Legg-Perthes disease with limping

A boy of 12 years has been suffering from pain in the right hip joint and limping of the right leg for three years. The pain was intermittent and relieved by pain killer as prescribed by local physician.

He has no fever and he is otherwise healthy.

As pain was not improving, he had his Xray done which shows subchondral erosion on the right side prominently and on the left side mildly. The changes are suggestive of Leg Perth’s disease.,

Osteotomy of the Rt femur was done below the neck and internal rotation and fixation done by our Orthopedic Specialist Prof Imamuddin(dr_imamuddin@yahoo.com). To improve the blodd supply and the change the aaxis of the load of through the leg.

The patient is now improving.

Badrud Doza

Congenital Hypoplastic Anaemia (Diamond-Blackfan Anaemia)

A boy of 2 months presented with persistant pallor and growth failure. He is normally delivered and breast fed.

He has no craniofacial deformity, limb anomalies or cardiac malformations. He has no lymphadenopathy or any other organomegaly.

On investigation, his Hb was 4.1 gm/dl, ESR -27 mm in 1st hr, platelet 1,86,000/cmm, Total RBC 3 m/cmm, Total WBC 4600/cmm, Neurophil-38%, Lympho-56%, Mono 04%, Eosini02%, Baso-00%.
Peripheral blood ilm shows anisochromia and anisocytosis with low distribution,WBC -mature and normal count and distribution, platelets are normal.
Bore marrow shows hypercellular marrow with increased M: E ratio. Erythropoesis is grossly depressed. Only occassional megaloid erythroblasts are seen.
Granulopoesis is hyperactive and maturing into segmented forms. Histocytes are increased.
Lymphocytes and plasma cell are within normal limit. Megakaryocytes are normal. The bone marrow is suggestive of Pure Red Cell apasia.

The case may be lebelled as Congenital Hypoplastic Anaemia or Diamond-Blackfan Anaemia.



Badrud Doza

Henoch -Schonlein Purpura with gastrointesinal bleeding and hematuria

A girl of 8 years presented with fever, pupuric rashes , gastrointestinal bleeding and hematuria of 2 weeks duration.

Fever is moderate in degree and intermittent in nature, palpable rashes are distributed on the external surfaces of the body with occasional overlap on the other areas, GI bleeding was in the form of hematomesis and melena , hematuria was mild in nature.

He had no past history of the same illness, no history of offending drugs or agents taking that may cause blood dyscrasias

On physical examination, the child has mild pallor with normal pulse, BP,temp and respiration. She has no lymphadenopathy or hepatospenomegaly. Other system reveals no abnormality.

The case was suspected as a case of Henoch Schulen Purpura.

Because of fever among the other possibilities we consider Dengue Haemorrhagic fever, Leaukemia, aplastic anaemia were considered.

On investigation, Hb was 13.5 gm/dl, TC, DC, BT, CT, Platelet, PBF, X-ray Chest were normal.

So the provisional diagnosis prevailed as the final diagnosis.

Pt responded well to prednisolone with the subsidence of bleeding tendencies. Patient is still our ward waiting for more recovery.

Badrud Doza

Badrud-Doza

Emaciation and vomiting ends in the diagnosis of Diabetic Ketoacidosis

A boy of 12 years presented with vomiting of several times for 7 days. On enquiry he reported to have polyuria and polydepsia for 1 month.

His father is a NIDDDM.

On physical examination, he was found apprehended, lethargic and emaciated. His ht is alright but the weight is less.

He was dehydrated and had mild acidotic breathing. His pulse was rapid and Bp was 90/50 mmHg. His other system was found normal.

On investigation his urine shows 4+ glucose. His random blood sugar was found 298mg/dl. Fasting blood sugar was 228 mg/dl.. In blood gas analysis PH was 7.18 and HCO3 was 19, pCO2, pO2, SaO2 were und normal, in serum electrolytes Na was 133 mmol/L and K 3.6 mmol/L, others optimum. Serum creatinn was found normal . His urine for ketone bodies was positive.

The case was diagnosed as a case of Diabetic Ketoacidosis.

The patient was given fluid, Insulin, potassium, antibiotic and diabetic diet.

Patient after becoming stable , transfer under care of a diabetologist.

Badrud Doza