1/4. Late onset of clinical symptoms and recurrent ecchymotic skin lesions in a 12-year-old girl with a severe double heterozygous protein c deficiency.The authors describe a 12-year-old girl with late-onset clinical symptoms due to severe protein c deficiency. Protein C gene analysis showed double heterozygosity for two distinct mutations, associated with type I protein c deficiency. Her parents and only brother were also evaluated. Coumarin-induced skin necrosis was a recurrent feature during oral anticoagulation therapy, forcing her physicians to treat her with nadroparin (Fraxiparin) for only a few months.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Bruising and hemophilia: accident or child abuse?Recognition and prompt reporting of suspect child abuse or neglect is necessary to institute programs aimed at preventing further neglect, re-injury or possible death. The families of children with chronic medical conditions, such as hemophilia, may be affected by economic and emotional stresses which may be expressed as abuse or neglect. Because the manifestations of even slight trauma are so common in children with bleeding problems, the physician may not routinely inquire about the cause of injury, delays in seeking medical attention, or accident prevention efforts in the home. Early referral of children with hemophilia to a multidisciplinary team providing medical, psychological, and social care is recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. The blue scrotum sign of Bryant: a diagnostic clue to ruptured abdominal aortic aneurysm.A 73-year-old man presented to the emergency department twice with nonspecific abdominal pain. He was diagnosed as having mild diverticulitis and was discharged. Four days later he presented to the emergency department in severe abdominal pain with scrotal and penile ecchymoses. After an initial urologic consultation the correct diagnosis of ruptured abdominal aortic aneurysm was made. We discuss the pathogenesis of the genital discoloration and make the correct historical attribution of this sign to John Henry Bryant, a turn-of-the-century physician at Guy's Hospital.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. ecchymosis of the lower leg. A sign of hemarthrosis with synovial rupture.Four patients with hemarthrosis of the knee, synovial rupture, and ecchymoses are reported. The patients presented with calf pain and swelling and large ecchymoses, which eventually extended to the ankle as a crescent about one or both malleoli. Appreciation of this physical sign, which appears to be characteristic for the hemorrhagic subset of synovial rupture, should alert the physician to the correct diagnosis and steer him away from contraindicated anticoagulant therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |