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1

Adenocarcinoma of the Small Bowel  

Microsoft Academic Search

PURPOSE: Primary small-bowel adenocarcinoma is uncommon. There are few large studies that have evaluated the prognostic impact of clinical and pathologic parameters. The purpose of this study was to perform a comprehensive analysis of the Cleveland Clinic experience with small-bowel adenocarcinoma, with emphasis on histopathologic parameters as prognostic indicators. METHODS: Thirty-seven cases of primary small-bowel adenocarcinomas resected at the Cleveland

Neil A. Abrahams; Amy Halverson; Victor W. Fazio; Lisa A. Rybicki; John R. Goldblum

2002-01-01

2

The Role of Defective Mismatch Repair in Small Bowel Adenocarcinoma in Celiac Disease  

Microsoft Academic Search

Celiac disease is associated with an increased risk of small bowel adenocarcinoma. The aims of this study were to investigate the molecular basis, assess outcomes, and identify clinicopathologic characteristics of small bowel adenocarcinoma in celiac disease. Retrospective case control cohort study of all celiac disease patients treated at our institution for small bowel adenocarcinoma and matched control patients with sporadic

D. Dean Potter; Joseph A. Murray; John H. Donohue; Lawrence J. Burgart; David M. Nagorney; Jon A. van Heerden; Matthew F. Plevak; Alan R. Zinsmeister; Stephen N. Thibodeau

2004-01-01

3

Retrospective analysis of 119 small bowel adenocarcinoma in chinese patients.  

PubMed

Background: Small bowel adenocarcinoma (SBA) is a rare occurrence and few studies have addressed it adequately, especially in China. Methods: Clinicopathological features, survival and prognostic analysis were retrospectively done in SBA patients admitted between 2001 and 2011 in the People's Liberation Army General Hospital. Results: The study included 68 men and 51 women with a median age of 56.5 year. Tumors mainly occurred in duodenum (93.3%). Abdominal pain was the most frequent symptom (36.8%). Patients (30.3%) who received postoperative adjuvant chemotherapy had an increased, but not significant, median overall survival (MOS) rate compared to those who did not receive chemotherapy (37 vs 35 months, p = .324). One year disease free survival rate was higher in patients receiving postoperative chemotherapy (83.3% vs 71.1%). Patients survived longer in the curative surgery group (median survival time of 49.0 months) than those in the palliative group (7.0 months) (p < .001). Node-negative patients survived longer than node-positive patients (median OS: 49.0 vs 21.0 months, p = .004). Depth (95% CI: 1.013-1.517, p = .037), node involvement (95% CI: 1.234-3.890, p = .007), palliative surgery (95% CI, 2.998-10.555, p = .0005), and the site of tumor (95% CI: 0.052-0.970, p = .045) were independent predictors of OS in a multivariate analysis. Conclusions: SBA is rare and there is lack of obvious clinical manifestations. Depth, node involvement, palliative surgery, and the site of tumor are associated with a poor prognosis. Our analysis highlights the need for further studies to find out the exact role of postoperative adjuvant chemotherapy in these patients. PMID:24654694

Guo, Xiao-Chuan; Mao, Zhi-Yuan; Su, Dan; Wang, Li-Jie; Zhang, Ting-Ting; Bai, Li

2014-06-01

4

Adnexal mass: an unusual presentation of small-bowel adenocarcinoma.  

PubMed Central

Malignancy of the small bowel presents unique diagnostic and therapeutic challenges resulting in a delayed diagnosis in many cases. Small-bowel tumors respond poorly to most forms of treatment. Metastatic lesions to the ovaries comprise a small percentage of all ovarian malignant neoplasms. Ovarian metastases from primary small-bowel tumors are often difficult to differentiate from primary ovarian tumors. Only few reports have described ovarian metastases from small-bowel sources. A high index of suspicion can lead to an earlier diagnosis and can have an impact on the therapeutic options as well as the survival of the patients. The current report also underscores the importance of careful review of symptoms, investigative studies and pathology. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5

Husain, Syed; Thompson, Daniel; Thomas, Louys; Donaldson, Brian; Sabbagh, Raja

2006-01-01

5

Small Bowel Adenocarcinoma Presenting with Refractory Iron Deficiency Anemia - Case Report and Review of Literature  

PubMed Central

Cancers of the small bowel are relatively rare and account for approximately 1–2% of all gastrointestinal neoplasms. The most common histologic subtype – adenocarcinoma – constitutes 40% of all cases. These cancers generally present with vague abdominal discomfort and are often diagnosed at a late stage and carry a poor prognosis. The treatment of choice of early-stage small bowel adenocarcinoma is surgical resection. No standard treatment protocol has been defined for unresectable or metastatic disease. Here, we report a case of a 56-year-old woman who presented with unexplained iron deficiency anemia. Extensive initial studies with serial CT scans of the abdomen, esophagogastroduodenoscopy, small bowel capsule endoscopy and colonoscopy were noncontributory. She was later found to have a metastatic small bowel adenocarcinoma and treated with palliative chemotherapy. She achieved a modest response to the treatment. Interestingly, in our case, the sole presentation was unexplained iron deficiency anemia. Physician's awareness regarding the possibility of small bowel cancer especially in the setting of iron deficiency and its workup has been emphasized. This enhances the chance of early detection and hence better survival.

Poddar, Nishant; Raza, Shahzad; Sharma, Bhawna; Liu, Ming; Gohari, Arash; Kalavar, Madhumati

2011-01-01

6

Adenocarcinoma arising in a cystic duplication of the small bowel: case report and review of literature  

PubMed Central

Enteric duplications are rare, but can occur anywhere along the digestive tract. Most of the patients become symptomatic in early childhood and only a few cases of adult patients have been reported in literature. Here we report a unique case of an adenocarcinoma arising in a coincidentally found cystic duplication of the small bowel.

2012-01-01

7

Pathogenesis and Risk Factors of Small Bowel Adenocarcinoma: A Colorectal Cancer Sibling?  

Microsoft Academic Search

Small bowel adenocarcinoma (SBA) is a very rare entity accounting for one-fourth of the small intestine neoplasms. Usually accompanied by nonspecific symptoms occurring late in the course of the disease, they are associated with a dismal prognosis. It appears that SBA shares several genetic characteristics with large bowel tumors, but also has unique features. The purpose of this article is

Thierry Delaunoit; Florence Neczyporenko; Paul J. Limburg; Charles Erlichman

2005-01-01

8

Adenocarcinoma arising in a cystic duplication of the small bowel: case report and review of literature.  

PubMed

Enteric duplications are rare, but can occur anywhere along the digestive tract. Most of the patients become symptomatic in early childhood and only a few cases of adult patients have been reported in literature. Here we report a unique case of an adenocarcinoma arising in a coincidentally found cystic duplication of the small bowel. PMID:22490125

Blank, Gregor; Königsrainer, Alfred; Sipos, Bence; Ladurner, Ruth

2012-01-01

9

Unusually early presentation of small-bowel adenocarcinoma in a patient with Peutz-Jeghers syndrome  

PubMed Central

Peutz-Jeghers (PJS) syndrome is an autosomal dominant cancer predisposition syndrome characterized by melanotic macules, and hamartomatous polyps. Small-bowel surveillance in the pediatric PJS population is not designed to identify small-bowel malignancy which is thought to arise in adulthood. A 13 year old male presented with lead-point intussusception, requiring emergent surgical resection. A mucinous adenocarcinoma was found arising from high-grade dysplasia within a polyp. Based on these findings and mucosal pigmentation he was diagnosed with PJS. DNA sequencing revealed a heterozygous c.921-1G>T STK11 mutation. This case is the earliest onset of small-bowel carcinoma in PJS, an observation relevant to surveillance guidelines.

Wangler, Michael F.; Chavan, Rishikesh; Hicks, M. John; Nuchtern, Jed.G.; Hegde, Madhuri; Plon, Sharon E.; Thompson, Patrick A.

2013-01-01

10

Gastroesophageal heterotopia and HER2/neu overexpression in an adenocarcinoma arising from a small bowel duplication.  

PubMed

Small bowel duplications are congenital structures commonly lined by heterotopic gastric or pancreatic mucosa. Though benign in children, small bowel duplications have the potential for malignant degeneration in adulthood. Here, we present the first reported case of metastatic adenocarcinoma arising from a small bowel duplication lined by gastroesophageal mucosa. The cancer demonstrated overexpression of the HER2/neu oncoprotein and amplification of the HER2/neu gene. This represents the only report of HER2 overexpression in this type of lesion. The patient is being treated with traditional chemotherapeutic agents in addition to monoclonal antibody therapy directed at the HER2 protein, and has demonstrated a clinical benefit from treatment. This case demonstrates that the anatomic location of a mass may be distinct from its biological origin, and this difference may have important practical implications for diagnostic testing and treatment. PMID:24576036

Nussbaum, Daniel P; Bhattacharya, Syamal D; Jiang, Xiaoyin; Cardona, Diana M; Strickler, John H; Blazer, Dan G

2014-03-01

11

Adenocarcinoma of the upper small bowel complicating coeliac disease.  

PubMed Central

Adenocarcinoma of the small intestine complicating coeliac disease is uncommon. Only 14 cases have been reported, and in only one of these was a jejunal biopsy carried out more than eight months before the diagnosis of malignancy. We describe four more patients with this association, all with long histories of coeliac disease, confirmed in three by jejunal biopsy over five years before the diagnosis of malignancy. Important presenting features of carcinoma were abdominal pain, anaemia, occult gastrointestinal bleeding, abdominal mass, and intestinal obstruction, and these were the main indications for operation. After resection of the tumour survival may be prolonged, as evidenced by one of our cases who remains well eight years after surgery.

Holmes, G K; Dunn, G I; Cockel, R; Brookes, V S

1980-01-01

12

Occupation and small bowel adenocarcinoma: a European case-control study  

Microsoft Academic Search

OBJECTIVESBecause of the rarity of small bowel adenocarcinoma (SBA), little is known about the aetiology of this disease. This study aimed to identify occupational clustering of cases SBA as a systematic approach to new hypotheses on the aetiology of this disease.METHODSA European multicentre case-control study was conducted in 1995–7, inclusive. Incident cases aged 35–69 years with SBA (n=168) were recruited

Linda Kaerlev; Peter Stubbe Teglbjaerg; Svend Sabroe; Henrik A Kolstad; Wolfgang Ahrens; Mikael Eriksson; Agustin Llopis González; Pascal Guénel; Lennart Hardell; Guy Launoy; Enzo Merler; Franco Merletti; María M Morales Suárez-Varela; Andreas Stang

2000-01-01

13

Small bowel adenocarcinoma in Crohn disease: CT-enterography features with pathological correlation  

Microsoft Academic Search

Purpose  The aim of this study was to analyze the clinical, pathological, and CT-enterography findings of small bowel adenocarcinomas\\u000a in Crohn disease patients.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Clinical, histopathological, and imaging findings were retrospectively evaluated in seven Crohn disease patients with small\\u000a bowel adenocarcinoma. CT-enterography examinations were reviewed for morphologic features and location of tumor, presence\\u000a of stratification, luminal stenosis, proximal dilatation, adjacent

Philippe Soyer; Lora Hristova; Frank Boudghène; Christine Hoeffel; Xavier Dray; Valérie Laurent; Elliot K. Fishman; Mourad Boudiaf

14

Adenocarcinoma with adenoma in the jejunum suggesting an adenoma-carcinoma sequence in the small bowel: A case report  

PubMed Central

Other than that in the duodenum, adenocarcinoma in the small bowel is rare. The present study describes a case of adenocarcinoma with adenoma in the jejunum. A 70-year-old male was admitted to hospital due to dehydration induced by abdominal discomfort and difficulty with oral intake. Computed tomography revealed a tumor in the upper side of the jejunum, which was subsequently resected. The tumor contained adenocarcinoma and adenoma. The protein expression of p53 and Ki-67 was analyzed in the normal mucosa, adenoma and adenocarcinoma. The number of epithelial cells expressing p53 and Ki-67 was found to increase in the adenoma tissue compared with that in the normal mucosa. In the adenocarcinoma tissue, the number of cells expressing p53 and Ki-67 further increased, suggesting that an adenoma-adenocarcinoma sequence may occur in the small bowel, similar to that observed in the large bowel.

NAKANO, YORIKA; ADACHI, YASUSHI; OKAMOTO, HIDEKI; KIYAMA, YOSHIAKI; KOYAMA, TAKASHI; NAKAMURA, SHIN-ICHI; LI, QING; SAKAIDA, NORIKO; UEMURA, YOSHIKO; IKEHARA, SUSUMU

2014-01-01

15

Small bowel adenocarcinoma - terra incognita: A demand for cross-national pooling of data  

PubMed Central

To date, due to the rarity, tumor biology and carcinogenesis of small bowel adenocarcinoma (SBA), the disease has been explored insufficiently and immunophenotyping and molecular characterization have not been finalized. This knowledge gap consecutively leads to an overt lack of diagnostic and therapeutic recommendations. In the current study, we provide our experience with the treatment of SBA, and demand for cross-national data pooling to enable unlimited information transfer and higher powered study. A comprehensive database of all patients with SBA was established and consecutively reviewed for clinicopathohistological data, information concerning preoperative evaluation, surgical and chemotherapeutical treatment, as well as outcome parameters. Patients underwent curative intended surgery (42.4%; n=14), adjuvant chemotherapy (CTX) following resection (36.4%; n=12) or palliative care (21.2%; n=7). The majority of patients were diagnosed at an advanced disease stage (pT3, 36.4%; pT4, 39.4%) and the duodenum was the most common tumor site (57.1%; n=20). Complete surgical resection was achieved in 88.5% of patients, while postoperative complications occurred in 19.4%. Within a mean follow-up period of 31.4 months, 17 patients succumbed to the disease following a median survival time of 11 months. Mean overall survival (OS) was 47.4, 25.3 and 9.8 months for surgically, surgically and chemotherapeutically and palliatively treated patients, respectively. Early surgical resection remains the mainstay in the treatment of localized SBA, since it is associated with a prolongation of OS. The role of neoadjuvant and adjuvant CTX has not yet been defined. Thus, since no consensus exists on the adequate treatment of these malignancies, we demand an international collaboration and cross-national data pooling to pave the way for the implementation of evidence-based standard care operating procedures.

SCHWAMEIS, KATRIN; SCHOPPMANN, SEBASTIAN FRIEDRICH; STIFT, JUDITH; SCHWAMEIS, MICHAEL; STIFT, ANTON

2014-01-01

16

Small bowel radiology  

SciTech Connect

This book deals mainly with technique, experiences and results of the biphasic small bowel enema (enteroclysis) with barium and methyl cellulose. The method allows the evaluation of both morphology and function of the small bowel. The introduction describes the examination technique, basic patterns, interpretation and indications, while the atlas shows a broad spectrum of small bowel diseases (Crohn's disease, other inflammatory diseases, tumors, motility disorders, obstructions and malformations). The possibilities of small bowel radiology are demonstrated with reference to clinical findings and differential diagnoses.

Antes, G.; Eggemann, F.

1987-01-01

17

Small bowel fistulas  

Microsoft Academic Search

Most external small bowel fistulas follow surgical operation, but a few develop spontaneously. Seventy percent will close with conservative treatment including vigorous nutritional support and elimination of sepsis. Internal fistulas involving the small bowel always result from extension of disease in the bowel or in adjacent viscera, and they virtually never close spontaneously. Our 11-year experience of 71 Crohn's fistulas

Baldasarre Sansoni; Miles Irving

1985-01-01

18

Small bowel lymphoma  

Microsoft Academic Search

Opinion statement  Treatment of small bowel lymphoma requires the expertise of medical and surgical subspecialists. The two most important factors\\u000a that determine the optimal treatment are histology and staging of small bowel lymphoma. Other factors that may affect treatment\\u000a include age, multiple areas of involvement, tumor size, and perforation. At present, the best treatment for gastrointestinal\\u000a lymphoma (stage IE disease) is

Renard A. Rawls; Kenneth J. Vega; Bruce W. Trotman

2003-01-01

19

Small bowel neoplastic disease: demonstration by MRI.  

