Cholinergic stimulation increases thrombin activity and gene expression in cultured mouse muscle

Activity-dependent synapse reduction is a major determinant of neuromuscular innervation. Previous research has shown that nanomolar concentrations of hirudin, a specific thrombin antagonist, significantly attenuates this reduction, and protease nexin 1 (PN1), an endogenous thrombin inhibitor closely localized to the neuromuscular synapse, can inhibit synapse reduction at similar concentrations. Protease inhibitors which do not inhibit thrombin, including cystatin and aprotinin, had no effect on synapse reduction. We present a series of experiments examining whether prothrombin and/or PN1 gene expression, as well as thrombin activity, are regulated in muscle cultures by acetylcholine (ACh) receptor activation. We also studied the effect of exogenous thrombin on synapse elimination in co-cultures of muscle and cholinergic neurons. Cultured muscle cells were electrically blocked with tetrodotoxin (TTX), or co-treated with ACh in order to isolate ACh receptor activation. Electrical blockade resulted in a decrease in thrombin release to about two-thirds of control values. The application of ACh to electrically blocked muscle cultures resulted in a 2.5-fold increase in thrombin activity released into the medium and a 2-fold increase in prothrombin gene expression. In contrast, ACh treatment in the presence of TTX had no effect on PN1 gene expression compared to treatment with TTX alone. In addition, exogenous thrombin significantly increased synapse elimination in unstimulated muscle/cholinergic neuron co-cultures. These results suggest that thrombin or a thrombin-like molecule released from muscle is required for activity-dependent synapse elimination and is regulated by neuromuscular activity.

Congenital segmental dilatation of intestine

We are reporting two cases of segmental dilatation of small intestine presenting as neonatal intestinal obstruction. Clinco-pathological features, etiology and management are discussed in brief.

Endodermal sinus tumour of cervix--case report

Endodermal sinus tumor of Cervix is an extremely rare cause of vaginal bleeding. Because of its rarity and interesting features, it is reported with a brief review of literature.

Transanal and intraperitoneal prolapse in intussusception

An infant with intussusception who developed an unusual complication of transanal and intraperitoneal prolapse is reported. Complete venous occlusion of the intussusceptum for a prolonged period in a patient with congenital anomalous vascular supply of the colon is suggested as a mechanism responsible for rupture of the intussuscepiens.

Successful management of late presentation neonatal oesophageal atresia with distal tracheo-oesophageal fistula and significant pulmonary complications

The successful management of a neonate presenting with oesophageal atresia and a distal tracheo-oesophageal fistula on the twelfth day of life is described. This case is the most delayed diagnosis associated with survival known to have been reported. There were significant pulmonary complications at presentation and initial treatment was by gastrostomy under local anaesthesia, followed by a delayed primary repair.

Recurrent abdominal pseudocyst after ventriculoperitoneal shunt

A child with recurrent intra-abdominal pseudocyst following ventriculoperitoneal shunt is reported. Peritoneal tuberculosis was the most probable aetiology in this case.

Prone cross-table lateral view: an alternative to the invertogram in imperforate anus

The prone cross-table lateral radiograph provides equal or sometimes better information, compared to the invertogram, for demonstration of the level of rectal atresia in neonates. Easy positioning, better cooperation of the patient, elimination of the effect of gravity, and better delineation of the rectal gas shadow are the advantages of the prone lateral view. Among the 45 cases compared, equal findings were noted in 37, but in eight babies the level of rectal atresia was more caudal in the prone radiograph than in the invertogram.

Lymphangiomas in children

The records of one hundred and five children with lymphangiomas seen over a period of 12 years are presented. There were 6 boys and 38 girls. In 50% of the cases the lesions were noticed at birth. The neck was the commonest site of the lesion. Abdominal lymphatic cysts were next common in frequency, followed by the axilla. Rare sites such as the retroperitoneum, orbits, scrotum and larynx were occasionally found to be involved. Complete surgical excision could be achieved in 70 cases, while in 19 cases only partial excision could be done because of the extension of the lesions to inaccessible areas. The pathogenesis, clinical presentations and management of this condition are discussed, and three rare cases with interesting presentations are reported.

Biliary peritonitis following blunt abdominal trauma in children. Report of a case

Bile peritonitis, following blunt abdomen injury to the biliary tract, is not a very common condition. The clinical features, however, are typical, the treatment is delayed due to the quiescent interval between the symptoms. The operative treatment is simple draining of the area of perforation and the site of the collection of bile. A catheter in the gallbladder is helpful in assessing the stoppage of the leak and the restoration of biliary drainage. The prompt surgical treatment on diagnosis has good prognosis.

Neonatal duodenal obstruction

The records of 40 infants with intrinsic duodenal obstruction have been reviewed. Of these more than half had no bile in the vomit. Persistent vomiting had been considered as the major factor of doubt regarding duodenal obstruction. The incidence of other associated congenital abnormalities was 70%. The over all mortality rate was 42.5%. The association of mongoloidism to the intrinsic duodenal obstruction was found approximately in every third infant. The low birth weight without other congenital abnormality has very little effect on the mortality rate.

Partial duodenal obstruction in presence of complete rotation of the colon

Two children were admitted with partial obstruction of the duodenum due to its incomplete rotation and fixation. The colon in both cases was rotated normally. Our experience with these children, along with embryological evidence to understand the above entity, is presented.