UVC), umbilical arterial catheter (UAC) and Peripherally Inserted Central Catheter (PICC).The infant developed recurrent abdominal distension, associated with bilious aspirates and vomits. On examination, the abdomen appeared tense and shiny, with dilated veins. Necrotising enterocolitis (NEC) was suspected and enteral feeds were held repeatedly. Plain film abdominal x-rays revealed bowel distension. However they did not identify other radiological features of NEC or perforation, such as pneumatosis intestinalis or pneumoperitoneum.Coagulation screens were normal. On Day 36, the infant's clinical condition rapidly deteriorated. She developed a grossly distended abdomen, associated with increased oxygen requirement and desaturations. She required ventilation, inotropic support and transfer to a tertiary centre. She continued to deteriorate and further treatment was considered futile. Following discussion with her parents, palliative care was introduced and she passed away shortly afterwards.Subsequent postmortem examination revealed idiopathic superior mesenteric vein thrombosis. Discussion A differential diagnosis for neonatal abdominal distension and bilious vomiting includes necrotising enterocolitis (NEC), intestinal malrotation and volvulus. 3 Superior mesenteric vein thrombosis causes chronic, recurrent and progressive devitalisation of the small bowel wall. It is associated with pre-terminal neutropaenic sepsis and peritonitis. 4 It may be caused by an unidentified congenital thrombophilia. 5 Conclusion In refractory cases of suspected NEC, venous thromboembolism should be considered. Abdominal x-ray findings are non-specific and are unlikely to contribute to a correct diagnosis. More specific investigations include Doppler ultrasound and CT angiography. 6
pigmented naevus were irregularly shape macule, papules, and plaques of various colours.Multiple pigmented satellite lesions of size 4-5 cm were present over the body, head, face and extremities. Tufts of coarse hair were present over the satellite lesions, with finer hair covering the abdominal areas of pigmentation. Three nodular lesions were present in the perianal region. Areas of excoriation were noted on the flank areas. No other physical abnormalities were present. Neurological examination was unremarkable.MRI examination revealed extensive intracranial melanocytic infiltrate, confirming a diagnosis of CGMN with NCM. Discussion CGMN is an extremely rare condition with incidence estimated at 1/500000 births. Lesions are caused by genetic mutations which lead to defective proliferation, differentiation and migration of melanoblasts. Risk of transformation of GCMN to malignant melanoma varies between 0 and 3.8%, with 80% of this number symptomatic by the age of seven.CNN originates between the 5th-24th week of gestation and arises from gain of function mutations in either BRAF or NRAS. The protooncogenes c-met and c-kit have also been demonstrated to play a role in the formation of CMN. CMN are predominantly caused by sporadic de novo mutations.Neurocutaneous melanosis is a rare complication of CMN with just over 100 cases reported. Most patients with NCM are asymptomatic t birth with sequelae appearing later in development.Treatment of GCMN is both symptomatic and palliative, with surgical techniques including serial resection, excision and grafting and the use of tissue expanders. Non-excisional techniques include dermabrasion, laser ablation and curettage.
patients who described their cough as painful or warranting treatment. The MCLCS and VAS are simple cough assessment tools that can be readily used in research and clinical practice to better evaluate cough and facilitate the development of effective cough therapies.
UVC), umbilical arterial catheter (UAC) and Peripherally Inserted Central Catheter (PICC).The infant developed recurrent abdominal distension, associated with bilious aspirates and vomits. On examination, the abdomen appeared tense and shiny, with dilated veins. Necrotising enterocolitis (NEC) was suspected and enteral feeds were held repeatedly. Plain film abdominal x-rays revealed bowel distension. However they did not identify other radiological features of NEC or perforation, such as pneumatosis intestinalis or pneumoperitoneum.Coagulation screens were normal. On Day 36, the infant's clinical condition rapidly deteriorated. She developed a grossly distended abdomen, associated with increased oxygen requirement and desaturations. She required ventilation, inotropic support and transfer to a tertiary centre. She continued to deteriorate and further treatment was considered futile. Following discussion with her parents, palliative care was introduced and she passed away shortly afterwards.Subsequent postmortem examination revealed idiopathic superior mesenteric vein thrombosis. Discussion A differential diagnosis for neonatal abdominal distension and bilious vomiting includes necrotising enterocolitis (NEC), intestinal malrotation and volvulus. 3 Superior mesenteric vein thrombosis causes chronic, recurrent and progressive devitalisation of the small bowel wall. It is associated with pre-terminal neutropaenic sepsis and peritonitis. 4 It may be caused by an unidentified congenital thrombophilia. 5 Conclusion In refractory cases of suspected NEC, venous thromboembolism should be considered. Abdominal x-ray findings are non-specific and are unlikely to contribute to a correct diagnosis. More specific investigations include Doppler ultrasound and CT angiography. 6
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