Imperforate anus with congenital short colon (pouch colon syndrome)

There have not been many case reports of imperforate anus with congenital short colon (pouch colon syndrome). On the Indian subcontinent it is a commonly encountered entity in high ano rectal anomalies. Eighteen cases of pouch colon syndrome were treated in a period of 2 1/2 years, which constituted 26.08% of all high anorectal anomalies. All patients were male and the invertogram was diagnostic in all cases. Associated congenital malformations were common. Most of the patients were in poor general condition at the time of admission. Post-operative pulmonary complications and septicaemia were common. Pouch colostomy was performed in all cases. In the immediate post-operative period 44.44% of all patients died. A pull-through colonorraphy was done as a definitive procedure in 1 case.     

Haemangioendothelioma maxilla

Haemangioendothelioma of maxilla, a tumour of rare occurrence is seldom encountered in clinical practice. Primary sites of haemangioendothelioma are mammary gland, liver, bones, striated muscles, pleura, uterus, orbit, skin and subcutaneous tissues. There may be additional primary site like, tonsil and central nervous system. The malignant nature of this tumour is fully confirmed by the outcome of cases in this group. Most of the patients died with metastasis and with local persistence of disease. It is suggested that possibibility of haemangioendothelioma of maxilla should be kept in mind whenever there is no apparent lesion in nose and nasopharynx, in case, severe unilateral epistaxis occurs, before undertaking any surgery.     

Tubular cell-Escherichia coli interaction products modulate migration of monocytes through generation of transforming growth factor-beta and macrophage-monocyte chemoattractant protein-1

BACKGROUND: Urinary tract infection is a common occurrence often associated with renal interstitial inflammation in the form of accumulation of mononuclear cells. We hypothesized that bacteria activate tubular cells to secrete cytokines, which may promote migration of mononuclear cells at the site of interaction. MATERIALS AND METHODS: We evaluated the migration of monocytes in response to tubular cell products (TC-S) and interaction products of E. coli with proximal tubular cells (TC-EC-S; concentrations of 5%, 10%, and 25%) using a modified Boyden chamber. To determine the molecular mechanism, we evaluated the effect of antibodies against macrophage-monocyte chemoattractant protein-1 (MCP-1) and transforming growth factor-beta (TGF-beta) on E. coli-tubular cell interaction product-induced migration of monocytes. In addition, we studied the effect of free-radical scavengers on activation of tubular cells. RESULTS: The TC-EC-S enhanced (p < 0.0001) migration of monocytes compared with TC-S. Both anti-TGF-beta and anti-MCP-1 antibodies partly inhibited (p < 0.0001) TC-EC-S-induced monocyte migration. The modified TC-EC-S (produced in the presence of superoxide dismutase [SOD], dimethyl thiourea [DMTU], or catalase, all scavengers of free radicals) induced lesser monocyte migration than did TC-EC-S alone. CONCLUSIONS: These results suggest that E. coli activates tubular cells to generate cytokines such as MCP-1 and TGF-beta that promote migration of monocytes. Free radicals such as superoxide and hydrogen peroxide may be acting as second messengers in E. coli-induced tubular cell activation.     

Morphine-induced macrophage apoptosis modulates migration of macrophages: use of in vitro model of urinary tract infection

BACKGROUND: Morphine has been reported to alter immune function. Morphine-induced macrophage apoptosis has been shown to contribute to altered immune status in an opiate milieu. We studied the effect of morphine-induced macrophage apoptosis on the migration of macrophages. Because urinary tract infection (UTI) is one of the commonest infections to evoke an inflammatory response; i.e., migration of neutrophils and monocytes to the site of infection, we used an in vitro model of UTI to test our hypothesis. MATERIALS AND METHODS: We carried out both in vivo and in vitro studies. Mice of the FVB/N strain were treated with morphine for short (three doses, 24 hours) and long (11 doses, 96 hours) durations, and their bone marrow cells were isolated. In addition, apoptotic macrophages were prepared by heat treatment. To simulate the in vitro model of UTI, E. coli-activated tubular cell (TC)-conditioned medium containing transforming growth factor-beta (TGF-beta) and macrophage-monocyte chemoattractant protein-1 (MCP-1) was used to test migration of macrophages across a filter in a modified Boyden chamber. In addition, migration of macrophages into the peritoneal cavity was evaluated in both control and morphine-treated states. The effect of morphine on apoptosis as well as migration was studied in murine macrophages and bone marrow cells. RESULTS: Morphine not only promoted apoptosis of bone marrow cells (20% apoptotic cells) but also inhibited their migration across the filter. Control cells showed minimal apoptosis but displayed greater migration. Similarly, heat-treated (apoptotic) cells showed minimal migration. In peritoneal macrophage studies, morphine treatment retarded migration. CONCLUSION: Morphine inhibits macrophage migration both in vivo and in vitro. This attenuated transmigration of macrophages seems to be secondary to the apoptotic effect of morphine.     

