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Mucinous adenocarcinoma of the small bowel with peritoneal seeding  

Microsoft Academic Search

Aims: Small bowel adenocarcinoma has an extemely poor prognosis because of delayed diagnosis and the presence of advanced disease. Carcinomatosis associated with a small bowel primary cancer has not been reported to be successfully treated in the past. Methods: The clinical information prospectively recorded on six patients with carcinomatosis from small bowel adenocarcinoma was reviewed. All of these patients were

P Marchettini; P. H Sugarbaker



Small bowel adenocarcinomas-existing evidence and evolving paradigms.  


Small bowel cancers account for 3% of all gastrointestinal malignancies and small bowel adenocarcinomas represent a third of all small bowel cancers. Rarity of small bowel adenocarcinomas restricts molecular understanding and presents unique diagnostic and therapeutic challenges. Better cross-sectional imaging techniques and development of enteroscopy and capsule endoscopy have facilitated earlier and more-accurate diagnosis. Surgical resection remains the mainstay of therapy for locoregional disease. In the metastatic setting, fluoropyrimidine and oxaliplatin-based chemotherapy has shown clinical benefit in prospective non-randomized trials. Although frequently grouped under the same therapeutic umbrella as large bowel adenocarcinomas, small bowel adenocarcinomas are distinct clinical and molecular entities. Recent progress in molecular characterization has aided our understanding of the pathogenesis of these tumours and holds potential for prospective development of novel targeted therapies. Multi-institutional collaborative efforts directed towards cogent understanding of tumour biology and designing sensible clinical trials are essential for developing improved therapeutic strategies. In this Review, we endeavour to outline an evidence-based approach to present-day management of small bowel adenocarcinoma, describe contemporary challenges and uncover evolving paradigms in the management of these rare 'orphan' neoplasias. PMID:23897080

Raghav, Kanwal; Overman, Michael J



Spermatic cord metastasis as early manifestation of small bowel adenocarcinoma  

PubMed Central

Malignant tumors of the spermatic cord are rare. There are a few case reports on spermatic cord metastasis from colonic, gastric, pancreas, and prostatic cancer. Here, we report a 36-year-old man with brucellosis presenting with spermatic cord metastasis as early manifestation of small bowel adenocarcinoma.

Valizadeh, Nasim; Oskuie, Ali Eishi; Tehranchi, Ali



Small bowel adenocarcinoma in Crohn's disease: A case report and review of literature  

Microsoft Academic Search

Small bowel adenocarcinomas are remarkable for their rarity, difficult diagnosis and poor prognosis. Here we report an unusual case of a 33-year-old patient in whom infi ltrative adenocarcinoma of the small bowel was diag- nosed after a 10-year history of Crohn's disease. In most previously reported cases, detection of Crohn's disease was subsequent to that of carcinoma of the small

Irmgard E Kronberger; Wolfgang Vogel; Ivo W Graziadei


Small Bowel Adenocarcinoma Complicating Coeliac Disease: A Report of Three Cases and the Literature Review  

PubMed Central

Coeliac disease is associated with an increased risk of malignancy, not only of intestinal lymphoma but also of small intestinal adenocarcinoma which is 82 times more common in patients with celiac disease than in the normal population. We report three additional cases of a small bowel adenocarcinoma in the setting of coeliac disease in order to underline the epidemiological features, clinicopathological findings, and therapeutic approaches of this entity based on a review of the literature. The three patients underwent a surgical treatment followed by adjuvant chemotherapy based on capecitabine/oxaliplatin regimen, and they have well recovered.

Benhammane, Hafida; El M'rabet, Fatima Zahra; Idrissi Serhouchni, Karima; El yousfi, Mounia; Charif, Ilias; Toughray, Imane; Mellas, Naoufal; Riffi Amarti, Afaf; Maazaz, khalid; Ibrahimi, Sidi Adil; El mesbahi, Omar



Successful treatment of recurrent small bowel adenocarcinoma by cytoreductive surgery and chemotherapy: a case report and review of the literature  

PubMed Central

Introduction Small bowel adenocarcinoma is a rare malignancy associated with a poor prognosis and there is little evidence of effective treatment. Recurrent small bowel adenocarcinoma is an intractable disease for which there is little information available regarding its treatment by palliative therapy. We present a case of recurrent small bowel adenocarcinoma successfully treated by cytoreductive surgery and palliative chemotherapy. Case presentation We report the case of a 72-year-old Japanese female who developed a peritoneal metastasis from recurrent small bowel adenocarcinoma after curative resection and adjuvant chemotherapy with S-1 and polysaccharide K. She underwent cytoreductive surgery followed by chemotherapy with folinic acid/fluorouracil/oxaliplatin and folinic acid/fluorouracil/irinotecan with polysaccharide K. Subsequently, no sign of a recurrence was observed 42 months after the second operation. Conclusion To the best of our knowledge, this is the first case report of the successful treatment of peritoneal metastasis from small bowel adenocarcinoma by cytoreductive surgery and combination chemotherapy (folinic acid/fluorouracil/oxaliplatin and folinic acid/fluorouracil/irinotecan with polysaccharide K).



Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from small bowel adenocarcinoma.  


Peritoneal carcinomatosis arising from small bowel adenocarcinoma (PCSBA) carries a dismal prognosis. Presently, limited data have been published on the outcome of PCSBA treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). This series represents the largest series published to date examining our experience with 17 patients. From 1995 to 2011, 17 patients underwent HIPEC with mitomycin for PCSBA. Patients in this study were identified from a prospectively maintained database. Twenty HIPEC procedures were performed on 17 patients with a mean age of 52.2 years. Patients have achieved a mean overall postoperative survival of 18.4 months after progression on chemotherapy with an overall postoperative one- and three-year survival of 52 and 23 per cent, respectively. The mean total length of hospital stay was 10 days. There was no treatment-related mortality. Six patients were readmitted to the hospital within 30 days of discharge (35%). Eight patients (47%) experienced postoperative complications, in which two patients had major postoperative complications in the form of intra-abdominal abscess requiring interventions (12%). HIPEC has encouraging survival results for patients with PCSBA compared with similar patients treated with conventional treatments. However, even with such advancement in management, treatment for small bowel adenocarcinoma still remains a challenge. PMID:23711278

Sun, Yankai; Shen, Perry; Stewart, John H; Russell, Gregory B; Levine, Edward A



Precise endoscopic and pathologic features in a Crohn's disease case with two fistula-associated small bowel adenocarcinomas complicated by an anal canal adenocarcinoma.  


The patient was a 40-year-old man who had suffered from Crohn's disease (CD) for 19 years and developed an intractable perianal fistula and two strictures in the small bowel. Dilatation of the two strictures using double-balloon endoscopy did not improve the subileus symptoms. An anal canal adenocarcinoma was also detected using double-balloon endoscopy. The ileum and rectoperianal area were partially resected, and a precise immunohistochemical pathologic assessment revealed that all three lesions were fistula-associated adenocarcinomas. Accumulating endoscopic findings of CD-associated cancer and precise pathologic diagnostic findings will help to establish a suitable surveillance method. PMID:23411699

Sogawa, Mitsue; Watanabe, Kenji; Egashira, Yutaro; Maeda, Kiyoshi; Morimoto, Kenichi; Noguchi, Atsushi; Kamata, Noriko; Yamagami, Hirokazu; Watanabe, Toshio; Tominaga, Kazunari; Fujiwara, Yasuhiro; Oshitani, Nobuhide; Arakawa, Tetsuo



Small bowel bleeding  

Microsoft Academic Search

Opinion statement  The management of patients with small bowel bleeding remains a diagnostic and therapeutic challenge. In most gastrointestinal\\u000a bleeding episodes, the source of hemorrhage is localized to either the upper gastrointestinal tract or colon; however, in\\u000a about 5% of cases, upper endoscopy and colonoscopy are nondiagnostic, and the small intestine is the site of bleeding. Patients\\u000a with suspected small bowel

Thomas O. G. Kovacs; David Geffen



Pancreas, Duodenum, Small Bowel  

Microsoft Academic Search

\\u000a Multiple perforations of the small bowel are common after penetrating abdominal trauma. Small bowel perforation after blunt\\u000a trauma is less common and the diagnosis is challenging but recent advances in radiological imaging have improved the diagnostic\\u000a accuracy. Because of the retroperitoneal location of the pancreas, it is rarely injured, and the pre- and intraoperative diagnosis\\u000a relies on high index of

Ari K. Leppäniemi


Small bowel dysmotility  

Microsoft Academic Search

Opinion Statement  The most important initial step in treating patients with intestinal dysmotility is to exclud reversible causes, in particular\\u000a mechanical obstruction. The presence or absence of bacterial overgrowth should be determined by small bowel aspirate or breath\\u000a test, although an empiric trial with antibiotics is an appropriate alternative. Physicians should use agents effective against\\u000a gram-negative organisms, such as broad-spectrum penicillins

Edy E. Soffer



Postlaparoscopic small bowel obstruction  

Microsoft Academic Search

Background: Patients with early postoperative small bowel obstruction (SBO) are usually managed nonoperatively with nasogastric suction,\\u000a intravenous fluids, and observation. The majority of early postoperative SBO resolve without an operation.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: We performed a retrospective review of patients who had been diagnosed with postlaparoscopic SBO at three Chicago area teaching\\u000a hospitals.\\u000a \\u000a \\u000a \\u000a \\u000a Results: The patients were initially managed nonoperatively for up

J. M. Velasco; V. L. Vallina; S. R. Bonomo; T. J. Hieken



Small Bowel Dysmotility.  


The most important initial step in treating patients with intestinal dysmotility is to exclude reversible causes, in particular mechanical obstruction. The presence or absence of bacterial overgrowth should be determined by small bowel aspirate or breath test, although an empiric trial with antibiotics is an appropriate alternative. Physicians should use agents effective against gram-negative organisms, such as broad-spectrum penicillins or tetracycline, particularly those that provide coverage of anaerobes, such as metronidazole. Nutritional support, by enteral or parenteral means, is currently the most important aspect of management of patients with severe intestinal dysmotility. A low-fat diet, supplemented by liquid formulas, can be tried first. The presence of gastroparesis should be determined; if severe, jejunal feeding should be attempted. Because of the costs and risks associated with total parenteral nutrition (TPN), every attempt should be made to use the native intestine for feeding. A trial of several days of naso-jejunal feeding can help select those patients who can obtain sufficient nutrition by enteral routes and is recommended prior to committing a patient to TPN therapy. Even while on TPN, some oral intake should be encouraged. Prokinetic agents currently in use are less effective in the small bowel than they are in the stomach. They should always be tried initially, though, particularly because improvement of concomitant gastric dysmotility can alleviate symptoms. Although certain manometric patterns can select those patients who respond better to therapy, manometry should not be used to direct therapy in individual patients. For the moment, cisapride is the drug of choice. Erythromycin, particularly when given intravenously and in small, sub-antibiotic doses, can also be tried. The role of octreotide is not clear, but when given at small doses, and when combined with erythromycin, it may be useful in selected patients. Ablative surgery may be useful in a few, highly selected patients. One of the most beneficial surgical procedures is a venting jejunostomy. The use of this simple intervention can substantially reduce the number of hospital admissions and emergency room visits in selected patients with intermittent obstructive symptoms. PMID:11096558




X-ray induced photoacoustic tomography  

NASA Astrophysics Data System (ADS)

X-ray induced photoacoustic tomography, also called X-ray acoustic computer tomography (XACT) is investigated in this paper. Short pulsed (?s-range) X-ray beams from a medical linear accelerator were used to generate ultrasound. The ultrasound signals were collected with an ultrasound transducer (500 KHz central frequency) positioned around an object. The transducer, driven by a computer-controlled step motor to scan around the object, detected the resulting acoustic signals in the imaging plane at each scanning position. A pulse preamplifier, with a bandwidth of 20 KHz-2 MHz at -3 dB, and switchable gains of 40 and 60 dB, received the signals from the transducer and delivered the amplified signals to a secondary amplifier. The secondary amplifier had bandwidth of 20 KHz-30 MHz at -3 dB, and a gain range of 10-60 dB. Signals were recorded and averaged 128 times by an oscilloscope. A sampling rate of 100 MHz was used to record 2500 data points at each view angle. One set of data incorporated 200 positions as the receiver moved 360°. The x-ray generated acoustic image was then reconstructed with the filtered back projection algorithm. The twodimensional XACT images of the lead rod embedded in chicken breast tissue were found to be in good agreement with the shape of the object. This new modality may be useful for a number of applications, such as providing the location of a fiducial, or monitoring x-ray dose distribution during radiation therapy.

Xiang, Liangzhong; Han, Bin; Carpenter, Colin; Pratx, Guillem; Kuang, Yu; Xing, Lei



Clinical applications of small bowel capsule endoscopy  

PubMed Central

Video capsule endoscopy has revolutionized our ability to visualize the entire small bowel mucosa. This modality is established as a valuable tool for the diagnosis of obscure gastrointestinal bleeding, Crohn’s disease, small bowel tumors, and other conditions involving the small bowel mucosa. This review includes an overview of the current and potential future clinical applications of small bowel video endoscopy.

Kopylov, Uri; Seidman, Ernest G



Malignant melanoma involving the small bowel.  

PubMed Central

Small bowel is the commonest site of gastrointestinal metastases from cutaneous malignant melanoma. Five patients with malignant melanoma involving the small bowel are reported. One patient was operated on for suspected acute appendicitis, two patients for gastrointestinal bleeding and two patients for small bowel obstruction. Two patients remain well 4 and 5 years after surgery.

Wilson, B. G.; Anderson, J. R.



Risk factors for small bowel cancer in Crohn's disease.  


Suspected risk factors for adenocarcinoma of the small bowel in Crohn's disease include surgically excluded small bowel loops, chronic fistulous disease, and male sex. Review of all seven University of Chicago cases failed to confirm any suspected risk factor. A case-control study was performed to identify possible alternatives. Each case was matched to four randomly selected controls from an inflammatory bowel disease registry matched for year of birth, sex, and confirmed small bowel Crohn's disease. Three factors were significantly associated with the development of cancer: (1) Four cancers developed in the jejunum, and jejunal Crohn's disease was associated with the development of cancer [odds ratio (OR) 8.0, 95% confidence interval (CI) 1.6-39.3]. (2) There was an association between the development of cancer and occupations known to be associated with an increased colorectal cancer risk (OR 20.3, CI 2.7-150.5). Three cases (a chemist with exposure to halogenated aromatic compounds and aliphatic amines, a pipefitter with exposure to asbestos, and a machinist with exposures to cutting oils, solvents, and abrasives) and one of 28 controls (a fireman with multiple hazardous exposures) had an occupational risk factor. (3) Among medications taken for at least six months, only 6-mercaptopurine use was associated with cancer (OR 10.8, CI 1.1-108.7). In conclusion, proximal small bowel disease, 6-mercaptopurine use, and hazardous occupations are associated with cancer of the small bowel in patients with Crohn's disease and can be added to the list of suspected risk factors. PMID:1499440

Lashner, B A



Malignant small bowel neoplasms: histopathologic determinants of recurrence and survival.  

PubMed Central

INTRODUCTION: Small bowel neoplasms account for only a small percentage of gastrointestinal tumors, but their prognosis is one of the worst. PURPOSE: This study examines the histopathology, treatment, recurrence, and overall survival of a group of patients with primary small bowel tumors. METHODS: From 1970 to 1991, a retrospective review identified 73 patients with primary small bowel tumors. Four histologic groups were identified: 1) group 1, adenocarcinoma, 29 patients; group 2, lymphoma, 18 patients; group 3, sarcoma, 8 patients; and group 4, carcinoid, 18 patients. There were 44 men and 29 women. The median age was 57 years (range, 26 to 90). Median follow-up was 15 months. Survival analysis was by the Mantel-Cox and Breslow methods. RESULTS: The most common, by type, was group 1, duodenum; group 2, jejunum; group 3, jejunum; and group 4, ileum. The preoperative diagnosis was made in only 14 patients. The median survival for adenocarcinomas and lymphomas was 13 months, 18 months for sarcomas, and 36 months for carcinoids. Curative resection could be achieved in 48 (65%) of 73 patients, and the median survival was significantly longer for this group (26 months vs. 11 months, p < 0.05). Of the 48 curative resections, 20 patients (42%) recurred: group 1, 8/19 (42%); group 2, 4/12 (33%); group 3, 4/13 (31%); group 4, 4/4 (100%). The median time to recurrence was 17 months, and the median survival after recurrence was 20 months. Adjuvant chemotherapy-radiation therapy did not alter survival in any group. CONCLUSIONS: The preoperative diagnosis of small bowel tumors rarely is made because symptoms are vague and nonspecific. Surgical resection for cure results in improved survival. Recurrence is common and survival after recurrence is poor. Other treatment methods have no role in the management of these patients.

Cunningham, J D; Aleali, R; Aleali, M; Brower, S T; Aufses, A H



Pneumobilia associated with small-bowel obstruction  

SciTech Connect

The authors present a patient who admitted complaining of nausea, vomiting, and abdominal distention. A roentgenogram of the abdomen revealed a dilated stomach and pneumobilia. At surgery, he was found to have proximal small-bowel obstruction. To their knowledge, this is the first case of pneumobilia associated with proximal small-bowel obstruction not associated with a gallstone.

Bautista, J.L.; Budhraja, M.D.; Barcia, T.D.; Shankel, S.W.



Mesenteric pseudocyst of the small bowel in gastric cancer patient: a case report.  


Mesenteric pseudocyst is rare. This term is used to describe the abdominal cystic mass, without the origin of abdominal organ. We presented a case of mesenteric pseudocyst of the small bowel in a 70-year-old man. Esophago-gastro-duodenoscopy showed a 3.5 cm sized excavated lesion on the posterior wall of angle. Endocopic biopsy confirmed a histologic diagnosis of the poorly differentiated adenocarcinoma, which includes the signet ring cell component. Abdominal computed tomography scan showed a focal mucosal enhancement in the posterior wall of angle of the stomach, a 2.4 cm sized enhancing mass on the distal small bowel loop, without distant metastases or ascites in rectal shelf, and multiple gallbladder stones. The patient underwent subtotal gastrectomy with gastroduodenostomy, segmental resection of the small bowel, and cholecystectomy. The final pathological diagnosis was mesenteric pseudocyst. This is the first case report describing incidentally detected mesenteric pseudocyst of the small bowel in gastric cancer patients. PMID:22500263

Lee, Sang Eok; Choi, In Seok; Choi, Won Jun; Yoon, Dae Sung; Moon, Ju Ik; Ra, Yu Mi; Min, Hyun Sik; Kim, Yong Seok; Kim, Sun Moon; Sohn, Jang Sihn; Lee, Bong Soo



Tuberculous perforation of the small bowel.  

PubMed Central

Small bowel perforation occurs in up to 2 percent of patients with abdominal tuberculous. Patients present with an acute abdomen. Resection of the diseased segment and 18 months treatment with anti-tuberculosis drugs is recommended.

Aston, N. O.; de Costa, A. M.



X-ray induced photoconductivity in Vanadium Dioxide samples  

NASA Astrophysics Data System (ADS)

Vanadium Dioxide (VO2) goes through a first-order phase transition at approximately 340K, exhibiting both an insulator to metal transition (IMT) and a structural phase transition (SPT), with a monoclinic (M1) insulating phase at low temperatures and a rutile (R) metallic phase at high temperatures. We show an anomalous behavior of x-ray induced persistent photoconductivity (PPC) well below the temperature induced phase transition in VO2 devices. We present conductivity and X-ray Diffraction (XRD) measurements, revealing a large enhancement of conductivity due to photo-induced carriers. Moreover, with the addition of nominal electric fields, we are able to fully transition into the rutile metallic phase at room temperature. This effect is completely reversible, allowing the monoclinic insulating phase to be recovered via annealing.

Dietze, Sebastian; Mohanty, Jyoti; Marsh, Moses; Kim, Jong Woo; West, Kevin; Schuller, Ivan K.; Shpyrko, Oleg G.



Hydrodynamics of X-ray induced stellar winds  

SciTech Connect

We present new theoretical models for X-ray induced stellar winds in binary systems. We numerically solve the hydrodynamic equations in one dimension, utilizing a simplified model of the physics of an X-ray heated plasma. The character of the solutions depends on three dimensionless parameters: (1) the ratio of the X-ray spectral temperature to the photospheric temperature; (2) the ratio of the X-ray temperature to a temperature characterizing the escape energy from the stellar surface; and (3) the ratio of the flow time to the heating time. Holding the first parameter fixed at a high value ( = 100), we explore the complete range of solutions produced by variations in the other two parameters.

London, R.A.; Flannery, B.P.



Feasibility of laparoscopy for small bowel obstruction  

PubMed Central

Background Adherential pathology is the most common cause of small bowel obstruction. Laparoscopy in small bowel obstruction does not have a clear role yet; surely it doesn't always represent only a therapeutic act, but it is always a diagnostic act, which doesn't interfere with abdominal wall integrity. Methods We performed a review without any language restrictions considering international literature indexed from 1980 to 2007 in Medline, Embase and Cochrane Library. We analyzed the reference lists of the key manuscripts. We also added a review based on international non-indexed sources. Results The feasibility of diagnostic laparoscopy is high (60–100%), while that of therapeutic laparoscopy is low (40–88%). The frequency of laparotomic conversions is variable ranging from 0 to 52%, depending on patient selection and surgical skill. The first cause of laparotomic conversion is a difficult exposition and treatment of band adhesions. The incidence of laparotomic conversions is major in patients with anterior peritoneal band adhesions. Other main causes for laparotomic conversion are the presence of bowel necrosis and accidental enterotomies. The predictive factors for successful laparoscopic adhesiolysis are: number of previous laparotomies ? 2, non-median previous laparotomy, appendectomy as previous surgical treatment causing adherences, unique band adhesion as phatogenetic mechanism of small bowel obstruction, early laparoscopic management within 24 hours from the onset of symptoms, no signs of peritonitis on physical examination, experience of the surgeon. Conclusion Laparoscopic adhesiolysis in small bowel obstruction is feasible but can be convenient only if performed by skilled surgeons in selected patients. The laparoscopic adhesiolysis for small bowel obstruction is satisfactorily carried out when early indicated in patients with a low number of laparotomies resulting in a short hospital stay and a lower postoperative morbidity. Although a higher small bowel obstruction recurrence remains the major postoperative risk of the laparoscopic management of these patients.

Farinella, Eriberto; Cirocchi, Roberto; La Mura, Francesco; Morelli, Umberto; Cattorini, Lorenzo; Delmonaco, Pamela; Migliaccio, Carla; De Sol, Angelo A; Cozzaglio, Luca; Sciannameo, Francesco



The radiology of small bowel lesions  

PubMed Central

The techniques of radiological examination of the small bowel are considered. The importance of the routine barium meal and follow-through examination is stressed. The vast majority of lesions present a diagnostic problem in interpretation rather than in detection. Some examples of small bowel pathology are discussed and the need for interpretation in the light of the clinical picture is emphasized. Important radiological signs to be appreciated are considered. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7Fig. 8

Craig, Oscar



Laparoscopic management of acute small bowel obstruction  

Microsoft Academic Search

Background: The use of laparoscopy has expanded to include the management of acute abdomen. This study describes the author's experience\\u000a with laparoscopic management of acute small bowel obstruction.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: From February 1994 through March 1998, 19 patients underwent laparoscopic intervention for acute small bowel obstruction.\\u000a Their clinical data were analyzed to evaluate the outcome.\\u000a \\u000a \\u000a \\u000a \\u000a Results: A total of 19 patients

A. A. Al-Mulhim



Small bowel length in Crohn's disease  

Microsoft Academic Search

Background and aims This prospective study compared jejunoileal length in patients with Crohn's disease (CD) and the general population to determine whether this parameter can be related to outcome and management of CD complications. Patients and methods Small bowel (SB) length was measured during abdominal surgery prior to bowel resection in 93 patients with CD and 92 patients without inflammatory

O. Glehen; J. C. Lifante; J. Vignal; Y. Francois; F. N. Gilly; B. Flourié; L. Descos; R. J. H. Chung; F. Mithieux



Small bowel hemorrhage: Angiographic localization and intervention  

Microsoft Academic Search

Occult bleeding in the small bowel was localized with mesenteric angiography in 64 patients. Two groups of patients were identified. In the first group comprising 38 patients, bleeding sites were localized by the demonstration of contrast extravasation. In the second group of 26 patients, there was no extravasation. However, other angiographic findings suggested the source of bleeding. No active bleeding

Christopher L. Tillotson; Stuart C. Geller; Lisa Kantrowitz; Marlene R. Eckstein; Arthur C. Waltman; Christos A. Athanasoulis



X-ray-induced changes in growth of Mozambique tilapia  

SciTech Connect

Early fry (30 d postfertilization) and 7-8-week-old Mozambique tilapias (Tilapia mossambica) were exposed to X rays in dosages of 50, 100, 200, 300, 400 or 500 roentgens and reared in outdoor culture tanks between May 1981 and October 1988. Fish of either sex that were irradiated as fry grew faster than controls at all test X-ray doses. Among fish irradiated at 7-8 weeks, males grew significantly faster, but females grew significantly slower, than controls at all test doses. X-ray-induced changes in growth were dose-dependent: growth rates of fry (both sexes) and of juvenile males rose relative to those of controls with increased radiation dose. The growth increase per unit of radiation dose was higher for fry than for older juveniles. The length-weight regression was steeper for irradiated males than for controls. The average weights of F{sub 1} offspring of irradiated fish were greatly reduced as compared with controls, which suggests the transfer of the detrimental effects of X rays from irradiated parents to their offspring. 39 refs., 3 figs., 3 tabs.

Jana, B.B. [Univ. of Kalyani, West Bengal (India); Basu, M. [Univ. of Maiduguri (Nigeria)



Innovations in X-ray-induced electron emission spectroscopy (XIEES)  

SciTech Connect

Currently, a pressing need has arisen for controlling the local atomic and electron structure of materials irrespective of their aggregate state. Efficient approaches to the studies of short-range order are based on phenomena accompanied by interference of secondary electrons excited by primary X-ray radiation. The set of such approaches are commonly referred to as the X-ray absorption fine structure (XAFS) methods. In reality, the XAFS methods are based on the use of synchrotron radiation and applied to structural studies in two modes of measurements, transmission analysis and recording of secondary effects. Only two such effects-specifically, the X-ray fluorescence an d X-ray-induced electron emission effect-are commonly discussed. Access to synchrotron accelerators is problematic for most researchers, so a demand is created for designing laboratory systems that make direct access possible. Since the power of laboratory systems is much lower than that of synchrotrons, it is essential to use much more efficient detectors of secondary electrons. In addition, it is of interest to analyze energy characteristics with a high spatial resolution. Channel multipliers and multichannel boards are incapable of providing such a possibility. For this reason, an improved electron detector has been developed to analyze the photoemission effect in an accelerating field.

Pogrebitsky, K. Ju., E-mail:; Sharkov, M. D. [Russian Academy of Sciences, Ioffe Physicotechnical Institute (Russian Federation)



X-ray-induced cell death: Apoptosis and necrosis  

SciTech Connect

X-ray-induced cell death in MOLT-4N1, a subclone of MOLT-4 cells, and M10 cells was studied with respect to their modes of cell death, apoptosis and necrosis. MOLT-4N1 cells showed radiosensitivity similar to that of M10 cells, a radiosensitive mutant of L5178Y, as determined by the colony formation assay. Analysis of cell size demonstrated that MOLT-4N1 cells increased in size at an early stage after irradiation and then decreased to a size smaller than that of control cells, whereas the size of irradiated M10 cells increased continuously. Apoptosis detected by morphological changes and DNA ladder formation (the cleavage of DNA into oligonucleosomal fragments) occurred in X-irradiated MOLT-4N1 cells but not in M10 cells. Pulsed-field gel electrophoresis showed that the ladder formation involved an intermediate-sized DNA (about 20 kbp). Most of the DNA was detected at the origin in both methods of electrophoresis in the case of M10 cells, though a trace amount of ladder formation was observed. Heat treatment of M10 cells induced apoptosis within 30 min after treatment, in contrast to MOLT-4N1 cells. The results suggest that apoptosis and necrosis are induced by X rays in a manner which is dependent on the cell line irrespective of the capability of the cells to develop apoptosis. DNA fragmentation was the earliest change observed in the development of apoptosis. 27 refs., 8 figs., 1 tab.

Nakano, Hisako; Shinohara, Kunio [Tokyo Metropolitan Institute of Medical Science, Tokyo (Japan)



Determining small bowel integrity following drug treatment  

PubMed Central

Intestinal integrity is maintained by a delicate balance between mucosal defence and luminal aggressors that cause damage if exposed to the mucosa. The intestinal barrier function appears to be the gatekeeper for controlling this balance. It is becoming increasingly clear that if the intestinal barrier is disrupted the consequences are low grade intestinal inflammation which carry with it the risk of significant blood and protein loss both of which may cause clinical management problems. We review the strength and weaknesses of methods for assessing small bowel function that are useful for assessing drug-induced intestinal toxicity. There are a number of imaging methods for assessing intestinal integrity but these do not provide functional information. Intestinal permeability measurements have been optimized for specificity and there are now ways of measuring intestinal permeability regionally, but marker analyses continue to be cumbersome. Recent developments of faecal inflammatory markers make it a matter of routine to assess this in any routine chemical pathology laboratory. Bleeding, protein loss and other complications of inflammation can also be measured with good specificity, but again the methods are cumbersome. Using a combination of functional and imaging techniques it is now possible to characterize and define with precision, the small bowel side-effects of drugs, the best example being the small bowel side-effects of nonsteroidal anti-inflammatory drugs (NSAIDs).

Smale, Simon; Bjarnason, Ingvar



An Animal Model for the Study of Small-Bowel Tumors1  

Microsoft Academic Search

SUMMARY An animal model for the study of small-bowel tumors has been investigated. Tumors were induced in male Holtzman rats by X-irradiation of only the hypoxic, temporarily exteriorized ileum and jejunum. Following an exposure of 2000 R, 56% of the rats developed adenocarcinoma some where in the irradiated segment. Macroscopic métastases were not observed outside the small intestine: however, métastases

Kenneth L. Coop; J. Graham Sharp; James W. Osborne; George R. Zimmerman


Analysis of X-ray-Induced HPRT Mutations in CHO Cells: Insertion and Deletions.  

National Technical Information Service (NTIS)

Molecular alterations were examined in the hypoxanthine guanine phosphoribosyltransferase (hprt) gene of 41 independent X-ray-induced thioguanine-resistant (TGR) Chinese hamster ovary (CHO) cell clones. Rapid screening of the clones by multiplex polymeras...

J. C. Fuscoe L. J. Zimmerman A. Fekete R. W. Setzer B. J. F. Rossiter




EPA Science Inventory

Molecular alterations were examined in the hypoxanthine guanine phosphoribosyltransferase (hprt) gene of 41 independent X-ray-induced thioguanine-resistant (TGR) Chinese hamster ovary (CHO) cell clones. Rapid screening of the clones by multiplex polymerase chain reaction (PCR) fo...


Double-balloon enteroscopy in small bowel tumors: A Chinese single-center study  

PubMed Central

AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and operation results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be considered the gold standard for the investigation of small bowel tumors.

Chen, Wen-Guo; Shan, Guo-Dong; Zhang, Hong; Li, Lin; Yue, Min; Xiang, Zun; Cheng, Ying; Wu, Chen-Jiao; Fang, Ying; Chen, Li-Hua



Diagnostic yield of small bowel capsule endoscopy depends on the small bowel transit time  

PubMed Central

AIM: To investigate whether the small bowel transit time (SBTT) influences the diagnostic yield of capsule endoscopy (CE). METHODS: Six hundred and ninety-one consecutive CE procedures collected in a database were analyzed. SBTT and CE findings were recorded. A running mean for the SBTT was calculated and correlated to the diagnostic yield with a Spearman’s correlation test. Subgroup analyses were performed for the various indications for the procedure. RESULTS: There was a positive correlation between the diagnostic yield and SBTT (Spearman’s rho 0.58, P < 0.01). Positive correlations between diagnostic yield and SBTT were found for the indication obscure gastrointestinal bleeding (r = 0.54, P < 0.01), for polyposis and carcinoid combined (r = 0.56, P < 0.01) and for the other indications (r = 0.90, P <0.01), but not for suspected Crohn’s disease (r = -0.40). CONCLUSION: The diagnostic yield in small bowel capsule endoscopy is positively correlated with the small bowel transit time. This is true for all indications except for suspected Crohn’s disease.

Westerhof, Jessie; Koornstra, Jan J; Hoedemaker, Reinier A; Sluiter, Wim J; Kleibeuker, Jan H; Weersma, Rinse K



Blunt abdominal trauma with transanal small bowel evisceration  

PubMed Central

Small bowel evisceration through the anus can occur spontaneously or post traumatically. Traumatic transanal small bowel evisceration results from iatrogenic injuries, suction injuries, and blunt abdominal trauma (BAT). We report a 48-year-old female who presented with evisceration of small intestinal loops through the anus following BAT and discuss the etiologies and mechanisms of injury of this rare presentation.

Medappil, Noushif; Prashanth, Adiga K; Latheef, Abdul



Blunt abdominal trauma with transanal small bowel evisceration.  


Small bowel evisceration through the anus can occur spontaneously or post traumatically. Traumatic transanal small bowel evisceration results from iatrogenic injuries, suction injuries, and blunt abdominal trauma (BAT). We report a 48-year-old female who presented with evisceration of small intestinal loops through the anus following BAT and discuss the etiologies and mechanisms of injury of this rare presentation. PMID:23493429

Medappil, Noushif; Prashanth, Adiga K; Latheef, Abdul



A prospective randomized comparison between small bowel enteroclysis and small bowel follow-through in Crohn's disease  

Microsoft Academic Search

BACKGROUND & AIMS: Small bowel enteroclysis (SBE) has been suggested to be superior to the small bowel follow-through (SBFT) for diagnosing the presence and extent of Crohn's disease. The aim was to perform a prospective randomized study at a single university medical center comparing SBE with SBFT in patients with Crohn's disease.METHODS: Consecutive patients with known Crohn's disease were randomized

CN Bernstein; HM Greenberg; W van der Putten; G Duffy; GR Grahame



Genetics of X-Ray Induced Double Strand Break Repair in Saccharomyces Cerevisiae.  

National Technical Information Service (NTIS)

The possible fates of x-ray-induced double-strand breaks in Saccharomyces cerevisiae were examined. One possible pathway which breaks can follow, the repair pathway, was studied by assaying strains with mutations in the RAD51, RAD54, and RAD57 loci for do...

M. E. Budd



DNA sequence analysis of X-ray induced Adh null mutations in Drosophila melanogaster  

SciTech Connect

The mutational spectrum for 28 X-ray induced mutations and 2 spontaneous mutations, previously determined by genetic and cytogenetic methods, consisted of 20 multilocus deficiencies (19 induced and 1 spontaneous) and 10 intragenic mutations (9 induced and 1 spontaneous). One of the X-ray induced intragenic mutations was lost, and another was determined to be a recombinant with the allele used in the recovery scheme. The DNA sequence of two X-ray induced intragenic mutations has been published. This paper reports the results of DNA sequence analysis of the remaining intragenic mutations and a summary of the X-ray induced mutational spectrum. The combination of DNA sequence analysis with genetic complementation analysis shows a continuous distribution in size of deletions rather than two different types of mutations consisting of deletions and point mutations'. Sequencing is shown to be essential for detecting intragenic deletions. Of particular importance for future studies is the observation that all of the intragenic deletions consist of a direct repeat adjacent to the breakpoint with one of the repeats deleted.

Mahmoud, J.; Fossett, N.G.; Arbour-Reily, P.; McDaniel, M.; Tucker, A.; Chang, S.H.; Lee, W.R. (Louisiana State Univ., Baton Rouge (United States))



Diarrhoea due to small bowel diseases  

PubMed Central

Small intestinal diseases are a common, though often overlooked cause of diarrhoeal illness. Fully 1% of the Caucasian population are affected by coeliac disease and a substantial portion of children living in poverty in the developing world are affected by environmental enteropathy. These are but two examples of the many diseases that cause mucosal injury to the primary digestive and absorptive organ in our body. While diarrhoea may be a common, though not universally seen symptom of small bowel mucosal disease, the consequent malabsorption can lead to substantial malnutrition and nutrient deficiencies. The small intestine, unlike the colon, has been relatively inaccessible, and systematic evaluation is often necessary to identify and treat small intestinal mucosal diseases that lead to diarrhoea. Immunodeficiency states, including HIV enteropathy, adult autoimmune enteropathy, drug-associated enteropathy, and tropical sprue continue to occur and require specific therapy. All patients with severe diarrhoea or diarrhoea associated with features suggestive of malabsorption may have a disease of the small intestinal mucosa that requires careful evaluation and targeted management.

Murray, Joseph A.; Rubio-Tapia, Alberto



Are there x-ray induced signature mutations in human cells?  

SciTech Connect

Investigations of mutational spectra generally have two primary objectives: identification of mutagen specific hallmark mutations, and insight into mutagenic mechanisms. In order to address these two crucial issues we have examined the spectrum of 116 x-ray induced, and 78 spontaneous, HPRT{sup -} mutants derived from the human B lymphoblastoid cell line TK6. Multiplex PCR analysis demonstrated that the overall representation of large deletions was not significantly different in the 2 spectra, although highly significant differences were observed for specific deletion types. Total gene deletions represented 41/78 (.53) of x-ray induced, but only 7/43 (.16) of spontaneous, deletions (p < .0001). In contrast, 5{prime} terminal deletions were significantly more common among spontaneous (17/43, .40) than x-ray induced (13/78, .17) large deletions (p=.0079). Chromosomal scale investigation of x-ray induced and spontaneous hprt total deletion mutants was also performed using cytogenetic examination, and X-linked PCR probes. The types of point mutations induced by x-ray exposure were very diverse, including all classes of transitions and transversions, tandem base substitutions, frameshifts, and a deletion/insertion compound mutation. Compared to spontaneous data, radiation induced point mutations exhibited a significantly reduced number of transitions, and an increased representation of small deletions. Small deletions were uniformly surrounded by direct sequence repeats. The distribution of x-ray induced point mutations was characterized by a cluster of 8 mutants within a 30 base region of exon 8. Thirteen HPRT{sup -} point mutants exhibited aberrant splicing, 4 of which were attributable to coding sequence alterations within exons 4 and 8. These results suggest that it may be possible to identify hallmark mutations associated with x-ray exposure of human cells.

Nelson, S.L.; Giver, C.R.; Grosovsky, A.J. [Univ. of California, Riverside, CA (United States)



Mitochondrial disorders in NSAIDs-induced small bowel injury  

PubMed Central

Recent studies using small bowel endoscopy revealed that non-steroidal anti-inflammatory drugs including low-dose aspirin, can often induce small bowel injury. Non-steroidal anti-inflammatory drugs-induced small bowel mucosal injury involves various factors such as enterobacteria, cytokines, and bile. Experimental studies demonstrate that both mitochondrial disorders and inhibition of cyclooxygenases are required for development of non-steroidal anti-inflammatory drugs-induced small bowel injury. Mitochondrion is an organelle playing a central role in energy production in organisms. Many non-steroidal anti-inflammatory drugs directly cause mitochondrial disorders, which are attributable to uncoupling of oxidative phosphorylation induced by opening of the mega channel called mitochondrial permeability transition pore on the mitochondrial membrane by non-steroidal anti-inflammatory drugs. Bile acids and tumor necrosis factor-? also can open the permeability transition pore. The permeability transition pore opening induces the release of cytochrome c from mitochondrial matrix into the cytosol, which triggers a cascade of events that will lead to cell death. Therefore these mitochondrial disorders may cause disturbance of the mucosal barrier function and elevation of the small bowel permeability, and play particularly important roles in early processes of non-steroidal anti-inflammatory drugs-induced small bowel injury. Although no valid means of preventing or treating non-steroidal anti-inflammatory drugs-induced small bowel injury has been established, advances in mitochondrial studies may bring about innovation in the prevention and treatment of this kind of injury.

Watanabe, Toshio; Tanigawa, Tetsuya; Nadatani, Yuji; Otani, Koji; Machida, Hirohisa; Okazaki, Hirotoshi; Yamagami, Hirokazu; Watanabe, Kenji; Tominaga, Kazunari; Fujiwara, Yasuhiro; Arakawa, Tetsuo



Use of early gastrografin small bowel follow-through in small bowel obstruction management.  


Small bowel follow-through (SBFT) is a diagnostic tool commonly used in the management of patients with small bowel obstruction (SBO). This study assessed whether early implementation of Gastrografin SBFT would reduce the time to resolution of the SBO and decrease the time to operative intervention. In this retrospective chart review, 103 patients with the clinical diagnosis of adhesive SBO were evaluated. End points of the study were resolution of SBO with nonoperative management or operative intervention. The patient group that had received a SBFT was then compared with those that did not receive a SBFT. There were 103 patients with adhesive SBO who met inclusion criteria for this study. Seventy-two of 103 patients had undergone Gastrografin SBFT and 31 did not. In the SBFT group, mean time to the operating room was 1.0 days after SBFTs, whereas in the group that did not receive SBFT, it was 3.7 days (P < 0.0001). Mean time to nonoperative resolution of SBO in the SBFT group was 1.8 days and 4.7 days in the no SBFT group (P < 0.0001). There were no Gastrografin-related complications. Obtaining Gastrografin SBFT in patients with adhesive SBO leads to both a shorter time in identifying the need for operative intervention and to resolution of SBO with nonoperative management. SBFT seems to be a more definitive assessment of whether an SBO will resolve on its own or if operative intervention is necessary. PMID:23896246

Galardi, Nicholas; Collins, Jay; Friend, Kara



Pathophysiology of Enlargement of the Small Bowel Fold.  

National Technical Information Service (NTIS)

Enlargement of the valvulae conniventes is an integral part of the pattern diagnosis of primary small bowel disease causing malabsorption. The pathophysiology underlying enlargement of the fold and the most typical diseases with prominent folds leading to...

D. E. Reagin W. W. Olmsted



Analysis of 178 Penetrating Stomach and Small Bowel Injuries  

Microsoft Academic Search

Surgical site infections (SSIs), such as wound infection, fascial dehiscence, and intraabdominal abscess, commonly occur following\\u000a penetrating abdominal trauma. However, most of the literature involves penetrating colon injuries. There are few reports describing\\u000a complications following penetrating stomach and small bowel injuries. Based on the hypothesis that SSIs are commonly found\\u000a following penetrating stomach and small bowel trauma, a prospective observational

Ali Salim; Pedro G. R. Teixeira; Kenji Inaba; Carlos Brown; Timothy Browder; Demetrios Demetriades



X-ray-induced photo-chemistry and X-ray absorption spectroscopy of biological samples.  


As synchrotron light sources and optics deliver greater photon flux on samples, X-ray-induced photo-chemistry is increasingly encountered in X-ray absorption spectroscopy (XAS) experiments. The resulting problems are particularly pronounced for biological XAS experiments. This is because biological samples are very often quite dilute and therefore require signal averaging to achieve adequate signal-to-noise ratios, with correspondingly greater exposures to the X-ray beam. This paper reviews the origins of photo-reduction and photo-oxidation, the impact that they can have on active site structure, and the methods that can be used to provide relief from X-ray-induced photo-chemical artifacts. PMID:23093745

George, Graham N; Pickering, Ingrid J; Pushie, M Jake; Nienaber, Kurt; Hackett, Mark J; Ascone, Isabella; Hedman, Britt; Hodgson, Keith O; Aitken, Jade B; Levina, Aviva; Glover, Christopher; Lay, Peter A



X-ray-induced photo-chemistry and X-ray absorption spectroscopy of biological samples  

PubMed Central

As synchrotron light sources and optics deliver greater photon flux on samples, X-ray-induced photo-chemistry is increasingly encountered in X-ray absorption spectroscopy (XAS) experiments. The resulting problems are particularly pronounced for biological XAS experiments. This is because biological samples are very often quite dilute and therefore require signal averaging to achieve adequate signal-to-noise ratios, with correspondingly greater exposures to the X-ray beam. This paper reviews the origins of photo-reduction and photo-oxidation, the impact that they can have on active site structure, and the methods that can be used to provide relief from X-ray-induced photo-chemical artifacts.

George, Graham N.; Pickering, Ingrid J.; Pushie, M. Jake; Nienaber, Kurt; Hackett, Mark J.; Ascone, Isabella; Hedman, Britt; Hodgson, Keith O.; Aitken, Jade B.; Levina, Aviva; Glover, Christopher; Lay, Peter A.



Ultraintense X-Ray Induced Ionization, Dissociation, and Frustrated Absorption in Molecular Nitrogen  

SciTech Connect

Sequential multiple photoionization of the prototypical molecule N{sub 2} is studied with femtosecond time resolution using the Linac Coherent Light Source (LCLS). A detailed picture of intense x-ray induced ionization and dissociation dynamics is revealed, including a molecular mechanism of frustrated absorption that suppresses the formation of high charge states at short pulse durations. The inverse scaling of the average target charge state with x-ray peak brightness has possible implications for single-pulse imaging applications.

Hoener, M. [Western Michigan University Physics Department, Kalamazoo, Michigan 49008 (United States); Advanced Light Source, Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States); Fang, L.; Murphy, B.; Berrah, N. [Western Michigan University Physics Department, Kalamazoo, Michigan 49008 (United States); Kornilov, O.; Gessner, O. [Ultrafast X-ray Science Laboratory Chemical Sciences Division Lawrence Berkeley National Laboratory, Berkeley, California 94720 (United States); Pratt, S. T.; Kanter, E. P. [Argonne National Laboratory, Argonne, Illinois 60439 (United States); Guehr, M.; Bucksbaum, P. H.; Cryan, J.; Glownia, M.; McFarland, B.; Petrovic, V. [PULSE Institute for Ultrafast Energy Science, SLAC National Accelerator Laboratory, Menlo Park, California 94025 (United States); Blaga, C.; DiMauro, L. [Ohio State University, Department of Physics, Columbus, Ohio 43210 (United States); Bostedt, C.; Bozek, J. D.; Coffee, R.; Messerschmidt, M. [Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park, California 94025 (United States)



Masked rat: an x-ray-induced mutant with chronic blepharitis, alopecia, and pasteurellosis  

Microsoft Academic Search

An autosomal recessive mutation had been previously x-ray-induced in the rat and named the masked rat (genotype mk\\/mk). This study describes the mutant's appearance, histology, and microflora. The rat's eyelids were swollen, often to the point of closure, and its face was partially covered by a brownish crust, giving the mutant a mask-like appearance. The chronic blepharitis was also accompanied

R. L. Kent; M. A. Lutzner; C. T. Hansen



Edaravone, a known free radical scavenger, enhances X-ray-induced apoptosis at low concentrations  

Microsoft Academic Search

Edaravone has been reported to have a radioprotective effect at high concentrations. We now report that a lower dose of edaravone enhanced X-ray-induced apoptosis of some cell lines harboring p53 wild-type status, such as MOLT-4, Nalm-6, and HepG2. The knock-down of p53 using siRNA in MOLT-4 cells abolished the radiosensitizing effect of edaravone. Enhanced phosphorylations of p53 at Ser 15

N. Sasano; A. Enomoto; Y. Hosoi; Y. Katsumura; Y. Matsumoto; A. Morita; K. Shiraishi; K. Miyagawa; H. Igaki; K. Nakagawa



Genetics of x-ray induced double strand break repair in Saccharomyces cerevisiae  

Microsoft Academic Search

This thesis examined the possible fates of x-ray induced double strand breaks in Saccharomyces cerevisiae. One possible pathway which breaks can follow is the repair pathway and this pathway was studied by assaying strains with mutations in RAD51, RAD54, and RAD57 loci for double strand break repair using neutral sucrose sedimentation. Rad54-3 strains were sensitive to x-ray at 36° and




Scanning force microscopy studies of X-ray-induced double-strand breaks in plasmid DNA  

Microsoft Academic Search

We present an analysis of X-ray-induced damage in ?X174 plasmid DNA, applying doses between D?=?250 and 1,500 Gy. To analyse this damage in detail, the distribution of plasmid fragments after irradiation have been determined\\u000a by scanning force microscopy. The results show that even for the lowest dose of D?=?250 Gy, a significant amount of double-strand breaks are observed. For increasing dose, the

M. Brezeanu; F. Träger; F. Hubenthal



Measurement of the energy dependence of X-ray-induced decomposition of potassium chlorate.  


We report the first measurements of the X-ray induced decomposition of KClO3 as a function of energy in two experiments. KClO3 was pressurized to 3.5 GPa and irradiated with monochromatic synchrotron X-rays ranging in energy from 15 to 35 keV in 5 keV increments. A systematic increase in the decomposition rate as the energy was decreased was observed, which agrees with the 1/E(3) trend for the photoelectric process, except at the lowest energy studied. A second experiment was performed to access lower energies (10 and 12 keV) using a beryllium gasket; suggesting an apparent resonance near 15 keV or 0.83 ? maximizing the chemical decomposition rate. A third experiment was performed using KIO3 to ascertain the anionic dependence of the decomposition rate, which was observed to be far slower than in KClO3, suggesting that the O-O distance is the critical factor in chemical reactions. These results will be important for more efficiently initiating chemical decomposition in materials using selected X-ray wavelengths that maximize decomposition to aid useful hard X-ray-induced chemistry and contribute understanding of the mechanism of X-ray-induced decomposition of the chlorates. PMID:23444908

Pravica, Michael; Bai, Ligang; Sneed, Daniel; Park, Changyong



Liver structure and function following small bowel resection  

PubMed Central

The observation that patients with extensive small bowel resection have impaired hepatocellular function with reduced BSP clearance and fatty change in biopsies from the liver led to a systematic study of liver structure and function following proximal and distal small bowel resection in the rat. While anaesthesia and surgery impaired BSP clearance per se, small bowel resection further reduced BSP clearance with impairment of both uptake and excretion phases of BSP excretion. The increased BSP retention was more marked after distal than after proximal small bowel resection, but in both experimental groups the abnormalities of BSP excretion spontaneously returned to normal three to four weeks after surgery. Circulating liver enzymes were normal but serum alkaline phosphatase was significantly depressed, particularly after distal resection. Isoenzyme studies showed that the depression of serum AP was due to a reduced intestinal isoenzyme. While serum levels remained consistently depressed up to eight weeks after proximal resection, in parallel with mucosal regeneration, serum AP returned to normal two to four weeks after ileectomy. While these minor changes in hepatic structure and function would normally be of little clinical importance, the additional insult of hepatic dysfunction may well be important in malnourished patients after extensive small bowel resection.

Gupta, M. C.; Neale, Graham; Dowling, R. Hermon



Mesenteric Air Embolism Following Enteroscopic Small Bowel Tattooing Procedure  

PubMed Central

Double balloon enteroscopy (DBE) is a revolutionary procedure in which the entire small bowel can be visualized endoscopically. DBE has the advantage of both diagnostic and therapeutic capabilities in the setting of small bowel neoplasms and vascular malformations. We present a unique case of a 76-year-old female who underwent small bowel DBE tattoo marking of a distal small bowel tumor complicated by development of severe abdominal pain postprocedure secondary to bowel air embolism into the mesenteric veins. Mesenteric air can be seen after other endoscopic procedures such as biopsy, mucosal clip placement and polypectomy, or following a colonoscopy. Mesenteric air embolism following small bowel tattooing procedure has not been previously reported in the literature. Mesenteric air when present may be attributed to mesenteric ischemia and can subject the patient to unnecessary surgical intervention if misdiagnosed. Thus, this report holds significance for the radiologist as computed tomography (CT) findings of mesenteric air embolism must be evaluated in the context of appropriate clinical history before treatment decisions are made.

Chen, Natalie; Lamba, Ramit; Lee, John; Lall, Chandana



ENETS TNM Staging Predicts Prognosis in Small Bowel Neuroendocrine Tumours  

PubMed Central

Introduction. Small bowel neuroendocrine tumours (NETs) are the most common type of gastrointestinal neuroendocrine tumours. The incidence and prevalence of these tumours are on the rise. The aims of this study were to determine prognostic clinicopathological features and whether the ENETS TNM staging system predicts prognosis and also. Method. Clinical data was collected retrospectively from 138 patients with histologically proven small bowel NETs managed at King's College Hospital. Histology was reviewed and small bowels tumours, were staged according to the ENETS TNM staging system. Results. Median age was 65 years (range 29–87). The 5-year survival was 79.5% and the 10-year survival was 48.5%. Resection of the primary tumour was associated with improved survival (120 versus 56 months, P < 0.05). On multivariate analysis prognostic factors were primary tumour resection and not having a carcinoid heart disease. TNM staging significantly separated survival of stage 2 and stage 3 from stage 4 NETs. Conclusion. Small bowel primary tumour resection and not having carcinoid heart disease are prognostic factors. The ENETS TNM staging and grading system appears to be of prognostic relevance to small bowel NETs.

Srirajaskanthan, Rajaventhan; Ahmed, A.; Prachialias, A.; Srinivasan, P.; Heaton, N.; Jervis, N.; Quaglia, A.; Vivian, G.; Ramage, J. K.



Role of X-ray-induced transcripts in adaptive responses following X-rays: Progress report -- year 2.  

National Technical Information Service (NTIS)

The overall goal of this proposal is to clone low dose X-ray-induced genes via molecular biology cloning techniques. From previous data, certain human cells can clearly carry out adaptive survival responses (ASRs) following ionizing radiation. Research go...

D. A. Boothman



X-ray Methods in High-Intensity Discharges and Metal-Halide Lamps: X-ray Induced Fluorescence  

SciTech Connect

We describe the use of x-ray induced fluorescence to study metal-halide high-intensity discharge lamps and to measure equilibrium vapor pressures of metal-halide salts. The physical principles of metal-halide lamps, relevant aspects of x-ray-atom interactions, the experimental method using synchrotron radiation, and x-ray induced fluorescence measurements relevant to metal-halide lamps are covered.