PubMed

This study demonstrates the appearance of small bowel tumors on MR images. Sixteen patients with tumors involving small bowel were studied by MRI. All tumors were proven with histopathology. Eleven patients had primary tumors of the small bowel, which included the following: four carcinoid tumors, three adenocarcinomas, two lymphomas, one leiomyosarcoma, and one leiomyoma. Five patients had recurrent or metastatic disease to small bowel: two patients had colon cancer, one patient had pancreatic cancer, one patient had uterine leiomyosarcoma, and one patient had chloroma (leukemia). MR examination included breath-hold T1-weighted spoiled gradient echo (all patients), immediate postgadolinium-spoiled gradient echo (10 patients), and 2 to 4 minutes postgadolinium T1-weighted, fat-suppressed images (all patients). Tumor size, local extent, signal intensity, and enhancement features of tumor and adjacent tissue were determined. Tumor ranged in diameter from 1 to 9 cm (mean, 4.0 cm). Tumors had similar signal intensity to normal small bowel on precontrast images. Fourteen malignant tumors showed heterogeneous enhancement greater than adjacent bowel on gadolinium-enhanced images. Tumor local extent was best shown on precontrast-spoiled gradient-echo images and postgadolinium T1-weighted fat-suppressed images. Image quality was most consistent on breath-hold images. The results of this study show that small bowel tumors are demonstrable on MR images. Precontrast breath-hold T1-weighted spoiled gradient-echo images and gadolinium-enhanced fat suppressed images demonstrate tumor extent most reliably. PMID:8956128

Semelka, R C; John, G; Kelekis, N L; Burdeny, D A; Ascher, S M

1996-01-01

20

Small Bowel Transplant  

PubMed Central

EXECUTIVE SUMMARY Objective The Medical Advisory Secretariat undertook a review of the evidence on the effectiveness and cost-effectiveness of small bowel transplant in the treatment of intestinal failure. Small Bowel Transplantation Intestinal failure is the loss of absorptive capacity of the small intestine that results in an inability to meet the nutrient and fluid requirements of the body via the enteral route. Patients with intestinal failure usually receive nutrients intravenously, a procedure known as parenteral nutrition. However, long-term parenteral nutrition is associated with complications including liver failure and loss of venous access due to recurrent infections. Small bowel transplant is the transplantation of a cadaveric intestinal allograft for the purpose of restoring intestinal function in patients with irreversible intestinal failure. The transplant may involve the small intestine alone (isolated small bowel ISB), the small intestine and the liver (SB-L) when there is irreversible liver failure, or multiple organs including the small bowel (multivisceral MV or cluster). Although living related donor transplant is being investigated at a limited number of centres, cadaveric donors have been used in most small bowel transplants. The actual transplant procedure takes approximately 12-18 hours. After intestinal transplant, the patient is generally placed on prophylactic antibiotic medication and immunosuppressive regimen that, in the majority of cases, would include tacrolimus, corticosteroids and an induction agent. Close monitoring for infection and rejection are essential for early treatment. Medical Advisory Secretariat Review The Medical Advisory Secretariat undertook a review of 35 reports from 9 case series and 1 international registry. Sample size of the individual studies ranged from 9 to 155. As of May 2001, 651 patients had received small bowel transplant procedures worldwide. According to information from the Canadian Organ Replacement Register, a total of 27 small bowel transplants were performed in Canada from 1988 to 2002. Patient Outcomes The experience in small bowel transplant is still limited. International data showed that during the last decade, patient survival and graft survival rates from SBT have improved, mainly because of improved immunosuppression therapy and earlier detection and treatment of infection and rejection. The Intestinal Transplant Registry reported 1-year actuarial patient survival rates of 69% for isolated small bowel transplant, 66% for small bowel-liver transplant, and 63% for multivisceral transplant, and a graft survival rate of 55% for ISB and 63% for SB-L and MV. The range of 1-year patient survival rates reported ranged from 33%-87%. Reported 1-year graft survival rates ranged from 46-71%. Regression analysis performed by the International Transplant Registry in 1997 indicated that centres that have performed at least 10 small bowel transplants had better patient and graft survival rates than centres that performed less than 10 transplants. However, analysis of the data up to May 2001 suggests that the critical mass of 10 transplants no longer holds true for transplants after 1995, and that good results can be achieved at any multiorgan transplant program with moderate patient volumes. The largest Centre reported an overall 1-year patient and graft survival rate of 72% and 64% respectively, and 5-year patient and graft survival of 48% and 40% respectively. The overall 1-year patient survival rate reported for Ontario pediatric small bowel transplants was 61% with the highest survival rate of 83% for ISB. The majority (70% or higher) of surviving small bowel transplant recipients was able to wean from parenteral nutrition and meet all caloric needs enterally. Some may need enteral or parenteral supplementation during periods of illness. Growth and weight gain in children after ISB were reported by two studies while two other studies reported a decrease in growth velocity with no catch-up growth. The quality of life after SBT was reported to be comparable t

2003-01-01

21

Small bowel enteroscopy  

PubMed Central

Over the past decade, the advent of capsule endoscopy and balloon-assisted enteroscopy has revolutionized the approach to small intestinal diseases. The small bowel is no longer out of reach, and has fallen within the diagnostic and therapeutic realm of the gastrointestinal endoscopist. Double-balloon enteroscopy was the first type of balloon-assisted endoscopy and is the method for which there are the most data. Single-balloon enteroscopy has since been introduced as an alternative balloon-assisted method, followed more recently by the development of spiral overtube-assisted enteroscopy. The purpose of the present article is to review these methods of small bowel enteroscopy and to discuss the latest developments. While the investigation of small bowel diseases cannot be addressed without considering the central role of capsule endoscopy, a detailed assessment is beyond the scope of the present article, and capsule endoscopy will only be discussed as it pertains to enteroscopy.

Teshima, Christopher W; May, Gary

2012-01-01

22

Small bowel obstruction  

Microsoft Academic Search

Opinion statement  The optimal treatment of patients with small bowel obstruction should be predicated upon answering the following diagnostic\\u000a questions in each patient: 1) does the patient have mechanical bowel obstruction or an ileus?, 2) could the patient have colonic\\u000a obstruction or a cause of obstruction other than adhesions (eg, hernia, cancer, Crohn’s disease)?, 3) is the obstruction partial or complete?,

Joshua M. Cooper; Richard C. Thirlby

2002-01-01

23

Small Bowel Hamartoma: A Huge Diverticulum of Small Bowel  

PubMed Central

A-20-year old male, with no significant medical history, presented with clinical features mimicking a perforated acute appendicitis. Because of features of peritonitis, a laparotomy was performed which showed a segment of small bowel with multiple large diverticula and mesenteric cysts. A segmental small bowel resection was performed. The patient made an uneventful recovery from surgery. Histology revealed features of a small bowel hamartoma.

Eltweri, Amar M.; Salama, Yahya; Gorgees, Neshtman; Naidu, Leena; Bowrey, David J.

2013-01-01

24

X-ray induced electron emission  

Microsoft Academic Search

The development and use of a magnetic spectrograph for the measurement of X-ray induced electron emission is described. Results are presented for metal and dielectric targets ranging in atomic number from Z=6 to Z-82. Materials studied were lead, tantalum, copper, aluminum, magnesium, solar cell cover glass, silica cloth, thermal control paint, Kevlar, Mylar, and conducting\\/nonconducting epoxy. Direct measurement was made

C. A. Aeby

1982-01-01

25

Small bowel and colon perforation.  

PubMed

For patients with small bowel and colonic perforations, a definitive diagnosis of the cause of perforation is not necessary before operation. Bowel obstruction and inflammatory bowel disease are the most common causes of nontraumatic intestinal perforations in industrialized countries, whereas infectious causes of intestinal perforations are more common in developing countries. Treatment of small bowel and colonic perforations generally includes intravenous antibiotics and fluid resuscitation, but the specific management of the bowel depends on the underlying cause of the perforation. PMID:24679432

Brown, Carlos V R

2014-04-01

26

Severe adhesive small bowel obstruction.  

PubMed

Adhesive small bowel obstruction is a frequent cause of hospital admission. Water soluble contrast studies may have diagnostic and therapeutic value and avoid challenging demanding surgical operations, but if bowel ischemia is suspected, prompt surgical intervention is mandatory. A 58-year-old patient was operated for extensive adhesive small bowel obstruction after having had two previous laparotomies for colorectal surgery, and had a complex clinical course with multiple operations and several complications. Different strategies of management have been adopted, including non-operative management with the use of hyperosmolar water soluble contrast medium, multiple surgical procedures, total parenteral nutrition (TPN) support, and finally use of antiadherences icodextrin solution. After 2 years follow-up the patient was doing well without presenting recurrent episodes of adhesive small bowel obstruction. For patients admitted several times for adhesive small bowel obstruction, the relative risk of recurring obstruction increases in relation to the number of prior episodes. Several strategies for non-operative conservative management of adhesive small bowel obstruction have already addressed diagnostic and therapeutic value of hyperosmolar water soluble contrast. According to the most recent evidence-based guidelines, open surgery is the preferred method for surgical treatment of strangulating adhesive small bowel obstruction as well as after failed conservative management. Research interest and clinical evidence are increasing in adhesions prevention. Hyaluronic acid-carboxycellulose membrane and icodextrin may reduce incidence of adhesions. PMID:23054502

Di Saverio, Salomone; Catena, Fausto; Kelly, Michael D; Tugnoli, Gregorio; Ansaloni, Luca

2012-12-01

27

Incidence of Small Bowel Cancer in the United States and Worldwide: Geographic, Temporal, and Racial Differences  

Microsoft Academic Search

Objective: To examine the demographic and geographic patterns of small bowel cancer incidence in the United States and worldwide. Methods: Incidence data from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 to 2000 were used to analyze the four histologic types of small bowel cancer, adenocarcinomas, carcinoid tumors, lymphomas, and sarcomas. International comparisons were made using data from

Tmirah Haselkorn; Alice S. Whittemore; David E. Lilienfeld

2005-01-01

28

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

2013-01-01

29

Small Bowel and Liver/Small Bowel Transplantation in Children  

PubMed Central

A clinical trial of intestinal transplantation was initiated at the University of Pittsburgh in May 1990. Eleven children received either a combined liver/small bowel graft (n = 8) or an isolated small bowel graft (n = 3). Induction as well as maintenance immunosuppression was with FK-506 and steroids. Four patients were male, and seven were female; the age range was 6 months to 10.2 years. There were 3 deaths (all in recipients of the combined liver/small bowel graft), which were attributed to graft-versus-host disease (n = 1), posttransplant lymphoproliferative disease (n = 1), and biliary leak (n = 1). Transplantation of the intestine has evolved into a feasible operation, with an overall patient and graft survival rate of 73%. These survivors are free of total parenteral nutrition, and the majority are home. These encouraging results justify further clinical trials.

Reyes, Jorge; Tzakis, Andreas G.; Todo, Satoru; Nour, Bakr; Starzl, Thomas E.

2010-01-01

30

X-ray induced electron emission  

NASA Astrophysics Data System (ADS)

The development and use of a magnetic spectrograph for the measurement of X-ray induced electron emission is described. Results are presented for metal and dielectric targets ranging in atomic number from Z=6 to Z-82. Materials studied were lead, tantalum, copper, aluminum, magnesium, solar cell cover glass, silica cloth, thermal control paint, Kevlar, Mylar, and conducting/nonconducting epoxy. Direct measurement was made of the quantum yield and energy distribution of electrons emitted at angles of 0 deg, 30 deg, 45 deg and 60 deg with respect to the surface normal of targets exposed to normal incidence filtered and unfiltered 50 kV bremsstrah lung X-rays. Experimental results are compared with previous measurements where possible, and with computer code predictions where predictive capability matches the measurement range. The experimental results corroborates the cos theta angular dependence predicted by simple theoretical models, particularly for medium and high Z materials. A trend toward isotropic emission distribution is noted for the lower Z materials. Compared to the measured results, the emission yields predicted by a commonly used analytical model are low by approximately a factor of 2 for the unfiltered X-ray spectrum.

Aeby, C. A.

1982-04-01

31

Magnetic resonance imaging of small bowel neoplasms  

PubMed Central

Abstract Magnetic resonance (MR) imaging is rapidly increasing clinical acceptance to evaluate the small bowel and can be the initial imaging method to investigate small bowel diseases. MR examinations may provide the first opportunity to detect and characterize tumours of the small bowel. Intra- and extraluminal MR findings, combined with contrast enhancement and functional information, help to make an accurate diagnosis and consequently characterize small bowel neoplasms. MR enteroclysis should be recommended for the initial investigation in patients suspected of having small bowel tumours. In this article, the MR findings of primary small bowel neoplasms are described and the MR findings for the differential diagnosis are discussed.

Casciani, Emanuele; Polettini, Elisabetta; Laghi, Francesca; Gualdi, Gianfranco

2013-01-01

32

Recurrent adhesive small bowel obstruction  

Microsoft Academic Search

Adhesive obstruction of the small bowel complicates about 5% of laparotomies; of these, 5–10% have recurrent attacks. The etiology of adhesions is incompletely understood and attempts to prevent their formation are of unproven value. Patients with recurrent acute obstruction that threatens strangulation, or that fails to subside, require laparotomy. If numerous adhesions have to be divided, it is worth considering

Peter F. Jones; Alexander Munro

1985-01-01

33

Small bowel intussusception in adults.  

PubMed

Intussusception is the telescoping of a proximal segment of the gastrointestinal tract into an adjacent distal segment. This rare form of bowel obstruction occurs infrequently in adults. We report a case of small bowel intussusception in an adult male patient. We have also performed a literature review of this rare condition. PMID:24417823

Potts, J; Al Samaraee, A; El-Hakeem, A

2014-01-01

34

Utility of positron emission tomography/CT in the evaluation of small bowel pathology  

PubMed Central

We describe the management principles and different roles of positron emission tomography (PET)/CT in the evaluation of patients with small bowel tumours (adenocarcinoma, gastrointestinal stromal tumour, lymphoma, metastases) from initial staging, monitoring response to treatment, to detection of recurrent disease. We also discuss the various non-malignant aetiologies of small bowel fludeoxyglucose (FDG) PET uptake, and other pitfalls in FDG PET/CT interpretation. Awareness of the imaging appearances of small bowel tumours, patterns of disease spread and potential PET/CT interpretation pitfalls are of paramount importance to optimise diagnostic accuracy.

Cronin, C G; Scott, J; Kambadakone, A; Catalano, O A; Sahani, D; Blake, M A; Mcdermott, S

2012-01-01

35

Living Related Small Bowel Transplantation  

PubMed Central

Objective: To describe a standardized technique for ileal graft procurement in the setting of living related bowel transplantation. Summary Background Data: Living donor transplantation has been successfully developed for kidney, liver, pancreas, and lung transplantation. More recently, living related small bowel transplantation (LR-SBTx) has been developed with the aim of expanding the pool of intestinal graft donors and reducing the mortality in patients on the waiting list. To date, a total of 25 LR-SBTx worldwide have been reported to the international registry. We herein report the largest single center experience. Methods: A segment of ileum, 150 to 200 cm, is resected 20 cm proximal to the ileocecal valve (ICV), which is always preserved. The arterial inflow is given by the terminal branch of the superior mesenteric artery and venous outflow by a proximal segment of the superior mesenteric vein. The entire bowel is measured intraoperatively and at least 60% of intestine length is left in the donor. Results: Since 1998, we have performed 9 terminal ileum resections for small bowel donation. None of the donors has experienced persistent alteration of bowel habits or malabsorption; only 1 minor wound complication has occurred. Conclusions: Terminal ileal resection with preservation of the ICV seems to assure fast functional recovery of the donor and has minimal postoperative complications.

Testa, Giuliano; Panaro, Fabrizio; Schena, Stefano; Holterman, Mark; Abcarian, Herand; Benedetti, Enrico

2004-01-01

36

Oral Urografin in Postoperative Small Bowel Obstruction  

Microsoft Academic Search

.   The aim of our study was to determine whether Urografin has the potential to offer surgeons a way of differentiating complete\\u000a from partial small bowel obstruction and whether partial small bowel obstruction can be treated nonoperatively. Altogether\\u000a 116 patients who had postoperative small bowel obstructions without any toxic signs underwent Urografin studies. Urografin\\u000a (40 ml) mixed with 40 ml

Shyr-Chyr Chen; King-Jen Chang; Po-Huang Lee; Shih-Ming Wang; Kai-Mo Chen; Fang-Yue Lin

1999-01-01

37

Noninflammatory conditions of the small bowel.  

PubMed

Magnetic resonance (MR) imaging has been playing an evolving role in evaluating noninflammatory small-bowel conditions, such as tumors and malabsorption syndrome. MR imaging has shown to be superior to other diagnostic methods in identifying tumors of the small bowel. MR enterography and MR enteroclysis are both valid for studying noninflammatory conditions of the small intestine, although MR enteroclysis may be considered the modality of choice because of its accuracy in the diagnosis of small-bowel neoplasms. Intraluminal and extraluminal MR findings, combined with contrast-agent enhancement and functional information, help to make an accurate diagnosis and consequently to characterize small-bowel diseases. PMID:24238132

Masselli, Gabriele; Polettini, Elisabetta; Laghi, Francesca; Monti, Riccardo; Gualdi, Gianfranco

2014-02-01

38

Endoscopic techniques for small bowel imaging.  

