Reversible posterior leukoencephalopathy syndrome in a case of adult onset Still's disease with concurrent thrombotic thrombocytopenic purpura: response to high dose immunoglobulin infusions.

Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder characterized by a pentad consisting of thrombocytopenic, microangiopathic hemolytic anemia, renal dysfunction, neurological signs and fever. Coexistence of thrombotic thrombocytopenic purpura and Adult Onset Still's Disease (AOSD) is extremely rare. We report a case of 18 year old girl with AOSD who developed TTP. Neuroimaging of brain demonstrated white matter edema consistent with reversible posterior leukoencephalopathy syndrome (RPLS). Complete recovery occurred with prompt anti-hypertensive treatment and high dose immunoglobulin infusions (IVIg). Plasma exchange is the standard of care and the first line treatment for patient with TTP. We used IVIg alone in our case and this showed a gratifying response. Use of IVIG before considering plasmapharesis is justifiable or not requires randomized control clinical trials. This should determine the optimal therapeutic strategies for TTP.

Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis.

BACKGROUND: In our clinical setting, patients with perforative peritonitis are frequently malnourished. Immediate postoperative enteral feeding has been shown effective in reducing septic morbidity in patients with abdominal trauma. This study was designed to investigate the feasibility and efficacy of immediate postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis. STUDY DESIGN: A prospective study spanning 1 year was conducted on patients with nontraumatic intestinal perforation and peritonitis. After laparotomy, patients were assigned randomly to a control or study group. The study group underwent a feeding jejunostomy and received enteral feeding from 12 hours postoperatively. A low-residue, milk-based diet was used. All patients underwent assessment for severity of sepsis and nutritional status at admission. Studies of nutritional status and nitrogen balance were repeated on days 4 and 7. RESULTS: Forty-three patients (21 in the study group; 22 in the control group) were included. The two groups were comparable except for a higher sepsis score in the study group (p < 0.05). Patients in the study group achieved a positive nitrogen balance by the third postoperative day; patients in the control group remained in negative nitrogen balance throughout the study. Abdominal distention (four patients) required temporary withdrawal of feeding. Diarrhea occurred in four patients but was controlled easily. The mortality rate was similar in the control and study groups (18.2% versus 19.1%). The control group had a total of 22 septic complications, versus eight in the study group (p < 0.05). CONCLUSIONS: Immediate postoperative feeding is feasible in patients with perforative peritonitis and reduces septic morbidity.

Amino acid content in relation to growth of Helminthosporium maydis Nishikado and Miyake.

During the growth period of thirty days, altogether thirteen amino acids showed their presence and activity in the developing culture of Helminthosporium maydis Nishikado and Miyake. Initiation of growth by the 5th day coincided with the appearance of profuse amounts of dl-alanine and serine, and moderate amounts of valine, threonine, and aspartic acid. The thirteen amino acids, which appeared in full complement by the 15th day, were actively engaged in accelerating mycelial accumulation. Beyond this growth period, there was a decline in the amino acids.

Varying spectrum of amino acids in relation to growth in Helminthosporium oryzae Breda de Haan.

Fifteen amino acids were detected in the developing mycelium of Helminthosporium oryzae Breda de Haan. During the first fortnight of mat accumulation, which was more rapid, a marked influence of amino acids on the growth pattern was discernible. A high level maintenance of dl-alanine l-cysteine, l-leucine/isoleucine, threonine, tyrosine, glutamic, and aspartic acids, as well as an increase in the amount of gamma-aminobutyric acid and proline during the first fortnight of culture development were effective in initiating growth and keeping it at a more rapid pace. Glutamine and methionine appeared in the latter half of fungal growth. During this slow pace of mycelial accumulation in the latter half period, there was a general and overall decline in the amount of most of the amino acids. The amino acids started disappearing from the mycelial extract from the 20th day onwards till the end of the 30th day. In the culture filtrate, aspartic acid and proline appeared during the rapid growth phase and dl-alanine and methionine during the slower phase.

Fluctuation in amino-acid constituents of a developing culture of Sclerotium rolfsii Sacc. and its relation to growth.

Altogether eleven amino acids were detected in the mycelial extract of Sclerotium rolfsii Sacc. Here, with the appearance of aspartic acid and homoserine on the 5th day, growth was initiated. The maximum mycelial output, achieved by the 15th day, coincided with the detection of leucine/isoleucine and valine in the mycelial extract and of methionine in the culture filtrate. Lysine and gamma-amino-butyric acid which appeared late in the mycelium did not contribute to its growth. Tyrosine, an aromatic amino acid, was present only in the culture filtrate and not in the fungal extract. Aspartic acid, homoserine, and methionine were profusely produced in the culture filtrate during the decline of mycelial growth, suggesting that these amino acids could be fungal autolysis products as well.