Small intestinal dysmotility following abdominal irradiation in the rat small intestine

Abdominal symptoms such as diarrhoea, abdominal cramps and vomiting are common during and after abdominal radiotherapy for gynaecological and pelvic malignancy. It has recently been recognized that small intestinal dysmotility may contribute to these symptoms but the underlying mechanisms are unclear in part because of the technical difficulties inherent in performing studies in irradiated small intestine. The aim of the current study was to evaluate small intestinal motor activity using perfused micromanometric techniques in 6-8-cm segments of ileum during arterial perfusion with isotonic oxygenated fluorocarbon solution. Intestinal segments from six rats were studied 4 days after treatment with 10 Gy abdominal irradiation. Ileal segments from nine nonirradiated animals acted as controls. For each experiment the total number of pressure waves, high-amplitude (> 20 mmHg, long-duration > 6 sec) pressure waves, and long (> 20 associated) bursts of pressure waves were determined. Irradiation had no effect on the overall number of pressure waves, but increased high-amplitude long-duration (HALD) pressure waves (248 vs 7, P < 0.01). In control animals HALD waves were localized to a single recording site but after radiotherapy 74% of HALD waves were temporally associated with similar pressure waves in other manometric channels. Forty-seven per cent of associated HALD waves migrated aborally. Retrograde migration of HALD waves was seen in five segments following irradiation. Irradiation abolished bursts of > 20 pressure waves.     

The effects of sodium ricinoleate on small intestinal function and structure

The mechanism of hydroxy fatty acid-induced secretion was investigated in perfused hamster small intestine in vivo. Sodium ricinoleate at an 8-mM concentration resulted in not only secretion of water and sodium, but an increase in intestinal clearance of inulin and a 16,000 mol wt dextran as well. A concentration of ricinoleate (2 mM) which did not affect water transport, however, did not alter intestinal permeability. Ricinoleate-induced intestinal secretion was also accompanied by increased mucosal cell exfoliation as measured by the appearance of DNA in the perfusate and by apparent injury to epithelial cell membranes as judged by measurement of sucrase activity and phospholipid in cell-free aliquots of luminal fluid. Light and electron microscopic studies demonstrated substantial mucosal architectural changes with 8 mM ricinoleate with villus shortening and injury to epithelial cells at the villus tips. In contrast, cholera enterotoxin caused marked secretion of sodium and water, presumably by a cyclic AMP mechanism, but did not alter inulin clearance or enhance DNA or sucrase appearance in the lumen. These studies suggest that at least a component of ricinoleate-induced intestinal secretion is related to structural alterations of the mucosa.     

Long-term results of short segmental syngeneic small intestinal transplantation: comparison of jejunal and ileal grafts

A short-segment intestinal graft is favorable to reduce the rate of rejection and the incidence of graft-versus-host disease in recipients of small intestine transplantation. To determine whether a jejunal or an ileal graft is preferable with respect to intestinal morphology and function, syngeneic two-step small intestinal transplantations were performed using male Lewis rats (RT1(1)). They were divided into two groups according to the small intestine donor site (group 1 received 10 cm of jejunum; group 2 received 10 cm of ileum). There was no significant difference in the survival rate or weight gain between the two groups. Nearly all the hematologic findings, serum nutritional parameters, and results of liver function tests were normal for both groups. The only difference was that the serum total bile acid level was significantly higher in group 2. Fifty weeks after transplantation, the graft mucosa showed normal architecture, with adaptive hyperplasia of villi and crypt noted through histological study. The villus height of group 1 was 595 +/- 64 microns (control, 452 +/- 67 microns); that of group 2 was 732 +/- 53 microns (control, 217 +/- 20 microns). The crypt depth of group 1 was 228 +/- 35 microns (control, 165 +/- 24 microns); that of group 2 was 320 +/- 19 microns (control, 102 +/- 19 microns). These compensatory changes were more pronounced in group 2. The authors conclude that, on the basis of long-term functional capacity, there was no significant difference between jejunal and ileal grafts, and that both segments were suitable for transplantation. However, the ileal graft was considered to be better with respect to morphological adaptation.     