PubMed

Advances in small bowel enteroscopy have led to an increase in the endoscopic evaluation and management of small bowel disorders. The entire small bowel can now be visualized in a noninvasive manner by capsule endoscopy, while therapeutic management can be performed with deep enteroscopy techniques, including balloon-assisted and spiral enteroscopy. Each of these enteroscopy tools has its unique advantages and disadvantages, which need to be taken into consideration during selection of the appropriate tool. Capsule endoscopy and deep enteroscopy are often used as complementary tests in the evaluation of small bowel disorders. PMID:23182515

Pasha, Shabana F; Leighton, Jonathan A

2013-01-01

39

Small Bowel Endoscopy in Inflammatory Bowel Disease  

PubMed Central

Crohn disease (CD) is a chronic inflammatory bowel disease that affects the entire gastrointestinal tract but is most frequently localized to the large and small bowel. Small bowel endoscopy helps with the differential diagnosis of CD in suspected CD patients. Early diagnosis of CD is preferable for suspected CD conditions to improve chronic inflammatory infiltrates, fibrosis. Small bowel endoscopy can help with the early detection of active disease, thus leading to early therapy before the onset of clinical symptoms of established CD. Some patients with CD have mucosal inflammatory changes not in the terminal ileum but in the proximal small bowel. Conventional ileocolonoscopy cannot detect ileal involvement proximal to the terminal ileum. Small bowel endoscopy, however, can be useful for evaluating these small bowel involvements in patients with CD. Small bowel endoscopy by endoscopic balloon dilation (EBD) enables the treatment of small bowel strictures in patients with CD. However, many practical issues still need to be addressed, such as endoscopic findings for early detection of CD, application compared with other imaging modalities, determination of the appropriate interval for endoscopic surveillance of small bowel lesions in patients with CD, and long-term prognosis after EBD.

Watanabe, Kenji; Kamata, Noriko; Sogawa, Mitsue; Arakawa, Tetsuo

2013-01-01

40

Perforation from endoscopic small bowel biopsy.  

PubMed Central

Two patients, having undergone an apparently straightforward endoscopy with small bowel biopsy, developed a perforation. One, who proved to have normal small bowel mucosa, needed laparotomy and suturing of the duodenal perforation. The other, who had coeliac disease, settled with conservative management.

Scott, B; Holmes, G

1993-01-01

41

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.

1988-10-07

42

Perforated small bowel diverticulitis after gastric bypass.  

PubMed

We report a rare case of complicated jejunal diverticulitis in a patient with previous bariatric surgery. Small bowel diverticulosis is generally considered an inoffensive disease. In this report we describe a case of small bowel perforation in an obese subject who had undergone laparoscopic Roux-en-Y gastric bypass. PMID:24680159

Corcelles, Ricard; Pavel, Mihai; Lacy, Antonio

2014-01-01

43

Mesenteric Pseudocyst of the Small Bowel in Gastric Cancer Patient: A Case Report  

PubMed Central

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.

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

2012-01-01

44

Small bowel emergency surgery: literature's review  

PubMed Central

Emergency surgery of the small bowel represents a challenge for the surgeon, in the third millennium as well. There is a wide number of pathologies which involve the small bowel. The present review, by analyzing the recent and past literature, resumes the more commons. The aim of the present review is to provide the main indications to face the principal pathologies an emergency surgeon has to face with during his daily activity.

2011-01-01

45

Evaluation of small bowel tumors: MR enteroclysis  

Microsoft Academic Search

Magnetic resonance imaging (MRI) of the small bowel has become widely accepted at centers dedicated to the diagnosis and treatment\\u000a of inflammatory bowel disease, due to the method’s diagnostic efficacy. MR enteroclysis is an imaging modality that combines\\u000a the advantages of enteroclysis and multiplanar MR and allows the detection and the manifestations of small bowel diseases\\u000a wherever they are located

Gabriele Masselli; Gianfranco Gualdi

2010-01-01

46

Small bowel emergency surgery: literature's review.  

PubMed

Emergency surgery of the small bowel represents a challenge for the surgeon, in the third millennium as well. There is a wide number of pathologies which involve the small bowel. The present review, by analyzing the recent and past literature, resumes the more commons. The aim of the present review is to provide the main indications to face the principal pathologies an emergency surgeon has to face with during his daily activity. PMID:21214933

Vallicelli, Carlo; Coccolini, Federico; Catena, Fausto; Ansaloni, Luca; Montori, Giulia; Di Saverio, Salomone; Pinna, Antonio D

2011-01-01

47

Left paraduodenal hernia causing small bowel obstruction.  

PubMed

A case of small bowel obstruction secondary to a left paraduodenal hernia is illustrated together with its radiological features and intra-operative appearance. Paraduodenal hernias are rare congenital causes of small bowel obstruction, and various approaches to surgical treatment are available including conventional open and minimally invasive laparoscopic techniques. This case presents one possible option for surgical management and briefly reviews the literature for the various surgical techniques and strategies available to the surgeon when faced with a left paraduodenal hernia. PMID:24771461

Poh, Benjamin R; Sundaramurthy, Senthilkumar R; Mirbagheri, Naseem

2014-07-01

48

Small bowel transplantation—a clinical review  

Microsoft Academic Search

The results of small bowel transplantation improved in the last 5 yr because of the development of new immunomodulating drugs and surgical techniques, as well as better candidate selection. We still need much experience until this procedure will be in routine use for terminal intestinal insufficiency.

Yaron Niv; Eythan Mor; Andreas G Tzakis

1999-01-01

49

Transabdominal Ultrasonography of the Small Bowel  

PubMed Central

In the era of double balloon enteroscopy, capsule endoscopy, CT, and MRI enterography is transabdominal ultrasonography (TUS) underestimated method for evaluation of small bowel pathology. As often initial imagine method in abdominal complaints, nowadays has TUS much better diagnostic potential than two decades ago. High-resolution ultrasound probes with harmonic imaging significantly improve resolution of bowel wall in real time, with possibility to asses bowel peristalsis. Color flow doppler enables evaluation of intramural bowel vascularisation, pulse wave doppler helps to quantificate flow in coeliac and superior mesenteric arteries. Small intestine contrast ultrasonography with oral contrast fluid, as well as contrast enhanced ultrasonography with intravenous microbubble contrast also improves small bowel imaging. We present a review of small intestine pathology that should be detected during ultrasound examinations, discuss technical requirements, advantages and limitations of TUS, typical ultrasound signs of Crohn's disease, ileus, celiac disease, intussusception, infectious enteritis, tumours, ischemic and haemorrhagic conditions of small bowel. In the hands of experienced investigator, despite some significant limitations(obesity, meteorism), is transabdominal ultrasonography reliable, noninvasive and inexpensive alternative method to computerised tomography (CT) and magnetic resonance imaging (MRI) in small bowel examination.

Trnovsky, Peter; Kopacova, Marcela

2013-01-01

50

A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease  

Microsoft Academic Search

Background & Aims: This study was undertaken to prospectively compare the clinical outcomes of small bowel radiographs with the wireless capsule endoscopy. Methods: Twenty-two patients were selected consecutively because of suspected small bowel disease. Two patients were excluded owing to ileal stenosis. Thus, the results of barium follow-through and the Given M2A wireless video capsule (Given Imaging Ltd., Yoqneam, Israel)

Guido Costamagna; Saumil K. Shah; Maria Elena Riccioni; Francesca Foschia; Massimiliano Mutignani; Vincenzo Perri; Amorino Vecchioli; Maria Gabriella Brizi; Aurelio Picciocchi; Pasquale Marano

2002-01-01

51

Non-small-bowel abnormalities identified during small bowel capsule endoscopy  

PubMed Central

AIM: To investigate the incidence of non-small-bowel abnormalities in patients referred for small bowel capsule endoscopy, this single center study was performed. METHODS: Small bowel capsule endoscopy is an accepted technique to investigate obscure gastrointestinal bleeding. This is defined as bleeding from the digestive tract that persists or recurs without an obvious etiology after a normal gastroduodenoscopy and colonoscopy. Nevertheless, capsule endoscopy sometimes reveals findings outside the small bowel, i.e., within reach of conventional endoscopes. In this retrospective single center study, 595 patients undergoing capsule endoscopy between 2003 and 2009 were studied. The incidence of non-small bowel abnormalities was defined as visible abnormalities detected by capsule endoscopy that are located within reach of conventional endoscopes. RESULTS: In 595 patients, referred for obscure gastrointestinal bleeding or for suspected Crohn’s disease, abnormalities were found in 306 (51.4%). Of these 306 patients, 85 (27.7%) had abnormalities within reach of conventional endoscopes; 63 had abnormalities apparently overlooked at previous conventional endoscopies, 10 patients had not undergone upper and lower endoscopy prior to capsule endoscopy and 12 had abnormalities that were already known prior to capsule endoscopy. The most common type of missed lesions were vascular lesions (n = 47). Non-small-bowel abnormalities were located in the stomach (n = 15), proximal small bowel (n = 22), terminal ileum (n = 21), colon (n = 19) or at other or multiple locations (n = 8). Ten patients with abnormal findings in the terminal ileum had not undergone examination of the ileum during colonoscopy. CONCLUSION: A significant proportion of patients undergoing small bowel capsule endoscopy had lesions within reach of conventional endoscopes, indicating that capsule endoscopy was unnecessarily performed.

Hoedemaker, Reinier A; Westerhof, Jessie; Weersma, Rinse K; Koornstra, Jan J

2014-01-01

52

Isolated ileal bezoar causing small bowel obstruction  

PubMed Central

Bezoars are a mass of ingested foreign materials commonly found in stomach in patients with psychiatric problems or history of gastric surgery. Bezoars are classified based on their composition. Frequently encountered are trichobezoars and phytobezoars composed of hair and fibres of fruits and vegetables, respectively. Primary small-bowel bezoars are a rarity and are essentially encountered in patients having small-bowel diseases such as diverticuli, strictures or tumours. Ileal bezoar leading to intestinal obstruction in absence of parent bezoar in stomach is very rare and so we present a case report here. The diagnosis was made on CT scan in which the cause was found to be an ileal bezoar. Surgical resection of the involved segment was performed and diagnosis confirmed on histopathological examination.

Shah, Dharita; Desai, Aditi Bhagirath

2012-01-01

53

Small bowel imaging in managing Crohn's disease patients.  

PubMed

The small bowel is essential to sustain alimentation and small bowel Crohn's disease (CD) may severely limit its function. Small bowel imaging is a crucial element in diagnosing small bowel CD, and treatment control with imaging is increasingly used to optimize the patients outcome. Thereby, capsule endoscopy, Balloon-assisted enteroscopy, and Magnetic resonance imaging have become key players to manage CD patients. In this review, role of small bowel imaging is detailed discussed for use in diagnosing and managing Crohn's disease patients. PMID:22474438

Albert, Jörg G

2012-01-01

54

X-ray induced electron emission. Final report  

SciTech Connect

The development and use of a magnetic spectrograph for the measurement of X-ray induced electron emission is described. Results are presented for metal and dielectric targets ranging in atomic number from Z=6 to Z-82. Materials studied were lead, tantalum, copper, aluminum, magnesium, solar cell cover glass, silica cloth, thermal control paint, Kevlar, Mylar, and conducting/nonconducting epoxy. Direct measurement was made of the quantum yield and energy distribution of electrons emitted at angles of 0 deg, 30 deg, 45 deg and 60 deg with respect to the surface normal of targets exposed to normal incidence filtered and unfiltered 50kV bremsstrah lung X-rays. Experimental results are compared with previous measurements where possible, and with computer code predictions where predictive capability matches the measurement range. The experimental results corroborates the cos theta angular dependence predicted by simple theoretical models, particularly for medium and high Z materials. A trend toward isotropic emission distribution is noted for the lower Z materials. Compared to the measured results, the emission yields predicted by a commonly used analytical model are low by approximately a factor of 2 for the unfiltered X-ray spectrum.

Aeby, C.A.

1982-04-01

55

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)

1994-10-01

56

Laparoscopic-assisted small bowel resection for treatment of adult small bowel intussusception: a case report  

Microsoft Academic Search

BACKGROUND: Intussuception is a rare cause of intestinal obstruction in adults. Diagnosis is often difficult due to the variable and sometimes episodic nature of symptoms. Surgery is the recommended treatment option in adults if the diagnosis is proven. CASE PRESENTATION: We present a case of a 33 year old Caucasian female admitted with a small bowel obstruction and no history

Donald Stewart; Michael Hughes; William W Hope

2008-01-01

57

Small bowel endoscopy and Peutz-Jeghers syndrome.  

PubMed

Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant inherited disease. It is clinically characterized by the development of gastrointestinal hamartomas, mainly located in the small bowel. These hamartomas are prone to complications such as intussusceptions, abdominal complaints and anaemia. Furthermore, patients are at increased risk for developing small bowel cancer. Therefore, regular surveillance of the small bowel is indicated. However, the optimal strategy for surveillance has not been determined yet. This review gives an overview of the different techniques that have been described to examine the small bowel of PJS patients. First, a number of radiologic and endoscopic imaging modalities with diagnostic value are discussed. Secondly, recently developed advanced endoscopy techniques are described that can serve both as a diagnostic and therapeutic tool in the surveillance of the small bowel. Finally, a recommendation is given how to apply these individual techniques for small bowel surveillance in a step-up approach. PMID:22704569

Korsse, Susanne E; Dewint, Pieter; Kuipers, Ernst J; van Leerdam, Monique E

2012-06-01

58

X-Ray Induced Luminescence of Amorphous Silicon Dioxide  

NASA Astrophysics Data System (ADS)

These measurements represent the first comprehensive, systematic study of the x-ray induced luminescence (XRL) of a-SiO2. The XRL was studied over a wide range of x-ray dose for several different samples, varying in critical material parameters, particularly hydroxyl content and oxygen stoichiometry, and manufactured by several different techniques. The equipment, x-ray dose rates, and sample sizes necessary for the detection of the entire visible XRL spectrum were determined. The XRL spectra were numerically deconvolved to yield the dose dependence of the intensities of four Gaussian peaks centered at 1.9, 2.2, 2.6, and 2.75 eV. These peaks were common to all samples studied, but their relative intensities and dose dependence varied. The dose dependence of these peaks was compared to the hydroxyl (OH) content and oxygen stoichiometry of the sample, and correlations made with the dose dependence of paramagnetic defects which have previously been assigned as being responsible for visible photoluminescence. The XRL was also studied after soft thermal annealing and the results compared to the behavior of paramagnetic defects in samples which had undergone similar treatment. It was determined that the present assignments of the defect centers responsible for these luminescence bands cannot be complete, particularly in terms of describing XRL. The dose dependence of the 1.9 eV band cannot be completely explained by permanent non-bridging oxygen hole centers (NBOHC) as is widely reported in the literature. A portion of this signal must be due to centers that are distinct from, but related to, the NBOHC. A model involving transient NBOHC centers was developed which explains discrepancies between the 1.9 eV XRL and the NBOHC concentration. The 2.6 and 2.75 eV bands were determined to be related, with nearly identical dose dependencies. In low- (OH) samples there exists a strong correlation with the E?' center. In high- (OH) materials that correlation was not seen, possibly due to EPR spectra which may have recorded a combination of E?' and E?' centers. A very strong 2.2 eV XRL band was found to be related to an unknown impurity.

Miller, Allen James

1997-12-01

59

An Immunoglobulin G4-Related Sclerosing Disease of the Small Bowel: CT and Small Bowel Series Findings  

PubMed Central

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

Ko, Younghwan; Kim, Jeong Won; Hong, Hye Sook; Yang, Ik; Lee, Yul; Hwang, Daehyun; Min, Seon Jeong

2013-01-01

60

An immunoglobulin G4-related sclerosing disease of the small bowel: CT and small bowel series findings.  

PubMed

Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation. PMID:24043971

Ko, Younghwan; Woo, Ji Young; Kim, Jeong Won; Hong, Hye Sook; Yang, Ik; Lee, Yul; Hwang, Daehyun; Min, Seon Jeong

2013-01-01

61

Intestinal absorption following small-bowel resection.  

PubMed Central

Proximal or distal small-bowel resection was performed on female Wistar rats. Water, glucose, electrolyte, and bile acid absorption from the perfusate was studied in bile-fistula sham-operated rats and in animals 3 months after intestinal resection, using an in-vivo recirculation perfusion system. The jejunum and caecum, but not the colon, showed adaptive increases in intestinal absorption after resection of the ileum, and supranormal bile acid absorption and enhanced glucose, water, and electrolyte absorption were demonstrated in the ileum after jejunal resection. The improvement in diarrhoea observed in some patients after right hemicolectomy may be due to compensatory changes in the residual colon; rectal mucosal thickness becomes significantly increased after right hemicoletomy. Images Fig. 1 Fig. 4

Perry, M.

1975-01-01

62

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

2012-01-01

63

MR imaging of the small bowel in Crohn's disease  

Microsoft Academic Search

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 advantage of these techniques over tradition barium fluoroscopic examinations secondary to improvements in spatial and temporal resolution combined with improved bowel distending agents. The preference of MR vs. CT has been geographical and based

Hassan Siddiki; Jeff Fidler

2009-01-01

64

Small bowel perforation in the premature neonate: congenital or acquired?  

