UDP-glucuronosyltransferases in human intestinal mucosa

While UDP-glucuronosyltransferases (UGTs) are known to be expressed at high levels in human liver, relatively little is known about extrahepatic expression. In the present study, UGT2B family isoforms involved in the glucuronidation of steroid hormones and bile acids have been characterized in microsomes prepared from jejunum, ileum and colon from six human subjects. Glucuronidation of androsterone and testosterone was highly significant and increased from proximal to distal intestine. In contrast, hyodeoxycholic acid was glucuronidated at a low level in jejunum and ileum and activity was barely detectable in colon. No significant glucuronidation of lithocholic acid was found. Small phenols were glucuronidated with much lower activity than found in liver. High levels of UGT protein were detected with polyclonal anti-rat androsterone- and testosterone-UGT antibodies, whereas UGT2B4, a major hepatic hyodeoxycholic acid-specific UGT, was undetectable using a highly specific anti-human UGT2B4 antibody. Screening for RNA expression by RT-PCR confirmed the absence of UGT2B4 and UGT1A6 and showed expression of UGT2B7, a hepatic isoform shown to glucuronidate androsterone, in all intestinal segments. To our knowledge, the presence of functional androsterone and testosterone directed isoforms in human intestine is a novel finding which supports the idea that the intestinal tract functions as a steroid-metabolizing organ and plays a significant role in steroid hormone biotransformation.     

Parenteral nutrition in postoperative period

Results of surgical procedures in malnutrished patients are worse than in well-nutrished patients. Perioperative nutritional treatment lead to diminished percentage of postoperative complications and mortality. Authors presents the influence of early postoperative enteral nutrition in 35 malnutrished patients on body composition and anthropometrical and biochemical parameters of their nutritional status. Results shows that enteral nutrition in postoperative phase can decrease catabolic effect of surgical treatment.     

Parenteral nutrition in oncologic patients]

A B16 melanoma-specific CD8+ T cell line (AB1) was established from the spleen cells of C57BL/6 mice cured of B16 melanoma with interleukin (IL)-12 treatment. The AB1 line exclusively used T cell receptor Vbeta11. The AB1 cells exhibited a cytolytic activity against both syngeneic B16 melanoma and allogeneic P815 mastocytoma, whereas a cold inhibition assay revealed specificity of the AB1 cells against B16 melanoma. Their lostability to kill a class I loss variant of B16 melanoma was restored by the transfection of H-2Kb gene. In addition, their interferon (IFN)-gamma production was significantly suppressed by the addition of anti-H-2Kb monoclonal antibody, and RT-PCR analysis showed that the AB1 line expressed the mRNA encoding IFN-gamma, but not IL-4 or IL-10. The experiment using synthetic peptides of tyrosinase-related protein-2 (TRP-2) revealed that the AB1 cells could recognize TRP-2(181-188) peptide. Moreover, the AB1 cells showed an in vivo antitumor effect against established pulmonary metastases of B16 melanoma. Overall, these results indicate that the Tc1-type Vbeta11+ AB1 cells exert an antitumor activity against syngeneic B16 melanoma through recognition of TRP-2(181-188) peptide in an H-2Kb-restricted manner.     

