Neonatal cholestasis and hypopituitarism

The diagnosis of optic nerve hypoplasia and hypopituitarism must be entertained in infants who present for evaluation of cholestatic jaundice, particularly if there is associated hypoglycaemia and wandering nystagmus. Although the hepatic dysfunction seems to resolve, the long term prognosis of liver disease in optic nerve hypoplasia remains unknown.     

Anti B cell targeted immunotherapy for treatment of refractory autoimmune haemolytic anaemia in a young infant

We report the case of an 8 week old infant with fulminant autoimmune haemolytic anaemia refractory to conventional immunomodulating treatment. Massive haemolysis resulted in cardiac decompensation and acute renal failure which necessitated mechanical ventilation and peritoneal dialysis. Rituximab, a chimeric anti-CD20 monoclonal antibody, halted progression of the haemolytic process, but the patient died of acute viral pneumonia and disseminated fungal infection. Earlier introduction of rituximab might have prevented the renal complications. Paediatricians should be aware of this useful therapeutic tool for treatment of refractory autoimmune haemolytic anaemia and balance its use against the risk of potential life threatening infection.     

Relationship between Myopia and Optical Components - A Study among Chinese Hong Kong Student Population

Purpose: To establish the prevalence and severity of myopia among the Chinese Hong Kong students and to study the relationship between myopia and optical components.Methods;One thousand and seventy-five freshmen of the 1993-1994 academic year in the Chinese University of Hong Kong underwent the eye examination including evaluation of refractive error, keratometry, and A-scan ultrasonic biometry. The data were analyzed with the SPSS/PC 4. 01 statistical package. Results: The prevalence of myopia was 91. 7% with the mean refraction being -4. 00 ± 2. 64D in this young adult population. The statistical analyses demonstrated a significant correlation between refractive value and axial length of the globe (r=-0. 78), vitreous length (r=-0. 76), anterior chamber depth (r=-0. 33), lens thickness (r = 0. 13) and corneal curvature (r = 0. 19). Conclusion: The refractive status is mainly dependent on the axial length. In general, the higher the myopia was, the longer the eyeball, the deeper the anterior chamber,     

A Case of Upper Limb Compartment Syndrome following Snake Envenomation Measure Twice,Cut Once

We report a case of a 16-year old male patient who sustained a poisonous bite from a mapepire balsain snake on the dorsum of his left hand. The subject presented within one hour of envenomation and subsequently developed clinical features of acute compartment syndrome in the involved upper limb. Early diagnosis and emergency fasciotomy effectively treated his condition. Aggressive physiotherapy coupled with this ensured best functional outcome.     

Massive subdural haematoma: An unusual complication of septicaemia in preterm very low birthweight infants

Non-traumatic massive subdural haematoma is a rare condition in newborn infants and is usually associated with hereditary coagulation disorders or congential vascular malformation. Its occurrence in preterm very low birthweight infants secondary to systemic bacterial infection has not been reported. We describe two extremely preterm neonates who developed massive subdural haematoma as a result of Gram-negative septicaemia and disseminated intravascular coagulation. Both infants suffered severe parenchymal cerebral injury and hydrocephalus. Clinicians should be aware of this unusual and catastrophic complication if a very low birthweight infant with severe sepsis and disseminated intravascular coagulation suddenly deteriorates despite successful treatment with antibiotics. Radiological imaging by cranial ultrasound or computed tomography scanning should be routinely considered in all such infants for the detection of intracranial bleeding.