Gastric gland metaplasia in the small and large intestine

Fifty-six surgical specimens with various ulcerative intestinal disorders were microscopically investigated for evidence of gastric gland metaplasia. Thiry-one specimens (55-4%) showed pyloric gland metaplasia. Among the 31 patients with pyloric gland metaplasia, five showed true gastric metaplasia, consisting of parietal cells, chief cells, and mucous neck cells. The percentage of true gastric metaplasia among pyloric gland metaplasia was as high as 16%, an overall frequency of 9% among various ulcerative intestinal disorders. The mechanism of pyloric gland metaplasia and true gastric metaplasia is not understood, but may occur secondary to submucosal response to ulcer healing and subsequent alteration of the intraluminal condition in the intestine.     

Late results of Childs-Phillips mesenteric plication for therapy and prevention of small intestine ileus

During the past 7 years 45 patients have been operated upon using the Childs-Phillips method. Of those, 37 were subsequently examined for the study--7 patients had died in the meantime. None of the deaths occurred as a direct result of transmesenteric small-bowel plication. An early recurrence of intestinal obstruction occurred in 4.4% and a laparotomy was repeated. During the most recent examinations 86.5% of those patients checked had (virtually) no complaints--91.9% based upon the Visick classification. A subtotal intestinal obstruction occurred during the period of the study in 8.1% of cases, but could be conservatively treated. Up until the most recent examination there were still no instances of a late recurrence. Most intestinal obstruction recurrences are due to errors specific to the technique and are early recurrences. On the basis of our results, we are of the opinion that plication in the presence of existing peritonitis, as well as partial plication, is acceptable.     

Cyclic AMP-dependent anion secretion in human small and large intestine

Cyclic AMP-dependent Cl- secretion is the major secretion pathway in human intestine. The aim of the present study was to examine mechanisms involved in cAMP-dependent anion secretion in human small and large intestine. Surgical resection specimens from both jejunum and distal colon were studied under short circuited conditions. Addition of the phosphodiesterase inhibitor IBMX induced an increase in the short-circuit current (Isc) equivalent to the net increase in Cl- secretion. The Isc was inhibited by diphenylamine decarboxylate (DPC; Cl- channel blocker), bumetanide (basolateral Na+/K+/2Cl- cotransporter), BaCl2 (basolateral K+ channel) and Cl- free buffer in both segments and indomethacin (cyclo-oxygenase inhibitor) in colon alone. Diphenylamine decarboxylate appears to directly inhibit secretion in jejunum, although its inhibitory effect is possibly mediated by inhibition of cyclo-oxygenase in the colon. A small component of IBMX-stimulated Isc was inhibited by acetazolamide. Cyclic AMP-dependent secretion is largely apical Cl- secretion, although a small component appears to be HCO3. Secretion is dependent on basolateral K+ channels and Na+/K+/2Cl- cotransporters and, in the colon, is inhibited by indomethacin, implying a role for cyclo-oxygenase metabolites. The chloride channel blocker DPC inhibits secretion in both areas. This class of compounds may have potential for treatment of secretory diarrhoea.     

The factors determining survivorship in patients with colorectal carcinoma complicated by obstructive ileus of the large intestine

A total of 232 patients with obturation ileus, caused by locally advanced colorectal carcinoma, are operated over a 12-year period (1979-1990). In 160 patients (68.97 per cent) the tumor is located in the colon, and in 72 (31.03 per cent)-in the rectum. The operative interventions performed are distributed as follows: 122 (52.58 per cent) radical, and 110 (47.42 per cent) palliative. There are 84 patients (36.03 per cent) in IV clinical stage. Postoperative lethality among those subjected to radical operation amounts to 25.41 per cent, with leading underlying causes-peritonitis (35.08 per cent) and serious ileus intoxication (21.05 per cent). The survival over 1, 3 and 5-year periods among those radically operated is 74.59, 48.37 and 34.06 per cent, respectively. Histologically differentiated adenocarcinoma is demonstrated in 69.38 per cent, undifferentiated-in 17.50 per cent, and mucinous adenocarcinoma-in 13.12 per cent. The factors with a high prognostic value include: stage of primary tumor development, lymph involvement, type of operative intervention and histological variant of the neoplasm.     