A morphological study of human epipharyngeal mucosa: 10 autopsy cases

The epipharynx lies between the nasal cavity and the mesopharynx, which is behind the oral cavity. It is a conduit for respired air, contributes to the equalization of pressure within the middle ear space via the eustachian tube and is closed by the soft palate during swallowing of food and fluid. It acts as a drainage channel for the mucous secreted by the nose and the glands within the epipharynx area. Various exchanges of the epipharyngeal mucosa occur because of the function of the epipharynx. In this study, distribution of the 3 types of epithelium in the epipharynx, which are ciliated, transitional and squamous epithelium, was investigated. The specimens of the mucosa with the bony wall of the epipharynx were collected from 10 autopsy cadavers at, (6 males and 4 females, aged from 37 to 83 years). Distribution of the 3 types of epithelium differed with the type, but there was no marked difference between the right and left halves of the epipharynx. Therefore, the distribution pattern was investigated by drawing superimposed geographical schemata of the epithelia, which were confirmed histologically in all 10 cases. The results obtained were as follows. On the superior-posterior wall, the squamous epithelium was invaginated into an area of the ciliated epithelium just like islands or bands in the nasal side and the epithelia of all 3 types were mixed in the mesopharyngeal side. The lateral wall was covered with a mixture of ciliated and transitional epithelia on the nasal side from the posterior lip of the eustachian tube and with a mixture of transitional and squamous epithelia on its mesopharyngeal side. The inferior wall was covered mostly with ciliated epithelium on the nasal side and with squamous epithelium on the mesopharyngeal side from Passavant's ridge. The transitional epithelium was distributed like an island between the areas of the ciliated and squamous epithelia in the lateral wall. The clearly definite schema of the 3 types of epithelium in the epipharynx, reported by Ali, has been generally accepted. However, the 3 types appeared as a mosaic or an island in the epipharyngeal wall and their distribution pattern was different in each individual.     

Electron microscopic changes of the intestinal mucosa following truncal vagotomy

Ultrastructural changes on the mucosa of the jejunum and ileum after truncal vagotomy were studied in the dog. Tests performed 2, 3, 7 and 10 days, 2, 4, 5, 6, 7, 8 and 9 weeks as well as 4, 5, 6, 9 and 12 months after vagotomy showed no significant changes in the epithelial cells. The microvilli, smooth and rough surface endoplasmic reticulum, the free iebosomes and the terminal web area were completely intact. In some cells a swelling of the mitochondria was observed. It is concluded that vagotomy causes no such morphological changes of the intestinal mucosa which could explain postvagotomic diarrhoea.     

Reversibility of the curdlan feeding effects on the morphological structure of intestinal mucosa in rats

We reported in the previous paper that rats fed a curdlan diet showed significant increases in the weight of the cecum and its contents, a decrease in fecal wet weight, a retardation in the transit time of the gastrointestinal tract and morphological changes of the ileal and cecal mucosal surface when compared with the rats fed a cellulose diet. In the present study, we intended to learn if the curdlan effects on the morphological structure of intestinal mucosa were reversible. When rats were fed on the curdlan diet for 2 weeks followed by a cellulose diet for another 2 weeks, the cecum and cecal contents were not different from those of the cellulose group. The transit time of the gastrointestinal tract of the curdlan-followed-by-cellulose group was shorter than that of the curdlan group, whereas it was longer than that of the cellulose group. In scanning electron micrographs, the ileal villi of the curdlan-followed-by-cellulose group were normal, as in the cellulose group. However, their ileal and cecal microvilli were similar to those of the curdlan group, that is, the microvilli were crowded and more tightly packed, and some appeared to have been squeezed out. From these results, it was concluded that the effects of the curdlan feeding were only partially reversible, but the effects on the surface structure of intestinal mucosa were still sustained even after curdlan feeding of 2 weeks was discontinued. This might result from response to the high viscosity of the intestinal contents remaining after discontinuation of the curdlan.     

Early enteral nutrition in gastrointestinal surgery: a pilot study

Hot tar burns compose a unique class of thermal injury, because removal of this highly sticky compound may be very difficult without inflicting additional tissue damage. Early removal of tar facilitates assessment of the burn and improves patient comfort. Although the use of many substances for the painless removal of tar has been described, we used sunflower oil effectively in the treatment of four tar burn patients. This first report describes the practical and successful use of sunflower oil which was easily obtained from the hospital kitchen.     

Analysis of reflex changes in hepatic tissue blood flow elicited from the intestinal mucosa

The case of a 20-year-old female patient is which ileo-colic Crohn's disease developed after repeated attempts at contraceptive treatment (no rgestrel-ethinyl estradiol) had resulted in periods of diarrhea, which ceased after stopping treatment, is reported. As a consequence of the severity of the disease, after the 3rd attempt at using oral contraceptives (OCs) a partial removal of the ileum and colon had to be performed. The relation between Crohn's disease and other acute ulcerative colitis in patinets receiving OCs and the role of these drugs as a triggering factor in Crohn's disease are discussed. It is conclude d that, while their causative role is unproven, in view of studies on th e relation between pregnancy and this disease, OCs may favor the development of the disease, and intestinal disorders during OC treatment should be carefully monitored.     

