN) at C1-C4, in the central part of lamina VII at C5-T1, in the medial part of lamina VI and the adjoining dorsomedial part of lamina VII at C2/C3-T1, and in Clarke's column. They were also found in lamina V at C1 and C7-T1, and in lamina VIII at all levels. In both species only very few DYTB/FB double-labeled neurons, representing neurons with branching axons, were observed; in C1-T1, only about 0,5% of all TB/FB-labeled Spinocerebellar neurons and about 0,05% of all DY-labeled descending propriospinal neurons were double-labeled. The double-labeled neurons were all located centrally in lamina VII at C5-T1, but even in that area they constituted not more than 1,5% (rat) and 4% (cat) of the labeled spinocerebellar neurons. These findings indicate that, in the cervical cord of the rat and the cat, descending propriospinal neurons and spinocerebellar neurons are to a large extent separate populations.     

Outcomes for Patients With Acute Promyelocytic Leukemia in South Africa

BackgroundThe characteristics and outcomes of patients with acute promyelocytic leukemia (APL) from sub-Saharan Africa have not been published.Patients and MethodsWe report retrospectively on consecutively diagnosed APL patients treated in Cape Town, South Africa, during 1998-2019. A total of 69 patients were treated, of whom 27 (39%) were classified as having high risk APL.ResultsEarly death rates at 7 and 30 days were 7% and 13%, respectively, including 4 patients who died before any treatment could be administered. Overall survival at 3 years was 76.5% (95% confidence interval, 63.9-85.2) for the entire cohort, and 82.5% (95% confidence interval, 69.7-90.2) if patients who died within 7 days of diagnosis were excluded. For 13 patients (18.8%), there was a delay of 5 or more days from time of initial presentation at a peripheral hospital until arrival at the leukemia center and administration of all-trans retinoic acid; only 1 of these patients died within 30 days.ConclusionDespite the challenges faced in the public healthcare system of a developing country, outcomes of APL patients treated at our center are similar to outcomes from developed countries.     

Propriospinal neurons with ascending collaterals to the dorsal medulla,the thalamus and the tectum: a retrograde fluorescent double-labeling study of the cervical cord of the rat

Summary Branching neurons with descending propriospinal collaterals and ascending collaterals to the dorsal medulla, the thalamus and the tectum were studied in the rat's cervical spinal cord (C1–C8), using the retrograde fluorescent double-labeling technique: Diamidino Yellow Dihydrochloride (DY) was injected in the cord at T2, True Blue (TB) was injected in the brain stem. DY-labeled descending propriospinal neurons were present in all laminae, except lamina IX. They were concentrated in lamina I, laminae IV to VIII, and in the lateral spinal nucleus, LSN. TB-labeled neurons projecting to the dorsal medulla were concentrated in lamina IV and the medial parts of laminae V and VI (probably representing postsynaptic dorsal column — PSDC — neurons), but were also present in lamina I, the LSN, the lateral dorsal horn, and in laminae VII and VIII. DY-TB double-labeled neurons giving rise to both a descending propriospinal collateral and an ascending collateral to the dorsal medulla were intermingled with the TB single-labeled neurons. About 4% of the descending propriospinal neurons gave rise to an ascending collateral to the dorsal column nuclei; these double-labeled cells constitute a sizable fraction (10%) of the PSDC neurons. TB-labeled spinothalamic and spinotectal neurons were located in lamina I, the lateral cervical nucleus (LCN), the LSN, the lateral lamina V, lamina VII and VIII, lamina X and in the spinal extensions of the dorsal column nuclei, predominantly contralateral to the TB injections. DY-TB double-labeled neurons were present throughout C1–C8 in the LSN, lateral lamina V, lamina VIII, ventromedial lamina VII, and lamina X. Only very few were observed in lamina I and the LCN, and none in the spinal extensions of the dorsal column nuclei. The double-labeled neurons constituted only a minor fraction of all labeled neurons; 3–5% of the spinothalamic neurons and about 1–7% of the spinotectal neurons were double-labeled. Conversely, only about 1% of the labeled descending propriospinal neurons gave rise to an ascending spinothalamic collateral, and even fewer (0.1 to 0.6%) to a collateral to the dorsal midbrain. The LSN displayed the highest relative content of branching neurons. Up to 20% of its ascending spinothalamic and spinotectal neurons and up to 8% of its descending propriospinal neurons were found to be branching neurons, indicating that the LSN constitutes an unique cell-group in the rat spinal cord.     

Additional prognostic value of bone marrow histology in patients subclassified according to the International Prognostic Scoring System for myelodysplastic syndromes.

PURPOSE: The most recent and powerful prognostic instrument established for myelodysplastic syndromes (MDS) is the International Prognostic Scoring System (IPSS), which is primarily based on medullary blast cell count, number of cytopenias, and cytogenetics. Although this prognostic system has substantial predictive power in MDS, further refinement is necessary, especially as far as lower-risk patients are concerned. Histologic parameters, which have long proved to be associated with outcome, are promising candidates to improve the prognostic accuracy of the IPSS. Therefore, we assessed the additional predictive power of the presence of abnormally localized immature precursors (ALIPs) and CD34 immunoreactivity in bone marrow (BM) biopsies of MDS patients. PATIENTS AND METHODS: Cytogenetic, morphologic, and clinical data of 184 MDS patients, all from a single institution, were collected, with special emphasis on the determinants of the IPSS score. BM biopsies of 173 patients were analyzed for the presence of ALIP, and CD34 immunoreactivity was assessable in 119 patients. Forty-nine patients received intensive therapy. RESULTS: The presence of ALIP and CD34 immunoreactivity significantly improved the prognostic value of the IPSS, with respect to overall as well as leukemia-free survival, in particular within the lower-risk categories. In contrast to the IPSS, both histologic parameters also were predictive of outcome within the group of intensively treated MDS patients. CONCLUSION: Our data confirm the importance of histopathologic evaluation in MDS and indicate that determining the presence of ALIP and an increase in CD34 immunostaining in addition to the IPSS score could lead to an improved prognostic subcategorization of MDS patients.