Radiation-induced damage in different segments of the rat intestine after external beam irradiation of the liver

Introduction

The out-of-field effects on the intestine, caused by radiation treatment of a parenchymatous organ, have not previously been studied.

Methods

A single dose of 25 Gy was administered percutaneously to the liver of male Wistar rats after a planning CT-scan. Sham-irradiated animals served as controls. At 1, 6, 24, 96 h, 1.5 and 3 months the duodenum, jejunum, ileum and distal colon were removed, washed and deep-frozen or prepared for paraffin staining.

Results

All animals survived the treatment. Epithelial cell damage occurred in all small-intestinal segments. However, prolonged denudation of the villi together with destruction of the crypt lining was only observed in the ileum, resulting in deficient regeneration. In the colon, changes were minor. Radiation mucositis with granulocyte (MP0 +) infiltration was seen from 1 to 24 h in the duodenum and jejunum, when ED1 + macrophages, CD3 + T-lymphocytes, and CD34 + hematopoietic precursor cells were recruited, accompanied by an increase in the chemokines MCP-1, MIP-1α, MIP3α and Il-8. In the ileum, early granulocyte infiltration was delayed but continuous. Recruitment of macrophages and lymphocytes was deficient and induction of chemokines as of the adhesion molecules PECAM-1, ICAM-1 was lacking.

Conclusion

Post-irradiation damage to the ileum was delayed and followed by an altered repair process with structural changes of the villi. The observed changes might result from a higher sensitivity to oxidative stress mechanisms with subsequent damage of the regenerative capacity of the crypt–villus axis, accompanied by a sustained “inflammatory response” and vascular damage with a lack of regeneratory cell recruitment.     

Taurine Ameliorates Water Avoidance Stress–Induced Degenerations of Gastrointestinal Tract and Liver

We investigated the role of taurine, is a potent free radical scavenger, on water avoidance stress (WAS)-induced degeneration of the gastric, ileal, and colonic mucosa and liver parenchyma. Wistar albino rats were exposed to chronic WAS (WAS group) 2 hr daily for 5 days. After exposing animals to chronic WAS (WAS + taurine group), 50 mg/kg taurine was injected IP for 3 days. Control animals received vehicle solution only. The stomach, ileum, colon, and liver samples were investigated under light microscope for histopathologic changes. To demonstrate the topography of the luminal mucosa of the stomach, ileum, and colon, scanning electron microscope was used and for hepatocyte ultastructure transmission electron microscope was used. Malondialdehyde (MDA, a biomarker of oxidative damage) and glutathione (GSH, a biomarker of protective oxidative injury) levels were also determined in all tissues. In the WAS group, the stomach epithelium showed ulceration in some areas, dilatations of the gastric glands, and degeneration of gastric glandular cells; prominent congestion of the capillaries was apparent. In the WAS group, severe vascular congestion was observed along with degeneration of ileal and colonic epithelium. Prominent vascular congestion and dilated sinusoids, activated Kupffer cells, dilated granular endoplasmic reticulum membranes, and focal pyknotic nuclei were observed in liver parenchyma. MDA levels (stomach, P < 0.01; ileum, colon, and liver P < 0.05) were increased and GSH levels (P < 0.01) were decreased in all tissues in the WAS group compared with the control group. The morphology of gastric, ileal, and colonic mucosa and liver parenchyma in the WAS + taurine group (stomach and ileum, P < 0.05; colon and liver, P < 0.01) showed a significant amelioration when compared to the WAS group. Increased MDA and decreased GSH levels in the WAS group were ameliorated with taurine treatment. Based on the results, taurine supplementation effectively attenuates the oxidative damage of gastrointestinal mucosa and liver because of WAS induction possibly by its antioxidant effects.     

Ileocolic intussusception due to giant ileal lipoma: Review of literature and report of a case

INTRODUCTIONIntussusception in adults accounts for less than 5% of all intussusceptions. It occurs when a segment of intestine invaginates into itself.PRESENTATION OF A CASEWe report a case of ileocolic intussusception in an adult caused by a giant ileal lipoma.DISCUSSIONIntussusceptions can be classified as ileocolic, ileocecal, colo-colic and ileo-ileal. Most are due to neoplasms (60% malign and 24–40% benign). In the colon, the possibility of malignancy is higher than in small intestine.Lipomas are the most common benign mesenchymal intestinal tumors, accounting for less than 5% of all gastrointestinal tumors. They are more frequent in colon than small intestine. Small lipomas (less than 2 cm) are usually asymptomatic. Larger lesions may produce symptoms such as abdominal pain, obstruction or intussusception. Lipomas can be diagnosed with endoscopy, capsule endoscopy, barium enemas, CT and US.CONCLUSIONIntussusceptions in adults is a rare condition, most of them are caused by a malign neoplasms followed by benign neoplasms. US and CT are useful for diagnosis. Surgery is mandatory.     

270. Das Morbus Crohn-Rezidiv aus chirurgischer Sicht

Zusammenfassung Im Zeitraum 1960-1980 wurden 294 Patienten mit Enteritis regionalis Crohn stationär behandelt, 214 davon einem resezierendem Eingriff zugeführt. In 69 Fällen (32%) trat ein symptomatisches Rezidiv auf, das bei 41 Patienten nach einem mittleren Intervall von 3,8 Jahren zur erneuten Resektion führte. End-Seit und Seit-Seit Anastomosen bildeten eine bevorzugte Rezidivlokalisation, das neue terminate Ileum fand sich in 73% mitbeteiligt. Das linksseitige Colon wies bei der Wiedererkrankung eine höhere Befallquote auf. Die Letalität der ersten Reintervention betrug 7,5 %.     