Randomized trial of immune-enhancing enteral nutrition in burn patients

BACKGROUND: "Immune-enhancing" diets (IEDs) are aimed at improving outcomes in patients suffering trauma and infection. This study was conducted to evaluate a popular IED in patients suffering burn injury. METHODS: Fifty burned patients were randomized to receive either Impact (Sandoz Nutrition, Minneapolis, Minn), an IED enhanced with omega-3 fatty acids, arginine, and RNA, or Replete (Clintec, Deerfield, Ill), our standard high-protein diet. Feedings were begun within 48 hours of injury, and continued until patients supported themselves with oral intake. RESULTS: Forty-nine patients completed the study. The two feeding groups did not differ with respect to age, burn size, incidence of inhalation injury, or the quantity of calories and protein received. There were no differences between groups in mortality, length of hospitalization, hospital charges, days of ventilator support, or incidence of complications. Patients with inhalation injuries required more ventilatory support, and had longer lengths of hospitalization and higher costs. CONCLUSIONS: Administration of an IED has no clear advantages over the use of less expensive high-protein enteral nutrition in burn patients.     

Biliary sludge formation during enteral nutrition: prevalence and natural history

BACKGROUND: Total parenteral nutrition is an etiologic factor in the formation of biliary sludge. We studied whether enteral nutrition is also a risk factor for sludge. METHODS: Fifty patients with a needle catheter jejunostomy (NCJ) placed during a major abdominal operation underwent preoperative and weekly postoperative ultrasonography until NCJ feedings were discontinued (1 to 6 weeks). RESULTS: All patients were men. The mean age was 63.2 +/- 1.6 years. Fourteen asymptomatic patients (28.0%) had biliary sludge within 2 weeks of beginning enteral feedings through a NCJ. Complete ultrasonographic resolution of sludge was observed in 13 of the 14 positive patients within 1 to 2 weeks of resuming an oral diet. One patient was lost to follow-up after 14 week; a positive sonogram had persisted but the patient remained asymptomatic. During the period of observation, no other patient had signs of biliary tract disease. CONCLUSIONS: (1) Biliary sludge may form in some patients during enteral feeding with NCJ. (2) Sludge is cleared by the gallbladder once an oral diet is resumed. (3) There appears to be little risk of complications during postoperative enteral feeding.     

Adaptive changes in intestinal mucosa of the small intestine as a result of intraluminal stress

Under physiological conditions, the intestinal mucosa is the site of a delicate balance between cell proliferation in the crypt region and cell desquamation at the villus tips. This balance can be deranged by a number of endogenous or exogenous factors, oneof which is the intraluminal contents. This review discusses the effects of different modifications of the luminal milieu on the structure and function of the mucosa. Following intestinal resection or loop transposition, the contents reaching the remnant or the transposed loop differ markedly from those with which they come into contact under normal conditions. Hyperplasia without zonal transformation then develops in the experimental loop. The villi do not become wider, and changes in the strucutre of the epithelium are not observed. There are conflicting resutls in the literature concerning the enzyme activities in the individual enterocytes resulting from this hyperplasia. However, the epithelium its functionally immature, since transport capacities measured in vitro are reduced. On the other hand, the hyperplasia of the mucosa is such that absorptive capacities in vivo, when expressed in terms of intestinal length, are larger than normal. When the intestine is subjected to prolonged infusion of lactic acid, the enterocytes are damaged and increased exfoliation results. A similar result is obtained in the blind-loop syndrome, where the accumulation of bile acids and bacteria provides the stress responsible for the destruction of the enterocytes, and in non-tropical spure, where the epithelium is attacked by noxious peptides in the diet. The first consequence of the accelerated desquamation is epithelial hyperplasia without zonal transformation, though the enterocytes are damaged - in contrast to those of the resected intestine - and apparently possess reduced enzyme activities. If the application of the stress is continued, a stage is reached in which the cell proliferation does not suffice to counteract the cell loss at the villus tips. Then a zonal transformation occurs whereby, despite the lengthened crypts, the villi become shorter and wider until, in extreme cases, the mucosa is completely devoid of villi. The transport capacity in vitro and in vivo - even when expressed in terms of unit-length is reduced, and good correlations exist between the reduction in function and the diminution in surface area of the intestine. In a self-emptying blind loop, the intestine is devoid of all contact with nutritional material. Under these circumstances, hypoplasia of the mucosa develops in which the enterocytes appear unchanged, though in extreme cases they may possess reduced enzyme levels, and the absorption capacity in vivo is consequently reduced.     