Microsoft Academic Search

To determine the potential aetiological factors of small bowel perforation in the premature neonate, we performed a retrospective chart review of those neonates with spontaneous intestinal perforation (SIP) of the small bowel seen in our tertiary paediatric hospital between January 1980 and December 2000. Data were collected on gestational feto-maternal health, medical interventions prior to perforation and the subsequent operative

A. J. A. Holland; A. Shun; H. C. O. Martin; C. Cooke-Yarborough; J. Holland

2003-01-01

65

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

2012-01-01

66

Laparoscopic Management of Obstructing Small Bowel GIST Tumor  

PubMed Central

Background: Gastrointestinal stromal (GIST) tumors make < 1% of all gastrointestinal neoplasms and 20% of small bowel neoplasms. The most common acute presenting symptom of these tumors is gastrointestinal hemorrhage with obstruction being rare. We discuss our laparoscopic approach to 2 patients with small bowel GIST tumors that presented to our institution with obstruction of the small bowel. Case Presentation: Two patients presented to the emergency department with signs and symptoms of small bowel obstruction. On workup, each was found to have a solid lesion either within or adjacent to the small bowel at the point of obstruction and both were emergently taken to the operating room. The pathologic diagnosis of small bowel GIST tumor was the same in both cases, but the pathophysiologies of the obstructing tumors were different. Results: Both patients underwent laparoscopic surgery with successful resection of the lesions. The details and crucial points of the laparoscopic approach to these tumors are described with specific attention to its appropriateness and safety in treating GIST tumors. Attention to particular details of the manipulation and management of the bowel in the face of obstruction and removal of the lesions is described. Conclusion: The laparoscopic approach to GIST tumors of the small bowel, even in the face of emergent surgery, is a safe method.

Morrison, John E.

2013-01-01

67

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

2011-01-01

68

Small Bowel Pseudomelanosis Associated with Oral Iron Therapy  

PubMed Central

An accumulation of pigment deposits on mucosa, called melanosis or pseudomelanosis, of the small bowel is observed infrequently during endoscopic examination. We describe 6 cases of small bowel pseudomelanosis; the possible etiology of which was chronic iron intake. We observed numerous brown spots in duodenum, jejunum, and terminal ileum during upper and lower endoscopy. Interestingly, all patients have been taking oral iron for several years. Histology showed pigment depositions within macrophages of the lamina propria and a positive Prussian blue stain indicating hemosiderin deposition. Herein, we demonstrate that long term iron therapy may result in pseudomelanosis of small bowel, such as duodenum, jejunum, and ileum.

Kim, Seung Young; Kwon, Bo Sung; Hyun, Jong Jin; Jung, Sung Woo; Koo, Ja Seol; Yim, Hyung Joon; Lee, Sang Woo; Choi, Jai Hyun

2013-01-01

69

Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma.  

PubMed

Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reduction of ileocolic intussusception demonstrated a small bowel tumor in the ileum 15 cm proximal to the ileocecal valve. The intussusception was reduced, and the patient underwent partial resection of the ileum encompassing the small bowel tumor. Histological findings confirmed the diagnosis of lipoma of the small bowel. The patient made a satisfactory recovery and remains well. PMID:21103257

Shiba, Hiroaki; Mitsuyama, Yoshinobu; Hanyu, Ken; Ikeuchi, Kenji; Hayashi, Hirotaka; Yanaga, Katsuhiko

2009-01-01

70

Partial small bowel obstruction: clinical issues and recent technical advances  

Microsoft Academic Search

Mechanical small bowel obstruction (SBO) remains a common clinical problem despite ever-increasing medical and surgical advances.\\u000a The predominant etiology continues to be postoperative adhesions, accounting for approximately two-thirds of all obstructive\\u000a events. As opposed to high-grade or complete small bowel obstruction where the clinical and radiographic findings are typically\\u000a more diagnostic and the treatment plan more defined, partial SBO represents

Michael L. Kendrick

2009-01-01

71

Protein digestion and absorption after massive small bowel resection  

Microsoft Academic Search

The digestion, absorption, and intestinal propulsion of a14C-labeled protein meal were examined in rats with a 70% proximal small bowel resection at one and at six weeks after surgery. In addition, rats were studied one week after 70% small bowel resection plus ileocecal valve bypass. Comparison with sham-operated controls showed no significant impairment of digestion or absorption of the protein

Kimberly J. Curtis; Marvin H. Sleisenger; Young S. Kim

1984-01-01

72

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.

2013-01-01

73

Small bowel intramural hematoma secondary to abdominal massage.  

PubMed

Oral anticoagulant therapy with warfarin is commonly used to prevent thromboembolic event in patients at risk with atrial fibrillation [1]. Spontaneous intramural hematoma of small intestine is rare complication of anticoagulant therapy and occurs in patient who receives excessive warfarin that may result in potentially serious complications. Small bowel intramural hematoma secondary to warfarin therapy is a recognized complication [2]. In the present report, we report an unusual case of small bowel intramural hemorrhage secondary to anticoagulant therapy after abdominal massage. The emergency physicians should be aware that the potential spontaneous small bowel intramural hemorrhage in the patients has a high index of suspicion because most patients are treated nonoperatively with a good outcome. PMID:23380131

Chen, Hsin-Ling; Wu, Chin-Chu; Lin, Aming Chor-Ming

2013-04-01

74

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

2012-01-01

75

Primary Tumours of the Small Bowel and its Mesentery  

PubMed Central

Twenty-seven primary small bowel tumours encountered at the University of Alberta Hospital in a 10-year period have been reviewed. Seventeen symptomatic growths were treated by resection and 10 asymptomatic tumours were discovered incidentally. During this same period, three intramesenteric lipomas were found. Small bowel tumours were malignant in 15 of the 17 symptomatic cases and benign in seven of the nine asymptomatic cases. Carcinoid tumours, malignant lymphomas, non-lymphoid sarcomas and carcinomas were the common malignant neoplasms while adenomas, lipomas, myomas, fibromas and angiomas comprised the majority of benign growths reported. Symptoms of anorexia, anemia, abdominal pain, obstruction and hemorrhage suggest small bowel tumour if commoner pathology has been ruled out. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5

Wiancko, Kenneth B.; MacKenzie, Walter C.

1963-01-01

76

Capsule Endoscopy in the Small Bowel Crohn's Disease  

PubMed Central

CD is a chronic inflammatory disorder associated to mucosal and transmural inflammation of the bowel wall. It is well known that CD can affect the entire gastrointestinal. Therefore, ileocolonoscopy and biopsies of the terminal ileum as well as of each colonic segment to look for microscopic evidence of CD are the first-line procedures to establish the diagnosis. However, it has been observed that up to 30% of the patients have only small bowel involvement. Evaluation of the small bowel has been made with radiological procedures, barium radiography, and abdominal computed tomography or by ileocolonoscopy or enteroscopy, but they have many recognized limitations. CE is undoubtedly a very useful diagnostic tool proposed to observe small-bowel lesions undetectable by conventional endoscopy or radiologic studies. We review different studies that have been published reporting the use of CE in suspected and evaluation of the extension or the recurrence in CD and also its use in pediatric population and its complications.

Arguelles-Arias, Federico; Rodriguez-Oballe, Juan; Duarte-Chang, Calixto; Castro-Laria, Luisa; Garcia-Montes, Josefa Maria; Caunedo-Alvarez, Angel; Herrerias-Gutierrez, Juan Manuel

2014-01-01

77

Diagnosing small bowel Crohn's disease with wireless capsule endoscopy  

PubMed Central

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 conventional modalities, and to determine the diagnostic yield of the M2A Given Capsule. Patients: Seventeen patients (eight males, mean age 40 (15) years) with suspected CD fulfilled study entry criteria: nine had iron deficiency anaemia (mean haemoglobin 10.5 (SD 1.8) g%), eight had abdominal pain, seven had diarrhoea, and three had weight loss. Small bowel x ray and upper and lower gastrointestinal endoscopic findings were normal. Mean duration of symptoms before diagnosis was 6.3 (SD 2.2) years. Methods: Each subject swallowed an M2A Given Capsule containing a miniature video camera, batteries, a transmitter, and an antenna. Recording time was approximately eight hours. The capsule was excreted naturally in the patient’s bowel movement, and the data it contained were retrieved and interpreted the next day. Results: Of the 17 study participants, 12 (70.6%, six males, mean age 34.5 (12) years) were diagnosed as having CD of the small bowel according to the findings of the M2A Given Capsule. Conclusions: Wireless capsule endoscopy diagnosed CD of the small bowel (diagnostic yield of 71%). It was demonstrated as being an effective modality for diagnosing patients with suspected CD undetected by conventional diagnostic methodologies.

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

2003-01-01

78

Small bowel perforation after radiotherapy for cervical carcinoma.  

PubMed

Radiotherapy is the treatment of choice for carcinoma of the uterine cervix. We report on a 62-year-old Chinese woman with cervical carcinoma, in whom a small bowel perforation developed 5 months after radiotherapy. Ten centimetres of small bowel, including the perforation site, were resected. No bowel adhesion was detected during the operation. The postoperative course was uneventful, and the patient was discharged home 7 days after surgery. Histological examination confirmed post-irradiation injury. The presenting complaints of patients with bowel perforation following radiotherapy vary, and signs of peritonitis may be absent. Emergency physicians must be alert for these complications in patients who have been treated with radiotherapy. PMID:14660815

Cheung, C P; Chiu, H S; Chung, C H

2003-12-01

79

Causes of small bowel obstruction after laparoscopic gastric bypass  

Microsoft Academic Search

Background  Small bowel obstruction after laparoscopic Roux-en-Y gastric bypass is not a rare complication, occurring in approximately\\u000a 3% of patients. The goal of this study was to review the causes and timing of small bowel obstruction as an aid to diagnosis,\\u000a treatment, and prevention.\\u000a \\u000a \\u000a \\u000a Methods  The records of consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass at the authors' center from 4\\/99

R. F. Hwang; D. E. Swartz; E. L. Felix

2004-01-01

80

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

2013-01-01

81

Enteroscopy in small bowel Crohn's disease: A review.  

PubMed

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. PMID:24147191

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

2013-10-16

82

Unexpected small bowel intussusception caused by lung cancer metastasis on 18F-fluorodeoxyglucose PET-CT.  

PubMed

Small bowel metastasis from primary lung cancer is rare. We report the case of an unexpected small bowel intussusception caused by primary non-small cell lung cancer, which was primarily detected by 18 fluorine ((18)F)-fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT). A 74-year-old man underwent FDG PET-CT for the diagnostic workup of a lung mass in the left upper lobe. On FDG PET-CT images, intense FDG uptake was observed in the primary lung mass lesion and mediastinal paraesophageal area. Furthermore, unexpected intense FDG uptake was observed in the jejunum along with the findings of intussusception in the proximal jejunum on the CT images of the PET-CT, which suggested jejunojejunal intussusception caused by lung cancer metastasis. The patient underwent an immediate operation, and the histopathologic results of the resected bowel indicated metastatic lesion from adenocarcinoma of the lung. PMID:21095361

Lee, Jeong Won; Kim, Seok-Ki; Park, Ji Won; Lee, Hyun-Sung

2010-12-01

83

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

PubMed

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

2012-11-01

84

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.

2012-01-01

85

Detection of Postoperative Intestinal Ischemia in Small Bowel Transplants  

PubMed Central

Small bowel transplantation is acknowledged as auto- and allotransplantation. In both instances, there is up to a 4%–10% risk of postoperative ischemia, and as the small bowel is extremely susceptible to ischemia, the timely diagnosis of ischemia is important. The location of the transplant, whether it is buried in the abdominal cavity or in the neck region, increases the challenge, as monitoring becomes more difficult and the consequences of neglect more dangerous. All methods for the early detection of postoperative ischemia in small bowel transplants are described together with the requirements of the ideal monitoring method. A small bowel transplant can be inspected directly or indirectly; the blood flow can be monitored by Doppler or by photoplethysmography, and the consequences of the blood flow can be monitored. The ideal monitoring method should be reliable, fast, minimally invasive, safe, objective, easy, cheap, and comfortable. No monitoring methods today fulfill the criteria of the ideal monitoring method, and evidence-based guidelines regarding postoperative monitoring cannot be made. The choice of whether to implement monitoring of ischemia—and if so, which method to choose—has to be made by the individual surgeon or center.

Birke-Sorensen, Hanne

2012-01-01

86

Ultrasound in Crohn’s disease of the small bowel  

Microsoft Academic Search

Objective: The purpose of this work is to prospectively evaluate high resolution ultrasonography with graded compression in the ability to detect Crohn's disease of the small bowel (CDSB) together with its complications and activity signs, compared with enteroclysis, CT and immunoscintigraphy in the mirror of the final diagnosis. Methods and material: In a series of 73 consecutive patients, who were

Zsolt Tarján; Géza Tóth; Tamás Györke; Ádám Mester; Kinga Karlinger; Ern? K Makó

2000-01-01

87

Exocrine pancreatic function in intestinal malabsorption and small bowel disease  

Microsoft Academic Search

Exocrine pancreatic function was studied by means of secretin\\/pancreozymin stimulation in 50 patients with small bowel disease. Forty-five patients had clinical and biochemical evidence of malabsorption. In none of the patients was there evidence of primary pancreatic disease. Impaired amylase or bicarbonate concentration was found in 62% of the patients; however, in only 6 was there gross pancreatic insufficiency and

B. H. Novis; Simmy Bank; I. N. Marks

1972-01-01

88

HNPCC-associated small bowel cancer: Clinical and molecular characteristics  

Microsoft Academic Search

Background & Aims: The risk for small bowel cancer (SBC) is significantly increased in hereditary nonpoly- posis colorectal cancer (HNPCC). HNPCC-associated SBCs are poorly characterized. Methods: Thirty-two SBCs were characterized according to clinical, patho- logic, and germline mutation data. Histomorphologic characteristics, microsatellite instability (MSI) testing, mismatch repair (MMR) protein expression, and frameshift mutations of 7 coding mononucleotide re- peats were

Karsten Schulmann; Frank E. Brasch; Erdmute Kunstmann; Christoph Engel; Constanze Pagenstecher; Holger Vogelsang; Stefan Krüger; Tilman Vogel; Hanns-Peter Knaebel; Josef Rüschoff; Stephan A. Hahn; Magnus V. Knebel-Doeberitz; Gabriela Moeslein; Stephen J. Meltzer; Hans K. Schackert; Christiane Tympner; Elisabeth Mangold; Wolff Schmiegel

2005-01-01

89

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

PubMed

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

2012-05-01

90

Obstructive small bowel metastasis from uterine leiomyosarcoma: a case report.  

PubMed

Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents. PMID:24716034

Tunio, Mutahir A; Alasiri, Mushabbab; Saleh, Rasha M; Akbar, Shomaila Amir; Ali, Nagoud M; Senosy Hassan, Mohamed Abdalazez

2014-01-01

91

Obstructive Small Bowel Metastasis from Uterine Leiomyosarcoma: A Case Report  

PubMed Central

Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents.

