- Email: [email protected]
Thrombotic thrombocytopenic purpura (T.T.P.) and systemic lupus erythematosus (S.L.E.)
ABSTRACTS OF A N ~ L J A L MEETING
1979 293
parenchyma, leaving only the capsule. and causes haemattiria and renal colic. Infection is acquired by cating poorly cooked lieshwater fish. After 1-3 yr the worm may die and disintegrate. Diagnosis may bc made by finding the eggs in the urine. Treatment is surgical.
THROMBOTIC THROMBOCYTOPENIC PURPURA (T.T.P.) AND SYSTEMIC LUPUS ERYTHEMATOSUS (S.L.E.)
f. Princr Alfred Ho.y)i)ital,k S ~ d n c , ~ 3 P. A. GATENBY & H. SMn'll C ' l i n i u l Imnrunolvgj~D e p u r t m ~ ~ nRo?d und Haemurology Departmen f . Royul Brrshun~Hospituf T.T.P. and S.L.E. are both multisystem diseases and the latter may manifest a wide range of haemopoietic abnormalities that may mimic T.T.P. This has led to diagnostic confusion and reports of the two diseases occurring in the one patient. We describe an illustrative case of a 15-yr-old girl who presented at the age of 12 with purpura, fever. headaches and changes in conscious state. She had thronibocytopenia, microangiopathic haemolytic anaemia. and despite the absence of renal disease T.T.P. was diagnosed. ANA and LE cells were negative then. and when repeated I yr later. In 1979 she presented again with the nephrotic syndrome with a positive ANA (1:lOO) and elevated DNA antibodies (79 Uiml, N i25). Platelet count was 270.000. PTTK 6 1 sec (N 2 5 4 0 ) and a circulating anticoagulant was present. Renal biopsy confirmed the presence of lupus nephritis. U p to 207,; of cases of T.T.P. have features of S.L.E. This case is presented to illustrate this overlap between the two entities, both of which are associated with immune complexes, and the possible diagnostic difficulties. SCLEROSING STROMAL TUMOURS OF THE OVARY
D. C. GEE& P. RUSSELL DepurlnJrnl of Gwuiwlogieul Hisroiputhologj~.King George ' L M r / ? ~ o r i u ~ Hvspirul,Sydney Four cases of sclerosing stromal tumour (S.S.T.)of the ovary were diagnosed during a review of all ( 168) ovarian stromal tumours seen at this hospital between 1950 and 1975. An additional case was recently referred for consultation. The tumours occurred predominantly in young women. One patient was postmenopausal. Two cases had clinical features suggestive of oestrogenic activity. The diagnostic histological features of a pseudolobular pattern produced by stromal oedema and sclerosis, and cellular areas of polyhedral and spindlecells were present in all cases. However, analysis of both histological patterns and clinical presentations in these 5 cases suggests that the entity of S.S.T. may not he as clearly circumscribed as has heen previously reported. HALOPHILIC VlBRlOS IN HUMAN TISSUE INFECTIONS
H. K. GHOSH& T. E. Bowm Buc/eriolo,g~~ Depurtnrrn/, The R o j d Nenwstli~ HoJpitcrl und Parhology Luhoratories.Wollo~7g:rm~ Ho.vpitul Vibrios that need 0.074.4 M Na + for growth in v i m ) are common in inshore sea waters. especially in the summer. Assimilation tests differentiate 11 species and a heterogenous group of the genus Benrc,keu, and 3 species of the genus Phoiohactrrium. One species, B. parahuemolyticus. has been implicated for some years in food-poisoning. This species and B. u/gino/yticus and the lactose-fermenting B. vu1n;ficu.y have been isolated from human tissue infections in the northern hemisphere, with a few cases in Australia. We isolated 16 strains of the 3 species from routine swabs orear and wound infections, pneumonia and salpingitis, identified them using the 'expanded' API 20E kit plus NaCl tolerance. The species were confirmed h) assimilation tests. THE ACTIVITY OF CEFOXlTlN IN VITRO AGAINST HOSPITAL PATHOGENS, AND IN VlVO IN SEPTICAEMIC PATIENTS
C. S. GOODWINDepurtmrnf Of' Microhiolox,:,. Rvyul Prrih Hospitul Cefoxitin is the first cephamycin antibiotic having a different structure to cephalosporin antibiotics. Cephamycins are remarkably resistant to all beta-lactamases, but some organisms including Pscudomofurs species are resistant to cefoxitin either because the antibiotic fails to penetrate the cell or because the site ofantibiotic activit) is insensitive
1979 293
parenchyma, leaving only the capsule. and causes haemattiria and renal colic. Infection is acquired by cating poorly cooked lieshwater fish. After 1-3 yr the worm may die and disintegrate. Diagnosis may bc made by finding the eggs in the urine. Treatment is surgical.
