Cytologic presentation of primary leptomeningeal sarcomatosis

The cytologic findings in the cerebrospinal fluid of a 25-year-old male who presented with a diffuse neurologic disease clinically diagnosed as meningoencephalitis are described. Primary leptomeningeal sarcomatosis was subsequently diagnosed at postmortem examination. The potential value of cerebrospinal fluid cytology as a primary diagnostic tool in this rare and unusual tumor is discussed.     

Primary Amoebic Meningoencephalitis Caused by Naegleria fowleri: An Old Enemy Presenting New Challenges

First discovered in 1899, Naegleria fowleri is a protist pathogen, known to infect the central nervous system and produce primary amoebic meningoencephalitis. The most distressing aspect is that the fatality rate has remained more than 95%, despite our advances in antimicrobial chemotherapy and supportive care. Although rare worldwide, most cases have been reported in the United States, Australia, and Europe (France). A large number of cases in developing countries go unnoticed. In particular, religious, recreational, and cultural practices such as ritual ablution and/or purifications, Ayurveda, and the use of neti pots for nasal irrigation can contribute to this devastating infection. With increasing water scarcity and public reliance on water storage, here we debate the need for increased awareness of primary amoebic meningoencephalitis and the associated risk factors, particularly in developing countries.     

Intralymphatic administration of antibiotics in the complex treatment of suppurative complications in patients with neurosurgical pathology

The efficacy of endolymphatic route of gentamicin and ceporin administration was studied in 89 patients with neurosurgical pathological processes complicated by acute pneumonia (80 patients) and meningoencephalitis (9 patients) usually after ineffective antibiotic therapy according to the routine methods. The antibiotics were used in accordance with the antibiograms of the causative agents isolated from the bronchial tree or CSF. The endolymphatic use of gentamicin or ceporin once a day in doses of 80 mg or 1 g respectively provided rapid sanation and arresting of the inflammatory foci, lowering of the intoxication level, more rapid promotion of the positive time course of the clinico-roentgenological and laboratory indices and decreasing of the recovery periods by 1.5-2 times in 86 per cent of the patients with pneumonia. The endolymphatic administration of gentamicin in a dose of 80 mg twice a day or ceporin in a dose of 1 g twice a day allowed one to maintain the antibiotic therapeutic levels in the cerebrospinal fluid and to obtain satisfactory clinical results in the combined treatment of meningoencephalitis. The endolymphatic administration of the drugs was well tolerated by the patients and no adverse reactions were observed. This route of administration of antibiotics and in particular broad spectrum antibiotics may be recommended for urgent antibacterial therapy of especially severe neurosurgical patients with pyo-inflammatory complications and patients who did not respond to the routine antibiotic therapy.     

Study of brain and vascular plexus gangliosides in meningoencephalitis of various etiology.

The content of brain and vascular plexus gangliosides and their composition have been studied in 15 cases of meningoencephalitis of various etiology and degree of disease. The most pronounced decrease of ganglioside concentration was found in brain of children, who died from herpes virus infection. Decrease of ganglioside content was revealed in brain grey matter of patients with influenza virus or meningococcus infection, but not in cases of mycoplasma infection. These data provide evidence of nerve cell destruction due to meningoencephalitis of various etiology. The biochemical data obtained are in good agreement with the results of the brain of children infection by herpes virus (increase of GD1b content in grey matter). Ganglioside content in vascular plexes of patients with meningoencephalitis was found to be, on the contrary, much higher (ca 4 times) than in the controls. The higher the lesion of choroid plexes in meningoencephalitis is, the higher the ganglioside content in them is.     

