Chemotaxis and umbilical separation

Urachal duct remnant-like umbilical clear cell acanthoma in an infant: an unusual presentation and pitfall in clinical practice

BACKGROUND

Although an umbilical nodule is common in neonates and young infants, an umbilical nodule of poor therapeutic response will increase the likelihood of other uncommon etiology. Clear cell acanthoma (CCA) has never been described as an oozing umbilical nodule on infants.

METHODS

To present a case of CCA which occurred on an 8-month-old female infant presenting with one weeping nodule on the umbilicus since early neonate. The lesion underwent skin biopsy and subsequent hematoxylin-eosin and periodic acid-Schiff staining.

RESULT

Three courses of liquid nitrogen cryosurgery were performed after the diagnosis of CCA was confirmed. The lesion resolved rapidly.

CONCLUSION

This report presents the first and youngest case of umbilical CCA in the English literature. This case supports the inflammatory dermatosic nature of CCA.

History and implications of the neutrophil glycoprotein deficiencies

This review focuses on the initial clinical descriptions and subsequent investigation of the syndrome of recurrent infections associated with neutrophil membrane glycoprotein deficiencies. Characterization of the missing group of three glycoprotein heterodimers and their role in adhesion-related neutrophil function is summarized. Study of the clinical consequences of these genetically determined membrane glycoprotein defects has also contributed to the understanding of the role of normal neutrophils in both host defense and host tissue damage.

The time of separation of the umbilical cord

The time of separation of the umbilical cord was studied in 911 neonates. The mean time of separation was 7.4 days (SD 3.3, range 1-29 days). We sought a possible relationship between the time of cord separation and various factors in the perinatal period. Cord separation was delayed when antibiotics needed to be administered to the neonate because of sepsis, when the infant was born prematurely, delivered by Caesarean section or had a low birth weight. The cord separated slightly earlier in female than in male infants. None of the infants studied suffered from omphalitis and it would appear that "delayed" separation of the cord is not always necessarily accompanied by severe leucocyte dysfunction.

Delayed separation of the umbilical cord, severe widespread infections, and immunodeficiency

Three of 4 children in a family died from infection before age one year. All 3 had delayed separation of the umbilical cord in the third week. One child was found to have defects both in specific antibody production and in neutrophil function; these were not improved by treatment with ascorbic acid or levamisole.