Lamina propria T cell subsets in the small and large intestine of euthymic and athymic mice

We investigated lamina propria T cells from the small intestine (jejunum/ileum) and the large intestine (colon) of euthymic (BALB/c, C.B-17, C57BL/6) and athymic (C57BL/6 nu/nu; BNX bg/bg nu/nu xid/xid) mice. CD3+ T cells represented about 40% of the lamina propria lymphocytes (LPL) from the small or the large intestine of euthymic mice, and 20-30% of the LPL populations from the small or large intestine of athymic mice. In the lamina propria T cell population of the small intestine, 85% were of the alpha beta lineage in euthymic mice, but only 40% were of the alpha beta lineage in athymic mice. T cells of the gamma delta lineage were thus more frequent than T cells of the alpha beta lineage in the intestinal lamina propria T cells of extrathymic origin. CD4+ T cells represented 40% of the lamina propria T cells in the small as well as in the large intestine of euthymic mice, and 20-30% of the T cells in the lamina propria of the nude mouse gut. In euthymic mice, 40% of the T cells in the small intestine lamina propria, and 30% of the T cells in the colonic lamina propria were CD8+. In intestinal lamina propria T cell populations of athymic mice, the CD8+ T cell population was expanded. Most (60-70%) CD8+ T cells in the lamina propria of the small and the large intestine of euthymic and athymic mice expressed the homodimeric CD8 alpha + beta- form of the CD8 coreceptor. A fraction of 15-20% of all CD3+ T cells in the lamina propria of the small and the large intestine of euthymic and athymic mice were 'double negative' CD4- CD8-. A large fraction of the TCR alpha beta + T cells in the colonic lamina propria (but not in the small intestine lamina propria) of euthymic mice expressed the CD2 and the CD28 costimulator molecules, the adhesion molecule LECAM-1 (CD62 L), and could be activated in vitro by CD3 ligation. These data reveal a considerable heterogeneity in the surface phenotype and the functional phenotype of murine lamina propria T cells.     

Use of protease inhibitors to improve calcitonin absorption from the small and large intestine in rats

The objective of this study was to examine the effects of protease inhibitors on the absorption of calcitonin from different regions of the intestine in rats. The absorption experiments were investigated by in-situ use of closed intestinal loops in rats and stability of calcitonin was examined in mucosal homogenates and intestinal fluids. The intestinal absorption of calcitonin was evaluated by measurement of its hypocalcaemic effect. No substantial hypocalcaemic response was observed when calcitonin was administered into the jejunum or colon. A slight hypocalcaemic effect was observed after administration of calcitonin into the ileum. Of the co-administered protease inhibitors, bacitracin (20mM) strongly promoted calcitonin absorption from the jejunum, ileum and colon. A significant hypocalcaemic effect was also obtained after intestinal administration of calcitonin with soybean trypsin inhibitor (10mgmL(-1)), camostat mesylate (20mM) or aprotinin (2mgmL(-1)). In the stability experiment, bacitracin reduced the degradation of calcitonin in the different intestinal homogenates. Soybean trypsin inhibitor significantly reduced the degradation of calcitonin in the fluids of the small intestine. We also examined the different endopeptidases in gut luminal fluids and the different exopeptidases in gut mucosal homogenates of rats. The ranking order for the total endopeptidase activity of the intestinal fluids was jejunum > ileum > colon. That for total exopeptidase activity of the intestinal mucosa was jejunum > ileum > colon. These results suggest that endo- and exopeptidases might be responsible for the hydrolysis of calcitonin and that protease inhibitors might usefully improve absorption of calcitonin to the systemic circulation from the large intestine.     

Fluid intake and behavioral changes in rats associated with the distension of the small and large intestine.

Effects of volumetric distension of the small and the large intestine on rats' behavior were compared. Rats were stimulated by a rubber balloon inserted into chronic isolated intestinal loops prepared from the lower duodenum-upper jejunum and from the upper colon in the same animal. Thresholds of 3 reaction classes (weak, strong, and painful) were not different from each other in the 2 loops. Distension decreased fluid intake in an intensity-dependent way, with weak and painful stimuli being less effective in the large intestine and strong stimuli less effective in the small bowel. Behavioral indexes supported intake data, satiety indexes were similar to each other and changed in time, whereas aversivity indexes differed in the 2 loops and as a function of intensity but not time. The author suggests that mild discomfort is a physiological satiety factor whereas strong and painful stimuli signal danger and induce aversivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lipomas of the large intestine

The incidence of lipomas of the colon is difficult to evaluate due to lack of symptoms. They are often discovered by chance during endoscopic or radiological examination and sometimes display only obstructive symptoms. A barium enema may be useful for the preoperative diagnosis of lipoma of the colon. The difficulty of obtaining a clear preoperative diagnosis influences the type of surgical treatment undertaken. Thus, a resection is often preferred to the simple removal of the lipoma by colotomy or endoscopy.     

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.     

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.     

Malignant melanoma in the small intestine

A case story of malignant melanoma is presented. The tumour was localised to the jejunum. The symptoms, diagnosis and treatment are described and the pathogenesis is discussed.