Tuberculous orchiepididymitis, meningoencephalitis and hydrocephalus

Tuberculous meningoencephalitis (TBM) is a rare and serious, often fatal presentation of active tuberculosis and account for about 1% of cases. Early diagnosis and prompt treatment of TBM is essential to reduce morbidity and mortality. Here, we report a case of TBM in 60-year-old man. TBM was considered on the basis of clinical presentation, laboratory findings (hyponatraemia), cerebrospinal fluid studies, radiological findings (hydrocephalus on multi-slice computed tomography), and history of orchiepididymitis of unknown origin one year earlier, together with information that the patient originated from Kosovo where incidence of tuberculosis is still high. Mycobacterium tuberculosis was cultured from cerebrospinal fluid on Lowenstein-Jensen medium confirming diagnosis of TBM. Subsequently, acid-fast bacilli (AFB) staining on samples obtained after orchiectomy a year ago was performed, revealing AFB. Anti-tuberculosis therapy is still in course. This is the second case of tuberculous meningoencephalitis with the same disease pattern (i.e. tuberculous orchiepididymitis - meningoencephalitis) in our Department, and this fact was crucial for the presumptive diagnosis and urgent treatment of TBM. The former case was described five years ago.     

Floral structure, breeding system and fruit-set in the threatened sub-shrub Tetratheca juncea Smith (Tremandraceae)

Tetratheca juncea Smith (Tremandraceae) has undergone a range contraction of approx. 50 km in the last 100 years and is now listed as a vulnerable sub-shrub restricted to the central and north coast regions of New South Wales, Australia. There are approx. 250 populations in a 110 km north-south distribution and populations are usually small with fewer than 50 plants/clumps. The reproductive ecology of the species was studied to determine why seed-set is reportedly rare. Flowers are bisexual, odourless and nectarless. Flowers are presented dependentally and there are eight stamens recurved around the pistil. Anthers are poricidal, contain viable pollen and basally contain a deep-red tapetal fluid that is slightly oily. Thus flowers are presented for buzz pollinators, although none were observed at flowers during our study. The species was found to be facultatively xenogamous with only one in 50 glasshouse flowers setting seed autogamously, i.e. without pollinator assistance. Field studies revealed fertile fruit in 24 populations but production varied significantly across sites from exceedingly low (0.6 fruits per plant clump) to low (17 fruits per plant clump). Fruit-set ranged from 0 to 65 %, suggesting that pollen vectors exist or that autogamy levels in the field are variable and higher than glasshouse results. Fruit production did not vary with population size, although in three of the five populations in the south-west region more than twice as much fruit was produced as in populations elsewhere. A moderately strong relationship between foliage volume and fruit : flower ratios suggests that bigger plants may be more attractive than smaller plants to pollinators. A review of Tetratheca pollination ecology revealed that several species are poorly fecund and pollinators are rare. The habitat requirements for Tetratheca, a genus of many rare and threatened species, is discussed.     

Severe course of Lyme neuroborreliosis in an HIV-1 positive patient; case report and review of the literature

Background  

Lyme Neuroborreliosis (LNB) in a human immunodeficiency virus (HIV) positive patient is a rare co-infection and has only been reported four times in literature. No case of an HIV patient with a meningoencephalitis due to LNB in combination with HIV has been described to date.     

Descriptive epidemiology of Kaposi sarcoma in Europe. Report from the RARECARE project

Kaposi sarcoma (KS) is a virus-related malignancy which most frequently arises in skin, though visceral sites can also be involved. Infection with Kaposi sarcoma herpes virus (KSHV or HHV-8) is required for development of KS. Nowadays, most cases worldwide occur in persons who are immunosuppressed, usually because of HIV infection or as a result of therapy to combat rejection of a transplanted organ, but classic Kaposi sarcoma is predominantly a disease of the elderly without apparent immunosuppression. We analyzed 2667 KS incident cases diagnosed during 1995–2002 and registered by 75 population-based European cancer registries contributing to the RARECARE project. Total crude and age-standardized incidence rate was 0.3 per 100,000 per year with an estimated 1642 new cases per year in the EU27 countries. Age-standardized incidence rate was 0.8 per 100,000 in Southern Europe but below 0.3 per 100,000 in all other regions. The elevated rate in southern Europe was attributable to a combination of classic Kaposi sarcoma in some Mediterranean countries and the relatively high incidence of AIDS in several countries. Five-year relative survival for 2000–2002 by the period method was 75%. More than 10,000 persons were estimated to be alive in Europe at the beginning of 2008 with a past diagnosis of KS. The aetiological link with suppressed immunity means that many people alive following diagnosis of KS suffer comorbidity from a pre-existing condition. While KS is a rare cancer, it has a relatively good prognosis and so the number of people affected by it is quite large. Thus it provides a notable example of the importance of networking in diagnosis, therapy and research for rare cancers.     