Curry, John J.; Lapatovich, Walter P.; Henins, Albert (NIST)



A Case of Small Bowel Ulcer Associated with Helicobacter pylori  

PubMed Central

The etiology of peptic ulcer disease in children may be primary, associated with Helicobacter pylori infection, or secondary, relied on underlying disease. Ulcerative lesions by H. pylori are mainly distributed in the duodenal bulb and they are rare below the ampulla of Vater because H. pylori growth is inhibited by bile juice. In this reason, there are only some restrictive reports presented small bowel ulcer associated H. pylori. We found multiple small bowel ulcerative lesions associated with H. pylori in an 11-year-old girl without any systemic disease while performing esophagogastroenteroscopy to the level of the proximal jejunum for differentiating bezoar. The abdominal pain improved after the patient was administered H. pylori eradication therapy. Because a small bowel ulcer associated with H. pylori has rarely been reported, we report it here with literature review.

Kim, Eun Young; Kim, Ji Hyun; Woo, Saet Byul; Lee, Jeong Won; Lee, Kon Hee; Shin, Su Rin



Small bowel endoscopy: cost-effectiveness of the different approaches.  


Obscure gastrointestinal haemorrhage is defined the presence of overt or occult bleeding in the setting of a normal endoscopic examination of the upper and lower gastrointestinal tracts. While obscure bleeding is not common, the evaluation and management of these patients often incurs considerable expense. Potential options for small bowel evaluation include traditional radiographic studies, push enteroscopy, video capsule endoscopy, deep enteroscopy, tagged red blood cell scans, angiography, and enterography examinations with either computed tomography and/or magnetic resonance imaging. The decision regarding which modality to employ depends on the cost of the procedure, its effectiveness in rendering a diagnosis, and the potential for administration of therapy. This article will discuss determination of costs associated with technology for small bowel imaging, quality of life data associated with chronic GI haemorrhage, and available cost-effectiveness studies comparing the options for small bowel exploration. PMID:22704574

Gerson, Lauren B



Diospyrobezoar as a Cause of Small Bowel Obstruction  

PubMed Central

Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki). We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery.

de Toledo, Andreia Padilha; Rodrigues, Fernanda Hurtado; Rodrigues, Murilo Rocha; Sato, Daniela Tiemi; Nonose, Ronaldo; Nascimento, Enzo Fabricio; Martinez, Carlos Augusto Real



Evaluation of the small bowel in inflammatory bowel disease.  


Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect the entire GI tract, and adequate visualization of the small bowel is imperative for both diagnosis and management. Magnetic resonance and computed tomography enterography have gradually replaced barium-based studies. Magnetic resonance enterography has the distinct advantage of avoiding ionizing radiation to which many patients with IBD are overexposed. Endoscopy-based techniques, including capsule endoscopy and device-assisted enteroscopy, allow direct visualization of the small bowel mucosa. Deep enteroscopy has the additional benefit of allowing sampling of the mucosa for histological analysis. Small intestine contrast ultrasound is rapidly gaining credence as an excellent, radiation-free imaging technique, but is not available in all countries. Other imaging modalities, such as positron emission tomography and leucocyte scintigraphy, continue to be studied and may have a role in specific circumstances. This review summarizes the evidence for the various techniques for evaluating the small bowel in IBD. PMID:23445233

Cullen, Garret; Donnellan, Fergal; Doherty, Glen A; Smith, Martin; Cheifetz, Adam S



Giant mesenteric lymphatic malformation presenting as small bowel volvulus  

PubMed Central

Abdominal pain with bilious emesis is an ominous clinical presentation with many possible causes. We describe a previously healthy 4-year-old boy who presented with these symptoms and ultrasound findings of fluid throughout most of the abdominal cavity. Computed tomography imaging revealed a large cystic mass (21-by-13 cm) associated with a small bowel obstruction due to volvulus. A laparoscopic exploration was undertaken, revealing a large mass arising from the small intestinal mesentery and causing a segmental volvulus of the small bowel. Conversion to mini-laparotomy allowed reduction of the volvulus and segmental resection of the small bowel associated with a giant mesenteric lymphatic malformation. This case describes a rare cause of intestinal volvulus due to a mesenteric lymphatic malformation.

Cauley, Christy E.; Spencer, Philip J.; Sagar, Pallavi; Goldstein, Allan M.



Roles of oxidative stress in synchrotron radiation X-ray-induced testicular damage of rodents  

PubMed Central

Synchrotron radiation (SR) X-ray has characteristic properties such as coherence and high photon flux, which has excellent potential for its applications in medical imaging and cancer treatment. However, there is little information regarding the mechanisms underlying the damaging effects of SR X-ray on biological tissues. Oxidative stress plays an important role in the tissue damage induced by conventional X-ray, while the role of oxidative stress in the tissue injury induced by SR X-ray remains unknown. In this study we used the male gonads of rats as a model to study the roles of oxidative stress in SR X-ray-induced tissue damage. Exposures of the testes to SR X-ray at various radiation doses did not significantly increase the lipid peroxidation of the tissues, assessed at one day after the irradiation. No significant decreases in the levels of GSH or total antioxidation capacity were found in the SR X-ray-irradiated testes. However, the SR X-ray at 40 Gy induced a marked increase in phosphorylated H2AX – a marker of double-strand DNA damage, which was significantly decreased by the antioxidant N-acetyl cysteine (NAC). NAC also attenuated the SR X-ray-induced decreases in the cell layer number of seminiferous tubules. Collectively, our observations have provided the first characterization of SR X-ray-induced oxidative damage of biological tissues: SR X-ray at high doses can induce DNA damage and certain tissue damage during the acute phase of the irradiation, at least partially by generating oxidative stress. However, SR X-ray of various radiation doses did not increase lipid peroxidation.

Ma, Yingxin; Nie, Hui; Sheng, Caibin; Chen, Heyu; Wang, Ban; Liu, Tengyuan; Shao, Jiaxiang; He, Xin; Zhang, Tingting; Zheng, Chaobo; Xia, Weiliang; Ying, Weihai



Small-bowel lymphoma and regional enteritis: radiographic similarities  

SciTech Connect

Lymphoma and regional enteritis may demonstrate strikingly similar patterns in the small bowel. Fifty cases of regional enteritis and small-bowel lymphoma were reviewed. Of these, there were 12 cases of both diseases in which a confident radiographic distinction could not be made. Both diseases may narrow the terminal ileum, present as inflammatory processes, and demonstrate nodular patterns. Other similarities include aneurysmal dilatation, several types of ulceration, fistula formation, mesenteric masses, and involvement of the terminal ileum either alone or in association with skip areas. Clinical implications and the pathologic processes responsible for the radiographic similarity between these entities are discussed.

Sartoris, D.J.; Harell, G.S.; Anderson, M.F.; Zboralske, F.F.



Enteroscopy in small bowel Crohn's disease: A review  

PubMed Central

Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes within the gastrointestinal tract and most importantly a supportive histology. The article is intended mainly for the general gastroenterologist and for other interested physicians. Management of small bowel CD has been suboptimal and limited due to the inaccessibility of the small bowel. Enteroscopy has had a significant renaissance recently, thereby extending the reach of the endoscopist, aiding diagnosis and enabling therapeutic interventions in the small bowel. Radiologic imaging is used as the first line modality to visualise the small bowel. If the clinical suspicion is high, wireless capsule endoscopy (WCE) is used to rule out superficial and early disease, despite the above investigations being normal. This is followed by push enteroscopy or device assisted enteroscopy (DAE) as is appropriate. This approach has been found to be the most cost effective and least invasive. DAE includes balloon-assisted enteroscopy, [double balloon enteroscopy (DBE), single balloon enteroscopy (SBE) and more recently spiral enteroscopy (SE)]. This review is not going to cover the various other indications of enteroscopy, radiological small bowel investigations nor WCE and limited only to enteroscopy in small bowel Crohn’s. These excluded topics already have comprehensive reviews. Evidence available from randomized controlled trials comparing the various modalities is limited and at best regarded as Grade C or D (based on expert opinion). The evidence suggests that all three DAE modalities have comparable insertion depths, diagnostic and therapeutic efficacies and complication rates, though most favour DBE due to higher rates of total enteroscopy. SE is quicker than DBE, but lower complete enteroscopy rates. SBE has quicker procedural times and is evolving but the least available DAE today. Larger prospective randomised controlled trial’s in the future could help us understand some unanswered areas including the role of BAE in small bowel screening and comparative studies between the main types of enteroscopy in small bowel CD.

Tharian, Benjamin; Caddy, Grant; Tham, Tony CK



Acute Lower Gastrointestinal Haemorrhage Secondary to Small Bowel Ascariasis  

PubMed Central

Acute lower gastrointestinal haemorrhage secondary to small bowel ascariasis is extremely rare. A high level of suspicion should be maintained when dealing with acute gastrointestinal haemorrhage in migrants and travellers. Small bowel examination is warranted when carefully repeated upper and lower endoscopies have failed to elicit the source of bleeding. Appropriate test selection is determined by the availability of local expertise. We present a case of acute lower gastrointestinal haemorrhage secondary to jejunal ascariasis and a literature search on lower gastrointestinal haemorrhage associated with jejunal infestation with Ascaris.

Daphne Dewi, Stephen; Sze Li, Siow



Influence of caffeine on X-ray-induced killing and mutation in V79 cells  

SciTech Connect

Effects produced by caffeine on X-irradiated Chinese hamster V79 cells depended on the growth conditions of the cells. For exponentially growing cells, nontoxic concentrations of caffeine decreased the shoulder width from the survival curve, but the slope remained unchanged. The yield of mutants under the same conditions also remained unaffected. In case of density-inhibited cells, delaying trypsinization for 24 h after X irradiation increased the survival and decreased the yield of mutants. The presence of caffeine during this incubation period inhibited such recovery and significantly increased the yield of X-ray-induced mutants.

Bhattacharjee, S.B.; Bhattacharyya, N.; Chatterjee, S.



Genetics of x-ray induced double strand break repair in saccharomyces cerevisiae  

Microsoft Academic Search

The possible fates of x-ray-induced double-strand breaks in Saccharomyces cerevisiae were examined. One possible pathway which breaks can follow, the repair pathway, was studied by assaying strains with mutations in the RAD51, RAD54, and RAD57 loci for double-strand break repair. In order of increasing radiation sensitivity one finds: rad57-1(23°)> rad51-1(30°)> rad54-3(36°). At 36°, rad54-3 cells cannot repair double-strand breaks, while




Differential effects of radical scavengers on X-ray-induced mutation and cytotoxicity in human cells  

SciTech Connect

The cytotoxic and mutagenic effects of X irradiation on a human lymphoblast cell line were examined in the presence of two radioprotective agents which modulate damage to DNA. The cells were treated with X rays alone or in the presence of either dimethyl sulfoxide or cysteamine. Surviving fraction and mutation to trifluorothymidine resistance (tk locus) and to 6-thioguanine resistance (hgprt locus) were measured. Survival was enhanced when the cells were irradiated in the presence of dimethyl sulfoxide; the D0 rose from 58 to 107 rad. However, at both genetic loci the induced mutant fractions were identical in the presence or absence of dimethyl sulfoxide. Survival was enhanced to a greater degree when the cells were irradiated in the presence of cysteamine; the D0 rose from 58 to 200 rad. Cysteamine also protected the cells from X-ray-induced mutation; the frequencies of X-ray-induced mutation at both the tk and hgprt loci were reduced by 50-75%. No protective effects were observed unless dimethyl sulfoxide or cysteamine was present during irradiation. These findings are discussed in terms of the hypothesis that, unlike for cell killing, radiation-induced mutagenesis in human lymphoblast cells is not mediated by the actions of aqueous free radicals, but rather by the direct effects of ionizing radiation.

Corn, B.W.; Liber, H.L.; Little, J.B.



Isolation of x-ray-inducible transcripts from radioresistant human melanoma cells  

SciTech Connect

Twelve x-ray-induced transcripts (xips), differentially expressed 8- to 230-fold in x-irradiated versus unirradiated radioresistant human melanoma (U1-Mel) cells, were isolated as cDNA clones (xip1 through xip12) after four rounds of differential hybridization. Northern analyses revealed rare, medium, and abundant xips, ranging in size from 1.2 to 10 kb. All transcripts were transiently expressed and induced by low, but not by high (>600 cGy), doses of radiation. Three transcripts (xip4, -7, and -12) were induced only by ionizing radiation, and many (i.e., xip1, -2, -3, -5, -6, -8, -9, -10, and -11) were also induced by UV irradiation or phorbol 12-myristate 13-acetate. Heat shock did not induce any of the xips, but it decreased basal levels of xip4, -7, -11, and -12. Three xip cDNA clones were identified as encoding thymidine kinase, DT diaphorase, and tissue-type plasminogen activator. The remaining nine cDNA clones showed little homology to known genes. Three clones contained regions homologous to c-fes/fps protooncongene, recombination activating gene 1, or the human angiogenesis factor gene. X-ray-inducible genes may function in damaged cells to regulate DNA repair, apoptosis, mutagenesis, and carcinogenesis.

Boothman, D.A.; Lee, S.W. (Harvard Medical School, Boston, MA (United States) Univ. of Michigan, Ann Arbor (United States)); Meyers, M.; Fukunaga, N. (Univ. of Michigan, Ann Arbor (United States))



Characterization of X-ray-induced immunostaining of proliferating cell nuclear antigen in human diploid fibroblasts  

SciTech Connect

The repair of X-ray-induced DNA damage related to the proliferating cell nuclear antigen (PCNA) was characterized in human diploid fibroblasts by an indirect immunofluorescence method. PCNA staining induced by X rays was lost after DNase I treatment but not after RNase treatment. The staining was not induced when ATP was depleted or the temperature was lowered to 0{degrees}C during the X irradiation. When cells were incubated at 37{degrees}C after X irradiation, PCNA staining diminished gradually and was almost entirely absent 12-15 h later. On the other hand, PCNA staining persisted during aphidicolin treatment even 20 h after X irradiation. Induction of PCNA staining was not affected by the aphidicolin treatment. Cycloheximide treatment did not affect induction of the staining either, but did inhibit the disappearance of the staining. There was no difference in the staining pattern and time course of PCNA staining after X irradiation between normal and xeroderma pigmentosum group A (XP-A) cells. These results imply that PCNA-dependent, aphidicolin-sensitive DNA polymerases may be involved in repair of X-ray-induced DNA damage in vivo, but the repair initiation step could be different from that of nucleotide excision repair initiated by XP proteins. 39 refs., 6 figs.

Miura, Masahiko; Sasaki, Takehito [Tokyo Medical and Dental Univ. (Japan); Takasaki, Yoshinari [Juntendo Univ., Tokyo (Japan)



[Post-traumatic small-bowel obstruction: two case studies].  


Post-traumatic small-bowel obstructions are rare and late complications following blunt abdominal trauma. Timely diagnosis is frequently impeded because of nonspecific associated symptoms, and furthermore, the degree of urgency is frequently underestimated due to the accidental cause. During the last 6 years (2005-2011), we have observed only 2 cases (4 and 10 years old) with post-traumatic small-bowel obstruction. On admission the patients had a contusion on the abdominal wall, duodenal hematoma and a Chance fracture of the lumbar spine on the computed tomography (CT) scan. Although early clinical improvement was noted, progression of the disorder was observed for the following 15 days like an occlusive syndrome (abdominal distension, nausea, emesis). Abdominal ultrasound and computed tomography scan revealed small-bowel obstruction. At laparotomy, jejunal stenosis was found associated with mesenteric tears, which was resected with end-to-end anastomosis. Six to 8 months of follow-up ascertained the therapeutic efficacy of the procedure. Post-traumatic small-bowel obstructions are rare; the clinical presentation is unspecific and appears with a time lag following the trauma. Echography and computed tomography scan can establish both the diagnosis and therapeutic choice. PMID:22463958

Faure, A; Maurin, C; Lauron, J; Jouve, J-L; De Lagausie, P; Merrot, T



Closure and Summary of Ninth International Small Bowel Transplantation Symposium  

Microsoft Academic Search

The highlights of The Ninth International Small Bowel Transplantation Symposium included the latest results from the Intestinal Transplant Registry (ITR), which demonstrated that the number of transplants performed annually continued to rise to 180 per year, most of which were performed in the United States, where the greatest number of home parenteral nutrition (PN) patients live (a prevalence of around

S. V. Beath



X-ray differential diagnosis in small bowel disease  

SciTech Connect

This book is a compendium of the author's experience with contrast fluid irrigation techniques of the small intestine. This book contains 300 radiographs, X-rays and detailed figures. It presents an overview of differential diagnosis of abnormal conditions of the small bowel.

Sellink, S.L. (University Hospital, Leiden (NL))



An unusual cause of small bowel obstruction: dried apricots.  


Small bowel obstruction is rarely caused by bezoars. An important cause of phytobezoars are dried fruits. A 56 year old man presented to our department with symptoms of acute intestinal obstruction. Abdomen was distended and tender at the right and left lower quadrants. Bowel movements were decreased, and rectum was empty on digital examination. Upright plain films of the abdomen revealed multiple air-fluid levels and patient was immediately operated on. Due to the ischaemia of short small bowel segment, resection and end to end anastomosis were performed. After resection, bowel was opened and an apricot was found in the small bowel lumen. Although the dried apricot was small enough to pass through the pylorus spontaneously, it became swollen in fluid and started to obstruct the small bowel lumen especially in the terminal ileum. Obstruction by undigested food is rare and mostly seen in children, edentulous older people and patients with mental disorders. In conclusion, dried fruits, when swallowed without chewing, may cause intestinal obstruction. PMID:22125996

Gümüs, Metehan; Kapan, Murat; Onder, Akin; Tekbas, Güven; Yagmur, Yusuf



Small Bowel Injury in Peritoneal Encapsulation following Penetrating Abdominal Trauma.  


Small bowel encapsulation is a rare entity which is usually found incidentally at autopsy. We report the first case of peritoneal encapsulation encountered serendipitously at laparotomy undertaken for penetrating abdominal trauma and review the literature on peritoneal encapsulation. We also compare this phenomenon to abdominal cocoon and sclerosing encapsulating peritonitis. PMID:23533912

Naidoo, K; Mewa Kinoo, S; Singh, B



Adult postoperative intussusception: a rare cause of small bowel obstruction.  


A case is reported of postoperative jejunojejunal intussusception in a 45-year-old Afro-Caribbean male following an emergency truncal vagotomy and pyloroplasty. This is a rare cause of postoperative small bowel obstruction, and the pathogenesis and diagnosis of postoperative intussusception in the adult is discussed. Differences between conventional childhood, postoperative childhood, adult, and postoperative adult intussusception are outlined. PMID:17943053

Zbar, A P; Murphy, F; Krishna, S M



Langerhan's cell histiocytosis complicating small bowel Crohn's disease.  

PubMed Central

Langerhan's cell histiocytosis is a rare infiltrative disorder of unknown aetiology. A variety of tissues may be affected, but clinically evident intestinal involvement is unusual. An adult patient is described with Crohn's disease of the terminal ileum who subsequently developed Langerhan's cell histiocytosis with extensive infiltration of the small bowel. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6

Lee-Elliott, C; Alexander, J; Gould, A; Talbot, R; Snook, J A



Small Bowel Injury in Peritoneal Encapsulation following Penetrating Abdominal Trauma  

PubMed Central

Small bowel encapsulation is a rare entity which is usually found incidentally at autopsy. We report the first case of peritoneal encapsulation encountered serendipitously at laparotomy undertaken for penetrating abdominal trauma and review the literature on peritoneal encapsulation. We also compare this phenomenon to abdominal cocoon and sclerosing encapsulating peritonitis.

Naidoo, K.; Mewa Kinoo, S.; Singh, B.



Cell Turnover Following Small Bowel Resection and By-Pass  

Microsoft Academic Search

Changes in epithelial cell turnover play a central role in the regenerative response of the residual small intestine after partial small bowel resection. This article reviews these changes both in experimental animals and in man and discusses how alterations in cell turnover may influence villous morphology, the enzyme content of the cells and the absorptive and digestive function of the

Hermon Dowling; M. H. Gleeson



Bedside placement of small bowel feeding tubes in hospitalized patients  

Microsoft Academic Search

ObjectiveThe benefits of enteral nutrition when compared with parenteral nutrition are well established. However, provision of enteral nutrition may not occur for several reasons, including lack of optimal feeding access. Gastric feeding is easier to initiate, but many hospitalized patients are intolerant to gastric feeding, although they can tolerate small bowel feeding. Many institutions rely on costly methods for placing

Gail Cresci; Robert Martindale



REVIEW: Small Bowel Review: Diseases of the Small Intestine  

Microsoft Academic Search

In the past year there have been many advances in the area of small bowel physiology and pathology and therapy. In preparation for this review, over 1500 papers were assessed. The focus is on presenting clinically useful information for the practicing gastroenterologist. Selected important clinical learning points include the following: (1) glutamine may restore the AIDs-associated increased intestinal permeability to

A. B. R. Thomson; M. Keelan; A. Thiesen; M. T. Clandinin; M. Ropeleski; G. E. Wild



Primary Malignancies of the Small Bowel: A Report of 96 Cases and Review of the Literature  

PubMed Central

The clinical records and histologic sections of 96 cases of primary small bowel malignancies (excluding lymphomas and periamullary lesions) were reviewed. The location, clinical presentation, pathologic findings, treatment and outcome are compared to the collected published experience, approximately 2400 cases. There were 48 adenocarcinomas, 37 carcinoids, and 11 leiomyosarcomas. Fifty-one men and 45 women ranged from 31 to 83 years old. Eighty-four caused symptoms leading to operative diagnosis; 12 carcinoids were incidental autopsy findings. The most common presentation was pain (33%) followed by weight loss (23%) obstruction (16%), hemorrhage (15%), jaundice (5%), intussusception (3%) and perforation (3%). Masses were felt in 30% of the cases, but were usually dilated bowel or intussusception rather than the tumor per se. Curative resection was attempted in 80 of 84 operatively diagnosed tumors. The 80% mortality among patients followed 5 years is attributed to the late appearance of symptoms and anatomic obstacles to a truly radical operation.

Wilson, James M.; Melvin, David B.; Gray, George F.; Thorbjarnarson, Bjorn



Effect of caffeine on the expression of a major X-ray induced protein in human tumor cells  

SciTech Connect

We have examined the effect of caffeine on the concomitant processes of the repair of potentially lethal damage (PLD) and the synthesis of X-ray-induced proteins in the human malignant melanoma cell line, Ul-Mel. Caffeine administered at a dose of 5mM after X radiation not only inhibited PLD repair but also markedly reduced the level of XIP269, a major X-ray-induced protein whose expression has been shown to correlate with the capacity to repair PLD. The expression of the vast majority of other cellular proteins, including seven other X-ray-induced proteins, remained unchanged following caffeine treatment. A possible role for XIP269 in cell cycle delay following DNA damage by X irradiation is discussed.

Hughes, E.N.; Boothman, D.A. (Univ. of Pennsylvania School of Medicine, Philadelphia (USA))



PVDF measurement of soft x ray induced shock and filter debris impulse  

NASA Astrophysics Data System (ADS)

PVDF piezoelectric polymer shock stress sensors have been used to measure the shock and impulse generated by soft X-rays and by filter debris in the SATURN Plasma Radiation Source at Sandia National Laboratories, NM. SATURN was used to generate 30 to 40 kJ, 20-ns duration, line radiation at 2 to 3 keV. Fluence on samples was nominally 40, 200, and 400 kJ/m(sup 2) (1, 5, and 10 cal/cm(sup 2)). Measurements of X-ray induced material shock response exposing both aluminum and PMMA acrylic samples agree well with companion measurements made with single crystal X-cut quartz gauges. Time-of-flight, stress, and impulse produced by Kimfol (polycarbonate/aluminum) filter debris were also measured with the PVDF gauges.

Johnson, D. E.; Lee, L. M.; Hedemann, M. A.; Bauer, F.


Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy  

Microsoft Academic Search

Background: The small bowel is the most commonly affected site of Crohn’s disease (CD) although it may involve any part of the gastrointestinal tract. The current methodologies for examining the small bowel are x ray and endoscopy.Aims: To evaluate, for the first time, the effectiveness of wireless capsule endoscopy in patients with suspected CD of the small bowel undetected by

Z Fireman; E Mahajna; E Broide; M Shapiro; L Fich; A Sternberg; Y Kopelman; E Scapa



Multiresolution analysis and classification of small bowel medical images.  


This is the first reported work in the area of small bowel image classification and a novel analysis system was developed. Principles of human texture perception were used to design features which can discriminate between abnormal and normal images. The proposed method extracts statistical features from the wavelet domain, which describe the homogeneity of localized areas within the small bowel images. To ensure that robust features were extracted, a shift-invariant discrete wavelet transform (SIDWT) was explored. LDA classification was used with the leave one out method to improve classification under the small database scenario. A total of 75 abnormal and normal bowel images were used for experimentation resulting in high classification rates: 85% specificity and 85% sensitivity. The success of the system can be accounted to the discriminatory and robust feature set (translation, scale and semi-rotational invariant), which successfully classified various sizes and types of pathologies at multiple viewing angles. PMID:18003011

Khademi, April; Krishnan, Sridhar



Anticoagulation-induced spontaneous intramural small bowel haematomas.  


Small intestinal intramural haematomas may develop spontaneously, especially in patients with deranged clotting function. We present a case of a 57-year-old man who developed abdominal pain in the setting of abnormal clotting function secondary to an inadvertent warfarin overdose. A CT scan showed thickening of parts of the distal ileum, terminal ileum and duodenum. Dilation of the small bowel proximal to the thickening was also reported, indicative of a degree of small bowel obstruction. The patient was treated conservatively with a nasogastric tube and intravenous fluids. His anticoagulation was fully reversed with fresh frozen plasma and vitamin K. The patient remained well 6 months following discharge, with well-controlled anticoagulation levels and resolution of the findings on CT. PMID:23737571

Zammit, Adrian; Marguerat, Deborah Grech; Caruana, Clifford



[Value of small bowel double contrast enema in clinical interventions].  


The double contrast enema is the most effective morphological screening method for the evaluation of the whole small bowel. Its sensitivity is 85%, its specifity 96.7%. In specific clinical problems the number of pathological roentgen findings rises: from 34.4% when all indications are taken into consideration to 58% in indications specific to the small intestine such as Morbus Crohn or the malabsorption syndrome. Search for tumours and the double contrast of the small bowel in unclear gastro-intestinal bleeding are unproductive. The weak point of this screening method is the lower part of the small intestine. Therefore, the selective peroral or retrograde analysis of the terminal ileum supplement the contrast method. A precondition for good results is an adequate technical standard. Besides the clinical results some technical results are therefore discussed such as contrast medium quantities, examination and X-ray time, radiation exposure and influences on the image quality. PMID:3083480

Rödl, W; Possel, H M; Prull, A; Wunderlich, L



Telemetry system for slow wave measurement from the small bowel  

Microsoft Academic Search

A telemetry capsule system was designed and implemented to measure the slow wave activity of the small bowel, which is an\\u000a important parameter for the diagnosis of gastric diseases. The capsule amplified the slow wave signal from the intraluminal\\u000a electrodes, and transmitted the digitally sampled data by means of a radio frequency transmitter. The implemented capsule\\u000a (11 × 21 mm2) was smaller than

S. H. Woo; J. H. Cho



Acute gastric dilation and ischemia secondary to small bowel obstruction  

PubMed Central

Acute gastric dilation leading to ischemia of the stomach is an under-diagnosed and potentially fatal event. Multiple etiologies can lead to this condition, and all physicians should be aware of it. Without proper and timely diagnosis and treatment, gastric perforation, hemorrhage, and other serious complications can occur. We report a case of acute gastric dilation and ischemia secondary to small bowel obstruction. We also review the world literature and discuss the etiology, diagnosis, and management of this condition.

Lamont, Jeffrey; Petrey, Laura



Early Microcirculatory Changes after Ischemic Preconditioning and Small Bowel Autotransplantation  

Microsoft Academic Search

Background\\/Aims: Ischemia-reperfusion injury contributes to the high complication rate of small bowel transplantation (SBTX). Ischemic preconditioning (IPC) protects against reperfusion injury in several organs, but the IPC-induced microcirculatory reaction in the intestine is unknown. Methods: We examined the effects of IPC on the macrohemodynamics and graft microcirculation in a canine model of SBTX during a 4-hour reperfusion period. In group

A. Wolfárd; J. Kaszaki; S. Varga; G. Lázár; M. Boros



Phytobezoar: an uncommon cause of small bowel obstruction.  

PubMed Central

Phytobezoars are an unusual cause of small bowel obstruction. We report 13 patients presenting with 16 episodes of small bowel obstruction from phytobezoars. Eleven patients had previously undergone surgery for peptic ulceration (eight truncal vagotomy and pyloroplasty). A history of ingestion of persimmon fruit was common and the majority of cases presented in the autumn when this fruit is in season. One phytobezoar causing obstruction at the third part of the duodenum was removed by endoscopic fragmentation, while an episode of jejunal obstruction was precipitated by endoscopic fragmentation of a gastric bezoar. Twelve patients underwent surgery for obstruction on 15 occasions, with milking of the phytobezoar to the caecum performed in ten, enterotomy and removal in four and resection in one patient. Associated gastric phytobezoars were found in two cases and multiple small bowel bezoars in two other cases. These were removed to prevent recurrent obstruction. Phytobezoar should be considered preoperatively as a cause of obstruction in patients with previous ulcer surgery. Wherever possible milking of a phytobezoar to the caecum should be performed. Careful assessment for other phytobezoars should be made. Prevention of phytobezoars is dependent upon dietary counselling of patients by surgeons after gastric resection or vagotomy and drainage for peptic ulcer.

Chisholm, E. M.; Leong, H. T.; Chung, S. C.; Li, A. K.



Isochronal annealing study of X-ray induced defects in single- and double-walled carbon nanotubes  

NASA Astrophysics Data System (ADS)

X-ray induced defects in single-walled (SWCNTs) and double-walled carbon nanotubes (DWCNTs) were characterized by Raman scattering spectroscopy. Frenkel defects, interstitial-vacancy pairs, were revealed to form in both SWCNTs and DWCNTs after X-ray irradiation because these defects were entirely healed by thermal annealing. In order to clarify the structure of the X-ray induced defect in SWCNT and DWCNT, isochronal-annealing experiments were performed on the irradiated samples and the activation energy for defect healing was estimated. The intensity of D band (defect induced band) on Raman spectra was used as a measure of the density of X-ray induced defects. The experimental results were in good agreement with the simulated values using second order reaction model, which indicated that the defect healing was determined by the migration energy of interstitials on the carbon layer. We also found that the activation energy for defect healing of SWCNT and DWCNT were around 0.5 eV and 0.32 eV, respectively. The X-ray induced defects in SWCNTs were more stable than those in DWCNTs. Compared these estimated activation energies to previous theoretical reports, we concluded that bridge and/or dumbbell interstitials are formed in both SWCNT and DWCNT by X-ray irradiation.

Murakami, Toshiya; Yamamoto, Yuki; Kisoda, Kenji; Itoh, Chihiro



NAD+ administration significantly attenuates synchrotron radiation X-ray-induced DNA damage and structural alterations of rodent testes  

PubMed Central

Synchrotron radiation (SR) X-ray has great potential for its applications in medical imaging and cancer treatment. In order to apply SR X-ray in clinical settings, it is necessary to elucidate the mechanisms underlying the damaging effects of SR X-ray on normal tissues, and to search for the strategies to reduce the detrimental effects of SR X-ray on normal tissues. However, so far there has been little information on these topics. In this study we used the testes of rats as a model to characterize SR X-ray-induced tissue damage, and to test our hypothesis that NAD+ administration can prevent SR X-ray-induced injury of the testes. We first determined the effects of SR X-ray at the doses of 0, 0.5, 1.3, 4 and 40 Gy on the biochemical and structural properties of the testes one day after SR X-ray exposures. We found that 40 Gy of SR X-ray induced a massive increase in double-strand DNA damage, as assessed by both immunostaining and Western blot of phosphorylated H2AX levels, which was significantly decreased by intraperitoneally (i.p.) administered NAD+ at doses of 125 and 625 mg/kg. Forty Gy of SR X-ray can also induce marked increases in abnormal cell nuclei as well as significant decreases in the cell layers of the seminiferous tubules one day after SR X-ray exposures, which were also ameliorated by the NAD+ administration. In summary, our study has shown that SR X-ray can produce both molecular and structural alterations of the testes, which can be significantly attenuated by NAD+ administration. These results have provided not only the first evidence that SR X-ray-induced tissue damage can be ameliorated by certain approaches, but also a valuable basis for elucidating the mechanisms underlying SR X-ray-induced tissue injury.

Sheng, Caibin; Chen, Heyu; Wang, Ban; Liu, Tengyuan; Hong, Yunyi; Shao, Jiaxiang; He, Xin; Ma, Yingxin; Nie, Hui; Liu, Na; Xia, Weiliang; Ying, Weihai



Transmucosal myotomy of the small bowel after ileoanal anastomosis.  


Posterior transmucosal myotomy of the small bowel distal to the pelvic pouch was carried out in two patients who underwent restorative proctocolectomy for ulcerative colitis. Painful spasms of the efferent limb and outlet obstruction of the reservoir were the main indications for surgery. Laparotomy was unnecessary, as the operation could be performed either through a transanal route or by means of a rigid sigmoidoscope. Both patients showed marked clinical improvement after myotomy; therefore, it may be considered an effective and safe procedure in the treatment of functional and mechanical disorders of the small intestine above an ileoanal anastomosis. PMID:6714049

Pescatori, M; Parks, A G



Global Small Bowel Motility: Assessment with Dynamic MR Imaging.  


Purpose: To assess the repeatability in human volunteers of software-quantified small bowel motility captured with magnetic resonance (MR) imaging and to test the ability to detect changes in motility induced by pharmacologic agents. Materials and Methods: The study was approved by the Royal Free Research Ethics Committee, and all subjects gave full written informed consent. Twenty-one healthy volunteers (14 men, seven women; mean age, 28 years) underwent cine MR imaging with a three-dimensional balanced turbo field-echo sequence to capture small bowel motility. Volume blocks (15 cm thick) were acquired every second during a 20-second breath hold. A randomized, blinded, placebo-controlled crossover study of either 0.5 mg neostigmine or saline (n = 11) or 20 mg intravenous butylscopolamine or saline (n = 10) was performed with motility MR imaging at baseline and repeated at a mean of 4 weeks (range, 2-7 weeks). Two readers independently drew regions of interest around the small bowel, and motility was quantified by using a registration algorithm that provided a global motility metric in arbitrary units. Repeatability of the motility measurements at baseline was assessed by using Bland-Altman and within-subject coefficient of variation measures. Changes in mean motility measurements after drug administration were compared with those after placebo administration by using paired t testing. Results: The repeatability between baseline measurements of motility was high; the Bland-Altman mean difference was -0.0025 (range, 0.28-0.4), the 95% limit of agreement was ±0.044 arbitrary units (au), and the within-subject coefficient of variation was 4.9%. Measured motility with neostigmine (mean, 0.39 au) was significantly higher than that with placebo (mean, 0.34 au; P < .001), whereas that with butylscopolamine (mean, 0.13 au) was significantly lower than that with placebo (mean, 0.30 au; P < .001). Conclusion: Quantification of small bowel motility with use of MR imaging in healthy volunteers is repeatable and sensitive to changes induced by means of pharmacologic manipulation. © RSNA, 2013 Supplemental material: PMID:23801770

Menys, Alex; Taylor, Stuart A; Emmanuel, Anton; Ahmed, Asia; Plumb, Andrew A; Odille, Freddy; Alam, Ahsan; Halligan, Steve; Atkinson, David



Delayed Presentation of Trichobezoar with Small Bowel Obstruction  

PubMed Central

Small bowel obstruction is a common surgical emergency but trichobezoar as an etiology, rarely reported. A seven year old school going female child presented with acute intestinal obstruction with a palpable and mobile mass in the abdomen. At exploration, a 10 cm long trichobezoar was found in the distal ileum which was removed through enterotomy. Postoperative course remained uneventful. Further probing revealed that child used to eat her own scalp hairs at the age of 2 years and the habit persisted for about 18 months which resulted in alopecia at that time. Later on she started showing normal behavior.

Akhtar, Jamshed; Ahmed, Soofia



Late presentation of small bowel obstruction following blunt abdominal trauma  

Microsoft Academic Search

Background  Motor vehicle accidents have increasingly become a major cause of serious blunt abdominal and chest injury, the pattern and\\u000a mechanism of which has changed in recent years largely due to seatbelt legislation.\\u000a \\u000a \\u000a \\u000a Aim  A case of blunt abdominal and chest trauma is reported which resulted in a mesenteric tear — the small bowel subsequently\\u000a herniated through and strangulated.\\u000a \\u000a \\u000a \\u000a Conclusion  This case highlights

R. G. Casey; J. Ryan; P. Gillen



Evisceration of small bowel after cauterization of an umbilical mass.  


The omphalomesenteric duct (OMD), a temporary structure essential to fetal development, normally involutes completely by week 8 or 9 of gestation. On occasion, the OMD persists, the clinical presentations of which vary widely. We describe a case of a 6-week-old male with a patent OMD remnant that was initially treated as an umbilical granuloma, which then potentially allowed for prolapse of the small bowel through the umbilical ring. The patient required resection of the incarcerated bowel but had an otherwise uneventful and complete recovery. PMID:23166332

Kondrich, Janienne; Woo, Theodore; Ginsburg, Howard B; Levine, Deborah A



Dose response of soft X-ray-induced bystander cell killing affected by p53 status.  


A radiation-induced bystander response, which is generally defined as a cellular response that is induced in nonirradiated cells that received bystander signals from directly irradiated cells within an irradiated cell population. In our earlier X-ray microbeam studies, bystander cell killing in normal human fibroblasts had a parabolic relationship to the irradiation dose. To elucidate the role of p53 in the bystander cell killing, the effects were assessed using human non-small cell lung cancer cells expressing wild-type or temperature-sensitive mutated p53. The surviving fraction of bystander wild-type p53 cells showed a parabolic relationship to the irradiation dose; survival was steeply reduced up to 0.45 Gy, recovered toward to 2 Gy, and remained at control levels up to 5 Gy. In contrast, in the mutated p53 cells at a nonpermissive temperature, the surviving fraction was steeply reduced up to 1 Gy and remained at the reduced level up to 5 Gy. When the mutated p53 cells were incubated at a permissive temperature, the decrease in the surviving fraction at 2 Gy was suppressed. The wild-type p53 cells were not only restrained in releasing bystander signals at 2 Gy, but were also resistant to the signals released by the mutated p53 cells. These results suggest that the X-ray-induced bystander cell killing depends on both the irradiation dose and the p53 status of the targeted cells and the bystander cells. PMID:23289390

Tomita, Masanori; Maeda, Munetoshi; Kobayashi, Katsumi; Matsumoto, Hideki



Gold nanoparticles enhance the X-ray-induced degradation of human centrin 2 protein  

NASA Astrophysics Data System (ADS)

In the war against cancer, radiotherapy is a prominent tool but counterbalanced by the fact that it also induces damages in healthy tissues. Nanotechnologies could open a new possibility to decrease these side effects. In particular, gold nanoparticles (GNPs) could be used as radio-sensitizers. As the role of proteins in the processes leading to cell death cannot be neglected, their radio-sensitization by GNPs is of great interest. This is particularly true in the case of the human centrin 2 protein, which has been proposed to be involved in DNA repair processes. To investigate this effect, we quantified for the first time the degradation of this protein in a gold colloidal solution when submitted to X-rays. We showed that the X-ray-induced degradation of the human centrin 2 protein is enhanced 1.5-fold in the presence of GNPs, even though no covalent bond exists between protein and GNPs. Among the conditions tested, the maximum enhancement was found with the higher GNP:protein ratio of 2×10-4 and with the higher X-ray energy of 49 keV.

Brun, Emilie; Duchambon, Patricia; Blouquit, Yves; Keller, Gérard; Sanche, Léon; Sicard-Roselli, Cécile



Ischemic Necrosis of Small Bowel Following Laparoscopic Surgery  

PubMed Central

Background and Objective: Small bowel ischemia following laparoscopy was described recently as a rare fatal complication of the CO2 pneumoperitoneum. Of the 8 cases reported in the surgical literature, 7 were fatal, 1 was not. In this report, we describe the first gynecological case. Methods: A 34-year-old woman who underwent laparoscopy with extensive adhesiolysis and myolysis was re-admitted with an acute abdomen on postoperative day 4. Immediate laparotomy revealed acute peritonitis, extensive adhesions, and a 3-cm defect in the small bowel. Tissue examination showed ischemic necrosis of edematous, but essentially normal, bowel mucosa. The postoperative course was extremely complicated. She was discharged after a 2-month hospital stay in the intensive care unit for rehabilitation. Results: Data are available on 7 patients (including ours). All procedures were described as uneventful. The intraabdominal pressure was set at 15 mm Hg when specified. Some abdominal pain occurred in all, nausea and vomiting in 4, diarrhea in 2, abdominal distention in 1, fever in none. Quick reintervention laparotomy was performed in 2 and delayed in 5 (up to 4 days). Discussion: The CO2 pneumoperitoneum is a predisposing factor for intestinal ischemia as it reduces cardiac output and splanchnic blood flow. However, critical ischemia relies on underlying vasculopathy or an inciting event. Conclusion: Patient selection, maintaining intraabdominal pressure at 15 mm Hg or less, and intermittent decompression of the gas represent the best options for preventing this complication.

Galanopoulos, Christos; Langerman, Alexander



Laparoscopic resection of small bowel lipoma causing obscure gastrointestinal bleeding.  


Small bowel lipomas are rare gastrointestinal benign neoplasms, whose signs and symptoms are often obscure. When symptoms are clinically present, one of the most common is usually gastrointestinal (GI) bleeding. It is very difficult to make a precise preoperative diagnosis in the absence of evident signs. Definitive diagnosis can only be made through histopathological examination, after the surgical resection. We report a case of obscure and persistent GI bleeding in a 78-year-old woman. Through the combination of endoscopy and computed tomography (CT), it was possible to identify a small bowel lesion, being its direct cause. CT showed a certain fat component within the mass pinpointing the hypothesis of a lipoma. We then performed a laparoscopic resection of 21 cm of the middle jejunum, including the mass and an intussusception. The results of the subsequent histopathological examination of the resected specimen allowed us to conclude that the lesion was an intestinal lipoma. Surgical resection appears to be the most successful approach as good short- and long-term results are achieved. PMID:21691916

Ferrara, Francesco; Duburque, Clothilde; Quinchon, Jean-François; Gaudissart, Quentin



Surgical aspects of radiation enteritis of the small bowel  

SciTech Connect

Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.

Wobbes, T.; Verschueren, R.C.; Lubbers, E.J.; Jansen, W.; Paping, R.H.



Small bowel transplantation promotes bacterial overgrowth and translocation.  


Alterations in the symbiotic relationship between immunocompromised hosts and their resident gut microflora may lead to serious complications following small bowel transplantation (SBT). This study examined the effects of SBT and cyclosporine (CsA) immunosuppression on gut bacterial populations and translocation to the mesenteric lymph nodes. Sixty adult male meat-fed Lewis rats were divided into six groups: normal controls, CsA alone (24 mg/kg im qod), CsA carrier vehicle alone, isografts, isografts given CsA, and allografts given CsA. Rats were killed after 3 weeks and segments of small bowel and colon were harvested for quantitative tissue culture. Mesenteric lymph nodes and blood were cultured to identify translocation. Transplantation alone led to an increase in gram-negative aerobes from 2.6 to 4.6 colony forming units/100 mg tissue (P less than 0.05) in the distal ileum (transplanted segment). Eighty-four percent of transplanted animals receiving CsA had bacteria recovered from their mesenteric lymph nodes compared to none in controls (P less than 0.001) and 20% in isografts not receiving CsA (P less than 0.02). Intestinal transplantation alone appears to promote gram-negative overgrowth while the addition of CsA therapy facilitates translocation to the mesenteric lymph nodes and may predispose to gut-associated sepsis following SBT. PMID:1943089

Browne, B J; Johnson, C P; Edmiston, C E; Hlava, M A; Moore, G H; Roza, A M; Telford, G L; Adams, M B



Genetics of x-ray induced double strand break repair in Saccharomyces cerevisiae  

SciTech Connect

This thesis examined the possible fates of x-ray induced double strand breaks in Saccharomyces cerevisiae. One possible pathway which breaks can follow is the repair pathway and this pathway was studied by assaying strains with mutations in RAD51, RAD54, and RAD57 loci for double strand break repair using neutral sucrose sedimentation. Rad54-3 strains were sensitive to x-ray at 36/sup 0/ and resistant at 23/sup 0/, while rad57-1 strains are sensitive to radiation at 23/sup 0/ and resistant at 36/sup 0/. In order of increasing radiation sensitivity one finds: rad57-1(23/sup 0/)> rad51-1(30/sup 0/)>rad54-3(36/sup 0/). At the restrictive temperature 36/sup 0/, rad54-3 cells are unaable to repair double strand breaks, while at the permissive temperature, 23/sup 0/, these strains are able to repair double strand breaks. On the other hand, strains with the rad57-1 mutation appear to be able to rejoin broken chromosomes at both the permissive and restrictive temperature. However, the low assay is not distinguishing large DNA fragments which allow cell survival from large DNA fragments which cause cell death. A rad51-1 strain also appeared able to rejoin broken chromosomes, and is thus capable of incomplete repair. The data can be explained with the hypotheses that rad54-3 cells are blocked in a later step of repair. The fate of double strand breaks when they are left unrepaired was also investigated with the temperature conditional rad54-3 mutation. If breaks are prevented from entering the RAD54 repair pathway they are modified and become uncommitted lesions. The rate these uncommitted lesions are repaired is slower than the rate the original breaks are repaired.

Budd, M.E.



Role of x-ray-induced transcripts in adaptive responses following x-rays  

SciTech Connect

Potentially lethal damage repair (PLDR) and sublethal damage repair, may be the same manifestations of a series of common enzymatic steps. PLDR, has two distinct phases based upon DNA lesion repair and survival recovery studies. The first phase of PLDR occurs very quickly (t{sub {1/2}}:2--20 mins) to increase the survival of X-irradiated cells by mending the vast array of DNA lesions created by ionizing radiation. The second slower phase of PLDR proceeds much later (i.e., >1--2 hrs) following X-irradiation, during which the remaining double-stranded DNA breaks are completely repaired. This second phase of repair closely corresponds to the restructuring of gross chromosomal damage, and can be partially blocked in some human cells by inhibiting protein synthesis. This slower phase of PLDR correlated with a rapid decline in X-ray-induced transformation of normal cells. The fast component of PLDR may be due to constitutively synthesized DNA ligases, topoisomerases, or polymerases, which act immediately to repair damaged, DNA. In contrast, the slow phase of PLDR in human cells may require the induction of specific genes and gene product's involved in the repair of potentially lethal or carcinogenic DNA lesions. Induced gene products (i.e., proteins) specifically synthesized in response to physiological doses of ionizing radiation in radioresistant human melanoma (U1-Mel) cells, and in a variety of other human normal and cancer-prone cells, were identified using two-dimensional gel electrophoresis. We identified and partially characterized ten proteins synthesized by U1-Mel cells. The synthesis of eight of these proteins were specifically induced by ionizing radiation and two proteins were repressed Neither heat shock, UV-irradiation, nor bifunctional alkylating agent treatments resulted in the induction of these proteins. The expression of one protein, XIP269, correlated very well with PLDR capacity.

Boothman, D.A.



Genetics of x-ray induced double strand break repair in saccharomyces cerevisiae  

SciTech Connect

The possible fates of x-ray-induced double-strand breaks in Saccharomyces cerevisiae were examined. One possible pathway which breaks can follow, the repair pathway, was studied by assaying strains with mutations in the RAD51, RAD54, and RAD57 loci for double-strand break repair. In order of increasing radiation sensitivity one finds: rad57-1(23/sup 0/)> rad51-1(30/sup 0/)> rad54-3(36/sup 0/). At 36/sup 0/, rad54-3 cells cannot repair double-strand breaks, while 23/sup 0/, they can. Strains with the rad57-1 mutation can rejoin broken chromosomes at both temperatures. However, the low survival at 36/sup 0/ shows that the assay is not distinguishing large DNA fragments which allow cell survival from those which cause cell death. A rad51-1 strain could also rejoin broken chromosomes, and was thus capable of incomplete repair. The data can be explained with the hypothesis that rad54-3 cells are blocked in an early step of repair, while rad51-1 and rad57-1 strains are blocked in a later step of repair. The fate of double-strand breaks when they are left unrepaired was investigated with the rad54-3 mutation. If breaks are prevented from entering the RAD54 repair pathway they become uncommitted lesions. These lesions are repaired slower than the original breaks. One possible fate for an uncommitted lesion is conversion into a fixed lesion, which is likely to be an unrepairable or misrepaired double-strand break. The presence of protein synthesis after irradiation increases the probability that a break will enter the repair pathway. Evidence shows that increased probability of repair results from enhanced synthesis of repair proteins shortly after radiation. (ERB)

Budd, M.E.



MRI of the small-bowel: how to differentiate primary neoplasms and mimickers  

PubMed Central

MRI of the gastrointestinal tract is gaining clinical acceptance and is increasingly used to evaluate patients with suspected small-bowel diseases. MRI may be performed with enterography or enteroclysis, both of which combine the advantages of cross-sectional imaging with those of conventional enteroclysis. In this paper, MRI features of primary small-bowel neoplasms, the most important signs for differential diagnosis and the diseases that can be considered as mimickers of small-bowel neoplasms, are discussed.

Masselli, G; Colaiacomo, M C; Marcelli, G; Bertini, L; Casciani, E; Laghi, F; D'Amico, P; Caprasecca, S; Polettini, E; Gualdi, G



Effect of traps on the current impulse from X-ray induced conductivity in wide-gap semiconductors  

NASA Astrophysics Data System (ADS)

This article presents a theoretical model for the calculation of the current impulse from X-ray induced conductivity in wide-gap semiconductors that contain different types of traps and recombination centres. The absorption of one X-ray photon in a semiconductor with ohmic contacts was investigated. The influence of the main parameters of the traps and recombination centres on the shape and amplitude of the current impulse was determined.

Degoda, V. Ya.; Sofiienko, A. O.



High-Resolution Measurements of Th and U Lgamma-X-rays Induced by Energetic O Ions  

Microsoft Academic Search

The first experimental results of a high-resolution study of Th and U Lgamma-X-rays induced in collisions with 230 MeV and 360 MeV oxygen ions, undertaken to investigate the dynamics of the multiple ionization in M-, N- and O-shells and the structure of M- and N-shell X-ray satellites, are reported. The measurements were performed using the transmission curved- crystal spectrometer installed

M. Pajek; D. Banas; D. Castella; D. Corminboeuf; J.-Cl. Dousse; Y.-P. Maillard; O. Mauron; P. A. Raboud; D. Chmielewska; I. Fija; M. Jasköa; A. Korman; T. Ludziejewski; J. Rzadkiewicz; Z. Sujkowski; J. Hoszowska; M. Polasik; T. Mukoyama



Diagnosis of chronic small bowel disease in cats: 100 cases (2008-2012).  


Objective-To determine whether a diagnosis of chronic small bowel disease could be established in a subset of cats that had clinical signs of chronic vomiting, chronic small bowel diarrhea, weight loss, or a combination of these, combined with ultrasonographically determined thickening of the small bowel. Design-Retrospective case series. Animals-100 client-owned domestic cats. Procedures-Medical records of cats with clinical signs of chronic vomiting, chronic small bowel diarrhea, weight loss, or a combination of these, combined with ultrasonographically determined small bowel thickening, that underwent laparotomy and multiple small bowel biopsies between 2008 and 2012 were examined. Biopsy specimens were submitted for histologic evaluation, immunohistochemical evaluation, and, when findings were ambiguous, PCR assay for antigen receptor rearrangement. Results-Chronic small bowel disease was diagnosed in 99 of the 100 cats. The most common diagnoses were chronic enteritis and intestinal lymphoma. Conclusions and Clinical Relevance-Results suggested that cats with clinical signs of chronic small bowel disease should undergo detailed diagnostic testing because they are likely to have clinically important, diagnosable, treatable disease. Clinical signs of small bowel disease, especially weight loss and chronic or recurrent vomiting, are extremely common in cats. These signs should not be considered a normal condition and should not be ignored, regardless of common explanations given by owners, and cats with these signs should undergo appropriate diagnostic testing. PMID:24171376

Norsworthy, Gary D; Scot Estep, J; Kiupel, Matti; Olson, Jennifer C; Gassler, Loren N



Phytobezoar in a jejunal diverticulum as a cause of small bowel obstruction: a case report  

PubMed Central

Introduction Phytobezoars are concretions of poorly digested fruit and vegetable fibers found in the alimentary tract. Previous gastric resection, gastrojejunostomy, or pyloroplasty predispose people to bezoar formation. Small-bowel bezoars normally come from the stomach, and primary small-bowel bezoars are very rare. They are seen only in patients with underlying small-bowel diseases such as diverticula, strictures, or tumors. Primary small-bowel bezoars almost always present as intestinal obstructions, although it is a very rare cause, being responsible for less than 3% of all small-bowel obstructions in one series. Jejunal diverticula are rare, with an incidence of less than 0.5%. They are usually asymptomatic pseudodiverticula of pulsion type, and complications are reported in 10% to 30% of patients. A phytobezoar in a jejunal diverticulum is an extremely rare presentation. Case presentation A 78-year-old Pakistani man presented to our clinic with small-bowel obstruction. Upon exploration, we found a primary small-bowel bezoar originating in a jejunal diverticulum and causing jejunal obstruction. Resection and anastomosis of the jejunal segment harboring the diverticulum was performed, and our patient had an uneventful recovery. Conclusion Primary small-bowel bezoars are very rare but must be kept in mind as a possible cause of small-bowel obstruction.



