First report of Escherichia coli co-producing NDM-1 and OXA-232

Recently Gram-negative bacteria co-producing multiple carbapenemases have emerged in different parts of the world. We report the first isolation of an Escherichia coli strain co-producing the carbapenemases NDM-1 and OXA-232.

[Myelodysplastic syndromes (MDS). Aspects of hematopathologic diagnosis]

Myelodysplastic syndromes (MDS) are a heterogenous group of clonal stem cell disorders which generally occur in older adults but may also affect children. Primary MDS should be distinguished from secondary MDS associated with antineoplastic or immunosuppressive therapy (t-MDS), exposure to toxic compounds, or genetic disorders. The establishment of a neoplastic clone is reflected by dysplastic features and impaired function which may affect all three hematopoietic cell lineages. The ineffective hematopoiesis which causes bone marrow failure is accompanied by peripheral blood cytopenia and is considered to result from increased apoptosis, at least in the less advanced MDS stages. The elucidation of the molecular pathogenesis of MDS has provided evidence that chromosomal abnormalities are present in about 50% of patients with primary MDS. They include numerical aberrations such as monosomy 5 or 7, trisomy 8, loss of the Y-chromosome and structural abnormalities such as deletion of the long arm of chromosome 5 (5q-syndrome), 7, or 8. Based on the percentage of blasts (<5%, 5-20%, 20-30%) and the presence of >15% ringed sideroblasts for marrows with <5% blasts, the French-American-British (FAB) classifies MDS into 4 morphologic categories: refractory anemia (RA), refractory anemia with excess of blasts (RAEB), refractory anemia with excess of blasts in transformation (RAEB-t), and refractory anemia with ringed sideroblasts. The fifth morphologic type is chronic myelomonocytic leukemia characterized by peripheral blood monocytosis (>1x10(9)/l). However, a modification of this classification will be proposed by the World Health Organization, with the intention of lowering the threshold for the diagnosis of AML from 30% to 20% blast cells. In patients presenting with cytopenias suggesting impaired hematopoiesis, the initial diagnosis depends mainly on the cytological evaluation of bone marrow and blood smears and the histological findings of trephine bone marrow biopsy. In a retrospective analysis we evaluated the occurrence of the distinct FAB-categories as percentage of the total number of MDS cases diagnosed at the Institute of Pathology of the University of Freiburg. A total of 63% fullfilled the criteria of RA/RARS, 17% of RAEB, 14% of RAEB-t, and 6% of CMML. A fibrotic variant of MDS was observed in 7.67% of all cases, ranging from 2.34% in RA up to 15. 42-15.84% in the categories which did not show significant differences with regard to myelofibrosis. The histologic evaluation of a trephine bone marrow biopsy is of critical importance for the evaluation of fibrotic or hypocellular MDS since these patterns are not reflected by the cytological examination. The combined cytological and histological diagnosis of bone marrow and peripheral blood is a reliable tool for the initial diagnosis of MDS. In addition, cytogenetic and molecular analysis should be performed. Presently, the risk of leukemic transformation is evaluated using the International Prognostic Scoring System for MDS, which is the sum of the scores of bone marrow blasts, karyotypes and cytopenia. In the context of clinical trials therapeutic modalities should be considerd according to the age and the general performance state and the prognostic scores of individual patients.

[Percutaneous ultrasonic-guided nephropyelostomy in tumor-caused block of urinary outflow]

A report is given on the method and results of ultrasound-guided nephropyelostomy which has been performed here for several years without open surgical intervention. The method has a low rate of complications and can be applied in severely ill patients, too. The problems of ureteral obstruction are quickly eliminated, even if the tumor has not been removed by chemotherapy, radiotherapy, or surgery. The authors report on 47 interventions performed in 36 patients.

[Complications of percutaneous nephropyelostomy with special reference to the sonographic real-time puncture technic]

99 ultrasonographically-guided percutaneous nephropyelostomies (PNP) were done in 77 patients. Average age at operation was 60 years, most often PNP was done in cancer patients. In 26 cases compound-scanning technique and in 73 cases real-time technique was used. Real-time ultrasound imaging of the kidney is superior to compound-scan technique and allows dynamical imaging of percutaneously introduced canulas. Thus guidance of puncture technique and security of reaching the calix system have been optimized. Correct placement of nephrostomy catheter was achieved in 88.5% using compound-scanning technique compared to 92% using real-time ultrasonography. Moreover puncture of the calix system by needle was successful in every case using real-time ultrasonography. Complication rate was 2%. In one patient the calix system was perforated and one with macrohematuria required open surgery. Real-time ultrasound technique enables us to perform controlled percutaneous nephropyelostomy easily without hazardous complications.

Transgluteal sonography. A new approach to the posterior pelvic compartment

Ten patients with presacral tumors proved by histologic and computed-tomographic investigations underwent ultrasound scanning. The sound beam was directed through the ischial foramen along longitudinal, transverse, and oblique planes. Nine of 10 tumors localized in the sacral fossa were identified sonographically. In six of 10 instances, tumor demarcation was possible. Sonographic evaluation was impaired because of distance between the transducer and the target due to a patient's large volume and by the cranial location of the tumor. The transgluteal approach is suggested for sonographically guided percutaneous biopsy.

Percutaneous nephropyelostomy under continuous real-time ultrasound guidance

Fifty-five percutaneous nephrostomies in 40 patients under ultrasound guidance are reported. Twenty-six procedures were performed using a compound scanner and 29 were performed under real-time guidance. Fifty of the 55 procedures were successful. The puncture modalities of both techniques are compared and it was concluded that only real-time guidance permits the continuous two-dimensional visual control of the procedure. It is, therefore, the safer and more precise technique for establishing a percutaneous nephrostomy.