Behandlungs- und Forschungszentrum für Seltene Erkrankungen Tübingen

The first German national treatment and research center for patients with rare disease has been opened in Tübingen. A disease is considered “rare” when it averagely affects less than one in 2000 persons. Approximately 3 million patients live with rare diseases in Germany. According to current knowledge, up to 80% of rare diseases have at least some genetic association. Thus the care of these patients is particularly challenging for human geneticists. The majority of rare diseases are complex disorders affecting more than one organ system. This requires intensive interdisciplinary treatment, which can usually only be provided in university clinics.     

稀有鮈鲫的繁殖生物学

根据野外调查与室内养殖的结果,稀有鮈鲫的繁殖季节为3—11月,在人工控制条件下可周年繁殖。在适宜的水温和充足的饵料条件下孵出后4个月左右即可达性成熟并产卵。对7对鱼共136批次产卵进行了观察统计,平均每尾雌鱼5.4d产卵一次,平均每次产卵300.3粒。根据卵母细胞发育进程、卵径分布、产卵频次以及年产卵量大于怀卵量、含卵量等特征,建议将稀有鮈鲫的特殊产卵类型命名为连续产卵类型,并与生态学上常用的“多次产卵”、“分批产卵”加以区别。最后就稀有鲍鲫作为一种新的实验鱼等应用前景作了展望。       

Spatial distribution of rare species: statistical approach

Many species are locally rare (have low occurrences in a given region). The method is proposed for the analysis of spatial distribution of such species. The procedure is based on the comparison of actual mean distances between records with Monte-Carlo-simulated mean distances expected for random occurrence pattern. The method was applied to two datasets: benthic macrofauna from the Barents and Kara Seas (Kucheruk, Kotov, 2002) and the Black Sea interstitial ciliates (original data). For both datasets, the number of rare species positively correlates with number of common species per site and with the total number of species. Furthermore (and irrespectively of total diversity pattern), rare species usually were locally clumped in their distribution: each of the species was mostly found at sites that were close together. This tendency, however, was significant for the macrofauna species but not for ciliates.     

重症单核细胞增多性李斯特菌脑膜脑炎1例

李斯特菌脑膜脑炎是单核细胞增多性李斯特菌(LM)引起的细菌性脑膜脑炎,通常发生于免疫功能低下者.LM是人畜共患致病菌,通过污染的食物传播.欧美国家报道较多,国内报道较少.李斯特菌脑膜脑炎病死率高,临床表现与其他细菌性脑膜炎类似.脑脊液检查与结核性脑膜炎亦难鉴别,确诊依赖于脑脊液涂片及培养.本文报道1例重症李斯特菌脑膜脑...     

Recommended Criteria for Cardiac Catheterization in Patients with Aortic Valve Disease

Criteria for selection of patients with aortic valve disease for cardiac catheterization are described, based on a study of 81 cases. Children with aortic stenosis warrant catheterization at the time when the clinical diagnosis is made, but in adults this examination may be deferred until symptoms appear or left ventricular hypertrophy is recognized. In patients with pure aortic insufficiency catheterization may be deferred until symptoms appear. When severe stenosis and insufficiency co-exist, the valve is usually heavily calcified. Thirty-seven per cent of patients with aortic valve disease have co-existing mitral lesions and these patients are usually women, are fibrillating and, as a rule, have atrial enlargement in contrast to those with aortic valve disease only. On rare occasions, patients with mitral valve disease have clinically silent but angiographically demonstrable aortic insufficiency; therefore, aortography should precede open-heart correction of a mitral lesion so as to detect minor degrees of aortic insufficiency.     