Small bowel perforation secondary to enteric Salmonella paratyphi A infection  

PubMed Central

A patient of Pakistani-origin was admitted to Bradford Royal Infirmary, UK, following a 3-week history of cough, headache and general malaise. He had recently spent 10 weeks in Pakistan and on return had been diagnosed in the community with Swine flu. He developed abdominal pain and diarrhoea in the week prior to admission, and presented to hospital with fever, tachycardia and raised inflammatory markers. He deteriorated rapidly, developing signs of peritonism and Salmonella paratyphi A was grown from blood cultures. CT demonstrated a small volume of free fluid within the abdomen and the patient underwent laparotomy. A small bowel perforation was resected and a side to side anastomosis fashioned. Treatment with intravenous antibiotics was completed and the patient was discharged 9 days postoperatively.

Dunne, J A; Wilson, J; Gokhale, J



Small bowel obstruction secondary to transport aircraft: Coincidence or reality?  


Small bowel obstructions (SBO) are a leading cause of admission to general surgery, posing the problem of the aetiology and treatment based on the diagnosis. More than 300 patients were admitted for SBO in 2011 in our institution. In our clinical practice, we have had to care for patients with SBO immediately after air travel, all of whom had an antecedent of abdominal surgery by laparotomy. The finding of episodes of acute SBO immediately following a commercial flight has never been reported in the literature. We report the cases of four patients for whom we offer several pathophysiological hypotheses, and we publish the first dietary rules for people with a history of intraperitoneal surgery to adopt during a flight. PMID:23806628

Massalou, D; Fournier, M; Salucki, B; Baqué, P



An unusual cause of small bowel obstruction: Gossypiboma - case report  

PubMed Central

Background The term "gossypiboma" denotes a mass of cotton that is retained in the body following surgery. Gossypiboma is a medico-legal problem especially for surgeons. To the best of our knowledge, the patient presented herein is the second reported patient in whom the exact site of migration of a retained surgical textile material into the intestinal lumen could be demonstrated by preoperative imaging studies. Case presentation A 74-year-old woman presented with symptoms of small bowel obstruction due to incomplete intraluminal migration of a laparotomy towel 3 years after open cholecystectomy and umbilical hernia repair. Plain abdominal radiography did not show any sign of a radio-opaque marker in the abdomen. However, contrast enhanced abdominal computerized tomography revealed a round, well-defined soft-tissue mass with a dense, enhanced wall, containing an internal high-density area with air-bubbles in the mid-abdomen. A fistula between the abscess cavity containing the suspicious mass and gastrointestinal tract was identified by upper gastrointestinal series. The presence of a foreign body was considered. It was surgically removed with a partial small bowel resection followed by anastomosis. Conclusions Although gossypiboma is rarely seen in daily clinical practice, it should be considered in the differential diagnosis of acute mechanical intestinal obstruction in patients who underwent laparotomy previously. The best approach in the prevention of this condition can be achieved by meticulous count of surgical materials in addition to thorough exploration of surgical site at the conclusion of operations and also by routine use of surgical textile materials impregnated with a radio-opaque marker.

Gencosmanoglu, Rasim; Inceoglu, Resit



NADPH oxidase-mediated generation of reactive oxygen species: A new mechanism for X-ray-induced HeLa cell death  

SciTech Connect

Oxidative damage is an important mechanism in X-ray-induced cell death. Radiolysis of water molecules is a source of reactive oxygen species (ROS) that contribute to X-ray-induced cell death. In this study, we showed by ROS detection and a cell survival assay that NADPH oxidase has a very important role in X-ray-induced cell death. Under X-ray irradiation, the upregulation of the expression of NADPH oxidase membrane subunit gp91{sup phox} was dose-dependent. Meanwhile, the cytoplasmic subunit p47{sup phox} was translocated to the cell membrane and localized with p22{sup phox} and gp91{sup phox} to form reactive NADPH oxidase. Our data suggest, for the first time, that NADPH oxidase-mediated generation of ROS is an important contributor to X-ray-induced cell death. This suggests a new target for combined gene transfer and radiotherapy.

Liu Qing [Department of Radiobiology, Institute of Modern Physics, Chinese Academy of Sciences, 509 Nanchang Rd., Lanzhou 730000 (China); Key Laboratory of Heavy Ion Radiation Medicine of Gansu Province, 509 Nanchang Rd., Lanzhou 730000 (China); He Xiaoqing [First Affiliated Hospital of Lanzhou University, 1 Donggang West Rd., Lanzhou 730000 (China); Liu Yongsheng [Key Laboratory of Animal Virology of Ministry of Agriculture, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural, 1 Xujiaping Rd., Lanzhou 730046 (China); Du Bingbing; Wang Xiaoyan [College of Medicine, Lanzhou University, 222, South Tianshui Rd., Lanzhou 730000 (China); Zhang Weisheng [Gansu Province People's Hospital, 160 Donggang West Rd., Lanzhou 730000 (China); Jia Pengfei [Institute of Cell Biology, School of Life Science, Lanzhou University, 222, South Tianshui Rd., Lanzhou 730000 (China); Dong Jingmei [Institute of Sports Medicine, Lanzhou City University, Jiefang Rd., Lanzhou 730070 (China); Ma Jianxiu [College of Medicine, Northwest University for Nationalities, 1 Northwest New Village, Lanzhou 730030 (China); Wang Xiaohu [Department of Radiology, Gansu Province Cancer Hospital, 2 Xiaoxihu East Rd., Lanzhou 730050 (China); Li Sha [Department of Radiology, Lanzhou General Hospital of PLA, 98 Xiaoxihu West Rd., 730050 (China); Zhang Hong [Department of Radiobiology, Institute of Modern Physics, Chinese Academy of Sciences, 509 Nanchang Rd., Lanzhou 730000 (China); Key Laboratory of Heavy Ion Radiation Medicine of Gansu Province, 509 Nanchang Rd., Lanzhou 730000 (China)], E-mail:



Postheparin plasma diamine oxidase values in the follow up of patients with small bowel Crohn's disease  

Microsoft Academic Search

Measurement of postheparin plasma diamine oxidase (PHD) activity has been proposed to assess mucosal integrity in several diseases of the small intestine. In Crohn's disease, PHD values identify a group of patients with predominantly small bowel mucosal damage. To determine the role of mucosal involvement in the progression of small bowel Crohn's disease and whether different PHD values can predict

L DAgostino; S Pignata; B Daniele; M Visconti; C Ferraro; G DAdamo; G Tritto; G Ambrogio; G Mazzacca



The Nectarine Pit as a Cause for Small Bowel Obstruction and Perforation: A Case Report  

PubMed Central

Ingestion of a foreign body is a rare cause of small bowel obstruction. Ingested foreign bodies will usually pass without clinical sequelae, however on occasion can contribute to significant morbidity. Here we present an unusual case of small bowel obstruction and perforation as a result of accidental ingestion of a nectarine pit.

Arthur, Thomas



The smaller bowel: imaging the small bowel in paediatric Crohn's disease  

Microsoft Academic Search

Crohn's disease begins in childhood in 20% of cases. Imaging of the small bowel is needed for diagnosis and management and also to inform the clinician of the location, extent, and activity of disease. There are several modalities available to image the small bowel and the combined use of these is often required to optimise benefit. Methods available for imaging

Sam Stuart; Thomas Conner; Asia Ahmed; Michael Steward; Jody Maclachlan; Peter Wylie; Isobel Beal



The pattern of rejection after combined stomach, small bowel, and pancreas transplantation in the rat  

Microsoft Academic Search

This study was designed to investigate whetherin combined stomach, small bowel, and pancreas transplantation allograft rejection occurs in the individual organs concomitantly and with the same intensity. Heterotopic enbloc transplantation of the stomach, small bowel, and pancreas was performed in a Lewis-to-Brown Norway rat combination. Group 1 animals received no immunosuppressive therapy while animals in group, 2 were treated with

G. Oberhuber; T. Schmid; W. Thaler; G. Klima; R. Margreiter



Incarcerated Trocar Site Herniation of the Small Bowel following Laparoscopic Myomectomy  

PubMed Central

Small bowel herniation through the fascial defect created by the entry of trocars is one of the major complications of the laparoscopic surgery. In this paper, we describe a 42-year-old woman developing an incarcerated trocar site herniation of the small bowel following laparoscopic myomectomy and treated by laparoscopic approach.

Zomer, Monica Tessmann; de Azevedo, Rafael Menezes



Incarcerated Trocar Site Herniation of the Small Bowel following Laparoscopic Myomectomy.  


Small bowel herniation through the fascial defect created by the entry of trocars is one of the major complications of the laparoscopic surgery. In this paper, we describe a 42-year-old woman developing an incarcerated trocar site herniation of the small bowel following laparoscopic myomectomy and treated by laparoscopic approach. PMID:23956895

Kondo, William; Zomer, Monica Tessmann; Braga-Baiak, Andresa; de Azevedo, Rafael Menezes



Alveolar Soft Part Sarcoma Metastatic to Small Bowel Mucosa Causing Polyposis and Intussuseption  

PubMed Central

A report of alveolar soft part sarcoma metastatic to the small bowel is presented. Hematogenous metastases to the small bowel from primary tumors outside the abdominal cavity are uncommon, and most remain asymptomatic and are not discovered until autopsy. However, small bowel metastases can lead to intestinal obstruction, intussuseption or even perforation. While metastases to the small bowel have been described for other tumor types, including melanoma and lung cancer, this is extremely uncommon for sarcoma, especially alveolar soft part sarcoma. We describe a 42-year-old male with a long history of alveolar soft part sarcoma, metastatic to the lung and brain, who developed an intussuseption from metastases to the small bowel.

Sabel, Michael S.; Litwin, Allan; Mcgrath, Brian; Kraybill, William B.; Brooks, John J.



Note: Experiments in hard x-ray chemistry: in situ production of molecular hydrogen and x-ray induced combustion.  


We have successfully loaded H(2) into a diamond anvil cell at high pressure using the synchrotron x-ray induced decomposition of NH(3)BH(3). In a second set of studies, radiation-assisted release of O(2) from KCLO(3), H(2) release from NH(3)BH(3), and reaction of these gases in a mixture of the reactants to form liquid water using x-rays at ambient conditions was observed. Similar observations were made using a KCLO(3) and NaBH(4) mixture. Depending on reaction conditions, an explosive or far slower reaction producing water was observed. PMID:22462968

Pravica, Michael; Bai, Ligang; Park, Changyong; Liu, Yu; Galley, Martin; Robinson, John; Hatchett, David



X-ray-induced mutations in Escherichia coli K-12 strains with altered DNA polymerase I activities  

Microsoft Academic Search

Spectra of ionizing radiation mutagenesis were determined by sequencing X-ray-induced endogenous tonB gene mutations in Escherichia coli polA strains. We used two polA alleles, the polA1 mutation, defective for Klenow domain, and the polA107 mutation, defective for flap domain. We demonstrated that irradiation of 75 and 50Gy X-rays could induce 3.8- and 2.6-fold more of tonB mutation in polA1 and

Yuki Nagata; Masakado Kawata; Jun-ichiro Komura; Tetsuya Ono; Kazuo Yamamoto



Lessons learned: Optimization of a murine small bowel resection model  

PubMed Central

Background/Purpose Central to the use of murine models of disease is the ability to derive reproducible data. The purpose of this study was to determine factors contributing to variability in our murine model of small bowel resection (SBR). Methods Male C57Bl/6 mice were randomized to sham or 50% SBR. The effect of housing type (pathogen-free versus standard housing), nutrition (reconstituted powder versus tube feeding formulation), and correlates of intestinal morphology with gene expression changes were investigated Multiple linear regression modeling or one-way ANOVA was used for data analysis. Results Pathogen-free mice had significantly shorter ileal villi at baseline and demonstrated greater villus growth after SBR compared to mice housed in standard rooms. Food type did not affect adaptation. Gene expression changes were more consistent and significant in isolated crypt cells that demonstrated adaptive growth when compared with crypts that did not deepen after SBR. Conclusion Maintenance of mice in pathogen-free conditions and restricting gene expression analysis to individual animals exhibiting morphologic adaptation enhances sensitivity and specificity of data derived from this model. These refinements will minimize experimental variability and lead to improved understanding of the complex process of intestinal adaptation.

Taylor, Janice A.; Martin, Colin A.; Nair, Rajalakshmi; Guo, Jun; Erwin, Christopher R.; Warner, Brad W.



Small bowel review: diseases of the small intestine.  


In the past year there have been many advances in the area of small bowel physiology and pathology and therapy. In preparation for this review, over 1500 papers were assessed. The focus is on presenting clinically useful information for the practicing gastroenterologist. Selected important clinical learning points include the following: (1) glutamine may restore the AIDs-associated increased intestinal permeability to normal; (2) substance P is a major mediator of diarrhea caused by Costridium difficile toxin A, acting by binding to a G-protein-coupled receptor, and represents a possible 2therapeutic target; (3) the serological diagnosis of celiac disease has been greatly enhanced with the use of anti-endomysial antibody testing, and the recent antitransglutaminase; (4) a quarter of patients with celiac disease may have secondary pancreatic insufficiency and require enzyme replacement therapy; (5) in the patient with unexplained elevation in the serum transaminase concentration, consider celiac disease as an obscure possibility; (6) bosentan and endothelin receptor agonist may prove to be useful in reducing gut ischemia in patients with septic shock; and (7) the administration of recombinant human fibroblast growth factor-2 may prove to be useful to prevent radiation damage to the gastrointestinal tract. PMID:11768246

Thomson, A B; Keelan, M; Thiesen, A; Clandinin, M T; Ropeleski, M; Wild, G E



Small bowel MRI enteroclysis or follow through: Which is optimal?  

PubMed Central

AIM: To determine if a nasojejunal tube (NJT) is required for optimal examination of enteroclysis and if patients can be examined only in the supine position. METHODS: Data were collected from all patients undergoing small bowel (SB) magnetic resonance imaging (MRI) examination over a 32-mo period. Patients either underwent a magnetic resonance (MR) follow-through (MRFT) or a MR enteroclysis (MRE) in the supine position. The quality of proximal and distal SB distension as well as the presence of motion artefact and image quality were assessed by 2 radiologists. RESULTS: One hundred and fourteen MR studies were undertaken (MRFT-49, MRE-65) in 108 patients in the supine position only. Image artefact was more frequent in MRE than in MRFT (29.2% vs 18.4%), but was not statistically significant (P = 0.30). Adequate distension of the distal SB was obtained in 97.8% of MRFT examinations and in 95.4% of MRE examinations, respectively. Proximal SB distension was, however, less frequently optimal in MRFT than in MRE (P = 0.0036), particularly in patients over the age of 50 years (P = 0.0099). Image quality was good in all examinations. CONCLUSION: All patients could be successfully imaged in the supine position. MRE and MRFT are equivalent for distal SB distension and artefact effects. Proximal SB distension is frequently less optimal in MRFT than in MRE. MRE is, therefore, the preferred MR examination method of the SB.

Lawrance, Ian C; Welman, Christopher J; Shipman, Peter; Murray, Kevin



Small Bowel Intussusception due to Metastasized Sarcomatoid Carcinoma of the Lung: A Rare Cause of Intestinal Obstruction in Adults  

PubMed Central

Although small bowel intussusception is one of the most common abdominal emergencies in childhood, it is rare in adults and usually occurs as a result of an underlying pathology. Sarcomatoid carcinoma, a very rare subtype of lung cancer, rarely metastasizes to small bowel and causes complications. In this paper, we aim to describe a patient with small bowel intussusception caused by an isolated small bowel metastasis of the sarcomatoid carcinoma of the lung by reviewing the literature.

Guner, Ali; Karyagar, Savas; Livaoglu, Ayten; Kece, Can; Kucuktulu, Uzer



Small Bowel Intussusception due to Metastasized Sarcomatoid Carcinoma of the Lung: A Rare Cause of Intestinal Obstruction in Adults.  


Although small bowel intussusception is one of the most common abdominal emergencies in childhood, it is rare in adults and usually occurs as a result of an underlying pathology. Sarcomatoid carcinoma, a very rare subtype of lung cancer, rarely metastasizes to small bowel and causes complications. In this paper, we aim to describe a patient with small bowel intussusception caused by an isolated small bowel metastasis of the sarcomatoid carcinoma of the lung by reviewing the literature. PMID:23346451

Guner, Ali; Karyagar, Sava?; Livaoglu, Ayten; Kece, Can; Kucuktulu, Uzer



X-ray-induced mutations in Escherichia coli K-12 strains with altered DNA polymerase I activities.  


Spectra of ionizing radiation mutagenesis were determined by sequencing X-ray-induced endogenous tonB gene mutations in Escherichia coli polA strains. We used two polA alleles, the polA1 mutation, defective for Klenow domain, and the polA107 mutation, defective for flap domain. We demonstrated that irradiation of 75 and 50 Gy X-rays could induce 3.8- and 2.6-fold more of tonB mutation in polA1 and polA107 strains, respectively, than spontaneous level. The radiation induced spectrum of 51 tonB mutations in polA1 and 51 in polA107 indicated that minus frameshift, A:T-->T:A transversion and G:C-->T:A transversion were the types of mutations increased. Previously, we have reported essentially the same X-ray-induced tonB mutation spectra in the wild-type strain. These results indicate that (1) X-rays can induce minus frameshift, A:T-->T:A transversion and G:C-->T:A transversion in E. coli and (2) presence or absence of polymerase I (PolI) of E. coli does not have any effects on the process of X-ray mutagenesis. PMID:12873727

Nagata, Yuki; Kawata, Masakado; Komura, Jun-ichiro; Ono, Tetsuya; Yamamoto, Kazuo



Deconjugation of bile acids by lactobacilli in the mouse small bowel.  

PubMed Central

Conjugated and unconjugated bile acid concentrations in the small bowel contents and portal serum samples collected from mice with and without lactobacilli (RLFL and RLF, respectively) as gastrointestinal inhabitants were measured. The major portion of bile acids in the small bowel contents of RLFL mice was unconjugated (67.9%) in contrast to that of RFL animals in which a smaller portion of bile acids was unconjugated (23.5%). This study demonstrated that bile salt hydrolase produced by lactobacilli is active under the conditions prevailing in the proximal small bowels of mice.

Tannock, G W; Tangerman, A; Van Schaik, A; McConnell, M A



Small bowel perforation after drawing a blood sample in the femoral artery: a case report.  


Small bowel perforation is a rare complication of femoral artery access in cases of femoral hernia. A 48-year-old woman was admitted to the intensive care unit due to pulmonary insufficiency. After a routine femoral arterial blood gas analysis, severe abdominal pain and nausea began. She underwent emergency laparotomy due to acute abdomen. Laparotomy revealed small bowel perforation. Segmental resection and end-to-end anastomosis were performed. The femoral canal was closed using plaque mesh. Special attention is needed during femoral artery access to avoid accidental small bowel perforation. As seen in this case, a careful examination should be done in cases of femoral hernia. PMID:20517757

Ara, Cengiz; Coban, Sacid; I?ik, Burak; Ozcan, Canan Ceran; Yilmaz, Sezai



Delayed enhancement of the bowel wall: A new CT sign of small bowel strangulation  

SciTech Connect

To report a new CT sign of small bowel strangulation. Two cases of small bowel obstruction evaluated by spiral CT with intravenous contrast injection. In both cases we observed an absence of parietal enhancement of the diseased bowel loop, visible on early scans only. This feature was accompanied by signs of bowel obstruction. The two patients had a segment of necrotic ileum resected. Delayed enhancement of a bowel loop in cases of small bowel obstruction should suggest the diagnosis of strangulation and lead to rapid surgical treatment. 8 refs., 2 figs.

Zalcman, M.; Van Gansbeke, D.; Lalmand, B.; Braude, P. [Erasme Hospital, Brussels (Belgium)] [and others



CT enterography: state-of-the-art CT technique for small bowel imaging.  


Multi-detector computed tomography has become a first-line imaging modality for the evaluation of small bowel disease. Its high speed and resolution ensure excellent imaging of the small bowel with simultaneous evaluation of the lumen and wall, adjoining mesentery, and extraluminal structures in the abdominal cavity. Optimal luminal distension is an important prerequisite. Computed tomography enterography (CTE) is a dedicated adaptation for the study of the small bowel. This review discusses CTE with emphasis on procedural technique and image interpretation. PMID:23475544

Ghonge, Nitin P; Aggarwal, Bharat; Gothi, Rajesh



Small bowel intussusception with the Meckel's diverticulum after blunt abdominal trauma: a case report  

PubMed Central

Intussusception with the Meckel's diverticulum is a rare but well-known cause of small bowel obstruction in the adult. After blunt abdominal trauma, intussusception is exceedingly rare and has been reported previously only in few cases. We present a case of a previously healthy 28-year-old man developing four days after blunt abdominal trauma signs of small bowel obstruction. Ileo-ileal intussusception was suggested by computed tomography. Exploration revealed ileo-ileal intussusception with Meckel's diverticulum. A diverticulectomy with small bowel resection was performed.

Benjelloun, El Bachir; Ousadden, Abdelmalek; Ibnmajdoub, Karim; Mazaz, Khalid; Taleb, Khalid Ait



Small bowel evisceration through the anus in rectal prolapse in an Indian male patient.  


Evisceration of small intestine through anus is a rare presentation in emergency. We reported a case with long history of recurrent complete rectal prolapse presenting in emergency as small bowel protruding out through anal orifice. The small bowel herniated out from a spontaneous perforation in rectosigmoid. After resuscitation, emergency exploratory laparotomy was carried out and small bowel was reposited in the peritoneal cavity through the site of perforation by pulling and pushing maneuvere and the perforated segment of rectosigmoid was exteriorised as double barrel colostomy. PMID:24014329

Kumar, Sanjeev; Mishra, Anand; Gautam, Shefali; Tiwari, Sandeep



/sup 20/neon ion- and x-ray-induced mammary carcinogenesis in female rats  

SciTech Connect

One of the proposed uses of heavy ion irradiation is to image lesions of the human female breast. The rat model system was chosen to assess the carcinogenic potential of heavy ion irradiation in the belief that data obtained from rat studies would have a qualitatively predictive value for the human female. Accordingly, female rats were exposed to /sup 20/Ne ions at the BEVALAC and studied for the development of mammary neoplasia for 312 +- 2 days at Brookhaven along with rats exposed concurrently to x-irradiation or to no irradiation. As the dose of either type of radiation was increased the percent of rats with mammary adenocarcinomas, and the percent of rats with mammary fibroadenomas, tended to increase. At a prevalence of 20%, the RBE for /sup 20/Neon ions for mammary adenocarcinomas was estimated to be larger than 5 and for mammary fibroadenomas the RBE was estimated to be less than 2. No conclusion was reached concerning whether or not the RBE might vary with dose. We suggest that /sup 20/Ne ions do have a carcinogenic potential for rat mammary tissue and that this carcinogenic potential is likely to be greater than for x-irradiation. (DT)

Shellabarger, C.J.; Baum, J.W.; Holtzman, S.; Stone, J.P.



Effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy  

Microsoft Academic Search

Abstract Abstract Abstract Abstract Abstract AIM: To determine the effect of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. METHODS:Consecutive patients who underwent,capsule

Wai K Leung; Francis KL Chan; Sara SL Fung; Mei-Yin Wong; Joseph JY Sung



A patient presenting with acute abdomen due to metastatic small bowel melanoma: a case report  

PubMed Central

Introduction Malignant tumors of the small bowel are rare. Melanoma of the small intestine is in most cases metastatic from a primary skin lesion. Perforation of small bowel melanoma is an extremely rare entity. To the best of our knowledge this is the fifth case published to date. Case presentation We report a rare case of acute abdomen due to perforated metastatic small bowel melanoma in a 38-year-old Caucasian man. Conclusions In the majority of cases small bowel melanoma represents metastasis from cutaneous sites. Although rare, the possibility of abdominal metastatic melanoma presenting with the clinical picture of acute abdomen must be always considered by the operating surgeon in patients with a history of primary cutaneous malignant lesion.



Characterization of small bowel resection and intestinal adaptation in germ-free rats  

Microsoft Academic Search

BackgroundAfter massive small bowel resection (SBR), the remnant bowel adapts by increasing enterocyte proliferation and apoptosis. The purpose of this study was to investigate the relevance of luminal bacteria on postresection intestinal cell turnover.

Russell J Juno; Andrew W Knott; Marcus D Jarboe; Sherri A Profitt; Christopher R Erwin; Brad W Warner



Small bowel rupture after blunt trauma: Computed tomographic signs and their sensitivity  

Microsoft Academic Search

The purpose of this study is to describe the characteristic computed tomographic (CT) signs of small bowel perforation after\\u000a blunt abdominal trauma and to evaluate their sensitivity. Nineteen preoperative CT scans were obtained from 16 patients with\\u000a surgically proven small bowel rupture secondary to blunt abdominal trauma. Only the CT findings described in the original\\u000a CT reports were used. Eleven

Linda Casey; Dan Vu; Allen J. Cohen



Small bowel obstruction due to phytobezoar formation within meckel diverticulum: CT findings  

SciTech Connect

Intestinal obstruction due to a phytobezoar within a Meckel diverticulum is exceedingly rare, with only seven reported cases in the surgical literature. The most important precipitating factor is the ingestion of agents high in fiber and cellulose. Small bowel obstruction in all but one case was due to retrograde propagation of the bezoar into the small bowel lumen. We report the clinical and CT findings in such a patient following a vegetarian diet. 14 refs., 2 figs.

Frazzini, V.I. Jr.; English, W.J.; Bashist, B.; Moore, E. [Columbia Univ. College of Physicians and Surgeons, New York, NY (United States)



Malignant Peripheral Nerve Sheath Tumor of the Small Bowel: An Unusual Presentation with Fatal Outcome  

PubMed Central

Malignant peripheral nerve sheath tumor of the small bowel is an extremely rare disease. Histologic distinction from other types of soft tissue sarcoma especially fibrosarcoma and leiomyosarcoma requires electron microscopy. Complete surgery remains the only curative treatment. However, late diagnosis makes curative surgery more difficult. The contribution of chemotherapy to incomplete surgery has been proved without controlled studies. We report a case of this type of lesion discovered following a small bowel perforation.

Mohtaram, Amina; Mesmoudi, Siham; M'rabti, Hind; Rami, Amal; Latib, Rachida; Bernoussi, Zakia; Aaribi, Imane; Ben Ameur El Youbi, Meryam; Errihani, Hassan



Intestinal epithelial cell proliferation is dependent on the site of massive small bowel resection  

Microsoft Academic Search

Early intestinal adaptation after massive small bowel resection (SBR) is driven by increased epithelial cell (EC) proliferation.\\u000a There is a clear clinical difference in the post-operative course of patients after the loss of proximal (P) compared to distal\\u000a (D) small bowel. This study examined the effects of the site of SBR on post-resectional intestinal adaptation, and investigated\\u000a the potential mechanisms

Emir Q. Haxhija; Hua Yang; Ariel U. Spencer; Xiaoyi Sun; Daniel H. Teitelbaum



Endoscopic Interventions in the Small Bowel Using Double Balloon Enteroscopy: Feasibility and Limitations  

Microsoft Academic Search

BACKGROUND:Double-balloon enteroscopy (DBE) is a new endoscopic tool that not only allows diagnostic workup of small bowel diseases, but also makes it possible to carry out therapeutic interventions. However, for a variety of reasons, endoscopic therapy appears to be more difficult to carry out deep in the small bowel than in the upper or lower gastrointestinal tract.AIM:The purpose of this

Andrea May; Lars Nachbar; Jürgen Pohl; Christian Ell



Transstomal Small Bowel Evisceration after Colonic Perforation Secondary to Ischemic Colitis  

PubMed Central

Intestinal stomas are commonly used in a temporary or permanent fashion in gastrointestinal surgeries. The complication rate of stomas has been reported to vary between 23 and 50%. There is only one case in the literature involving transstomal small bowel evisceration following colonic perforation. In this paper, we aimed to present a patient with a perforated colon secondary to ischemic colitis, which resulted in small bowel evisceration through this perforation site.

Guner, Ali; Kahraman, Izzettin; Ozkan, Omer Faruk; Aktas, Adem; Kece, Can



Comparison of the Clinical Characteristics of Patients with Small Bowel and Gastric Anisakiasis in Jeju Island  

PubMed Central

Background/Aims Anisakiasis is frequent in Jeju Island because of the people's habit of ingesting raw fish. This study evaluated the clinical characteristics of patients with small bowel anisakiasis and compared them with those of patients with gastric anisakiasis. Methods We retrospectively reviewed the medical records of 109 patients diagnosed with anisakiasis between May 2003 and November 2011. Results Of the 109 patients diagnosed with anisakiasis, those with suspicious anisakiasis (n=38) or possible anisakiasis (n=12) were excluded. The age and gender distributions did not differ between patients with small bowel anisakiasis (n=30; age, 45±13 years) and those with gastric anisakiasis (n=29; age, 46±10 years). The mean duration of hospitalization was 5.4±4.3 days for patients with small bowel anisakiasis and 0.5±1.7 days for patients with gastric anisakiasis. Small bowel anisakiasis was accompanied by leukocytosis (76.7% vs 25.5%, p=0.003) and elevated C-reactive protein levels (3.4±3.2 mg/dL vs 0.5±0.3 mg/dL, p=0.009). Contrast-enhanced abdominopelvic computed tomography showed small bowel wall thickening with dilatation in 93.3% (28/30) of patients and a small amount of ascites in 80.0% (24/30) of patients with small bowel anisakiasis. Conclusions Compared with gastric anisakiasis patients, small bowel anisakiasis patients had a longer hospitalization time, higher inflammatory marker levels, and small bowel wall thickening with ascites.

Kim, Taeyun; Jeong, Seung Uk; Choi, Eun Kwang; Cho, Yoo-Kyung; Kim, Heung Up; Song, Byung-Cheol; Kim, Kwang Sig; Kim, Bong Soo; Kim, Young Ree



Fecal bile acids related to small-bowel length before and after ileal exclusion.  


We studied the relationship among the small-bowel length, the fecal excretion of bile acids and neutral steroids, and cholesterol synthesis in 16 patients with familial hypercholesterolemia before and 1 month after the ileal bypass operation. The mean small-bowel length measured during the operation was 6.3 +/- 0.3 (SEM) m before and 4.3 +/- 0.2 m after the bypass of the distal third of the small bowel. The preoperative fecal bile acid excretion was negatively correlated (r = 0.63, p less than 0.01) with the small-bowel length, whereas this correlation was insignificant for fecal neutral steroid excretion and cholesterol synthesis. Postoperative amounts of fecal bile acids and neutral steroids and cholesterol synthesis were negatively correlated with the length of the small bowel remaining in function (r = -0.52, -0.51, and -0.62, respectively). Our study suggests that fecal bile acid excretion and, hence, bile acid synthesis are related to the small-bowel length even under physiologic conditions. PMID:3659832

Koivisto, P; Lempinen, M; Miettinen, T A



Surgical Relief of Small Bowel Obstruction by Migrated Biliary Stent: Extraction Without Enterotomy  

PubMed Central

Background: Distal stent migration is a well-known complication following insertion of biliary stents. Most such cases can be managed expectantly, because the stents pass through the gastrointestinal tract. However, small bowel obstruction as a result of the stent mandates surgical intervention. Methods: We report the case of a patient who had distal stent migration causing a small bowel obstruction. We successfully retrieved the stent without an enterotomy, by using a combination of laparoscopy, endoscopy, and fluoroscopy. Our unique technique greatly decreased the risk of bacterial peritonitis in this patient with decompensated cirrhosis and associated ascites, which in this patient population results in a high mortality. Results: Management of small bowel obstruction secondary to biliary stent migration necessitates operative intervention. Retrieval of a dislodged stent can be performed safely without subjecting the patient to an enterotomy or a small bowel resection. Postoperative morbidity should be significantly reduced by this approach. Conclusion: Retrieval of biliary stents in cases of small bowel obstruction without perforation may be successfully performed without enterotomy or bowel resection. A similar approach may be applied to other foreign bodies dislodged in the small bowel.

Zagzag, Jonathan; Khaykis, Inessa; Liang, Howard



Acute small bowel volvulus in adults. A sporadic form of strangulating intestinal obstruction.  

PubMed Central

Small bowel volvulus is an uncommon but important cause of small intestinal obstruction. It often results in ischemia or even infarction. Delay in diagnosis and surgical intervention increases morbidity and mortality rates. Based on cause, small bowel volvulus can be divided into primary and secondary type. Goals for treatment of small bowel volvulus should include physician awareness of this uncommon diagnosis, accurate workup, and advanced surgical intervention. The presentation and subsequent management of 35 patients with small bowel volvulus confirmed by laparotomy are reviewed and discussed. The incidence of small bowel volvulus in the adult European and North American is low. The resultant mortality rate, however, makes diagnosis critically important. The cardinal presenting symptom is abdominal pain. There is no single specific diagnostic clinical sign or abnormality in laboratory or radiologic finding. In practice, the diagnosis can only be made by laparotomy. The failure to perform an exploratory laparotomy cannot be justified. Early diagnosis and early surgery are the keys for successful management of strangulation obstruction of the small bowel.

Roggo, A; Ottinger, L W



Note: Experiments in hard x-ray chemistry: In situ production of molecular hydrogen and x-ray induced combustion  

SciTech Connect

We have successfully loaded H{sub 2} into a diamond anvil cell at high pressure using the synchrotron x-ray induced decomposition of NH{sub 3}BH{sub 3}. In a second set of studies, radiation-assisted release of O{sub 2} from KCLO{sub 3}, H{sub 2} release from NH{sub 3}BH{sub 3}, and reaction of these gases in a mixture of the reactants to form liquid water using x-rays at ambient conditions was observed. Similar observations were made using a KCLO{sub 3} and NaBH{sub 4} mixture. Depending on reaction conditions, an explosive or far slower reaction producing water was observed.

Pravica, Michael; Bai Ligang; Liu Yu; Galley, Martin; Robinson, John [High Pressure Science and Engineering Center (HiPSEC) and Department of Physics, University of Nevada Las Vegas (UNLV), Las Vegas, Nevada 89154-4002 (United States); Park, Changyong [HPCAT, Geophysical Laboratory, Carnegie Institution of Washington, 9700 South Cass Ave., Argonne, Illinois 60437 (United States); Hatchett, David [Department of Chemistry, University of Nevada Las Vegas (UNLV), Las Vegas, Nevada 89154-4003 (United States)



Curcumin protects metronidazole and X-ray induced cytotoxicity and oxidative stress in male germ cells in mice.  


Metronidazole (MTZ) is a common antiparasitic and antibacterial drug. The drug and X-ray induced effects in mouse sperm count, sperm head abnormality and some oxidative stress parameters have been studied. Simultaneously the protective role of curcumin has been evaluated. MTZ, 40 mg/kg bw and 13.4 mg/kg bw × 3 days exposure induced abnormal sperm head and reduced total sperm count in Swiss albino mice both after 24 h and 35 days of exposure. However, MTZ treatment in mice receiving X-ray irradiation (0.5 Gy) did not changed the incidence of abnormal sperm population or decrease in the total sperm count. Hepatic glutathione (GSH), superoxide dismutase (SOD) declined significantly during the treatment phase with significant rise in lipid peroxidation of the tissue. The cellular changes were estimated by using lipid peroxidative indices like thiobarbituric acid reactive substances (TBARS). Elevated TBARS is indicative of oxidative stress in treated mice. Furthermore, curcumin pre-treatment apparently reduced the frequency of sperm head abnormality and TBARS induced by MTZ alone or in combination with X-ray and increased the levels of hepatic GSH and SOD. The additive effects of MTZ and X-ray could not be observed with regards to sperm head abnormality and total sperm count in the tested dose range although the cellular antioxidants were found to be significantly lowered and lipid peroxidantion increased. The possible role of MTZ and X-ray inducing sperm abnormality, decreased sperm count and alteration in GSH, SOD and TBARS and defensive role of curcumin have been evaluated. PMID:23777800

Singh, S; Das Roy, L; Giri, S



Inpatient capsule endoscopy leads to frequent incomplete small bowel examinations  

PubMed Central

AIM: To examine the predictive factors of capsule endoscopy (CE) completion rate (CECR) including the effect of inpatient and outpatient status. METHODS: We identified 355 consecutive patients who completed CE at Rush University Medical Center between March 2003 and October 2005. Subjects for CE had either nothing by mouth or clear liquids for the afternoon and evening of the day before the procedure. CE exams were reviewed by two physicians who were unaware of the study hypotheses. After retrospective analysis, 21 cases were excluded due to capsule malfunction, prior gastric surgery, endoscopic capsule placement or insufficient data. Of the remaining 334 exams [264 out-patient (OP), 70 in-patient (IP)], CE indications, findings, location of the patients [IP vs OP and intensive care unit (ICU) vs general medical floor (GMF)] and gastrointestinal transit times were analyzed. Statistical analysis was completed using SPSS version 17 (Chicago, IL). Chi-square, t test or fisher exact-tests were used as appropriate. Multivariate logistic regression analysis was used to identify variables associated with incomplete CE exams. RESULTS: The mean age for the entire study population was 54.7 years. Sixty-one percent of the study population was female, and gender was not different between IPs vs OPs (P = 0.07). The overall incomplete CECR was 14% in our study. Overt obscure gastrointestinal bleeding (OGB) was significantly more common for the IP CE (P = 0.0001), while abdominal pain and assessment of IBD were more frequent indications for the OP CE exams (P = 0.002 and P = 0.01, respectively). Occult OGB was the most common indication and arteriovenous malformations were the most common finding both in the IPs and OPs. The capsule did not enter the small bowel (SB) in 6/70 IPs and 8/264 OPs (P = 0.04). The capsule never reached the cecum in 31.4% (22/70) of IP vs 9.5% (25/ 264) of OP examinations (P < 0.001). The mean gastric transit time (GTT) was delayed in IPs compared to OPs, 98.5 ± 139.5 min vs 60.4 ± 92.6 min (P = 0.008). Minimal SB transit time was significantly prolonged in the IP compared to the OP setting [IP = 275.1 ± 111.6 min vs OP = 244.0 ± 104.3 min (P = 0.037)]. CECR was also significantly higher in the subgroup of patients with OGB who had OP vs IP exams (95% vs 80% respectively, P = 0.001). The proportion of patients with incomplete exams was higher in the ICU (n = 7/13, 54%) as compared to the GMF (n = 15/57, 26%) (P = 0.05). There was only a single permanent SB retention case which was secondary to a previously unknown SB stricture, and the remaining incomplete SB exams were due to slow transit. Medications which affect gastrointestinal system motility were tested both individually and also in aggregate in univariate analysis in hospitalized patients (ICU and GMF) and were not predictive of incomplete capsule passage (P > 0.05). Patient location (IP vs OP) and GTT were independent predictors of incomplete CE exams (P < 0.001 and P = 0.008, respectively). CONCLUSION: Incomplete CE is a multifactorial problem. Patient location and related factors such as severity of illness and sedentary status may contribute to incomplete exams.

Yazici, Cemal; Losurdo, John; Brown, Michael D; Oosterveen, Scott; Rahimi, Robert; Keshavarzian, Ali; Bozorgnia, Leila; Mutlu, Ece



Online adaptive radiotherapy of the bladder: Small bowel irradiated-volume reduction  

SciTech Connect

Purpose: To assess the potential reduction of small bowel volume receiving high-dose radiation by using kilovoltage X-ray cone beam computed tomography (CBCT) and quantized margin selection for adaptive bladder cancer treatment. Methods and Materials: Twenty bladder patients were planned conformally using a four-field, 15-mm uniform margin technique. Two additional planning target volumes (PTVs) were created using margins quantized to 5 and 10 mm in the superior direction only. CBCTs ({approx}8 scans/patient) were acquired during treatment. CBCT volumes were registered with CT planning scans to determine setup errors and to select the appropriate PTV of the day. Margin reduction in other directions was considered. Outlining of small bowel in every fraction is required to properly quantify the volume of small bowel spared from high doses. In the case of CBCT this is not always possible owing to artifacts created by small bowel movement and the presence of gas. A simpler method was adopted by considering the volume difference between PTVs created using uniform and adapted margins, which corresponds to the potential volume of small bowel sparing. Results: The average small bowel volume that can be spared by this form of adaptive radiotherapy is 31 {+-} 23 cm{sup 3} ({+-}1 SD). The bladder for 1 patient was systematically smaller than the planning scan and hence demonstrated the largest average reduction of 76 cm{sup 3}. The clinical target volume to PTV margins in other directions can be safely reduced to 10 mm except in the anterior direction where, like the superior direction, the bladder showed significant variation. Conclusions: Online CBCT-assisted plan selection based on quantized margins can significantly reduce the volume of small bowel receiving high doses for some bladder patients. CBCT allows the 15-mm margins used in some directions to be safely reduced to 10 mm.

Burridge, Nichola [North Western Medical Physics, Christie Hospital NHS Trust, Manchester (United Kingdom)]. E-mail:; Amer, Ali [North Western Medical Physics, Christie Hospital NHS Trust, Manchester (United Kingdom); Marchant, Tom [North Western Medical Physics, Christie Hospital NHS Trust, Manchester (United Kingdom); Sykes, Jonathan [Cookridge Hospital, Leeds (United Kingdom); Stratford, Julie [Wade Centre for Radiotherapy Research, Christie Hospital, Manchester (United Kingdom); Henry, Ann [Cookridge Hospital, Leeds (United Kingdom); McBain, Catherine [Department of Clinical Oncology, Christie Hospital NHS Trust, Manchester (United Kingdom); Price, Pat [Academic Department of Radiation Oncology, Christie Hospital, Manchester (United Kingdom); Moore, Chris [North Western Medical Physics, Christie Hospital NHS Trust, Manchester (United Kingdom)



Characteristics of the Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Chronic Kidney Disease  

PubMed Central

Obscure gastrointestinal bleeding (OGIB) is one of the common complications in patients with chronic kidney disease (CKD), especially those who are on maintenance hemodialysis (HD). However, little is known about the characteristics of the small-bowel lesions in these patients, or of the factors that could predict the presence of such lesions. Therefore we enrolled a total of 42 CKD patients (including 19 HD patients and 23 non-HD patients), and compared the incidence of the small-bowel lesions among two groups. Furthermore, to identify predictive factors for the presence of small-bowel lesions, we performed multivariate logistic-regression-analyses. The incidence of small-bowel vascular lesions was significantly higher in CKD patients than in age-and-sex matched non-CKD patients (P < 0.001). On the other hand, there was any significant difference of the incidence of small-bowel lesions between HD and non-HD patients. In CKD patients, past history of blood transfusion (OR 5.66; 95% CI 1.10–29.1, P = 0.04) was identified as an independent predictor of the presence of vascular lesions, and history of low-dose aspirin use (OR 6.00; 95% CI 1.13–31.9, P = 0.04) was identified as that of erosive/ulcerated lesions. This indicated that proactive CE examination would be clinically meaningful for these patients.

Kawamura, Harunobu; Sakai, Eiji; Endo, Hiroki; Taniguchi, Leo; Hata, Yasuo; Ezuka, Akiko; Nagase, Hajime; Kessoku, Takaomi; Yamada, Eiji; Ohkubo, Hidenori; Higrashi, Takuma; Sekino, Yusuke; Koide, Tomoko; Iida, Hiroshi; Nonaka, Takashi; Takahashi, Hirokazu; Inamori, Masahiko; Maeda, Shin; Nakajima, Atsushi



The value of water-soluble contrast radiology in the management of acute small bowel obstruction.  

PubMed Central

A series of 127 consecutive patients with symptoms and signs and radiological features suggestive of acute small bowel obstruction underwent water-soluble contrast small bowel follow-through examination. A dose of 100 ml of Gastrograffin in adults, or 20-50 ml in children, was injected via a nasogastric tube and supine plain abdominal radiographs were taken at 30 min and 4 h after administration. If contrast passed to the colon a non-operative course was followed. If there was a clear cut-off in contrast level in the small bowel or if contrast failed to pass into the large bowel by 4 h, patients underwent laparotomy. Based on these radiological findings 15 patients (11.8%) underwent surgery and all had established small bowel obstruction at laparotomy. The remaining 112 patients were successfully managed conservatively. Water-soluble contrast radiology is safe, easy to use and to interpret, and is a major benefit in differentiating mechanical from other causes of small bowel obstruction. Our experience indicates that this underused technique is of significant value in identifying those patients who require urgent surgery. Images Figure 1 Figure 2 Figure 3

Joyce, W. P.; Delaney, P. V.; Gorey, T. F.; Fitzpatrick, J. M.



Diagnostic effect of capsule endoscopy in 31 cases of subacute small bowel obstruction  

PubMed Central

AIM: To evaluate the effectiveness and safety of capsule endoscopy (CE) in patients with recurrent subacute small bowel obstruction. METHODS: The study was a retrospective analysis of 31 patients referred to hospital from January 2003 to August 2008 for the investigation of subacute small bowel obstruction, who underwent CE. The patients were aged 9-81 years, and all of them had undergone gastroscopy and colonoscopy previously. Some of them received abdominal computed tomography or small bowel follow-through. RESULTS: CE made a definitive diagnosis in 12 (38.7%) of 31 cases: four Crohn’s disease (CD), two carcinomas, one intestinal tuberculosis, one ischemic enteritis, one abdominal cocoon, one duplication of the intestine, one diverticulum and one ileal polypoid tumor. Capsule retention occurred in three (9.7%) of 31 patients, and was caused by CD (2) or tumor (1). Two with retained capsules were retrieved at surgery, and the other one of the capsules was spontaneously passed the stricture by medical treatment in 6 mo. No case had an acute small bowel obstruction caused by performance of CE. CONCLUSION: CE provided safe and effective visualization to identify the etiology of a subacute small bowel obstruction, especially in patients with suspected intestinal tumors or CD, which are not identified by routine examinations.

Yang, Xiao-Yun; Chen, Chun-Xiao; Zhang, Bing-Ling; Yang, Li-Ping; Su, Hua-Jing; Teng, Li-Song; Li, You-Ming



The role of the arachidonic acid cascade in the species-specific X-ray-induced inflammation of the rabbit eye  

SciTech Connect

To identify the mediator(s) of the apparently species-specific X-ray-induced inflammation of the rabbit eye, inhibitors of the synthesis and/or release of known or putative mediators of ocular inflammation were administered prior to irradiation. The X-ray-induced ocular inflammation, particularly the rise in intraocular pressure, was found to be inhibited by intravenous pretreatment of rabbits with flurbiprofen, indomethacin, or imidazole (1, 10, and 100 mg/kg i.v., respectively), or by combined intravitreal and topical administration of flurbiprofen. Systemic, intravitreal, and/or topical pretreatment with prednisolone or disodium cromoglycate or the retrobulbar injection of ethyl alcohol or capsaicin failed to block the inflammatory response, whereas vitamin E apparently exerted some protective effect. These findings show that the X-ray-induced inflammation of the rabbit eye is mediated, at least in part, by prostaglandins (PGs) and/or related autacoids. In addition, these results suggest that the unique sensitivity of the rabbit eye to X-ray-induced inflammation is due either to the presence in this species of a unique or uniquely effective triggering mechanism for the release of PG precursors or to the greater sensitivity of this species to the ocular inflammatory effects of PGs. Thus the rabbit eye may provide a unique model for studying some aspects of arachidonic acid release or ocular PG effects, but extreme caution must be exercised in generalizing such findings to other species.

Bito, L.Z.; Klein, E.M.




Microsoft Academic Search

Experiments were performed with the roots of Allium cepa seedlings in ; order to analyze the rejoining behavior of x-ray-induced broken ends of ; chromosomes, and to test several hypotheses relating the results of such studies ; to the nature of chromosome organization. Studies with fractionstcd doses have ; shown that two classes of breaks, as judged by their average




Outcome of small-bowel motor impairment in systemic sclerosis--a prospective manometric 5-yr follow-up  

Microsoft Academic Search

Objective. To assess the 5-yr course of small-bowel motor disorders, using manometry in patients with systemic sclerosis (SSc), and to investigate for an association between small-bowel motor dysfunction outcome and other clinical manifestations of SSc. Methods. Fasting and post-prandial motor activity of the small-bowel was systematically assessed in eight consecutive patients with SSc, using 24 h manometry: initially and at

I. Marie; P. Ducrotte ´; P. Denis; M.-F. Hellot; H. Levesque



MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis  

Microsoft Academic Search

.   The aim of the study was to evaluate the additional findings of MRI following small bowel enteroclysis and to compare the\\u000a efficacy of negative and positive intraluminal contrast agents. Fifty patients with inflammatory or tumorous small bowel disease\\u000a were investigated by small bowel enteroclysis and consecutive MRI using breathhold protocol (T1-weighted fast low-angle shot,\\u000a T2-weighted turbo spin echo). Patients

A. Rieber; A. Aschoff; K. Nüssle; D. Wruk; R. Tomczak; M. Reinshagen; G. Adler; H.-J. Brambs



An unusual cause of small bowel obstruction in a child: ingested rhubarb.  


Small bowel obstruction is rarely caused by bezoars concretions formed from undigested foreign material in the gastrointestinal tract. An important cause of bezoars is phytobezoars, formed from vegetables or fruits. A four-year-old boy presented to our emergency department with symptoms of acute intestinal obstruction. Upright plain abdominal radiography revealed multiple air fluid levels. Ultrasound showed no abnormalities, and because of worsening symptoms computed tomography of abdomen was performed. It showed intraluminal obstruction of the terminal ileum. Exploratory laparotomy revealed a phytobezoar consisting of undigested rhubarb. The mass was milked through the large bowel and out the anus. Although rare in humans, bezoars are a well-documented cause of small bowel obstruction and should be considered when intraluminal bowel obstruction occurs. Bezoars causing small bowel obstruction may require surgical treatment. PMID:23878756

Glatstein, Miguel; Danino, Dana; Rimon, Ayelet; Keidar, Sergei; Scolnik, Dennis



The management of patients with suspected early postoperative small bowel obstruction.  

PubMed Central

A 10-year review of 101 patients sustaining an early postoperative small bowel obstruction within 30 days of celiotomy was carried out. Signs, symptoms, lab tests, and x-rays did not indicate which patients required operation. Twenty-three patients were operated on for either failure to resolve their obstruction or because it was feared that ischemic bowel was present. In none of these patients, nor the 78 patients who resolved without reoperation, did dead bowel occur. Early postoperative small bowel obstruction was most often due to adhesions and inflammatory processes. Seven patients died (6.9%), three in the operated and four in the nonoperated group. Because ischemic bowel is very unlikely in patients with early postoperative small bowel obstruction, we advise 10 to 14 days of nasogastric suction initially; after this, improvement is unlikely without reoperation.

Pickleman, J; Lee, R M



The management of patients with suspected early postoperative small bowel obstruction.  


A 10-year review of 101 patients sustaining an early postoperative small bowel obstruction within 30 days of celiotomy was carried out. Signs, symptoms, lab tests, and x-rays did not indicate which patients required operation. Twenty-three patients were operated on for either failure to resolve their obstruction or because it was feared that ischemic bowel was present. In none of these patients, nor the 78 patients who resolved without reoperation, did dead bowel occur. Early postoperative small bowel obstruction was most often due to adhesions and inflammatory processes. Seven patients died (6.9%), three in the operated and four in the nonoperated group. Because ischemic bowel is very unlikely in patients with early postoperative small bowel obstruction, we advise 10 to 14 days of nasogastric suction initially; after this, improvement is unlikely without reoperation. PMID:2757422

Pickleman, J; Lee, R M



Evidence that orthotopic transposition following rat heterotopic small bowel transplantation corrects overgrowth of potentially pathogenic bacteria.  


An overgrowth of pathogenic organisms occurs following rat heterotopic small bowel transplantation. This study assessed whether the bacterial microflora return to normal following subsequent orthotopic transposition of the graft. After 14 days the heterotopic graft was placed into continuity following resection of 15 cm of the host midintestinal loop. Quantitative and qualitative analyses of the intraluminal bacteria were performed studying the resected host intestine, the heterotopic graft at 14 days, and the graft 14 days after transposition. A group of normal rats were used as controls. An overgrowth of Staphylococcus epidermidis evident in the heterotopic graft at 14 days returned to a more normal bacterial profile following orthotopic transposition. These findings suggest that early interposition of a small bowel graft into an orthotopic position may prevent an alteration in the small bowel ecology toward potentially pathogenic organisms capable of translocation. PMID:8610395

Price, B A; Cumberland, N S; Clark, C L; Pockley, A G; Wood, R F



Complete small bowel obstruction in the early postoperative period complicating surgical sling procedure.  


The surgical insertion of an absorbable sling mesh has become the most promising technique for excluding the small bowel from the pelvis prior to radiotherapy. Both human and animal studies suggest that this procedure is very safe. The author reports what appears to be the first significant mesh-related complication. A 69-year-old man suffered early postoperative complete mechanical small bowel obstruction after insertion of a polyglactin 910 (Vicryl) surgical sling mesh at the time of low anterior resection for a stromal sarcoma of the rectum. Urgent laparotomy was required and revealed that the Vicryl mesh was associated with an intense inflammatory reaction. Radiation therapy is a critical component of contemporary multimodal treatment of patients with rectal cancer. This case suggests that inserting biodegradeable mesh to protect the small bowel from radiation effects is not without complications. PMID:8129251

Sloan, D A



Peritoneal carcinomatosis from a small bowel carcinoid tumour  

PubMed Central

Background Peritoneal carcinomatosis from a gastrointestinal carcinoid tumour is rare and the long-term management and prognosis have not been clearly defined. The natural history is different from gastrointestinal adenocarcinoma, although its capacity to invade regional lymph nodes and generate distal metastasis can make the management more complex. Whilst the development of carcinomatosis is uncommonly reported, it may be higher than expected. Case presentation A 63 years-old woman underwent emergency surgery in 1993 for right iliac fossa pain and a mass that was found to be an ileal carcinoid tumour. Over the next ten years, further surgery was required for disseminated disease with peritoneal carcinomatosis and liver metastasis. Systemic chemotherapy had little effect, although Somatostatin was used effectively to relieve symptoms caused by the disseminated disease (flushing and diarrhoea). Conclusion Peritoneal carcinomatosis from carcinoid tumours is not well documented in the literature. Aggressive surgery must be performed in order to control the disease since chemotherapy has not been reported to be effective. With repeated surgery long-term survival can be achieved in these patients.

