Multiform cervical melanocytoma: a case report

Melanocytomas are very rare benign melanocytic tumors of the central nervous system (CNS). We present a case of a cervical melanocytoma diagnosed after trauma as a result of persistent neck pain and abnormal neurological examination. Early recognition of benign melanocytic lesions of the CNS is important, as a complete resection can often lead to cure with no need for further treatment.     

Rattlesnake bites in children: antivenin treatment and surgical indications

BACKGROUND: Orthopaedic surgeons working in the Americas may be consulted in the care of patients bitten by venomous rattlesnakes (genus Crotalus ), particularly with regard to the possibilities of compartment syndrome and soft-tissue destruction. Despite considerable evidence regarding the safety and efficacy of antivenin in the treatment of rattlesnake bites in adults, controversy persists regarding the roles of antivenin and surgery in the treatment of rattlesnake envenomations in children. Our hypothesis is that aggressive use of antivenin is just as effective and safe for children as it is for adults. METHODS: We retrospectively reviewed the charts of twenty-four consecutive patients who had been managed at our hospital because of a bite from a western diamondback rattlesnake. Nineteen of the twenty-four patients had been envenomated. The uniformity of collected data was facilitated by the use of an intensive-care-unit protocol during the ten-year period that was reviewed. A questionnaire was developed for long-term follow-up. RESULTS: Aggressive use of polyvalent equine antivenin safely prevented the need for surgery in sixteen of the nineteen envenomated patients. Of the three patients who had surgical treatment, two were managed with limited soft-tissue debridement and one was managed with a fasciotomy of the leg because of a compartment syndrome that occurred when adequate antivenin was withheld. No serious adverse effects were noted in association with the antivenin, and no functional impairments were noted at the time of discharge. CONCLUSION: Antivenin, rather than surgery, is the proper initial treatment of severe rattlesnake envenomations in children.     

Early infantile pertussis; increasingly prevalent and potentially fatal

We report nine cases of severe early pertussis in infants less than 7 weeks of age. Clinical features at this age are atypical and may be confused with more common illnesses such as bronchiolitis. All were very difficult to manage. Ventilation was required for apnoeas in five cases, seizures in two or respiratory failure in two. Complications included hypotension in seven cases, pulmonary hypertension in one, pneumothoraces in two, seizures in five and co-infection in five. Two cases were referred for extracorporeal membrane oxygenation and six died. Infection was confirmed either at post mortem or by culture from pernasal swabs. The mother or other close family members were symptomatic at the time and thought to be the source of infection. Conclusion The nine cases suggest a significant resurgence of the infection, which may be fatal in early life. If reporting continues to increase, the immunisation schedule will need to be reviewed and secondary transmission prevented where possible, to protect this vulnerable pre-immunisation group. Received: 5 October 1999 / Accepted: 22 May 2000     

Haemoglobinopathy in Andhra Pradesh

Summary Children presenting with pallor, hepatosplenomegaly and other features suggestive of haemolytic disease were investigated for the presence of abnormal haemoglobins. In this effort, 67 cases of thalassaemia major, 118 of, thalassaemia minor, 9 of thalassaemia haemoglobin E disease, 8 of sickle cell anaemia and 98 parents with, the thalassaemia minor trait were detected. None of the cases had migrated from or had ancestors from West Bengal or East Bengal. From the Niloufer Hospital for Women and Children, and the Department of Pediatrics, Osmania Medical College, Hyderabad.     

An undescribed cause of patellar tendon rupture

We present a rare case of a myxoid-feature lipoma that arose in the patella fat pad and caused patellar tendon rupture.     

Blastocyst implantation failure in mice due to "nonreceptive endometrium": endometrial alterations by Hibiscus rosa-sinensis leaf extract

Many plants are known to possess antifertility activity. However, limited attempts have been made to scientifically evaluate these claims. Hibiscus rosa-sinensis flowers have been shown to possess antifertility and abortifacient activity. In this report, antiimplantation activity of water extract of leaves of H. rosa-sinensis was investigated. Pregnant female mice were dosed with extract (100 mg/kg body weight) from days 1 to 6 of pregnancy. No implantation sites were observed in treated animals when they were surgically opened on day 15 of pregnancy. Biochemical and biophysical alterations were observed in the endometrium in treated animals, especially on day 5, at 4:40 a.m., the day of implantation. A sharp increase in superoxide anion radical and a sharp fall in superoxide dismutase (SOD) activity, as seen in the endometrium from control animals, were altered in treated animals. The extract also exhibited antiestrogenic activity, as judged by increase in uterine weight. The physiological alterations induced by water extract of H. rosa-sinensis are discussed.     

Familial spontaneous pneumothorax in neonates

Spontaneous pneumothorax is a recognised cause of respiratory distress in the neonatal period. Spontaneous pneumothorax occurring during the neonatal period in siblings within a family is rare. We report a case of spontaneous pneumothorax occurring in two siblings in the neonatal period.     

Presumed infundibuloneurohypophysitis: unusual presentation in a postpartum patient

We describe a case of presumed postpartum infundibuloneurohypophysitis, which is a rare inflammatory process involving the pituitary stalk and posterior pituitary. Only one case has been previously reported in a postpartum woman. Serial MR images obtained in our patient revealed spontaneous regression of inflammation. The critical position of the inflammation leads to hormonal deficiencies, mostly involving the posterior pituitary. Treatment options include hormone replacement; the role of pharmacological steroids is controversial.