Epidemiologic features of an intracranial abscessation/suppurative meningoencephalitis complex in white-tailed deer

Case records of 683 white-tailed deer (Odocoileus virginianus) submitted to the Southeastern Cooperative Wildlife Disease Study (Georgia, USA) for diagnostic purposes from 1971 to 1989 were reviewed for the occurrence of pyogenic infections of the central nervous system, specifically intracranial abscessation or suppurative meningoencephalitis. These conditions, either alone or in combination, were diagnosed in 24 of 683 (4%) deer. Thirteen genera of bacteria were isolated; the most frequent species was Actinomyces pyogenes. The disease was strongly sex biased (P less than 0.01); 88% of the cases occurred in males. Cases were more prevalent (P less than 0.05) in older bucks; the median age of infected bucks was 3.2 yr, and 71% of these were greater than or equal to 2.5-yr-old. Intracranial abscessation/suppurative meningoencephalitis cases accounted for 20% of the diagnoses among 56 bucks greater than or equal to 3-yr-old. Cases were seasonal, occurring only from October to April. Characteristic necrosis, erosion, and pitting of skull bones were common, and this bone damage may be useful in determining cause of death when only skeletal remains are found. Males, especially older bucks, apparently are predisposed to intracranial abscessation/suppurative meningoencephalitis because of the cycle of antler development and behavioral traits associated with reproduction. The strong bias toward prime age bucks suggests that these infections could specifically hinder management strategies designed to produce populations with older buck age structures.     

Reappraisal of the pore channel system in the grooved pegs of Aedes aegypti

Pore channels occur along the grooves of lactic acid-receptive grooved pegs on the antennae of female Aedes aegypti. There are about 38 pore openings per groove or about 456 per peg. This finding is in conflict with the previous report that pore channels were extremely rare. The pore channels are of a similar electron density to the cuticle of the peg, making them difficult to see. For this reason many of the pore channels were probably overlooked in the previous study. We could not find a terminal pore in the grooved peg as has been reported. Scanning electron microscopy and negative staining of the pegs revealed a tip of variable shape, usually without a pore. It is possible that 'edge effect' (more secondary electrons escape from edges of objects, making them appear brighter than central regions) leads to an apparent terminal pore. Occasionally pegs have a number of small (20-40 nm) pores in the tip region and these might also have been misinterpreted as a terminal pore. Pore channels appear to be the primary means of entry for air-borne stimuli in these grooved pegs.     

Naegleria fowleri infection acquired by mice through swimming in amebae-contaminated water

Groups of mice were placed in water containing from 10(2) to 10(6) Naegleria fowleri amebae per ml and allowed to swim for 2.5 to 20 min. Mouse mortality ranged from 0 to 70% and was dependent upon the concentration of amebae per ml and the length of swimming exposure. That swimming mice can develop fatal naeglerial infection further confirms the mouse model for studying experimental primary amebic meningoencephalitis.     

An experimental model for Naegleria fowleri-induced primary amebic meningoencephalitis in rabbits

A new model was developed in rabbits for primary amebic meningoencephalitis, a rare disease caused by the free-living ameba, Naegleria fowleri. Naegleria fowleri was cultured in a liquid axenic medium, and then injected intracisternally into New Zealand White rabbits. Inocula of 10(3) or 10(5) trophozoites consistently produced a sanguinopurulent meningitis; duration of survival of rabbits was 57 or 45 hr, respectively. Counts of cells in cerebrospinal fluid were proportional to the size of inoculum used; white blood cell counts ranged from 30 to 1,055 cells/mm3, and red blood cell counts from five to 8,640 cells/mm3. Necropsies revealed severe basilar meningoencephalitis with extensive hemorrhagic necrosis and polymorphonuclear cell infiltration. Trophozoites of N. fowleri were seen within the meningeal exudate and the brain parenchyma. Potential applications of this model include studies of the host response to amebae in the CSF, evaluation of the optimal route of administration of amphotericin B, and in vivo studies of other chemotherapeutic agents that show in vitro efficacy.     