Gutierrez, Gonzalo; Daniels, Ian R; Garcia, Ana; Ramia, Jose M



Small bowel perforation resulting from blunt abdominal trauma: interval change of radiological characteristics  

Microsoft Academic Search

Purpose  We analyzed radiography and computed tomography (CT) findings of small bowel perforation due to blunt trauma to identify the\\u000a keys to diagnosis.\\u000a \\u000a \\u000a \\u000a Materials and methods  Twelve patients with surgically proven small bowel perforation were retrospectively studied. All patients underwent radiography\\u000a and CT, and five underwent presurgical follow-up CT. Radiological findings were evaluated and correlated to the elapsed time\\u000a from the onset

Madoka Saku; Kengo Yoshimitsu; Junji Murakami; Yusuke Nakamura; Syuuiti Oguri; Tomoyuki Noguchi; Katsuhiko Ayukawa; Hiroshi Honda



Small bowel intussusception following blunt abdominal trauma in an adult patient.  


Blunt abdominal trauma is a rare cause of small bowel intussusception in adults. A patient is described who presented with signs and symptoms of intestinal obstruction following a fall from a ladder. A CT scan revealed evidence of ileo-ileal intussusception. Exploratory laparotomy and resection of a necrotic bowel segment were performed. Rare occurrences like intussusception should be kept in mind in similar presentations with careful examination of the pathognomonic CT findings, as early detection and surgical intervention with manual reduction could preclude the need for small bowel resection and its untoward possible complications. PMID:19773508

Karam, J; Khreiss, M; Musallam, K M; Alaeddine, M H; Al-Kutoubi, A; Abi Saad, G S



Acute abdomen caused by a small bowel perforation due to a clinically unsuspected fish bone.  


We report the case of a 78-year-old woman with a three-day history of abdominal pain and vomiting. An abdominal plain film showed a distended small bowel loop and no signs of free intra-abdominal gas. An abdominal ultrasound revealed a mass containing a linear, hyperechoic structure. The mass was connected through a sinus tract to an adjacent aperistaltic small bowel loop. A laparotomy revealed a jejunal perforation and an omental granuloma containing a fish bone. Accidentally ingested foreign bodies should always be suspected in cases of acute abdomen, and ultrasonography remains a firstline examination tool for preoperative diagnoses of unsuspected foreign bodies and their complications. PMID:20683816

Drakonaki, Eleni; Chatzioannou, Maria; Spiridakis, Konstantinos; Panagiotakis, George



Constitutive basal and stimulated human small bowel contractility is enhanced in obesity.  


Small bowel contractility may be more prominent in obese subjects, such that there is enhanced nutrient absorption and hunger stimulation. However, there is little evidence to support this. This study examined in vitro small bowel contractility in obese patients versus non-obese patients. Samples of histologically normal small bowel were obtained at laparoscopic Roux-en-Y gastric bypass from obese patients. Control specimens were taken from non-obese patients undergoing small bowel resection for benign disease or formation of an ileal pouch-anal anastomosis. Samples were transported in a pre-oxygenated Krebs solution. Microdissected circular smooth muscle strips were suspended under 1 g of tension in organ baths containing Krebs solution oxygenated with 95% O2/5% CO2 at 37 degrees C. Contractile activity was recorded using isometric transducers at baseline and in response to receptor-mediated contractility using prostaglandin F2a, a nitric oxide donor and substance P under both equivocal and non-adrenergic, non-cholinergic conditions (guanethidine and atropine). Following equilibration, the initial response to the cholinergic agonist carbachol (0.1 mmol/L) was significantly increased in the obese group (n = 63) versus the lean group (n = 61) with a mean maximum response: weight ratio of 4.58 +/- 0.89 vs 3.53 +/- 0.74; (p = 0.032). Following washout and re-calibration, cumulative application of substance P and prostaglandin F2a produced concentration-dependent contractions of human small bowel smooth muscle strips. Contractile responses of obese small bowel under equivocal conditions were significantly increased compared with non-obese small bowel (p < 0.05 for all agonists). However, no significant differences were shown between the groups when the experiments were performed under NANC conditions. There were no significant differences found between the groups when challenged with nitric oxide, under either equivocal or NANC conditions. Stimulated human small bowel contractility is increased in obese patients suggesting faster enteric emptying and more rapid intestinal transit. This may translate into enhanced appetite and reduced satiety. PMID:19379492

Gallagher, Tom K; Baird, Alan W; Winter, Desmond C



Search for x-ray induced decay of the 31-yr isomer of {sup 178}Hf using synchrotron radiation  

SciTech Connect

Isomeric {sup 178}Hf (t{sub 1/2}=31 yr, E{sub x}=2.446 MeV, J{sup {pi}}=16{sup +}) was bombarded by a white beam of x rays from the Advanced Photon Source at Argonne National Laboratory. A search was made for x-ray induced decay of the isomer by detecting prompt and delayed {gamma} rays associated with the decay. No induced decay was observed. Upper limits for such a process for x-ray energies between 7 and 100 keV were set. The limits between 7 and 30 keV are below {approx_equal}3x10{sup -27} cm{sup 2} keV for induced decay that bypasses the 4-s isomer and {approx_equal}5x10{sup -27} cm{sup 2} keV for induced decay that is delayed through this isomer, which are orders of magnitude below values at which induced decay was reported previously. These limits are consistent with what is known about the properties of atomic nuclei.

Ahmad, I.; Gemmell, D.S.; Moore, E.F.; Schiffer, J.P. [Physics Division, Argonne National Laboratory, Argonne, Illinois 60439 (United States); Banar, J.C.; Bredeweg, T.A.; Miller, G.G.; Palmer, P.; Pangault, L.N.; Rundberg, R.S.; Wilhelmy, J.B. [Los Alamos National Laboratory, Los Alamos, New Mexico 87545 (United States); Becker, J.A.; Cooper, J.R.; Kraemer, A.; McNabb, D.P.; Wang, T.-F. [Lawrence Livermore National Laboratory, Livermore, California 94550 (United States); Mashayekhi, A.; Shastri, S.D. [Advanced Photon Source, Argonne National Laboratory, Argonne, Illinois 60439 (United States)



Direct observation of X-ray induced atomic motion using scanning tunneling microscope combined with synchrotron radiation.  


X-ray induced atomic motion on a Ge(111)-c(2 x 8) clean surface at room temperature was directly observed with atomic resolution using a synchrotron radiation (SR)-based scanning tunneling microscope (STM) system under ultra high vacuum condition. The atomic motion was visualized as a tracking image by developing a method to merge the STM images before and after X-ray irradiation. Using the tracking image, the atomic mobility was found to be strongly affected by defects on the surface, but was not dependent on the incident X-ray energy, although it was clearly dependent on the photon density. The atomic motion can be attributed to surface diffusion, which might not be due to core-excitation accompanied with electronic transition, but a thermal effect by X-ray irradiation. The crystal surface structure was possible to break even at a lower photon density than the conventionally known barrier. These results can alert X-ray studies in the near future about sample damage during measurements, while suggesting the possibility of new applications. Also the obtained results show a new availability of the in-situ SR-STM system. PMID:21776646

Saito, Akira; Tanaka, Takehiro; Takagi, Yasumasa; Hosokawa, Hiromasa; Notsu, Hiroshi; Ohzeki, Gozo; Tanaka, Yoshihito; Kohmura, Yoshiki; Akai-Kasaya, Megumi; Ishikawa, Tetsuya; Kuwahara, Yuji; Kikuta, Seishi; Aono, Masakazu



Persistence of X-ray-induced chromosomal rearrangements in long-term cultures of human diploid fibroblasts  

SciTech Connect

As part of a long-term study of mechanisms of human cell neoplastic transformation, the authors have examined the change in the frequencies of X-ray-induced chromosome rearrangements in density-inhibited human foreskin fibroblasts as a function of subculture time. In nonproliferating cells, the frequency of chromosomal aberrations declined within 24 to 48 hr but still remained at a relatively high level up to 43 days after irradiation. Aberrations disappeared rapidly, however, when the cells were allowed to proliferate, indicating that these lesions are lethal to dividing cells. The frequency of induced translocations, as determined by analysis of G-banded karyotypes, was dose dependent and remained stable up to 20 mean population doublings after irradiation. When subculture of density-inhibited cultures was delayed for 4 hr after irradiation (confluent holding), the frequency of chromosomal aberrations in the first mitosis declined, whereas the translocation frequencies at later passage were elevated as compared with cells subcultured immediately. This correlates with the reported increase in the frequency of transformation under similar conditions. These findings support the hypothesis that chromosomal rearrangements induced by DNA damage may be involved in the initiation of cancer.

Kano, Y.; Little, J.B.



Time course of adaptive regulatory peptide changes following massive small bowel resection in the dog  

Microsoft Academic Search

Basal and postprandial concentrations of gastrointestinal hormones were measured in 12 dogs before and at one and three months after a 75% small bowel resection. Five animals were studied again at six months. Concentrations of enteric hormones and neuropeptides, measured in the proximal jejunum and distal ileum adjacent to the anastomotic site at the time of euthanasia, were compared with

Thomas E. Adrian; Jon S. Thompson; Eamonn M. M. Quigley



Postheparin plasma diamine oxidase in subjects with small bowel mucosal atrophy  

Microsoft Academic Search

Diamine oxidase (DAO) is an enzyme whose low plasma values are enhanced by an intravenous injection of heparin, which releases the enzyme from the enterocytes of the villous tips. In 20 normal controls and 15 untreated subjects affected with an overt malabsorption syndrome and subtotal atrophy shown by Crosby jejunal mucosa biopsy (12 suspected celiac disease and three small bowel

Luciano D'agostino; Carolina Ciacci; Bruno Daniele; Maria Vittoria Barone; Rosa Sollazzo; Gabriele Mazzacca



Regional enteritis in children: Small bowel disease with normal terminal ileum  

Microsoft Academic Search

Regional enteritis in children may affect the small bowel without involvement of the terminal ileum. We have noted this distribution of disease in 4 of 20 consecutive cases of Crohn's disease. The clinical and radiologic features of these 4 patients are reported together with a review of similar observations in the literature.

D. R. Kirks; G. Currarino



The Role of Endoscopic Imaging of the Small Bowel in Clinical Practice  

Microsoft Academic Search

Enteroscopy, defined as direct visualization of the small bowel (SB) with the use of a fiberoptic or wireless endoscope, has progressed considerably over the past several years. Technological advancements in the field have facilitated endoscopic evaluation of the SB. This comprehensive clinical review summarizes the latest modalities available to aid gastroenterologists in exploring the SB for evaluation of obscure gastrointestinal

Jonathan A Leighton



NSAID-induced deleterious effects on the proximal and mid small bowel in seronegative spondyloarthropathy patients  

PubMed Central

AIM: To investigate the small bowel of seronegative spondyloarthropathy (SpA) patients in order to ascertain the presence of mucosal lesions. METHODS: Between January 2008 and June 2010, 54 consecutive patients were enrolled and submitted to avideo capsule endoscopy (VCE) examination. History and demographic data were taken, as well as the history of non-steroidal anti-inflammatory drug (NSAID) consumption. After reading each VCE recording, a capsule endoscopy scoring index for small bowel mucosal inflammatory change (Lewis score) was calculated. Statistical analysis of the data was performed. RESULTS: The Lewis score for the whole cohort was 397.73. It was higher in the NSAID consumption subgroup (P = 0.036). The difference in Lewis score between NSAID users and non-users was reproduced for the first and second proximal tertiles of the small bowel, but not for its distal third (P values of 0.036, 0.001 and 0.18, respectively). There was no statistical significant difference between the groups with regard to age or sex of the patients. CONCLUSION: The intestinal inflammatory involvement of SpA patients is more prominent in NSAID users for the proximal/mid small bowel, but not for its distal part.

Rimbas, Mihai; Marinescu, Madalina; Voiosu, Mihail Radu; Baicus, Cristian Rasvan; Caraiola, Simona; Nicolau, Adriana; Nitescu, Doina; Badea, Georgeta Camelia; Parvu, Magda Ileana



Effect of infliximab on small bowel stenoses in patients with Crohn's disease  

PubMed Central

AIM: To assess prospectively small bowel stenoses in Crohn’s disease (CD) patients treated with infliximab using Small Intestine Contrast Ultrasonography (SICUS). METHODS: Twenty patients (M 12, age, 42.7 ± 11.8 years), 15 of whom showed obstructive symptoms indicating the presence of small bowel stenosis, and 5 without stenosis, were treated with infliximab (5 mg/kg at wk 0, 2, 6 and 5 mg/kg every 8 wk thereafter) for steroid refractoriness, fistulizing disease, or to avoid high-risk surgery. SICUS was performed at the induction phase and at regular time intervals during the follow-up period of 34.7 ± 16.1 mo (range 7-58). Small bowel stenoses were detected by SICUS, endoscopy and MRI. RESULTS: In no case was progression of stenoses or the appearance of new ones seen. Of the 15 patients with stenosis, 5 stopped treatment after the induction phase (2 for no response, 3 for drug intolerance, one of whom showed complete regression of one stenosis). Among the remaining 10 patients, a complete regression of 8 stenoses (1 stenosis in 5 patients and 3 stenoses in one patient) was observed after 6-22 infliximab infusions. CONCLUSION: In patients with CD treated with infliximab we observed: (a) No progression of small bowel stenosis and no appearance of new ones, (b) Complete regression of 1/22 stenosis after the induction phase and of 8/15 (53.3%) stenosis after 6-22 infusions during maintenance therapy.

Pallotta, Nadia; Barberani, Fausto; Hassan, Naima Abdulkadir; Guagnozzi, Danila; Vincoli, Giuseppina; Corazziari, Enrico



A role for tumour necrosis factor ? in human small bowel iron transport  

PubMed Central

Cytokines are integral to the development of anaemia of chronic inflammation. Cytokines modulate hepcidin expression and iron sequestration by the reticuloendothelial system but their direct effects on small bowel iron transport are not well characterized. The aim of the present study was to examine the local effects of TNF? (tumour necrosis factor ?) on small bowel iron transport and on iron transporter expression in the absence of hepcidin. The effects of TNF? on iron transport were determined using radiolabelled iron in an established Caco-2 cell model. The effect of TNF? on the expression and localization of the enterocyte iron transporters DMT-1 (divalent metal transporter 1), IREG-1 (iron-regulated transporter 1) and ferritin was determined utilizing Caco-2 cells and in a human ex vivo small bowel culture system. TNF? mediated an early induction in both iron import and iron export, which were associated with increased DMT-1 and IREG-1 mRNA and protein expression (P<0.05). However, by 24 h, both iron import and iron export were significantly inhibited, coinciding with an induction of ferritin heavy chain (P<0.05) and a decrease in DMT-1 and IREG-1 to baseline levels. In addition, there was a relocalization of IREG-1 away from the basolateral cell border and increased iron deposition in villous enterocytes. In conclusion, TNF? has a direct effect on small bowel iron transporter expression and function, leading to an inhibition of iron transport.



CT and MR enterography in evaluating small bowel diseases: when to use which modality?  


MR and CT techniques optimized for small bowel imaging are playing an increasing role in the evaluation of small bowel disorders. Several studies have shown the advantages of these techniques over traditional barium fluoroscopic examinations due to improvements in spatial and temporal resolution combined with improved bowel distending agents. The preference of MR vs. CT has been geographical and based on expertise and public policy. With the increasing awareness of radiation exposure, there has been a more global interest in implementing techniques that either reduce or eliminate radiation exposure. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime or in studies that require sequential imaging time points such as in assessment of gastrointestinal motility. MRI has many properties that make it well suited to imaging of the small bowel: the lack of ionizing radiation, the improved tissue contrast that can be obtained by using a variety of pulse sequences, and the ability to perform real time functional imaging. Moreover, MR modalities allow visualization of the entire bowel, without overlapping bowel loops, as well as the detection of both intra- and extraluminal abnormalities.The intra- and extraluminal MR findings, combined with contrast enhancement and functional information, help to make an accurate diagnosis and consequently characterize small bowel diseases. PMID:23011551

Masselli, Gabriele; Gualdi, Gianfranco



Examination of Protective Effect of Ischemic Postconditioning After Small Bowel Autotransplantation  

Microsoft Academic Search

Ischemia\\/reperfusion (I\\/R) injury is a serious condition that results from some surgical procedures, including intestinal transplantation. Ischemic postconditioning is defined as brief periods of reperfusion alternating with reocclusion applied during the early minutes after reperfusion. The objective of this study was to investigate the effect of ischemic postconditioning before small bowel autotransplantation. Total orthotopic intestinal autotransplantation was performed in 30

A. Ferencz; I. Takács; S. Horváth; S. Ferencz; S. Jávor; T. Fekecs; K. Shanava; B. Balatonyi; G. Wéber



Dieulafoy's lesion of the small bowel causing massive gastrointestinal bleeding: two case reports and literature review  

Microsoft Academic Search

Dieulafoy's lesions are an often unrecognized cause of obscure, massive GI hemorrhage. Their diagnosis may elude conventional investigations, including upper and lower endoscopy, arteriography, and even laparotomy. In this paper, we report two cases of small-bowel Dieulafoy lesions. The first, a jejunal lesion, occurred in a young patient and was discovered at laparotomy. The second was an ileal Dieulafoy's malformation

Daniel Blecker; Meena Bansal; Robert L. Zimmerman; Franz Fogt; James Lewis; Robert Stein; Michael L. Kochman



Adaptation after small bowel resection is attenuated by sialoadenectomy: The role for endogenous epidermal growth factor  

Microsoft Academic Search

Background: Epidermal growth factor (EGF) is likely involved during adaptation after small bowel resection (SBR) because some studies have shown enhanced adaptation by EGF administration. Because the major source of endogenous EGF in mice is the submandibular glands, we sought to determine the effect of submandibular gland excision (SAL) and luminal or systemic EGF replacement on adaptation after SBR. Methods:

Michael A. Helmrath; Cathy E. Shin; James W. Fox; Christopher R. Erwin; Brad W. Warner



Renal histopathology and crystal deposits in patients with small bowel resection and calcium oxalate stone disease  

Microsoft Academic Search

We present here the anatomy and histopathology of kidneys from 11 patients with renal stones following small bowel resection, including 10 with Crohn's disease and 1 resection in infancy for unknown cause. They presented predominantly with calcium oxalate stones. Risks of formation included hyperoxaluria (urine oxalate excretion greater than 45 mg per day) in half of the cases, and acidic

Andrew P Evan; James E Lingeman; Elaine M Worcester; Sharon B Bledsoe; Andre J Sommer; James C Williams; Amy E Krambeck; Carrie L Philips; Fredric L Coe



Glutamine Reduces Bacterial Translocation after Small Bowel Transplantation in Cyclosporine-Treated Rats  

Microsoft Academic Search

Bacterial translocation (BT) of enteric organisms is a major cause of sepsis in patients undergoing small bowel transplantation (SBT). Cyclosporine (CsA) may be toxic to intestinal epithelium and increase the risk of BT. Glutamine (Gln) is the preferred enterocyte fuel and maintains graft epithelial integrity in experimental SBT. This study determined the effects of CsA on mucosal structure and function

W. Zhang; W. L. Frankel; A. Bain; D. Choi; D. M. Klurfeld; J. L. Rombeau



Evaluation of gastrointestinal injury and blood flow of small bowel during low-dose aspirin administration  

PubMed Central

Low-dose acetylsalicylic acid has been widely used. We evaluated small bowel and gastric injuries during acetylsalicylic acid administration using video capsule endoscopy and gastroduodenal endoscopy. We also investigated blood flow using contrast-enhanced ultrasonography. Six healthy volunteers were enrolled in this preliminary study. The subjects were administered 100 mg of enteric-coated aspirin daily for 14 days. Video capsule endoscopy and gastroduodenal endoscopy were simultaneously performed before administration and on days 1, 3, 7 and 14. Contrast-enhanced ultrasonography was performed before administration and on day 2, and 8. Video capsule endoscopy after administration of low-dose acetylsalicylic acid revealed small bowel mucosal damages of petechiae and erythema in all cases, and denuded area in one case. The total number of lesions in the small bowel increased according to duration of low-dose acetylsalicylic acid administration. However, the total number of lesions in the stomach peaked on day 3. Contrast-enhanced ultrasonography showed that the time-intensity curve peak value and Areas under the curves after acetylsalicylic acid administration were reduced. We observed not only gastric mucosal injuries but also small intestinal injuries with short-term low-dose acetylsalicylic acid administration. Acetylsalicylic acid administration also caused a decrease in small intestinal blood flow. Contrast-enhanced ultrasonography is useful for evaluation blood flow in the small bowel mucosa.

Nishida, Urara; Kato, Mototsugu; Nishida, Mutsumi; Kamada, Go; Ono, Shouko; Shimizu, Yuichi; Fujimori, Shunji; Asaka, Masahiro



Role of rat large intestine in reducing diarrhea after 50% or 80% distal small bowel resection  

Microsoft Academic Search

The effects of intestinal resection on several intestinal parameters have been studied in the large intestine of rats one month after the surgical operation. The results show that both 50% and 80% distal small bowel resection increased net fluid absorption and mucosal permeability and caused expansion of the intercellular spaces of the large intestine. The increase in net fluid absorption

Carmen M. Vazquez; Maria T. Molina; Anunciacion Ilundain



Ethanol inhibition of glucose absorption in isolated, perfused small bowel of rats  

SciTech Connect

There is evidence for both humans and rats that malnutrition frequently occurs when ethanol is chronically ingested. Small bowel /sup 14/C-labelled glucose absorption was measured with an ex vivo system in which the small bowel of the rat was surgically removed and then arterially perfused with an artificial medium. Glucose absorption for a control group of seven rats was 248 +/- 8 microM/min/gm dry weight of small bowel (mean +/- SEM). This was significantly greater than the value 112 +/- 12 microM/min/gm dry weight (P less than 0.005) for a group of five rats in which a competitive inhibitor of glucose absorption, phlorizin (0.2 mM), was added to the bowel lumen. In the presence of 3% ethanol within the gut lumen of five rats, glucose absorption was also reduced (to 131 +/- 12 microM/min/gm dry weight) compared to absorption in the control group (P less than 0.005). The calculated amount of glucose absorbed was corrected for metabolism to lactate and carbon dioxide. We conclude that both phlorizin and ethanol inhibit glucose absorption in the isolated and perfused small bowel of rats and that probably at least part of the malnutrition in ethanol-fed rats is due to glucose malabsorption.

Cobb, C.F.; Van Thiel, D.H.; Wargo, J.



EGF receptor signaling affects bcl-2 family gene expression and apoptosis after massive small bowel resection  

Microsoft Academic Search

BackgroundAfter massive small bowel resection (SBR), enterocyte apoptosis is elevated and inversely correlates with epidermal growth factor receptor (EGFR) signaling. The purpose of the current study was to determine whether EGFR manipulation affects the expression of specific bcl-2 family members.

Andrew W Knott; Russell J Juno; Marcus D Jarboe; Yufang Zhang; Sherri A Profitt; Janice C Thoerner; Christopher R Erwin; Brad W Warner



Preventing enterocyte apoptosis after massive small bowel resection does not enhance adaptation of the intestinal mucosa  

Microsoft Academic Search

BackgroundAfter massive small bowel resection (SBR), increased rates of enterocyte apoptosis are observed in the remnant bowel via a mechanism requiring bax gene expression. This study tested the hypothesis that adaptive mucosal growth could be enhanced by the novel strategy of preventing postresection enterocyte apoptosis.

Russell J. Juno; Andrew W. Knott; Sherri A. Profitt; Marcus D. Jarboe; Yufang Zhang; Christopher R. Erwin; Brad W. Warner



Is surveillance of the small bowel indicated for Lynch syndrome families?  

Microsoft Academic Search

BACKGROUND: Small bowel cancer (SBC) is one of the tumours associated with Lynch syndrome (LS). To advise on screening for this tumour it is paramount to be informed about the lifetime risk. The aim of this study was to calculate the lifetime risk of SBC in LS and to identify possible risk factors. METHODS: Clinical and pathological data were collected

G. L. ten Kate; J. H. Kleibeuker; F. M. Nagengast; M. Craanen; A. Cats; F. H. Menko; H F A Vasen



Ileocolic versus Small-Bowel Intussusception in Children: Can US Enable Reliable Differentiation?  


Purpose: To assess clinical and ultrasonographic (US) criteria that can be used to confidently differentiate ileocolic from small-bowel intussusception. Materials and Methods: Institutional review board approval was obtained for this retrospective study, and the need to obtain informed consent was waived. US and clinical data for children given a diagnosis of intussusception in the years 2007 through 2011 were evaluated. The diameters of the intussusception and the inner fat core, the outer bowel wall thickness, and the presence or absence of lymph nodes inside the intussusception and mesentery were noted. The Student t test, the Mann-Whitney test, and the Levene test were used for comparison of parametric variables, while the ?(2) and Fisher exact tests were used for comparison of categoric data. Results: There were 200 cases of intussusception in 174 patients (126 boys, 48 girls; mean age, 17.2 months (range, 0 years to 7 years 1 month); 57 (28.5%) were small-bowel and 143 (71.5%) were ileocolic intussusceptions. Mean lesion diameter was 2.63 cm (range, 1.3-4.0 cm) for ileocolic versus 1.42 cm (range, 0.8-3.0 cm) for small-bowel intussusception (P < .0001). Mean fat core diameter was 1.32 cm (range, 0.6-2.2 cm) for ileocolic versus 0.1 cm (range, 0-0.75 cm) for small-bowel intussusception (P < .0001). The ratio of inner fat core diameter to outer wall thickness was greater than 1.0 in all ileocolic intussusceptions and was less than 1.0 in all small-bowel intussusceptions (P < .0001). Lymph nodes inside the lesion were seen in 128 (89.5%) of the 143 ileocolic intussusceptions versus in eight (14.0%) of the 57 small-bowel intussusceptions (P < .0001). Children with ileocolic intussusception had more severe clinical symptoms and signs, with more vomiting (P = .003), leukocytosis (P = .003), and blood in the stool (P = .00005). Conclusion: The presence of an inner fatty core in the intussusception, lesion diameter, wall thickness, the ratio of fatty core thickness to outer wall thickness, and the presence of lymph nodes in the lesion may enable reliable differentiation between ileocolic and small-bowel intussusceptions. © RSNA, 2013. PMID:23801771

Lioubashevsky, Natali; Hiller, Nurith; Rozovsky, Katya; Segev, Lee; Simanovsky, Natalia



Decreasing gastrointestinal morbidity with the use of small bowel contrast during treatment planning for pelvic irradiation  

SciTech Connect

Small bowel tolerance is a major dose-limiting factor in treating the pelvis with radiation therapy (RT). The use of small bowel contrast during RT simulation is one technique used to localize the bowel and identify the treatment plan that would exclude the greatest volume. To determine the influence of treatment planning with oral contrast on gastrointestinal injury, acute and chronic small bowel morbidity was analyzed in 115 patients with endometrial and rectal carcinoma who received postoperative radiation therapy at the Fox Chase Cancer Center. Mean and median time of follow-up were 31 and 27 months, respectively. Acute diarrhea was seen in 82% of the patient population. Ten percent of patients experienced major complications requiring hospitalization. Ninety-three percent of patients simulated without contrast experienced side effects compared to 77% of patients simulated with contrast (p = .026). There was an increased incidence of chronic complications in patients who were not simulated with contrast dye (50% vs 23%, p = .014). Median duration of minor side effects was 4 months for patients planned without oral contrast and 1 month for patients who had contrast at the time of simulation (p = .036). The superior aspect of the treatment field was determined to be at a more inferior location in patients simulated with contrast, thereby excluding small bowel from treatment. Seventy-four percent of patients simulated without contrast had the upper border of the field placed at the superior aspect of the sacroiliac joint or above, compared to only 40% of patients planned with oral contrast (p = .002). This study has demonstrated decreased complications (both overall and chronic) as well as a change in the location of the treatment field with the use of small bowel contrast.

Herbert, S.H.; Curran, W.J. Jr.; Solin, L.J.; Stafford, P.M.; Lanciano, R.M.; Hanks, G.E. (Fox Chase Cancer Center, Philadelphia, PA (USA))



Increased Small Bowel Epithelial Turnover in Interleukin-1 Receptor Knockout Mice  

PubMed Central

Objective To determine whether interleukin-1 (IL-1) affects the cellular homeostasis of small bowel mucosa, the authors studied apoptosis and proliferation in small bowel epithelium in two groups of C57 mice: an IL-1 receptor knockout group, and a control wild-type group. Summary Background Data Gut mucosal integrity is maintained by a balance of cell proliferation and cell death. Recent reports suggest that IL-1, a proinflammatory cytokine, increases cell death by apoptosis in some epithelial cells. Methods Twenty-four male C57BL6 IL-1 receptor (type I) knockout mice were killed, and small bowel was removed for study. Twenty-four wild-type mice (C57-BL6) served as controls. Body weights, bowel length, and mucosal morphology were examined for phenotypic differences. Apoptosis was quantified by terminal deoxyuridine nick-end labeling (TUNEL) immunohistochemical staining and cellular proliferation by proliferation cell nuclear antigen staining. Whole mucosal protein was analyzed for nuclear factor-?B expression. Groups were analyzed by t test. Results The absence of IL-1 type I receptor in knockout mice was verified by reverse transcriptase–polymerase chain reaction. IL-1 receptor null mice were larger than wild-type controls, with a longer small bowel; however, the index of small bowel length to total body weight did not differ between groups. The percentage of apoptotic cells was higher in IL-1 receptor null mice than in wild-type mice; the proliferation index also increased. Mucosal height and other measures of mucosal morphology were not different. Genotypic absence of IL-1 receptors was associated with decreased expression of nuclear factor-?B in whole mucosal protein extracts. Conclusions Both apoptosis and proliferation increased in gut epithelial cells of mice without IL-1 receptors, suggesting increased cell turnover with no change in net balance. This model represents an opportunity to examine potential mechanisms of gut epithelial turnover in vivo, under both normal conditions and in conditions of mucosal proliferation and atrophy.

Wolf, Steven E.; Debroy, Meelie A.; Ikeda, Hiroto; Jeschke, Marc; Matin, Sina; Rajaraman, Srinivasan; Ko, Tien C.; Englander, Ella W.; Norman, James G.; Thompson, James C.



Rejoining of x-ray induced chromosome breaks in human cells and its relationship to cellular repair  

SciTech Connect

A method was developed to improve the resolution for measuring breaks produced in interphase chromosomes by X-rays following the induction of premature chromosome condensation (PCC). It is based on the principle of 5-BrdU incorporation into the DNA of HeLa mitotic cells, which act as inducers of PCC when they are fused to diploid human fibroblasts. After a modified Fluorescence Plus Giemsa (FPG) protocol, the PCC stain intensely, while the mitotic inducer chromosomes stain faintly. The dose response for density inhibited (G/sub 0/) human cells was linear from 10.9 to 600 rad, with a slope of 0.06 breaks per cell per rad. Upon incubation at 37/sup 0/C, half of the breaks disappeared in 2 hours. Following a dose of 600 rad the initial rate of break rejoining mirrored the rate of increase in survival from post-irradiation incubation, due to the repair of potentially lethal damage (PLD). The X-ray induced PCC rejoining characteristics from two ataxia telangiectasia (A-T) cell lines were compared to profiles obtained with normal cells. Both normal and A-T cells apparently sustained the same initial level of radiation damage, and both cell types rejoined breaks at the same rate. However, while normal cells eventually rejoined all but about 5% of the breaks produced by 600 rad, the A-T lines were left with 5-6 times the level of residual damage. These experiments demonstrate that progression of cells into S phase is not a necessary condition for the measured frequency of chromosome fragments observed in X-irradiated A-T cells.

Cornforth, M.N.



Escherichia coli radC is deficient in the recA-dependent repair of X-ray-induced DNA strand breaks.  


Escherichia coli K-12 cells incubated in buffer can repair most of their X-ray-induced DNA single-strand breaks, but additional single-strand breaks are repaired when the cells are incubated in growth medium. While the radC102 mutant was proficient at repairing DNA single-strand breaks in buffer (polA-dependent repair), it was partially deficient in repairing the additional single-strand breaks (or alkali-labile lesions) that the wild-type strain can repair in growth medium (recA-dependent repair), and this repair deficiency correlated with the X-ray survival deficiency of the radC strain. In studies using neutral sucrose gradients, the radC strain consistently showed a small deficiency in rejoining X-ray-induced DNA double-strand breaks, and it was deficient in restoring the normal sedimentation characteristics of the repaired DNA. PMID:3517933

Felzenszwalb, I; Sargentini, N J; Smith, K C



X-Ray Induced Formation of ?-H2AX Foci after Full-Field Digital Mammography and Digital Breast-Tomosynthesis  

PubMed Central

Purpose To determine in-vivo formation of x-ray induced ?-H2AX foci in systemic blood lymphocytes of patients undergoing full-field digital mammography (FFDM) and to estimate foci after FFDM and digital breast-tomosynthesis (DBT) using a biological phantom model. Materials and Methods The study complies with the Declaration of Helsinki and was performed following approval by the ethic committee of the University of Erlangen-Nuremberg. Written informed consent was obtained from every patient. For in-vivo tests, systemic blood lymphocytes were obtained from 20 patients before and after FFDM. In order to compare in-vivo post-exposure with pre-exposure foci levels, the Wilcoxon matched pairs test was used. For in-vitro experiments, isolated blood lymphocytes from healthy volunteers were irradiated at skin and glandular level of a porcine breast using FFDM and DBT. Cells were stained against the phosphorylated histone variant ?-H2AX, and foci representing distinct DNA damages were quantified. Results Median in-vivo foci level/cell was 0.086 (range 0.067–0.116) before and 0.094 (0.076–0.126) after FFDM (p?=?0.0004). In the in-vitro model, the median x-ray induced foci level/cell after FFDM was 0.120 (range 0.086–0.140) at skin level and 0.035 (range 0.030–0.050) at glandular level. After DBT, the median x-ray induced foci level/cell was 0.061 (range 0.040–0.081) at skin level and 0.015 (range 0.006–0.020) at glandular level. Conclusion In patients, mammography induces a slight but significant increase of ?-H2AX foci in systemic blood lymphocytes. The introduced biological phantom model is suitable for the estimation of x-ray induced DNA damages in breast tissue in different breast imaging techniques.

Schwab, Siegfried A.; Brand, Michael; Schlude, Ina-Kristin; Wuest, Wolfgang; Meier-Meitinger, Martina; Distel, Luitpold; Schulz-Wendtland, Ruediger; Uder, Michael; Kuefner, Michael A.



The nature of the X-ray-induced luminescence and the hole centres in CsI:Tl studied by optically detected electron paramagnetic resonance  

Microsoft Academic Search

In the X-ray-induced luminescence band peaking at 560 nm we have detected the electron paramagnetic resonance (EPR) spectrum using optical detection (ODEPR) Of VK centres, which have their molecular axes perpendicular to the magnetic field, an EPR was only detected as a microwave-induced change in the magnetic circular polarization of the emission, and not as an emission intensity change. No

J.-M. Spaeth; W. Meise; K. S. Song



Involvement of SAPK\\/JNK pathway in X-ray-induced rapid cell death of human T-cell leukemia cell line MOLT4  

Microsoft Academic Search

We found that SAPK\\/JNK was phosphorylated during X-ray-induced rapid cell death of MOLT-4 cells and that acid Sphingomyelinase inhibitor D609 suppressed the rapid cell death as well as phosphorylation of SAPK\\/JNK. Also C2-ceramide caused phosphorylation of SAPK\\/JNK, followed by rapid cell death. Further we isolated X-ray-resistant radiation-hybrid clones from MOLT-4 and 50 Gy irradiated mouse FM3A cells by repeated selections

Atsushi Enomoto; Norio Suzuki; Kazuya Hirano; Yoshihisa Matsumoto; Akinori Morita; Kazuo Sakai; Hideki Koyama



Cellular proliferation in the skin of X-rayed newt limbs (with a note on x-ray-induced limb regression)  

SciTech Connect

Left hind limbs, including the pelvis, of adult newts (Notophthalmus viridescens) were locally irradiated with a dose of x-rays that inhibited regeneration (2,000 R). This x-ray dose and other doses (700-2,000 R) capable of inhibiting limb regeneration also cause limb regression prior to amputation. Before limb regression occurred, there was a latent period of 3 to 6 weeks. Limb regression was characterized by necrotic wasting and resorption of distal elements. The degree of loss was variable and dependent upon dosage. After this further degenerative changes were not noted. Proliferation of epidermal cells was examined 4 days after irradiation prior to limb regression or after x-ray-induced degeneration of the limbs had ended. Proliferative activity in x-rayed limbs was also compared at various stages of contralateral control limb regeneration. Limbs examined after x-ray-induced limb regression had ended showed levels of (/sup 3/H)-thymidine incorporation into DNA comparable to normal epidermis. In contrast, limbs examined 4 days after irradiation had lower levels of DNA synthesis (P much less than 0.01). Amputation of limbs in both groups caused an increase in DNA synthesis (P much less than 0.01). Histological examination showed that cellular proliferation was associated primarily with the epidermis. These results indicate that epidermal cell proliferation was not resistant to x-rays. However, levels of normal cell division were observed after amputation of after cessation of x-ray-induced limb regression.

Wertz, R.L.



Radiation Dose-Volume Effects in the Stomach and Small Bowel  

SciTech Connect

Published data suggest that the risk of moderately severe (>=Grade 3) radiation-induced acute small-bowel toxicity can be predicted with a threshold model whereby for a given dose level, D, if the volume receiving that dose or greater (VD) exceeds a threshold quantity, the risk of toxicity escalates. Estimates of VD depend on the means of structure segmenting (e.g., V15 = 120 cc if individual bowel loops are outlined or V45 = 195 cc if entire peritoneal potential space of bowel is outlined). A similar predictive model of acute toxicity is not available for stomach. Late small-bowel/stomach toxicity is likely related to maximum dose and/or volume threshold parameters qualitatively similar to those related to acute toxicity risk. Concurrent chemotherapy has been associated with a higher risk of acute toxicity, and a history of abdominal surgery has been associated with a higher risk of late toxicity.

Kavanagh, Brian D., E-mail: Brian.Kavanagh@ucdenver.ed [Department of Radiation Oncology, University of Colorado-Denver School of Medicine, Aurora, CO (United States); Pan, Charlie C. [Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI (United States); Dawson, Laura A. [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada); Das, Shiva K. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Li, X. Allen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Ten Haken, Randall K.; Miften, Moyed [Department of Radiation Oncology, University of Colorado-Denver School of Medicine, Aurora, CO (United States)



[Small bowel obstruction due to metastatic lobular carcinoma of the breast].  


Although breast cancer most frequently metastasizes to the bone, lung, pleura, liver, adrenal glands and brain, it can also affect other organs such as the small bowel and ovaries, especially if the type of cancer is infiltrating and lobular. We present a case of metastases to the small bowel and ovaries from pleomorphic type infiltrating lobular breast carcinoma presenting as intestinal obstruction. Barium transit study revealed a stenosis in the jejunum and another in the terminal ileum at the ileocecal valve area. A flat formation in the area of the ileocecal valve was observed on endoscopy but the results of biopsy were negative, a fairly frequent finding due to the absence of infiltration of the intestinal mucosa. Pathological and immunohistochemical study of the intestinal and ovarian surgical specimens confirmed the diagnosis of metastases from lobular carcinoma of the breast, which was corroborated by breast biopsy. PMID:16420897

Gegúndez, Carlos; Paz, José Manuel; Mata, Isabel; Cao, Josefina; Conde, José; Couselo, José Manuel; Avila, Susana; Arija, Félix



Mesocaval shunt for portal hypertensive small bowel bleeding documented with intraoperative enteroscopy  

PubMed Central

INTRODUCTION Besides upper gastrointestinal tract, small bowel has also been implicated as a potential source of hemorrhage in patients with portal hypertension. PRESENTATION OF CASE We report an interesting case of recurrent massive small intestinal bleeding in a patient with portal hypertension secondary to liver cirrhosis treated with a mesocaval shunt. Endoscopic assessment with gastroscopy and colonoscopy failed to identify the source of hemorrhage. An intraoperative enteroscopy was conducted which revealed a diffuse bleeding pattern from the small bowel mucosa. DISCUSSION An interposition mesocaval shunt procedure was successfully carried out on an emergency basis that eventually managed to control bleeding. CONCLUSION In cases, where a diffuse pattern of hemorrhage exist or non-operative measures fail emergency mesocaval shunting seems to be an efficacious alternative treatment approach for portal hypertension related intestinal bleeding.

Symeonidis, Dimitrios; Koukoulis, Georgios; Christodoulidis, Grigorios; Mamaloudis, Ioannis; Chatzinikolaou, Ioannis; Tepetes, Konstantinos



Oesophageal stent migration following Billroth I gastrectomy: an unusual cause of small bowel obstruction  

PubMed Central

We report the case of an elderly female patient with a history of a previous Billroth I gastrectomy who presented with small bowel obstruction secondary to a migrated oesophageal stent. This patient had an iatrogenic oesophageal perforation following therapeutic endoscopy for a benign stricture 4 months prior to presentation. This was treated endoscopically with a covered stent that was not removed as planned. The stent migrated distally lodging in the terminal ileum, causing small bowel obstruction. Oesophageal stent migration is a rare but well-recognized complication of stent placement. Endoscopic stenting is an effective treatment for oesophageal perforation with lower morbidity and mortality than operative repair. Clinicians should be aware that although patients with a history of previous gastric surgery are at no greater risk of stent migration than others, the altered anatomy can affect the final resting place of the migrated stent and hence the clinical effects and sequalae.

Quinn, Morgan; Luke, David



Treatment planning for colorectal cancer: radiation and surgical techniques and value of small-bowel films  

SciTech Connect

For colorectal cancer, the adjuvant radiation dose levels required to achieve a high incidence of local control closely parallel the radiation tolerance of small bowel (4500-5000 rad), and for patients with partially resected or unresected disease, the dose levels exceed tolerance (6000-7000 rad). Therefore, both the surgeon and the radiation oncologist should use techniques that localize tumor volumes and decrease the amount of small intestine within the irradiation field. Surgical options include pelvic reconstruction and clip placement. Radiation options include the use of radiographs to define small bowel location and mobility combined with treatment techniques using multiple fields, bladder distention, shrinking or boost fields, and/or patient position changes. When both specialties interact in optimum fashion, local control can be increased with minimal side effects to the small intestine.

Gunderson, L.L.; Russell, A.H.; Llewellyn, H.J.; Doppke, K.P.; Tepper, J.E.



Preservation of Small Bowel Grafts – A Comparison with Two Standard Solutions  

Microsoft Academic Search

This study investigates the use of EuroCollins (EC) and University of Wisconsin (UW) solution, two major preservation fluids, for small bowel preservation. After in situ flushing, grafts were cold-stored at 4°C with either EC for 30 min (group 1a), 6 h (group 1b) and 12 h (group 1c) or with UW for 30 min (group 2a), 6 h (group 2b)

W. Thaler; G. Oberhuber; G. Klima; R. Margreiter; Th. Schmid



Dog immunoglobulins. I. immunochemical characterization of dog serum, parotid saliva, colostrum, milk and small bowel fluid.  

PubMed Central

The levels of immunoglobulins A, M and G were measured in dog serum, colostrum, milk, parotid saliva and small bowel fluid using the single radial immunodiffusion method. All the external secretions except early colostrum, by contrast with serum, were found to be rich in IgA with small quantities of IgM and IgG. Exocrine immunoglobulins were partially characterized by gel filtration.

Heddle, R J; Rowley, D



Estimation of small bowel transit time following colectomy and ileal reservoir construction.  


A study was carried out to evaluate the breath hydrogen test as a method of estimating small bowel transit in patients with an ileal pouch and to determine whether gut transit time influenced functional outcome. Twelve patients with an ileal reservoir and ten control subjects ingested a test meal of 400 ml chicken soup, 20 g lactulose and 50 ml dilute barium solution. Concurrent breath hydrogen testing and radiological screening was carried out until the head of the test meal reached the ileal pouch or caecum. At the time that the test meal arrived in the pouch, faecal anaerobic bacterial counts were obtained. Pouch compliance, functional capacity and anal sphincter pressures were also measured. While there was an excellent correlation between radiological and breath hydrogen measures of orocaecal transit time in controls (P less than 0.001), no such relationship was found for oropouch transit. Four of the 12 patients with a pouch produced no hydrogen after test meal ingestion, while in two other such patients breath hydrogen peaks occurred when the head of the meal was in the jejunum. The magnitude of the breath hydrogen rise in patients with an ileal pouch correlated well with faecal anaerobic bacterial counts (P less than 0.01). The median (95 per cent confidence interval) radiological small bowel transit time was more rapid in patients with a pouch than in control subjects: 28 (23-33) versus 72 (46-86) min (P less than 0.01). Increased 24-h frequency of defaecation was associated with more rapid small bowel transit after ileal reservoir construction (P less than 0.01) but correlated with neither pouch capacity nor compliance. These data show that small bowel transit time may be a determinant of ileal pouch function but that breath hydrogen estimation of gut transit time in patients with an ileal reservoir is unreliable. PMID:1643490

Kmiot, W A; O'Brien, J D; Awad, R; Keighley, M R



Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery  

Microsoft Academic Search

PURPOSE: The study contained herein was undertaken to establish the incidence of small-bowel obstruction, adhesiolysis for obstruction, and additional abdominal surgery after open colorectal and general surgery. METHODS: A retrospective cohort study was performed using patient-specific Health Care Financing Administration data to evaluate a random 5 percent sample of all Medicare patients who underwent surgery in 1993. Of these, 18,912

David E. Beck; Frank G. Opelka; H. Randolph Bailey; Stephen M. Rauh; Chris L. Pashos



Strangulated small bowel hernia through the port site: A case report  

Microsoft Academic Search

Port site hernia develops through a fascial or peritoneal layer that was inadequate or not repaired. It is a rare complication of laparoscopic surgery which may lead to serious problems. Here, we present a 77-year-old female, diagnosed with a small bowel hernia through a 10-mm port site. We had performed ten cases of laparoscopy-assisted distal gastrectomy before this case. The

Jun Hyun Lee; Wook Kim


A case of gallstone-induced small bowel necrosis masquerading as clinical appendicitis  

Microsoft Academic Search

Cholecysto-duodenal fistula and gallstone ileus are well-recognised complications of gallstone disease. However, small bowel\\u000a necrosis is a rare complication of gallstone disease. We describe a case of gallstone-induced ileal necrosis presenting with\\u000a symptoms and signs resembling acute appendicitis. A 79-year-old woman presented to the surgical team with central abdominal\\u000a pain which subsequently shifted to the right iliac fossa. Clinically, the

Siong-Seng Liau; Andrew Bamber; Malcolm MacFarlane; Justin Alberts



Gluten-dependent antibodies in horses with inflammatory small bowel disease (ISBD)  

Microsoft Academic Search

Background: Equine inflammatory small bowel disease (ISBD) is an idiopathic pathologic condition seeming to increase in prevalence.Objective: To investigate the potential role of gluten in equine ISBD.Animals & Methods: Antibodies known to be important in the diagnosis of human coeliac disease (CD): IgA antibodies to human recombinant and guinea pig tissue-transglutaminase (TGA), native gliadin (AGA), deamidated-gliadin-peptides (DGPA), and primate and

J. H. van der Kolk; L. A. van Putten; C. J. Mulder; G. C. M. Grinwis; M. Reijm; C. M. Butler; B. M. E. von Blomberg



Comparative analysis of adenosine triphosphate-magnesium chloride and allopurinol following small-bowel ischemia  

Microsoft Academic Search

The intestinal lesions caused by ischemia and reperfusion may lead to grave sequelae. To study the efficacy of adenosine triphosphate magnesium chloride (ATP-MgCl2) and allopurinol (ALLO) in protecting the small bowel from ischemia, rabbits in two groups, 1 (n = 7) and 2 (n = 7), were pretreated with either 1 ml saline or ATP-MgCl2 just prior to intestinal ischemia

Xian-ping Liao; Ya-xiong She; Cheng-ren Shi; Zong-de Zhang; Min Li



Enhanced growth of small bowel in transgenic mice expressing human insulin-like growth factor I  

Microsoft Academic Search

BACKGROUND & AIMS: Growth hormone and insulin-like growth factor I (IGF- I) stimulate small bowel growth. The aim of this study was to analyze whether IGF-I mediates enterotrophic actions of growth hormone.METHODS: IGF-I transgenic mice that overexpress an IGF-I transgene driven by the mouse metallothionein I promoter and are growth hormone deficient were compared with wild-type littermates. Growth of small

K Ohneda; MH Ulshen; CR Fuller; AJ D'Ercole; PK Lund



Effect of small bowel transplantation, denervation and ischaemia on rat intestinal microflora  

Microsoft Academic Search

The effects of denervation and warm ischaemia on quantitative and qualitative changes in small intestinal microflora following rat heterotopic small-bowel isotransplantation were assessed. Animals with Thiry-Vella fistula, but without transplants, acted as controls. Thirty and 40-fold increases in bacterial colony counts were seen in the isografts compared to controls at 2 and 7 days, respectively (PFlavobacterium meningosepticum occurred at 28

B. A. Price; N. S. Cumberland; C. L. Ingham Clark; A. G. Pockley; P. A. Lear; R. F. M. Wood



[A rare cause of recurrent small bowel intussusception. Case report and review of the literature].  


Small bowel intussusception is a rare cause of abdominal pain in adult patients. Due to varying symptoms and different underlying causes its diagnosis and treatment is challenging for physicians. This case report describes recurrent intussusception in an adult female patient and celiac disease could only be diagnosed as the cause of these symptoms after surgery. In addition a review of the literature regarding adult intussusception is presented. PMID:22695813

Haist, T; Behrens, A; Willenbrock, K; Fisseler-Eckhoff, A; Ell, C; Lorenz, D



Differential changes in intrinsic innervation and interstitial cells of Cajal in small bowel atresia in newborns  

PubMed Central

AIM: To investigate morphological changes of the enteric nervous system (ENS) and the interstitial cells of Cajal (ICCs) in small bowel atresia. METHODS: Resected small bowel specimens from affected patients (n = 7) were divided into three parts (proximal, atretic, distal). Standard histology and enzyme immunohistochemistry anti-S100, anti-protein gene product (PGP) 9.5, anti-neurofilament (NF), anti-c-kit-receptor (CD117) was carried out on conventional paraffin sections of the proximal and distal part. RESULTS: The neuronal and glial markers (PGP 9.5, NF, S-100) were expressed in hypertrophied ganglia and nerve fibres within the myenteric and submucosal plexuses. Furthermore, the submucous plexus contained typical giant ganglia. The innervation pattern of the proximal bowel resembled intestinal neuronal dysplasia. The density of myenteric ICCs was clearly reduced in the proximal bowel, whereas a moderate number of muscular ICCs were found. The anti-CD117 immunoreaction revealed additional numerous mast cells. The distal bowel demonstrated normal morphology and density of the ENS, the ICCs and the mast cells. CONCLUSION: The proximal and distal bowel in small bowel atresia revealed clear changes in morphology and density of the ENS and ICCs.

Gfroerer, Stefan; Metzger, Roman; Fiegel, Henning; Ramachandran, Priya; Rolle, Udo



Intussusception caused by an inverted Meckel's diverticulum: a rare cause of small bowel obstruction in adults  

PubMed Central

Adult intussusception due to Meckel's diverticulum is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report one case of intussusception due to Meckel's diverticulum in an adult. A 22-year-old patient was admitted to our hospital with vomiting and abdominal pain. The abdomen was hard with tenderness. We diagnosed an acute small bowel obstruction and performed emergency surgery. The intra operative findings were distention of the small bowel and intussusception of ileus due to an inverted Meckel's diverticulum located 70 cm from the ileocecal valve. 30 cm ischemic loop was identified. A segmental small bowel resection and hand-sewn anastomosis was performed. Histopathology distinguished Meckel's diverticulum measuring 5 cm x 3.5 cm x 1 cm and no signs of malignancy.

Bouassida, Mahdi; Feidi, Bilel; Ben Ali, Mechaal; Chtourou, Mohamed Fadhel; Krifa, Marouene; Sassi, Selim; Chebbi, Fathi; Mighri, Mohamed Mongi; Touinsi, Hassen; Sassi, Sadok



Aspirin-induced small bowel injuries and the preventive effect of rebamipide  

PubMed Central

AIM: To evaluate the influence of taking low-dose aspirin for 4 wk on small intestinal complications and to examine the preventive effect of rebamipide. METHODS: This study was conducted as a single-center, randomized, double-blind, cross-over, placebo-controlled study. Eleven healthy male subjects were enrolled. Each subject underwent video capsule endoscopy after 1 and 4 wk of taking aspirin and omeprazole, along with either rebamipide or placebo therapy. The primary endpoint was to evaluate small bowel damage in healthy subjects before and after taking low-dose aspirin for 4 wk. RESULTS: The number of subjects with mucosal breaks (defined as multiple erosions and/or ulcers) were 1 at 1 wk and 1 at 4 wk on the jejunum, and 6 at 1 wk (P = 0.0061) and 7 at 4 wk on the ileum (P = 0.0019). Rebamipide significantly prevented mucosal breaks on the ileum compared with the placebo group (P = 0.0173 at 1 wk and P = 0.0266 at 4 wk). CONCLUSION: Longer-term, low-dose aspirin administration induced damage in the small bowel. Rebamipide prevented this damage, and may be a candidate drug for treating aspirin-induced small bowel complications.

