Annular malignancies of the small bowel

True annular malignancies of the small bowel with mucosal destruction and shelflike margins are generally thought to be caused by primary adenocarcinoma. At our institution, 18 annular malignancies were diagnosed radiographically in the small bowel by enteroclysis (16 cases) and conventional small bowel follow-through studies (2 cases) between 1977 and 1984. However, pathologic data revealed only 4 primary adenocarcinomas with 10 metastatic lesions (6 colon cancers, 2 malignant melanomas, 1 lung cancer, and 1 cervical cancer), 2 leiomyosarcomas, 1 non-Hodgkin's lymphoma, and 1 malignant carcinoid tumor. While these lesions may be indistinguishable radiographically, annular carcinomas tended to be short, relatively nonobstructing lesions; annular metastases (except those from malignant melanoma) tended to be highly obstructing lesions with significant narrowing and/or angulation of the bowel. Leiomyosarcomas, lymphoma, and metastases from malignant melanoma tended to be longer lesions with extensive ulceration, wider channels, and little or no evidence of obstruction. Nevertheless, surgical resection or biopsy of the lesion is ultimately required for a definitive diagnosis.     

Irradiation injuries of the large intestine

A series of 15 patients suffering from irradiation injuries to the large bowel is reviewed. Ten patients required surgical intervention, initially a diverting stoma in eight; intestinal continuity was re-established in three patients. Loop ileostomy may be preferable to loop tranverse colostomy for fecal diversion, as the former is easier for the patient to manage, and ensures that there is no interference with blood supply to the colon should an abdomino-anal pull-through procedure be indicated later to restore continuity. As only three of the patients developed recurrent carcinoma, the initial operation for irradiation injury to the large bowel should be carefully planned so that the patient is not ultimately cured of carcinoma but left with a permanent stoma. Read at the Meeting of the American Society of Colon and Rectal Surgeons, Atlanta, Georgia, June 10 to 14, 1979     

Peritoneal fluid in children with intussusception: Its sonographic detection and relationship to successful reduction

A retrospective review of the abdominal/pelvic ultrasound (US) examinations in 21 consecutive children with intussusception proven on barium enema was performed to determine what is the incidence of US detected peritoneal fluid in this population and to see if the rate of reduction was different in this subset. Twelve of the 21 children (57%) had free fluid demonstrated with US. Eight of these 12 (67%) had successful reduction. Six of the nine children (67%) without free fluid were also successfully reduced.     

肠道血管瘤16例临床分析

目的 :探讨肠道血管瘤临床、内镜、选择性肠系膜动脉造影及病理等的特点和临床诊断线索。方法 :对 16例肠道血管瘤进行回顾性临床分析。结果 :87.5 %的病例有肠道出血 ,主要表现为慢性反复的小量出血 ;病程超过一年者有 6 2 .5 %。内镜下以稍隆起红斑状或广基的蓝色或紫色小肿块 ,表面充血、糜烂或有活动性出血 ,93.8%的病灶小于 1cm。DSA的主要表现为造影剂浓集或外渗 ,并可提示多发病灶。病理特点以海绵状血管瘤为主 ,占 5 6 .3% ,18.8%者表现为多发病灶。结论 :肠道血管瘤的临床表现无特异性 ,内镜及选择性肠系膜血管造影检查有助于确诊。可疑病例必须密切随访 ,严重者应手术探查 ,术前重点是确定病灶的多少和范围。为避免误诊、漏诊 ,应遵循一定的临床诊断程序。     

腹部术后足三里穴位注射山莨菪碱促进肠功能恢复的临床研究

目的:探讨足三里穴位注射山莨菪碱对术后肠功能的恢复及粘连性肠梗阻的预防作用。方法:将100例腹部手术患者随机分为实验组(足三里注射山莨菪碱)和对照组,分别记录肠鸣音恢复时间、排气时间和排便时间,随访4～16个月,观察粘连性肠梗阻的发生率。结果:实验组患者的肠鸣音恢复时间、排气时间,排便时间均早于对照组,粘连性肠梗阻的发生率也明显低于对照组(P<0.01,P<0.025)。结论:足三里穴位注射山莨菪碱可预防粘连性肠梗阻的发生,利于肠功能的恢复。     

