Dermatitis artefacta of the lip in an adolescent

Self-inflicted trauma is found in several patient groups including those with learning and developmental delay, the very young and those suffering from psychiatric disturbance. The diagnosis of artefactual disease can only be made when all possible organic disease has been excluded by specific investigations. The case presented is that of a 15-year-old girl complaining of persistent bleeding and crusting of her lips. Investigations provided no real information as to the cause of the allegedly spontaneous bleeding. The diagnosis of artefactual disease was finally decided upon and a referral to a child and adolescent psychiatrist made. CLINICAL RELEVANCE: Patients with unusual clinical signs may be examined regularly by their GDP. This case clearly illustrates the importance of considering a psychological disorder and referral in the differential diagnosis of conditions appearing with unusual clinical signs.     

Neurological dysfunction occurs in mice with targeted deletion of the selenoprotein P gene

Brain function and selenium concentration are well maintained in rodents under conditions of selenium deficiency. Recently, however, targeted deletion of the selenoprotein P gene (Sepp) has been associated with a decrease in brain selenium concentration and with neurological dysfunction. Studies were conducted with Sepp(-/-) and Sepp(+/+) mice to characterize the neurological dysfunction and to correlate it with dietary selenium level. When weanling Sepp(-/-) mice were fed the basal diet (<0.01 mg/kg selenium) supplemented with 0, 0.05 or 0.10 mg selenium/kg, they developed spasticity that progressed and required euthanasia. Supplementing the diet with > or =0.25 mg selenium/kg prevented the neurological dysfunction. To determine whether neurological dysfunction would occur in more mature Sepp(-/-) mice deprived of selenium, Sepp(-/-) mice that had been fed the basal diet supplemented with 1.0 mg selenium/kg for 4 wk were switched to a selenium-deficient diet. Within 3 wk they had developed neurological dysfunction and weight loss. At 3 wk, the 1.0 mg selenium/kg diet was reinstituted. Neurological function stabilized but did not return to normal. Brain selenium concentration did not increase. Weight gain resumed. This study shows that neurological dysfunction occurs when selenium supply to the brain is curtailed and that the dysfunction is not readily reversible. Both the absence of selenoprotein P and a low dietary selenium supply are necessary for the dysfunction to occur, indicating that selenoprotein P and at least one other form of selenium supply the element to the brain.     

Adding stability to the crescentic basilar first metatarsal osteotomy

Crescentic basilar osteotomies for metatarsus primus varus and hallux valgus allow for substantial correction of the first intermetatarsal angle and the hallux valgus angle. Crescentic osteotomies have two well-documented pitfalls: sagittal plane instability and difficulty in fixation. We describe the addition of a plantar shelf to crescentic basilar osteotomy that allows for easier fixation and less risk of elevation of the first metatarsal postoperatively. This plantar shelf is made in the metaphyseal portion of the first metatarsal, which provides the benefit of better bone healing. In 20 patients, we found an average reduction in the intermetatarsal angle of 9.3 degrees and an average reduction in the hallux valgus angle of 21.8 degrees. Eight weeks postoperatively, only one patient showed elevation of the first metatarsal.     

Parvovirus B19 infection and Diamond-Blackfan anaemia

It is the purpose of the study to report the frequency of parvovirus in children with a diagnosis of Diamond-Blackfan anaemia and to discuss the possible aetiological role of parvovirus in Diamond-Blackfan anaemia. We found parvovirus DNA in 3 of 11 bone marrow smears. Giant pronormoblasts showed low sensitivity (33%) and poor specificity (75%). The presence of giant pronormoblasts was associated with a very high myeloid: erythroid ratio, and may not be specific for parvovirus infection, but a feature of severely suppressed erythropoiesis. The three parvovirus-positive patients were the only children who experienced a remission, and who are free of medication. The seven surviving parvovirus-negative patients are all currently on steroid treatment.     

Time relationships between cessation of smoking and onset of ulcerative colitis

From 5 centres 154 patients with ulcerative colitis and a history of smoking completed a questionnaire about the temporal relationship between diagnosis of colitis and cessation of smoking. One hundred and thirty-eight of these were ex-smokers and 107 (69.5%) had stopped smoking before the diagnosis of colitis was made. Fifty-six patients (52%) developed colitis within 3 years of stopping smoking. The findings suggest that smoking exerts protective effect against the development of ulcerative colitis.