Tunio, Mutahir A.; AlAsiri, Mushabbab; Saleh, Rasha M.; Akbar, Shomaila Amir; Ali, Nagoud M.; Senosy Hassan, Mohamed Abdalazez

2014-01-01

92

REVIEW: Small Bowel Review: Normal Physiology Part 1  

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 practising gastroenterologist. Selected important clinical learning points include the following: (1) glucose absorption mediated by SGLT1 is controlled by mRNA

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

2001-01-01

93

Small bowel enema in non-responsive coeliac disease  

Microsoft Academic Search

A small bowel enema was performed in patients with non-responsive coeliac disease, in coeliac patients on a normal diet (untreated) and those who had shown a good response to a gluten free diet, and in control subjects to determine whether there were any specific radiological features of the non-responsive state. A significant reduction in the average number of jejunal folds

N Mike; U Udeshi; P Asquith; J Ferrando

1990-01-01

94

Oral purgative and simethicone before small bowel capsule endoscopy  

PubMed Central

AIM: To evaluate small bowel cleansing quality, diagnostic yield and transit time, comparing three cleansing protocols prior to capsule endoscopy. METHODS: Sixty patients were prospectively enrolled and randomized to one of the following cleansing protocols: patients in Group A underwent a 24 h liquid diet and overnight fasting; patients in Group B followed protocol A and subsequently were administered 2 L of polyethylene glycol (PEG) the evening before the procedure; patients in Group C followed protocol B and were additionally administered 100 mg of simethicone 30 min prior to capsule ingestion. Small bowel cleansing was independently assessed by two experienced endoscopists and classified as poor, fair, good or excellent according to the proportion of small bowel mucosa under perfect conditions for visualization. When there was no agreement between the two endoscopists, the images were reviewed and discussed until a consensus was reached. The preparation was considered acceptable if > 50% or adequate if > 75% of the mucosa was in perfect cleansing condition. The amount of bubbles was assessed independently and it was considered significant if it prevented a correct interpretation of the images. Positive endoscopic findings, gastric emptying time (GET) and small bowel transit time (SBTT) were recorded for each examination. RESULTS: There was a trend favoring Group B in achieving an acceptable (including fair, good or excellent) level of cleansing (Group A: 65%; Group B: 83.3%; Group C: 68.4%) [P = not significant (NS)] and favoring Group C in attaining an excellent level of cleansing (Group A: 10%; Group B: 16.7%; Group C: 21.1%) (P = NS). The number of patients with an adequate cleansing of the small bowel, corresponding to an excellent or good classification, was 5 (25%) in Group A, 5 (27.8%) in Group B and 4 (21.1%) in Group C (P = 0.892). Conversely, 7 patients (35%) in Group A, 3 patients (16.7%) in Group B and 6 patients (31.6%) in Group C were considered to have poor small bowel cleansing (P = 0.417), with significant fluid or debris such that the examination was unreliable. The proportion of patients with a significant amount of bubbles was 50% in Group A, 27.8% in Group B and 15.8% in Group C (P = 0.065). This was significantly lower in Group C when compared to Group A (P = 0.026). The mean GET was 27.8 min for Group A, 27.2 min for Group B and 40.7 min for Group C (P = 0.381). The mean SBTT was 256.4 min for Group A, 256.1 min for Group B and 258.1 min for Group C (P = 0.998). Regarding to the rate of complete examinations, the capsule reached the cecum in 20 patients (100%) in Group A, 16 patients (88.9%) in Group B and 17 patients (89.5%) in Group C (P = 0.312). A definite diagnosis based on relevant small bowel endoscopic lesions was established in 60% of the patients in Group A (12 patients), 44.4% in Group B (8 patients) and 57.8% in Group C (11 patients) (P = 0.587). CONCLUSION: Preparation with 2 L of PEG before small bowel capsule endoscopy (SBCE) may improve small bowel cleansing and the quality of visualization. Simethicone may further reduce intraluminal bubbles. No significant differences were found regarding GET, SBTT and the proportion of complete exploration or diagnostic yield among the three different cleansing protocols.

Rosa, Bruno Joel Ferreira; Barbosa, Mara; Magalhaes, Joana; Rebelo, Ana; Moreira, Maria Joao; Cotter, Jose

2013-01-01

95

Mesenteric cysts associated with recurrent small-bowel volvulus: cause or effect?  

PubMed

Recurrent small-bowel volvulus is a state of recurrent intermittent or long-standing persistent twisting of small-bowel loops around its mesentery. The association of mesenteric cysts with recurrent small-bowel volvulus as the cause or effect is a much debated issue in the literature. We report two cases of mesenteric lymphangioma and one case of enteric duplication cyst seen in association with recurrent small-bowel volvulus of long duration in absence of malrotation. PMID:22986751

Prabhu, Shailesh M; Anand, Rama; Narula, Mahender K; Shetty, Gurucharan S; Udiya, Alok K; Chauhan, Udit; Shukla, Shailaja; Grover, Jitendra Kumar

2012-12-01

96

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

2003-01-01

97

Note: A novel method for in situ loading of gases via x-ray induced chemistry  

SciTech Connect

We have developed and demonstrated a novel method to load oxygen in a sealed diamond anvil cell via the x-ray induced decomposition of potassium chlorate. By irradiating a pressurized sample of an oxidizer (KClO{sub 3}) with either monochromatic or white beam x-rays from the Advanced Photon Source at ambient temperature and variable pressure, we succeeded in creating a localized region of molecular oxygen surrounded by unreacted sample which was confirmed via Raman spectroscopy. We anticipate that this technique will be useful in loading even more challenging, difficult-to-load gases such as hydrogen and also to load multiple gases.

Pravica, Michael; Bai, Ligang; Park, Changyong; Liu, Yu; Galley, Martin; Robinson, John; Bhattacharya, Neelanjan (UNLV); (CIW)

2011-12-14

98

X-ray Induced Effects on Photocurrents in Amorphous Se Films  

NASA Astrophysics Data System (ADS)

Amorphous selenium (a-Se) is one of the X-ray photoconductors that is available for use in recently developed direct conversion flat panel X-ray image detectors for medical imaging. To obtain a better understanding of trapping and recombination effects in a-Se, we have studied light and X-ray induced photocurrents in a-Se films. The residual photocurrent, after X-ray exposure, decreases in sandwich cells whereas it increases in coplanar cells. These effects are recovered over a time scale of hours. We show that the results can be interpreted by using valence alternation pair (VAP) type charged defects.

Shimakawa, Koichi; Fukami, Kenji; Kishi, Hiroki; Belev, George; Kasap, Safa

2007-03-01

99

Imaging of the small bowel: Crohn's disease in paediatric patients  

PubMed Central

In more than 20% of all patients, the Crohn’s disease presents before the age of 18years. The diagnosis and management of Crohn’s disease in children has changed dramatically over the last decade, mainly due to increased awareness, availability of newer diagnostic modalities such as magnetic resonance imaging (MRI) and newer, more powerful treatments such as biologics. Imaging of the small bowel is needed for diagnosis, management, follow-up and also evaluation of the disease in terms of location, extent, activity and complications. We review all the methods (barium examinations, ultrasonography, computed tomography, MR, and computed tomography- positron emission tomography) commonly used for imaging the small bowel in paediatric patients with Crohn’s disease analyzing the advantages and disadvantages of each modality, with particular emphasis on MR imaging.

Casciani, Emanuele; De Vincentiis, Chiara; Polettini, Elisabetta; Masselli, Gabriele; Di Nardo, Giovanni; Civitelli, Fortunata; Cucchiara, Salvatore; Gualdi, Gian Franco

2014-01-01

100

Early solitary small bowel metastasis from stage I cutaneous melanoma  

PubMed Central

Patient Male, 63 Final Diagnosis: Melanoma Symptoms: Gastrointesinal haemorrhage Medication: — Clinical Procedure: Enterectomy Specialty: Oncology Objective: Unusual clinical course Background: It is reported that the time interval between the initial diagnosis of malignant melanoma and the diagnosis of the gastrointestinal metastases is 43.8±11.3 months. Case Report: We present the case of a 63-year-old Caucasian man who was operated on for superficial spreading Stage IB melanoma and 8 months later was diagnosed with solitary small bowel metastasis without other systemic metastases. Conclusions: Small bowel melanoma metastasis should be suspected in any patient with previous history of malignant melanoma who develops symptoms of anemia, gastrointestinal hemorrhage, and non-specific abdominal pain.

Gavriilidis, Paschalis; Efthimiopoulos, Georgios; Zafiriou, Georgios

2013-01-01

101

Small bowel obstruction associated with tension-free vaginal tape  

Microsoft Academic Search

A 73-year-old woman with stress urinary incontinence and uterine prolapse underwent vaginal hysterectomy followed by tension-free vaginal tape (TVT) placement. Postoperatively, she presented with low-grade fever and abdominal distension. Abdominal computed tomography revealed bowel distension and abrupt cutoff of the distended small bowel and normal bowel caliber. Transperitoneal laparotomy demonstrated perforation of the mesentery by the TVT without other injury.

Line Leboeuf; Luis E. Mendez; Angelo E. Gousse

2004-01-01

102

Living-Related Small Bowel Transplantation: Two Cases Experiences  

Microsoft Academic Search

We have recently performed living-related small bowel transplantation for 2 patients. The first patient was a 14-year-old boy with total parenteral nutrition (TPN)–dependent short-bowel syndrome associated with hypoganglionosis of the entire intestine. He received a bowel graft from his 43-year-old mother. The second patient was a 27-year-old woman, who had massive enterectomy due to volvulus and developed vitamin deficiencies and

M. Wada; T. Ishii; T. Kato; K. Nishi; Y. Kawahara; S. Amae; M. Nakamura; S. Yoshida; Y. Hayashi

2005-01-01

103

Small bowel bacterial overgrowth: Presentation, diagnosis, and treatment  

Microsoft Academic Search

Opinion statement  Small bowel bacterial overgrowth (SBBO) syndrome is associated with excessive numbers of bacteria in the proximal small intestine.\\u000a The pathology of this condition involves competition between the bacteria and the human host for ingested nutrients. This\\u000a competition leads to intraluminal bacterial catabolism of nutrients, often with production of toxic metabolites and injury\\u000a to the enterocyte. A complex array of

Virmeet V. Singh; Phillip P. Toskes

2004-01-01

104

Small bowel bacterial overgrowth: Presentation, diagnosis, and treatment  

Microsoft Academic Search

Small bowel bacterial overgrowth (SBBO) syndrome is associated with excessive numbers of bacteria in the proximal small intestine.\\u000a The pathology of this condition involves competition between the bacteria and the human host for ingested nutrients. This\\u000a competition leads to intraluminal bacterial catabolism of nutrients, often with production of toxic metabolites and injury\\u000a to the enterocyte. A complex array of clinical

Virmeet V. Singh; Phillip P. Toskes

2003-01-01

105

Laparoscopic Treatment of a Postoperative Small Bowel Obstruction  

PubMed Central

We describe the case report of a 25-year-old female who presented with signs and symptoms of bowel obstruction status after laparoscopic treatment of an ectopic pregnancy performed 3 weeks earlier. The patient underwent laparoscopic lysis of adhesions and reduction of small bowel obstruction. This case report presents an atypical cause of postoperative bowel obstruction and reviews the current literature regarding laparoscopic surgery as an approach for treatment.

Neff, Marc

2010-01-01

106

Small Bowel Obstruction After FloSeal Use  

PubMed Central

Objective: FloSeal is a thrombin-gelatin hemostatic matrix that is used to obtain hemostasis. There have been isolated case reports of FloSeal causing bowel obstructions, requiring surgical intervention. We report 3 cases of what we believe were FloSeal-induced small bowel obstructions (SBO). Methods: We present a series of small bowel obstructions after FloSeal use. Our series includes urology, gynecologic oncology, and general surgery cases at the same institution where the product was appropriately used and resulted in the same complication. Results: FloSeal was used for hemostasis in all patients. In each instance, a small bowel obstruction developed in 7 days to 9 days. All patients were reexplored laparoscopically and found to have an intense inflammatory reaction at the site of the FloSeal. The adhesions were lysed and the obstructions resolved. Conclusions: Although further study is needed, the common factor in all these SBOs was a hemostatic agent. In our and others’ series, the time to SBO was 7 days to 9 days. If an early postoperative SBO occurs after FloSeal is used, prompt reexploration should be considered.

Santillan, Antonio

2011-01-01

107

Multivisceral and Small Bowel Transplantation at Shiraz Organ Transplant Center  

PubMed Central

Background: Multivisceral transplantations were initially done in animal models to understand the immunological effects. Later on, in human beings, it has been considered a salvage procedure for unresectable complex abdominal malignancies. With advancement in surgical techniques, availability of better immunosuppressive drugs, and development of better post-operative management protocols, outcomes have been improved after these complex surgical procedures. Objective: To analyze and report results of multivisceral, modified multivisceral, and small bowel transplantations done at Shiraz Organ Transplant Center, Shiraz, southern Iran. Methods: Medical records of all patients who underwent multivisceral, modified multivisceral, and small bowel transplants were retrospectively analyzed. Results: There were 18 patients. The most common indications for the procedure in our series were unresectable carcinoma of pancreas followed by short bowel syndrome. 10 patients were alive after a median follow-up of 8.7 (range: 3–32) months. The remaining 8 patients died post-operatively, mostly from septicemia. Conclusion: Multivisceral and small bowel transplantations are promising treatments for complex abdominal pathologies.

Nikeghbalian, S.; Mehdi, S. H.; Aliakbarian, M.; Kazemi, K.; Shamsaeefar, A.; Bahreini, A.; Mansoorian, M. R.; Malekhosseini, S. A.

2014-01-01

108

Continuous X-ray induced Auger microprobe analysis and microscopy: First results  

NASA Astrophysics Data System (ADS)

X-ray induced Auger electron spectroscopy can be applied to the chemical analysis of thin samples with a spatial resolution in the 10 ?m range. The first experimental results obtained with various anode materials and various samples are reported. The signal intensities (in the range of 10 3 counts/s) are similar to those obtained by using a conventional electron spectrometer with a resolution in the millimeter range. Theoretical considerations together with the results obtained make it possible to evaluate the sensitivity of this technique and suggest how the spatial resolution can be improved further (20 ?m at present, 2-3 ?m in the near future). The radiation damage and sample thickness constraints of this new technique and of conventional Auger electron spectros- copy are compared. Application of X-ray induced Auger analysis to biological objects is suggested and the effect of the present results on scanning X-ray radiography and characteristic X-ray absorption microanalysis is also pointed out.

Nassiopoulos, A. G.; Gramari, D.; Cazaux, J.

1983-06-01

109

Clinical features and prognosis of children assessed for isolated small bowel or combined small bowel and liver transplantation  

Microsoft Academic Search

The hepatic histology and clinical status of 37 children on long-term parenteral nutrition (PN) referred for consideration of small bowel transplantation were determined. Seventy five percent of the children had splenomegaly and plasma bilirubin level of greater than 100 ?mol\\/L. All of 21 children who underwent liver biopsy, had increased fibrosis, but only half had established cirrhosis. Thirty-one children were

S. V Beath; S. J Needham; D. A Kelly; I. W Booth; F Raafat; R. G Buick; J. A. C Buckels; A. D Mayer

1997-01-01

110

An unusual cause of small bowel perforation: apricot pit.  

PubMed

Ingestion of foreign bodies can be a common problem, especially among children, alcoholics, and psychiatric and senile patients. Foreign bodies with smooth edges usually do not pose significant problems, but a sharp foreign object that is not retrieved immediately may penetrate the wall and cause complications. Ingested foreign bodies usually pass the intestinal tract uneventfully, and perforation occurs in less than 1%. In this study, we report a case of small bowel obstruction with perforation in a 73-year-old female due to the accidental swallowing of an apricot pit. PMID:21935813

Atila, Koray; Güler, Sanem; Bora, Seymen; Gülay, Hüseyin

2011-05-01

111

Neonatal intestinal obstruction secondary to a small bowel duplication cyst.  

PubMed

A 3-week-old neonate developed abdominal distension and vomiting which subsided after conservative management. However, there was a recurrence of symptoms for which a lower gastrointestinal tract contrast study was performed. The infant had a filling defect in the area of the transverse colon. A CT scan was performed, showing a duplication cyst arising from the small bowel and indenting the transverse colon. Resection of the duplication cyst and end-to-end anastomosis of the bowel was performed. The duplication cyst was of tubular type, and a sealed perforation was noted in the cyst wall. PMID:25006055

Puralingegowda, Anil Kumar; Mohanty, Pankaj Kumar; Razak, Abdul; Nagesh N, Karthik; Chandrayya, Ramachandra

2014-01-01

112

Meckel's diverticulitis causing small bowel obstruction by a novel mechanism  

PubMed Central

Meckel’s diverticulum occurs in 2% of the general population and majority of patients remain asymptomatic. Gastrointestinal bleeding is the most common presentation in the paediatric population. While asymptomatic and incidentally found Meckel’s diverticulum may be left alone, surgery is essential for treating a symptomatic patient. Despite advances in imaging and technology, pre-operative diagnosis is often difficult. We present a first report of an unusual mechanism of small bowel obstruction due to Meckel’s diverticulitis in a paediatric patient. The diagnosis was only apparent at laparotomy.

Shelat, Vishalkumar G.; Kelvin Li, Kaiwen; Rao, Anil; Sze Guan, Tay

2011-01-01

113

Finding the solution for incomplete small bowel capsule endoscopy  

PubMed Central

AIM: To evaluate whether the use of real time viewer (RTV) and administration of domperidone to patients with delayed gastric passage of the capsule could reduce the rate of incomplete examinations (IE) and improve the diagnostic yield of small bowel capsule endoscopy (SBCE). METHODS: Prospective single center interventional study, from June 2012 to February 2013. Capsule location was systematically checked one hour after ingestion using RTV. If it remained in the stomach, the patient received 10 mg domperidone per os and the location of the capsule was rechecked after 30 min. If the capsule remained in the stomach a second dose of 10 mg of domperidone was administered orally. After another 30 min the position was rechecked and if the capsule remained in the stomach, it was passed into the duodenum by upper gastrointestinal (GI) endoscopy. The rate of IE and diagnostic yield of SBCE were compared with those of examinations performed before the use of RTV or domperidone in our Department (control group, January 2009 - May 2012). RESULTS: Both groups were similar regarding age, sex, indication, inpatient status and surgical history. The control group included 307 patients, with 48 (15.6%) IE. The RTV group included 82 patients, with 3 (3.7%) IE, P = 0.003. In the control group, average gastric time was significantly longer in patients with IE than in patients with complete examination of the small bowel (77 min vs 26 min, P = 0.003). In the RTV group, the capsule remained in the stomach one hour after ingestion in 14/82 patients (17.0%) vs 48/307 (15.6%) in the control group, P = 0.736. Domperidone did not significantly affect small bowel transit time (260 min vs 297 min, P = 0.229). The capsule detected positive findings in 39% of patients in the control group and 49% in the RTV group (P = 0.081). CONCLUSION: The use of RTV and selective administration of domperidone to patients with delayed gastric passage of the capsule significantly reduces incomplete examinations, with no effect on small bowel transit time or diagnostic yield.