经腹膜外改良逆行膀胱全切术+原位回肠新膀胱术治疗男性浸润性膀胱癌临床观察

[目的]探究经腹膜外改良逆行膀胱全切术+原位回肠新膀胱术对男性浸润性膀胱癌的临床疗效.[方法]将本院于2016年1月至2017年1月收治的78例浸润性膀胱癌男性患者随机分为观察组和对照,每组各39例,分别采用经腹膜外改良逆行膀胱全切术+原位回肠新膀胱术及传统膀胱全切术+原位回肠新膀胱术治疗.比较两组术中出血量、手术时间、胃肠功能恢复时间和术后住院时间等指标及两组术后3个月及术后6个月白天、夜间的尿控情况;比较两组术后6个月尿流动力学、并发症发生情况.[结果]观察组的术中出血量、手术时间、胃肠功能恢复时间和术后住院时间等指标明显小于对照组(P<0.05);两组术后3个月及术后6个月白天、夜间的尿控情况比较差异无显著性(P>0.05),但其白天的尿控情况均好于夜间,差异均有统计学意义(P<0.05).两组术后6个月的尿动力学指标比较,差异无显著性(P>0.05).观察组的并发症总发生率5.13%明显小于对照组的20.51%,差异有统计学意义(P<0.05).[结论]经腹膜外改良逆行膀胱全切术+原位回肠新膀胱术治疗男性浸润性膀胱癌患者,临床疗效显著,能有效改善患者的尿控情况,且术后并发症少,安全可靠,值得临床推广应用.     

Free tubercular perforation of the ileum

BACKGROUND:

Peritonitis secondary to small bowel perforation is a common surgical emergency seen across the globe.

METHODS:

A young male patient presented with ileal perforation that was repaired primarily. He recovered uneventfully after the operation.

RESULTS:

Histopathology of the margins of the perforation revealed tuberculosis. A search for evidence of a primary focus of tuberculosis was unsuccessful. The patient was started on anti- tubercular therapy and he was followed up with good results.

CONCLUSION:

This present case underscores the importance of biopsy specimens taken from the margins of patients with ileal perforation to avoid the misdiagnosis of such condition.KEY WORDS: Peritonitis, Perforation, Ileum, Tuberculosis     

空回肠出血的病因和临床特征分析

目的 探讨空回肠出血的病因及临床特点.方法 收集山东省7个地市级医院1998年1月至2008年12月空回肠出血住院患者72例,其中男46例,女26例,年龄13～85岁,平均47岁.所有患者空回肠出血经内镜、影像学或手术确诊.回顾性分析空回肠出血的病因、诊断及主要临床表现等.结果 72例空回肠出血患者中,肿瘤为出血常见病因,占58.3%,42/72,其他依次为炎症(9/72,12.5%)、憩室(7/72,9.7%)、血管病变(7/72,9.7%)、克罗恩病(3/72,4.2%).男、女病因构成比及空肠、回肠出血病因构成比间差异均有统计学意义(P值均＜0.05).首发症状及临床表现以便血和便血伴腹痛为主.手术仍是目前确诊的主要手段(54.2%),其次为胶囊内镜(23.6%)、选择性动脉造影(9.7%)、小肠气钡X线造影(6.9%)、结肠镜(2.8%)和小肠镜(2.8%).伴随症状出现频率依次为贫血、肠梗阻、腹腔脏器转移、休克、肠粘连、肠穿孔.结论 小肠肿瘤是引起空回肠出血的主要原因,且主要位于空肠;而炎症、血管畸形和憩室则主要位于回肠.应加强胶囊内镜和小肠镜在临床中的应用.     

Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management

Neuroendocrine tumors of the small bowel are on the rise. In the US they have increased by 300%-500% in the last 35 years. At the same time their prognosis is much improved. Today, most neuroendocrine tumors (NETs) of the duodenum are detected "incidentally" and therefore recognized at an early stage. Duodenal NETs which are well differentiated, not larger than 10 mm and limited to the mucosa/submucosa can be endoscopically resected. The management of duodenal NETs ranging between 10 and 20 mm needs an interdisciplinary discussion. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. Surgery is recommended for well-differentiated duodenal NET tumors greater than 20 mm, for localized sporadic gastrinomas (of any size) and for localized poorly differentiated NE cancers. Surgery is recommended for any ileal NET. Advanced ileal NETs with a carcinoid syndrome are treated with long-acting somatostatin analogs. This treatment significantly improves (progression-free) survival in patients with metastatic NETs of the ileum. For optimal NET management, tumor biology, type, localization and stage of the neoplasm, as well as the patient's individual circumstances have to be taken into account.     

国人远段回肠粘膜的扫描电镜观察

本研究利用纤维结肠镜,对38例受检者进行逆行性回肠观察,并将活体检查组织制成扫描电镜标本进行观察。结果表明,国人的回肠粘膜绒毛以指状为主,有些呈舌状。嵴状罕见,未见分支、融合等形状的绒毛。