Lipoma of the small intestine as a rare cause of intestinal occlusion

Lipoma is a benign tumour of mesenchymal origin which is not frequently localized in the gastroenteric tract; in anatomopathological statistics it is less rare: this is due to the fact that it rarely reaches dimensions which warrant surgical treatment. It is usually either an occasional finding during the course of laparotomy due to other motives or is the cause of complications, as in the present case of intestinal occlusion due to ileocolic invagination, resulting in emergency surgery. As a cause of occlusion tumours of the small bowel are second in terms of incidence to adhesive factors, volvuli and hernias. Invaginations account for 2/3 of small bowel occlusions caused by up to 80% of tumours: the lipoma is the most frequent benign tumour to cause invagination in its submucous polypoid and more or less scissile form. Symptoms are not specific and this causes a delay in diagnosis. Patients are often young subjects with a history of recurrent abdominal colic and sensitivity to anti-spastic drugs so much so that in the past they were diagnosed as "chronic colic" sufferers. Sometimes the only symptom is dyspepsia, or nausea and vomiting, or occasionally abdominal distension with constipation or attacks of diarrhoea. Radiology is not of great value in the diagnosis except for indicating the possible need for emergency surgery. There are no radiological tests, with or without contrast mediums, echography, CAT or MNR which can diagnose this pathology. The decision to operate is usually triggered by the presence of a complication, but perioperative extemporary histological tests are advisable for a correct surgical approach: if the form is scissile, segmentary resection of the small bowel is necessary.(ABSTRACT TRUNCATED AT 250 WORDS)     

Active transport mechanisms in the intestinal mucosa of the small intestine and their functional disorders

The efficacy of an anion-exchange gel, Secholex, as a hypocholesterolemic agent was assessed in 46 patients in 4 different studies and the effects were compared with those of cholestyramine. All patients had severe Type II-a or II-b hyperlipoproteinemia. In short-term metabolic studies Secholex (15 g/day) and cholestyramine (16 g/day) decreased serum cholesterol levels and increased total fecal sterol output and serum methyl sterol concentration to a similar extent, but cholestyramine was more effective than Secholex in increasing fecal bile acid excretion. In crossover studies, the two drugs appeared to be equally effective in lowing serum cholesterol levels but the patients mostly preferred Secholex. Twenty patients were treated with Secholex over a two-year period. The average decrease in serum cholesterol levels from the mean pretreatment value of 406 mg/100 ml was 15% during the first year, and 13% during the second year. In 5 patients the serum cholesterol was permanently lowered by more than 20% (good responders), while in 7 patients the average reduction of serum cholesterol level during Secholex administration was less than 10% (non-responders). The serum triglyceride level was slightly decreased by Secholex in Type II-b patients but was unaltered in Type II-a patients. At the end of the treatment period, serum iron and vitamin B12 levels were normal but the serum folic acid concentration was reduced in eight of 20 patients. A dose--response study indicated that a similar cholesterol-lowering effect was obtained with daily doses of 9 and 15 g of Secholex. It is concluded that Secholex is a relatively safe drug which effectively reduces serum cholesterol levels in two-thirds of patients with severe hypercholesterolemia.     

Metastasis to the small intestine of malignant melanoma as a rare cause of intestinal hemorrhage

This is the case report of a 63 year old female patient, who was admitted to the hospital due to an unexplained anemia. A malignant melanoma of the cheek was excised four years previously (stage II, Clark level V, TNM classification: pT4, pNl, MO), followed by chemotherapy. By x-ray and CT examination an intestinal malignant growth was assumed. Laparotomy revealed a metastasis of the malignant melanoma, situated in the middle of the jejunum as cause of the occult bleeding. Complete resection of the tumor was successfully carried out. A second look laparotomy one year later revealed no further tumor growth in the abdominal cavity.     

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.     

Metastasis of malignant melanoma of the nasal mucosa to the small intestine

Malignant melanoma of the mucous membranes is rare and has a very poor prognosis. When localized in the nose, the tumor becomes apparent late in the course of the disease with nasal obstruction and epistaxis. Distant metastases are uncommon, but any organ of the body can be involved. A case of a malignant melanoma of the nasal mucosa with metastasis to the small intestine is presented, and the natural history of the metastatic disease is discussed.     

Morphological picture of the mucosa of small intestine in children with food allergy

40 children aged from 1 to 8 years with failure to thrive, suspected of food allergy were examined. In the small intestine biopsy, normal mucosa or atrophy of intestinal villi of various intensity were found. Eosinophilic infiltration in the submucosa was present. In children over the 3rd year of life, "prick" skin test was performed, confirming polyallergy. Total IgE level was tested in all patients but only in 25% of children was it elevated.     

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.     

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.     