Clinical effects of supplemental enteral nutrition solution in severe polytrauma

A clinical, bacteriological, serological and patho-anatomical study was carried out on 12 goats surviving the acute stage of contagious caprine pleuropneumonia (CCPP), experimentally produced with Mycoplasma capricolum ssp. capripneumoniae (M. capripneumoniae), with the major aims of investigating the chronic stage of the disease and elucidating the possibility of a carrier state beyond the acute fulminant phase. The goats were killed 9, 16, 82 or 126 days after the onset of acute clinical signs. On day 9, clinical signs included low grade fever and persistent coughing. Thereafter, only intermittent coughing was recorded. Serum titres of complement-fixing antibodies to M. capripneumoniae were high at the period of fever but dropped thereafter. Post-mortem examination showed acute fibrinous pleuropneumonia on days 9 and 16, and chronic pleuropneumonia on days 82 and 126, including sequester formations in goats killed on day 126. Mycoplasma capripneumoniae was isolated on days 9 and 16 but not on later occasions. The study showed that goats recovered from acute CCPP may have lesions for a long time thereafter but provide no evidence of a carrier state among long-term survivors.     

Percutaneous endoscopic gastrostomy and enteral nutrition in amyotrophic lateral sclerosis

Bulbar involvement in amyotrophic lateral sclerosis (ALS) is often related to a worse prognosis on account of the higher risk of pulmonary aspiration and undernutrition due to dysphagia. The aim of our study was to assess the effects of enteral feeding by percutaneous endoscopic gastrostomy (PEG) in a long-term follow-up of ALS patients. We report the results of PEG in 31 ALS patients with bulbar involvement. The patients were observed at 3-monthly intervals over a period of 2 years after PEG. All the data were compared with those obtained from a control group of 35 ALS patients who refused PEG. Mortality did not differ significantly between the two groups of patients during the first 6 months of observation, whereas after this period it was lower in the PEG group. In the patients who had had PEG, the body mass index showed a mild but statistically significant improvement after tube insertion while in the control group it decreased significantly. The findings of this study demonstrate that PEG can improve survival in elderly and young ALS patients with bulbar involvement; it enhances their quality of life and helps their integration in their social and family surroundings. We think that PEG should be included symptomatic treatment of all ALS patients with bulbar involvement from the onset of symptoms.     

Anemia and neutropenia due to copper deficiency in enteral nutrition

Although thrombomodulin (TM) in circulating blood is regarded as an indicator of vascular endothelial disorders, blood TM levels are also known to be affected by renal dysfunction. We measured plasma TM levels in primary glomerular disease (PGD) and lupus glomerulonephritis (GN) with the EIA method, and assessed the extent to which renal dysfunction and endothelial disorders contribute to plasma TM levels in these diseases. The plasma TM/serum creatinine (TM/Cr) ratio was significantly higher in lupus GN patients than in PGD patients or normal controls. A significant positive correlation was found between plasma TM and serum Cr levels in both PGD and lupus GN patients, but the slope (A) of the regression line (TM = A.Cr+B) in lupus GN patients was significantly steeper than in PGD patients. We conclude that plasma TM levels are greatly influenced by renal dysfunction, but that not only renal dysfunction but endothelial disorders may be an important determinant of increased plasma TM levels in diseases such as lupus GN.