Mizukami, Kazuhiro; Murakami, Kazunari; Abe, Takashi; Inoue, Kunimitsu; Uchida, Masahiro; Okimoto, Tadayoshi; Kodama, Masaaki; Fujioka, Toshio



Small bowel involvement in blue rubber bleb nevus syndrome: MR imaging features.  


Blue rubber bleb nevus syndrome (BRBNS) is a rare condition which is characterized by multiple venous malformations that may affect several organs. Gastrointestinal lesions, which mostly involve the small bowel and distal colon, may be responsible for gastrointestinal bleeding, causing more frequently chronic anemia. We report herein two cases of BRBNS causing gastrointestinal bleeding which were investigated by means of MR imaging. All venous malformations showed markedly high signal intensity on fat-suppressed T2-weighted MR images. In addition, extraintestinal venous malformations displayed high signal intensity similar to that of small bowel venous malformations. Fat-suppressed T2-weighted TSE images show both small bowel and colonic involvement, thus providing useful information relative to the most appropriate therapeutic approach to be used. MR imaging is especially helpful when capsule endoscopy or enteroscopy are contraindicated or not feasible. In addition, because of lack of radiation, MR imaging can be performed repeatedly to assess the evolution of the disease before a planned surgery or endoscopic resection. Also, because BRBNS is by essence a multifocal condition with extraintestinal involvement, MR imaging appears as an appropriate imaging technique to investigate the multiple locations of the disease in one session, thus replacing multiple examinations. PMID:18414932

Mechri, Myriam; Soyer, Philippe; Boudiaf, Mourad; Duchat, Florent; Hamzi, Lounis; Rymer, Roland



Low-Radiation-Dose Modified Small Bowel CT for Evaluation of Recurrent Crohn's Disease  

PubMed Central

Crohn's disease affects any part of the GI tract, commonly the terminal ileum. To decrease radiation exposure we developed a low-radiation-dose unenhanced CT (modified small Bowel CT, MBCT) to evaluate the small bowel using hyperdense oral contrast. Technique. MBCT was investigated in patients with pathologically proven Crohn's disease presenting with new symptoms from recurrent inflammation or stricture. After ethics board approval, 98 consecutive patients were retrospectively evaluated. Kappa values from two independent reviewers were calculated for presence of obstruction, active inflammation versus chronic stricture, and ancillary findings. Forty-two patients underwent surgery or colonoscopy within 3 months. Results. Kappa was 0.84 for presence of abnormality versus a normal exam and 0.89 for differentiating active inflammation from chronic stricture. Level of agreement for presence of skip areas, abscess formation, and fistula was 0.62, 0.75, and 0.78, respectively. In the subset with “gold standard” follow-up, there was 83% agreement. Conclusions. MBCT is a low-radiation technique with good to very good interobserver agreement for determining presence of obstruction and degree of disease activity in patients with Crohn's disease. Further investigation is required to refine parameters of disease activity compared to CT enterography and small bowel follow through.

Kielar, A. Z.; Tao, H.; McKeever, C.; El-Maraghi, R. H.



Effect of small bowel transplantation, denervation and ischaemia on rat intestinal microflora.  


The effects of denervation and warm ischaemia on quantitative and qualitative changes in small intestinal microflora following rat heterotopic small-bowel isotransplantation were assessed. Animals with Thiry-Vella fistula, but without transplants, acted as controls. Thirty and 40-fold increases in bacterial colony counts were seen in the isografts compared to controls at 2 and 7 days, respectively (P < 0.05). Aerobic faecal organisms predominated at 2 and 7 days, but an overgrowth of Flavobacterium meningosepticum occurred at 28 days in the transplanted and host bowels. The effect of warm ischaemia on intestinal microflora was assessed by the application of a microvascular clamp to the superior mesenteric artery for 90 min. The effect of denervation was assessed following microsurgical division of all nervous tissue around the superior mesenteric artery. After 7 days, lengths of jejunum and ileum were removed and intraluminal microflora assessed. The number of bacterial colonies isolated from the ileum in the warm ischaemia group was six times greater than the number in the control group, whereas no significant changes were seen in the upper bowel. In contrast, denervation led to a slight, but consistent, decrease in colony counts. These findings suggest that the increase in bacterial numbers in an isografted small bowel primarily results from warm ischaemia rather than from mesenteric denervation, and that physical aspects of the procedure may affect the development of sepsis following small-bowel transplantation. PMID:7993569

Price, B A; Cumberland, N S; Ingham Clark, C L; Pockley, A G; Lear, P A; Wood, R F



Graft-versus-host reaction in small bowel transplantation and possibilities for its circumvention  

SciTech Connect

To describe GVHR in small bowel transplantation and its underlying mechanisms and to find methods for circumventing that response, accessory small bowel transplantation was carried out in the rat model. Animals not treated with cyclosporine, irradiation, or removal of the mesenteric lymph nodes of the graft died within 22 days postoperatively due to graft versus host disease. Mesenteric lymph nodes of the graft and recipient spleen and peripheral lymph nodes showed strong immunologic stimulation histologically and high antihost T-cell-mediated cytotoxic antihost reactivity. Seventy-one percent of the animals that had received 15 mg of cyclosporine per kilogram body weight orally survived 150 days after transplantation. After donor irradiation with 50 rads, 77 percent of the recipients survived 120 days. After microsurgical removal of the mesenteric lymph nodes of the graft, 89 percent survived 120 days. We conclude that GVHR plays an important role in small bowel transplantation and that the experimental regimens of donor, graft, and recipient treatment described herein have proved their efficacy for circumventing GVHR.

Deltz, E.; Ulrichs, K.; Schack, T.; Friedrichs, B.; Mueller-Ruchholtz, W.M.; Mueller-Hermelink, H.K.T.; Thiede, A.



Cardiopulmonary bypass induced microcirculatory injury of the small bowel in rats  

PubMed Central

AIM: To investigate microvascular injury quantitatively in the small bowel with respect to cardiopulmonary bypass (CPB) and related mechanisms. METHODS: In 10 male SD rats, normothermic CPB was established and continued with a flow rate of 100-150 mL/kg per minute for 60 min, while another 10 sham-operated animals served as controls. An approximate 10-cm loop of the terminal ileum was exteriorized for observation by means of intravital fluorescence microscopy. The small bowel microcirculatory network including arterioles, capillaries, and collecting venules was observed prior to CPB, CPB 30 min, CPB 60 min, post-CPB 60 min and post-CPB 120 min. The intestinal capillary perfusion, microvascular permeability and leukocyte adherence were also measured. RESULTS: The systemic hemodynamics remained stable throughout the experiment in both groups. In CPB animals, significant arteriolar vasoconstriction, blood velocity reduction and functional capillary density diminution were found. As concomitances, exaggerated albumin extravasation and increased leukocyte accumulation were also noted. These changes were more pronounced and there were no signs of restitution at the end of the observation period. CONCLUSION: CPB induces significant microcirculatory injury of the small bowel in rats. The major underlying mechanisms are blood flow redistribution and generalized inflammatory response associated with CPB.

Dong, Guo-Hua; Wang, Chang-Tian; Li, Yun; Xu, Biao; Qian, Jian-Jun; Wu, Hai-Wei; Jing, Hua



Simultaneous measurement of the propulsion and mixing of small bowel contents in the rat.  


A method is presented for the simultaneous measurement of propulsion and mixing of small bowel contents in conscious rats. Through a permanent duodenal catheter two differently labeled test substances (125I-PVP and 131I-PVP) were infused continuously one after the other. The radioactive label was changed once during the total infusion period of 5 hours. Studies were performed in six groups of animals which differed with respect to time for interchange of test substance. At the end of the total infusion period the border zone had travelled to six different locations in the small bowel. The animals were then killed and the two radioactivities were recorded from the excised bowel specimen. The resulting activity densities along the small bowel were peaky and the overlap between the two labels in the border zone was minute, indicating that the intestinal contents were transported in isolated portions with only minor exchange of luminal contents between adjacent regions. The transport apparently proceeded steadily in a mainly aboral direction with no indications of abrupt changes in transport velocity. PMID:605736

Gustavsson, S; Jung, B; Nilsson, F



Small-bowel capsule endoscopy: A ten-point contemporary review  

PubMed Central

The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn’s disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn’s disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardizing its accuracy). Suspected Blood Indicator, QuickView and Fujinon Intelligent Chromo Endoscopy are some of the software tools that have been checked in various clinical studies to date.

Koulaouzidis, Anastasios; Rondonotti, Emanuele; Karargyris, Alexandros



Small-bowel capsule endoscopy: a ten-point contemporary review.  


The introduction of capsule endoscopy (CE) in clinical practice increased the interest for the study of the small-bowel. Consequently, in about 10 years, an impressive quantity of literature on indications, diagnostic yield (DY), safety profile and technical evolution of CE has been published as well as several reviews. At present time, there are 5 small-bowel capsule enteroscopy (SBCE) models in the worldwide market. Head-to-head trials have showed in the great majority of studies comparable results in terms of DY, image quality and completion rate. CE meta-analyses formed the basis of national/international guidelines; these guidelines place CE in a prime position for the diagnostic work-up of patients with obscure gastrointestinal bleeding, known and/or suspected Crohn's disease and possible small-bowel neoplasia. A 2-L polyethylene glycol-based purge, administered the day before the procedure, is the most widely practiced preparation regimen. Whether this regimen can be further improved (i.e., by further decreasing its volume, changing the timing of administration, coupling it with prokinetics and/or other factors) or if it can really affect the DY, is still under discussion. Faecal calprotectin has been used in SBCE studies in two settings: in patients taking non-steroidal anti-inflammatory drugs, to evaluate the type and extent of mucosal damage and, more importantly from a clinical point of view, in patients with known or suspected Crohn's disease for assessment of inflammation activity. Although there is still a lot of debate around the exact reasons of SBCE poor performance in various small-bowel segments, it is worth to remember that the capsule progress is non-steerable, hence more rapid in the proximal than in lower segments of the small-bowel. Capsule aspiration, a relatively unexpected complication, has been reported with increasing frequency. This is probably related with the increase in the mean age of patients undergoing CE. CE video review is a time-consuming procedure. Therefore, several attempts have been made to develop technical software features, in order to make CE video analysis easier and shorter (without jeopardizing its accuracy). Suspected Blood Indicator, QuickView and Fujinon Intelligent Chromo Endoscopy are some of the software tools that have been checked in various clinical studies to date. PMID:23840112

Koulaouzidis, Anastasios; Rondonotti, Emanuele; Karargyris, Alexandros



The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery  

Microsoft Academic Search

IntroductionThe purpose of this study was to evaluate the long-term complications of surgical site infection (SSI) in the colorectal population, specifically its association with incisional hernia and small bowel obstruction.

Bryce W. Murray; Daisha J. Cipher; Thai Pham; Thomas Anthony



Special diaphragm-like strictures of small bowel unrelated to non-steroidal anti-inflammatory drugs  

PubMed Central

AIM: To summarize clinical, endoscopic, radiologic and pathologic features of special diaphragm-like strictures found in small bowel, with no patient use of non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: From January 2000 to December 2009, 5 cases (2 men and 3 women, with a mean age of 41.6 years) were diagnosed as having diaphragm-like strictures of small bowel on imaging, operation and pathology. All the patients denied the use of NSAIDs. The clinical, endoscopic, radiologic and pathologic findings in these 5 patients were retrospectively reviewed from the hospital database. Images of capsule endoscopy (CE) and small bowel follow-through (SBFT) obtained in 3 and 3 patients, respectively, and images of double-balloon enteroscopy and computed tomography enterography (CTE) obtained in all 5 patients were available for review. RESULTS: All patients presented with long-term (2-16 years) symptoms of gastrointestinal bleeding and varying degrees of anemia. There was only one stricture in four cases and three lesions in one case, and all the lesions were located in the middle or distal segment of ileum. Circumferential stricture was shown in the small bowel in three cases in the CE image, but the capsule was retained in the small bowel of 2 patients. Routine abdomen computed tomography scan showed no other abnormal results except gallstones in one patient. The lesions were shown as circumferential strictures accompanied by dilated small bowel loops in the small bowel on the images of CTE (in all 5 cases), SBFT (in 2 cases) and double-balloon enteroscopy (in all cases). On microscopy, a chronic inflammatory infiltrate and circumferential diaphragm were found in all lesions. CONCLUSION: Diaphragm-like strictures of small bowel might be a special consequence of unclear damaging insults to the intestine, having similar clinical, endoscopic, radiologic and pathologic features.

Wang, Ming-Liang; Miao, Fei; Tang, Yong-Hua; Zhao, Xue-Song; Zhong, Jie; Yuan, Fei



Initial experience of wireless-capsule endoscopy for evaluating occult gastrointestinal bleeding and suspected small bowel pathology  

Microsoft Academic Search

OBJECTIVE:Small bowel pathology can be diagnosed using enteroscopy (which has limitations) and by x-ray (which is not sensitive for flat lesions). For the first time ever, we used a new technique, wireless-capsule video endoscopy, to diagnose small bowel pathology. Our aim was to prove the effectiveness and safety of this technology.METHODS:We used the Given (M2A) system in 35 patients, aged

Eitan Scapa; Harold Jacob; Shlomo Lewkowicz; Michal Migdal; Daniel Gat; Arkady Gluckhovski; Nurit Gutmann; Zvi Fireman



Preoperative Helical Tomotherapy and Megavoltage Computed Tomography for Rectal Cancer: Impact on the Irradiated Volume of Small Bowel  

Microsoft Academic Search

Purpose: Preoperative (chemo)radiotherapy is considered to be standard of care in locally advanced rectal cancer, but is associated with significant small-bowel toxicity. The aim of this study was to explore to what extent helical tomotherapy and daily megavolt (MV) CT imaging may reduce the irradiated volume of small bowel. Methods and Materials: A 3D-conformal radiotherapy (3D-CRT) plan with CTV-PTV margins

Benedikt Engels; Mark De Ridder; Koen Tournel; Alexandra Sermeus; Peter De Coninck; Dirk Verellen; Guy A. Storme



Radiation induced small bowel "web" formation is associated with acquired microvascular dysfunction  

PubMed Central

Background and aims: Radiation therapy of abdominal and pelvic solid tumours results in late intestinal toxicity of a severe nature in approximately 5% of cases. These manifestations may include ischaemia and stricture formation, which may present as “webs”. These webs are likely to play a role in the pathogenesis of recurrent bowel obstruction. The mechanisms of microvascular injury to the bowel in the setting of radiation have not been defined. We hypothesised that microvascular dysfunction with impaired vasodilation to acetylcholine (Ach) would be an acquired pathophysiological abnormality in radiation and “web” formation. Methods: A 40 year old patient treated with radiation, two years previously, for an anal squamous cell cancer presented with recurrent small bowel obstruction. “Webs” in the distal ileum were detected using wireless capsule endoscopy, after small bowel barium radiographs failed to demonstrate a lesion. Following resection, freshly isolated 50–150 ?m diameter arterioles from the “web” and adjacent normal calibre bowel were analysed with histology and microvessel physiological studies. Results: After constriction (30–50%) with endothelin, dilation to graded doses of Ach (10?9–10?4 M) was observed in vessels dissected from the stricture and the adjacent normal calibre area. Ach dilation was reduced in vessels from “web” (mean diameter 7 (2)%; n?=?3, p<0.01) compared with the adjacent unaffected bowel (mean diameter 85 (5)%). Dihydroethidine and dichlorofluorescein diacetate intravital staining demonstrated increased reactive oxygen species production in microvessels from “web” compared with adjacent normal calibre bowel. Histology from the strictured bowel demonstrated narrowing of the arterial lumen due to intimal and muscularis propria fibrosis, with endothelial preservation. Conclusions: External radiation is associated with acquired microvascular endothelial dysfunction and “web” formation in the small bowel.

Hatoum, O A; Binion, D G; Phillips, S A; O'Loughlin, C; Komorowski, R A; Gutterman, D D; Otterson, M F



Intraoperative localization of vascular malformation of small bowel by selective intra-arterial dye injection.  


Angiomatous malformation is the most common vascular abnormality, accounting for 30-40% cases of obscure GI bleeding from small bowel. Surgical resection is the treatment of choice in severe or recurrent hemorrhage requiring multiple blood transfusions. However, the diffuse nature of the lesions poses a challenge to localize them accurately preoperatively, for exact resection. We present a case in which we have used selective mesenteric angiography with selective cannulation and exact localization of the lesion by injecting dye such as methylene blue, indigo carmine, and fluorescein, to localize the angiomatous malformation before surgical resection and also to determine the exact resection to be done. PMID:20871200

Eshpuniyani, Priya B; Kantharia, Chetan V; Prabhu, Ramkrishna Y; Supe, Avinash N


Risk Factors for Early Postoperative Small-Bowel Obstruction After Colectomy in Colorectal Cancer  

Microsoft Academic Search

Background  Currently, colectomies are the most frequently performed procedure to manage colorectal cancer. However, early postoperative\\u000a small-bowel obstruction (EPSBO) is a common serious complication after colectomy. The purpose of our study was to assess the\\u000a incidence of EPSBO after colectomy for colorectal cancer, and attempt to identify associated risk factors for EPSBO.\\u000a \\u000a \\u000a \\u000a Methods  Between 2005 and 2006, 504 patients who underwent a

Jin Yong Shin; Kwan Hee Hong



Small bowel parasitosis as cause of obscure gastrointestinal bleeding diagnosed by capsule endoscopy.  


Hookworm infection is a relatively common cause of anemia in endemic areas. However, it is rarely encountered in Europe. In this report we describe the case of a 24-year old patient originating from an endemic area who was admitted due to severe anemia, with an Hct of 15.6% and eosinophilia (Eosinophils: 22.4%). While both esophagogastroduodenoscopy and colonoscopy were non-diagnostic, capsule endoscopy revealed a large number of hookworms infesting his small bowel and withdrawing blood. The patient was successfully treated with Albendazole. Capsule endoscopy was proven an important tool in diagnosing intestinal parasitosis. PMID:21173914

Christodoulou, Dimitrios K; Sigounas, Dimitrios E; Katsanos, Konstantinos H; Dimos, Georgios; Tsianos, Epameinondas V



Can we improve the diagnostic yield of small bowel video-capsule endoscopy?  

PubMed Central

Video-capsule endoscopy has revolutionized the examination of small bowel mucosa. However, this modality is relatively young and its diagnostic yield is low. Herein, we discuss different approaches to improve examination’s diagnostic yield. There are strong data supporting some of them while there is speculation about the rest. As capsule endoscopy continues to evolve there is also a strong belief that technology will overcome at least some of the obstacles that hamper capsule endoscopy’s diagnostic yield sometime in the near future.

Triantafyllou, Konstantinos



Influence of the site of small bowel resection on intestinal epithelial cell apoptosis  

Microsoft Academic Search

Massive small bowel resection (SBR) results in a significant increase in intestinal epithelial cell (EC) proliferation as\\u000a well as apoptosis. Because the site of SBR (proximal (P) vs. distal (D)) affects the degree of intestinal adaptation, we hypothesized\\u000a that different rates of EC apoptosis would also be found between P-SBR and D-SBR models. Wild-type C57BL\\/6J mice underwent:\\u000a (1) 60% P-SBR,

Emir Q. Haxhija; Hua Yang; Ariel U. Spencer; Xiaoyi Sun; Daniel H. Teitelbaum



Upper oesophageal images and Z-line detection with 2 different small-bowel capsule systems.  


Transmission of oesophageal images may vary between different small-bowel capsule endoscopy models. A retrospective review of 100 examinations performed with 2 different Small-bowel capsule endoscopy (SBCE) systems (PillCam(®) and MiroCam(®)) was performed. The oral cavity/aero-digestive tract (i.e., tongue, uvula and/or epiglottis) was captured/identified in almost all (99%) of PillCam(®) videos but in none of MiroCam(®) cases, P < 0.0001. Furthermore, oesophageal images (i.e., from the upper oesophageal sphincter to the Z-line were captured in 99% of PillCam(®) videos (mean ± SD, 60.5 ± 334.1 frames, range: 0-3329 frames) and in 66% of MiroCam(®) cases (mean ± SD, 11.1 ± 46.5 frames, range: 0-382 frames), P < 0.0001. The Z-line was identified in 42% of PillCam(®) videos and 17% of MiroCam(®), P = 0.0002. This information might be useful when performing SBCE in patients with high risks for aspiration. PMID:23139622

Koulaouzidis, Anastasios



Small bowel perforation due to CMV enteritis infection in an HIV-positive patient  

PubMed Central

Background Cytomegalovirus infection of the gastrointestinal tract is common and is more often seen in patients with acquired immunodeficiency syndrome (AIDS). Although small bowel infection is less common than infection of other parts of the gastrointestinal system, it may lead to perforation, an acute complication, with dreadful results. Case presentation This article reports a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum. The patient had poor prognosis and deceased despite the prompt surgical intervention and the antiviral therapy he received. At pathology a remarkable finding was the presence of viral inclusions in smooth muscle fibers. The destruction of muscle cells was the main cause of perforation. Conclusion Morbidity and mortality associated with perforation from CMV enteritis in AIDS patients are high and the life expectancy is short. Cytomegalovirus disease is multifocal; therefore, excision of one portion of the gastrointestinal tract may be followed by a complication elsewhere. Our case elucidate that muscle cell destruction by the virus is a significant cause leading to perforation.



Evaluation of small bowel blood flow in healthy subjects receiving low-dose aspirin  

PubMed Central

AIM: To investigate the relationship between low-dose aspirin-induced small bowel mucosal damage and blood flow, and the effect of rebamipide. METHODS: Ten healthy volunteers were enrolled in this study. The subjects were divided into two groups: a placebo group given low-dose aspirin plus placebo and a rebamipide group given low-dose aspirin plus rebamipide for a period of 14 d. Capsule endoscopy and contrast-enhanced ultrasonography were performed before and after administration of drugs. Areas under the curves and peak value of time-intensity curve were calculated. RESULTS: Absolute differences in areas under the curves were -1102.5 (95% CI: -1980.3 to -224.7, P = 0.0194) in the placebo group and -152.7 (95% CI: -1604.2 to 641.6, P = 0.8172) in the rebamipide group. Peak values of time intensity curves were -148.0 (95% CI: -269.4 to -26.2, P = 0.0225) in the placebo group and 28.3 (95% CI: -269.0 to 325.6, P = 0.8343) in the rebamipide group. Capsule endoscopy showed mucosal breaks only in the placebo group. CONCLUSION: Short-term administration of low-dose aspirin is associated with small bowel injuries and blood flow.

Nishida, Urara; Kato, Mototsugu; Nishida, Mutsumi; Kamada, Go; Yoshida, Takeshi; Ono, Shouko; Shimizu, Yuichi; Asaka, Masahiro



Small Bowel Bezoar in a Patient With Noonan Syndrome: Report of a Case  

PubMed Central

Abstract and Introduction Abstract Background and Aims Bezoars occur most commonly in patients with impaired gastrointestinal motility or a history of gastric surgery. Noonan syndrome is associated with gastrointestinal dysfunction and feeding difficulties in children. We report the case of a 64-year-old man with Noonan syndrome who was admitted to the hospital with a small bowel obstruction. An emergency laparotomy was performed and the patient was found to have a phytobezoar of the ileum that had caused edema of the intestinal wall resulting in the obstruction. Methods/Results A review of the literature was performed with PubMed using the keywords “Noonan syndrome,” “bezoars,” and “phytobezoar.” Although problems with gastrointestinal motility in Noonan syndrome appear to improve with age, it is conceivable that in this case, abnormal gastrointestinal motility may have predisposed the patient to this condition. Conclusion Bezoars are an uncommon but notable cause of small bowel obstruction. This is the first case of a bezoar in a patient with Noonan syndrome reported in the English literature.

Bitton, Asaf; Keagle, Jennifer N.; Varma, Madhulika G.



Small bowel obstruction caused by an incarcerated hernia after iliac crest bone harvest.  


The iliac crest has become an often used site for autogenous bone graft, because of the easy access it affords. One of the less common complications that can occur after removal is a graft-site hernia. It was first reported in 1945 (see the work by Oldfield, 1945). We report a case of iliac crest bone hernia in a 53-year-old male who was admitted for elective resection of a pseudarthrosis and reconstruction of the left femur with iliac crest bone from the right side. One and a half months after initial surgery, the patient presented with increasing abdominal pain and signs of bowel obstruction. A CT scan of the abdominal cavity showed an obstruction of the small bowel caused by the bone defect of the right iliac crest. A laparoscopy showed a herniation of the small bowel. Due to collateral vessels of the peritoneum caused by portal hypertension, an IPOM (intraperitoneal onlay-mesh) occlusion could not be performed. We performed a conventional ventral hernia repair with an onlay mesh. The recovery was uneventful. PMID:22084778

d'Hondt, Steven; Soysal, Savas; Kirchhoff, Philipp; Oertli, Daniel; Heizmann, Oleg



Small Bowel Obstruction Caused by an Incarcerated Hernia after Iliac Crest Bone Harvest  

PubMed Central

The iliac crest has become an often used site for autogenous bone graft, because of the easy access it affords. One of the less common complications that can occur after removal is a graft-site hernia. It was first reported in 1945 (see the work by Oldfield, 1945). We report a case of iliac crest bone hernia in a 53-year-old male who was admitted for elective resection of a pseudarthrosis and reconstruction of the left femur with iliac crest bone from the right side. One and a half months after initial surgery, the patient presented with increasing abdominal pain and signs of bowel obstruction. A CT scan of the abdominal cavity showed an obstruction of the small bowel caused by the bone defect of the right iliac crest. A laparoscopy showed a herniation of the small bowel. Due to collateral vessels of the peritoneum caused by portal hypertension, an IPOM (intraperitoneal onlay-mesh) occlusion could not be performed. We performed a conventional ventral hernia repair with an onlay mesh. The recovery was uneventful.

d'Hondt, Steven; Soysal, Savas; Kirchhoff, Philipp; Oertli, Daniel; Heizmann, Oleg



Detection of gastric MALT lymphoma spreading to the small bowel by enteroscopy.  


Mucosa-associated lymphoid tissue (MALT) lymphoma is thought to be a multifocal disease with sometimes synchronous involvement of various mucosal structures. In this study we aimed to evaluate the potential involvement of the small bowel in patients suffering from gastric MALT lymphoma by analyzing the results of enteroscopy, a technique that allows easy and safe access to the small bowel with the potential for histological assessment of biopsy samples. We have retrospectively evaluated 347 enteroscopies and found nine patients with gastric MALT lymphoma who had undergone push enteroscopy with serial biopsies during staging. All patients tolerated enteroscopy without side effects, and no local complications occurred. In eight cases no evidence of duodenal or jejunal involvement was found macroscopically or by histological assessment of biopsies, while in one patient enteroscopy revealed jejunal MALT lymphoma infiltration with macroscopic accentuation of mucosal parts and consecutive histopathological verification more distal than 50 cm. This single-center retrospective analysis shows that enteroscopy can provide additional diagnostic information in patients with gastric MALT lymphoma, although the number of patients was small and only one out of nine patients showed hitherto undetected MALT lymphoma deposits. Further studies may quantify the additional diagnostic yield provided by this easy and safe endoscopic method. PMID:21656457

Dolak, W; Raderer, M; Maresch, J; Muellauer, L; Puespoek, A; Chott, A; Haefner, M



Small-bowel bacterial overgrowth and systemic immunosuppression in experimental peritonitis.  


The effect of intraperitoneal infection on small-bowel flora and on systemic immunity was studied in a rat model, with use of the delayed-type hypersensitivity (DTH) response to keyhole limpet hemocyanin (KLH) as a measure of global immunologic integrity. Twenty-four hours after the induction of peritonitis by cecal ligation and puncture, concentrations of Escherichia coli in the proximal gastrointestinal tract increased from fewer than 10(3) colony-forming units (CFU)/ml to more than 10(9) CFU/ml, and the DTH response decreased from 10.0 +/- 0.2 to 2.1 +/- 0.4 mm. To assess the contribution of this altered luminal flora to the observed suppression of DTH scores, cecal ligation without puncture was performed in a group of animals whose endogenous flora had been suppressed by administration of oral neomycin. Oral administration of live antibiotic-resistant E. coli to the study animals resulted in significant DTH depression compared with controls given saline solution (2.7 +/- 0.4 vs 4.4 +/- 0.4 mm, p less than 0.005), even though the gastrointestinal tract was anatomically intact. Similar depression was seen if the challenge was limited to the small bowel as a result of the prior performance of an ileostomy and occurred in the absence of significant systemic or portal levels of viable bacteria. The results suggest that gut endotoxin plays a role in the immunosuppression associated with peritonitis. PMID:3041643

Marshall, J C; Christou, N V; Meakins, J L



The diagnostic value of double-balloon enteroscopy in children with small bowel disease: Report of 31 cases  

PubMed Central

BACKGROUND AND OBJECTIVE: Before the introduction of double-balloon enteroscopy (DBE), it was impossible to visualize the entire small bowel. Its diagnostic yield has been assessed in adults, but not yet in children. The present retrospective study evaluated the diagnostic usefulness and safety of DBE in children with suspected small bowel disease. METHODS: Between June 2003 and June 2007, 31 patients (19 boys and 12 girls, age range three to 14 years) with suspected small bowel disease underwent DBE after receiving negative evaluations using other diagnostic modalities. RESULTS: There were no severe complications. In two patients, the entire small bowel was viewed using oral and anal approaches, and for the remaining 29 patients, only one approach was used. The sites of disease in were identified in 25 of 31 cases (80.65%). The bleeding source was found in 21 of 27 patients with obscure gastrointestinal bleeding (diagnostic rate of 77.78%). Different diseases were identified in four children with chronic diarrhea. CONCLUSION: DBE is a safe and effective method to diagnose patients with suspected small bowel disorders.

Liu, Wei; Xu, Chundi; Zhong, Jie



MRI of the small bowel: can sufficient bowel distension be achieved with small volumes of oral contrast?  


Sufficient luminal distension is mandatory for small bowel imaging. However, patients often are unable to ingest volumes of currently applied oral contrast compounds. The aim of this study was to evaluate if administration of low doses of an oral contrast agent with high-osmolarity leads to sufficient and diagnostic bowel distension. Six healthy volunteers ingested at different occasions 150, 300 and 450 ml of a commercially available oral contrast agent (Banana Smoothie Readi-Cat, E-Z-EM; 194 mOsmol/l). Two-dimensional TrueFISP data sets were acquired in 5-min intervals up to 45 min after contrast ingestion. Small bowel distension was quantified using a visual five-grade ranking (5 = very good distension, 1 = collapsed bowel). Results were statistically compared using a Wilcoxon-Rank test. Ingestion of 450 ml and 300 ml resulted in a significantly better distension than 150 ml. The all-over average distension value for 450 ml amounted to 3.4 (300 ml: 3.0, 150 ml: 2.3) and diagnostic bowel distension could be found throughout the small intestine. Even 45 min after ingestion of 450 ml the jejunum and ileum could be reliably analyzed. Small bowel imaging with low doses of contrast leads to diagnostic distension values in healthy subjects when a high-osmolarity substance is applied. These findings may help to further refine small bowel MRI techniques, but need to be confirmed in patients with small bowel disorders. PMID:18500525

Kinner, Sonja; Kuehle, Christiane A; Herbig, Sebastian; Haag, Sebastian; Ladd, Susanne C; Barkhausen, Joerg; Lauenstein, Thomas C



Local lactate and histamine changes in small bowel circulation measured by microdialysis in pig hemorrhagic shock.  


Hemorrhagic shock results in inadequate tissue oxygenation. Plasma lactate (L) can characterize the degree of systemic oxygen debt (OD), but gives no information on local changes. The aim of this study was to characterize different degrees of hemorrhagic shock by microdialysis measurement of L and histamine (H) in small bowel circulation. Thirty-eight pigs were randomized to five groups of increasing OD (< 50 --> 120 ml/kg). The OD was accrued by hemorrhage over 60 min and was followed by retransfusion and observation for 3 days. In parallel to plasma probes, subserosa(ss)-, submucosa(sm)-, and intraluminal(il)-L- and H-probes were obtained by small bowel microdialysis every 30 min for 210 min. Ss- and sm-L increased during hemorrhage from 1.2 +/- 0.06 and 1.18 +/- 0.06 to 2.57 +/- 0.15 and 2.96 +/- 0.27 mmol/L. Highest mean L > 3.5mmol/L resulted 90 and 120 min after induction of hemorrhage. Although ss- and sm- levels hardly differed, il-L was significantly decreased with 0.27 +/- 0.02 mmol/L at 0 min and highest mean il-L at 120 min: 2.45 +/- 0.51 mmol/L. Sm-L was significantly increased after 60, 90, 120, and 150 min of highest hemorrhage severity (OD > 100 mL/kg). In parallel, systemic L increased significantly during hemorrhage and correlated well with the severity of shock. Although systemic H increased significantly during hemorrhage (from 1.3 +/- 0.31 to 15.2 +/- 0.67 ng/mL), H-dialysates showed no effect either over time nor with the degree of hemorrhage. In conclusion, microdialysis allows evaluation of local L changes in small bowel circulation in pig hemorrhagic shock. Sm-L levels appear to correlate with the degree of shock. Local H changes were not observed during hemorrhagic shock in this study. PMID:12392280

Rixen, Dieter; Raum, Marcus; Holzgraefe, Bernhard; Schäfer, Ute; Hess, Simone; Tenhunen, Jyrki; Tuomisto, Leena; Neugebauer, Edmund A M



Readmission for small-bowel obstruction in the early postoperative period: etiology and outcome  

PubMed Central

Objectives To determine the frequency of readmission for early postoperative small-bowel obstruction (SBO), to highlight factors that may predispose to this condition, to define the risks of strangulation and to compare the immediate and long-term risks and benefits of operative versus nonoperative treatment. Design A chart review. Setting The Sir Mortimer B. Davis-Jewish General Hospital, a university-affiliated teaching hospital in Montreal. Patients Out of a total of 1001 cases of SBO in 552 patients, 30 patients were readmitted within 50 days of a previous laparotomy with the diagnosis of SBO. Intervention Selective nonoperative management and exploratory laparotomy. Main outcome measures The value of nonoperative management and need for operation. Results Adhesions were the cause of the obstruction in most cases (24); other causes were Crohn’s disease (2), hernia (1), malignant neoplasm (1) and a combination of adhesions and malignant disease (2). Thirteen (43%) of the procedures preceding the obstruction were primary small-bowel operations. There was only 1 episode of strangulated bowel. Of the patients readmitted for SBO, 7 (23%) were treated operatively with a long-term recurrence rate of 57% compared with 63% for those treated nonoperatively for the SBO. The median time to recurrence was 0.1 years (range from 0.02–6 yr) for those whose SBO was managed operatively, compared with 0.7 years (range from 0.08–5 yr) for those managed nonoperatively for the SBO. The median length of stay for patients managed operatively for SBO was 12 days (range from 9–17 d) compared with 6 days (range from 2–33 d) for those managed nonoperatively. Conclusions Readmission for SBO within 50 days of a previous laparotomy represents a small percentage of all cases of SBO. They frequently follow small-bowel operations. Cases of strangulation are no more common than in general cases of SBO. Patients treated nonoperatively for SBO did not experience less favourable outcomes with respect to resolution of symptoms, length of stay, risk of recurrence and reoperation. Thus, operative intervention is not necessary in an otherwise stable patient.

Miller, George; Boman, Jason; Shrier, Ian; Gordon, Philip H.



Collision tumor of the colon – colonic adenocarcinoma and ovarian granulosa cell tumor  

Microsoft Academic Search

BACKGROUND: Collision tumors of the colon are rare. We report the first case, to our knowledge in the English literature, of a collision tumor composed of a colonic adenocarcinoma arising in a sigmoid diverticulum coexisting with a recurrent ovarian granulosa cell tumor. CASE PRESENTATION: A 64-year old woman presented with small bowel obstruction and a large, heterogenous, solid\\/cystic serosal based

Mayur Brahmania; Chandra S Kanthan; Rani Kanthan



A Patient with Four-Year Survival after Nonsmall Cell Lung Carcinoma with a Solitary Metachronous Small Bowel Metastasis  

PubMed Central

Solitary small bowel metastasis secondary to lung cancer is very uncommon. In this report, we present a patient with NSCLC and a metachronous solitary metastasis of the jejunum. She is alive without evidence of disease and doing well four years after palliative surgery, radiotherapy, and chemotherapy. To the best of our knowledge, this is the first case report describing a prolonged survival in a patient with a symptomatic solitary small bowel metastasis treated with palliative surgery, chemo- and radiotherapy instead of complete surgical resection.

Kant, Klaas M.; Noordhoek Hegt, Vincent; Aerts, Joachim G. J. V.



Metastatic Deposits of Breast Lobular Carcinoma to Small Bowel and Rectum  

PubMed Central

Breast cancer is the most frequent malignancy in women accounting for approximately 32% of all cancers, with a lifetime risk of 1 in 10. It causes considerable morbidity and mortality. Recently, the survival rate has dramatically increased due to early detection of the disease and improvement in the treatment measures. However, more than 30% of the patients develop metastatic diseases following surgical treatment, radiotherapy, hormonal therapy, or chemotherapy. Distant spread is usually found in bones, lungs, liver, brain and skin. Rarely, it spreads to bowel, spleen, gallbladder, pancreas, urinary bladder, and eyes. Breast cancer is the second commonest primary tumour responsible for gastrointestinal metastases after malignant melanoma. We report a case of a Caucasian female who developed an intestinal obstruction secondary to metastatic deposits to the small bowel and later to the rectum from breast lobular carcinoma 2 years after mastectomy, axillary clearance, radiotherapy, hormonal therapy, and transverse rectus abdominis myocutaneous (TRAM) flap for reconstruction.

Eljabu, W.; Finch, G.; Nottingham, J.; Vaingankar, N.



Case report of small bowel obstruction caused by small intestinal metastasis of bilateral breast cancer  

PubMed Central

A 41-year-old female was admitted into hospital due to recurrent abdominal pain with bloating. An enteroscopy was carried out and stenosis in the lower jejunal lumen was identified. This led to a diagnosis of small bowel obstruction caused by inflammation. During the laparotomy, the resection and anastomosis of a narrow segment of small intestine was performed. In combination with the results of immunohistochemical analysis, the postoperative pathology indicated the presence of a poorly differentiated/undifferentiated carcinoma of the small intestine, which was considered to have arisen from breast cancer. Postoperative examination showed bilateral breast masses, and the pathology of the right breast tumor biopsy prompted the diagnosis of invasive lobular carcinoma. A breast MRI was reviewed following five cycles of XT chemotherapy and the evaluation was stable disease (SD). Since the mass was not sensitive to chemotherapy, a bilateral modified radical mastectomy was performed, and postoperative pathology confirmed the mass to be primary bilateral invasive lobular carcinoma.




Proximal small bowel obstruction caused by a massive intraluminal thrombus from a stress ulcer  

PubMed Central

We describe a case of proximal small bowel obstruction caused by an occlusive thrombus as a result of bleeding from a duodenal ulcer, which is likely to be stress induced. Initial presentation was confused as a bleeding duodenal ulcer and resultant ileus. Such reports are incredibly rare in the literature and never has one been reported as a result of a stress ulcer. Obstructive symptoms in the acute postoperative patient may be confused for an ileus but mechanical causes must be excluded. The presence of upper gastrointestinal bleeding must not detract from that possibility. Future identification of an occlusive clot on endoscopy that is impossible to circumnavigate may benefit from intraluminal injection of thrombolytic agents to prevent obstruction but this must be weighed with the risk of exacerbating any bleeding. Clearly a risk versus benefit analysis will be necessary on an individual basis.

Siddiky, AH; Gupta, P



Detection of small bowel slow-wave frequencies from noninvasive biomagnetic measurements.  


We report a novel method for identifying the small intestine electrical activity slow-wave frequencies (SWFs) from noninvasive biomagnetic measurements. Superconducting quantum interference device magnetometer measurements are preprocessed to remove baseline drift and high-frequency noise. Subsequently, the underlying source signals are separated using the well-known second-order blind identification (SOBI) algorithm. A simple classification scheme identifies and assigns some of the SOBI components to a section of small bowel. SWFs were clearly identified in 10 out of 12 test subjects to within 0.09-0.25 cycles per minute. The method is sensitive at the 40.3 %-55.9 % level, while false positive rates were 0 %-8.6 %. This technique could potentially be used to help diagnose gastrointestinal ailments and obviate some exploratory surgeries. PMID:19497806

Erickson, Jonathan C; Obioha, Chibuike; Goodale, Adam; Bradshaw, L Alan; Richards, William O



Capsule endoscopy in suspected small bowel Crohn's disease: Economic impact of disease diagnosis and treatment  

PubMed Central

AIM: To model clinical and economic benefits of capsule endoscopy (CE) compared to ileo-colonoscopy and small bowel follow-through (SBFT) for evaluation of suspected Crohn’s disease (CD). METHODS: Using decision analytic modeling, total and yearly costs of diagnostic work-up for suspected CD were calculated, including procedure-related adverse events, hospitalizations, office visits, and medications. The model compared CE to SBFT following ileo-colonoscopy and secondarily compared CE to SBFT for initial evaluation. RESULTS: Aggregate charges for newly diagnosed, medically managed patients are approximately $8295. Patients requiring aggressive medical management costs are $29?508; requiring hospitalization, $49?074. At sensitivity > 98.7% and specificity of > 86.4%, CE is less costly than SBFT. CONCLUSION: Costs of CE for diagnostic evaluation of suspected CD is comparable to SBFT and may be used immediately following ileo-colonoscopy.

Leighton, Jonathan A; Gralnek, Ian M; Richner, Randel E; Lacey, Michael J; Papatheofanis, Frank J



Seatbelt Injury Causing Small Bowel Devascularisation: Case Series and Review of the Literature  

PubMed Central

The use of seatbelts has increased significantly in the last twenty years, leading to a decrease in mortality from road traffic accidents (RTA). However, this increase in seatbelt use has also led to a change in the spectrum of injuries from RTA; abdominal injuries, particularly intestinal injuries have dramatically increased with the routine use of seatbelts. Such intestinal injuries frequently result from improper placement of the “lap belt”. We present 3 cases in which passengers wearing a seatbelt sustained significant devascularisation injuries to the small bowel requiring emergency surgical intervention. A high index of suspicion is crucial in such cases to prevent delays in diagnosis that can lead to severe complications and adverse outcomes. It is evident that while advocating seatbelt use, the importance of education in correct seatbelt placement should also be a focus of public health strategies to reduce RTA morbidity and mortality.

O'Dowd, Vincent; Kiernan, Christine; Lowery, Aoife; Khan, Waqar; Barry, Kevin



Detection of Small Bowel Slow Wave Frequencies from Noninvasive Biomagnetic Measurements  

PubMed Central

We report a novel method for identifying the small intestine electrical activity slow wave frequencies from noninvasive biomagnetic measurements. Superconducting QUantum Interference Device (SQUID) magnetometer measurements are pre-processed to remove baseline drift and high frequency noise. Subsequently, the underlying source signals are separated using the well-known SOBI algorithm. A simple classification scheme identifies and assigns some of the SOBI components to a section of small bowel. Slow wave frequencies were clearly identified in 10 out of 12 test subjects to within 0.09–0.25 cycles per minute. The method is sensitive at the 40.3–55.9% level, while false positive rates were 0–8.6%. This technique could potentially be used to help diagnose gastrointestinal ailments and obviate some exploratory surgeries.

Erickson, Jonathan C.; Obioha, Chibuike; Goodale, Adam; Bradshaw, L. Alan; Richards, William O.



Large bowel and small bowel obstruction due to gallstones in the same patient  

PubMed Central

This is the case report of an 85-year-old woman who on two consecutive occasions presented with acute abdominal pain. The first presentation was large bowel obstruction. CT abdomen revealed this was due to a cholecystocolic fistula, allowing a large gallstone to pass and obstruct in the sigmoid colon. The second presentation was after laparotomy; the second CT abdomen revealed another gallstone causing small bowel obstruction. This case is interesting because cholelithiasis rarely leads to sigmoid colon obstruction (gallstone coleus)1 and gallstone ileus. Unfortunately, this patient had both. A gallstone causing obstruction in either the small or large bowel is rare, but occurrence of both in the same patient has not been reported to date. This case also shows how the elderly unwell surgical patient was mismanaged and she could have been spared surgery and irradiation if she was managed appropriately from the start.

Ranga, Natasha



Comparison of Urografin versus standard therapy in postoperative small bowel obstruction.  


Water-soluble contrast media (Urografin) cause redistribution of intravascular and extracellular fluid into intestinal lumen due to their hyperosmolarity. As a consequence, these media decrease intestinal wall edema and act as a direct stimulant to intestinal peristalsis. In this prospective study, we aimed to examine objectively the therapeutic role and ability of Urografin in patients with postoperative small bowel obstruction for whom failed to respond to conservative treatment. Three hundred and seventeen patients with postoperative small bowel obstruction due to intraperitoneal adhesions were included prospectively in this study. In the Urografin group, 40 mL Urografin diluted in 40 mL distilled water was administered through the nasogastric tube. No contrast media were administered in the control group, but the patients were decompressed via a nasogastric tube continuously. The number of obstruction episode in 317 patients was 338. In total, 199 patients were in the Urografin group, and 118 patients were in the control group. In the Urografin group, 178 (89.4%) patients responded successfully to the treatment, but 21 (11.6%) patients underwent surgical operation. Intensive intraabdominal adhesions and obstructing fibrous bands were observed and repaired in 15 (71.4%) patients at the operation, while 6 patients underwent segmental small intestine resection in control group, conventional management was successful in only 89 (75.4%) patients, and the remaining 29 (24.6%) patients underwent surgical intervention. In conclusion, it was suggested that in patients with intestinal obstruction due to postoperative intra-abdominal adhesion, water-soluble contrast media such as Urografin may be safely administered via a nasogastric tube or oral route and may decrease the need for surgical operation; furthermore, they may help the physician to operate the patients who needs surgery as early as possible. PMID:16319052

Yagci, Gokhan; Kaymakcioglu, Nihat; Can, Mehmet Fatih; Peker, Yusuf; Cetiner, Sadettin; Tufan, Turgut


Ghrelin and glucagon-like peptide-2 increase immediately following massive small bowel resection.  


Children with short bowel syndrome face life-threatening complications. Therefore, there is an urgent need for a new therapy to induce effective adaptation of the remnant intestine. Adaptation occurs only during feeding. We focused on preprandial acyl ghrelin and des-acyl ghrelin, and postprandial glucagon-like peptide-2 (GLP-2), which are known to have active orexigenic and trophic actions. This study aims to clarify the secretion trends of these hormones after massive small bowel resection and to obtain basic data for developing a new treatment. Sixty-three growing male rats were used: 3 were designated as controls receiving no operation and 60 were randomized into the 80% small bowel resection (80% SBR) group and the transection and re-anastomosis group. Changes in body weight, food intake, and remnant intestine morphology were also assessed for 15 days after the operation. Acyl ghrelin and des-acyl ghrelin levels increased immediately, equivalently in both operation groups (P=0.09 and 0.70). Interestingly, in 80% SBR animals, des-acyl ghrelin peaked on day 1 and acyl ghrelin peaked on day 4 (P=0.0007 and P=0.049 vs controls). GLP-2 secretion was obvious in 80% SBR animals (P=2.25×10(-6)), which increased immediately and peaked on day 4 (P=0.009 vs. controls). Body weight and food intake in 80% SBR animals recovered to preoperative levels on day 4. Morphological adaptations were evident after day 4. Our results may suggest a management strategy to reinforce these physiological hormone secretion patterns in developing a new therapy for short bowel syndrome. PMID:23517879

Muto, Mitsuru; Kaji, Tatsuru; Mukai, Motoi; Nakame, Kazuhiko; Yoshioka, Takako; Tanimoto, Akihide; Matsufuji, Hiroshi



Towards a less costly but accurate test of gastric emptying and small bowel transit  

SciTech Connect

Our aim is to develop a less costly but accurate test of stomach emptying and small bowel transit by utilizing selected scintigraphic observations 1-6 hr after ingestion of a radiolabeled solid meal. These selected data were compared with more detailed analyses that require multiple scans and labor-intensive technical support. A logistic discriminant analysis was used to estimate the sensitivity and specificity of selected summaries of scintigraphic transit measurements. We studied 14 patients with motility disorders (eight neuropathic and six myopathic, confirmed by standard gastrointestinal manometry) and 37 healthy subjects. The patient group had abnormal gastric emptying (GE) and small bowel transit time (SBTT). The proportion of radiolabel retained in the stomach from 2 to 4 hr (GE 2 hr, GE 3 hr, GE 4 hr), as well as the proportion filling the colon at 4 and 6 hr (CF 4 hr, CF 6 hr) were individually able to differentiate health from disease (P less than 0.05 for each). From the logistic discriminant model, an estimated sensitivity of 93% resulted in similar specificities for detailed and selected transit parameters for gastric emptying (range: 62-70%). Similarly, combining selected observations, such as GE 4 hr with CF 6 hr, had a specificity of 76%, which was similar to the specificity of combinations of more detailed analyses. Based on the present studies and future confirmation in a larger number of patients, including those with less severe motility disorders, the 2-, 4-, and 6-hr scans with quantitation of proportions of counts in stomach and colon should provide a useful, relatively inexpensive strategy to identify and monitor motility disorders in clinical and epidemiologic studies.

Camilleri, M.; Zinsmeister, A.R.; Greydanus, M.P.; Brown, M.L.; Proano, M. (Mayo Clinic and Foundation, Rochester, MN (USA))



Metachronic malignant transformation of small bowel and rectal endometriosis in the same patient  

Microsoft Academic Search

BACKGROUND: Malignant transformation of intestinal endometriosis is a rare event with an unknown rate of incidence. Metachronous progression of endometriosis to adenocarcinoma from two distant intestinal foci happening in the same patient has not been previously reported. CASE PRESENTATION: We describe a case of metachronic transformation of ileal and rectal endometriosis into an adenocarcinoma occurring in a 45-year-old female without

Joaquin Marchena-Gomez; Alicia Conde-Martel; Marion Hemmersbach-Miller; Ana Alonso-Fernandez



Can Tissue Transglutaminase Antibody Titers Replace Small-Bowel Biopsy to Diagnose Celiac Disease in Select Pediatric Populations?  

Microsoft Academic Search

Objectives. The use of screening tests for celiac disease has increased the number of patients referred for evaluation. We proposed that the subgroup of patients with very high tissue transglutaminase anti- body (TTG) titers is positive for celiac disease and a small-bowel biopsy is not necessary to make the diagno- sis. A gluten-free diet should be attempted and, if the

Collin C. Barker; Craig Mitton; Gareth Jevon; Thomas Mock



CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases.  


Computed tomographic (CT) enterography combines the improved spatial and temporal resolution of multi-detector row CT with large volumes of ingested neutral enteric contrast material to permit visualization of the small bowel wall and lumen. Adequate luminal distention can usually be achieved with oral hyperhydration, thereby obviating nasoenteric intubation and making CT enterography a useful, well-tolerated study for the evaluation of diseases affecting the mucosa and bowel wall. Unlike routine CT, which has been used to detect the extraenteric complications of Crohn disease such as fistula and abscess, CT enterography clearly depicts the small bowel inflammation associated with Crohn disease by displaying mural hyperenhancement, stratification, and thickening; engorged vasa recta; and perienteric inflammatory changes. As a result, CT enterography is becoming the first-line modality for the evaluation of suspected inflammatory bowel disease. CT enterography has also become an important alternative to traditional fluoroscopy in the assessment of other small bowel disorders such as celiac sprue and small bowel neoplasms. PMID:16702444

Paulsen, Scott R; Huprich, James E; Fletcher, Joel G; Booya, Fargol; Young, Brett M; Fidler, Jeff L; Johnson, C Daniel; Barlow, John M; Earnest, Franklin


Gradient-enhanced volume rendering: an image processing strategy to facilitate whole small bowel imaging with MRI.  


MRI of the small bowel with positive contrast from orally administered contrast agent is a promising non-invasive imaging method. The aim of our study was to introduce small bowel MRI in a display format that clinicians are accustomed to and that maximizes the amount of information visualized on a single image. Twelve healthy volunteers, median age 32 years (range 18-49 years) participated in the study. A mixture of 20 ml Gd-DOTA (Dotarem), 0.8 g/kg body weight psyllium fibre (Metamucil) and 1.2 l water were sequentially administered over a period of 4 h. Imaging was performed on a 1.5 T unit (Philips Gyroscan, Intera). Fat-saturated, 3D, gradient echo imaging was performed while the patient was in apnea (30 s). Bowel motion was reduced with 40 mg intravenously administered scopolamine (Buscopan). A 3D, gradient-enhanced, volume rendering technique was applied to the 3D data sets. Standard projections [left anterior oblique (LAO), right anterior oblique (RAO), supine and prone] resembling conventional enteroclysis were successfully generated within fewer than 10 min processing time. Reconstructions were reproducible and provided an entire overview of the small bowel. In addition thin-slab volume rendering allowed an overlap-free display of individual structures. Positive contrast from orally administered contrast agent, combined with a gradient enhanced volume rendering method, allows the reconstruction of the small bowel in a pattern resembling conventional double-contrast enteroclysis. Segmental display without overlay is possible. PMID:17021699

Wyss, Michael; Froehlich, Johannes M; Patak, Michael A; Juli, Christoph F; Scheidegger, Markus B; Zollikofer, Christoph L; Wentz, Klaus U



Experimental small bowel preservation using Polysol: A new alternative to University of Wisconsin solution, Celsior and histidine-tryptophan-ketoglutarate solution?  

Microsoft Academic Search

AIM: To evaluate the potential of Polysol, a newly developed preservation solution, in cold storage of small bowel grafts, compared with the current standards, University of Wisconsin solution (UW), Celsior and histidine-tryptophan-ketoglutarate solution (HTK). METHODS: Male Wistar rats were used as donors. Small bowels were retrieved, flushed and then stored in the respective 4 solutions for 18 h at 4?.

