皮膚科および皮膚科疾患ジャーナル

The congenital melanocytic nevi (CMN) are very rare, hyper pigmented macular lesions formed by overgrowth of the melanocytes and melanoblasts. This exists since birth and also named as bathing trunk, coat sleeve or stocking nevi. They occur in less than 1% of the neonates in any site of the body but commonly occur over the trunk and thigh areas. The giant congenital nevus is greater than 20 cm in size, pigmented and often hairy. Here, we are discussing a classical case of large congenital melanocytic nevus presented over right part of torso, lower limb, lower back and buttocks, with multiple satellite lesions all over body with right lower limb hypotrophy. The diagnosis was confirmed by histopathology. Apart from the rarity of the disease, this case report highlights the rare association of CMN with hypotrophy of limb.

Systemic Lupus Erythematosus (SLE) is an autoimmune multisystem disease that predominantly affects the skin with diverse presentation and complications. We are reporting this case because of the distinctive presentation of a common disease. In our knowledge this is the first case report of such presentation of lupus erythematosus from world.

Background: Early restoration of patency of infarct related artery is a universally accepted goal in the treatment of acute myocardial infarction. These could be achieved by Primary PCI or fibrinolysis. Primary PCI is preferred reperfusion strategy over fibrinolysis. Identifying initial area at risk in patients with acute myocardial infarction had been shown to have a direct impact on patients adverse clinical outcomes as well as prediction of systolic dysfunction. Area flow index (AFI) calculation in patients with acute myocardial infarction may predict initial area at risk during primary PCI.
Aim: To investigate the clinical utility of Area flow index to predict systolic dysfunction and adverse clinical outcomes in patients with acute anterior ST elevation myocardial infarction Patients: 250 consecutive patients with acute anterior ST elevation myocardial infarction treated with primary PCI presenting to Alexandria main university hospital and ICC hospital from June 2013 till December 2014. Methods: Echocardiographic assessment of LV systolic function 5-7 days after myocardial infarction by calculation of ejection fraction using modified simpson method. Area flow index was calculated by dividing culprit segment cross sectional area to total coronary cross sectional area. Where DC is the culprit segment diameter, D1 left anterior descending diameter, D2 left circumflex diameter, D3 right coronary diameter. All patients were followed one month for the occurrence of MACE. Results: Patients were grouped according to their ejection fraction following myocardial infarction into 3 groups: -Group I: severe LV systolic dysfunction EF <30%. -Group II: moderate LV systolic dysfunction EF 30-45%. -Group III: mild LV systolic dysfunction EF>45% There was a significant negative correlation between AFI and LVEF (r=-0. 58, P<0. 001). The mean AFI for patients in group I was 33. 1 ± 7.4, patients in group II was 26. 6 ± 7.4, and those in group III was 20.0 ± 6. 1. AFI>28.4% had a 75.6% sensitivity and 78.1% specificity in predicting severe LV systolic dysfunction. Also the composite one month MACE was higher in the group with AFI>28.4% (p<0. 001).
Conclusion: Area flow index calculated from coronary angiography at time of primary PCI is a new strong independent predictor of LV systolic dysfunction and 1month MACE in patients with acute anterior myocardial infarction.

According to our knowledge, the case reports about the Suicide behaviors in patients with vitiligo and obesity are rare. The chronic diseases like vitiligo and obesity are two risks factors that may have a synergistic effect for hopelessness and suicide ideation and attempt. The skin is the outer covering of the body and face, and the defects in skin can cause some psychological problems. Two sisters with vitiligo and obesity were referred to psychiatrist. They were depressed, hopeless and helpless with recent and previous history of suicide attempt. Psychiatrist started psychotherapy, counseling and pharmacotherapy, but, the therapeutic response was poor.