How I explore.... The small intestine using double-lumen enteroscopy

A 14-year 4-month-old boy sustained a triplane fracture of the distal radius. Reduction and maintenance of reduction were achieved by closed manipulation and cast. The triplane fracture can occur in areas other than the distal tibia and distal humerus and can be successfully treated nonoperatively.     

Localization of vitamin A in the small intestine of mouse. An electron microscope radioautographic study

Localization of vitamin A in the small intestine of mice was studied with electron microscope radioautography after administration of tritiated vitamin A. The label was concentrated over lipid droplets in cells distributed in the lamina propria and the submucous layer. The cells were similar both to fibroblasts and to fat-storing cells in their morphological features. The name "Vitamin A-Storing Cell" is proposed for these labeled cells, including the fat-storing cell in the liver.     

Leiomyosarcoma of the small intestine and the colorectum. A case contribution

Smooth muscle tumors of the alimentary tract are uncommon. A retrospective study was made of 7 patients treated for leiomyosarcoma of the small and large bowel to identify prognostic factors that influence results. The symptoms associated with these tumors varied according to the anatomic sites of the lesions and the position of the growth in relation to the intestinal lumen but the most common presenting clinical signs are bleeding or obstruction. The differential diagnosis between benign and malignant smooth muscle tumors is sometimes quite difficult. Clinical behavior of the myosarcomas of the gastrointestinal tract can be predicted to a large extent by the site of the tumor, the presence or absence of invasion of adjacent vital organs, and the histopathologic grade of malignancy. Although the mitotic activity of a gastrointestinal stromal tumor remains the most critical prognostic factor, tumors have been seen to recur locally and to metastasize even with rare or absent mitotic figures. Further studies are needed to pinpoint the factors that may be correlated to the prognosis.     

Endoscopic sclerotherapy versus variceal ligation in the long-term management of patients with cirrhosis after variceal bleeding. A prospective randomized study

BACKGROUND/AIMS: Long-term endoscopic injection sclerotherapy of oesophageal varices prevents rebleeding in patients with cirrhosis surviving an acute variceal bleeding episode. However, this treatment is associated with a substantial complication rate. Endoscopic band ligation is a newly developed technique in an attempt to provide a safer alternative. The aim of this study was to compare the efficacy and safety of injection sclerotherapy versus variceal ligation in the management of patients with cirrhosis after variceal haemorrhage. METHODS: Seventy-seven patients with cirrhosis who proved to have oesophageal variceal bleeding were studied. After initial control of haemorrhage by sclerotherapy, 40 of the patients were randomly assigned to sclerotherapy and 37 to ligation. Both procedures were performed under midazolam sedation at intervals of 7-14 days until all varices in the distal oesophagus were eradicated or were too small to receive further treatment. RESULTS: The eradication of varices required a lower mean number of sessions with ligation (3.7 +/- 1.9) than with sclerotherapy (5.8 +/- 2.7, p = 0.002). The mean duration of follow-up was similar in both groups (15.6 months +/- 7.3 and 15 +/- 7.4, respectively). The proportion of patients remaining free from recurrent bleeding against time was significantly higher in the ligation group as compared to the sclerotherapy group (chi 2 = 3.86, p = 0.05). Only 13 patients (35%) developed complications in the ligation group as compared to 24 (60%, p = 0.05) in the sclerotherapy group. The mortality rate was similar in both groups (20% and 21%, respectively). CONCLUSIONS: Variceal ligation is better than sclerotherapy in the long-term management of patients with cirrhosis after variceal haemorrhage which was initially controlled with sclerotherapy.     

Acceleration of small intestine contrast study by ceruletide

The effect of ceruletide on the small bowel transit time of barium sulfate suspension was studied in 165 patients. The control group consisted of 115 cases. An intramuscular injection of 500--750 ng/kg body weight ceruletide was given in 106 cases (group A), 20 ng/kg ceruletide was intravenously injected in 35 patients (group B), and 40 ng/kg was intravenously injected in 24 cases (group C). The mean transit time in group A was 62 +/- 41 min (mean +/- SD), and 126 +/- 62 min in the corresponding control group of 83 cases. (P less than 0.001). The mean transit time in group B was 65 +/- 50 min, and 69 +/- 56 min in group C, whereas in the corresponding control group of 32 cases the mean transit time was 137 +/- 79 min (P less than 0.01). A normal radiographic pattern was found in 75%, and slightly increased segmental contractions in 21%. Overtonicity and pronounced segmental contractions were seen in 4%. The recommended standardized small bowel study using ceruletide reduces the examination time by roughly one-half and produces simultaneous and uniform opacification of the jejunum and ileum.     

Chrysotherapy. A prospective study

A 4-year prospective clinical study of chrysotherapy was designed to reexamine old beliefs and traditions, and to test potentially new approaches to chrysotherapy. The standard weekly dosage of 50 mg was compared to that based on 1 mg/kg body weight; no significant differences were found. The rapidly absorbed aqueous thiomalate was compared to the slowly absorbed oil repository thioglucose; the latter produced significantly less side effects and an appreciably higher percentage of improvement. Almost half (43%) of nonresponders on standard regimen had a satisfactory clinical response at higher dosage levels without increase in toxicity. Some of these findings vary so much with traditional beliefs and practices that the authors urge caution in their interpretation. But generally speaking these problems are technical and do not detract from the conviction that chrysotherapy is valuable and comparatively safe in the management of rheumatoid arthritis and that it deserves more widespread application in clinical practice.     