Microevolution in an electronic microcosm

The evolution of microbial populations in simple environments such as chemostats is still not fully understood. The classical interpretation of adaptation involves a process of successive substitution whereby a new dominant genotype arises by mutation from the genotype previously dominant and spreads more or less rapidly through the population until it is nearly fixed. The population is, thus, nearly uniform most of the time. Some observations suggest that the process may be more complicated, but it remains formidably difficult to assemble the phylogeny of an evolving culture in sufficient detail to be sure. We report experiments with an electronic microcosm inhabited by self-replicating computer programs whose phylogeny can be rendered completely transparent. The physiology of these programs is different in many respects from that of organic creatures, but their population biology has many features in common, including a very extensive, if not unbounded, range of variation. Experimental populations evolved through point mutations (many of which were quasi-neutral when they were viable) and through rearrangements that led to a change in genome size and often had large effects on fitness. As a general rule, smaller genomes execute fewer instructions in order to replicate, the rate of replication increases as the number of instructions executed declines, and the rate of replication in pure culture is a good predictor of success in mixture. When cultured with CPU (central processing unit) time as the sole limiting resource, smaller genomes, therefore, evolve as a correlated response to natural selection for faster replication. The genetic basis of adaptation was highly contingent and always differed in replicate experiments. The pattern of evolution depends on mutation rate. At low mutation rates of 0.01 per genome per generation or less, we observed classic periodic selection, with each dominant genotype descending from the previous dominant and rising to a frequency of 0.8 or more. At higher mutation rates of about 0.1 per genome per generation, the most abundant genotypes rarely exceeded a frequency of about 0.4, and rare genotypes present in a few copies comprised a large part of the population. New dominant genotypes did not usually descend directly from previous dominants but, instead, from one of the many rare or moderately abundant genotypes. We suggest that the conventional chemostat paradigm may hold only as a special case at very low mutation rates and that the dynamics and diversity of evolving populations, even in the simplest conditions, may be more complex than is usually recognized. Artificial genetic autoadaptive systems are likely to be useful in constructing theory for situations that lie beyond the boundary of conventional population genetics.     

SYSTEMIC TOXIC REACTIONS TO LOCAL ANESTHETICS

The topical use of anesthetic agents involves an element of risk. Systemic toxic reactions are rare, but they do occur and may result in death. When a reaction occurs from a topical application, it usually progresses rapidly to respiratory and cardiovascular collapse, and thus therapy must be instituted with more haste to avoid deaths. Fatal systemic toxic reactions from topically administered anesthetic drugs are, in effect, usually not due to well informed use of the drug but to misuse owing to less than complete understanding of absorption.Emphasis is placed on the causes, prophylaxis and treatment of severe systemic toxic reactions which follow the topical application of local anesthetic drugs. If systemic toxic reactions resulting from a safe dose of a local anesthetic agent are correctly treated, there will usually follow an uneventful recovery rather than a catastrophe.     

Epiphytic lichens on Juniperus communis – an unexplored component of biodiversity in threatened alvar grassland

Semi‐natural grasslands, among them thin‐soil calcareous grasslands (alvars), have great conservation value but have become increasingly rare in Europe. The main threat to alvar grasslands is the encroachment by juniper Juniperus communis and therefore it is usually removed during the restoration practice. Juniper can also be a host plant for many epiphytic lichens, but its role as a phorophyte is poorly known. We studied epiphytic lichen diversity on 126 junipers in 17 sites in western Estonia and found 140 lichenized taxa including several rare and red‐listed species. Using indirect and direct multivariate analyses (DCA, pCCA) and general linear models we revealed that both habitat and phorophyte properties affect lichen assemblies on juniper. Lichen species richness per site showed a unimodal relationship with compound factors of site productivity and juniper characteristics (stem circumference and juniper width). Lichen species richness per phorophyte was increasing with its size and with the proportion of dead branches, and was twice higher in plate alvars than in ryhk alvars. Also, the species composition in plate alvars differed from ryhk alvars by having 42 characteristic lichen species in plate alvars vs three indicators of ryhk alvars. The composition of lichens was significantly influenced by encroachment of alvars, e.g. by high juniper cover and shrub layer height, as well as by the proportion of dead branches and stem circumference of juniper. We conclude that the epiphytic lichen assemblies on junipers are threatened by grassland encroachment similarly to ground layer lichen assemblies. We suggest that some old and scencent junipers should be preserved during the restoration of alvar grasslands.