Experimental mucosal disease in cattle: changes in the number of lymphocytes and plasma cells in the mucosa of the small and large intestine

Changes in the number of lymphocyte and plasma cell subtypes were investigated in the lamina propria and in the epithelium of the small and large intestine of cattle with mucosal disease. Mucosal disease had been induced experimentally in seven out of 13 animals persistently viremic with non cytopathogenic BVD-virus by inoculation with a matching cytopathogenic BVD-virus. For comparison, six clinically healthy, persistently viremic cattle were used. IgA+, IgM+ and IgG1+ plasma cells, BoCD4+, BoCD8+ and gamma delta + T-lymphocytes, and the antigen of the cytopathogenic BVD-virus were demonstrated in tissue sections by immunohistochemistry. Distribution of cellular subtypes in the controls was consistent with data reported from non infected cattle. In cattle with mucosal disease, a decrease in the number of plasma cells which was significant for IgA+ and IgM+, but not for IgG1+ plasma cells was found in the lamina propria. The number of BoCD4+ T-lymphocytes was reduced in the small intestine, whereas their number per mm2 of mucosa was increased in the large intestine. Numbers of intraepithelial BoCD8+ and gamma delta + T-lymphocytes were severely decreased. Antigen of the cytopathogenic BVD-virus was detected predominantly in epithelial cells of the crypts. Overall there is a severe loss of effector cells which are essential components of the humoral and cell mediated immune protection of the mucosal barrier. The decrease of immunoregulatory cells in the lamina propria and epithelium may contribute to the transformation of mucosal architecture in mucosal disease.     

The roles on intraluminal oxygen and glucose in the protection of the rat intestinal mucosa from the effects of ischaemia

Rat ileal loops were subjected to 15 minutes ischaemia by clamping both mesenteric and collateral vessels, after which the functional capacity of their mucosae was assessed according to their ability to accumulate phenylalanine "in vitro". Groups of intestines were rinsed before being subjected to ischaemia. Independent and additive protective effects were observed when the rinsing buffer was oxygenated and/or when it contained glucose. Indeed, an oxygenated, glucose-containing buffer afforded full protection to the mucosa, whereas a nitrogenated, glucose-free buffer had no action.     

Early fetal development of the small intestine mucosa in cattle (Bos primigenius taurus)

Mirrors have been used to focus attention to aspects of the self (e.g., to known strategies, standards). We hypothesized that this could be important for students with hyperactivity/inattention, who typically direct attention outward to external novelty. In this study, we administered a partially solvable word puzzle to 43 middle school students, with and without hyperactivity/inattention, in the presence and absence of a mirror, counterbalanced for condition and form order. Differences between students with hyperactivity/inattention and comparisons in accuracy were found only in the no mirror condition. Furthermore, the beneficial effect of the mirror for children with hyperactivity/inattention was most pronounced for those who looked at the mirror. Findings were interpreted in terms of their potential to remedy the production deficits of these children.     

The mechanism of escape of plasma protein from small blood vessels in the mucosa of the small intestine of the rat

A study has been made in rats of the relative rates of escape of plasma protein, measured by accumulation of Evans Blue, and of the large marker particle, HgS, into uninjured small bowel and into an area of intradermal injection of histamine. The rate of escape of Evans Blue, per unit mass of tissue, into small bowel and into an area of histamine-stimulated skin were found to be almost the same, but leakage of HgS into the bowel was only about 1/10 of leakage of the same tracer into a site of intradermal histamine injection. If it be assumed, as is generally accepted, that all the protein that leaks from histamine-stimulated vessels does so via gaps in vascular endothelium that are large enough to allow escape of large marker particles like HgS, these findings show that only a small fraction of the protein that leaks into normal intestinal mucosa can escape via gaps, and that most of the leakage must occur by a route not permeable to particles of HgS. The findings give no indication of the nature of the alternative route for escape of protein.     

Lymphocyte-filled villi: comparison with other lymphoid aggregations in the mucosa of the human small intestine

BACKGROUND & AIMS: Solitary lymphoid structures that may be sites of primary extrathymic T-cell differentiation have been described recently in murine (cryptopatches) and rat (lymphocyte-filled villi) small intestine. This study tests the hypothesis that similar structures occur in human small intestine. METHODS: Normal small intestine was obtained during surgery. Fixed tissue was examined histologically, and frozen sections were examined by an indirect immunoperoxidase technique using a panel of mouse monoclonal antibodies. RESULTS: A new isolated lymphoid structure, with epithelium resembling follicle-associated epithelium of Peyer's patches, is described as a lymphocyte-filled villus. These structures contain major histocompatibility complex (MHC) class II-positive dendritic cells, a majority of memory T cells, a variable B-cell component, and no evidence of immature lymphocytes that express either c-kit or CD1a. Two previously described lymphoid aggregations (isolated lymphoid follicles and submucosal lymphoid aggregations) are components of a single structure. The complete structure contains a B-cell follicle, T cells with mainly memory (CD45RO-positive) phenotype, high endothelial venules, and no detectable population of immature lymphocytes. CONCLUSIONS: A new solitary lymphoid structure is described in the human small intestine. Neither these structures nor isolated lymphoid follicles appear to be similar to solitary primary lymphoid structures in rodent intestine.