Cotter, Jose; de Castro, Francisca Dias; Magalhaes, Joana; Moreira, Maria Joao; Rosa, Bruno

2013-01-01

114

Noninvasive videomicroscopic monitoring of rat small-bowel rejection.  

PubMed

Successful small-bowel transplantation requires an early diagnosis of graft rejection. To date, little is known about macroscopic mucosal alterations during rejection. In the present study, these changes were analyzed in detail. Videomicroscopic monitoring of an enterostoma was performed after allogeneic heterotopic small-bowel transplantation in the rat (BN to LEW). Up to postoperative day (POD) 3 a mucosal edema was noticed (stage I of videomicroscopical alterations). The earliest changes related to rejection appeared on POD 6. The mucosa of the grafted intestine developed patchy paleness and interruptions in mucosal architecture. Crypts were slightly widened and their color turned to dark red (stage IIa). Progressively, these alterations spread over the mucosa on POD 7 (stage IIb). On POD 9, the mucosa appeared pale, villi were shortened, and crypts appeared wide and rounded. The mucosal surface was coated with fibrinous membranes (stage III). The videomicroscopic findings were closely related to the histological grading of rejection. We regard this technique of mucosal monitoring a simple and noninvasive method of detecting allograft rejection. PMID:10188832

Hoppe, H; Gasser, M; Gassel, A M; Vowinkel, T; Timmermann, W; Otto, C; Tykal, K; Thiede, A

1999-01-01

115

Laparoscopic resection of small bowel lipoma causing obscure gastrointestinal bleeding.  

PubMed

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

2012-06-01

116

Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension  

Microsoft Academic Search

The purpose of this study was to compare two osmotic carbohydrate sugar alcohols (mannitol 2.5% and sorbitol 2.5%, 2.0%, and 1.5% watery solutions) in combination with 0.2% locust bean gum (LBG) for small bowel distension for MR imaging. Small bowel distension was quantified on coronal 2D TrueFISP images by measuring the diameters of 16 small bowel loops in each of

Waleed Ajaj; Susanne C. Goehde; Hubert Schneemann; Stefan G. Ruehm; Jörg F. Debatin; Thomas C. Lauenstein

2004-01-01

117

Intestinal distribution of hyaluronan in small bowel allografting in the rat  

Microsoft Academic Search

Hyaluronan (hyaluronic acid: HA) was demonstrated and quantified in small bowel tissue at different times after small bowel transplantation. Semiallogeneic or semisyngeneic rat models were used to elicit either unidirectional graft rejection or graft-versus-host disease (GVHD). In normal rat small bowel, HA was present in the villous lamina propria and around medium-sized vessels in the interstitium of the crypt area.

J. Wallander; R. Hiillgren; A. Scheynius; B. Gerdin; G. Tufveson

1993-01-01

118

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

2012-01-01

119

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

PubMed

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. PMID:22422388

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

2012-06-01

120

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

SciTech Connect

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; Itoh, Chihiro [Department of Materials Science and Chemistry, Wakayama University, Wakayama 640-8510 (Japan)] [Department of Materials Science and Chemistry, Wakayama University, Wakayama 640-8510 (Japan); Kisoda, Kenji [Department of Physics, Wakayama University, Wakayama 640-8510 (Japan)] [Department of Physics, Wakayama University, Wakayama 640-8510 (Japan)

2013-09-21

121

Small Bowel Metastasis of Hepatocellular Carcinoma Detected by Capsule Endoscopy  

PubMed Central

We report a rare case of metastasis of hepatocellular carcinoma (HCC) to the small bowel that presented as a pedunculated epithelial polyp. A 60-year-old man with liver cirrhosis type B was treated for HCC (stage IVb) at our hospital. He had been admitted for melena and anemia. Capsule endoscopy was performed in this patient with obscure gastrointestinal bleeding. It showed a polypoid lesion with bleeding in the ileum. Double-balloon endoscopy was performed. The lesion was determined to be a pedunculated polyp in the ileum. Histological examination of biopsy specimens showed tumor cells resembling HCC. We performed endoscopic mucosal resection for the lesion by double-balloon endoscopy to prevent bleeding from the tumor. The patient had no melena or anemia and his condition improved after endoscopic mucosal resection. However, he died of liver failure 2 months later.

Igawa, A.; Oka, S.; Tanaka, S.; Nakano, M.; Aoyama, T.; Watari, I.; Aikata, H.; Arihiro, K.; Chayama, K.

2013-01-01

122

Crypt apoptotic count reproducibility in small bowel allograft biopsies.  

PubMed

Enumeration of crypt apoptotic bodies (AB) is used in the diagnosis of acute cellular rejection (ACR) in small bowel allografts. Due to differing definitions, there is a potential for variation in AB numbers between pathologists that may affect diagnosis. Thirty biopsies from allografts were obtained: 10 negative for ACR, 10 indeterminate, and 10 with mild ACR. Three pathologists blindly reviewed each case twice and counted the maximal AB number per 10 crypts. Intraobserver kappa ranged from 0.423 to 0.913 and interobserver kappa from 0.478 to 0.686 depending on AB definition. Intraobserver diagnosis agreement based on classical AB number occurred in 81 of 90 instances (90%) and in 77 of 90 using the liberal definition (85%), P < .01). There was substantial intraobserver and moderate to substantial interobserver agreement in crypt AB counts. However, both intraobserver and interobserver variability would have led to diagnostic discrepancies in a small subset of cases. PMID:22832111

Talmon, Geoffrey; El Behery, Radwa; Radio, Stanley; Fischer, Ryan; Shostrom, Valerie; Wisecarver, James

2013-06-01

123

Small Bowel Bacterial Overgrowth in Symptomatic Older People: Can It Be Diagnosed Earlier?  

Microsoft Academic Search

Background\\/Objectives: In older people, small bowel bacterial overgrowth syndrome may be a common, but under-diagnosed, cause of diarrhoea and nutrient malabsorption. We aim to determine which clinical features and baseline laboratory investigations indicate a high likelihood of small bowel bacterial overgrowth as defined by a positive glucose breath test. Methods: A retrospective analysis of records for all patients referred for

D. A. Elphick; T. S. Chew; S. E. Higham; N. Bird; A. Ahmad; D. S. Sanders

2005-01-01

124

Inhibition of HIF-1? by the anticancer drug TAS106 enhances X-ray-induced apoptosis in vitro and in vivo  

PubMed Central

In a previous study, we showed that a novel anticancer drug, 1-(3-C-ethynyl-?-D-ribo-pentofuranosyl)cytosine (TAS106, ECyd) increased the antitumour efficacy of X-irradiation. However, its effects on hypoxic cells in tumours remain unclarified. Here, we show that TAS106 enhances the induction of apoptosis in X-irradiated human gastric adenocarcinoma MKN45 and MKN28 cells under hypoxia in vitro. At the same time, the accumulation of HIF-1? observed under hypoxia was shown to be decreased to the level of normoxia in the presence of 0.1??M TAS106. To study the function of HIF-1? protein in apoptosis of hypoxic cells, we employed an HIF-1? reductive approach using its specific antisense oligodeoxynucleotide. The reduction of HIF-1? gene expression dramatically enhanced X-ray-induced apoptosis in hypoxic cells. In in vivo experiments in which MKN45 cells were transplanted into severe combined immunodeficient (SCID) mice, TAS106 (0.5?mg?kg?1) suppressed HIF-1? expression and subsequently reduced the area of the hypoxic region in the tumour and enhanced the induction of apoptosis in the hypoxic region when combined with 2?Gy of X-irradiation. These results suggest the possibility that TAS106 acts as a potent radiosensitiser through the inhibition of HIF-1? expression and can be a useful agent against radiotherapy-resistant hypoxic cells in solid tumours.

Yasui, H; Ogura, A; Asanuma, T; Matsuda, A; Kashiwakura, I; Kuwabara, M; Inanami, O

2008-01-01

125

Aberrant Mesoappendix Vasculature: A Unique Cause of Partial Small Bowel Obstruction  

PubMed Central

Small bowel obstructions are most frequently caused by hernias or adhesive bands. However, there have been several rare reported cases of mechanical small bowel obstructions caused by loops of bowel or vascular bands. We describe a case of a 30-year-old woman with a clinical presentation suggestive of appendicitis. Laparoscopic evaluation showed an aberrant vessel looping around the small bowel extending from the lateral anterior abdominal wall to the mesoappendix, resulting in a partial small bowel obstruction. We review the literature relating to bowel obstructions resulting from bowel knots and vascular bands. To our knowledge, this is the first reported case of a small bowel obstruction caused by an aberrant intraabdominal vessel.

Sparks, Dorothy Ann; Chase, Daniel Mark; Marx, Robert Joseph

2010-01-01

126

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.

2001-01-01

127

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.

1992-01-01

128

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.

1982-07-01

129

Minority additive distributions in a ceramic metal-halide arc lamp using high-energy x-ray induced fluorescence  

Microsoft Academic Search

X-ray induced fluorescence is used to measure the elemental densities of minority additives in a metal-halide arc contained inside a translucent ceramic envelope. A monochromatic x-ray beam from the Sector 1 Insertion Device beamline at the Advanced Photon Source is used to excite K-shell x-ray fluorescence in the constituents of a ceramic metal-halide arc lamp dosed with DyI3 and CsI.

J. J. Curry; H. G. Adler; S. D. Shastri; J. E. Lawler

2001-01-01

130

Adenocarcinoma of the jejunum associated with nontropical sprue  

Microsoft Academic Search

Summary A patient with a thirty-year history of celiac disease, developed malabsorption and ultimately intestinal obstruction. He failed to respond to a strict gluten-free diet, steroids, and antibiotics. Postmortem examination revealed primary adenocarcinoma of the small bowel. The relationship between adenocarcinoma of the jejunum and celiac disease is reviewed.

Edward P. Petreshock; Marius Pessah; Eliyahu Menachemi

1975-01-01

131

Molecular analysis of X-ray-induced mutants at the HPRT locus in V79 Chinese hamster cells.  

PubMed

Spontaneous and X-ray-induced mutants at the hypoxanthine phosphoribosyl transferase (HPRT) locus have been isolated from V79 Chinese hamster cells and characterized at the biochemical and cytogenetic levels. Fourteen spontaneous and 24 X-ray-induced clones were azaguanine and thioguanine resistant, did not grow in HAT medium (AZRTGRHATS) and failed to incorporate significant levels of [14C]hypoxyanthine. Cytogenetic analysis of two spontaneous and eight X-ray-induced mutants revealed no major X chromosome rearrangements. In two induced mutants, one of which was hypotetraploid (mode 35-39) with 2 X chromosomes, the short arm of the chromosome (Xp) was slightly shorter than normal. A third mutant was hyperdiploid (mode 22-23) compared with the parental clone (mode 21). When compared with wild-type clones, no other cytogenetic changes were evident in the remaining mutants. Analysis at the DNA level using a Chinese hamster HPRT cDNA probe showed major deletion of HPRT sequences in two and partial deletion in another two induced mutants. In two of the mutants with deletions of HPRT sequences there was a visible shortening of the Xp arm. In the other six mutants two spontaneous and four induced) no karyotypic changes or alterations in restriction fragment patterns were detected suggesting that they carry small deletions or point mutations at the HPRT locus. PMID:3486844

Fuscoe, J C; Ockey, C H; Fox, M

1986-06-01

132

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.

2008-01-01

133

Critical assessment of small bowel biopsy in children.  

PubMed Central

176 biopsies of small bowel mucosa taken during a 5-year period from 162 children were reviewed, and 92 of them were subjected to quantitative measurement using surface/volume ratio and intraepithelial lymphocyte counting. There was good general agreement between stereomicroscopical appearance of fresh tissue, routine pathology reporting, and our independent histological assessment. Most of those in which there was divergence of opinion (11--15%) had intermediate mucosal changes. There was a significant difference between the surface/volume ratio for each of the three grades of histology (P less than 0.001, less than 0.001, less than 0.01), indicating a relationship between qualitative and quantitative methods of assessment. The range of measurements in intermediate biopsies overlapped those of the other two grades. In the 92 biopsies there was a correlation between surface/volume ratio and intraepithelial lymphocyte count (r = -0.56; P less than 0.001) which may reflect our clinical experience, in that 88% of the biopsies were graded as either normal or flat (probable coeliac disease). Very short children had shorter villi than those with nonspecific diarrhoea and a more normal height.

Glasgow, J F; Corkey, C W; Molla, A

1979-01-01

134

Biomagnetic Techniques for Assessing Gastric and Small Bowel Electrical Activity  

NASA Astrophysics Data System (ADS)

Recent advances in electrophysiology of the gastrointestinal tract have emphasized the need for methods of noninvasive assessment of gastric and small intestinal electrical activity (GEA and IEA). While the cutaneous electrogastrogram (EGG) may reveal the frequency dynamics of gastric electrical activity, other parameters important for characterizing the propagating electrical activity are not available from EGG recordings. Recent studies on the electroenterogram (EENG) are promising, but low-conductivity abdominal layers have complicated the identification of small intestinal electrical rhythms in cutaneous recordings. The magnetogastrogram (MGG) and magnetoenterogram (MENG) are able to characterize gastric and intestinal electrical activity noninvasively in terms of its frequency, power and characteristics of its propagation. Superconducting QUantum Interference Device (SQUID) magnetometers are used to detect the minute magnetic fields associated with electrical activity of the gastrointestinal syncytium formed by interstitial cells of Cajal and smooth muscle networks. Changes in GEA and IEA that occur in response to disease or abnormal conditions are reflected in MGG and MENG signals. Magnetic methods for assessing the electrical activity of the stomach and small bowel thus show great clinical promise.

Bradshaw, L. Alan

2004-09-01

135

Improvement of abnormal lactulose\\/rhamnose permeability in active Crohn's disease of the small bowel by an elemental diet  

Microsoft Academic Search

Intestinal permeability to sugar has been used as an objective measure of small bowel integrity to assess the efficacy of an elemental diet as the sole treatment or Crohn's disease of the small bowel. Fourteen children aged 11-17 years with active small bowel Crohn's disease were given an elemental diet for six weeks. Investigations with iso-osmolar oral test solutions before

I R Sanderson; P Boulton; I Menzies; J A Walker-Smith

1987-01-01

136

Reducing false positives of small bowel segmentation on CT scans by localizing colon regions  

NASA Astrophysics Data System (ADS)

Automated small bowel segmentation is essential for computer-aided diagnosis (CAD) of small bowel pathology, such as tumor detection and pre-operative planning. We previously proposed a method to segment the small bowel using the mesenteric vasculature as a roadmap. The method performed well on small bowel segmentation but produced many false positives, most of which were located on the colon. To improve the accuracy of small bowel segmentation, we propose a semi-automated method with minimum interaction to distinguish the colon from the small bowel. The method utilizes anatomic knowledge about the mesenteric vasculature and a statistical method of colon detection. First, anatomic labeling of the mesenteric arteries is used to identify the arteries supplying the colon. Second, a statistical detector is created by combining two colon probability maps. One probability map is of the colon location and is generated from colon centerlines generated from CT colonography (CTC) data. Another probability map is of 3D colon texture using Haralick features and support vector machine (SVM) classifiers. The two probability maps are combined to localize colon regions, i.e., voxels having high probabilities on both maps were labeled as colon. Third, colon regions identified by anatomical labeling and the statistical detector are removed from the original results of small bowel segmentation. The method was evaluated on 11 abdominal CT scans of patients suspected of having carcinoid tumors. The reference standard consisted of manually-labeled small bowel segmentation. The method reduced the voxel-based false positive rate of small bowel segmentation from 19.7%±3.9% to 5.9%±2.3%, with two-tailed P-value < 0.0001.

Zhang, Weidong; Liu, Jiamin; Yao, Jianhua; Summers, Ronald M.

2014-03-01

137

Mesenteric vasculature-guided small bowel segmentation on 3-D CT.  

