WORLD'S FIRST ROBOTIC ASSISTED DOUBLE VALVE REPLACEMENT HEART SURGERY

Criteria of growing pains

A 12-year-old obese boy presents to your office complaining of bilateral leg pain that occurs only at night. His mother denies any pain during the day and reports he has not had a limp. The most likely diagnosis is :

A) slipped capital femoral epiphysis
B) Legg-Calve-Perthes disease
C) Osgood Schlatter's disease
D) patellofemoral syndrome
E) growing pains

Answer and Discussion

The answer is E.
A diagnosis of growing pains must meet three criteria:
(1) the leg pain is bilateral;
(2) the pain occurs only at night; and
(3) the patient has no limp, pain, or symptoms during the day.
To inaccurately diagnose a limping child with growing pains can be dangerous, as the physician risks missing the underlying pathology. However, if a child does fit the criteria for growing pains, the parents should be reassured that this is a benign, self-limited process that occurs for unknown reasons.

Mottled skin or Cutis Marmorata in neonates

Cutis marmorata or "marbled skin" refers to mottled skin, typically in newborns in the first few months of life.
This reticulated pattern of constricted capillaries and venules is often called "mottling" due to vasomotor instability in immature infants. It generally resolves with increasing age and for most infants is of no significance.

Explanation of cutis marmorata :

This phenomenon is caused by instability or immaturity of the nerve supply to the superficial capillary blood vessels in the skin. This causes the blood vessels in some regions of the skin to dilate, producing a red color of the skin, while other regions are contracting, producing pale skin.

In spite of it`s insignificance in most babies ,it may reflect underlying poor perfusion and infants who develop mottling and are unwell need to be clinically evaluated for sepsis and other illnesses.

Cutis Marmorata Telangiectatica Congenita :

Reticular skin lesions on the right arm of a 7-y girl

It is localised , marked and more pronounced form of cutis marmorata which may be associated with other defects. It is uncommon and sometimes called (congenital generalized phlebectasia)
cutis marmorata telangiectatica congenita is often reported in association with a variety of other congenital anomalies, the most common anomaly associated is Body asymmetry.

A case of Chromoblastomycosis

A 55-year-old man presented with vegetating lesions on the right foot that had been slowly enlarging during the past several years ;The photo:

  On physical examination, several nodular and verrucous lesions were seen in the distal region of the foot. The patient lived in a rural area and had walked barefoot for most of his life. Analysis of a skin-biopsy specimen revealed clusters of small, round, thick-walled, brown sclerotic bodies in the stratum corneum (muriform cells), which are diagnostic for chromoblastomycosis.
Chromoblastomycosis is a chronic, soft-tissue fungal infection commonly caused by Fonsecaea pedrosoi, Phialophora verrucosa, Cladosporium carrionii, or F. compacta. The infection occurs in tropical or subtropical climates and often in rural areas. The fungi are usually introduced to the skin through cutaneous injury from thorns, splinters, or other plant debris. The patient was treated with multiple surgical excisions and itraconazole for 24 months with a complete resolution of symptoms.