Glutathione S-transferase in the midgut tissue of gypsy moth (Lymantria dispar) caterpillars exposed to dietary cadmium

Activity of glutathione S-transferase (GST) in midgut of gypsy moth caterpillars exposed to 10 and 30 μg Cd/g dry food was examined. Based on the enzyme reaction through conjugation with glutathione, overall activity remained unaltered after acute and chronic treatment. No-observed-effect-concentration (10 μg Cd/g dry food) significantly increased activity only after 3-day recovery following cadmium administration. Almost all comparisons of the indices of phenotypic plasticity revealed statistically significant differences. Despite the facts that GST has important role in xenobiotic biotransformation, our results indicate that this enzyme in insect midgut does not represent the key factor in cadmium detoxification.     

Intestinal obstruction from midgut volvulus after laparoscopic cholecystectomy

Congenital midgut malrotation, a rare anatomic anomaly that can lead to duodenal or small bowel obstruction, rarely is recognized beyond the first year of life. We report a case of unrecognized congenital midgut malrotation that resulted in midgut volvulus, causing intestinal obstruction and requiring emergent reoperation after laparoscopic cholecystectomy. This unusual complication, first reported in 1994, involved a 56-year-old man and resulted in cecal infarction recognized and treated on the second postoperative day. This second case describes a less acute postoperative course, with multiple bouts of partial bowel obstruction leading to two readmissions and finally resulting in a reexploration and definitive treatment on the 19th postoperative day. Received: 16 February 1999/Accepted: 22 March 1999     

Management of midgut volvulus with extensive necrosis by “patch,drain, and wait” in early infancy and childhood

Midgut volvulus with extensive intestinal necrosis in the newborn period and in early infancy and childhood presents a difficult therapeutic dilemma of how to control sepsis and preserve a maximum and life-sustaining amount of large and small intestine. This problem is similar to that faced in cases of necrotizing enterocolitis with extensive intestinal ischemia and necrosis. The successful use of the patch, drain, and wait approach in necrotizing enterocolitis suggested its potential usefulness in midgut volvulus with similarly extensive necrosis in early life [7]. The basic principles of this approach involve maximum bowel salvage by avoidance of both resection and enterostomy; extensive bilateral Penrose drainage of the peritoneal cavity to provide an exit for sepsis and debris for peritonitis control; and de facto enterostomies for potential enteric fistula capture, gastrostomy for upper gastrointestinal tract venting and decompression, and Broviac catheter placement for long-term hyperalimentation. Three cases involving the successful use of this approach are reported.     

Intestinal malrotation: a rare but important cause of bowel obstruction in adults

PURPOSE: Complications of intestinal malrotation are familiar to pediatric surgeons but are rarely encountered by those caring strictly for adults. The aim of this study was to review our experience with disorders of intestinal rotation in adult patients and to emphasize the clinical presentation, radiographic features, and results of surgical treatment. METHODS: Ten adult patients (mean age, 42 (range, 22–73) years) with complications of intestinal malrotation were identified by review of department records. Clinical presentation, operative treatment, and outcome were recorded. RESULTS: Nine patients presented with obstructive symptoms (five chronic and four acute). A diagnosis of malrotation was made preoperatively in all cases by a small-bowel contrast study or CT scan. Patients were treated by laparotomy with adhesiolysis (4 cases including one paraduodenal hernia and two midgut volvuli), Ladds procedure (4 cases), or duodenopexy and cecopexy (1 case). One patient presented with an acute abdomen and was found to have appendicitis. There was no mortality. Two patients developed complications (wound infection and ileus). Two patients had recurrent episodes of small-bowel obstruction with a mean follow-up of 30 (range, 2–69) months and one required reoperation. CONCLUSIONS: Complications of intestinal rotation can occur in adult patients and may present with chronic or acute symptoms. Prompt recognition and surgical treatment usually lead to a successful outcome. The diagnosis of intestinal malrotation should be considered in any adult patient with signs and symptoms of small-bowel obstruction.     

Reversed rotation of the midgut in adults – a case report

Intestinal obstruction is a common surgical emergency. It is often due to adhesions; however, when the patient is young and has a virgin abdomen, we have to consider uncommon causes. We present a rare case of reversed rotation of the midgut as a cause for intestinal obstruction.     

Staged Second-Look Laparoscopy to Evaluate Ischemic Bowel

Background and Objectives:

An open, second-look laparotomy often is required to assess ischemic bowel after extensive mesenteric lymphadenectomy to cytoreduce midgut carcinoids. Aggressive resection of tumor at the base of the mesentery may compromise the integrity of the blood supply to the involved segment of intestine. Long segments of bowel that initially appear ischemic are sometimes created. The surgeon is faced with the decision to perform a resection or to close the abdomen temporarily knowing that this patient will require a second-look laparotomy.