PubMed

Due to its importance and possible applications in visualization, tumor detection and preoperative planning, automatic small bowel segmentation is essential for computer-aided diagnosis of small bowel pathology. However, segmenting the small bowel directly on computed tomography (CT) scans is very difficult because of the low image contrast on CT scans and high tortuosity of the small bowel and its close proximity to other abdominal organs. Motivated by the intensity characteristics of abdominal CT images, the anatomic relationship between the mesenteric vasculature and the small bowel, and potential usefulness of the mesenteric vasculature for establishing the path of the small bowel, we propose a novel mesenteric vasculature map-guided method for small bowel segmentation on high-resolution CT angiography scans. The major mesenteric arteries are first segmented using a vessel tracing method based on multi-linear subspace vessel model and Bayesian inference. Second, multi-view, multi-scale vesselness enhancement filters are used to segment small vessels, and vessels directly or indirectly connecting to the superior mesenteric artery are classified as mesenteric vessels. Third, a mesenteric vasculature map is built by linking vessel bifurcation points, and the small bowel is segmented by employing the mesenteric vessel map and fuzzy connectness. The method was evaluated on 11 abdominal CT scans of patients suspected of having carcinoid tumors with manually labeled reference standard. The result, 82.5% volume overlap accuracy compared with the reference standard, shows it is feasible to segment the small bowel on CT scans using the mesenteric vasculature as a roadmap. PMID:23807437

Zhang, Weidong; Liu, Jiamin; Yao, Jianhua; Louie, Adeline; Nguyen, Tan B; Wank, Stephen; Nowinski, Wieslaw L; Summers, Ronald M

2013-11-01

138

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] [Erasme Hospital, Brussels (Belgium); and others

1996-05-01

139

Glucagon in the scintigraphic diagnosis of small-bowel hemorrhage by Tc-99m-labeled red blood cells  

SciTech Connect

Twelve patients undergoing scintigraphy with Tc-99m-labeled red blood cells (RBC) exhibited abnormal small-bowel activity and were given glucagon to assess its role in detecting bleeding from the small bowel. Six demonstrated focal accumulation of activity which was not identified prior to glucagon. Endoscopy, barium studies, angiography, and colonoscopy located the small-bowel bleeding site in 4 patients; in the other 2, studies of the colon failed to show the bleeding site and the origin was presumed to be the small bowel. The authors suggest that intravenous glucagon can be beneficial as an adjuvant to Tc-99m-RBC when diagnosing bleeding from the small bowel.

Froelich, J.W.; Juni, J.

1984-04-01

140

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: zhangh@impcas.ac.cn

2008-12-19

141

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

2003-01-01

142

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.

2013-01-01

143

Intussusception of the small bowel secondary to an enterolith from a jejunal diverticulum.  

PubMed

We report a case of acute, small bowel obstruction secondary to intussusception caused by an enterolith from a jejunal diverticulum, in an elderly female with a history of chronic, intermittent abdominal pain. Diagnostic work-up of the patient included a computed tomographic (CT) scan which demonstrated the intussusception, but not the enterolith, which was characteristically radiolucent. A laparotomy was performed and the enterolith was found and delivered. A fistula between the gallbladder and small bowel was sought, but not found. Multiple diverticulae were found throughout the small bowel. Although small bowel diverticulosis is rare, it should be considered in the differential diagnosis of the acute abdomen and chronic abdominal pain, especially in those with known colonic diverticulosis, in whom this condition is more common. PMID:21785881

di Marco, Aimee N; Purkayastha, Sanjay; Zacharakis, Emmanouil

2012-09-01

144

Small bowel evisceration through the anus - report of a case and review of literature  

PubMed Central

An 84-year-old lady with a history of chronic recurrent rectal prolapse, presented to accident and emergency with a significant portion of small bowel and mesentery protruding out of her anus. The small bowel was not contained within peritoneum, nor was this a pararectal herniation. On examination of the rectum, a longitudinal tear was found in the anterior rectal wall, through which the small bowel had prolapsed. Hours after reducing the small bowel back into the anus, it prolapsed a second time. Due to multiple co-morbidities, this patient was not fit for surgery. The defect was temporarily repaired on the ward and the patient treated with aggressive antibiotic therapy. The patient continued to deteriorate, became septic, acidotic, hypotensive and died a day later.

Berwin, James Theo; Ho, T K; D'Souza, Rovan

2012-01-01

145

Celiac Disease: How Common Is Jejunoileal Fold Pattern Reversal Found at Small-Bowel Follow Through?  

Microsoft Academic Search

with celiac disease. We asked three questions regarding jejunoileal fold pattern reversal found at small-bowel follow-through in patients with celiac disease. (1) How often is it present, either partially or completely? (2) How often is it associated with other findings of malabsorption? (3) How reliably can it be distinguished from the normal pattern? MATERIALS AND METHODS. Twenty-eight small-bowel follow-through examinations

John M. Barlow; C. Daniel Johnson; David H. Stephens

146

Significance of intraepithelial lymphocytosis in small bowel biopsy samples with normal mucosal architecture  

Microsoft Academic Search

OBJECTIVES:The aim of this study was to determine the specificity of increase in intraepithelial lymphocytes (IELs) with normal villous architecture in small bowel biopsy samples for diagnosis of gluten sensitivity (GS) and its significance in the absence of GS.METHODS:Small bowel biopsy samples from 43 patients with increased IELs and no other pathology were reviewed. Patients with prior diagnosis of GS

Sanjay Kakar; Vandana Nehra; Joseph A. Murray; Gerald A. Dayharsh; Lawrence J. Burgart

2003-01-01

147

Do Clinical Characteristics Predict the Presence of Small Bowel Angioectasias on Capsule Endoscopy?  

Microsoft Academic Search

Background and Aims  Angioectasias (AVMs) are the most common vascular anomaly of the gastrointestinal (GI) tract, and these lesions are often\\u000a associated with obscure gastrointestinal bleeding (OGIB). It is unknown if the presence of upper and\\/or lower gastrointestinal\\u000a AVMs are predictive of small bowel AVMs. The aims of this study are to define the small bowel segmental distribution of AVMs\\u000a and

Anthony T. DeBenedet; Sameer D. Saini; Mimi Takami; Laurel R. Fisher

2011-01-01

148

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

2013-01-01

149

Small bowel bacterial overgrowth in adults: A potential contributor to intestinal failure  

Microsoft Academic Search

Small bowel bacterial overgrowth (SBBO), in which colon-derived bacteria colonize the upper small bowel, is found in a wide\\u000a variety of adult diseases associated with intestinal failure and dysfunction, including short bowel syndrome and other conditions\\u000a following massive bowel resection, dysmotility disorders, and inflammatory bowel disease. SBBO also appears to be relatively\\u000a common in the elderly, in whom it often

Thomas R. Ziegler; Conrad R. Cole

2007-01-01

150

Importance of colonic support for energy absorption as small-bowel failure proceeds.  

PubMed

Digestive processes in the human colon are affected by the bacterial fermentation of malabsorbed carbohydrates and protein to short-chain fatty acids, which are absorbed and supply energy. Energy absorption was measured by assessing fecal bomb calorimetry in 148 patients with extremely different small-bowel lengths. Colectomy increased fecal loss of energy by 0.8 MJ/d and carbohydrate excretion fivefold in patients with a small-bowel length between normal and 150-200 cm. Patients with 100-150 cm small bowel, with and without a colon, excreted 1.3 +/- 0.3 and 4.7 +/- 0.5 MJ/d, respectively (P = 0.002), a difference of 3.4 MJ/d. Patients with < 100 cm small bowel excreted 3.1 +/- 0.4 and 8.0 +/- 1.3 MJ/d, respectively (P = 0.03), a difference of 4.9 MJ/d. Similar and highly significant differences were calculated by linear-regression analysis. Considerably less energy was excreted as carbohydrate than as fat in patients with preserved colonic function, probably because fermentation removed carbohydrate as absorbed short-chain fatty acids, whereas a comparable amount of energy was lost as carbohydrate and fat in patients without colonic function. The correlation between malabsorbed energy and small-bowel length was poor (r = -0.41) but increased when data for patients with and without a colon were separated (r = -0.56 and r = -0.58, respectively). Small-bowel length, however, was still an inaccurate measure of intestinal failure to absorb nutrient energy. In conclusion, colonic digestion may support energy supply with up to approximately 4.2 MJ/d as small-bowel failure proceeds, but it is of minor importance in patients with a small-bowel length > 200 cm or malabsorption < 2.1 MJ/d. PMID:8694024

Nordgaard, I; Hansen, B S; Mortensen, P B

1996-08-01

151

Novel Single Nucleotide Polymorphism Markers for Low Dose Aspirin-Associated Small Bowel Bleeding  

PubMed Central

Background Aspirin-induced enteropathy is now increasingly being recognized although the pathogenesis of small intestinal damage induced by aspirin is not well understood and related risk factors have not been established. Aim To investigate pharmacogenomic profile of low dose aspirin (LDA)-induced small bowel bleeding. Methods Genome-wide analysis of single nucleotide polymorphisms (SNPs) was performed using the Affymetrix DMET™ Plus Premier Pack. Genotypes of candidate genes associated with small bowel bleeding were determined using TaqMan SNP Genotyping Assay kits and direct sequencing. Results In the validation study in overall 37 patients with small bowel bleeding and 400 controls, 4 of 27 identified SNPs: CYP4F11 (rs1060463) GG (p=0.003), CYP2D6 (rs28360521) GG (p=0.02), CYP24A1 (rs4809957) T allele (p=0.04), and GSTP1 (rs1695) G allele (p=0.04) were significantly more frequent in the small bowel bleeding group compared to the controls. After adjustment for significant factors, CYP2D6 (rs28360521) GG (OR 4.11, 95% CI. 1.62 -10.4) was associated with small bowel bleeding. Conclusions CYP4F11 and CYP2D6 SNPs may identify patients at increased risk for aspirin-induced small bowel bleeding.

Shiotani, Akiko; Murao, Takahisa; Fujita, Yoshihiko; Fujimura, Yoshinori; Sakakibara, Takashi; Nishio, Kazuto; Haruma, Ken

2013-01-01

152

Twenty-one cases of small bowel intussusception: the pathophysiology of idiopathic intussusception and the concept of benign small bowel intussusception  

Microsoft Academic Search

Ultrasonography (US) was used to study intussusceptions prospectively at Kiyama Hospital in 1999 and 2000 under the classification of small bowel intussusception (SBI) and large bowel or ileo-ileo-colic intussusception (LBI). The clinical features, management, outcome and etiology were analyzed. All LBIs and SBIs with ischemic symptoms and SBIs complicated by LBI were treated by enema reduction, whereas SBIs considered to

Osamu Doi; Koji Aoyama; John M. Hutson

2004-01-01

153

Application of fecal hemoglobin-haptoglobin complex testing for small bowel lesions.  

PubMed

Abstract Objective. Fecal hemoglobin-haptoglobin (Hb-Hpt) complex testing is theoretically superior to immunochemical fecal occult blood test detecting human hemoglobin (Hb), as Hb-Hpt is more stable compared to Hb during passage through the gastrointestinal (GI) tract. The aim was to examine the role of fecal Hb-Hpt complex testing in predicting small bowel lesions detected by video capsule endoscopy (VCE). Materials and methods. Stools from patients undergoing small bowel VCE for obscure GI bleeding (OGIB) without ongoing overt bleeding were included. Two stool specimens were obtained on different days just before VCE to measure Hb-Hpt complex by ELISA and Hb by latex agglutination turbidimetric immunoassay. Results. Seventy-six patients (39 men and 37 women, average age 66 years) with suspected small bowel lesions entered. Median Hb-Hpt complex and Hb levels were significantly higher (p < 0.001) in those with small bowel lesions compared to those without. Using the suitable cutoff points (Hb >10 ng/ml and Hb-Hpt complex >5 ng/ml), the sensitivity and specificity of the Hb-Hpt complex test to predict small bowel lesions were 71.4% and 73.3%, and those of the Hb test were 61.2% and 89.3%. Small bowel lesions were found in 58.3% with only Hb-Hpt complex positive results (15.8% of total subjects) compared to 83.3% when both were positive (55.3% of total). Conclusions. Measuring fecal Hb-Hpt complex in addition to Hb may be useful to predict the presence of small bowel lesions in patients with OGIB. PMID:24621414

Shiotani, Akiko; Tarumi, Ken-Ichi; Honda, Keisuke; Fujita, Minoru; Matsumoto, Hiroshi; Manabe, Noriaki; Kamada, Tomoari; Hata, Jiro; Haruma, Ken

2014-05-01

154

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: nichola.burridge@physics.cr.man.ac.uk; 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)

2006-11-01

155

Lymphangioma of the small bowel mesentery: a case report and review of the literature.  

PubMed

Lymphangioma is a rare benign condition characterized by proliferation of lymphatic spaces. It is usually found in the head and neck of affected children. Lymphangioma of the small-bowel mesentery is rare, having been reported for less than 1% of all lymphangiomas. Importantly, it can cause fatal complications such as volvulus or involvement of the main branch of the mesenteric arteries, requiring emergency surgery. Moreover, the gross and histopathologic findings may resemble benign multicystic mesothelioma and lymphangiomyoma. Immunohistochemical study for factor VIII-related antigen, D2-40, calretinin and human melanoma black-45 (HMB-45) are essential for diagnosis. Factor VIII-related antigen and D2-40 are positive in lymphangioma but negative in benign multicystic mesothelioma. HMB-45 shows positive study in the smooth-muscle cells around the lymphatic spaces of the lymphangiomyoma. We report a case of small-bowel volvulus induced by mesenteric lymphangioma in a 2-year-and-9-mo-old boy who presented with rapid abdominal distension and vomiting. The abdominal computed tomography scan showed a multiseptated mass at the right lower quadrant with a whirl-like small-bowel dilatation, suggestive of a mesenteric cyst with midgut volvulus. The intraoperative findings revealed a huge, lobulated, yellowish pink, cystic mass measuring 20 cm × 20 cm × 10 cm, that was originated from the small bowel mesentery with small-bowel volvulus and small-bowel dilatation. Cut surface of the mass revealed multicystic spaces containing a milky white fluid. The patient underwent tumor removal with small-bowel resection and end-to-end anastomosis. Microscopic examination revealed that the cystic walls were lined with flat endothelial cells and comprised of smooth muscle in the walls. The flat endothelial cells were positive for factor VIII-related antigen and D2-40 but negative for calretinin. HMB-45 showed negative study in the smooth-muscle cells around the lymphatic spaces. Thus, the diagnosis was lymphangioma of the small bowel mesentery with associated small bowel volvulus. PMID:23180956

Suthiwartnarueput, Worapop; Kiatipunsodsai, Siriphut; Kwankua, Amolchaya; Chaumrattanakul, Utairat

2012-11-21

156

Small Bowel Transglutaminase 2-specific IgA Deposits in Dermatitis Herpetiformis.  

PubMed

Dermatitis herpetiformis (DH) is an extraintestinal manifestation of coeliac disease. Untreated coeliac disease patients are known to have transglutaminase 2 (TG2)-targeted IgA deposits in the small bowel mucosa. To evaluate whether similar intestinal IgA deposits are also present in DH and whether the deposits disappear with gluten-free diet, 47 untreated and 27 treated DH patients were studied. Seventy-nine percent of untreated and 41% of the treated DH patients had TG2-specific IgA deposits in the small bowel, and the presence of the deposits showed a significant association with the degree of small bowel villous atrophy (p?small bowel mucosal intraepithelial ??+ T cells was increased in 91% of untreated and 73% of treated DH patients. The results show that the majority of untreated DH patients have similar gluten-dependent TG2-specific IgA deposits the small bowel mucosa as coeliac disease patients. PMID:24352382

Salmi, Teea T; Hervonen, Kaisa; Laurila, Kaija; Collin, Pekka; Mäki, Markku; Koskinen, Outi; Huhtala, Heini; Kaukinen, Katri; Reunala, Timo

2014-06-24

157

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

2013-01-01

158

Small Bowel Dose Parameters Predicting Grade ?3 Acute Toxicity in Rectal Cancer Patients Treated With Neoadjuvant Chemoradiation: An Independent Validation Study Comparing Peritoneal Space Versus Small Bowel Loop Contouring Techniques  

SciTech Connect

Purpose: To determine whether volumes based on contours of the peritoneal space can be used instead of individual small bowel loops to predict for grade ?3 acute small bowel toxicity in patients with rectal cancer treated with neoadjuvant chemoradiation therapy. Methods and Materials: A standardized contouring method was developed for the peritoneal space and retrospectively applied to the radiation treatment plans of 67 patients treated with neoadjuvant chemoradiation therapy for rectal cancer. Dose-volume histogram (DVH) data were extracted and analyzed against patient toxicity. Receiver operating characteristic analysis and logistic regression were carried out for both contouring methods. Results: Grade ?3 small bowel toxicity occurred in 16% (11/67) of patients in the study. A highly significant dose-volume relationship between small bowel irradiation and acute small bowel toxicity was supported by the use of both small bowel loop and peritoneal space contouring techniques. Receiver operating characteristic analysis demonstrated that, for both contouring methods, the greatest sensitivity for predicting toxicity was associated with the volume receiving between 15 and 25 Gy. Conclusion: DVH analysis of peritoneal space volumes accurately predicts grade ?3 small bowel toxicity in patients with rectal cancer receiving neoadjuvant chemoradiation therapy, suggesting that the contours of the peritoneal space provide a reasonable surrogate for the contours of individual small bowel loops. The study finds that a small bowel V15 less than 275 cc and a peritoneal space V15 less than 830 cc are associated with a less than 10% risk of grade ?3 acute toxicity.