Lai Wei; Koichiro Hata; Benedict Marie Doorschodt; Reinhard Büttner; Thomas Minor; René H Tolba


Role of Magnetic Resonance Enterography in Differentiating between Fibrotic and Active Inflammatory Small Bowel Stenosis in Patients with Crohn's Disease  

PubMed Central

Objective: To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in prospectively differentiating between fibrotic and active inflammatory small bowel stenosis in patients with Crohn's disease (CD). Materials and Methods: A total of 111 patients with histologically proven CD presenting with clinical and plain radiographic signs of small bowel obstruction underwent coronal and axial MRI scans after oral administration of polyethylene glycol solution. A stenosis was judged present if a small bowel segment had >80% lumen reduction as compared to an adjacent normal loop and mural thickening of >3 mm. At the level of the stenosis, both T2 signal intensity and post-gadolinium T1 enhancement were quantified using a 5-point scale (0: very low; 1: low; 2: moderate; 3: high; and 4: very high). A stenosis was considered fibrotic if the sum of the two values (activity score: AS) did not exceed 1. Results: A small bowel stenosis was identified in 48 out of 111 patients. Fibrosis was confirmed at histology in all of the 23 patients with AS of 0 or 1, who underwent surgery within 3 days of the MRI examination. In the remaining 25 patients (AS: 2–8), an active inflammatory stenosis was suspected and remission of the obstructive symptoms was obtained by means of medical treatment. One of these patients (AS: 2), however, underwent surgery after 14 days, due to recurrence. MRI had 95.8% sensitivity, 100% specificity, and 97.9% accuracy in the diagnosis of fibrotic stenosis. Conclusion: MRI is reliable in differentiating fibrotic from inflammatory small bowel stenosis in CD.

Fornasa, Francesca; Benassuti, Chiara; Benazzato, Luca



Intestinal epithelial cell proliferation is dependent on the site of massive small bowel resection.  


Early intestinal adaptation after massive small bowel resection (SBR) is driven by increased epithelial cell (EC) proliferation. There is a clear clinical difference in the post-operative course of patients after the loss of proximal (P) compared to distal (D) small bowel. This study examined the effects of the site of SBR on post-resectional intestinal adaptation, and investigated the potential mechanisms involved. C57BL/6J mice (n = 7/group) underwent: (1) 60% P-SBR, (2) 60% D-SBR, (3) 60% mid (M)-SBR and (4) SHAM-operation (transection/reanastomosis). Mice were sacrificed at 7 days after surgery and ECs and adjacent mucosal lymphocytes (IELs) isolated. Adaptation was assessed in both jejunum and ileum by quantification of villus height, crypt depth, villus cell size, crypt cell size (microns), goblet cell number, and EC proliferation (%BrdU incorporation). Proliferation signalling pathways including keratinocyte growth factor (KGF)/KGFR(1), IL-7/IL-7R, and epidermal growth factor receptor (EGFR) were measured by RT-PCR. Expression of IL-7 was further analysed by immunofluorescence. Data were analyzed using ANOVA. All three SBR models led to significant increases in villus height, crypt depth, goblet cell numbers and EC proliferation rate when compared to respective SHAM groups. The strongest morphometric changes were found for jejunal segments after M-SBR and for ileal segments after P-SBR. Furthermore, morphometric analysis showed that at 1-week post-resection a tremendous increase in EC numbers occurred in jejunal villi (cell hyperplasia), whereas a significant increase in EC size predominated in ileal villi (cell hypertrophy). mRNA expression of KGF, KGFR(1), IL-7R, and EGFR showed a significant increase only after D-SBR, whereas IL-7 increased significantly after SBR in all investigated models, and this was confirmed by immunofluorescence studies. Early intestinal adaptation shows distinct differences depending on the site of SBR, and is predominately driven by cell hyperplasia in jejunal villi and cell hypertrophy in ileal villi. However, the exact mechanisms, which guide these signalling pathways are still unclear. PMID:17205293

Haxhija, Emir Q; Yang, Hua; Spencer, Ariel U; Sun, Xiaoyi; Teitelbaum, Daniel H



X-ray-induced DNA double-strand breaks in mouse l1210 cells: a new computational method for analyzing neutral filter elution data.  


The aim of this article is to present a method for studying the shape of the dose and repair responses for X-ray-induced double-strand breaks (DSBs) as measured by neutral filter elution (NFE). The approach is closely related to a method we developed for the use of specific molecular size markers and used for determination of the absolute number of randomly distributed radiation-induced DSBs by pulsed-field gel electrophoresis (PFGE). Mouse leukemia L1210 cells were X-irradiated with 0-50 Gy. Samples were then evaluated both with PFGE and with NFE. Assuming that with both migration (PFGE) and elution (NFE), a heterogeneous population of double-stranded DNA fragments will start with the smallest fragments and proceed with increasingly larger fragments, it is possible to match the migration behavior of fractions of fragments smaller than a certain size to the fraction eluted at a specific time. This assumption does not exclude the possibility of DNA being sheared in the NFE filter. The yield, as determined by the size markers in PFGE, was used to find the corresponding elution times in the NFE experiment. These experimentally used elution times could then reversely be interpreted as size markers which finally were used to calculate DSBs/Mbp as a function of X-ray dose. The resulting lines were almost straight. The data were also plotted as relative elution and showed that, as expected, the dose response then appears with a more pronounced sigmoid shape. PMID:12643794

Cedervall, Björn; Edgren, Margareta R; Lewensohn, Rolf



First glimpse of the soft x-ray induced excited spin-state trapping effect dynamics on spin cross-over molecules  

NASA Astrophysics Data System (ADS)

The dynamics of the soft x-ray induced excited spin state trapping (SOXIESST) effect of Fe(phen)2(NCS)2 (Fe-phen) powder have been investigated by x-ray absorption spectroscopy (XAS) using the total electron yield method, in a wide temperature range. The low-spin (LS) state is excited into the metastable high-spin (HS) state at a rate that depends on the intensity of the x-ray illumination it receives, and both the temperature and the intensity of the x-ray illumination will affect the maximum HS proportion that is reached. We find that the SOXIESST HS spin state transforms back to the LS state at a rate that is similar to that found for the light induced excited spin state trapping (LIESST) effect. We show that it is possible to use the SOXIESST effect in combination with the LIESST effect to investigate the influence of cooperative behavior on the dynamics of both effects. To investigate the impact of molecular cooperativity, we compare our results on Fe-phen with those obtained for Fe{[Me2Pyrz]3BH}2 (Fe-pyrz) powder, which exhibits a similar thermal transition temperature but with a hysteresis. We find that, while the time constant of the dynamic is identical for both molecules, the SOXIESST effect is less efficient at exciting the HS state in Fe-pyrz than in Fe-phen.

Davesne, V.; Gruber, M.; Miyamachi, T.; Da Costa, V.; Boukari, S.; Scheurer, F.; Joly, L.; Ohresser, P.; Otero, E.; Choueikani, F.; Gaspar, A. B.; Real, J. A.; Wulfhekel, W.; Bowen, M.; Beaurepaire, E.



Mechanisms for dominance: Adh heterodimer formation in heterozygotes between ENU or x-ray induced null alleles and normal alleles in drosophila melanogaster  

SciTech Connect

To study mechanisms for dominance of phenotype, eight ENU- and four x-ray-induced mutations at the alcohol dehydrogenase (Adh) locus were analyzed for partial dominance in their interaction with normal alleles. All ENU and one of the x-ray mutations were single base substitutions; the other three x-ray mutations were 9-21 base deletions. All but one of the 12 mutant alleles were selected for this study because they produced detectable mutant polypeptides, but seven of the 11 producing a peptide could not form dimers with the normal peptide and the enzyme activity of heterozygotes was about half that of normal homozygotes. Four mutations formed dimers with a decreased catalytic efficiency and two of these were near the limit of detectability; these two also inhibited the formation of normal homodimers. The mutant alleles therefore show multiple mechanisms leading to partial enzyme expression in heterozygotes and a wide range of dominance ranging from almost complete recessive to nearly dominant. All amino acid changes in mutant peptides that form dimers are located between amino acids 182 and 194, so this region is not critical for dimerization. It may, however, be an important surface domain for catalyzation. 34 refs., 8 figs., 2 tabs.

Jiang, J.C.; Lee, W.R.; Chang, S.H.; Silverman, H. (Louisiana State Univ., Baton Rouge (United States))



Secondary extramedullary plasmacytoma causing small bowel intussusception in a patient with multiple myeloma - A case report  

PubMed Central

INTRODUCTION Multiple myeloma is a monoclonal, immunoproliferative plasma-cell neoplasm of the B lymphoid cells. Extramedullary plasmacytoma is a type of plasma-cell neoplasm that can present as a primary tumour or secondary to another plasma-cell neoplasm, such as multiple myeloma. Secondary extramedullary plasmacytoma is usually noted in the advanced stages of the disease with ileum involvement being very rare. PRESENTATION OF CASE We report a rare case of a 58-year-old man, with known multiple myeloma, re-presenting with evidence of small bowel obstruction, secondary to an intussusception due to a malignant plasma cell deposit, which was successfully resected at laparotomy. Previous two similar admissions, prior to this index admission, failed to arrive at this difficult rare diagnosis. DISCUSSION Primary and secondary extramedullary plasmacytoma mainly affects the upper aero-digestive tract. Involvement of the ileum, as in this case, is a rare complication. Prognosis of secondary extramedullary plasmacytoma affecting the gastrointestinal tracts is unknown, due to the small number of cases reported in the literature, but suggestive of a poor prognosis. The role of surgery is often palliative to deal with resolvable life-threatening emergencies and where possible to prolong life. CONCLUSION The case adds to the current literature of the rare event of visceral secondary extramedullary plasmacytoma involving the gastrointestinal tract, in the course of multiple myeloma and highlights the need for a high index of suspicion for such uncommon complications, to avoid delay in diagnosis and treatment.

Ariyarathenam, Arun; Galvin, Nick; Akoh, Jacob A.



Secular Trends in Small Bowel Obstruction and Adhesiolysis in the United States, 1988-2007  

PubMed Central

Background Post-operative adhesions are common following surgery and can cause small bowel obstruction (SBO) and require adhesiolysis. The impact that laparoscopy and other surgical advances have had on rates of SBO and adhesiolysis remains controversial. This study examines trends in discharges from US hospitals for SBO and adhesiolysis from 1988–2007. Methods We performed an analysis of secular trends for SBO and adhesiolysis, utilizing the National Hospital Discharge Survey (NHDS). Spearman correlation coefficients were calculated to assess trends over time. Results Rates of SBO were stable over time (?=0.140, p=0.28). Adhesiolysis rates were stable over time (?=?0.18, p=0.17, though there were significant downward trends in those >65 (?=?0.55, p=0.01) and 15–44 (?=?0.84, p<0.01). Conclusions There has been no significant change in overall rates of SBO or adhesiolysis from 1988–2007. For adhesiolysis, there were decreasing trends when stratified by age. Further research is required to understand the factors associated with adhesion-related complications.

Scott, Frank I.; Osterman, Mark T.; Mahmoud, Najjia N.; Lewis, James D.



Small-Bowel Capsule Endoscopy in Patients with Suspected Crohn's Disease--Diagnostic Value and Complications  

PubMed Central

Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.

Figueiredo, Pedro; Almeida, Nuno; Lopes, Sandra; Duque, Gabriela; Freire, Paulo; Lerias, Clotilde; Gouveia, Hermano; Sofia, Carlos



Computer-aided detection of small bowel strictures in CT enterography  

NASA Astrophysics Data System (ADS)

The workflow of CT enterography in an emergency setting could be improved significantly by computer-aided detection (CAD) of small bowel strictures to enable even non-expert radiologists to detect sites of obstruction rapidly. We developed a CAD scheme to detect strictures automatically from abdominal multi-detector CT enterography image data by use of multi-scale template matching and a blob detector method. A pilot study was performed on 15 patients with 22 surgically confirmed strictures to study the effect of the CAD scheme on observer performance. The 77% sensitivity of an inexperienced radiologist assisted by CAD was comparable with the 81% sensitivity of an unaided expert radiologist (p=0.07). The use of CAD reduced the reading time to identify strictures significantly (p<0.0001). Most of the false-positive CAD detections were caused by collapsed bowel loops, approximated bowel wall, muscles, or vessels, and they were easy to dismiss. The results indicate that CAD could provide radiologists with a rapid and accurate interpretation of strictures to improve workflow in an emergency setting.

Sainani, Nisha I.; Näppi, Janne J.; Sahani, Dushyant V.; Yoshida, Hiroyuki



In vitro hydrogen production by enteric bacteria cultured from children with small bowel bacterial overgrowth.  


Lactulose breath hydrogen test and Enterotest string test were carried out simultaneously on 19 children 3-5 years old. Bacteria isolated from the jejunal fluid in upper small intestines of these children were incubated with lactulose at neutral pH. Anaerobes were present in all but one child, and in 15 children they were present in numbers greater than 5 log10 organisms per ml. Most of these bacteria did not produce hydrogen in vitro. Hydrogen production (greater than 100 ppm) was observed with the following bacteria: Bacteroides (5%), clostridia (8%), anaerobic corynebacteria (5%), Escherichia coli (67%), Lactobacillus (8%), Staphylococcus (8%), and Streptococcus (9%). The following bacteria did not produce hydrogen in vitro: Actinobacter, Actinomyces, anaerobic cocci, Bifidobacterium, Fusobacterium, micrococci, Neisseria, Sarcina, and Veillonella. This study suggests that in the diagnosis of small bowel bacterial overgrowth using lactulose breath hydrogen test, it is important to consider that patients with a flat breath hydrogen response to a carbohydrate challenge during the first 60 min may be infected with enteric bacteria which are not capable of producing H2. PMID:1534365

Khin-Maung-U; Tin-Aye; Ku-Tin-Myint; Tin-Oo; Myo-Khin; Thackway, S A; Connor, S J; Bolin, T D; Duncombe, V M



Propulsion and mixing of small bowel contents after laparotomy in rat.  


Radioactive test substances were infused slowly into the duodenum of conscious rats via a permanent catheter starting 2, 12 and 24 h after a standardized laparotomy. Two differently labelled but otherwise identical test substances were used. The first test substance (125I-PVP) was infused for 4 h, the second (131I-PVP) for the remaining 1 h of the 5-hour infusion period. Immediately after the infusion the animals were killed, and the radioactivity emanating from each isotope was recorded from the excised bowel specimen. The bowel length passed by the border zone and the degree of overlap between the labels in this zone were taken as measures of propulsion and mixing, respectively. Propulsion and mixing were uninfluenced by laparotomy as measured 2--17, 12--17 and 24--29 h after laparotomy. The present findings indicate that laparotomy is not followed by a disturbance in the capability of the small bowel to transport and mix chyme, at least when no high demands with respect to chyme volume are required. PMID:689053

Wilén, T; Gustavsson, S; Rentzhog, L



Influence of different protocols of antibiotic prophylaxis on endoluminal bacterial overgrowth and translocation following small-bowel or combined liver-small-bowel transplantation in a large-animal model  

Microsoft Academic Search

Bacterial translocation from the intestinal tract can cause systemic sepsis and multiple-organ failure in traumatized and immunocompromised patients. Compared to transplantation of other organs, small-bowel transplantation (SBT) is at higher risk of bacterial sepsis. Septic episodes are probably related to the overgrowth of endoluminal microflora and bacterial translocation.Translocation may be secondary to mucosal damage, immunologic impairment, and changes in microflora;

G. Privitera; R. Biffi; G. Rossi; E. Conte; B. Andreoni; S. Gatti



Phytobezoars--an overlooked cause of small bowel obstruction following vagotomy and drainage operations for duodenal ulcer.  


Phytobezoar impaction is an important cause of small bowel obstruction in patients who have had previous vagotomy and drainage procedures for duodenal ulcer. Most cases present with typical symptoms and signs of small bowel obstruction, but in some there are no definite radiological signs of bowel obstruction on plain X-ray. In these the phytobezoar is often located by barium studies. Operation is required in the majority of cases and the phytobezoar milked into the large bowel or removed at enterotomy. Before laparotomy is performed, it is essential to endoscope these patients to avoid overlooking gastric phytobezoars which are easily removed via a gastrotomy at the time of the laparotomy. The incidence of phytobezoar obstruction will be reduced by the giving of simple dietary advice and by employing highly selective vagotomy whenever possible in the surgery of duodenal ulcer. PMID:3463292

Vellar, D J; Vellar, I D; Pucius, R; Steedman, P K



Disruption of the Murine Glp2r Impairs Paneth Cell Function and Increases Susceptibility to Small Bowel Enteritis  

PubMed Central

Exogenous glucagon-like peptide-2 receptor (GLP-2R) activation elicits proliferative and cytoprotective responses in the gastrointestinal mucosa and ameliorates experimental small and large bowel gut injury. Nevertheless, the essential physiological role(s) of the endogenous GLP-2R remain poorly understood. We studied the importance of the GLP-2R for gut growth, epithelial cell lineage allocation, the response to mucosal injury, and host-bacterial interactions in Glp2r?/? and littermate control Glp2r+/+ mice. Glp2r?/? mice exhibit normal somatic growth and preserved small and large bowel responses to IGF-I and keratinocyte growth factor. However, Glp2r?/? mice failed to up-regulate intestinal epithelial c-fos expression in response to acute GLP-2 administration and do not exhibit changes in small bowel conductance or small or large bowel growth after administration of GLP-2R agonists. The crypt and villus compartment and the numbers and localization of Paneth, enteroendocrine, and goblet cells were comparable in Glp2r+/+ vs. Glp2r?/? mice. Although the severity and extent of colonic mucosal injury in response to 3% oral dextran sulfate was similar across Glp2r genotypes, Glp2r?/? mice exhibited significantly increased morbidity and mortality and increased bacterial translocation after induction of enteritis with indomethacin and enhanced mucosal injury in response to irinotecan. Moreover, bacterial colonization of the small bowel was significantly increased, expression of Paneth cell antimicrobial gene products was reduced, and mucosal bactericidal activity was impaired in Glp2r?/? mice. Although the Glp2r is dispensable for gut development and the response to colonic injury, Glp2r?/? mice exhibit enhanced sensitivity to small bowel injury, and abnormal host-bacterial interactions in the small bowel.

Lee, Seung-Jun; Lee, Jennifer; Li, Karen K.; Holland, Dianne; Maughan, Heather; Guttman, David S.; Yusta, Bernardo; Drucker, Daniel J.



Surveillance of FAP: a prospective blinded comparison of capsule endoscopy and other GI imaging to detect small bowel polyps  

PubMed Central

Background Familial adenomatous polyposis (FAP) is a hereditary disorder characterized by polyposis along the gastrointestinal tract. Information on adenoma status below the duodenum has previously been restricted due to its inaccessibility in vivo. Capsule Endoscopy (CE) may provide a useful adjunct in screening for polyposis in the small bowel in FAP patients. This study aims to evaluate the effectiveness of CE in the assessment of patients with FAP, compared to other imaging modalities for the detection of small bowel polyps. Method 20 consecutive patients with previously diagnosed FAP and duodenal polyps, presenting for routine surveillance of polyps at The Royal Melbourne Hospital were recruited. Each fasted patient initially underwent a magnetic resonance image (MRI) of the abdomen, and a barium small bowel follow-through study. Capsule Endoscopy was performed four weeks later on the fasted patient. An upper gastrointestinal side-viewing endoscopy was done one (1) to two (2) weeks after this. Endoscopists and investigators were blinded to results of other investigations and patient history. Results Within the stomach, upper gastrointestinal endoscopy found more polyps than other forms of imaging. SBFT and MRI generally performed poorly, identifying fewer polyps than both upper gastrointestinal and capsule endoscopy. CE was the only form of imaging that identified polyps in all segments of the small bowel as well as the only form of imaging able to provide multiple findings outside the stomach/duodenum. Conclusion CE provides important information on possible polyp development distal to the duodenum, which may lead to surgical intervention. The place of CE as an adjunct in surveillance of FAP for a specific subset needs consideration and confirmation in replication studies. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12608000616370



Preoperative Helical Tomotherapy and Megavoltage Computed Tomography for Rectal Cancer: Impact on the Irradiated Volume of Small Bowel  

SciTech Connect

Purpose: Preoperative (chemo)radiotherapy is considered to be standard of care in locally advanced rectal cancer, but is associated with significant small-bowel toxicity. The aim of this study was to explore to what extent helical tomotherapy and daily megavolt (MV) CT imaging may reduce the irradiated volume of small bowel. Methods and Materials: A 3D-conformal radiotherapy (3D-CRT) plan with CTV-PTV margins adjusted for laser-skin marks (15, 15, and 10 mm for X, Y, and Z directions, respectively) was compared with helical tomotherapy (IMRT) using the same CTV-PTV margins, and to helical tomotherapy with margins adapted to daily MV-CT imaging (IMRT/IGRT; 8, 11, 7, and 10 mm for X, Y{sub ant}, Y{sub post} and Z resp.) for 11 consecutive patients. The planning goals were to prescribe 43.7 Gy to 95% of the PTV, while minimizing the volume of small bowel receiving more than 15 Gy (V{sub 15} {sub SB}). Results: The mean PTV was reduced from 1857.4 {+-} 256.6 cc to 1462.0 {+-} 222.3 cc, when the CTV-PTV margins were adapted from laser-skin marks to daily MV-CT imaging (p < 0.01). The V{sub 15} {sub SB} decreased from 160.7 {+-} 102.9 cc to 110.9 {+-} 74.0 cc with IMRT and to 81.4 {+-} 53.9 cc with IMRT/IGRT (p < 0.01). The normal tissue complication probability (NTCP) for developing Grade 2+ diarrhea was reduced from 39.5% to 26.5% with IMRT and to 18.0% with IMRT/IGRT (p < 0.01). Conclusion: The combination of helical tomotherapy and daily MV-CT imaging significantly decreases the irradiated volume of small bowel and its NTCP.

Engels, Benedikt [Department of Radiation Oncology, Oncologisch Centrum UZ Brussel, Brussels (Belgium); De Ridder, Mark [Department of Radiation Oncology, Oncologisch Centrum UZ Brussel, Brussels (Belgium)], E-mail:; Tournel, Koen [Department of Radiation Oncology, Oncologisch Centrum UZ Brussel, Brussels (Belgium); Sermeus, Alexandra [Department of Gastroenterology, Oncologisch Centrum UZ Brussel, Brussels (Belgium); De Coninck, Peter; Verellen, Dirk; Storme, Guy A. [Department of Radiation Oncology, Oncologisch Centrum UZ Brussel, Brussels (Belgium)



Evaluation of Small Bowel Injury in Patients with Rheumatoid Arthritis by Capsule Endoscopy: Effects of AntiRheumatoid Arthritis Drugs  

Microsoft Academic Search

Background and Aim: The medical treatment of rheumatoid arthritis (RA) includes nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose corticosteroids, and disease-modifying antirheumatic drugs (DMARDs). We evaluated the incidence of small bowel injury in RA patients who were taking anti-RA drugs with or without concomitant NSAIDs by capsule endoscopy. Methods: A total of 28 RA patients who took low-dose corticosteroids and\\/or DMARDs for

Satoshi Sugimori; Toshio Watanabe; Masahiko Tabuchi; Natsuhiko Kameda; Hirohisa Machida; Hirotoshi Okazaki; Tetsuya Tanigawa; Hirokazu Yamagami; Masatsugu Shiba; Kenji Watanabe; Kazunari Tominaga; Yasuhiro Fujiwara; Nobuhide Oshitani; Tatsuya Koike; Kazuhide Higuchi; Tetsuo Arakawa



Experimental colonic carcinogenesis: changes in faecal bile acids after promotion of intestinal tumours by small bowel resection in the rat.  

PubMed Central

Small bowel resection promotes the development of colonic tumours in azoxymethane treated rats. As high faecal bile acid concentrations are associated with colonic cancer and may be altered by resection, we have studied changes in faecal bile acid concentrations during promotion of colonic carcinogenesis by increasing small bowel resection. Twenty rats in each group underwent either jejunal transection or 20%, 50%, or 80% proximal small bowel resection. Tumours were induced with azoxymethane 10 mg/kg by 12 weekly subcutaneous injections, and faecal bile acid concentrations were measured at six and 16 weeks. Colonic tumour number rose from 0.6 per rat in the transection group to 1.6 per rat in the 50% resection group (p less than 0.01) but were not significantly different to transection values at 0.8 per rat in the 80% resection group. Total daily faecal bile acid excretion and bile acid concentrations fell with increasing resection from 14.2 (1.6) mg/rat/day and 5.8 (0.7) mg/g dry faeces respectively in the transection group to 6.5 (0.5) mg/rat/day and 2.9 (0.2) mg/g respectively in the 80% resection group (p less than 0.001). The greatest reduction was seen in the concentration of deoxycholic acid which has been particularly associated with the aetiology of colonic cancer. The promotion of colonic tumours following small bowel resection in carcinogen treated rats is unlikely to be mediated by changes in faecal bile acid concentration or composition.

Savage, A P; Sian, M S; Matthews, J L; Bloom, S R; Cooke, T



Obscure gastrointestinal bleeding and small bowel pathology: comparison between wireless capsule endoscopy and multidetector-row CT enteroclysis  

Microsoft Academic Search

Obscure gastrointestinal bleeding is defined as bleeding of unknown origin, that persists or recurs after negative conventional\\u000a barium contrast studies and upper and lower tract endoscopy. The causes of such a bleeding frequently arise in the small bowel,\\u000a and they are represented by mucosal vascular abnormalities, neoplasms and other conditions such as Crohn’s disease, Meckel’s\\u000a diverticulum, and vasculitis. Conventional barium

Antonella Filippone; Roberta Cianci; Angelo Milano; Sergio Valeriano; Veronica Di Mizio; Maria Luigia Storto



Dieulafoy’s lesion of the small bowel causing massive gastrointestinal bleeding: two case reports and literature review  

Microsoft Academic Search

Dieulafoy’s lesions are an often unrecognized cause of obscure, massive GI hemorrhage. Their diagnosis may elude conventional investigations, including upper and lower endoscopy, arteriography, and even laparotomy. In this paper, we report two cases of small-bowel Dieulafoy lesions. The first, a jejunal lesion, occurred in a young patient and was discovered at laparotomy. The second was an ileal Dieulafoy’s malformation

Daniel Blecker; Meena Bansal; Robert L Zimmerman; Franz Fogt; James Lewis; Robert Stein; Michael L Kochman



Transabdominal Ultrasonography of the Small Bowel After Oral Administration of a Non-absorbable Anechoic Solution: Comparison with Barium Enteroclysis  

Microsoft Academic Search

AIM: The aim of this study was to determine if oral administration of a non-absorbable anechoic solution conveys any benefit during abdominal ultrasound (US), with special reference to its accuracy.MATERIALS AND METHODS: Fifty-three adult out-patients scheduled for small bowel barium enema (SBE) were included. The day before SBE all patients underwent abdominal US before and after oral administration of an

Giuseppe Cittadini; Veronica Giasotto; Giacomo Garlaschi; Enzo de Cicco; Alessandra Gallo; Giorgio Cittadini



Comparison of magnetic resonance enterography, capsule endoscopy and gastrointestinal radiography of children with small bowel Crohn's disease  

PubMed Central

The aim of this study was to compare magnetic resonance enterography (MRE) findings with those of video capsule endoscopy (VCE) or conventional gastrointestinal radiography (CGR) in pediatric patients with small bowel Crohn’s disease. A total of 55 cases of small bowel Crohn’s disease that were diagnosed through clinical, laboratory, surgical and histopathological findings were reviewed. Prior to the examination, children suspected of having other types of diseases of the small intestinal were identified. The pulse sequences included coronal T2-true-fast imaging with steady-state precession (TrueFISP) images, navigation axial and coronal T1-weighted images, T2-weighted fat-suppressed images and coronal fat-suppressed three-dimensional gradient-echo images, immediately followed by contrast-enhanced axial and coronal T1-weighted fat-suppressed images. Findings from MRE were compared with those of VCE (n=39) and CGR (n=37). MRE results exhibited a number of features characteristic to small bowel Crohn’s disease, including wall thickening, mesenteric fibrofatty changes and mesenteric vasculature changes. VCE, MRE and CGR demonstrated sensitivities of 94.6, 85.7 and 71.1% with specificities of 72.7, 70 and 40%; accuracies of 89.6, 82.2 and 61.1%; positive predictive values of 92.1, 90.9 and 59.6%; and negative predictive values of 80, 58.3 and 40%, respectively. VCE depicted mucosal pathologies missed by MRE in three patients. MRE revealed 83 extraenteric findings in 55 patients and CGR was able to show the dynamic evolution of the gastrointestinal function. MRE is a simple, safe, non-invasive and effective method for evaluating small bowel Crohn’s disease. VCE allows visualization and readily characterizes subtle mucosal lesions missed by MRE, whereas MRE yields additional mural, perienteric and extraenteric information. However, oral barium CGR utilizes radiation, which is not suitable for repeated use in children.




Low-grade fibromyxoid sarcoma of the small bowel mesentery: computed tomography and magnetic resonance imaging findings  

Microsoft Academic Search

Low-grade fibromyxoid sarcoma (LGFMS) is a rare tumor that commonly arises in the lower extremities but rarely in the mesentery.\\u000a We report computed tomography (CT) and magnetic resonance imaging (MRI) findings of LGFMS of the small bowel mesentery. On\\u000a CT, the mass was composed of two components. One component, on its right side, appeared to have isointense attenuation relative\\u000a to

Shinya Fujii; Yoko Kawawa; Shinichiro Horiguchi; Noriko Kamata; Toshibumi Kinoshita; Toshihide Ogawa



Effect of intestinal P-glycoprotein on daily tacrolimus trough level in a living-donor small bowel recipient  

Microsoft Academic Search

We have examined whether the expression levels of the intestinal absorptive barriers, MDR1 gene product P-glycoprotein and cytochrome P450 IIIA4 (CYP3A4), correlate with the trough levels of orally administered tacrolimus in a recipient of small bowel transplant for 4 months. By using a competitive polymerase chain reaction, the expression of MDR1 messenger RNA (mRNA) and CYP3A4 mRNA by intestinal cells

Satohiro Masuda; Shinji Uemoto; Tohru Hashida; Yukihiro Inomata; Koichi Tanaka; Ken-ichi Inui



Is small bowel biopsy necessary in adults with suspected celiac disease and IgA anti-endomysium antibodies?  

Microsoft Academic Search

The comparative diagnostic value of IgA anti-endomysium and IgA antigliadin antibodies in adults with histologically confirmed celiac disease is reported. Sera from 144 adult patients (without concurrent dermatitis herpetiformis or IgA deficiency) who underwent small bowel biopsy were analyzed for both IgA anti-endomysium and IgA anti-gliadin antibodies. Nineteen patients (13%) had celiac disease. The presence of IgA antiendomysium antibodies had

Trausti Valdimarsson; Lennart Franzen; Ewa Grodzinsky; Thomas Skogh; Magnus Ström



Bleeding small bowel cavernous haemangioma following blunt trauma to the abdomen presenting as subacute intestinal obstruction in a child  

PubMed Central

The authors report a case of a 6-year-old girl who developed subacute intestinal obstruction after a trivial blunt trauma to her abdomen. Her normal vital signs masked the presence of intestinal bleeding. An incidental finding at surgery of a haematomatous polypoid vascular growth of the ileum was subsequently confirmed to be cavernous haemangioma of the small bowel. Surgical resection was curative in this patient.

Aziz, Dayang Anita Abdul; Khandasamy, Yugasaravanan; Tamba, Riana Pauline; Zaki, Faizah Mohd



Percutaneous endoscopic gastrojejunostomy for a patient with an intractable small bowel injury after repeat surgeries: a case report  

PubMed Central

Introduction The management of intestinal injury can be challenging, because of the intractable nature of the condition. Surgical treatment for patients with severe adhesions sometimes results in further intestinal injury. We report a conservative management strategy using percutaneous endoscopic gastrojejunostomy for an intractable small bowel surgical injury after repeated surgeries. Case presentation A 78-year-old Japanese woman had undergone several abdominal surgeries including urinary cystectomy for bladder cancer. After this operation, she developed peritonitis as a result of a small bowel perforation thought to be due to an injury sustained during the operation, with signs consistent with systemic inflammatory response syndrome: body temperature 38.5°C, heart rate 92 beats/minute, respiratory rate 23 breaths/minute, white blood cell count 11.7 × 109/L (normal range 4-11 × 109/?L). Two further surgical interventions failed to control the leak, and our patient's clinical condition and nutritional status continued to deteriorate. We then performed percutaneous endoscopic gastrojejunostomy, and continuous suction was applied as an alternative to a third surgical intervention. With this endoscopic intervention, the intestinal leak gradually closed and oral feeding became possible. Conclusion We suggest that the technique of percutaneous endoscopic gastrojejunostomy combined with a somatostatin analog is a feasible alternative to surgical treatment for small bowel leakage, and is less invasive than a nasojejunal tube.



Correlation of MRI-determined small bowel Crohn's disease categories with medical response and surgical pathology  

PubMed Central

AIM: To determine whether magnetic resonance imaging (MRI) can be used to categorize small bowel Crohn’s disease (SB CD) into groups that correlate with response to medical therapy and surgical pathology. METHODS: Data was collected from all patients with MRI evidence of SB CD without significant colonic disease over a 32-mo period. Two radiologists, blinded to clinical findings, evaluated each MRI and grouped them based on bowel wall thickness and wall enhancement. These categories were: (1) “fibrosis”, (2) “mild segmental hyper-enhancement and mild wall thickening”, (3) “mild segmental hyper-enhancement and marked wall thickening”, (4) “marked segmental transmural hyper-enhancement”. Patient response to additional medical therapy post-MRI was prospectively determined at 8-wk. Non-responders underwent endoscopy and were offered therapeutic endoscopy or surgery. Surgical pathology was assessed against the MRI category. RESULTS: Fifty-five patients were included. Females and category “2” patients were more likely, and patients with luminal narrowing and hold-up less likely, to respond to medical therapy (P < 0.05). Seventeen patients underwent surgery. The surgical pathological findings of fibrosis and the severity of inflammation correlated with the MRI category in all cases. CONCLUSION: Our findings suggest that SB CD can be grouped by the MRI findings and that these groups are associated with patients more likely to respond to continued medical therapy. The MRI categories also correlated with the presence and level of intestinal inflammation and fibrosis on surgical pathology, and may be of prognostic use in the management of CD patients.

Lawrance, Ian Craig; Welman, Christopher J; Shipman, Peter; Murray, Kevin



How Predictive are the Signs and Symptoms of Small Bowel Obstruction  

PubMed Central

Objective The present study aims to determine the diagnostic significance of signs and symptoms of Small Bowel Obstruction (SBO) and to ascertain if there was any delay in presentation of the patients to the hospital. Methods This retrospective case study spanning 3 years was conducted at Riyadh Medical Complex, Saudi Arabia. All adult patients admitted from the ER with a diagnosis of SBO were included in the study. The medical records of the patients with International Classification of Diseases (ICD) 9 codes 552.8, 560, 560.8, 560.81 and 560.9 were searched and retrieved. Results A total of 195 patients were included in the study out of which 174 patients had a definitive diagnosis of SBO. The study group was composed of 76.4% males and 71.8% were aged between 20 years to 60 years. The mean duration of symptoms was 4.8 days, ranging from 6 hours to 17 days. The cardinal signs and symptoms of obstruction had low sensitivity (Range: 56-75), and specificity (Range: 28-61), but relatively high positive predictive value (PPV) (Range: 86-93). The morbidity was 13.8% while mortality was 3.4%. Conclusion The cardinal features of SBO are neither specific nor sensitive, and though they may have an acceptable PPV, the predicted rate of false positive diagnosis is unacceptable. Therefore, the clinician may not rely on the clinical picture alone for the diagnosis of SBO. The presentation of the studied patients was delayed compared to the literature and it may be an important factor in increasing morbidity and mortality, but this aspect needs to be studied further.

Al Salamah, Saleh Mohammad; Fahim, Fraz; Hameed, Abdul Majeed Abdul; Abdulkarim, Amal A.; Al Mogbal, Ebtehal S.; Al Shaer, Adel



[Examination of cytoprotective and anti-inflammatory effect of PACAP-38 on small bowel autotransplantation].  


Introduction: The small intestine is one of the most sensitive organs to ischemia-reperfusion injury during transplantation. Cytoprotective effect of pituitary adenylate cyclase-activating polypeptide (PACAP) is well known. The aim of our study was to measure changes of PACAP-38-like immunoreactivities and cytokine levels in intestinal grafts stored PACAP-38 containing preservation solution. Material and methods: Small-bowel autotransplantation was performed on male Wistar rats (n = 56). Grafts were stored in University of Wisconsin (UW) solution at 4 °C for 1 (GI), 3 (GII), and 6 hours (GIII); and in PACAP-38 containing UW solution for 1 (GIV), 3 (GV), and 6 hours (GVI). Reperfusion lasted 3 hours in each group. Intestinal PACAP-38 immunoreactivities were measured by radioimmunoassay. To measure cytokine from tissue homogenates we used rat cytokine array and Luminex Multiplex Immunoassay. Results: Levels of PACAP-38-like and PACAP-27-like immunoreactivities decreased by preservation time compared to control. This decrease was significant following 6 hours cold storage (p < 0.05). Values remained significantly higher in grafts stored in PACAP-38 containing UW. Expressions of sICAM-1, L-selectin, tissue inhibitor of metalloproteinase-1 were increased in GIII and were decreased in GVI. Conclusion: PACAP-38 increased tissue levels of PACAP-38 and PACAP-27, and decreased cytokine expression. This indicates that PACAP-38 has anti-inflammatory and cytoprotective effects in intestinal autotransplantation model. Supported by Grant OTKA (PD77474, 104984, CNK78480), Bolyai Scholarship and "Lendület" program of the Hungarian Academy of Sciences. PMID:24144817

Nedvig, Klára; Szabó, Györgyi; Csukás, Domokos; Sándor, József; Németh, József; Kovács, Krisztina; Regl?di, Dóra; Kemény, Agnes; Wéber, György; Ferencz, Andrea




PubMed Central

Background Massive small bowel resection (SBR) results in a significant increase in intestinal epithelial cell (EC) proliferation as well as apoptosis. Because the site of SBR (proximal (P) vs. distal (D)) affects the degree of intestinal adaptation, we hypothesized that different rates of EC apoptosis would also be found between P-SBR and D-SBR models. Methods Wild-type C57BL/6J mice underwent: 1) 60% P-SBR, 2) 60% D-SBR, or 3) SHAM-operation (transection-reanastomosis) at the mid-gut point. Mice were sacrificed after 7 days. EC apoptosis was measured by Tunel staining. EC-related apoptotic gene expression including intrinsic and extrinsic pathways was measured with RT-PCR. Bcl-2 and bax protein expression were analyzed by Western immunobloting. Results Both models of SBR led to significant increases in villus height and crypt depth; however the morphologic adaptation was significantly higher after P-SBR compared to D-SBR (P<0.01). Both models of SBR led to significant increases in enterocyte apoptotic rates compared to respective sham levels; however apoptotic rates were 2.5-fold higher in ileal compared to jejunal segments (P<0.01). P-SBR led to significant increases in bax (pro-apoptotic) and Fas expression, whereas D-SBR resulted in a significant increase in TNF-? expression (P<0.01). Conclusions EC apoptosis seems to be an important component of intestinal adaptation. The significant difference in EC apoptotic rates between proximal and distal intestinal segments appeared to be due to utilization of different mechanisms of action.

Haxhija, Emir Q.; Yang, Hua; Spencer, Ariel U.; Sun, Xiaoyi; Teitelbaum, Daniel H.



Influence of the site of small bowel resection on intestinal epithelial cell apoptosis.  


Massive small bowel resection (SBR) results in a significant increase in intestinal epithelial cell (EC) proliferation as well as apoptosis. Because the site of SBR (proximal (P) vs. distal (D)) affects the degree of intestinal adaptation, we hypothesized that different rates of EC apoptosis would also be found between P-SBR and D-SBR models. Wild-type C57BL/6J mice underwent: (1) 60% P-SBR, (2) 60% D-SBR, or (3) SHAM-operation (transaction-reanastomosis) at the mid-gut point. Mice were sacrificed after 7 days. EC apoptosis was measured by TUNEL staining. EC-related apoptotic gene expression including intrinsic and extrinsic pathways was measured with reverse transcriptase-polymerase chain reaction. Bcl-2 and bax protein expression were analyzed by Western immunoblotting. Both models of SBR led to significant increases in villus height and crypt depth; however, the morphologic adaptation was significantly higher after P-SBR compared to D-SBR (P<0.01). Both models of SBR led to significant increases in enterocyte apoptotic rates compared to respective sham levels; however, apoptotic rates were 2.5-fold higher in ileal compared to jejunal segments (P<0.01). P-SBR led to significant increases in bax (pro-apoptotic) and Fas expression, whereas D-SBR resulted in a significant increase in TNF-alpha expression (P<0.01). EC apoptosis seems to be an important component of intestinal adaptation. The significant difference in EC apoptotic rates between proximal and distal intestinal segments appeared to be due to utilization of different mechanisms of action. PMID:16307277

Haxhija, Emir Q; Yang, Hua; Spencer, Ariel U; Sun, Xiaoyi; Teitelbaum, Daniel H



A serum factor(s) after small bowel resection induces intestinal epithelial cell proliferation: effects of timing, site, and extent of resection  

Microsoft Academic Search

Background\\/purposeAfter small bowel resection (SBR), serum induces proliferation in rat intestinal epithelial cells (RIEC-6). This study was designed to elucidate the effects of postoperative time interval, site, and magnitude of SBR on RIEC-6 proliferation.

Russell J Juno; Andrew W Knott; Christopher R Erwin; Brad W Warner



Role of small bowel investigation in iron deficiency anaemia after negative endoscopic\\/histologic evaluation of the upper and lower gastrointestinal tract  

Microsoft Academic Search

Background. The usefulness of small bowel investigation in iron deficiency anaemia (IDA) patients is controversial.Aim. To evaluate the presence of small bowel lesions likely to cause IDA in patients with unexplained IDA after negative gastroscopy with biopsies and colonoscopy (CS).Methods. A total of 117 outpatients, referred for unexplained IDA, underwent gastroscopy with biopsies and colonscopy. In 17 (14.5%) patients, endoscopic\\/histological

B. Annibale; G. Capurso; F. Baccini; E. Lahner; G. D’Ambra; E. Di Giulio; G. Delle Fave



Limitations of indirect methods of estimating small bowel transit in man.  


Experiments were carried out in healthy volunteers to explore the utility of a new [14C]lactulose breath test for measuring small intestinal transit time in man and to use this procedure to test whether two antidiarrheal agents, codeine and clonidine, alter small intestinal transit time during digestion of a liquid meal. In an initial validation study performed in 12 subjects (three studies in each subject), a liquid test meal containing 10 g [14C]lactulose was administered and the colonic entry time estimated from the time course of 14CO2 excretion in breath compared with that of H2 excretion. There was a fair correlation (r = 0.77; P less than 0.001) between results obtained by the two methods; both methods gave similar results, but 14CO2 output was delayed when compared to H2 output and was incomplete. The meal also contained xylose and [13C]glycine, permitting the duodenal entry time of the meal to be estimated by the appearance of xylose in blood and 13CO2 in breath, respectively. The same liquid meal was then used to examine the effect on small intestinal transit time (colonic entry time minus duodenal entry time) of codeine or clonidine. 99Tc-sulphur colloid was also added to the meal to permit a comparison of small intestinal transit estimated by imaging with that estimated by the 14CO2-lactulose breath test. 99Tc radioactivity appeared in the cecum (as assessed using gamma scintigraphy) about 2 hr before 14CO2 radioactivity appeared in breath; the correlation between transit time estimated by the two methods was moderate (r = 0.61; P less than 0.05). Based on the [14C]lactulose data, small intestinal transit time ranged from less than 1 to 3 hr for a liquid meal containing 10 g lactulose; within-subject variation (coefficient of variation 17%) was considerably less than between-subject variation (coefficient of variation 56%). Codeine increased the small intestinal transit time significantly (from 2.7 +/- 0.3 hr to 5.0 +/- 0.9 hr; mean +/- SE), whereas clonidine did not alter small intestinal transit time, as estimated by the colonic entry time minus duodenal entry time. Neither drug influenced duodenal entry time. These results suggest that the [14C]lactulose breath test, which has only moderate accuracy, may have occasional utility as a convenient, noninvasive method for estimating small intestinal transit time in man. However, this study also suggests that indirect methods of estimating small bowel transit in man have limitations, variability, and possibly may lack the desired sensitivity. PMID:3109861

Pressman, J H; Hofmann, A F; Witztum, K F; Gertler, S L; Steinbach, J H; Stokes, K; Kelts, D G; Stone, D M; Jones, B R; Dharmsathaphorn, K



Is laparoscopy equal to laparotomy in detecting and treating small bowel injuries in a porcine model?  

PubMed Central

AIM: To evaluate the safety and effectiveness of laparoscopy compared with laparotomy for diagnosing and treating small bowel injuries (SBIs) in a porcine model. METHODS: Twenty-eight female pigs were anesthetized and laid in the left recumbent position. The SBI model was established by shooting at the right lower quadrant of the abdomen. The pigs were then randomized into either the laparotomy group or the laparoscopy group. All pigs underwent routine exploratory laparotomy or laparoscopy to evaluate the abdominal injuries, particularly the types, sites, and numbers of SBIs. Traditional open surgery or therapeutic laparoscopy was then performed. All pigs were kept alive within the observational period (postoperative 72 h). The postoperative recovery of each pig was carefully observed. RESULTS: The vital signs of all pigs were stable within 1-2 h after shooting and none of the pigs died from gunshot wounds or SBIs immediately. The SBI model was successfully established in all pigs and definitively diagnosed with single or multiple SBIs either by exploratory laparotomy or laparoscopy. Compared with exploratory laparotomy, laparoscopy took a significantly longer time for diagnosis (41.27 ± 12.04 min vs 27.64 ± 13.32 min, P = 0.02), but the time for therapeutic laparoscopy was similar to that of open surgery. The length of incision was significantly reduced in the laparoscopy group compared with the laparotomy group (5.27 ± 1.86 cm vs 15.73 ± 1.06 cm, P < 0.01). In the final post-mortem examination 72 h after surgery, both laparotomy and laparoscopy offered a definitive diagnosis with no missed injuries. Postoperative complications occurred in four cases (three following laparotomy and one following laparoscopy, P = 0.326). The average recovery period for bowel function, vital appearance, and food re-intake after laparoscopy was 10.36 ± 4.72 h, 14.91 ± 3.14 h, and 15.00 ± 7.11 h, respectively. All of these were significantly shorter than after laparotomy (21.27 ± 10.17 h, P = 0.004; 27.82 ± 9.61 h, P < 0.001; and 24.55 ± 9.72 h, respectively, P = 0.016). CONCLUSION: Compared with laparotomy, laparoscopy offers equivalent efficacy for diagnosing and treating SBIs, and reduces postoperative complications as well as recovery period.

Shan, Cheng-Xiang; Ni, Chong; Qiu, Ming; Jiang, Dao-Zhen



Effect of leptin on intestinal re-growth following massive small bowel resection in rat.  


Recent evidence suggests that the adipose tissue-derived cytokine leptin (LEP) is involved in modulation of growth and differentiation of normal small intestine. The purpose of the present study was to evaluate the effects of parenteral LEP on structural intestinal adaptation, cell proliferation and apoptosis in a rat model of short bowel syndrome (SBS). Male Sprague-Dawley rats were divided into three experimental groups: Sham rats underwent bowel transection and re-anastomosis, SBS-rats underwent a 75% small bowel resection, and SBS-LEP-rats underwent bowel resection and were treated with LEP given subcutaneously at a dose of 20 mug/kg, once daily, from day 3 through 14. Parameters of intestinal adaptation (bowel and mucosal weights, mucosal DNA and protein, villus height and crypt depth in jejunum and ileum), enterocyte proliferation and enterocyte apoptosis were determined on day 15 following operation. Ileal tissue samples were taken for detection of bax and bcl-2 gene expression using RT-PCR technique. Statistical analysis was performed using the non-parametric Kruskal-Wallis ANOVA test, with P<0.05 considered statistically significant. Treatment with subcutaneous LEP resulted in a significant increase in jejunal (17%, P<0.05) and ileal (13%, P<0.05) bowel weight, jejunal (10%, P<0.05) and ileal (25%, P<0.05) mucosal weight, jejunal (26%, P<0.05) and ileal (38%, P<0.05) mucosal DNA, ileal (25%, P<0.05) mucosal protein, jejunal (41%, P<0.05) and ileal (21%, P<0.05) villus height, jejunal (37%, P<0.05) crypt depth, and jejunal (24%, P<0.05) and ileal (21%, P<0.05) enterocyte proliferation compared to SBS-animals. Enterocyte apoptosis increased significantly after bowel resection in jejunum and ileum compared to sham animals and was accompanied by an increased bax gene expression and a decreased bcl-2 gene expression in ileal samples. SBS-LEP rats showed a trend toward a decrease in enterocyte apoptosis in ileum and a mild decrease in bax gene expression compared to SBS-untreated animals. In conclusion, in a rat model of SBS parenteral LEP stimulates structural intestinal adaptation. Increased cell proliferation and decreased cell death via apoptosis may be responsible for this increased cell mass. PMID:16328335

Sukhotnik, Igor; Vadasz, Zahava; Coran, Arnold G; Lurie, Michael; Shiloni, Eitan; Hatoum, Ossama A; Mogilner, Jorge G



Small bowel video capsule endoscopy in Crohn's disease: What have we learned in the last ten years?  

PubMed Central

Since its introduction in 2001, capsule endoscopy (CE) has become the most important advance in the study of small bowel disease, including Crohn’s disease (CD). This technique has been demonstrated to be superior to all other current forms of radiological investigation in detecting mucosal abnormalities of small bowel nonstricturing CD. CE has proven to be extremely useful in diagnosing CD in patients with inconclusive findings from ileocolonoscopy and x-ray-based studies. Almost half of all patients with CD involving the ileum also present lesions in proximal intestinal segments, with the small bowel being exclusively involved in up to 30% of all CD cases. Despite the widespread use of CE, several questions concerning the utility of this technique remain unanswered. The lack of commonly agreed diagnostic criteria for defining CD lesions with the aid of CE may have had an influence on the variation in diagnostic results for CE reported in the literature. The utility of CE in monitoring CD and in guiding therapy has also been proposed. Furthermore, CE could be a useful second-line technique for patients with an established diagnosis of CD and unexplained symptoms. Finally, as no threshold for CD diagnosis has been agreed upon, a severity scale of mucosal disease activity has not been universally followed. None of the available activity indexes based on CE findings has been independently validated. This article discusses several cutting-edge aspects of the usefulness of CE in CD 10 years after its introduction as a sensible method to study the small intestine.

Lucendo, Alfredo J; Guagnozzi, Danila



Acute small bowel toxicity and preoperative chemoradiotherapy for rectal cancer: Investigating dose-volume relationships and role for inverse planning  

SciTech Connect

Purpose: The relationship between volume of irradiated small bowel (VSB) and acute toxicity in rectal cancer radiotherapy is poorly quantified, particularly in patients receiving concurrent preoperative chemoradiotherapy. Using treatment planning data, we studied a series of such patients. Methods and Materials: Details of 41 patients with locally advanced rectal cancer were reviewed. All received 45 Gy in 25 fractions over 5 weeks, 3-4 fields three-dimensional conformal radiotherapy with daily 5-fluorouracil and folinic acid during Weeks 1 and 5. Toxicity was assessed prospectively in a weekly clinic. Using computed tomography planning software, the VSB was determined at 5 Gy dose intervals (V{sub 5}, V{sub 1}, etc.). Eight patients with maximal VSB had dosimetry and radiobiological modeling outcomes compared between inverse and conformal three-dimensional planning. Results: VSB correlated strongly with diarrheal severity at every dose level (p < 0.03), with strongest correlation at lowest doses. Median VSB differed significantly between patients experiencing Grade 0-1 and Grade 2-4 diarrhea (p {<=} 0.05). No correlation was found with anorexia, nausea, vomiting, abdominal cramps, age, body mass index, sex, tumor position, or number of fields. Analysis of 8 patients showed that inverse planning reduced median dose to small bowel by 5.1 Gy (p = 0.008) and calculated late normal tissue complication probability (NTCP) by 67% (p = 0.016). We constructed a model using mathematical analysis to predict for acute diarrhea occurring at V{sub 5} and V{sub 15}. Conclusions: A strong dose-volume relationship exists between VSB and acute diarrhea at all dose levels during preoperative chemoradiotherapy. Our constructed model may be useful in predicting toxicity, and this has been derived without the confounding influence of surgical excision on bowel function. Inverse planning can reduce calculated dose to small bowel and late NTCP, and its clinical role warrants further investigation.

Tho, Lye Mun [Colorectal Cancer Team, Beatson Oncology Centre, Western Infirmary, Glasgow (United Kingdom)]. E-mail:; Glegg, Martin [Department of Radiation Physics, Beatson Oncology Centre, Western Infirmary, Glasgow (United Kingdom); Paterson, Jennifer [Department of Radiation Physics, Beatson Oncology Centre, Western Infirmary, Glasgow (United Kingdom); Yap, Christina [Robertson Centre for Biostatistics, University of Glasgow, Glasgow (United Kingdom); MacLeod, Alice [Colorectal Cancer Team, Beatson Oncology Centre, Western Infirmary, Glasgow (United Kingdom); McCabe, Marie [Colorectal Cancer Team, Beatson Oncology Centre, Western Infirmary, Glasgow (United Kingdom); McDonald, Alexander C. [Colorectal Cancer Team, Beatson Oncology Centre, Western Infirmary, Glasgow (United Kingdom)



Lassoing of the small bowel mesentery and abdominal pain caused by band tubing after "band on bypass".  


