1/22. Acute infantile hemorrhagic oedema.Acute infantile hemorrhagic oedema (AIHO) was first described in 1913 but, despite frequent reports in the European literature, it is not well recognized in the English language literature. It is considered by many to be a variant of Henoch Schonlein purpura (HSP) because of similarities in cause and histopathology. However, because of the benign nature of this condition and frequent absence of IgA associated with HSP, it may be sensible to consider this as a distinct variety of cutaneous small vessel vasculitis (CSVV). We report this case to highlight the condition and emphasize its benign nature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/22. Non-Hodgkin's lymphoma presenting as anasarca: probably mediated by tumor necrosis factor alpha (TNF-alpha).Two patients presented with anasarca, fevers and sweats. Subsequent evaluation revealed aggressive lymphoproliferative disease. Both patients were treated with CHOP chemotherapy. One patient responded with spontaneous, vigorous diuresis and complete resolution of the edema. She relapsed two months later with recurrent edema that responded a second time to salvage chemotherapy. The second patient died of gram positive sepsis a week after diagnosis. As anasarca is an unusual presenting symptom of non-Hodgkin's lymphoma, we postulated that the malignant cells were secreting a cytokine that resulted in "vascular leakage" of fluid and development of diffuse edema. Several serum cytokine levels were tested. Both patients had elevated TNF-alpha levels, which could have been the cause of the edema; or there might be yet another unidentified mediator that was responsible for the anasarca. We report these two cases to bring to attention the unusual nature of this presentation.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
3/22. prenatal diagnosis of Milroy's primary congenital lymphedema.Milroy's primary congenital lymphedema (PCL) (hereditary lymphedema type I, Milroy disease) is present at birth, and mostly affects the dorsal aspects of feet. It is mostly a life-long condition but does not affect longevity. Complications are rare except for chronic discomfort and warmness of affected areas. PCL is an autosomal dominant disease with incomplete penetrance due to a mutation in the gene locus encoding for VEGFR3 with resultant dysgenesis of microlymphatic vessels. We report on two fetuses where ultrasonographic examination at 15 weeks of gestation showed significant edema of the dorsal aspects of both feet with no evidence of other major malformations. Whereas in one fetus the edema resolved completely, it persisted in the second fetus and proved after birth to be of lymphedematous nature. To the best of our knowledge, this is the first report of early prenatal diagnosis of primary congenital lymphedema via fetal ultrasonographic examination and of spontaneous resolution of lymphedema during fetal life.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
4/22. Acute renal failure in children with idiopathic nephrotic syndrome.Acute renal failure (ARF) is an uncommon but alarming complication of idiopathic nephrotic syndrome. The renal failure could be secondary to causes evident from the history and evaluation, such as severe intravascular volume depletion, acute tubular necrosis, allergic interstitial nephritis, bilateral renal vein thrombosis, acute pyelonephritis, or rapid progression of the original glomerular disease. It may be termed idiopathic if the underlying cause is undetermined. We present three children with idiopathic nephrotic syndrome who were admitted with acute renal failure. One case was due to drug-induced allergic interstitial nephritis. The other two were idiopathic in nature. Improvement in renal function occurred in the three patients over a variable period of 10 days to 4 weeks. After careful exclusion of well-known causes of acute renal failure, idiopathic acute renal failure (IARF) should be considered as a diagnostic possibility in these patients. The exact pathophysiology of IARF is not understood. Possible proposed explanations include interstitial edema, tubular obstruction, altered glomerular permeability, and unrecognized hypovolemia.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
5/22. Parapharyngeal space tumour presenting as recurrent uvular oedema.neoplasms of the parapharyngeal space are uncommon and usually present as an intra-oral or neck mass. They often elude early diagnosis due to their deep-seated nature. Here we report a case presenting with recurrent oedema of the uvula. The pathophysiology of this previously unreported mode of presentation is discussed.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
6/22. Tympanic electrocochleography: normal and abnormal patterns of response.Electrocochleography has been widely used in human and animal studies of endolymphatic hydrops. A variety of response patterns have been reported in normal and hydropic ears. Recent clinical studies have focused almost exclusively on the amplitude ratio of the summating potential (SP) and action potential (AP) derived from alternating polarity click responses. In this report normal response patterns are described with a tympanic membrane electrode employing condensation, rarefaction and alternating polarity clicks and tone burst stimulation. A variety of response abnormalities are described in patients with suspected endolymphatic hydrops. The exclusive use of alternating polarity clicks is not adequate to reveal the nature of these abnormalities.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
7/22. Inflammatory myopathies in children.Juvenile idiopathic inflammatory myopathies are rare conditions that are probably autoimmune in nature. Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy. This article describes a recent patient who presented with typical JDM and uses her case to discuss aspects of the childhood inflammatory myopathies.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
8/22. Facial edema induced by isotretinoin use: a case and a review of the side effects of isotretinoin.isotretinoin (13-cis-retinoic acid) is a retinoid that is used to treat cystic acne, comedonal acne, and other diseases. For the treatment of acne, isotretinoin is dosed at 0.5 to 2 mg/kg daily for 5 months with a target total dose of approximately 120 mg/kg. Its most common side effects are mucocutaneous and ocular in nature (ie, cheilitis, ocular sicca, and decreased dark adaptation). It can also cause xerosis. patients should be made aware of these side effects before taking isotretinoin and also that utilization of moisturizers and eye drops can help to mitigate such side effects. Sometimes, however, the dose of isotretinoin needs to be decreased to reduce the induction of side effects. isotretinoin's most significant side effect is the induction of birth defects if a fetus is exposed to isotretinoin, which is pregnancy category X. isotretinoin should be used with 2 forms of birth control by fecund women. It can rarely increase serum levels of triglycerides, which can, if very elevated, be related to the development of pancreatitis and xanthomas. isotretinoin's well-documented but rarer side effects include intracranial hypertension. It can induce bony changes. A review of the literature demonstrates that isotretinoin is not linked to depression and suicide. Facial swelling has been linked to isotretinoin use in 3 previous case reports. We note herein the first case of facial swelling that occurred in an acne patient being treated with isotretinoin who at the time the swelling developed had no cysts, comedones, pustules, or evidence of bacterial infection. Possible reasons for the patient's facial swelling include some type of retinoid induced angioedema, exacerbation of inflammation by isotretinoin, and isotretinoin induced capillary leak syndrome.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
9/22. Fatal massive edema of the head and neck secondary to scalp laceration: report of case.A case of fatal massive edema of the head and neck secondary to subgaleal involvement from a scalp laceration has been presented. Subgaleal infections have been rare since the advent of antibiotics. The unusual and serious nature of the condition is made evident, with considerations of differential diagnosis included.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
10/22. Massive subgaleal hematoma resulting in skin compromise and airway obstruction.Subgaleal hematomas following minimal trauma, haircombing, and hair pulling by playground swings have been described. Recently a case was reported that progressed to otic hemorrhage and upper facial edema. We present a case (of a previously unreported nature) of a subgaleal hematoma that resulted in airway obstruction, massive edema of the entire face and neck, and limited epidermolysis of facial skin.- - - - - - - - - - ranking = 0.5keywords = nature (Clic here for more details about this article) |
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