Body composition in early onset eating disorders

BACKGROUND: Body mass index (BMI) or equivalent weight for height indices are the most widely used measures of body composition in early onset and adolescent eating disorders. Although of value as screening instruments the limitation in disease states is their inability to discriminate fat and fat-free components of body weight. OBJECTIVE: To compare height-adjusted fat and fat-free components of body composition in children and young adolescents with different types of eating disorders with those of age matched reference children. DESIGN: Weight, height, triceps and subscapular skinfold thickness were measured in 172 children (aged 7-16 y) with eating disorders receiving specialist treatment. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated using Slaughter's and Deurenberg's equations and normalisation for height. Using data from 157 normal children, representative of the UK 1990 growth reference data, reference curves for FMI and FFMI+/-2 s.d. were derived. Results for patient groups were superimposed on these reference curves. RESULTS: FMI and FFMI were both reduced in eating disorders associated with malnutrition, including anorexia nervosa (AN). AN subjects did not differ from other subjects with comparable degrees of malnutrition. Children with eating disorders of normal weight, such as bulimia nervosa and selective eating, did not differ significantly from reference children in their relative FM and FFM. CONCLUSIONS: FM and FFM merit independent consideration in disorders of malnutrition in children, rather than expressing data as percentage body fat or percentage BMI. The implications of loss of FFM on growth and development merit further investigation.     

Energy intake and resting metabolic rate in preschool Jamaican children with homozygous sickle cell disease

BACKGROUND: A relative energy deficiency consequent to a high resting metabolic rate (RMR) may contribute to growth impairment in persons with homozygous (SS genotype) sickle cell disease (SCD). The growth deficit in SCD emerges at an early age, but few studies have addressed the adequacy of energy intake relative to RMR in young children. OBJECTIVE: Our objective was to test the hypothesis that energy intake relative to RMR is lower in children with SCD than in control subjects. DESIGN: The dietary intake of 41 children with SCD and 31 control subjects with a normal hemoglobin genotype (AA) aged 3-6 y was assessed by weighing all food consumed during 3 d. RMR was determined with the use of indirect calorimetry. RESULTS: The RMR in the children with SCD ( +/- SD: 5.47 +/- 0.93 MJ/d) was higher than that in the control subjects (5.19 +/- 1.3 MJ/d) after adjustment for sex and weight (P = 0.04). Energy intake did not differ significantly between the 2 genotype groups. The ratio of energy intake to RMR was lower in the children with SCD ( +/- SD: 1.13 +/- 0.33) than in the control subjects (1.35 +/- 0.38) after adjustment for sex and weight (P = 0.005). CONCLUSIONS: Prepubertal children with SCD fail to compensate for their higher RMR by increasing their energy intake. This observation is consistent with a hypothesis of a relative energy deficiency in SCD.     

Early nutrition and leptin concentrations in later life

BACKGROUND: Formula feeding or overweight in infancy may increase the later risk of obesity, but the mechanisms involved are uncertain. Because obesity is associated with high leptin concentrations relative to fat mass, programming of leptin concentrations may be one mechanism by which early nutrition influences later obesity. OBJECTIVE: We tested the hypothesis that high nutrient intake or formula feeding in infancy programs greater leptin concentrations relative to fat mass in later life. DESIGN: Serum leptin concentrations were measured by radioimmunoassay in 197 adolescents aged 13-16 y who were born preterm and randomly assigned at birth to receive either a nutrient-enriched preterm formula or banked donated breast milk (trial 1) or a preterm formula or a standard formula (trial 2). Fat mass was estimated with the use of bioelectrical impedance analysis. RESULTS: After combining the results of trials 1 and 2 as planned, the ratio of leptin to fat mass was significantly greater in the children who received the preterm formula (geometric : 0.84 microg x L(-1) x kg(-1)) than in those who received standard formula or banked breast milk (0.62 microg x L(-1) x kg(-1); mean difference: 30.8%; 95% CI for difference: 8.4%, 53.2%; P = 0.007). The difference between the diet groups remained significant after adjustment for age, sex, Tanner stage, social class, and fat mass. Human milk intake was significantly associated with lower leptin concentrations relative to fat mass in adolescence (P = 0.023), independent of potential confounding factors. CONCLUSION: Programming of relative leptin concentrations by early diet may be one mechanism that links early nutrition with later obesity.     

Civilian firearm injuries in head and neck

Firearm injuries to the head and neck contribute to substantial medical, medicolegal, economic as well as social problems. Internal wounds in the head and neck by firearms are usually complicated and are diagnostically and therapeutically challenging cases. Based on four cases of non-fatal firearm injuries, we discuss problems related to firearm wounds, their irregular path, final lodgment of the bullet and their diagnostic and therapeutic consequences. In the present study it was observed that a fatal looking firearm injury can result in a favourable and interesting outcome.