Weight regain after laparoscopic gastric bypass can be difficult to manage. A common finding is an enlarged gastrojejunal complex (dilated gastric pouch and/or jejunum, dilated gastrojejunal anastomosis). Revision of the gastrojejunal complex can be accomplished by surgical resection, endoscopic plication techniques, or more recently, placement of an adjustable band around the dilated gastric pouch ("band on bypass," BoB). We present an unusual complication of the BoB procedure, in which the band tubing looped around the small bowel causing severe abdominal pain. PMID:23219587

Magee, Conor; Saha, Shopon; Kerrigan, David D



Effect of bran particle size on gastric emptying and small bowel transit in humans: a scintigraphic study.  

PubMed Central

Bran is an effective treatment for constipation but its use is often limited by heartburn and bloating. This study examined the effect of fine and coarse bran (15 g) on the gastric emptying and small bowel transit of a 325 kcal rice test meal. Twelve healthy volunteers underwent a three way cross over study, ingesting the technetium-99m labelled rice meal with or without 15 g of indium-111m labelled fine or coarse bran, in random order. Serial scintigraphic images were obtained to define gastric emptying and colonic arrival of label. Compared with control values (99 (9) minutes) (mean (SEM)), the time to 50% gastric emptying was significantly delayed by coarse but not fine bran, being 121 (6) and 104 (9) minutes respectively, p < 0.05, n = 12. Fundal emptying was unchanged but both brans seemed to increase the proportion of isotope in the antrum at 90 minutes. Small bowel transit was slightly faster with both bran types but in this study the difference was not significant. Both the bran and rice labels moved down the gut without significant separation. Fine bran causes less disturbance of gastric physiology than coarse bran.

Vincent, R; Roberts, A; Frier, M; Perkins, A C; MacDonald, I A; Spiller, R C



Fungal sacral osteomyelitis as the initial presentation of Crohn's disease of the small bowel: report of a case.  


We report a unique case of Candida albicans sacral osteomyelitis in a 48 year-old female with previously undiagnosed Crohn's disease. The patient was ill for one year with fatigue, weakness, and a 60-lb weight loss. At the time of presentation, she developed chills, fever, right lower quadrant abdominal pain, and right knee pain. Physical examination was significant for a palpable right lower quadrant abdominal mass. A computed tomographic scan of the abdomen and pelvis identified a large right-sided retroperitoneal mass, severe right hydronephrosis, and air within the right sacrum. Findings at laparotomy included small-bowel changes consistent with Crohn's disease, a multiloculated retroperitoneal abscess, and evidence of sacral osteomyelitis. A right hemicolectomy with sacral debridement and placement of presacral drains was performed. Bone cultures from the sacrum demonstrated a predominance of C. albicans, in addition to coliforms and enterococcus. The patient was placed on amphotericin B and intravenous antibiotics. Because serial computed tomographic scans of her pelvis demonstrated progression of her pelvic osteomyelitis to include the sacrum, right ilium, right acetabulum, and right femoral head, a repeat debridement with resection of the right femoral head was performed. After 12 months of follow-up, she was doing well without medications and had no constitutional symptoms or radiographic evidence of disease progression. This report illustrates a unique case of Crohn's disease presenting as sacral osteomyelitis secondary to small-bowel fistulization. Aggressive multidisciplinary surgical and medical management were the key to the successful management of this difficult case. PMID:9860342

Armstrong, N; Schurr, M; Helgerson, R; Harms, B



Arterial hypertension due to fructose ingestion: model based on intermittent osmotic fluid trapping in the small bowel  

PubMed Central

Based on recently reported data that fructose ingestion is linked to arterial hypertension, a model of regulatory loops involving the colon role in maintenance of fluid and sodium homeostasis is proposed. In normal digestion of hyperosmolar fluids, also in cases of postprandial hypotension and in patients having the "dumping" syndrome after gastric surgery, any hyperosmolar intestinal content is diluted by water taken from circulation and being trapped in the bowel until reabsorption. High fructose corn sirup (HFCS) soft drinks are among common hyperosmolar drinks. Fructose is slowly absorbed through passive carrier-mediated facilitated diffusion, along the entire small bowel, thus preventing absorption of the trapped water for several hours. Here presented interpretation is that ingestion of hyperosmolar HFCS drinks due to a transient fluid shift into the small bowel increases renin secretion and sympathetic activity, leading to rise in ADH and aldosterone secretions. Their actions spare water and sodium in the large bowel and kidneys. Alteration of colon absorption due to hormone exposure depends on cell renewal and takes days to develop, so the momentary capacity of sodium absorption in the colon depends on the average aldosterone and ADH exposure during few previous days. This inertia in modulation of the colon function can make an individual that often takes HFCS drinks prone to sodium retention, until a new balance is reached with an expanded ECF pool and arterial hypertension. In individuals with impaired fructose absorption, even a higher risk of arterial hypertension can be expected.



Tuberculosis versus non-Hodgkin's lymphomas involving small bowel mesentery: Evaluation with contrast-enhanced computed tomography  

PubMed Central

AIM: To evaluate the specific computed tomography (CT) imaging criteria for differentiating tuberculosis involving the small bowel mesenteric lymph nodes from lymphomas. METHODS: We retrospectively reviewed the anatomic distribution, CT enhancement patterns of lymphoma in 18 patients with mesenteric tuberculosis and 22 with untreated non-Hodgkin’s lymphomas (NHL) involving small bowel mesentery (SBM). Of the 18 patients with tuberculosis, 9 had purely mesenteric tuberculous lymphadenopathy (TL), and 9 had mesenteric TL accompanied with tuberculous mesenteritis (TLM). RESULTS: CT showed that tuberculosis and NHL mainly affected lymph nodes in the body and root of SBM. Homogeneously enhanced lymph nodes in the body and root of SBM were found more often in the NHL (P < 0.05). Homogeneously mixed peripheral enhanced lymph nodes in the body of SBM were found more often in mesenteric TL and TLM (P < 0.05). Peripheral enhanced lymph nodes in the root of SBM were found more often in mesenteric TL and TLM (P < 0.01). “Sandwich sign” in the root of SBM was observed more often in NHL (P < 0.05). CONCLUSION: Anatomic lymph node distribution, sandwich sign and specific enhancement patterns of lymphadenopathy in SBM on CT images can be used in differentiating between tuberculosis and untreated NHL involving SBM.

Dong, Peng; Wang, Bin; Sun, Quan-Ye; Cui, Hui



Use of tissue expansion to facilitate liver and small bowel transplant in young children with contracted abdominal cavities.  


Liver and small bowel transplant is an established treatment for infants with IFALD. Despite organ reduction techniques, mortality on the waiting list remains high due to shortage of size-matched pediatric donors. Small abdominal cavity volume due to previous intestinal resection poses a significant challenge to achieve abdominal closure post-transplant. Seven children underwent tissue expansion of abdominal skin prior to multiorgan transplant. In total, 17 tissue expanders were placed subcutaneously in seven children. All seven subjects underwent re-exploration to deal with complications: hematoma, extrusion, infection, or port related. Three expanders had to be removed. Four children went on to have successful combined liver and small bowel transplant. Two children died on the waiting list of causes not related to the expander and one child died from sepsis attributed to an infected expander. Tissue expansion can generate skin to facilitate closure of abdomen post-transplant, thus allowing infants with small abdominal volumes to be considered for transplant surgery. Tissue expansion in children with end-stage liver disease and portal hypertension is associated with a very high complication rate and needs to be closely monitored during the expansion process. PMID:23992350

Vidyadharan, R; van Bommel, A C M; Kuti, K; Gupte, G L; Sharif, K; Richard, B M



A pedunculated polyp-shaped small-bowel lymphangioma causing gastrointestinal bleeding and treated by double-balloon enteroscopy.  


We report a rare case of a small-bowel lymphangioma causing massive gastrointestinal (GI) bleeding that we successfully diagnosed and treated using double-balloon enteroscopy (DBE). An 81-year-old woman suffering from repeated GI bleeding of unknown origin underwent a capsule endoscopy at a previous hospital. She was suspected of having bleeding from the jejunum, and was referred to our department for diagnosis and treatment. An oral DBE revealed a 20 mm × 10 mm, regularly surfaced, white to yellowish, elongated, pedunculated jejunal polyp with small erosions at 10 cm distal to the ligament of Treiz. Since no other source of bleeding was identified by endoscopy in the deep jejunum, an endoscopic polypectomy (EP) was performed for this lesion. A subsequent histopathological examination of the resected polyp showed clusters of lymphatic vessels with marked cystic dilatation in the submucosa and the deep layer of the lamina propria mucosae. These characteristics are consistent with the typical features of small-bowel lymphangioma with erosions. Although clipping hemostasis was performed during EP, re-bleeding occurred. Finally, a complete hemostasis was achieved by performing an additional argon plasma coagulation. PMID:23002353

Kida, Akihiko; Matsuda, Koichiro; Hirai, Satoshi; Shimatani, Akiyoshi; Horita, Yousuke; Hiramatsu, Katsushi; Matsuda, Mitsuru; Ogino, Hidero; Ishizawa, Shin; Noda, Yatsugi



Chromium-51-EDTA and technetium-99m-DTPA excretion for assessment of small bowel Crohn's disease  

SciTech Connect

In the present study, 4 patients with radiologically documented Crohn's disease were given 100 of Cr-51-EDTA and 5 mCi of Tc-99m-DTPA together orally in 10ml of water, and urine was collected during the following 24 hr period. Sequential imaging of the stomach and the GI tract was done with a LFOV gamma camera at 10 min intervals until the activity cleared the small bowel. The images failed to show any localization of the activity in any disease process and no extraintestinal accumulation site was observed scintigraphically. Mean 24 hr urinary excretion for Tc-99m-DTPA was 4.8 +- 2.6% comparable to that of Cr-51-EDTA in these patients. This study suggests that a comparable oral dose of Tc-99m-DTPA could be substituted for Cr-51-EDTA as a far more readily available agent for documenting small bowel Crohn's disease by quantitative assessment of its urinary excretion.

O'Morain, C.; Chervu, L.; Milstein, D.M.; Das, K.M.



Two cases of post-coital vaginal cuff dehiscence with small bowel evisceration after robotic-assisted laparoscopic hysterectomy  

PubMed Central

INTRODUCTION Vaginal cuff dehiscence following robotic surgery is uncommon. Published reports of vaginal cuff dehiscence following robotic surgery are increasing, but the true incidence is unknown. PRESENTATION OF CASE Case 1. A 45 year old female had sexual intercourse and presented with a vaginal cuff dehiscence complicated by small bowel evisceration 4 months after RA-TLH. Case 2. A 44 year old female had sexual intercourse and presented with a vaginal cuff dehiscence with small bowel evisceration 6 weeks after RA-TLH. DISCUSSION We discuss the rate of vaginal cuff dehiscence by mode of hysterectomy, surgical and non-surgical risk factors that may contribute to vaginal cuff dehiscence, and proposed preventative methods at the time of RA-TLH to reduce this complication. CONCLUSION Vaginal cuff dehiscence with associated evisceration of intraabdominal contents is a potentially severe complication of hysterectomy. We recommend counseling patients who undergo RA-TLH to abstain from vaginal intercourse for a minimum of 8–12 weeks.

Nguyen, My-Linh T.; Kapoor, Monica; Pradhan, Tana S.; Pua, Tarah L.; Tedjarati, Sean S.



Effect of bran, ispaghula, and inert plastic particles on gastric emptying and small bowel transit in humans: the role of physical factors.  

PubMed Central

BACKGROUND: Coarse bran is known to accelerate transit through the whole gut and to increase stool weight. This effect is much reduced by grinding the bran, suggesting that particle size influences gut motor patterns. AIMS: To compare the effect of 15 g coarse bran with 15 g inert plastic particles and 7 g of ispaghula on the gastric emptying and small bowel transit of a rice pudding test meal. SUBJECTS: 13 healthy volunteers. METHODS: Transit of 99mTc labelled rice studied by gamma-scintigraphy measuring gastric emptying and colonic arrival over 10 hours. Small bowel transit was estimated from the difference between time to 50% gastric emptying and 50% colonic arrival. RESULTS: Bran delayed gastric emptying by 22 (SEM 8) minutes compared with control values of 88 (SEM 6) minutes p < 0.05. Ispaghula and plastic particles had no significant effect. Small bowel transit was accelerated compared with control values of 322 (SEM 29) minutes, decreasing by 95 (29) minutes and 62 (22) minutes after bran and plastic particles respectively. Ispaghula again showed no significant effect. CONCLUSION: Coarse bran delays gastric emptying and accelerates small bowel transit. The marked acceleration of small bowel transit also seen with inert plastic particles may be due to increased upper gut secretions after stimulation of enteric nerves.

McIntyre, A; Vincent, R M; Perkins, A C; Spiller, R C



Gastric emptying rate and small bowel transit time in patients with irritable bowel syndrome determined with 99mTc-labeled pellets and scintigraphy  

SciTech Connect

A new method employing 99mTc-labeled pellets for determination of the gastric emptying rate and small bowel transit time is described. The participants were six normal subjects and 16 patients with irritable bowel syndrome (eight with diarrhea and eight with obstipation as the primary complaint). The gastric emptying rate was the same in the three groups. The patients in the obstipation group had a significantly longer small bowel transit time than the normals (P less than 0.02) and the patients in the diarrhea group (P less than 0.01). There was no demonstrable difference between the small bowel transit time in the normals and in the patients in the diarrhea group.

Nielsen, O.H.; Gjorup, T.; Christensen, F.N.



Laparoscopic management of a small bowel herniation from an ileal conduit: report of a case and review of the literature.  


Bladder carcinoma can be treated with cystectomy and urinary diversion. Ileal conduit is a popular technique, originally performed with closure of all mesenteric and peritoneal defects to minimize internal herniation. Recent advances in laparoscopic and robotic techniques often leave these defects open. We present a case of a 75-year-old gentleman with a small bowel entrapment underneath an intraperitoneal ileal conduit and ureter causing obstruction. This internal hernia occurred 2 months after undergoing a DaVinci robotic-assisted laparoscopic cystoprostatectomy with an ileal conduit. Bowel obstruction is an important complication associated with the need for reoperation and patient mortality. Historical review shows a precedent for closure of the mesenteric defect, obliterating the peritoneal defect in the right lumbar gutter, and suturing the ileal conduit to the posterior peritoneum to prevent potential internal hernias. The literature involving ileal conduits is examined for consensus on the preferred method of treating these potential spaces. PMID:23579536

Coughlin, Lisa M; Orr, Dennis P



A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report  

PubMed Central

Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.



Small bowel obstruction and gastric ulceration resulting from rice cake ingestion -computed tomography diagnosis in eight patients-.  


Here we report the cases of eight patients who developed small bowel obstruction and/or gastric ulcers after ingesting rice cake, the traditional Asian food, and were managed conservatively. This report adds to the existing literature on gastrointestinal disorders induced by rice cake ingestion, which are characterized by gastrointestinal obstruction, perforation, and ulceration and are occasionally accompanied by peritonism. These conditions tend to occur in 50-60-year-old males who wear dentures or eat rapidly. Therapeutically, hard rice cake remnants in the upper gastrointestinal tract can be broken up by endoscopic snaring and can be detected by computed tomography as homogeneous high-density material at approximately 145 (range:120-206) Hounsfield units. PMID:24097152

Oka, Akihiko; Amano, Yuji; Uchida, Yasushi; Kagawa, Kouji; Takatori, Kento; Kitajima, Naoto; Sonoyama, Hiroki; Tada, Yasumasa; Kusunoki, Ryusaku; Fukuba, Nobuhiko; Oshima, Naoki; Moriyama, Ichiro; Yuki, Takafumi; Kawashima, Kousaku; Ishihara, Shunji; Kinoshita, Yoshikazu



Small bowel fistula and its impact: incorrect placement of left ventricular assist device cannulas leads to severe intestinal complications  

PubMed Central

A young man presented with a chronic abdominal dermal irritation 4 years after implantation of a left ventricular assist device (LVAD; Berlin heart excor). The LVAD was needed because of end-stage heart failure following a chronic parvovirus B19 Infection. The implantation of mechanical circulatory support systems (MCS) has nowadays become an accepted treatment modality for patients with end-stage heart failure. Recent literature shows several intestinal complications related to MCS, but no case presents the development of a small bowel fistula to the jejunum, transversal colon and stomach. We present a case of inaccurate placement of Berlin heart excor LVAD cannulas and its impact. This case emphasises the importance of correct placement of VAD cannulas to achieve an optimal long-term result. After surgical treatment the postoperative course was prolonged because of increasing peritonitis probably based on ongoing intraperitoneal chronic contamination with intestinal germs. The patient unfortunately deceased.

Yilmaz, Kadir; Erpenbeck, Heinrich; Drews, Thorsten; Hetzer, Roland



SEMS vs cSEMS in duodenal and small bowel obstruction: High risk of migration in the covered stent group  

PubMed Central

AIM: To compare clinical success and complications of uncovered self-expanding metal stents (SEMS) vs covered SEMS (cSEMS) in obstruction of the small bowel. METHODS: Technical success, complications and outcome of endoscopic SEMS or cSEMS placement in tumor related obstruction of the duodenum or jejunum were retrospectively assessed. The primary end points were rates of stent migration and overgrowth. Secondary end points were the effect of concomitant biliary drainage on migration rate and overall survival. The data was analyzed according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS: Thirty-two SEMS were implanted in 20 patients. In all patients, endoscopic stent implantation was successful. Stent migration was observed in 9 of 16 cSEMS (56%) in comparison to 0/16 SEMS (0%) implantations (P = 0.002). Stent overgrowth did not significantly differ between the two stent types (SEMS: 3/16, 19%; cSEMS: 2/16, 13%). One cSEMS dislodged and had to be recovered from the jejunum by way of laparotomy. Time until migration between SEMS and cSEMS in patients with and without concomitant biliary stents did not significantly differ (HR = 1.530, 95%CI 0.731-6.306; P = 0.556). The mean follow-up was 57 ± 71 d (range: 1-275 d). CONCLUSION: SEMS and cSEMS placement is safe in small bowel tumor obstruction. However, cSEMS is accompanied with a high rate of migration in comparison to uncovered SEMS.

Waidmann, Oliver; Trojan, Jorg; Friedrich-Rust, Mireen; Sarrazin, Christoph; Bechstein, Wolf Otto; Ulrich, Frank; Zeuzem, Stefan; Albert, Jorg Gerhard



Effect of preoperative feeding on gallbladder size and peristaltic of the small bowel following spinal anesthesia for the hip surgery.  


The main aim of our study was to determine the influence of preoperative feeding with clear carbohydrate rich drink (PreOp 200 mL) on peristaltic of the small intestine and gallbladder size early after the orthopedic surgery in spinal anesthesia. Clinical study includes 120 patients with fracture of femoral neck or pertrochanteric fracture. All patients were randomized in two groups, sixty patients, PreOp group, consumed carbohydrate drink two hours before surgery. Other 60 patients, Control group, represent patients who fasted overnight. After surgery, patients were submitted to ultrasound examination for measurement of the small bowel motions and gallbladder size. Four quadrants (up-right, up-left, down-right and down-left) of the abdomen were examined, each one in duration of 30 seconds. The results show that the length of the gallbladder is considerably different across the two groups; 5.866 cm in the PreOp group and 7.178 cm in the Control group (p = 0.00). The width, however, differed somewhat less (PreOp group 2.437 cm, Control group 2.735 cm) and the statistically significant difference can be observed at 7% level (p = 0.073). We found no statistically significant relationship between PreOp and Control group variables of each abdominal quadrant (lowest p > 0.087). Accordingly, the means of the variables were found statistically significantly different between groups (p > 0.05). In conclusion our study showed that the preoperative feeding of the patients undergoing orthopedic surgery in spinal anesthesia shortens the length but not the width of the gallbladder when compared with overnight fasting patients and also clearly enhance motility of the small bowel in all four quadrant of the abdomen. PMID:21305734

Proti?, Alen; Bobinac, Mirna; Ivanci?, Aldo; Zuvi?-Butorac, Marta; Sustis, Alan; Jakljevic, Tomislav



Aperistaltic effect of hyoscine N-butylbromide versus glucagon on the small bowel assessed by magnetic resonance imaging.  


The aim of this prospective study was to compare the intraindividual aperistaltic effect of 40 mg hyoscine N-butylbromide (HBB/Buscopan) with that of 1 mg glucagon on small bowel motility by using magnetic resonance imaging (MRI). Ten healthy volunteers underwent two separate 1.5-T MRI studies (HBB/glucagon) after a standardized oral preparation with an aqueous solution of Gd-DOTA and ispaghula (Metamucil). A 2D T1-w GRE sequence was acquired (TR 2.7 ms/TE 1.3 ms, temporal resolution 0.25 s) before and after intravenous (i.v.) drug administration and motility was followed over 1 h. On the resulting images the cross-sectional luminal diameters were assessed and plotted over time. Baseline motility frequency, onset of aperistalsis, duration of arrest, reappearance of motility and return to normal motility were analysed. Significant differences regarding reliability and duration of aperistalsis were observed. In the HBB group aperistalsis lasted a mean of 6.8 +/- 5.3 min compared with 18.3 +/- 7 min after glucagon (p < 0.0001). In 50% of cases HBB did not accomplish aperistalsis, whereas glucagon always succeeded (p = 0.05). There were no significant differences in terms of baseline and end frequencies for the onset of aperistalsis (22.2 +/- 37.5 s HBB/13.4 +/- 9.2 s glucagon, p = 0.1), nor for the return to normal motility. Arrest of small bowel motion is achieved more reliably and lasts significantly longer after i.v. administration of 1 mg glucagon compared with 40 mg HBB. PMID:19190916

Froehlich, Johannes M; Daenzer, Muriel; von Weymarn, Constantin; Erturk, S Mehmet; Zollikofer, Christoph L; Patak, Michael A



The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults  

Microsoft Academic Search

Introduction: The main role of the radiologist in the management of patients with suspicion of small bowel obstruction is to help triage patients into those that need immediate surgical intervention from those that require medical therapy or delayed surgery. Ultrasound examination is usually considered not helpful in bowel obstruction because of air in the intestinal lumen that interferes the evaluation

Roberto Grassi; Stefania Romano; Fenesia D’Amario; Antonio Giorgio Rossi; Luigia Romano; Fabio Pinto; Roberto Di Mizio



Lower Expression of Tight Junction Protein 1 Gene and Increased FOXP3 Expression in the Small Bowel Mucosa in Coeliac Disease and Associated Type 1 Diabetes Mellitus  

Microsoft Academic Search

Background: The role of regulatory T cells expressing FOXP3 in the pathogenesis of coeliac disease (CD) and type 1 diabetes (T1D) has been reported. Recent data have placed special focus on the interplay between the intestinal barrier and immunoregulatory processes. We aimed to determine whether the expression of tight junction protein 1 (TJP1), which reflects small bowel mucosa permeability, is

Tamara Vorobjova; Oivi Uibo; Ivi Ojakivi; Kaupo Teesalu; Marina Panarina; Kaire Heilman; Raivo Uibo



Parenteral Antibiotics and Selective Intestinal Decontamination Do Not Prevent Enteric Bacterial Overgrowth or Translocation Observed in a Swine Model of Small Bowel Transplantation  

Microsoft Academic Search

Alterations in the luminal microflora and increased intestinal translocation have been reported to occur following experimental and clinical small bowel transplantation (SBT). Selective intestinal decontamination (SID) has been used to prevent luminal overgrowth and bacterial translocation. Despite the wide use of SID in clinical SBT, there are no data supporting its usefulness in this situation. Thus, the aim of this

Roberto Biffi; Gaetano Privitera; Caterina Matinato; Simonetta Pozzi; Lorenzo Marzona; Paolo De Rai; Bruno Andreoni; Giorgio Tiberio; Ermenegildo Frezza; David H. Van Thiel



Radiographic plain film and CT findings in lipoid pneumonia in infants following aspiration of mineral oil used in the treatment of partial small bowel obstruction by Ascaris lumbricoides  

Microsoft Academic Search

Four children developed lipoid pneumonia following ingestion of mineral oil for the treatment of partial small bowel obstruction\\u000a byAscaris lumbricoides whorl. CT of the chest showed negative Hounsfield numbers which may prove useful in diagnosis.

G. A. de Oliveira; S. R. Del Caro; C. M. Bender Lamego; P. R. Merçon Vargas; V. E. C. Vervloet



Prospective study of treatment techniques to minimize the volume of pelvic small bowel with reduction of acute and late effects associated with pelvic irradiation  

Microsoft Academic Search

The volume, distribution, and mobility of opacified pelvic small bowel (PSB) were determined by fluoroscopy and orthogonal radiographs in 150 consecutive patients undergoing pelvic irradiation. Various techniques including uteropexy, omental transposition, bladder distention, inclining the patient, and anterior abdominal wall compression in the supine and prone treatment position were studied for their effect on the volume and location of small

Michael J. Gallagher; Harmar D. Brereton; Robert A. Rostock; Jeffrey M. Zero; Debbie A. Zekoski; Leo F. Poyss; Melvyn P. Richter; Morton M. Kligerman



Does massive proximal small bowel resection influence prostaglandin E 2 synthesis in the stomach and ileum during adaptive process in rats?  

Microsoft Academic Search

It is unclear whether massive small bowel resection (SBR) affects prostaglandin E2 synthesis in the gastrointestinal tracts. Thus the aim of this study was to investigate possible changes over tissue levels of prostaglandin E2 in the stomach and ileum after massive proximal SBR. Female Swiss-Albino rats underwent control operation (groups 1, 3, 5) or an 80% SBR (groups 2, 4,

Adnan Aslan; Nimet Izgut-Uysal; Cem Boneval; Mustafa Melikoglu



Low-grade fibromyxoid sarcoma of the small bowel mesentery: computed tomography and magnetic resonance imaging findings.  


Low-grade fibromyxoid sarcoma (LGFMS) is a rare tumor that commonly arises in the lower extremities but rarely in the mesentery. We report computed tomography (CT) and magnetic resonance imaging (MRI) findings of LGFMS of the small bowel mesentery. On CT, the mass was composed of two components. One component, on its right side, appeared to have isointense attenuation relative to muscle, whereas the other component, on its left side, appeared to have low attenuation. On MRI the mass on the right side showed hypointensity similar to muscle on both T1-and T2-weighted images as well as mostly slight enhancement on contrast-enhanced T1-weighted images. On the other hand, the mass on the left side showed relative hypointensity on T1-weighted images and hyperintensity on T2-weighted images as well as intense enhancement on contrast-enhanced T1-weighted images, suggesting that the tumor contained myxoid tissue. The myxoid area of LGFMS may have a tendency to reveal intense enhancement on contrast-enhanced images. PMID:18509725

Fujii, Shinya; Kawawa, Yoko; Horiguchi, Shinichiro; Kamata, Noriko; Kinoshita, Toshibumi; Ogawa, Toshihide



Colon Adenocarcinoma  


... to have colon adenocarcinoma? Colon cancer stems from colon polyps that turn cancerous, and individuals who develop polyps ... structure. Polyp: A benign tumor found in the colon. Polyps can become cancerous if undetected or ignored. Malignant: ...


The Role of the Small Bowel in the Regulation of Circulating Ghrelin Levels and Food Intake in the Obese Zucker Rat  

Microsoft Academic Search

Circulating levels of ghrelin, a stomach peptide that promotes food intake, rise before and fall after meal. We aimed to investigate whether there is an independent contribution of the small bowel to the regulation of ghrelin and appetite. A duodenal-jejunal bypass (DJB) with preservation of normal gastric volume and exposure to nutrients was performed in 12-wk-old obese Zucker ZDF fa\\/fa

Francesco Rubino; Philippe Zizzari; Catherine Tomasetto; Marie-Therese Bluet-Pajot; Antonello Forgione; Michel Vix; Dominique Grouselle; Jacques Marescaux



Morphometric Analysis of Small-Bowel Mucosa in Turkish Children with Celiac Disease and Relationship with the Clinical Presentation and Laboratory Findings  

Microsoft Academic Search

We aimed to analyze morphometric features of the small-bowel mucosa in children with celiac disease, to assess the diagnostic\\u000a limit values of morphometric findings, and to examine the association of morphometric findings with the clinical presentation\\u000a and laboratory findings. The study comprised 33 patients with celiac disease and 35 pediatric patients undergoing endoscopy\\u000a for other causes. Biopsy specimens were reanalyzed

Cigdem Arikan; Cuneyt Zihni; Murat Cakir; Murat Alkanat; Sema Aydogdu



Prevention of graft rejection and graft-versus-host reaction by a novel immunosuppressant, FTY 720, in rat small bowel transplantation  

Microsoft Academic Search

In the present study, we examined the immunosuppressive effect of a new drug, FTY 720, on small bowel transplantation (SBT)\\u000a in rats. Grafts from (LEW × BN) F 1-to-LEW rats treated with FTY 720 at 0.5 mg\\/kg from day 0 to 14 post-SBT survived significantly\\u000a longer than untreated grafts. In addition, the administration of FTY 720 combined with cyclosporin (CyA;

Makoto Mitsusada; Seiichi Suzuki; Eiji Kobayashi; Shin Enosawa; Toshihiro Kakefuda; Michio Miyata



Short and long-term effects of small bowel resection: a unique histological study in a piglet model of short bowel syndrome  

Microsoft Academic Search

If we are to develop successful interventions to improve clinical outcomes for short bowel syndrome patients we require (1)\\u000a knowledge of changes within the epithelial population following small bowel resection (SBR) and (2) an idea of when these\\u000a changes occur to inform on the timing of potential interventions aimed at enhancing the adaptive response. The aim of this\\u000a study was

Prue M. Pereira-FantiniSarah; Sarah L. Thomas; Guineva Wilson; Russell G. Taylor; Magdy Sourial; Julie E. Bines



Synergistic effects of RAD and Neoral in inhibition of host-vs.-graft and graft-vs.-host immune responses in rat small-bowel transplantation.  


The combined effects of RAD and Neoral were tested in a rat orthotopic small-bowel transplantation model. Seven groups (n = 6) were involved in this study, and each one was included in three rejection models for the evaluation of host-vs.-graft disease (HVG) (LBN-F1 to LEW), graft-vs.-host disease (GVH) (LEW to LBN-F1), and combined HVG and GVH immune responses (BN to LEW). Both drugs were administered orally throughout the study. Low doses of RAD (1.0-2.5 mg/kg/day) combined with Neoral (2.0-5.0 mg/kg/day) produced strong synergistic effects in the prolongation of small-bowel graft survival in HVG (combination index, CI = 0.095, 0.1212), GVH (CI = 0.027, 0.020), and combined HVG and GVH immune responses (CI = 0.070, 0.301). The combination therapy of RAD and Neoral produces a strong synergistic effect toward the inhibition of HVG, GVH, and combined HVG and GVH immune responses in a rat small-bowel transplantation model. PMID:14558006

Johnson, Stéphane; Qi, Shiji; Xu, Dasheng; Jolicoeur, Marc; Liu, Dingyi; Barama, Azemi; Busque, Stéphane; Smeesters, Christian; Daloze, Pierre; Chen, Huifang



Studies on the transport of small bowel contents. An experimental study in the rat with special reference to the evaluation of non-propulsive intestinal movements.  


An earlier study (4) of chyme propagation through the small bowel in conscious rats has revealed that the luminal contents are transported in separate portions, which exchange material only to a limited extent. In the present study this transport pattern was confirmed also after the following changes in the standardized experimental conditions used previously: (a) replacement of the standard radioactive labels (125I-PVP and 131I-PVP) with Na2(51CrO4) and 99Tcm-sulphur colloid, (b) replacement of the test meal with saline and (c) investigation of animals without a preceding starvation period. It was also found that the small bowel propulsion was enhanced when the test substance was infused at a higher rate, and that this change did not affect the exchange of material between the portions. The small mixing was further confirmed in experiments in which shifts of label were made repeatedly at constant intervals throughout the infusion period. Distinct regions in which one of the labels predominated could be demonstrated along the entire small bowel when the time interval was diminished to 30 but not to 20 min. PMID:715949

Gustavsson, S



Reactivation of arthritis induced by small bowel bacterial overgrowth in rats: role of cytokines, bacteria, and bacterial polymers.  

PubMed Central

Arthritis is often associated with intestinal diseases, but the etiology is not known. We developed a rat model whereby arthritis was reactivated by experimental small bowel bacterial overgrowth (SBBO). Self-limited monoarticular arthritis was induced by intra-articular injection of 2 micrograms of rhamnose peptidoglycan-polysaccharide derived from group A streptococci into the ankle joints in female Lewis rats. Eleven days after intra-articular injection, when swelling was resolving, experimental SBBO induced by surgical creation of jejunal self-filling blind loops reactivated arthritis, but SBBO induced by creation of self-emptying blind loops, which minimally increases luminal bacteria, and sham operation did not (P < 0.001). Increased joint diameters in rats with self-filling blind loops persisted for at least 56 days after surgery. Reactivation of arthritis due to SBBO was prevented by anti-tumor necrosis factor alpha antiserum and interleukin 1 receptor antagonist (P < 0.001), indicating that these cytokines mediate joint swelling secondary to intestinal injury. Recombinant bactericidal/permeability-increasing protein, an agent which neutralizes endotoxin, and metronidazole, which is active against anaerobic bacteria, prevented arthritis (P < 0.001), but polymyxin B (which also neutralizes endotoxin) and gentamicin had no effect. Mutanolysin, an enzyme which degrades peptidoglycan-polysaccharide from group A streptococci, exacerbated arthritis for the first 6 days but then diminished joint swelling from 12 to 21 days after surgery (P < 0.001). These studies introduce a reproducible animal model of reactivation of arthritis secondary to intestinal injury and demonstrate a role for bacterial products from endogenous enteric organisms.

Lichtman, S N; Wang, J; Sartor, R B; Zhang, C; Bender, D; Dalldorf, F G; Schwab, J H



Occupational risk factors for small bowel carcinoid tumor: a European population-based case-control study.  


Small bowel carcinoid tumor (SBC) is a rare disease of unknown etiology but with an age-, sex-, and place-specific occurrence that may indicate an occupational origin. A European multicenter population-based case-control study was conducted from 1995 through 1997. Incident SBC cases between 35 and 69 years of age (n = 101) were identified, together with 3335 controls sampled from the catchment area of the cases. Histological review performed by a reference pathologist left 99 cases for study; 84 cases and 2070 population controls were interviewed. The industries most closely associated (a twofold or more odds ratio [OR]) with SBC, taking into account a 10-year time lag after exposure were, among women, employment in wholesale industry of food and beverages (OR, 8.2; 95% confidence interval [CI], 1.9 to 34.9]) and among men, manufacture of motor vehicle bodies (OR, 5.2; 95% CI, 1.2 to 22.4), footwear (OR, 3.9; 95% CI, 0.9 to 16.1), and metal structures (OR, 3.3; 95% CI, 1.0 to 10.4). The identified high-risk occupations with an OR above 2 were shoemakers, structural metal preparers, construction painters and other construction workers, bookkeepers, machine fitters, and welders (men). The OR for regular occupational use of organic solvents for at least half a year was 2.0 (95% CI, 1.0 to 4.2). Exposure to rust-preventive paint containing lead was suggested as another potential occupational exposure (OR, 9.1; 95% CI, 0.8 to 107). This explorative study suggests an association between certain occupational exposures and SBC, but some of these associations could be attributable to chance. All findings should be regarded as tentative. PMID:12085477

Kaerlev, Linda; Teglbjaerg, Peter Stubbe; Sabroe, Svend; Kolstad, Henrik A; Ahrens, Wolfgang; Eriksson, Mikael; Guénel, Pascal; Hardell, Lennart; Cyr, Diane; Ballard, Terri; Zambon, Paola; Morales Suárez-Varela, María M; Stang, Andreas; Olsen, Jorn



Chlamydia trachomatis antigens in enteroendocrine cells and macrophages of the small bowel in patients with severe irritable bowel syndrome  

PubMed Central

Background Inflammation and immune activation have repeatedly been suggested as pathogentic factors in irritable bowel syndrome (IBS). The driving force for immune activation in IBS remains unknown. The aim of our study was to find out if the obligate intracellular pathogen Chlamydia could be involved in the pathogenesis of IBS. Methods We studied 65 patients (61 females) with IBS and 42 (29 females) healthy controls in which IBS had been excluded. Full thickness biopsies from the jejunum and mucosa biopsies from the duodenum and the jejunum were stained with a monoclonal antibody to Chlamydia lipopolysaccharide (LPS) and species-specific monoclonal antibodies to C. trachomatis and C. pneumoniae. We used polyclonal antibodies to chromogranin A, CD68, CD11c, and CD117 to identify enteroendocrine cells, macrophages, dendritic, and mast cells, respectively. Results Chlamydia LPS was present in 89% of patients with IBS, but in only 14% of healthy controls (p < 0.001) and 79% of LPS-positive biopsies were also positive for C. trachomatis major outer membrane protein (MOMP). Staining for C. pneumoniae was negative in both patients and controls. Chlamydia LPS was detected in enteroendocrine cells of the mucosa in 90% of positive biopsies and in subepithelial macrophages in 69% of biopsies. Biopsies taken at different time points in 19 patients revealed persistence of Chlamydia LPS up to 11 years. The odds ratio for the association of Chlamydia LPS with presence of IBS (43.1; 95% CI: 13.2-140.7) is much higher than any previously described pathogenetic marker in IBS. Conclusions We found C. trachomatis antigens in enteroendocrine cells and macrophages in the small bowel mucosa of patients with IBS. Further studies are required to clarify if the presence of such antigens has a role in the pathogenesis of IBS.



Impact of antimouse CD52 monoclonal antibody on graft's ?? intraepithelial lymphocytes after orthotopic small bowel transplantation in mice.  


Alemtuzumab, a humanized CD52 monoclonal antibody (mAb), has been used for immune induction in clinical small bowel transplantation (SBT). However, the local impact of CD52 mAb on the transplanted intestine is not known. In this study, we investigated the effects of CD52 mAb on the intestinal intraepithelial lymphocytes (iIELs) in grafts using a murine orthotopic SBT model. The antimouse CD52 mAb was used as a surrogate antibody. Graft rejection was assessed by histopathologic analysis, iIELs were isolated for flow cytometric analysis, the mucosal keratinocyte growth factor (KGF) expression was evaluated by real-time polymerase chain reaction, and epithelial cell (EC) proliferation (percent bromodeoxyuridine incorporation) was measured by immunohistochemistry. No mice showed evidence of rejection. Seven days after SBT, when the CD52 mAb was used, the numbers of iIELs and both T-cell receptor (TCR) ?? and TCR?? subpopulations were decreased, and the number of TCR?? iIELs of donor origin was prominently reduced in the allografts. Furthermore, TCR?? iIEL-derived KGF messenger RNA expression and EC proliferation decreased significantly after CD52 mAb application. These data demonstrate that the antimouse CD52 mAb could deplete iIELs in the transplanted intestine, especially the TCR?? subset of donor origin. The reduction of TCR?? iIELs accompanied the decrease in mucosal KGF expression and EC proliferation, which may slow down the epithelial turnover and retard the repair of the damaged epithelium. PMID:23503501

Shen, Bo; Yu, Hong; Hao, Xianhua; Qu, Linlin; Cai, Xiujun; Li, Ning



Effect of resection margins on the recurrence of Crohn's disease in the small bowel. A randomized controlled trial.  

PubMed Central

OBJECTIVE: The authors assess the effect of surgical margin width on recurrence rates after intestinal resection of Crohn's Disease (CD). BACKGROUND: The optimal width of margins when resecting DC of the small bowel is controversial. Most studies have been retrospective and have had conflicting results. METHODS: Patients undergoing ileocolic resection for CD (N = 152) were randomly assigned to two groups in which the proximal line of resection was 2 cm (limited resection) or 12 cm (extended resection) from the macroscopically involved area. Patients also were classified by whether the margin of resection was microscopically normal (category 1), contained nonspecific changes (category 2), were suggestive but not diagnostic for CD (category 3), or were diagnostic for CD (category 4). Recurrence was defined as reoperation for recurrent preanastomotic disease. RESULTS: Data were collected on 131 patients. Median follow-up time was 55.7 months. Disease recurred in 29 patients: 25% of patients in the limited resection group and 18% of patients in the extended resection group. In the 90 patients in category 1 with normal tissue, recurrence occurred in 16, whereas in the 41 patients with some degree of microscopic involvement, recurrence occurred in 13. Recurrence rates were 36% in category 2, 39% in category 3, and 21% in category 4. No group differences were statistically at the 0.01 level. CONCLUSION: Recurrence of CD is unaffected by the width of the margin of resection from macroscopically involved bowel. Recurrence rates also do not increase when microscopic CD is present at the resection margins. Therefore, extensive resection margins are unnecessary.

Fazio, V W; Marchetti, F; Church, M; Goldblum, J R; Lavery, C; Hull, T L; Milsom, J W; Strong, S A; Oakley, J R; Secic, M



Small bowel resection  


... day, you will most likely be able to drink clear liquids. Your doctor or nurse will slowly add thicker fluids and then soft foods as your bowel begins to work again. If a large amount of your small ...


Small bowel amyloidosis.  


Amyloidosis often involves the gastrointestinal tract. The small intestine is the most commonly involved gastrointestinal site. Gastrointestinal manifestations of amyloidosis involvement of the small intestine include diarrhea, gastrointestinal bleeding, and obstruction. High index of suspicion leading to early diagnosis is important in tailoring appropriate therapeutic management of these patients. PMID:24065604

Gould, Milena; Zarrin-Khameh, Neda; Sellin, Joseph



Small bowel bacterial overgrowth  


Overgrowth - intestinal bacteria; Bacterial overgrowth - intestine ... Normally, the small intestine contains a low number of bacteria. This is different from the large intestine, which contains large numbers of bacteria. ...


Small Bowel Polyposis Syndromes  

Microsoft Academic Search

Intestinal polyposis syndromes are relatively rare. However, it is important for clinicians to recognize the potential risks\\u000a of these syndromes. Based on histology, these syndromes can be classified mainly into hamartomatous polyposis syndromes and\\u000a familial adenomatous polyposis (FAP), which affects mainly the large intestine. This review discusses the clinical manifestations\\u000a and underlying genetics of the most common small intestinal polyposis

Nadir Arber; Menachem Moshkowitz


Soft x-ray induced Ag diffusion in amorphous pulse laser deposited As{sub 50}Se{sub 50} thin films: An x-ray photoelectron and secondary ion mass spectroscopy study  

SciTech Connect

In the present paper, x-ray photoelectron spectroscopy (XPS) is used to induce and study the Ag diffusion and dissolution in pulsed laser deposited As{sub 50}Se{sub 50} amorphous chalcogenide films. Dynamic secondary ion mass spectroscopy (SIMS) is also employed to investigate the Ag atomic concentration in depth. Dynamic SIMS measurements reveal that even before x-ray irradiation a considerable percentage of the total silver amount diffuses into the matrix forming an {approx}70 nm mixed Ag-Se-As layer. XPS analysis shows that x-ray irradiation induces further diffusion of silver into the chalcogenide matrix. At the end of the procedure silver is found to be homogeneously dissolved into the matrix leaving only a 5-7 nm thick surface layer with excess silver concentration. In this surface layer stable Ag{sub 2}Se clusters existing probably in quasicrystalline form prohibit further diffusion. The origin of the mechanism of the x-ray induced Ag diffusion and dissolution in amorphous chalcogenides is discussed in light of the present results.

Kalyva, M.; Siokou, A.; Yannopoulos, S. N. [Foundation of Research and Technology Hellas-Institute of Chemical Engineering and High Temperature Chemical Processes (FORTH/ICE-HT), P.O. Box 1414, Rio, Patras GR-26504 (Greece); Wagner, T.; Krbal; Orava, J.; Frumar, M. [Department of General and Inorganic Chemistry and Research Center, University of Pardubice, Legions Square 565, Pardubice 53210 (Czech Republic)



Continuous-time photon-stimulated desorption spectroscopy studies on soft x-ray-induced reactions of CF{sub 3}Br adsorbed on Si(111)-7x7  

SciTech Connect

Continuous-time core-level photon-stimulated desorption (PSD) spectroscopy was used to study the soft x-ray-induced reactions of CF{sub 3}Br molecules adsorbed on Si(111)-7x7 near the Si(2p) edge (98-110 eV). The monochromatic synchrotron radiation was employed as a soft x-ray light source in the photon-induced reactions and also as a probe for investigating the produced fluorination states of the bonding surface Si atom in the positive-ion PSD spectroscopy. Several different surface coverages were investigated. The PSD spectra from the low-CF{sub 3}Br-covered surfaces show the production of surface SiF species, while those from the high-CF{sub 3}Br-covered surfaces depict the formation of surface SiF, SiF{sub 2}, and SiF{sub 3} species. The photolysis cross section of the submonolayer CF{sub 3}Br-covered surface is determined as {approx}4.3x10{sup -18} cm{sup 2}. A comparison with the results on CF{sub 3}Cl/Si(111)-7x7 surface is discussed.

Tsai, W.-C.; Wang, S.-K.; He, T.-M.; Chou, L.-C.; Hsieh, Y.-C.; Liao, K.-Y.; Chen, H.-C.; Wen, C.-R. [Department of Physics, National Cheng Kung University, Tainan 70101, Taiwan (China)



Use of Balloon Enteroscopy in Preoperative Diagnosis of Neurofibromatosis-Associated Gastrointestinal Stromal Tumours of the Small Bowel: A Case Report  

PubMed Central

Neurofibromatosis type I (NF1) is one of the most common inheritable disorders and is associated with an increased risk of gastrointestinal stromal tumours (GISTs). However, the predominant location of these lesions in the small bowel makes them difficult to diagnose. We report the successful use of balloon enteroscopy in conjunction with conventional methods for clinical diagnosis of jejunal GISTs in a 70-year-old man with NF1 who presented with melaena. The importance of screening NF1 patients for GISTs and the complementary role of balloon enteroscopy with capsule endoscopy in such diagnoses is discussed.

Takakura, Kazuki; Kajihara, Mikio; Sasaki, Shigemasa; Nagano, Tomohisa; Ohta, Arihito; Ikegami, Masahiro; Eto, Ken; Kashiwagi, Hideyuki; Yanaga, Katsuhiko; Arihiro, Seiji; Kato, Tomohiro; Tajiri, Hisao



Association of DNA methylation and epigenetic inactivation of RASSF1A and beta-catenin with metastasis in small bowel carcinoid tumors  

Microsoft Academic Search

We analyzed promoter methylation of RASSF1A, CTNNB1, CDH1, LAMB3, LAMC2, RUNX3, NORE1A, and CAV1 using methylation-specific\\u000a PCR in 33 cases of small bowel carcinoid with both matched primary and metastatic tumors. The methylation status of RASSF1A\\u000a and CTNNB1 were also determined in six primary appendiceal carcinoid tumors. Two neuroendocrine cell lines, NCI-H727 and HTB-119,\\u000a were analyzed for promoter methylation. Immunohistochemical

He-Yu Zhang; Kandelaria M. Rumilla; Long Jin; Nobuki Nakamura; Gail A. Stilling; Katharina H. Ruebel; Timothy J. Hobday; Charles Erlichman; Lori A. Erickson; Ricardo V. Lloyd



Nonsteroidal anti-inflammatory drug-induced small-bowel lesions identified by double-balloon endoscopy: endoscopic features of the lesions and endoscopic treatments for diaphragm disease  

Microsoft Academic Search

Background  Nonsteroidal anti-inflammatory drugs (NSAIDs) occasionally induce small-bowel injury. However, the clinical features have\\u000a only been partially clarified. The aim of this study was to clarify the clinical features of the disease and evaluate the\\u000a effectiveness of endoscopic balloon dilation therapy for diaphragm disease, using double-balloon endoscopy (DBE).\\u000a \\u000a \\u000a \\u000a Methods  This is a retrospective case study using our DBE database. Our inclusion criteria

Yoshikazu Hayashi; Hironori Yamamoto; Hiroki Taguchi; Keijiro Sunada; Tomohiko Miyata; Tomonori Yano; Masayuki Arashiro; Kentaro Sugano



[Primary adenocarcinoma of jejunum with obscure gastrointestinal bleeding].  


A case of primary small bowel adenocarcinoma is reported because of the rarity of this malignancy. Interestingly, the location of the tumour was in jejunum, instead of the most common site in duodenum. The clinical presentation was anemia, with positive fecal blood test, under antiaggregant platelet treatment for coronary heart disease, initially related to endoscopic evidence of erosive gastroduodenitis. The exacerbation of gastrointestinal bleeding during proton pump inhibitors therapy and the recurrence of abdominal pain caused careful investigation. The source of the obscure gastrointestinal bleeding had been achieved by wireless capsule endoscopy, because of not diagnostic findings of conventional upper endoscopy control, colonscopy, double contrast enteroclysis and selective arteriography. The primary definitive therapy was a radical resection of the jejunal neoplastic loop, important prognostic factor. PMID:17147051

Bulfoni, A


Small bowel obstruction secondary to strangulation through a defect in the falciform ligament after blunt abdominal trauma in a pediatric patient.  


Obstruction caused by strangulation internal hernia secondary to incarceration within the falciform ligament, although rare, has been previously reported in the literature. These cases, however, were unrelated to trauma. We report on the first case in the pediatric literature of a strangulated internal hernia secondary to incarceration in the falciform ligament precipitated by blunt abdominal trauma. A 12-year-old girl presented to the emergency room less than 24 hours after sustaining a kick to the right upper quadrant. She described sharp, nonradiating, right-upper-quadrant abdominal pain, which was associated with nausea and vomiting. A KUB (kidney, ureter, bladder) view showed a paucity of bowel in the right upper quadrant with distended adjacent bowel. An ultrasound showed a small amount of abdominal ascites and a prominent liver. Computed tomography scan revealed a linear hypodensity at the tip of the right lobe of the liver, suggestive of a laceration. Moderate abdominal and pelvic ascites and multiple collapsed small-bowel loops with diffuse wall thickening and poor enhancement were seen in the right upper quadrant. Significantly, pneumatosis was noted, raising the question of obstruction/volvulus and/or bowel ischemia. An exploratory laparotomy revealed incarcerated small bowel herniated into a defect in the falciform ligament, which was resected. The defect was repaired. Seemingly trivial trauma may play a precipitating role in strangulation in a patient who already has a defect in the falciform ligament. PMID:20531130

Sykes, Joseph A; Norton, Karen I; Bhattacharya, Nishith; Stombaugh, Lauretta



Myelo-optico-neuropathy in copper deficiency occurring after partial gastrectomy. Do small bowel bacterial overgrowth syndrome and occult zinc ingestion tip the balance?  


Acquired copper deficiency has recently been recognized as a cause of myeloneuropathy mimicking subacute combined degeneration due to vitamin B-12 deficiency. A remote history of gastric surgery is frequently associated with this syndrome. However, the very limited prevalence of severe copper deficiency in patients with a history of gastric surgery suggests that additional contributing factors are likely to be involved. We describe a patient with copper deficiency and a previous Billroth II partial gastrectomy for gastric carcinoma, presenting with severe myelo-optico-neuropathy, demyelinating lesions of the brain, and subjective hyposmia. An abnormal glucose breath test also revealed small bowel bacterial overgrowth syndrome. Copper replacement therapy associated with antibiotic therapy was effective in preventing further neurological damage and in obtaining mild improvement. We propose that copper status should be evaluated in all patients presenting with unexplained noninflammatory myeloneuropathy. Small bowel bacterial overgrowth syndrome should be investigated as a cause of generalized malabsorption and a possible contributing factor to copper deficiency after gastric surgery, as should occult zinc ingestion. PMID:17415508

Spinazzi, Marco; De Lazzari, Franca; Tavolato, Bruno; Angelini, Corrado; Manara, Renzo; Armani, Mario



Association of DNA methylation and epigenetic inactivation of RASSF1A and beta-catenin with metastasis in small bowel carcinoid tumors.  


We analyzed promoter methylation of RASSF1A, CTNNB1, CDH1, LAMB3, LAMC2, RUNX3, NORE1A, and CAV1 using methylation-specific PCR in 33 cases of small bowel carcinoid with both matched primary and metastatic tumors. The methylation status of RASSF1A and CTNNB1 were also determined in six primary appendiceal carcinoid tumors. Two neuroendocrine cell lines, NCI-H727 and HTB-119, were analyzed for promoter methylation. Immunohistochemical analyses for RASSF1A and beta-catenin were performed in 28 matched primary and metastatic tumors. Western blot analysis for RASSF1A and beta-catenin was also performed. Normal enterochromaffin cells were unmethylated in all eight genes examined. RASSF1A and CTNNB1 were unmethylated in appendiceal carcinoids. Methylation of RASSF1A and CTNNB1 promoters was more frequent in metastatic compared to primary tumors (p = 0.013 and 0.004, respectively). The NCI-H727 and HTB-119 cells lines were methylated in the RASSF1A promoter region, and after treatment with 5-aza-2'-deoxycytidine (5-AZA), RASSF1A mRNA was expressed in both cell lines. Western blot results for RASSF1A and beta-catenin supported the methylation-specific PCR findings. The other six genes did not show significant differences. These results suggest that increased methylation of RASSF1A and CTNNB1 may play important roles in progression and metastasis of small bowel carcinoid tumors. PMID:17526942

Zhang, He-Yu; Rumilla, Kandelaria M; Jin, Long; Nakamura, Nobuki; Stilling, Gail A; Ruebel, Katharina H; Hobday, Timothy J; Erlichman, Charles; Erickson, Lori A; Lloyd, Ricardo V



Surgical therapy of radiation-induced small-bowel lesions. Report of 34 cases with a high share of patients with combined chemotherapy  

SciTech Connect

Operations on irradiation-injured bowel are rare, bear a high postoperative mortality, and the procedure of choice (resection vs bypass) is still controversial. Thirty-seven operations on small bowel for late effects of irradiation in 16 years were analyzed retrospectively. Fifty-one percent of the operations were performed in the last four years. Ovarian cancer treated by a combination of radiotherapy and chemotherapy was the most frequent underlying disease of 20 patients (58%) followed by carcinoma of the cervix (eight (24%) of the patients). The median latent period between irradiation and surgery was eight months after the combined radiotherapy/chemotherapy, and 12 months after radiotherapy alone. Thirty operations (81%) were done for small-bowel stricture, four for fistula, and three for perforation. Bypass was performed in 17 patients and resection in 16. Complications (fistula, peritonitis, perforation) occurred after 13 operations (35%). All three patients who developed peritonitis died (mortality, 8.1%): two after resection and one after bypass. Suture-associated complications occurred in three (23%) of 13 cases after single-layer and in three (35%) of 17 cases after two-layer anastomoses. Ten patients are still alive two to 76 months (median, 32 months) after operation, six of them free of tumor. All are underweight and suffer from diarrhea (four to 12 stools per day). Pernicious anemia developed in all six patients surviving more than two years.

