Subcutaneous fat necrosis associated with severe hypocalcaemia in a neonate.

Subcutaneous fat necrosis (SFN) of the newborn is an uncommon disorder of the adipose tissue, mostly affecting full-term or post-term newborns who experience perinatal distress. The lesions of SFN typically occur during the first six weeks of life; they are usually self-limited and no specific therapy is required. The disorder may be rarely complicated with hypercalcaemia. We present the case of a neonate with perinatal asphyxia who manifested SFN followed by hypocalcaemia instead of hypercalcaemia and a biochemical profile of pseudohypoparathyroidism four weeks after the eruption of skin lesions. The infant was treated with alfacalcidiol. Blood biochemistry was normalized within one week and serum parathyroid hormone levels declined to normal over the next two months. It is suggested that perinatal asphyxia was the common etiopathogenetic factor for the development of both SFN and pseudohypoparathyroidism.     

Double appendixes: A rare case report

Anomalies of the appendix are rare, and one of the rarest is the double appendixes. Most anomalies of the appendix are observed in adults and are discovered incidentally during surgery that does not primarily involve the appendix. It is usually missed, often with life‐threatening consequences.     

Serum lipids in preterm infants fed a formula supplemented with nucleotides

BACKGROUND: The effect of dietary nucleotides on lipid metabolism has been the subject of clinical studies with conflicting results. We measured serum triglycerides, total cholesterol (total-C), and lipoprotein cholesterol levels (HDL-C, LDL-C, and VLDL-C) in preterm neonates fed formula with and without nucleotide supplements. METHODS: This prospective, randomized, controlled study included 150 healthy preterm neonates (gestational age, 33.0 +/- 1.9 weeks) matched for gestational age, birth weight, and gender. Subjects were assigned at birth to receive either a standard milk formula supplemented with nucleotides (group F-NT) or the same formula without nucleotides (group F). Serum was obtained before discharge (29.1 +/- 10.0 days of life) and triglycerides, total-C, and HDL-C were determined enzymatically. LDL-C and VLDL-C were estimated by the Friedewald formula. For statistical analysis t test, Mann Whitney-U test, two-way ANOVA, and chi2 test were used, as appropriate. The influence of several factors on serum lipid levels was evaluated by linear regression analysis. RESULTS: Serum triglycerides, total-C, and VLDL-C levels did not differ between groups. HDL-C levels (median; 25th-75th percentiles) were significantly higher (P < 0.001) in group F-NT (48.0 mg/dL; 40.5-57.0 mg/dL) than in group F (34.5 mg/dL; 27.2-44.0 mg/dL). On the contrary, LDL-C levels (median; 25th-75th percentiles) were significantly lower (P < 0.001) in group F-NT (39.0 mg/dL; 26.0-54.0 mg/dL) than in group F (65.0 mg/dL; 41.0-73.0 mg/dL). In the multiple regression analysis, nucleotide supplementation was identified as one of the controlled independent factors influencing serum HDL-C and LDL-C levels. CONCLUSIONS: Preterm neonates fed from birth with formula supplemented with nucleotides have significantly higher HDL-C and lower LDL-C serum levels than do neonates fed unsupplemented formula. The clinical relevance of these results remains to be elucidated.     

Histologic findings in left ventricle papillary muscle arteries from human hearts

We describe original histologic findings of left ventricle papillary muscle (LVPM) arteries in people under 30 years of age. We examined 666 samples taken from the tip, mid-portion and base of papillary muscles in 56 males and 55 females, as well as several samples from the rest of the left ventricle. The number of smooth muscle cells (SMC) in the tunica media of the LVPM arteries led us to divide the samples examined into three groups: (i) group 1, 355 samples (53%) with a normal number of SMC and a normal lumen (the number of group 1 samples increased from the tip (21%) to the base (47%)); (ii) group 2, 252 samples (38%) with a mild to moderately increased number of SMC (the number of these samples decreased from the tip (44%) to the base (22%)); and (iii) group 3, 59 samples (9%) with abundant SMC that were more than twofold greater in size and number of normal arteries, in contrast with the other two groups. The shape of the SMC in group 3 samples was round and the extremely narrow, centrally located lumen of these SMCE had a round or oval shape. These changes were restricted only to papillary muscle arteries and the number of group 3 samples decreased from the tip (63%) to the mid-portion (37%). No inflammatory reaction or chronic ischemic changes were found in the LVPM arteries and surrounding area. The SMC changes in groups 2 and 3 were found in subjects aged more than 2 months. These findings will provide anatomists, cardiologists, pathologists and physiologists with valuable knowledge and will trigger further investigation into the etiology of the structural changes observed and their evolution with age.     

Ossifying fibromyxoid tumor may express CD56 and CD99: a case report

Ossifying fibromyxoid tumor (OFMT) is an uncommon soft tissue neoplasm characterized by a combination of myxoid and/or fibrous stroma with areas of ossification. Although most authors postulate a neuroectodermal origin for this peculiar tumor, there is no agreement in the literature regarding its histogenesis. In this article, we present the immunohistochemical findings of a case of a 39-year-old white male with an OFMT of the soft tissue in the mandibular region. The tumor was positive to S-100 protein, glial fibrillary acidic protein, CD99, CD56 and negative to smooth muscle actin, cytokeratins AE1/AE3, epithelial membrane antigen, and CD68. To the best of our knowledge, this is the first case reported to be positive to CD56 and CD99. Immunoreactivity to these two antibodies, together with reactivity for S-100 protein and glial fibrillary acidic protein, suggests that OFMT is of a neuroectodermal origin. In our opinion, in the absence of reactivity to at least one neuroectodermal marker one should seriously question a diagnosis of OFMT.