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Humeroulnar synostosis: case report.

This is a report of a case of humeroulnar synostosis at the right elbow of a native Nigerian girl in whose family there is no history of genetic/hereditary diseases. This defect was not associated with any other deformity. This is a rare defect that has never been mentioned in literature. By excluding any causes, this case has been proved to be a failure of differentiation that is one of the major categories in the classification of congenital limb defects by Alfred B. Swanson.

Child, Preschool↗

Mature sacrococcygeal teratoma: a case report and literature review.

BACKGROUND: Sacrococcygeal teratomas are derived from embryonic germ cell layers. They present mostly in infancy and are extremely rare in adults; with an associated risk of malignancy. Modern imaging technique may be helpful to delineate the extent of the mass but surgical excision is generally indicated at the time of detection. PATIENTS AND METHODS: A case report is presented with a review of literature utilising MEDLINE, Microsoft Net and Yahoo search engines. RESULTS: A three day old female baby presented with a mature sacrococcygeal teratoma containing well-developed limb buds. She had surgical excision and primary repair with good results. A two-year follow up utilising serial serum alpha-fetoprotein assay and CT Scan revealed no evidence of tumour recurrence. CONCLUSION: Sacrococcygeal teratoma is a rare tumour that may be benign or malignant. Complete excision is the primary therapy and is adequate if the tumour is benign. Chemotherapy and radiotherapy are however indicated in malignant cases and in recurrence after previous excision.

Biopsy↗

A preliminary report of fine-needle aspiration biopsy in superficially accessible lesions in children.

BACKGROUND: Fine-Needle Aspiration Biopsy (FNAB) is a diagnostic technique which has achieved widespread use and acceptance. Its clinical use has continued to widen with the availability of more sophisticated methods of imaging. Its minimal invasiveness, cheap cost and easy application make it a technique of choice in investigating swellings even in children. AIMS AND OBJECTIVES: To investigate the reliability, safety and diagnostic value of FNAB in superficial masses including lymph nodes in children. PATIENTS AND METHODS: Superficial masses and lymph nodes of twenty consecutive children aged 2-13years were subjected to FNAB. Open biopsies were also performed on them to validate the FNAB. All specimens were subjected to examination by a cytopathologist and a histopathologist. RESULTS: Nine of the patients (45 %) had malignant diseases (lymphoma and osteosarcoma); seven had tuberculous lymphadenopathy while four had reactive lymphadenitis. Open biopsies corroborated these findings. There were no false-negative or false-positive cytology results from aspirates. There were no complications related to the procedures. CONCLUSION: Fine-needle aspiration biopsy is a reliable, safe, less invasive and relatively cheaper alternative method of establishing a pathologic diagnosis, compared to open biopsy, in children.

Adolescent↗

Plasma homocysteine and retinal artery occlusive disease: a case-control study.

BACKGROUND: Previous studies have documented that elevated plasma homocysteine is a risk factor for cardiovascular, cerebrovascular and peripheral vascular disease. In a case-control study, we sought to determine whether elevated homocysteine (HCY) is a risk factor for retinal artery occlusive disease PATIENTS AND METHODS. Study subjects consisted of 20 patients (12 male, 8 female) (mean age, 55.8; range 42-70 years) with clinical and objective evidence of retinal vascular occlusive disease and 20 age-matched control subjects (9 males, 11 females) (mean age, 55.3 years; range 50-68 years). Hyperhomocysteinemia was defined as a plasma HCY level >15 micromol/L by HPLC. We also measured concentrations of triglycerides, and total cholesterol, LDL cholesterol, and HDL cholesterol. RESULTS: The mean plasma HCY level in the patient group was 21.23+/-9.53 micromol/L (range, 8.00-43.99 micromol/L) compared with 12.59+/-4.97 micromol/L (range, 6.38 to 22.88 micromol/L) in the control group (P<0.008). There was no correlation between HCY and serum triglycerides or cholesterol levels within each group. We conclude that high plasma HCY level may be a risk factor for retinal artery occlusive disease.

Adult↗

The association of plasma homocysteine levels with serum leptin and apolipoprotein B levels in childhood obesity.

BACKGROUND: An elevated plasma total homocysteine (tHcy) level has recently been established as an independent risk factor for thrombosis and vascular disease. However, the relationship between hyperhomocysteinemia and cardiovascular disease and obesity remains controversial. The aim of the study was to investigate a possible relationship between plasma tHcy levels and measures of childhood obesity. SUBJECTS AND METHODS: Forty children and adolescents with exogenous obesity and 20 non-obese subjects in an age-and sex-matched control group were investigated. Fasting samples were collected for plasma tHcy, serum insulin, leptin, vitamin B12, folate, creatinine and lipid parameters. Anthropometric characteristics and body compositions were assessed in both groups. RESULTS: The obese patients had significantly higher tHcy levels than the non-obese controls (14.3+/-11.8 micromol/L vs 8.7+/-5.9 micromol/L; P=0.017). In both groups, plasma tHcy was positively related to serum leptin, but serum apolipoprotein B (apo B) levels were positively related to plasma tHcy levels only in obese patients. CONCLUSIONS: Our study demonstrates for the first time that leptin and apo B are main correlates of tHcy in obese children and adolescents and suggests that hyperleptinemia and increased apo B may contribute to impairment of tHcy metabolism in childhood obesity.

Adolescent↗

Ruptured false iliac artery aneurysm--a case report from Nigeria.