Survival in small intestinal adenocarcinoma

All cases of adenocarcinoma in the duodenum (n = 263) and jejunum/ileum (n = 663), diagnosed between 1960 and 1988, were recruited from the Swedish Cancer Registry. Corrected and overall survival were investigated by sex, age and year of diagnosis with life-table and Cox proportional hazards analyses. The corrected 5- and 10-year survival rates were 39% and 37% for duodenal tumours and 46% and 41% for those in jejunum/ileum (P = 0.16 for difference between sites). The corrected 5- and 10-year survival rates were 52% and 48% for women and 40% and 34% for men with tumours in jejunum/ileum (P = 0.0095 for difference by sex) while no such relation was found in duodenal tumours (P = 0.84). Survival correlated with age at diagnosis for duodenal tumours (P = 0.03377). A Cox proportional hazards analysis revealed a temporal trend with more favourable prognosis in recent years. This study confirms that prognosis of small bowel adenocarcinoma is serious, but gives a more optimistic outlook than many hitherto published series.     

Postoperative electromyographic monitoring of small intestine function in patients with peritonitis and acute intestinal obstruction

In 49 patients with general peritonitis and acute ileus, the authors used the method of direct electromyography. On the basis of analysis of the results, the functional state of the intestine, dynamics of its motor activity, effectiveness of the treatment performed were assessed and outcome of the disease was predicted.     

Techniques of intestinal transplantation in rat

Two surgical models of intestinal transplantation in the rat are described. One is the implantation of fetal and newborn intestine as free grafts into the omentum of adult recipients, the other the adult intestine transplantation as an accessory graft using vascular anastomoses. A hundred and sixteen small-bowel transplantations were done; 36 of which were fetal intestine (group I), 40 of newborn intestine (group II), and 40 of adult intestine (group III). In the fetal and newborn intestinal transplantation, we emphasize the practices that allowed us to avoid ischemic and traumatic injury to the graft. In the adult intestine transplantation with vascular anastomoses, we heighten the modifications in the surgical technique that made the operation easier and the strategies used to prevent hypothermia and hypovolemic shock. Once experienced with the two chosen surgical techniques, transplantation using an avascular segment became much easier and quicker than transplantation with vascular anastomoses.     

Anatomic variability of rejection in intestinal allografts after pediatric intestinal transplantation

The internal mammary artery is routinely used for coronary artery bypass grafting because of its optimal long-term patency profile. This vessel can be imaged by angiography, but only the proximal tract at the origin from the succlavian artery can be imaged by conventional echography. The aim of our study was to visualize the intrathoracic course of the native and grafted internal mammary arteries by a new ultrasound equipment which allows high-resolution transthoracic color Doppler imaging of the chest wall vessels and coronary arteries. We studied 35 patients, 16 non operated and 19 operated of coronary surgery with the internal mammary artery grafted to the left anterior descending coronary artery. We used a multifrequency 3.5-7 MHz transducer with a small insonating surface, placed at the second-fifth intercostal space at the left and right sternal border, to image the native mammary arteries. The grafted mammary artery was detected at the fourth-fifth left intercostal space 2-4 cm lateral to the sternal border. The native left internal mammary artery was visualized in all 16 non operated patients, and the right internal mammary artery in 14/16 (87%). The native left internal mammary artery peak flow velocity was 41-160 cm/s (mean 81 +/- 34 cm/s), and the mean flow velocity was 28-89 cm/s (mean 45 +/- 17 cm/s). The right internal mammary artery peak flow velocity was 35-153 cm/s (mean 82 +/- 36 cm/s), and mean flow velocity was 21-82 cm/s (mean 46 +/- 22 cm/s). The grafted left internal mammary artery was visualized in 16/19 patients (84%), evaluated at 6 days to 36 months after surgery. Peak diastolic flow velocity ranged from 24 to 80 cm/s (mean 48 +/- 17 cm/s), and mean diastolic flow velocity ranged from 13 to 57 cm/s (mean 33 +/- 11 cm/s). The left anterior descending peak flow velocity distal to the anastomosis was 22-62 cm/s (mean 37 +/- 15 cm/s) and mean flow velocity was 18-53 cm/s (mean 29 +/- 12 cm/s). We conclude that transthoracic color Doppler echocardiography allows to image the native and grafted mammary arteries, with potential clinical applications in the management of patients with coronary artery disease.     

Histological and functional studies of small intestinal mucosa in intestinal tuberculosis

Twelve cases of peptic ulcer with diabetes mellitus were found in 165 hospitalized diabetics. All of them had gastric ulcer and no duodenal ulcers were found. The incidence of peptic ulcer in diabetics was comparatively higher than the previously reported series. But there was nosignificant correlation between the duration of diabetes and the onset of gastric ulcer. The gastric ulcer with poorly controlled diabetes showed more intractability than those without triopathy and well-controlled diabetes.