内毒素血症时小肠黏膜损害的实验研究

目的观察大鼠内毒素血症早期枯否细胞(KC)在小肠黏膜损害中的作用及氯化钆(GdCl3)阻断KC功能后对肠道完整性的影响。方法将大鼠分为3组。A组:单纯注入内毒素;B组注入内毒素之前24h先经静脉注入GdCl3;C组:假手术对照组。注射内毒素后4h处死大鼠,取材并收集胆汁。光镜下观察回肠黏膜的形态学变化。分离大鼠的KC,用RT-PCR检测KC中肿瘤坏死因子-α(TNF-α)和白细胞介素6(IL-6)mRNA的表达。采用ELISA检测胆汁和血浆中TNF-α和IL-6水平的变化。结果A组回肠黏膜绒毛上皮表浅坏死,伴中性粒细胞浸润以及上皮脱落;B组回肠黏膜损害明显减少;C组回肠黏膜的形态学无改变。A组KC表达TNF-α和IL-6mRNA显著;B组表达明显减少;C组表达不明显。A组胆汁中TNF-α和IL-6的水平分别为(1032±107)pg/ml和(1185±127pg/ml,血浆中TNF-α和IL-6的水平分别为(207±29)pg/ml和(213±33)pg/ml,显著高于B组犤(521±76)pg/ml和(572±54)pg/ml,(113±18)pg/ml和(147±22)pg/ml犦及C组犤(72±13)pg/ml和(118±22)pg/ml,(67±10)pg/ml和(109±18)pg/ml犦(P均<0.05)。结论内毒素血症早期K释放的TNF-α和IL-6在回肠黏膜损害的启动和进程中可能起重要作用。     

Drug transport in intestine,liver and kidney

Drug transport in intestine, liver and kidney is similar, because in each case transport occurs across a barrier of epithelial cells. However, the physiological conditions differ in each organ: intestinal drug absorption is largely influenced by physicochemical conditions in the intestinal lumen; actual transport across the epithelial barrier occurs mainly by diffusion; carrier-mediated transport plays a subordinate role. In contrast, hepatic uptake is mediated by specific carriers, which transport a wide variety of drugs into the liver cell and then release them either into bile, or back into the portal blood. It is unclear how many carrier systems are involved, how they are organized in the liver cell membrane, and to what extent their substrate specificities overlap. Renal secretion and reabsorption of drugs is mediated by highly active carrier systems for cations and anions. Their cooperative action results in either active reabsorption or active secretion of drugs.Dedicated to Professor Dr. med. Herbert Remmer on the occasion of his 65th birthday     

Vagal unitary responses to intestinal amino acid infusions in the anesthetized cat: a putative signal for protein induced satiety

Single unitary discharges in the nodose ganglia were recorded extracellularly in chloralose anesthetized cats while amino acid solutions were being perfused through the small intestine via implanted cannulae. Test infusions consisted of either amino acid mixtures (12 amino acids; 120 mM in all) or individual amino acids (50 mM each) dissolved in Krebs Henseleit buffer. Units which were activated by amino acid infusions were also tested with 10% glucose infusions performed in the same way. Control infusions consisted of either buffer alone or a physiological saline solution isotonic to the test solution. All perfusions were performed at 38 degrees C, pH 7.4 by means of a syringe over a 10 second period. Out of 1250 vagal units activated by electrical vagal stimulation, 92 units showed an increased firing rate in response to amino acid intestinal perfusions. Of these, only 1/7 were also responsive to glucose perfusions. Osmotic, thermal or mechanical stimuli associated with infusions did not modify vagal responses to the amino acids. Among vagal units responding only to amino acid but not to glucose infusion, some were activated in a specific manner, depending on the specific amino acid infused intraduodenally. These neurons illustrated a very strict specificity regarding the nature of chemical stimuli. The very short latency, mean of 9 sec +/- 0.7 (SE) of these vagal neurons to amino acid infusions unequivocally indicates that chemoreceptors are located at the preabsorptive level. The corresponding fibers were non-myelinated (conduction velocities: 0.8/1.4 m/sec.) and were of the C type. The functional characteristics of these vagal amino acid receptors are discussed in terms of the role of intestinal signals in short term protein satiety.     

Sepsis following operation for inflammatory intestinal disease

The incidence and pathogenesis of sepsis following 107 elective operations in 87 patients with inflammatory bowel disease has been studied. Eighteen per cent developed wound sepsis and 13 per cent developed intra-abdominal abscess postoperatively. The prophylactic antimicrobial regimens used did not reduce the overall postoperative sepsis rates. The risk of developing postoperative sepsis was increased in patients with preoperative enterocutaneous or entero-enteric fistulas, pre-existing abscess and those with evidence of active disease (serum albumin less than 3.0 g/dl and serum seromucoids greater than 400 mg/dl). The incidence of postoperative sepsis was not affected by corticosteroid therapy at the time of surgery