THROMBOTIC THROMBOCYTOPENIC PURPURA (T.T.P.) AND SYSTEMIC LUPUS ERYTHEMATOSUS (S.L.E.)
f. Princr Alfred Ho.y)i)ital,k S ~ d n c , ~ 3 P. A. GATENBY & H. SMn'll C ' l i n i u l Imnrunolvgj~D e p u r t m ~ ~ nRo?d und Haemurology Departmen f . Royul Brrshun~Hospituf T.T.P. and S.L.E. are both multisystem diseases and the latter may manifest a wide range of haemopoietic abnormalities that may mimic T.T.P. This has led to diagnostic confusion and reports of the two diseases occurring in the one patient. We describe an illustrative case of a 15-yr-old girl who presented at the age of 12 with purpura, fever. headaches and changes in conscious state. She had thronibocytopenia, microangiopathic haemolytic anaemia. and despite the absence of renal disease T.T.P. was diagnosed. ANA and LE cells were negative then. and when repeated I yr later. In 1979 she presented again with the nephrotic syndrome with a positive ANA (1:lOO) and elevated DNA antibodies (79 Uiml, N i25). Platelet count was 270.000. PTTK 6 1 sec (N 2 5 4 0 ) and a circulating anticoagulant was present. Renal biopsy confirmed the presence of lupus nephritis. U p to 207,; of cases of T.T.P. have features of S.L.E. This case is presented to illustrate this overlap between the two entities, both of which are associated with immune complexes, and the possible diagnostic difficulties. SCLEROSING STROMAL TUMOURS OF THE OVARY
D. C. GEE& P. RUSSELL DepurlnJrnl of Gwuiwlogieul Hisroiputhologj~.King George ' L M r / ? ~ o r i u ~ Hvspirul,Sydney Four cases of sclerosing stromal tumour (S.S.T.)of the ovary were diagnosed during a review of all ( 168) ovarian stromal tumours seen at this hospital between 1950 and 1975. An additional case was recently referred for consultation. The tumours occurred predominantly in young women. One patient was postmenopausal. Two cases had clinical features suggestive of oestrogenic activity. The diagnostic histological features of a pseudolobular pattern produced by stromal oedema and sclerosis, and cellular areas of polyhedral and spindlecells were present in all cases. However, analysis of both histological patterns and clinical presentations in these 5 cases suggests that the entity of S.S.T. may not he as clearly circumscribed as has heen previously reported. HALOPHILIC VlBRlOS IN HUMAN TISSUE INFECTIONS
H. K. GHOSH& T. E. Bowm Buc/eriolo,g~~ Depurtnrrn/, The R o j d Nenwstli~ HoJpitcrl und Parhology Luhoratories.Wollo~7g:rm~ Ho.vpitul Vibrios that need 0.074.4 M Na + for growth in v i m ) are common in inshore sea waters. especially in the summer. Assimilation tests differentiate 11 species and a heterogenous group of the genus Benrc,keu, and 3 species of the genus Phoiohactrrium. One species, B. parahuemolyticus. has been implicated for some years in food-poisoning. This species and B. u/gino/yticus and the lactose-fermenting B. vu1n;ficu.y have been isolated from human tissue infections in the northern hemisphere, with a few cases in Australia. We isolated 16 strains of the 3 species from routine swabs orear and wound infections, pneumonia and salpingitis, identified them using the 'expanded' API 20E kit plus NaCl tolerance. The species were confirmed h) assimilation tests. THE ACTIVITY OF CEFOXlTlN IN VITRO AGAINST HOSPITAL PATHOGENS, AND IN VlVO IN SEPTICAEMIC PATIENTS
C. S. GOODWINDepurtmrnf Of' Microhiolox,:,. Rvyul Prrih Hospitul Cefoxitin is the first cephamycin antibiotic having a different structure to cephalosporin antibiotics. Cephamycins are remarkably resistant to all beta-lactamases, but some organisms including Pscudomofurs species are resistant to cefoxitin either because the antibiotic fails to penetrate the cell or because the site ofantibiotic activit) is insensitive