Congenital bile duct dilatation: review of 35 cases

Thirty-five patients with congenital bile duct dilatation or choledochal cyst were seen in the General Hospital, Kuala Lumpur, during a 10-year period from 1981 to 1990. The highest incidence occured in the group less than 1 year of age. Jaundice was the commonest symptom, occuring in 69% of patients. In most it was mild and intermittent, but a small group (29%) had persistent jaundice and acholic stools. These patients were all less than 1 year of age and represented a poor-prognosis group (30% mortality). Ultrasonography was the most useful diagnostic procedure, having an accuracy of 94%.The treatment of choice was total excision of the cyst and Roux-en-Y hepaticojejunostomy. Internal drainage procedures are not recommended because of the high incidence of cholangitis and the potential for malignancy occuring in the remnant cyst later in life. Operative mortality and morbidity were uncommon, and a good prognosis can be expected on long-term follow-up. Correspondence to: H. K. Goon     

Modulatory effects of melatonin on behavior, hemolymph metabolites, and neurotransmitter release in crayfish

Melatonin affects a variety of circadian processes such as behavior and neurotransmitter release in vertebrates. Crayfish melatonin production occurs in the eyestalks, and the cycle of production may change seasonally. To date, however, melatonin's roles and mechanisms of action in crustacean physiology are unclear. We injected melatonin or saline into crayfish in scotophase and monitored activity and hemolymph glucose/lactate over 24 h in early spring. Crayfish were significantly more active in photophase versus the expected scotophase, and had concurrent glucose/lactate peaks. Melatonin reversed the activity pattern, causing a scotophase activity peak, but not the glucose/lactate patterns. This study was repeated in late summer, during which control activity and glucose/lactate levels were elevated in scotophase. Melatonin decreased the amplitude of scotophase activity and glucose/lactate, eliminating activity and glucose cycles. We also injected melatonin or saline at various times of day in early summer and monitored locomotor activity for 1 h. Controls had high activity at 1200 (mid-photophase) and 2100 h (early scotophase), and melatonin increased activity at 1200 h but decreased it at 2100 h. Melatonin also increased activity at 1500 h but not 1800 h (late photophase). Next, we examined the influence of melatonin on crayfish neurophysiology. Melatonin (10 microM) enhanced synaptic transmission at the neuromuscular junction (NMJ). The presynaptic action resulted in more vesicles being released during evoked stimulation. Our study indicates that melatonin may have a phylogenetically conserved role in the transduction of circadian information in invertebrates as in vertebrates. Behavioral and physiological effects may be mediated by modulation of central pathways, enhanced at the peripheral level via neuromodulation of the NMJ.     

The pudendal thigh fasciocutaneous flap for vaginal atresia reconstruction

Vaginal defects can either be congenital or acquired due to tumor or trauma. The reconstructions are aimed in producing a good physical and functional result with the least donor site morbidity. The pudendal thigh flap is a sensate fasciocutaneous flap based on the terminal branch of the superficial perineal artery, the continuation of the internal pudendal artery. Although various flaps have been described for vaginal reconstruction, the pudendal thigh flap offers a very attractive alternative.     

Treatment of pulmonary hemorrhage in childhood systemic lupus erythematosus with mycophenolate mofetil

Systemic lupus erythematosus is a chronic autoimmune disease of unknown etiology with multisystem involvement. Pulmonary hemorrhage is a major life-threatening manifestation in children and adolescents with systemic lupus erythematosus, as well as in adults. Treatment has traditionally been with high-dose corticosteroids, with or without the addition of cytotoxic agents. We report the response of a patient with childhood systemic lupus erythematosus with recurrent pulmonary hemorrhage to treatment with mycophenolate mofetil.