Multiple giant congenital melanocytic nevi with central nervous system melanosis.

A case of multiple giant congenital melanocytic naevi in whom central nervous system melanosis was detected at 6 weeks of age is described. The infant was asymptomatic, but presence of risk factors such as multiple naevi, giant naevi and naevi on scalp and posterior axial location prompted a magnetic resonance imaging study of the brain. To our knowledge, neurocutaneous melanosis at such a young age has not been reported in Indian literature.

An unusual presentation of scurvy following head injury.

We report an unusual clinical presentation of scurvy in a one and half year old child. The child presented with abrupt onset of peri-orbital ecchymoses and scalp hemorrhage following head injury. The child also had a history of temper tantrums and head banging. Our case did not have any of the typical clinical features of scurvy. The diagnosis was eventually confirmed radiologically and by observing a dramatic response to vitamin C therapy. It is important to remember that scurvy can present atypically i.e. without bleeding gums, painful limbs, pseudo-paralysis or scorbutic rosary. Scurvy should be kept as a differential diagnosis in a young child presenting with bleeding manifestations. Taking a detailed dietary history is of utmost importance in pediatric practice.

Hepatic hydatid cyst rupturing into sub-diaphragmatic space and pericardial cavity.

A ten-year-old male child presented with a large hepatic hydatid cyst which ruptured into the sub-diaphragmatic space and pericardial cavity, giving rise to a pericardial effusion. This communication between the hydatid cyst and the pericardium was documented on computerised tomographic scan of the chest and abdomen. The cyst was aspirated carefully and then enucleated. There was an associated right-sided reactionary pleural effusion. The pericardial effusion and pleural effusion resolved on albendazole therapy and did not require surgical intervention.

Cerebellar atrophy in an epileptic child: is it due to phenytoin?

A four and half year old epileptic child on phenytoin therapy since one year presented with signs of cerebellar dysfunction. Serum phenytoin level was high (33 mcg/ml) and computerised tomographic scan of the brain showed severe generalised cerebellar atrophy. The cerebellar signs represented drug over dosage and toxicity and persisted long after omission of phenytoin.

Assessment of percent body fat content in young and middle aged men: skinfold method v/s girth method.

Percent body fat content was found in apparently normal healthy 30 young (17-20 Yrs.) and 30 middle aged men (30-46 Yrs.) by measuring the skinfold and girth. None of the subjects were athletes or did regular physical exercise. Body density was calculated using mean of the four skinfold measurements as per the equations advocated by Durnin and Womersley, while percent body fat content was calculated from the body density by the Siri's equation. The mean % body fat content by this method in young men was 15.87 +/- 3.85% and in middle aged men was 24.75 +/- 3.55%. Ten percent of the young subjects and 90% of the middle aged subjects were found to be obese. Percent body fat content was also calculated from the girth measurements as advocated by McArdle et al. The mean of % body fat content with this method was 14.91 +/- 3.82% in young men and 24.30 +/- 3.35% in middle aged men. On comparison, the difference in percent body fat content calculated by both the methods was found to be significant in young men but not for middle aged men. The correlation, coefficient between girth method and skinfold method was 0.95 in case of young men and 0.90 for middle aged men. Therefore, we advocate that girth measurements can be used to determine percent body fat content, main advantage being simplicity of technique and requirement of inexpensive instruments for measurement.