Methods:

Segments of bowel showing signs of possible ischemia were preserved based on signs of perfusion. A side-side anastomosis was performed in the standard fashion. A Jackson Pratt drain was placed in an area adjacent to the anastomosis and brought out through the abdominal wall, and the incision was closed. Forty-eight hours later, a laparoscopic second-look operation was performed. A pneumoperitoneum was established using the drain tubing as the CO₂ inflation port. The drain was removed, and a 5-mm trocar was inserted into the abdomen via its tract. Segments of previously questionable dusky bowel and the anastomosis were inspected with a laparoscope.

Results:

Our 3 second-look operations were completed in approximately 5 minutes, and the patients recovered without complication or prolonged hospital course. Our fourth patient progressed extremely well postoperatively and was able to avoid the planned second-look laparos-copy.

Conclusions:

This technique provides an easy solution for the intraoperative finding of questionable blood supply in the intestines.     

The changing spectrum of intestinal malrotation: diagnosis and management

Background

Management of typical malrotation is universally accepted, but management of atypical malrotation is less well defined in both children and adults.

Methods

Records of patients with malrotation diagnosed over 6 years were reviewed. Patients were grouped into typical or atypical based on ligament of Treitz location. Outcomes were evaluated using chi-square analysis.

Results

Of 275 patients, 148 diagnosed with typical malrotation underwent Ladd’s procedure. Based on symptoms, 91 of 127 patients with atypical malrotation were managed operatively. The remaining 36 patients were asymptomatic or had reflux symptoms only and were observed. Six of 36 subsequently required surgery due to symptoms, but 30 remain asymptomatic. No observed patients developed acute midgut volvulus. The overall postoperative complication rates were higher for atypical versus typical malrotation, 27% versus 16% (P < .05).

Conclusions

Close observation with repeat contrast study is an acceptable management option for patients with atypical malrotation who are asymptomatic or exhibit only reflux symptoms.     

Abdominal Surgery in Patients with Midgut Carcinoid Tumors

In patients with midgut carcinoid tumors a curative, radical tumor removal should be attempted when possible. As these tumors are generally malignant, irrespective of size, the radical surgery implies that intestinal resection for excision of a primary tumor should be combined with an extended mesenteric resection. When the patients present with the carcinoid syndrome the disease is, with few exceptions, too advanced for curative surgery. However, surgery often has to be performed also in patients with the advanced carcinoids. Patients with more extensive disease may thus benefit from surgical debulking of large mesenteric or hepatic metastases. Moreover, when the patients present with abdominal symptoms it is important to exclude a threatening major abdominal complication, such as intestinal obstruction or ischemia. As these complications may cause malnutrition and deterioration, it is important to treat them properly, sometimes by repeated surgery.     

抗斯氏按蚊中肠蛋白组分的抗体对约氏疟原虫卵囊的作用

目的 观察抗斯氏按蚊中肠蛋白组分的抗体对约氏疟原虫卵囊的抑制作用。 方法 解剖实验室饲养斯氏按蚊雌蚊，取中肠（胃）制备中肠蛋白抗原并免疫BALB/c小鼠（8只， 100 μg/只)， 共免疫4次， 每次间隔7～10 d，末次免疫后10 d，腋窝动脉取血，分离血清。用蛋白质印迹（Western blotting）分析中肠蛋白的免疫活性抗原。用葡聚糖凝胶过滤法获得相对分子质量（Mr）为38 000~50 000的蛋白。用该中肠蛋白免疫小鼠（12只， 100 μg/只)， 共免疫4次，每次间隔7~10 d。同时设PBS对照组。末次免疫后7 d，ELISA检测小鼠血清中的抗体，抗体效价≥1 : 2 560时，该免疫组小鼠和对照组小鼠经腹腔接种感染约氏疟原虫（约含2×10⁷个感染疟原虫的红细胞），感染后3 d取小鼠尾血镜检，雌配子体数＞2/10个视野的小鼠作为供血鼠，斯氏按蚊成蚊吸血后9 d解剖，计数中肠的卵囊数量。 结果 Western blotting显示斯氏按蚊中肠蛋白抗原的显色区带有8条，其中Mr 38 000~50 000的区带显色较清晰；实验组和对照组中肠卵囊感染率分别为28.70%（62/216）和51.09%（47/92）（P＜0.05），中肠卵囊指数分别为14.14（1 541/109）和26.02（1 223/47），两者差异有统计学意义（P＜0.01）。 结论 斯氏按蚊Mr 38 000~50 000中肠蛋白有免疫活性；针对该中肠蛋白的抗体对约氏疟原虫卵囊的发育有明显的抑制作用。