Is chronic detergent ingestion harmful to the gut?

Synthetic detergents are used in large quantities as household and industrial cleaners. Because of the common practice of leaving dishes washed in detergent solutions to dry without rinsing these compounds are ingested. We have calculated that an adult takes in about 1 mg/kg detergent a day and babies can be administered between seven and 10 mg/kg a day. Rats were fed a dose of 100 mg/kg a day in a pilot experiment and gross abnormalities were found in the gastrointestinal tract, the most striking being subtotal villous atrophy of the small bowel mucosa and glandular atrophy in the colon. These changes were not reversible 12 weeks after cessation of detergent administration.     

Metabolic activation of aflatoxin B1 by liver tissue from male fischer F344 rats of various ages

The effect of aging on the ability of the liver to activate chemical procarcinogens was studied using 12-, 18-, and 27-month-old male Fischer F344 rats. The cytochrome P-450 content of the S9 and microsomal fractions of the liver decreased approximately 30% between 12 and 18 months of age. The structural conformation of cytochrome P-450 in microsomes from 12-, 18-, and 27-month-old rats was studied using electron-spin resonance spectroscopy. An age-related decrease in the amount of cytochrome P-450 ferric iron in the liver microsomes was observed. The conversion of the chemical procarcinogen aflatoxin B1 to mutagenic compounds by the S9 and microsomal fractions of liver was measured using the Salmonella typhimurium bioassay. A 40-50% decrease in the metabolic activation of aflatoxin B1 was observed between 12 and 18 months of age. However, the activation of aflatoxin B1 did not change after 18 months of age. The age-related decrease in the activation of aflatoxin B1 by liver appears to be due to a decrease in the metabolic activity of the mixed-function oxidase system.     

Alpha-1-antitrypsin hepatic cell globules in autotransplanted liver of rats

The autotransplantation of liver into the subcutaneous tissues in rats and hamsters resulted in the development of periodic acid Schiffs staining positive granules, which were resistant to diastase digestion. These granules were confirmed as alpha-1-antitrypsin by immunohistochemical staining. The appearance of the alpha-1-antitrypsin containing hepatic granules is comparable to those seen in the liver of humans with genetically determined alpha-1-antitrypsin deficiency.     

Thoracic aorta to popliteal artery bypass for bilateral lower-extremity critical limb ischemia

Thoracic aortic to infrainguinal arterial bypasses are rare in the literature, even more so when the outflow is the popliteal artery bilaterally. The case of a patient presenting with critical limb ischemia, chronic infrarenal aortic occlusion, and recurrent thrombosis of a unilateral axillobifemoral graft managed with thoracoretroperitoneal bitransobturator bipopliteal bypass is presented. The patient's vascular history was significant for multiple previous groin procedures for thrombectomy of her axillobifemoral graft, aortomesenteric bypass, redo aortomesenteric bypass for graft thrombosis, and multiple bowel resection procedures for acute mesenteric ischemia. The thoracic aorta and popliteal arteries were selected as sites for proximal and distal anastomoses, respectively, given anticipated difficulty in exposing the supraceliac aorta and femoral arteries. The technique of this operative approach is discussed.     

Intraoperative pancreatoscopy with narrow band imaging: a novel method for assessment of resection margins in case of intraductal papillary mucinous neoplasm

Background

Intraductal papillary mucinous neoplasm (IPMN) is characterized by intraductal proliferation of neoplastic mucinous cells with a variable extent along the main duct or its branches. The lesion may be continuous or discontinuous. Skip lesions have been described in about 6?C19?% of cases. Complete resection without leaving behind any skip lesions is important, to such an extent that many groups suggest even total pancreatectomy, a major and morbid surgery.

Methods

A 40?year-male patient with chronic pancreatitis presented with recent-onset diabetes mellitus and weight loss. Ultrasound and computed tomography (CT) scan showed a cystic lesion in the head and uncinate process of pancreas. Peroral pancreatoscopy showed villous projections with dilated tortuous vessel in the head, suspicious of IPMN. The duct beyond pancreatic head could not be visualized and remained unassessed. At pancreatoduodenectomy, pancreatoscopy with narrow band imaging (NBI) was done using flexible pancreatoscope through the cut end of the duct at the neck to assess the duct in the body and tail.

Results

Pancreatoscopy with NBI showed a normal-looking resection margin and a skip lesion 1?cm beyond it. The revised resection margin confirmed the skip lesion on frozen section and also that the fresh cut margin was negative. The remaining duct in the body and tail was normal on pancreatoscopy. Total clearance of the disease could be achieved without a major procedure such as total pancreatectomy.

Conclusions

Intraoperative pancreatoscopy, especially with NBI, is a good diagnostic tool for IPMN and also helps in intraoperative decision-making of the resection margins.