Miholic, J.; Schlappack, O.; Klepetko, W.; Koelbl, H.S.; Szepesi, T.; Moeschl, P.



The effect of rejection and graft-versus-host disease on small intestinal microflora and bacterial translocation after rat small bowel transplantation.  


Bacterial translocation and the development of sepsis after small bowel transplantation may be promoted by immunological damage to the intestinal mucosa or by quantitative and qualitative changes in intestinal microflora. This study assessed the effects of rejection, graft-versus-host disease (GVHD) and immunosuppression on intestinal microflora and bacterial translocation after heterotopic rat small bowel transplantation. Isografts, allografts with and without CsA immunosuppression, and the semi-allogeneic parent to the F1 hybrid GVHD model were studied. Intestinal microflora in graft and host loops and bacterial translocation to host organs and the graft mesenteric lymph node were determined. Bacterial colonies were counted and individual colonies identified using API 20E nutrient and fermentation indicator techniques. Colony counts in isografts and allografts were significantly higher than in the native intestine, whereas there was a massive overgrowth in the native intestine in the GVHD group. The species profile for the host and graft loops was similar in animals that had received isografts, allografted animals receiving CsA, and animals undergoing GVHD. However, there was a large increase in Staphylococcus epidermidis in animals with rejection. Bacterial translocation was not detected in isografted animals, but was observed in all other animal groups, with S. epidermidis being the most prevalent organism. These findings demonstrate that rejection and GVHD are associated with shifts in intestinal microflora toward potentially pathogenic organisms and that bacterial translocation into recipient tissues poses a major threat for the development of sepsis. PMID:8249102

Price, B A; Cumberland, N S; Clark, C L; Pockley, A G; Lear, P A; Wood, R F



Quantitation of the involvement of the recA, recB, recC, recF, recJ, recN, lexA, radA, radB, uvrD, and umuC genes in the repair of X-ray-induced DNA double-strand breaks in Escherichia coli.  


Isogenic Escherichia coli strains carrying single DNA-repair mutations were compared for their capacity for (i) the repair of X-ray-induced DNA double-strand breaks (DSB) as measured using neutral sucrose gradients; (ii) medium-dependent resistance, i.e., a recA-dependent X-ray survival phenomenon that correlates closely with the capacity for repairing DSB; and (iii) the growth medium-dependent, recA-dependent repair of X-ray-induced DNA single-strand breaks (SSB) as measured using alkaline sucrose gradients (about 80% of these SSB are actually parts of DSB). These three capacities were measured to quantitate more accurately the involvement of the various genes in the repair of DSB over a wide dose range. The mutations tested were grouped into five classes according to their effect on the repair of X-ray-induced DSB: (I) the recA, recB, recC, and lexA mutants were completely deficient; (II) the radB and recN mutants were about 90% deficient; (III) the recF and recJ mutants were about 70% deficient; (IV) the radA and uvrD mutants were about 30% deficient; and (V) the umuC mutant resembled the wild-type strains in its capacity for the repair of DSB. PMID:3526390

Sargentini, N J; Smith, K C



High chromosomal instability in adenocarcinoma of the ileum arising from multifocal gastric heterotopia with gastritis cystica profunda.  


Adenocarcinoma of the small intestine arising from heterotopic gastric mucosa is extremely rare. In this report, we present the case of a 68-year-old woman who complained of abdominal pain, weight loss and subileus. Gross examination of resected small bowel revealed multiple flat polypous lesions with cysts in the ileal submucosa, one of which containing an ulcerated, stenosing tumour. On microscopic examination, an adenocarcinoma of the ileum arising from multifocal gastric heterotopia with secondary gastritis cystica profunda was diagnosed. Comparative genomic hybridization of the adenocarcinoma revealed chromosomal gains at 1q, 3q, 5p, 8q, 11p, 12p, 13q and losses at Xp, 4q, 8p, 10p, 14q, 17p, 20p, compatible with a high degree of genomic instability. PMID:20577832

Schaefer, Inga-Marie; Schüler, Philipp; Enders, Christina; Scharf, Jens-Gerd; Cameron, Silke; Ramadori, Giuliano; Füzesi, László



Duodeno-jejunal adenocarcinoma as a first presentation of coeliac disease.  

PubMed Central

Long standing coeliac disease is associated with an increased risk of malignancy, not only of intestinal lymphoma but also small intestinal adenocarcinoma. Two patients whose initial presentation was adenocarcinoma of the small bowel, but who were subsequently found to have coeliac disease after Whipple's resection, are described. The diagnosis was made early in the postoperative period in the first patient after close histological examination of the tumour-free mucosal margins. This patient was placed on a gluten-free diet and had an uncomplicated postoperative recovery with rapid weight gain. Diagnosis and dietary intervention in the second patient was very delayed and resulted in the development of severe malabsorption and weight loss. This illustrates the importance of ruling out coeliac disease prior to surgery in patients with small intestinal malignancies. Images

MacGowan, D J; Hourihane, D O; Tanner, W A; O'Morain, C



Plasma cell infiltration of the small bowel: lack of evidence for a non-secretory form of alpha-heavy chain disease.  

PubMed Central

Eight patients with diffuse plasma cell infiltration of the small bowel who had the clinical features of immunoproliferative small intestinal disease (IPSID), but whose serum was negative for free alpha-heavy chains, were investigated for evidence of a non-secretory form of alpha-chain disease (alpha-CD). Molecular sieving and immunoblotting of serum, immunoperoxidase staining of biopsy specimens, and in vitro protein synthesis studies utilising an immunoprecipitation technique and polyacrylamide gel electrophoresis, failed to detect any new cases of alpha-CD. Four of the eight cases were found to have diffuse intestinal lymphoma. The remaining four patients, who were unsuccessfully investigated for evidence of a significant abnormality in cellular immunity, have not developed detectable alpha-CD protein or lymphoma over a mean of 143 months. Despite continuing exposure to possible environmental stimuli, it is concluded that not all cases of IPSID elaborate detectable alpha-CD protein or evolve to lymphoma. Images Fig. 2 Fig. 3

Gilinsky, N H; Mee, A S; Beatty, D W; Novis, B H; Young, G; Price, S; Purves, L R; Marks, I N



Computed tomography enterography and 18F-FDG PET/CT features of primary signet ring cell carcinoma of the small bowel in a patient with Crohn's disease.  


We report a case of a primary signet ring cell carcinoma (PSRCC) of the small bowel in a patient with long-standing Crohn's disease, describing computed tomography (CT)-enterography (CTE) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT features of this rare tumor. CTE demonstrated submucosal thickening of a long ileal segment with preserved mural stratification. PET/CT examination showed increased 18F-FDG uptake in the affected ileal loop, hypermetabolic abdominal and mediastinal lymphadenopathies, and multiple hypermetabolic bone lesions. Iliac crest osteo-medullary biopsy revealed bone marrow infiltration by "signet ring" cells with intestinal differentiation. Double-balloon enteroscopy was used to obtain biopsies that confirmed the ileal origin of the PSRCC. PMID:23768742

Paparo, Francesco; Piccardo, Arnoldo; Clavarezza, Matteo; Piccazzo, Riccardo; Bacigalupo, Lorenzo; Cevasco, Luca; Marinaro, Eugenio; Rollandi, Gian Andrea



Parenteral antibiotics and selective intestinal decontamination do not prevent enteric bacterial overgrowth or translocation observed in a swine model of small bowel transplantation.  


Alterations in the luminal microflora and increased intestinal translocation have been reported to occur following experimental and clinical small bowel transplantation (SBT). Selective intestinal decontamination (SID) has been used to prevent luminal overgrowth and bacterial translocation. Despite the wide use of SID in clinical SBT, there are no data supporting its usefulness in this situation. Thus, the aim of this investigation was to examine the effects of cyclosporine A (CsA) and SID upon bacterial overgrowth and translocation in a swine model of SBT. Nineteen Large White female pigs weighing 30 +/- 2 kg underwent a total orthotopic SBT and were randomly allocated to one of the following experimental groups as follows: Group 1 (No. 8) CSA 25 mg/kg body weight (b.w.)/day administered subcutaneously and Cefazolin 2 g/day im. Group 2 (No. 6) received the identical immunosuppression but the Cefazolin 2 g/day im was discontinued on the 5th Postoperative Day (pod) and switched to a SID regimen consisting of Vancomycin, 1 g, Nystatin, 500,000 IU, Colistin, 1,500,000 IU, and Tobramycin, 100 mg, given through a gastrostomy tube. Group 3 (No. 5) received no immunosuppression but antibiotic consisting of Cefazolin 2 g im/day. Group 4 (No. 7) underwent a small bowel autotransplantation. Group 4 received SID as in group 2 but no immunosuppression was given. Finally, 17 normal animals were sham-operated and were used as normal controls (N group). The animals in groups 1, 2, and 4 were sacrificed on the 29th pod. Those in group 3 were sacrificed on the 7th pod.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7723317

Biffi, R; Privitera, G; Matinato, C; Pozzi, S; Marzona, L; De Rai, P; Andreoni, B; Tiberio, G; Frezza, E; Van Thiel, D H



The utility of single-balloon enteroscopy for the diagnosis and management of small bowel disorders according to their clinical manifestations: a retrospective review  

PubMed Central

Background The advent of double-balloon enteroscopy has enabled more accurate diagnosis and treatment of small bowel disorders. Single-balloon enteroscopy permits visualization of the entire small intestine less often than does double-balloon enteroscopy. However, the relative clinical advantages of the 2 methods remain controversial. This study therefore aimed to identify the indications for and therapeutic impact of performing single-balloon enteroscopy. Methods We retrospectively reviewed prospectively collected data from adults who underwent single-balloon enteroscopy from January 2007 through November 2011 and analyzed their baseline characteristics, endoscopic findings, pathological diagnoses, and clinical outcomes. Results A total of 145 procedures were performed in 116 patients with a mean age of 58.1?±?17.7 years (range, 18–89 years). The most common indications for performing single-balloon enteroscopy were overt gastrointestinal (GI) bleeding, chronic diarrhea, and occult GI bleeding, accounting for 57.9%, 12.4%, and 9.7% of the patients, respectively. The area of interest was achieved in 80.7% of the cases, with a 5.5% rate of technical failure. An overall positive finding was detected in 65.5% of the cases, of which 33.8% were ulcers and erosions; 8.3%, masses; and 3.4%, angiodysplasia. The diagnostic yields were 42.9%, 52.4%, 78.6%, 50.0%, and 25.0% for patients with overt GI bleeding, occult GI bleeding, abdominal pain, chronic diarrhea, and abnormal imaging results, respectively. Therapeutic procedures were performed in 11% of patients with GI bleeding and achieved a therapeutic yield of 14.6% with a minor complication rate of 11.7%. Conclusions Single-balloon enteroscopy was effective for the diagnosis and treatment of small bowel disorders, especially in patients who presented with abdominal pain, GI bleeding, or focal abnormalities on imaging scans.



Treatment of pancreatic cancer tumors with intensity-modulated radiation therapy (IMRT) using the volume at risk approach (VARA): Employing dose-volume histogram (DVH) and normal tissue complication probability (NTCP) to evaluate small bowel toxicity  

Microsoft Academic Search

The emergent use of a combined modality approach (chemotherapy and radiation) in pancreatic cancer is associated with increased gastrointestinal toxicity. Intensity-modulated radiation therapy (IMRT) has the potential to deliver adequate dose to the tumor volume while decreasing the dose to critical structures such as the small bowel. We evaluated the influence of IMRT with inverse treatment planning on the dose-volume

Jerome C Landry; Gary Y Yang; Joseph Y Ting; Charles A Staley; William Torres; Natia Esiashvili; Lawrence W Davis



Current Diagnostic Approaches Lack Sensitivity in the Diagnosis of Perforated Blunt Small Bowel Injury: Analysis from 275,557 Trauma Admissions from the EAST Multi-Institutional HVI Trial  

Microsoft Academic Search

Objectives: Blunt SBI is infrequent and its diagnosis may be difficult, espe- cially in the face of confounding variables. The purpose of this study was to evaluate methods for making the diagnosis of blunt SBI. Methods: Patients with blunt small bowel injury (SBI) were identified from the registries of 95 trauma centers for a 2-year period (1998 -1999). Patients with

Samir M. Fakhry; Dorraine D. Watts; Fred A. Luchette



Preservation of small bowel with the selective use of heparin and second look laparotomy in acute mesenteric ischaemia: A case report  

PubMed Central

Introduction Acute mesenteric ischaemia may occur due to mesenteric arterial embolus, thrombosis, non-occlusive mesenteric ischaemia or venous thrombosis resulting in ischaemia of the bowel wall. Presentation of case A 41 year old woman presented with worsening abdominal pain, decreased appetite, nausea and vomiting. Examination revealed right lower quadrant tenderness. Investigations revealed elevation of her inflammatory markers. At laparotomy two separate segments of ischaemic but potentially viable small bowel were identified secondary to mesenteric venous thrombosis. Bowel salvage was attempted with the use of intravenous unfractionated heparin and this was confirmed following a second look laparotomy. Discussion Despite a normal platelet count at presentation a diagnosis of JAK-2 positive essential thrombocythaemia was made thus explaining the acquired prothrombotic state underlying the venous thrombosis. The selective use of intravenous unfractionated heparin and second look laparotomy may provide a means for bowel preservation in these cases. Conclusion This case highlights the potential of bowel salvage can be achieved following an episode of acute mesenteric ischaemia with the use of intravenous unfractionated heparin and selective second look laparotomy and the importance of considering underlying myeloproliferative disease in such cases even in the absence of a thrombocytosis at presentation.

Fouad, Dina; Nanthakumaran, Shayanthan; Watson, Henry G.; Millar, Colin G.; King, Peter M.



Low-Dose Radiotherapy as a Chemopotentiator of Gemcitabine in Tumors of the Pancreas or Small Bowel: A Phase I Study Exploring a New Treatment Paradigm  

SciTech Connect

Purpose: To determine the maximum tolerated dose of upper abdominal low-dose fractionated radiotherapy (<1.0 Gy per fraction) given in combination with, and as a chemopotentiator for, gemcitabine. Methods and Materials: Gemcitabine was given at 1,250 mg/m{sup 2} at 10 mg/m{sup 2}/min on Days 1 and 8 of a 3-week cycle. Low-dose fractionated radiotherapy was tested at two dose levels: 60 cGy per fraction and 70 cGy per fraction. Radiotherapy was given b.i.d. on Days 1, 2, 8, and 9. Four cycles were planned. Results: Twenty-seven patients have been put on study. Ten patients have been entered in Phase I: 6 with metastatic/recurrent pancreatic carcinoma and 4 with unresectable pancreatic/small bowel carcinoma. Two of four patients at Dose Level 2 experienced dose-limiting toxicity. The overall radiographic response was 30%, and median survival was 11 months (range, 4-37 months). Conclusion: Low-dose fractionated radiotherapy to the upper abdomen is well tolerated at 60 cGy per fraction when combined with gemcitabine. Phase II evaluation is ongoing.

Regine, William F. [Department of Radiation Oncology, University of Maryland, Baltimore, MD (United States)]. E-mail:; Hanna, Nader [Department of Surgery, University of Maryland, Baltimore, MD (United States); Garofalo, Michael C. [Department of Radiation Oncology, University of Maryland, Baltimore, MD (United States); Doyle, Austin [Department of Medicine, University of Maryland, Baltimore, MD (United States); Arnold, Susanne [Division of Hematology-Oncology, University of Kentucky, Lexington, KY (United States); Kataria, Ritesh [Department of Radiation Oncology, University of Maryland, Baltimore, MD (United States); Sims, Jacqueline [Department of Radiation Medicine, University of Kentucky, Lexington, KY (United States); Tan Ming [Department of Biostatistics, University of Maryland, Baltimore, MD (United States); Mohiuddin, Mohammed [Geisinger-Fox Chase Cancer Center, Wilkes-Barre, PA (United States)



The rate of bloodstream infection is high in infants with short bowel syndrome: Relationship with small bowel bacterial overgrowth, enteral feeding and inflammatory and immune responses  

PubMed Central

Objective This pilot study in parenteral nutrition (PN) dependent infants with short bowel syndrome (SBS) evaluated the impact of feeding route and intestinal permeability on bloodstream infection (BSI), small bowel bacterial overgrowth (SBBO) and systemic immune responses, and fecal calprotectin as a biomarker for SBBO. Study design 10 infants (ages 4.2-15.4 months) with SBS due to necrotizing enterocolitis were evaluated. Nutritional assessment, breath hydrogen testing, intestinal permeability, fecal calprotectin, serum flagellin- and LPS- specific antibody titers, and proinflammatory cytokine concentrations (TNF-?, IL-1 ?, IL-6, IL-8) were performed at baseline, 60 and 120 days. Healthy, age-matched controls (n=5) were recruited. Results BSI incidence was high (80%) and SBBO was common (50%). SBBO increased the odds for BSI (> 7-fold; p=0.009). Calprotectin levels were higher in children with SBS and SBBO versus those without SBBO and healthy controls (p<0.05). Serum TNF-?, was elevated at baseline versus controls. Serum TNF-?, IL-1 ?, IL-6 and IL-8 levels diminished with increased enteral nutrition. Anti-flagellin and anti-LPS IgG levels in children with SBSwere lower versus controls and rose over time. Conclusion In children with SBS, SBBO increases the risk for BSI and systemic proinflammatory response decreases with increasing enteral feeding and weaning PN.

Cole, Conrad R.; Frem, Juliana C.; Schmotzer, Brian; Gewirtz, Andrew T.; Meddings, Jonathan B.; Gold, Benjamin D.; Ziegler, Thomas R.



Changes in both acyl-CoA:cholesterol acyltransferase activity and microsomal lipid composition in rat liver induced by distal-small-bowel resection.  

PubMed Central

The acyl-CoA:cholesterol acyltransferase (ACAT) activity and lipid composition of hepatic microsomal membrane were investigated 6 weeks after both 50 and 75% distal-small-bowel resection (SBR). A significant decrease in hepatic cholesteryl ester levels was observed after SBR, with a significant increase in the cholesteryl ester content of the livers of 75% SBR compared with the 50% SBR. Hepatic total acylglycerols, free cholesterol and phospholipid levels were not modified after the surgical operation. Microsomal free cholesterol was increased after both 50 and 75% SBR. However, a decrease in both microsomal ACAT activity and cholesteryl ester levels were found in microsomes (microsomal fractions) of resected rats, both changes being higher after 75 than after 50% resection. The total phospholipid content of the microsomes did not change after the surgical operation. The microsomal phospholipid fatty acid composition indicated higher changes after 75 than after 50% SBR. These results demonstrated that, in resected animals: (1) the activity of the enzyme responsible for catalysing cholesterol esterification (ACAT) is decreased, and (2) hepatic microsomal free cholesterol does not appear to influence the activity of ACAT.

Molina, M T; Vazquez, C M; Ruiz-Gutierrez, V



[Diagnostic accuracy and clinical significance of combined small bowel enema and scintigraphy with pure fractions of neutrophil granulocytes labeled with HMPAO-Tc99m in chronic intestinal inflammation].  


Enema is the primary imaging method in the diagnosis of Crohn's disease in the small bowel, with clinical follow-up examinations performed by gastroenterologists as the gold standard. The information provided by small bowel enema, in addition to endoscopic findings, is usually sufficient for the gastroenterologist to make the definitive diagnosis and to plan the whole treatment. Scintigraphy with leukocytes labelled with HMPAO-Tc99m has several unique characteristics favoring its use as a diagnostic imaging method in Crohn's disease and ulcerative colitis. It is a noninvasive method requiring no bowel preparation and it is safe in severely ill patients in whom such conventional imaging methods as barium enema or colonscopy might be hazardous. In this study, the authors report the results of their experience with diagnostic small bowel enema and leukocyte scintigraphy with HMPAO-Tc99m in 28 patients with inflammatory bowel disease (Crohn's disease in 18 patients, ulcerative colitis in 7 and radiation-induced inflammatory stenosis of the sigma-rectum, bowel inflammation after appendicectomy and bladder surgery, respectively, in 1 patient each). Scintigraphy with autologous granulocytes with HMPAO-Tc99m was positive in 26 patients and negative in 2. Twenty-five patients were true positives and 1 was a false positive. Fifteen patients were also submitted to small bowel enema: 12 of them were positive (true positive) and 3 negative (1 false negative and 2 true negative). The results of granulocytes scintigraphy were compared with those of small bowel enema: the radionuclide study appeared superior in the assessment of bowel inflammation associated with Crohn's disease and ulcerative colitis. Indeed, scintigraphy depicted granulocyte uptake in the colon where enema had shown no major findings in 4 patients with Crohn's disease. In the author's opinion, the overall sensitivity, specificity and positive predictive value of combined leukocyte scintigraphy and small bowel enema play a major role in the early diagnosis of Crohn's disease and ulcerative colitis and in the assessment of disease extent and activity. PMID:9045240

Celentano, L; Cirillo, L C; D'Arienzo, A; De Santis, D A



How Is Small Intestine Adenocarcinoma Diagnosed?  


... used more often before endoscopy was available. Upper GI series: This test, also known as a barium ... pictures of the small intestine than the upper GI with small bowel follow-through. For this procedure, ...


Correlations of Plasma Citrulline Levels With The Clinical Score, Endoscopic Score, Blood Markers According to Small Bowel Involvement in Pediatric Crohn's Disease.  


OBJECTIVE:: Several studies have indicated that plasma citrulline levels reflect the extent of mucosal injury of the small intestine. This study was performed to determine whether plasma citrulline levels correlate with the disease activity in pediatric Crohn's disease patients. METHODS:: A total of 63 Crohn's disease (CD) and 23 ulcerative colitis (UC) patients were included in this study. Disease severity was assessed by pediatric CD activity index (PCDAI), pediatric UC activity index (PUCAI), simplified endoscopic activity score for Crohn's disease (SES-CD), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The correlations between these variables and plasma citrulline levels were evaluated. We performed subgroup analysis whether correlations beween plasma citrulline levels and disease activity depend on small bowel involvement in CD patients. RESULTS:: The plasma citrulline levels correlated negatively with CRP (r?=?-0.332, P?=?0.008), ESR (r?=?-0.290, P?=?0.022), and PCDAI (r?=?-0.424, P?=?0.001) in CD patients. The plasma citrulline levels were significantly lower in patients with jejunal involvement than in those without (P?=?0.027). In subgroup analysis, CD patients with jejunal involvement showed significantly negative correlations of plasma citrulline levels with CRP (r?=?-0.628, P?=?0.016) and PCDAI (r?=?-0.632, P?=?0.015); however, CD patients without jejunal involvement revealed no correlations of plasma citrulline levels with CRP and PCDAI. There were no significant correlations between plasma citrulline levels and SES-CD. There were no significant correlations of plasma citrulline levels with CRP, ESR, and PUCAI in UC patients. CONCLUSIONS:: Plasma citrulline levels correlated with disease severity as measured by PCDAI, CRP, and ESR in pediatric CD patients with jejunal involvement. PMID:23752073

Lee, Eun Hye; Ko, Jae Sung; Seo, Jeong Kee



'Let's just wait one more day': impact of timing on surgical outcome in the treatment of adhesion-related small bowel obstruction.  


Controversy exists but most surgeons agree that surgical treatment for failed conservative management of adhesion-related small bowel obstruction (SBO) should be within 48 hours. However, many find themselves delaying definitive treatment in the hopes of resolution. Our aim was to determine what impact timing has on surgical outcomes of SBO. A retrospective review of all consecutive patients surgically treated for adhesion-related SBO was performed from January 2001 to August 2006. Study groups included patients treated emergently (less than 6 hours), expeditiously (6 to 48 hours), and delayed (greater than 48 hours). Laparoscopic, open, and converted treatment types were controlled for as confounding variables using analysis of variance. Outcome measures were return of bowel function after surgery (RBF), length of stay after surgery (LOS), and morbidity. There were 27 emergencies, 30 treated expeditiously, and 34 delayed. Groups were matched in age and gender. RBF after surgery was significantly longer for those delayed in treatment compared with those treated expeditiously (greater than 48 hours = 7.4 days vs less than 6 hours = 7.6 and 6 to 48 hours = 5.4; P < .05) as well as LOS after surgery (greater than 48 hours = 12.3 days vs less than 6 hours = 10.1 and 6 to 48 hours = 7.6; P < 0.05). Patients treated with laparoscopy within 6 to 48 hours had a significantly shorter RBF and LOS than any other combination of timing and treatment. Postoperative morbidity was higher in the delayed group (79%) than the other groups (44% emergent and 40% expeditious) (P < 0.05). There was one death in the delayed group. Delaying surgical treatment beyond 48 hours for SBO is common and results in worse outcomes and longer LOS. Laparoscopic treatment within 48 hours is superior to open treatment. PMID:23336657

Joseph, Sigi P; Simonson, Mike; Edwards, Christopher



The Different Volume Effects of Small-Bowel Toxicity During Pelvic Irradiation Between Gynecologic Patients With and Without Abdominal Surgery: A Prospective Study With Computed Tomography-Based Dosimetry  

SciTech Connect

Purpose: To evaluate the effect of abdominal surgery on the volume effects of small-bowel toxicity during whole-pelvic irradiation in patients with gynecologic malignancies. Methods and Materials: From May 2003 through November 2006, 80 gynecologic patients without (Group I) or with (Group II) prior abdominal surgery were analyzed. We used a computed tomography (CT) planning system to measure the small-bowel volume and dosimetry. We acquired the range of small-bowel volume in 10% (V10) to 100% (V100) of dose, at 10% intervals. The onset and grade of diarrhea during whole-pelvic irradiation were recorded as small-bowel toxicity up to 39.6 Gy in 22 fractions. Results: The volume effect of Grade 2-3 diarrhea existed from V10 to V100 in Group I patients and from V60 to V100 in Group II patients on univariate analyses. The V40 of Group I and the V100 of Group II achieved most statistical significance. The mean V40 was 281 {+-} 27 cm{sup 3} and 489 {+-} 34 cm{sup 3} (p < 0.001) in Group I patients with Grade 0-1 and Grade 2-3 diarrhea, respectively. The corresponding mean V100 of Group II patients was 56 {+-} 14 cm{sup 3} and 132 {+-} 19 cm{sup 3} (p = 0.003). Multivariate analyses revealed that V40 (p = 0.001) and V100 (p = 0.027) were independent factors for the development of Grade 2-3 diarrhea in Groups I and II, respectively. Conclusions: Gynecologic patients without and with abdominal surgery have different volume effects on small-bowel toxicity during whole-pelvic irradiation. Low-dose volume can be used as a predictive index of Grade 2 or greater diarrhea in patients without abdominal surgery. Full-dose volume is more important than low-dose volume for Grade 2 or greater diarrhea in patients with abdominal surgery.

Huang, E.-Y. [Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan (China); Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Sung, C.-C. [Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan (China); Ko, S.-F. [School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan (China); Wang, C.-J. [Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan (China); Yang, Kuender D. [Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China)], E-mail:



Identification of a common oncofoetal protein in x-ray and chemically induced rat gastrointestinal tumours.  

PubMed Central

An apparently unique circulating common oncofoetal protein has been identified in rat small-bowel, colonic and pancreatic adenocarcinomas. The tumours were induced by ionizing radiation (small bowel), an alkyl hydrocarbon, 1,2-dimethylhydrazine (colon) and a polyaromatic hydrocarbon, 7,12-dimethylbenz[a]anthracene (pancreas). The oncofoetal protein was identified by the use of specific xenogenic antitumour rabbit sera generated to the X-ray-induced neoplasm. In addition, the foetal protein was also found always to occur in the liver and lungs of those animals bearing the chemically induced tumours as well as in their serum. These results suggest the existence of a close relationship at the molecular level in the tumorigenic processes, even though induction is by apparently different mechanisms, for cancers arising in tissue or common embryonic origin. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5

Stevens, R. H.; Cole, D. A.; Cheng, H. F.



Mucinous Adenocarcinoma of Colon  

PubMed Central

Bleeding per rectum is a common complaint in pediatric age group and mostly relates to benign conditions. Underlying colorectal carcinoma is a rare cause and carries a poor prognosis. We report two cases of mucinous adenocarcinoma of colon, one in a 9 years old male and other in a female of 12 years. The boy presented with rectal bleeding and increasing constipation of more than three years duration. He had mucinous adenocarcinoma (T3N0MX) of rectosigmoid region and underwent local complete resection of the tumor with colostomy. He also received postoperative chemotherapy and later underwent colostomy reversal. He is tumor free at two years follow up. The girl presented with signs of intestinal obstruction and at colonoscopy a stricture found in descending colon. The tumor was resected and biopsy reported as poorly differentiated mucinous adenocarcinoma with positive mesenteric nodes positive for tumor (T3N2MX). She is on chemotherapy.

Ahmed, Soofia; Akhtar, Jamshed



Prostatic adenocarcinoma with glomeruloid features  

Microsoft Academic Search

A wide variety of architectural patterns of adenocarcinoma may be seen in the prostate. We have recently encountered a hithertoundescribed pattern of growth characterized by intraluminal ball-like clusters of cancer cells reminiscent of renal glomeruli, which we refer to as prostatic adenocarcinoma with glomeruloid features. To define the architectural features, frequency, and distribution of prostatic adenocarcinoma with glomeruloid features, we

Anna Pacelli; Antonio Lopez-Beltran; A. J. Matthew Egan; David G Bostwick



X-ray induced damage observations in ZERODUR mirrors  

SciTech Connect

Catastrophic damage has been observed in some ZERODUR mirrors used as first mirrors in two beam lines at the National Synchrotron Light Source (NSLS). Despite the high reflectivity of the coatings used on these mirrors, a significant flux of high energy photons penetrates below the coating and is absorbed in the substrate. Although model calculations indicate that the local temperature does not increase significantly, the authors suspect that over long time periods the absorbed flux produces structural changes in the material, leading to a build-up of surface stress, gross figure changes, and growth of fractures. These changes are probably related to the nature of the two-phase glass-ceramic composition of the ZERODUR material. Metal mirrors and single-phase materials do not exhibit such catastrophic damage under similar exposure conditions.

Takacs, P.Z.; Furenlid, K.; Furenlid, L.



Recoil splitting of x-ray-induced optical fluorescence  

SciTech Connect

We show that the anisotropy of the recoil velocity distribution of x-ray-ionized atoms or molecules leads to observable splittings in subsequent optical fluorescence or absorption when the polarization vector of the x rays is parallel to the momentum of the fluorescent photons. The order of the magnitude of the recoil-induced splitting is about 10 {mu}eV, which can be observed using Fourier or laser-absorption spectroscopic techniques.

Gavrilyuk, S.; Aagren, H.; Gel'mukhanov, F. [Theoretical Chemistry, School of Biotechnology, Royal Institute of Technology, S-106 91 Stockholm (Sweden); Sun, Y.-P. [Theoretical Chemistry, School of Biotechnology, Royal Institute of Technology, S-106 91 Stockholm (Sweden); College of Physics and Electronics, Shandong Normal University, 250014 Jinan (China); Levin, S. [Institute for Physics, St. Petersburg University, Uljanovskaya 1, St. Petersburg RU-198904 (Russian Federation)



X-Ray Induced Electrical Polarization in Glass  

Microsoft Academic Search

Electrical polarization in a lead silicate glass induced by the action of x-rays on the material is found to exist. This phenomenon is surveyed experimentally as a function of total dose (incident and absorbed), dose rate, x-ray tube potential, radiation temperature, and temperature at which the polarization is released and measured. Net surface charges of the order of 10-9 coulomb\\/cm2

T. M. Proctor



Synchrotron X-Ray Induced Gold Nanoparticle Formation  

SciTech Connect

We reported a simple approach to generate gold nanoparticles from HAuCl4 containing aqueous solution by synchrotron x-ray irradiation at room temperature. The gold colloidal were investigated by a variety of characterization methods including Transmission Electron Microscope (TEM), Scanning Electron Microscope (SEM), Fourier transformation infrared (FTIR), Ultraviolet and Visible (UV-VIS) spectrometer and the effects of variables including pH value, radiation time were examined.

Yang, Y. C. [Dept. Mater. Min. Reso. Eng., National Taipei Univ. Tech., Taipei, Taiwan 106 (China); Wang, C. H.; Yang, T. Y.; Hwu, Y. [Institute of Physics, Academia Sinica, Nankang, Taipei, Taiwan 115 (China); Chen, C. H. [Dept. Mater. Sci. Eng., Pohang University of Science and Technology, Pohang (Korea, Republic of); Je, J. H. [China Steel Corporation, 1 Chung-Kang Road, Kaohsiung, Taiwan 812 (China); Margaritondo, G. [Ecole Polytechnique Federale de Lausanne (EPFL), CH-1015 Lausanne (Switzerland)




Microsoft Academic Search

From wheat pollen given dosages of ultraviolet and x rays roughly ; comparable in capacity to break chronmosomes, 56 and 124 plants, respectively, ; were obtained, all of which were analyzed cytologically. Reciprocal ; translocations and part- and whole-chromosome deiicieneies were found following ; both types of treatment, but more of the ultraviolet translocations were ; deficient for an apparently

L. M. Steintz-Sears; E. R. Sears



Adenocarcinoma of the cervix  

Microsoft Academic Search

Opinion statement  Cervical adenocarcinomas are increasing in incidence each year, comprising up to 25% of all cervical cancers diagnosed in\\u000a the United States. This increase largely reflects the inherent difficulty in detecting glandular precursor lesions using current\\u000a screening practices. However, there also appears to be a recent shift in the epidemiology of the disease process with younger\\u000a women being diagnosed more

John O. Schorge; Lynne M. Knowles; Jayanthi S. Lea



Adenocarcinoma in pulmonary sequestration.  


A 67-year-old male smoker presented with hemoptysis and recurrent pneumonia. Chest computed tomography showed an emphysematous cyst and air-fluid level cavities in the left lower lobe. A left lower lobectomy was performed. The intraoperative finding was intralobar sequestration. Histopathology revealed adenocarcinoma within the sequestrated lobe. Only 8 cases of lung cancer and sequestration have been reported since 1963. PMID:22160418

Lawal, Lukman; Mikroulis, Dimitrios; Eleftheriadis, Savvas; Karros, Panagiotis; Bougioukas, Ioannis; Bougioukas, Georgios



Pancreatic adenocarcinoma: epidemiology and genetics  

Microsoft Academic Search

Pancreatic adenocarcinoma is an important cause of death from cancer throughout the developed world. There are few established environmental risk factors, but a previous history of pancreatitis and exposure to tobacco and salted food appear to be the most important. A family history of pancreatic adenocarcinoma is not common in patients with this disease, but recent research has shown that

T Y Flanders; W D Foulkes



Pancreatic adenocarcinoma: Outstanding problems  

PubMed Central

Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive malignant tumors with an overall 5-year survival rate of less than 4%. Surgical resection remains the only potentially curative treatment but is only possible for 15%-20% of patients with pancreatic adenocarcinoma. About 40% of patients have locally advanced nonresectable disease. In the past, determination of pancreatic cancer resectability was made at surgical exploration. The development of modern imaging techniques has allowed preoperative staging of patients. Institutions disagree about the criteria used to classify patients. Vascular invasion in pancreatic cancers plays a very important role in determining treatment and prognosis. There is no evidence-based consensus on the optimal preoperative imaging assessment of patients with suspected pancreatic cancer and a unified definition of borderline resectable pancreatic cancer is also lacking. Thus, there is much room for improvement in all aspects of treatment for pancreatic cancer. Multi-detector computed tomography has been widely accepted as the imaging technique of choice for diagnosing and staging pancreatic cancer. With improved surgical techniques and advanced perioperative management, vascular resection and reconstruction are performed more frequently; patients thought once to be unresectable are undergoing radical surgery. However, when attempting heroic surgery, a realistic approach concerning the patient’s age and health status, probability of recovery after surgery, perioperative morbidity and mortality and life quality after tumor resection is necessary.

Zakharova, Olga P; Karmazanovsky, Grigory G; Egorov, Viacheslav I



Primary retroperitoneal mullerian adenocarcinoma  

PubMed Central

Mullerian tumors are extremely rare malignancies in the retroperitoneum. We report a case of a 46-year old woman who presented with an eight year history of lower abdominal mass. Ultrasonography (US) and computed tomography (CT) demonstrated a 15×10 cm cystic mass in the left lower retroperitoneum. As serial percutaneous needle aspiration cytology was negative for malignancy, she was observed for seven years. Eleven months ago, the mass was excised. The histopathology was reported as mucinous adenocarcinoma of the retroperitoneum. Six cycles of intraperitoneal (IP) chemotherapy was administered during the last six months after diagnosis of recurrence by aspiration cytology and high serum tumor markers (CEA, CA19-9). A few days ago, positron emission tomographic (PET) scanning showed evidence of local recurrence and single vertebral metastasis, so she was admitted again for systemic chemotherapy. Meticulous revision of additional sections of the tumor revealed papillary, serous, mucinous, and endometrioid subtypes of the mullerian adenocarcinoma. To our knowledge, there has been no similar case described in the literature.

Elnemr, Ayman; Yonemura, Yutaka; Shinbo, Masaya; Nishino, Eisei



Primary retroperitoneal mullerian adenocarcinoma.  


Mullerian tumors are extremely rare malignancies in the retroperitoneum. We report a case of a 46-year old woman who presented with an eight year history of lower abdominal mass. Ultrasonography (US) and computed tomography (CT) demonstrated a 15×10 cm cystic mass in the left lower retroperitoneum. As serial percutaneous needle aspiration cytology was negative for malignancy, she was observed for seven years. Eleven months ago, the mass was excised. The histopathology was reported as mucinous adenocarcinoma of the retroperitoneum. Six cycles of intraperitoneal (IP) chemotherapy was administered during the last six months after diagnosis of recurrence by aspiration cytology and high serum tumor markers (CEA, CA19-9). A few days ago, positron emission tomographic (PET) scanning showed evidence of local recurrence and single vertebral metastasis, so she was admitted again for systemic chemotherapy. Meticulous revision of additional sections of the tumor revealed papillary, serous, mucinous, and endometrioid subtypes of the mullerian adenocarcinoma. To our knowledge, there has been no similar case described in the literature. PMID:21139951

Elnemr, Ayman; Yonemura, Yutaka; Shinbo, Masaya; Nishino, Eisei



Mammaglobin expression in gynecologic adenocarcinomas.  


Mammaglobin (MGB) has been proposed as a sensitive and specific immunohistochemical marker for adenocarcinoma of the breast. The differential diagnosis of breast adenocarcinoma versus a gynecologic primary frequently arises. We performed a semiquantitative survey of MGB immunoreactivity in 26 benign gynecologic tissues (6 ectocervices, 9 endocervices, 11 endometria), 86 ovarian adenocarcinomas, 70 endometrial adenocarcinomas, and 10 endocervical adenocarcinomas. Among ovarian tumors, MGB was present in 40% of endometrioid carcinomas; 36%, serous carcinomas; 21%, clear cell carcinomas; and 6%, mucinous carcinomas. Among endometrial cancers, MGB reactivity was present in 57% of endometrioid carcinomas, but only 30% of serous carcinomas and 6% of clear cell carcinomas. MGB was absent in endocervical adenocarcinomas. Across all tumor types with positive staining, MGB was focal or patchy (ie, less than diffuse) in 50 of 57 cases. Using a scale of 0 to 3+, the only 3 tumors with 3+ MGB reactivity were all serous carcinomas (1 ovarian and 2 endometrial). There were no cases with diffuse 3+ MGB expression. On the other hand, diffuse 2+ MGB was seen in 4 cases: 1 endometrioid carcinoma of ovary, 1 serous carcinoma of ovary, and 2 clear cell carcinomas of ovary. In conclusion, a diagnostically significant proportion of gynecologic carcinomas are immunoreactive for MGB. Gynecologic primaries should be considered in the differential diagnosis of MGB-positive malignancies of unknown origin. PMID:23084633

Hagemann, Ian S; Pfeifer, John D; Cao, Dengfeng



The Genomics of Lung Adenocarcinoma  

PubMed Central

Standard cytotoxic chemotherapy is effective for some cancers, but for many others, available treatments offer only a limited survival benefit. Lung adenocarcinoma is one such cancer, responsible for approximately half of lung cancer deaths each year. Development of targeted therapies is thought to hold the most promise for successfully treating this disease, but a targeted approach is dependent on understanding the genomic state of the tumor cells. Exon-directed sequencing of large numbers of lung adenocarcinoma tumor samples has provided an initial low-resolution image of the somatic mutation profile of these tumors. Such cancer sequencing studies have confirmed the high frequency of TP53 and KRAS mutations in lung adenocarcinoma, have found inactivating mutations in known tumor suppressor genes not previously associated with lung adenocarcinoma, and have identified oncogenic mutations of EGFR upon which the first targeted therapy for lung adenocarcinoma patients was based. Additional candidate oncogenes await functional validation. It is anticipated that upcoming whole-exome and whole-genome lung adenocarcinoma sequencing experiments will reveal a more detailed landscape of somatic mutations that can be exploited for therapeutic purposes.

Greulich, Heidi



FAP related periampullary adenocarcinoma  

PubMed Central

INTRODUCTION The risk of periampullary neoplasia in patients with familial adenomatous polyposis (FAP) is significantly increased compared to the general population. PRESENTATION OF CASE We herein report the case of a 47-year-old woman with classic familial adenomatous polyposis with a history of total proctocolectomy for FAP who presented with an ulcerous ampullary lesion 8 years after primary colorectal surgery. Interestingly, the patient had not enrolled to optimal postoperative upper endoscopy follow-up. The patient underwent a Whipple procedure. Histology demonstrated a T2N0 ampullary adenocarcinoma. DISCUSSION Periampullary disease in patients with familial adenomatous polyposis occurs increasingly, especially in the subset of patients without proper endoscopic follow-up. Current recommendations concerning upper endoscopy and appropriate management are herein discussed; the importance of optimal postoperative endoscopy after total proctocolectomy in the FAP setting is discussed. CONCLUSION Periampullary cancer carries a significant risk in patients with FAP and proper endoscopic follow-up should be applied in this special patient group in order to manage ampullary manifestations of the disease in a timely manner.

Mantas, Dimitrios; Charalampoudis, Petros; Nikiteas, Nikolaos



Solitary Small Bowel Metastasis from Breast Cancer  

PubMed Central

The common sites of metastasis of breast cancer are bone, lung, and liver, but gastrointestinal metastasis from breast cancer is rare. We experienced a case of solitary ileal metastasis from breast cancer. A 45-years-old woman presented with melena for several weeks. She showed no other abdominal symptoms. Colonoscopy findings showed an ulcerative mucosal lesion in the terminal ileum, and biopsy was performed. Pathologic examination revealed metastatic carcinoma, originated from breast. The tumor cells were positive for estrogen receptor and negative for Cdx-2. She had had a previous medical history of bilateral breast cancer and undergone breast conserving surgery with sentinel lymph node biopsy for both breasts. The torso positron emission tomography scan at 19 months after surgery showed mildly increased uptake in the terminal ileum which was considered as inflammation. Finally, she was diagnosed with solitary ileal metastasis from breast cancer at 22 months after surgery.

Choi, Jung Eun; Park, Shin Young; Jeon, Myung Hoon; Kang, Su Hwan; Bae, Young Kyung; Kim, Min Kyoung



[Primary adenocarcinoma in appendiceal diverticulitis].  


A case of primary adenocarcinoma in appendiceal diverticulosis is reported. Such a case has never been mentioned before in the literature. It was not possible to diagnose the case preoperatively. This emphasizes the importance of histological examination of all appendiceal samples. PMID:10850196

Thomsen, J B; al-Suliman, N; Kåg, L; Lindebjerg, J



Plasmacytoid adenocarcinoma of the lung.  


Plasmacytoid adenocarcinoma of the lung has not been reported. Herein reported is the first case of plasmacytoid adenocarcinoma of the lung. A 68-year-old man presented with cough and sputum. X-P and CT demonstrated a large tumor (10 x 10 x 9 cm) in the right upper lobe. CT-guided needle biopsy was performed. The biopsy showed plasmacytoid malignant cells. The malignant cells were small, had eccentrically located nuclei, perinuclear halo, and basophilic cytoplasm. No mucins were observed by mucins stains. Immunohistochemical study showed that the tumor cells were positive for pancytokeratin AE1/3, pancytokeratin CAM5.2, TTF-1, Ki-67 (labeling 70%), CA19-9, and p53. They were negative for neuron specific enolase, CEA, CD45, CD68, chromogranin, synaptophysin, surfactant apoprotein A, CDX-2, ?-chain, ?-chain, KIT, and PDGFRA. Since epithelial markers and adenocarcinoma markers were positive, the pathological diagnosis was plasmacytoid adenocarcinoma of lung. The patient is now treated with chemotherapy. PMID:22670180

Terada, Tadashi



Vitiligo Associated with Esophageal Adenocarcinoma  

PubMed Central

Vitiligo is a disease that results in depigmented areas in the skin. It may develop at any age but the average age at onset is 20 years. Association of vitiligo and melanoma has been commonly reported, but malignancies other than melanoma have been rarely associated with vitiligo. We report a 73-year-old patient with new onset vitiligo who developed esophageal adenocarcinoma in the following years.

Asilian, Ali; Momeni, Iman; Khosravani, Parastou



Precursor lesions to prostatic adenocarcinoma  

Microsoft Academic Search

High-grade prostatic intraepithelial neoplasia (PIN) is the one well-documented precursor to adenocarcinoma of the prostate.\\u000a This review article defines both low- and high-grade PIN. Unusual variants of high-grade PIN are illustrated. Benign lesions\\u000a that may be confused with high-grade PIN, including central zone histology, clear cell cribriform hyperplasia, and basal cell\\u000a hyperplasia are described and illustrated. High-grade PIN is also

Jonathan I. Epstein



Nonbacterial thrombotic endocarditis associated with lung adenocarcinoma.  


Nonbacterial thrombotic endocarditis (NBTE) is a rather frequent neoplasic complication, most often occurring in adenocarcinomas of the lung and pancreas. The most frequent clinical manifestation is one of multiple cerebral infarcts, but other ischaemic events can occur. Diagnosis is frequently missed on transthoracic ultrasound, making transoesophagic ultrasound a more reliable diagnostic tool. We present a case of NBTE associated with lung adenocarcinoma. PMID:18055331

Martín-Martorell, P; Insa-Molla, A; Chirivella-González, M I; Cervera-Miguel, J I



Uterine adenocarcinoma with feline leukemia virus infection.  


Feline endometrial adenocarcinomas are uncommon malignant neoplasms that have been poorly characterized to date. In this study, we describe a uterine adenocarcinoma in a Persian cat with feline leukemia virus infection. At the time of presentation, the cat, a female Persian chinchilla, was 2 years old. The cat underwent surgical ovariohystectomy. A cross-section of the uterine wall revealed a thickened uterine horn. The cat tested positive for feline leukemia virus as detected by polymerase chain reaction. Histopathological examination revealed uterine adenocarcinoma that had metastasized to the omentum, resulting in thickening and the formation of inflammatory lesions. Based on the histopathological findings, this case was diagnosed as a uterine adenocarcinoma with abdominal metastasis. To the best of our knowledge, this is the first report of a uterine adenocarcinoma with feline leukemia virus infection. PMID:22232645

Cho, Sung-Jin; Lee, Hyun-A; Hong, Sunhwa; Kim, Okjin



Uterine adenocarcinoma with feline leukemia virus infection  

PubMed Central

Feline endometrial adenocarcinomas are uncommon malignant neoplasms that have been poorly characterized to date. In this study, we describe a uterine adenocarcinoma in a Persian cat with feline leukemia virus infection. At the time of presentation, the cat, a female Persian chinchilla, was 2 years old. The cat underwent surgical ovariohystectomy. A cross-section of the uterine wall revealed a thickened uterine horn. The cat tested positive for feline leukemia virus as detected by polymerase chain reaction. Histopathological examination revealed uterine adenocarcinoma that had metastasized to the omentum, resulting in thickening and the formation of inflammatory lesions. Based on the histopathological findings, this case was diagnosed as a uterine adenocarcinoma with abdominal metastasis. To the best of our knowledge, this is the first report of a uterine adenocarcinoma with feline leukemia virus infection.

Cho, Sung-Jin; Lee, Hyun-A; Hong, Sunhwa



Choroidal metastases from lung adenocarcinoma.  


A 32-year-old woman presented with an unknown visual deficit. Fundus examination revealed a lesion compatible with a metastatic focus. Diagnostic workup revealed a lung mass and the biopsy was compatible with lung adenocarcinoma. The intraocular lesion was the only metastatic site at the time of diagnosis. She received local choroidal treatment and further systemic therapy. A pneumonectomy was performed. Five months later she progressed systemically and has since then received several lines of chemotherapy. Choroidal metastases are an infrequent site of systemic dissemination and associated with a poor prognosis, with a median survival of around 2 months if it is the first manifestation of a lung neoplasm. Here we review the literature on choroidal metastases, their treatment options and epidemiology. PMID:19828413

Martín Martorell, Paloma; Marí Cotino, José F; Insa, Amelia



Curative Resection for Esophageal Adenocarcinoma  

PubMed Central

Objective To document what can be accomplished with surgical resection done according to the classical principles of surgical oncology. Methods One hundred consecutive patients underwent en bloc esophagectomy for esophageal adenocarcinoma. No patient received pre- or postoperative chemotherapy or radiation therapy. Tumor depth and number and location of involved lymph nodes were recorded. A lymph node ratio was calculated by dividing the number of involved nodes by the total number removed. Follow-up was complete in all patients. The median follow-up of surviving patients was 40 months, with 23 patients surviving 5 years or more. Results The overall actuarial survival rate at 5 years was 52%. Survival rates by American Joint Commission on Cancer (AJCC) stage were stage 1 (n = 26), 94%; stage 2a (n = 11), 65%; stage 2b (n = 13), 65%; stage 3 (n = 32), 23%; and stage 4 (n = 18), 27%. Sixteen tumors were confined to the mucosa, 16 to the submucosa, and 13 to the muscularis propria, and 55 were transmural. Tumor depth and the number and ratio of involved nodes were predictors of survival. Metastases to celiac (n = 16) or other distant node sites (n = 26) were not associated with decreased survival. Local recurrence was seen in only one patient. Latent nodal recurrence outside the surgical field occurred in 9 patients and systemic metastases in 31. Tumor depth, the number of involved nodes, and the lymph node ratio were important predictors of systemic recurrence. The surgical death rate was 6%. Conclusion Long-term survival from adenocarcinoma of the esophagus can be achieved in more than half the patients who undergo en bloc resection. One third of patients with lymph node involvement survived 5 years. Local control is excellent after en bloc resection. The extent of disease associated with tumors confined to the mucosa and submucosa provides justification for more limited and less morbid resections.

Hagen, Jeffrey A.; DeMeester, Steven R.; Peters, Jeffrey H.; Chandrasoma, Para; DeMeester, Tom R.



Helicobacter pylori Infection and Gastric Adenocarcinoma  

PubMed Central

Gastric adenocarcinoma is the second leading cause of cancer-related mortality worldwide. Infection with Helicobacter pylori is the strongest recognized risk factor for gastric adenocarcinoma. This bacterial species colonizes the stomach of more than half of the world’s population; however, only a very small proportion of infected subjects develop adenocarcinoma. H. pylori causes a chronic gastritis that may last decades, and a multistep precancerous process is recognized for the most frequent histologic type of gastric adenocarcinoma: the intestinal type. The severity and long-term outcome of this infection is modulated by an increasing list of bacterial, host, and environmental factors, which interplay in a complex manner. Identification of individuals at high risk for gastric cancer that may enter a surveillance program and intervention during the precancerous process is the most suitable strategy for decreasing mortality due to this malignancy.

Correa, Pelayo; Piazuelo, M Blanca



Glassy cell adenocarcinoma of the uterine cervix  

Microsoft Academic Search

ObjectiveGlassy cell carcinoma of the cervix is a rare variant of cervical cancer accounting for a small percentage of cell types. This study was undertaken to review our experience with glassy cell adenocarcinoma.

Michael P Hopkins; George W Morley



Comparative proteome analysis of human adenocarcinoma  

Microsoft Academic Search

This study was designed to use comparative proteomics technology to find the differentially expressed proteins between human\\u000a lung adenocarcinoma and paired normal tumor-adjacent lung tissues. The total proteins of 20 human lung adenocarcinoma tissues\\u000a and paired normal tumor-adjacent lung tissues were separated by means of immobilized pH gradient-based two-dimensional gel\\u000a electrophoresis (2-DE) and Coomassie Blue staining. The differentially expressed proteins

Gaoming Xiao; Qionghui Lu; Cui Li; Wenxiang Wang; Yuejun Chen; Zhiqiang Xiao



[Liver metastases from colonic adenocarcinoma simulating cholangiocarcinoma].  


Macroscopic intrabiliary growth of liver metastases from colonic adenocarcinoma mimicki