Alexander K. C. Leung, MD

September 14, 2005

A boy was born to a gravida 2, para 1, 26-year-old woman at 37 weeks' gestation. The pregnancy had been complicated by gestational diabetes.

September 14, 2005

An irritable, lethargic, toxic-looking, and slightly cyanotic 2-month-old boy had a temperature of 40°C (104°F), malaise, and a cough for 2 days. The infant's heart rate was 98 beats per minute, and his respiratory rate was 55 breaths per minute. He had nasal flaring, sternal and subcostal retractions, diminished breath sounds, and scattered rales over the left lung, which was dull to percussion.

September 14, 2005

A 10-year-old boy presented with a 6-month history of a painless mass on the left side of the scrotum. The overlying skin had a bluish discoloration. The mass felt like a “bag of worms.” When the boy stood, venous varicosity could be palpated along the spermatic cord. This venous distention increased when he performed Valsalva's maneuver and decreased when he was recumbent.

September 14, 2005

A 40-year-old man requested evaluation of several cherry-red papules, which he had noticed on the upper part of his trunk for the past 12 months. The eruptions were diagnosed as cherry angiomas, also known as Campbell de Morgan spots.

September 14, 2005

Severe pain in the scrotum during a soccer game sent a 14-year-old boy to his physician. The right testicle was swollen and exquisitely tender. On exploration, it was hemorrhagic and blue-black. A small incision in the tunica of the testis revealed arterial bleeding, which indicated that the testis was still viable. The right testicle was untwisted and fixed to the scrotum.

September 14, 2005

A pruritic, erythematous rash developed in a 6-year-old boy over the previous 5 days. The rash erupted in crops; the lesions appeared initially as rose-colored macules, progressed rapidly to papules and vesicles, and finally crusted. The distribution of the lesions-with the greatest concentration on the trunk-is typical of chickenpox.

September 14, 2005

When this boy was born, he was covered by a transparent membrane resembling oiled parchment or collodion. The membrane was shed within 2 weeks and, subsequently, the infant was found to have normal skin. Lamellar ichthyosis usually develops in babies with this condition, although in some the skin clears completely.

September 14, 2005

A 37-year-old man presented with a reddish nodule in the umbilical area that had been present since early infancy. The lesion had been cauterized with silver nitrate several times in the past but had not resolved. No drainage or secondary infection was noted, and the patient was otherwise in good health.

September 14, 2005

At 3 days of age, this infant was noted to have an erythematous, maculopapular rash on the face, chest, abdomen, and back that included some pustule-like lesions.

September 14, 2005

Also known as congenital aganglionic megacolon, this condition is characterized by a congenital absence of ganglion cells in the submucosal (Meissner) plexus and the myenteric (Auerbach) plexus in one or more segments of the colon. This is attributable to a failure of migration of nerve cell elements from the neural crest in a cephalocaudal direction along the GI tract. The absence of parasympathetic innervation causes failure of relaxation of the internal anal sphincter. An aganglionic colon does not permit normal peristalsis to occur and thus results in a functional obstruction.