A 23 year old male Nigerian presented to the Nephrology unit of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with features of chronic renal failure secondary to chronic glomerulonephritis. He was referred to the surgical department of the hospital on account of severe torrential uncontrollable bleeding from an infected cannulation site. He was maintained on regular hemodialysis but developed femoral triangle sepsis at the cannulation site and aneurysm of the external iliac artery. The aneurysm later ruptured with severe jet exsanguinations bleeding. Exploration revealed a-4 cm rent in the external iliac artery that was sutured with 6/0 prolene, interrupted, using clamp and suture technique. Perfusion was satisfactory in the immediate post-operative period. The patient was transfused with 11 pints of blood within 12 hours and had an uneventful post-operative period.

Adult↗

A review of diagnosis and modes of presentation of tropical idiopathic lower limb gangrene.

BACKGROUND: Tropical idiopathic lower limb gangrene (TILLG) is also known as Symmetrical gangrene in the African, Idiopathic gangrene in the African and Idiopathic peripheral gangrene of the tropics. The aetiopathogenesis of this clinical entity is a mystery. OBJECTIVE: To review methods of diagnosing tropical idiopathic lower limb gangrene (TILLG) and highlight its clinical variants. METHOD: All Literature on idiopathic gangrene of the extremities was searched from libraries, colleagues and internet but only literature on TILLG (in Africans) from 1947 to date was scrutinised. Each case was studied to find out the basis of diagnosis. RESULT: TILLG is not fully understood and not easy to recognise. Two sets of criteria are known to be helpful in establishing diagnosis. These criteria can be classified as major and minor criteria. Major criteria are those clinical data that can establish the diagnosis of TILLG. No devices are required to identify them. Minor criteria are pathological changes that are consistent with TILLG. Devices are required to identify them. Three pathomorphological types of TILLG were described in literature and are classified as types A, B and C. CONCLUSIONS: This review is supposed to sensitise the clinician and make diagnosis easier. This will also encourage more researches. As more information becomes available, aetiopathogenesis of TILLG will be clearer and more clinical variants of the disease may be reported. This additional information will help in the prevention of gangrene, reducing the socioeconomic problems arising from amputation.

Africa↗

[The HLA-DR phenotype in Croatian children with gluten enteropathy].

Several studies of HLA and gluten enteropathy (GE) in European countries have found an association between this disease and certain DR phenotypes. However, no studies of DR phenotypes have been published in GE coming from Croatia. Therefore, we have studied HLA-A, B and DR specificities in 94 unrelated children with GE and in a group of healthy controls. In GE there was significant increase in the frequencies of A1 (61.70% v 24.50%; p < 0.0001) and B8 antigen (70.21% v 20.51%; p < 0.0001) compared with controls. The most frequent DR antigen was HLA-DR3 (87.23% v 18.82% in controls) with the relative risk of 29.65. The distribution of DR phenotypes in GE showed that the most frequent one was DR3/other DR (54.26%) and in decreasing order DR3/DR7 (17.02%), DR3/X (15.96%) and DR5/DR7 (8.51%). These phenotypes account for 95.75% of patients studied. A further 3.19% have DR4/DR5 phenotype. However, due to the frequency of certain antigen in controls, only phenotypes DR3/DR7 (relative risk: 28.92), DR3/X (relative risk: 13.29) and DR3/ other DR (relative risk: 10.04) were significantly associated with GE. The present study emphasizes the importance of studying the HLA-DR phenotypes in patients with GE.

Adolescent↗

Anorectal and perianal complications of hematologic malignant neoplasms.

Among 17 adults with hematologic malignant neoplasms in whom anorectal complications developed, the overall mortality was 53%; for those in whom the disease was not in remission the mortality was 69%, compared with zero for patients who were in remission. All but one of the deaths were directly attributable to septicemia secondary to the anorectal lesion. Over half of the patients had a history of previous anorectal problems or disordered bowel pattern preceding the anorectal complication. The anorectal lesions affecting these 17 patients included prolapsed hemorrhoids (in 5); discrete ulcers in the anal canal and surrounding cellulitis (8); necrosis of the anus and perianal area (2); and perirectal abscesses (2). Only the abscesses responded to surgical drainage. Treatment of the other lesions was conservative: bowel function was maintained as normal as possible, good perineal hygiene was practised and stool softeners were used, while efforts were directed towards achieving remission of the hematologic neoplastic disease.

Adult↗

The placenta in meconium staining: lesions and early neonatal outcome.

PURPOSE: To evaluate the immediate neonatal outcome and the presence of various placental lesions in 96 pregnancies with meconium-stained amniotic fluid. MATERIALS AND METHODS: The patients were divided into a group with acute (N = 41) and subacute and chronic (N = 55) meconium staining of the placenta. Apgar scores, arterial cord pH and admission to the neonatal intensive care unit (NICU) were determined in addition to the findings on gross and microscopic examination of the placentas. RESULTS: Of the 53 live births with subacute and chronic meconium staining, 13% had Apgar Scores < or = 7 at 5 minutes compared to 7% with acute meconium staining. Similarly, a significantly lower umbilical artery pH was determined in the former group [(32%) versus (7%)], (p < 0.01). When 9 different pathologic lesions of the placenta were evaluated microscopically, the frequency of villous vascular thrombosis (25.4%), infarcts (38%), acute chorioamnionitis (20%), villous edema (9.1%) and villitis (14.5%) was significantly higher in the group with longer meconium exposure compared to the other group (2.4%), (9.7%), (7.3%), (0%), and 1 (2.4%), respectively. In addition, when tested for 4 different lesions, cases with acute meconium were less likely to have one or more lesions. When one or more placental lesions were found, NICU admission rate was significantly higher in the patients with subacute and chronic meconium. CONCLUSION: Subacute and chronic meconium discharge is associated with significant placental lesions and an increased risk of adverse pregnancy outcome in the immediate neonatal period.

Acidosis↗