The diagnosis of malignant melanoma (MM) in children is difficult due to its uncommon occurrence as well histological similarities to Spitz nevus. A case of MM of the foot in an 11-year-old boy is reported illustrating the histological overlap between Spitz nevus and MM. In our patient, both the primary foot lesion and the regional inguinal metastases were amelanotic, further increasing the diagnostic difficulty. The literature on MM in children is limited and the documentation of such unusual cases is necessary to improve the knowledge on this disease.
A 13-year-old boy who had epigastric pain and pallor for 2 months and found to have an ulcerative mass in the stomach and underwent partial gastrectomy. A diagnosis of inflammatory myofibroblastic tumour (IMT) of the stomach was made on histological examination. Three years later, recurrence in the stomach, with invasion into the pancreas and hilum of the spleen was noted and was managed by wide wedge resection of the stomach, distal pancreatectomy and splenectomy. The patient has been recurrence-free for the past 2 years. Gastric IMT is an uncommon tumour in children with unpredictable prognosis.
In the initial clinical examination of a child with ambiguous genitalia an accurate measurement of the corporeal length is needed. Most often the corporeal length is measured with a ruler from the symphysis pubis to the tip of the glans of a stretched penis. More recently, ultrasound has been successfully used to measure corporeal length. This study aimed to (i) establish normal values for corporeal length in normal male newborns using ultrasound measurement, (ii) compare these measurements to stretched corporeal measurements, (iii) compare the corporeal length of newborns of different races, and (iv) determine the relationship between corporeal length and birth weight, birth length and head circumference. This was a prospective study of 141 newborns. Ultrasound imaging was done in an oblique parasagittal plane such that the corpus could be included in a single image and measured, Stretched corporeal length was measured with the penis stretched alongside a wooden spatula and the length from the pubic bone to the tip of the glans was marked on the spatula and measured. By ultrasound measurement the mean corporeal length of the normal newborn was 3.18 +/- 0.56cm. There was no significant difference in the mean corporeal length when determined by ultrasound and by stretched corporeal measurement. There was no significant difference in the mean corporeal length of the different races when the length was determined by either ultrasound or stretched corporeal measurement. There was a positive correlation between ultrasound length and birth weight and birth length. However, there was no correlation between ultrasound length and head circumference. There was no significant correlation between the stretched length and either birth weight, birth length or head circumference.
A 16-year-old boy was referred with features of Parkes Weber syndrome (PWS) involving the right lower limb. He had presented at birth with cutaneous vascular malformations (VM) in the right thigh and at the age of 7 years developed congestive cardiac failure, which was controlled with drugs. He received alpha interferon and steroids during this period without any benefit. He defaulted follow-up and at 12 years of age presented with further enlargement of the VM in the right thigh and leg with skin and soft tissue thickening. At this stage, embolization and subsequent excision of the VM were tried, but the surgery was abandoned because of massive hemorrhage. Over the next 4 years, the boy became totally bedridden because of massive increase in the size of the limb, repeated hemorrhages, and secondary infection of the VM. Right hip disarticulation was considered the best option to improve his quality of life. To prevent uncontrollable hemorrhage during surgery, the disarticulation was done under cardiopulmonary bypass with low circulatory flow. Postoperatively, the patient required intensive care nursing for a week. He is presently ambulatory with crutches. Cardiopulmonary bypass with low flow has been used for treating posttraumatic arteriovenous malformations. However, its use in surgery for PWS has not been reported earlier.
A survey of 142 cases of acute pancreatitis was undertaken in two major hospitals serving the state of Kelantan in Malaysia. Females outnumbered males by a ratio of more than 3:1. The incidence among females peaked in the third decade of life. Twenty-one percent (23/109) of the females were pregnant. Ultrasonography revealed gallstones in only 9.4% (13/138). However, abnormalities of serum transaminases were found in 35% (35/100), suggesting that occult gallstones or microlithiasis may be the cause in a significant proportion of patients. Alcohol was virtually absent as an aetiological factor. There was a higher frequency of Ascaris infection in this group than a control hospital population (11/35 vs 33/242; p < 0.02) suggesting that ascariasis may be an important cause of acute pancreatitis in Kelantan. Only 8.4% fell into the category of severe pancreatitis. The overall mortality rate was 2.1%.