Vaginal rupture with prolapse of the small intestine

We report on a case of recidival rupture of an enterocele with vaginal rupture and incarceration of small bowel. This event was probably caused by an extreme insufficiency of the patient's connective tissue. In literature four similar cases have been reported.     

Unusual anomaly of the small intestine with malabsorption

Malabsorption as a complication of anatomic congenital anomalies of the small bowel is uncommon. In this case, malabsorption syndrome in infancy, with features suggestive of coexisting disaccharide intolerance and blind loop syndrome, was the major clinical presentation of a combined anomaly, consisting of a large saccular dilation of the ileum containing heterotropic gastric mucosa, and an adjacent small intramesentric cyst partially lined by small bowel epithelium. Prompt reversal of metabolic and nutritional abnormalities followed surgical resection.     

Ganglioneuroma of the small intestine

The ganglioneuroma is a rare, benign tumor of the small bowel. The clinical symptomatology and morphology of the tumor are presented in detail. The differences in histopathology between ganglioneuroma and eosinophilic granulomatous polyp are discussed. Therapy should be resection of the tumor.     

Surgery of the small intestine

Although earlier reports describe a poor prognosis for small intestinal surgery in the horse, there is growing evidence that the short-term survival rate can exceed 80%. In addition to advancements in surgery and aftercare, early referral contributes considerably to the improved prognosis. Surgical procedures that restore anatomic and physiologic continuity to close to normal can minimize postoperative complications. Jejunojejunostomy carries a better prognosis than jejunocecostomy, probably because the latter involves anastomosis between two intestinal segments with dissimilar functions. Careful technique can reduce the prevalence of complications, such as postoperative ileus and serosal adhesions.     

Perforations of the small intestine

Six cases of perforation of the small intestine, one secondary to anaphylactoid purpura and five spontaneous, are reported. Ingestion of an iced drink acted as a trigger in two cases. A vascular genesis is put forward to explain the aetiopathogenesis of two cases and it is noted that perforation of this type is present in the final ileal ansa, at the mesenterial margin. In three cases, histology revealed the presence of double refraction crystal. These came from vegetal residues and are probably capable of penetrating from the lumen into the mucosa causing a foreign body reaction, abscess and subsequent perforation. In these cases, perforation occurred in an ansa located further away than the last ileal ansa (about 3 m) and on the mesenterial margin. Intestinal resection and subsequent end-to-end, single layer anastomosis were performed in all cases.     

Critical study of electric activity of the small intestine in the dog

Thanks to a cross-circulation, the authors caused to survive in the abdomen of a sacrificed dog, the whole of the small intestine, the motor activity of which was analysed by electro-enterography. This experimental preparation thus eliminates polygraphic recordings of all potential variations outside the small intestine, e.g. stomach, colon, diaphragm, muscle, myocardium. One thus obtains very pure tracings of the variations of potential originating in the small intestine, recorded from bipolar serous intestinal electrodes, they show the activity of the small intestine, consisting of a permanent basal electric rhythm on which are grafted spikes contemporary of motor phenomena. In the abdominal skin there were recorded only a cutaneous slow wave which was contemporary with the deep motor phenomena.     

Bleeding fibroma of the small intestine

A case of serious, recurrent enterorrhagia is reported. The cause could not be identified with normal diagnostic tools and was discovered only after explorative laparotomy. The finding was benign ulcerated tumour of the small intestine, histologically defined as fibroma with fluorishing cellularity.     

Primary adenocarcinoma of the small intestine

Eighteen cases of primary adenocarcinoma of the small intestine have been reviewed, which demonstrated the relative frequency of symptoms common to this disease. The clinical features, pathology, and treatment of small bowel adenocarcinoma have been presented and the literature reviewed.     

Nontraumatic perforations of the small intestine

Nontraumatic perforation of the small intestine is very rarely found as a cause of abdominal disease. A series of 8 patients admitted to our hospital from 1990-1994 was reviewed. Underlying conditions were typhoid ulcers, (two patients), adhesions (two patients), hemorrhagic ileitis, (one patient), radiation enteritis (one patient) and SLE (one patient). The cause remained unclear in one patient (idiopathic). As surgical therapy, resection and anastomosis were preferred in order to make thorough histologic examination of the perforated bowel possible. One anastomosis leakage with spontaneous closure was observed. There was no operative mortality.     

Malignant tumors of the small intestine

Primary malignant tumors of the small intestine are uncommon. The average annual incidence rate over a period of 30 years in Saskatchewan was 0.7 and 0.6 per 100,000 for male and females, respectively. The 209 patients who comprise the series represent 1.6% of the total number who had gastrointestinal cancers over the same period. The distribution of the tumors by site and histologic type is described. Both carcinoid and adenocarcinomatous tumors of the small intestine are associated with a high incidence of primary malignant neoplasms in other sites (17.0 and 20.3%, respectively). One patient with Peutz-Jeghers syndrome is of interest because of the malignant change which occurred in more than one of the small bowel polyps and because of consequent liver metastases. The reason for the poor prognosis in noncarcinoid small bowel malignant neoplasms is probably due to late diagnosis. The five-year disease-free survival in these tumors was 22.5%. Malignant carcinoids had a better overall five-year survival rate of 64%. For those confined to the bowel wall, the five-year survival rate was 73%, compared to 59% for those extending to nodes or metastasizing to distant organs.