Banerjee, Robyn, E-mail: robynbanerjee@gmail.com [Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada)] [Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada); Chakraborty, Santam; Nygren, Ian; Sinha, Richie [Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada)] [Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada)

2013-04-01

159

Small Bowel Transplantation in the Rat: Impact of Various Immunosuppressive Regimens on Graft-versus-Host Reaction  

Microsoft Academic Search

The effect of ciclosporin (CS) and methotrexate (MTX) on the development of graft-versus-host (GvH) disease was examined after small bowel allotransplantation in the rat. The drugs were tested either alone or in combination. Lewis small bowel allografts were transplantated into Brown Norway recipients in a heterotopic position. The native small bowel, spleen, liver, skin, mesenteric lymph nodes and the kidney

G. Oberhuber; Th. Schmid; Rosemarie Erdkönig; W. Thaler; D. Öfner; Gabi Köröszi; G. Klima; R. Margreiter

1991-01-01

160

A rare case of segmental small bowel pneumatosis intestinalis: A case report  

PubMed Central

Introduction Pneumatosis intestinalis is a rare condition affecting 0.03% of the population. It has a myriad of aetiological causes and hence presentation can vary immensely. The management of symptomatic pneumatosis intestinalis in an acute and outpatient setting remains a challenge to both physicians and surgeons. Case presentation We present a case of a 79 year old who presented in a gastroenterology outpatients department with a history suggestive of intermittent small bowel obstruction associated with abdominal pain aggravated by eating and posture. He was found to have signs suggestive of Marfan's syndrome. Computed tomography demonstrated extensive pneumatosis intestinalis of the small bowel. Due to deterioration in symptoms, an exploratory laparotomy was performed demonstrating segmental small bowel pneumatosis intestinalis secondary to a hypermobile mesentery. Conclusion This case highlights the importance of both surgical and gastroenterology expertise in successfully managing symptomatic pneumatosis intestinalis.

Slesser, A.A.P.; Patel, P.H.; Das, S.C.; Leahy, A.; Livingstone, J.; Riaz, A.A.

2011-01-01

161

Successful management of multiple small bowel perforations due to polyarteritis nodosa  

PubMed Central

Classic Polyarteritis nodosa (PAN)) is a medium-sized vessel vasculitis that usually occurs in middle-aged men. One of the dramatic manifestations of PAN that requires surgical intervention is multiple small bowel perforations. Many studies have reported a high rate of mortality in PAN due to acute abdominal complications. We report here the case of multiple small bowel perforations in a 22-year-old man, who presented with an acute abdomen, and eventually, PAN was diagnosed. In our case, PAN led to multiple small bowel perforations and diffuse patchy necrosis. All perforations were primarily repaired and corticosteroids were prescribed. Using corticosteroid in patients with abdominal sepsis is injurious; however, laparostomy is the method we suggest, to achieve the purpose, including prevention of a short bowel and infection control. Our patient was discharged, well, after 48 days of hospitalization and referred to a rheumatologist.

Mousavie, Seyed Hamzeh; Mirzaei, Rezvan; Mahjoubi, Bahar; Azizi, Rasoul

2014-01-01

162

An Unusual Cause of Small Bowel Obstruction in a Child: Ingested Rhubarb  

PubMed Central

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.

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

2013-01-01

163

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

2004-01-01

164

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

2003-01-01

165

Determinant of bacterial translocation in the newborn: Small bowel versus large bowel colonization  

Microsoft Academic Search

This study investigated the relationship between bacterial translocation (BT) and small and large bowel bacterial colonization in the neonatal rabbit. The authors have previously shown that spontaneous BT occurs in rabbits during the first week of life, but is less frequent before the third day of life. The authors have also shown that bacterial colonization of the small bowel is

Masahiko Urao; Jason Moy; Joan Van Camp; Robert Drongowski; Maher Altabba; Arnold G Coran

1995-01-01

166

Proliferating cell nuclear antigen expression is increased in small bowel epithelium in the elderly  

Microsoft Academic Search

Although previous studies suggest that in aging animals the small intestine is in a hyperproliferative state, no information is currently available on the influence of age on the proliferation pattern of human small bowel enterocytes. The immunohistochemical expression of the proliferating cell nuclear antigen (PCNA), the villous height to total mucosal thickness ratio and the enterocyte height were evaluated in

G. R Corazza; L Ginaldi; G Quaglione; F Ponzielli; L Vecchio; F Biagi; D Quaglino

1998-01-01

167

Tacrolimus and mycophenolate mofetil in pig small bowel transplantation: Different protocols and their outcome  

Microsoft Academic Search

Clinical trials using FK 506 (Tacrolimus)-based immunosuppression after intestinal transplantation are underway. Long-term survivals have been limited by toxicity and infection due to the high dosage of FK 506 needed to control acute cellular rejection (ACR). The aim of this study is to assess, in a pig model of small bowel transplantation (SBTx), the efficacy and safety of two immunosuppressive

M. Spada; M. Alessiani; P. Ferrari; I. Iacona; F. Abbiati; A. Viezzoli; M. B. Regazzi; G. Bellinzona; P. Dionigi; A. Zonta

1997-01-01

168

How much helpful is the capsule endoscopy for the diagnosis of small bowel lesions?  

Microsoft Academic Search

AIM: To assess the practically usefulness and diagnostic yield of this new method in a group of patients with suspected small bowel lesions. METHODS: Capsule endoscopic (CE) examination by using M2A capsule endoscope TM (Given Imaging, Yoqneam, Israel) was performed in thirty nine patients (26 males, 13 females) with suspected small intestinal lesions. The composing of the patients was as

Osman Ersoy; Bulent Sivri; Serap Arslan; Figen Batman; Yusuf Bayraktar

169

Minimization of small bowel volume within treatment fields utilizing customized belly boards  

SciTech Connect

Thirty consecutive patients with pelvic malignancies were evaluated prospectively for the impact of a novel bowel minimization device (belly board) on the volume of small bowel included within a four field pelvic radiation plan. A customized polyurethane and styrofoam bowel immobilization mold was created for each patient in the prone position. Using contrast enhanced CT scanning on a dedicated radiation treatment planning scanner, we imaged the location of the small intestine in the supine position and the prone position aided by the belly board. Custom in-house interactive image analysis software was developed to allow volumetric determination of small bowel within the treatment portals. The mean small bowel volume was reduced by 66% (299 cm3 to 102 cm3), comparing the standard supine position to the prone position assisted by the belly board. In 13 patients without prior pelvic surgery, the small bowel volume reduction was a more dramatic 74% (334 cm3 to 88 cm3). All patients were found to benefit from this prone belly board setup regardless of body habitus, weight, and age. Compliance with the set-up including use of bladder distension was excellent. All patients completed their pelvic radiotherapy without requiring a treatment break. Weight loss at completion averaged less than 5%. Seventy-six percent of patients experienced little or no diarrhea. This technique is comfortable, inexpensive, highly reproducible, and permits maximal bowel displacement from standard pelvic radiotherapy fields.

Shanahan, T.G.; Mehta, M.P.; Bertelrud, K.L.; Buchler, D.A.; Frank, L.E.; Gehring, M.A.; Kubsad, S.S.; Utrie, P.C.; Kinsella, T.J. (Univ. of Wisconsin School of Medicine, Madison (USA))

1990-08-01

170

Toxic effects of nonsteroidal antiinflammatory drugs on the small bowel, colon, and rectum  

Microsoft Academic Search

The gastrointestinal toxicity of conventional nonsteroidal antiinflammatory drugs (NSAIDs) is not confined to the stomach and proximal duodenum but extends also to the rest of the small bowel, colon, and rectum. Long-term NSAID therapy usually induces clinically silent enteropathy characterized by increased intestinal permeability and inflammation. Chronic occult bleeding and protein loss may result in iron-deficiency anemia and hypoalbuminemia. NSAIDs

Gérard Thiéfin; Laurent Beaugerie

2005-01-01

171

Double-balloon enteroscopy to remove a strangulated enteroclysis catheter from the small bowel.  

PubMed

We present the case of a 77-year-old male who was referred for magnetic resonance (MR) enteroclysis because of small bowel subobstruction. To optimise small bowel distention during MR, a nasojejunal balloon catheter was placed to perfuse iso-osmotic water solution into the small bowel. However, after deflation of the balloon, the catheter could not be removed by gentle traction. Subsequently, computed tomography (CT) of the abdomen revealed that the catheter was strangulated deep in the jejunum and traction resulted in painful backward intussusception of the small bowel. In order to avoid surgical intervention, we decided to perform urgent proximal double-balloon enteroscopy to remove the enteroclysis catheter. Under fluoroscopic guidance, the enteroscope was introduced into the jejunum until the tip of the enteroscope reached the tip of the catheter. By straightening the enteroscope, the catheter could then be retracted from the jejunum, using the enteroscope as a guide wire along the catheter. Urgent surgical intervention was avoided and the patient completely recovered the same day. PMID:21490896

Moreels, Tom G; Op de Beeck, Bart; Pelckmans, Paul A

2008-01-01

172

Laparoscopic repair of a small bowel herniation through a broad ligament defect.  

PubMed

A 44-year-old female presented with a diagnosis of intestinal obstruction from unknown origin. Laparoscopy revealed herniation of small bowel trough a defect in the left broad ligament. After reduction, the defect was corrected laparoscopically. The post operative recovery was uneventful. PMID:25013338

Buero, Agustín; Silberman, Ezequiel A; Medina, Pablo; Morra, Matias E; Bogetti, Diego J; Porto, Eduardo A

2014-07-01

173

Use of Bioresorbable Membrane to Prevent Postoperative Small Bowel Obstruction in Transabdominal Aortic Aneurysm Surgery  

Microsoft Academic Search

Purpose To evaluate the efficacy of Seprafilm (Genzyme, Cambridge, MA, USA), a bioresorbable membrane, in preventing or reducing early postoperative small bowel obstructions after transabdominal abdominal aortic aneurysm (AAA) surgery. Methods Fifty-one patients underwent aortic reconstruction via a midline transperitoneal approach for infrarenal AAAs. Twenty-one patients underwent surgery with Seprafilm (Seprafilm group) and the remaining 30 patients did not (control

Fabio A. Kudo; Toshiya Nishibe; Keiko Miyazaki; Toshifumi Murashita; Masayasu Nishibe; Keishu Yasuda

2004-01-01

174

Non-invasive quantification of small bowel water content by MRI: a validation study  

NASA Astrophysics Data System (ADS)

Substantial water fluxes across the small intestine occur during digestion of food, but so far measuring these has required invasive intubation techniques. This paper describes a non-invasive magnetic resonance imaging (MRI) technique for measuring small bowel water content which has been validated using naso-duodenal infusion. Eighteen healthy volunteers were intubated, with the tube position being verified by MRI. After a baseline MRI scan, each volunteer had eight 40 ml boluses of a non-absorbable mannitol and saline solution infused into their proximal small bowel with an MRI scan being acquired after each bolus. The MRI sequence used was an adapted magnetic resonance cholangiopancreatography sequence. The image data were thresholded to allow for intra- and inter-subject signal variations. The MRI measured volumes were then compared to the known infused volumes. This MRI technique gave excellent images of the small bowel, which closely resemble those obtained using conventional radiology with barium contrast. The mean difference between the measured MRI volumes and infused volumes was 2% with a standard deviation of 10%. The maximum 95% limits of agreement between observers were -15% to +17% while measurements by the same operator on separate occasions differed by only 4%. This new technique can now be applied to study alterations in small bowel fluid absorption and secretion due to gastrointestinal disease or drug intervention.

Hoad, C. L.; Marciani, L.; Foley, S.; Totman, J. J.; Wright, J.; Bush, D.; Cox, E. F.; Campbell, E.; Spiller, R. C.; Gowland, P. A.

2007-12-01

175

Simultaneous culture of saliva and jejunal aspirate in the investigation of small bowel bacterial overgrowth  

Microsoft Academic Search

Both saliva and jejunal aspirate were cultured from 22 patients with suspected small bowel bacterial overgrowth and from eight controls. Large numbers of organisms (greater than 10(6)\\/ml) were recovered from the jejunal aspirate of 16 subjects, in five of whom the same organisms were present in similar relative proportions in the saliva, suggesting contamination of the sample with saliva, while

B W Worsley; I Cobden; E M Cooke; J G Shoesmith; A T Axon

1982-01-01

176

Small-bowel bacterial overgrowth in children with chronic diarrhea, abdominal pain, or both  

Microsoft Academic Search

OBJECTIVE: To evaluate the frequency of small-bowel bacterial overgrowth (SBBO) as a cause of chronic digestive symptoms in a large cohort of children, using the glucose breath hydrogen test (BHT). DESIGN: Patients were 53 children (aged 2 months to 12 years) with chronic diarrhea, abdominal pain, or both. Diagnosis of SBBO was defined with a BHT by a change in

D. de Boissieu; M. Chaussain; J. Badoual; J. Raymond; C. Dupont

1996-01-01

177

Spiral enteroscopy--a novel method for the management of small bowel diseases--case report and description of technique.  

PubMed

Small bowel diseases are associated with difficult management. Recently, new methods such as single or double balloon enteroscopy and capsule endoscopy have been implemented for the investigation of small bowel, but none is perfect. Spiral enteroscopy seems to be an alternative primising technique for the diagnosis and therapy of small bowel diseases. We report two cases in which spiral enetroscopy was useful both for diagnosis and therapy. One was the case of a man with repeated digestive bleeding of unknown cause and spiral enteroscopy helped for diagnosis and treatment with argon plasma coagulation of the vascular lesions. The later was a patient with Gartner Syndrome with multiple duodenal and intestinal polyps and spiral enteroscopy allowed small bowel evaluation. In conclusion, this novel method seems to allow a rapid and efficient diagnosis of small bowel diseases. PMID:21682187

Drug, V L; Balan, Gh; Sângeap, Ana-Maria; Akbar, Q; Mitric?, Dana; Dimofte, G

2011-01-01

178

Small Bowel Obstruction After Antecolic Antegastric Laparoscopic Roux-en-Y Gastric Bypass Without Division of Small Bowel Mesentery: A Single-Centre, 7Year Review  

Microsoft Academic Search

Reported incidence of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass varies between 1.5% and 3.5%.\\u000a It has been suggested that the antecolic antegastric laparoscopic Roux-en-Y gastric bypass (AA-LRYGB) is associated with a\\u000a low incidence of internal herniation (IH). Therefore we routinely did not close mesenteric defects. The records of 652 consecutive\\u000a patients undergoing primary AA-LRYGB from January 2003

Mohamed Abasbassi; Hans Pottel; Bert Deylgat; Franky Vansteenkiste; Frank Van Rooy; Dirk Devriendt; Mathieu D’Hondt

179

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

PubMed

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

2011-04-01

180

High-resolution cytogenetic analysis of X-ray induced mutations of the HPRT gene of primary human fibroblasts.  

PubMed

We report cytogenetic analysis of X-ray induced mutants of the HPRT gene isolated from a primary human fibroblast line. The mutants were shown previously by molecular analysis to have total or partial HPRT gene deletions. Detailed analysis of the chromosomal region containing HPRT (the cytogenetic band Xq26) identified Xq26 aberrations in five of five total HPRT gene deletions but failed to detect any changes in two of two partial gene deletions. Four microdeletions were verified and quantified by a method termed the band ratio, which compares the distance between bands encompassing Xq26 and an adjacent X-chromosome region in elongated chromosomes. These measurements were supported by the presence or absence of the sub-band Xq26.2. One total HPRT gene deletion was also associated with an X;11 translocation involving band Xq26. The data strengthen earlier findings on the tolerance of the Xq26 region to large genetic changes (> 1 Mb), but also indicate that some mutations are more complex than simple deletion of DNA sequence. PMID:8508677

Simpson, P; Morris, T; Savage, J; Thacker, J

1993-01-01

181

A practical approach to small bowel biopsy interpretation: celiac disease and its mimics.  

PubMed

While celiac disease is the most common cause of villous remodeling and intraepithelial lymphocytosis in the proximal small bowel, there are many entities that can mimic its histologic appearance. The purpose of this review is to discuss normal small bowel histology and the differential diagnosis of celiac disease. Approaches to evaluate increased intraepithelial lymphocytes are presented, followed by a detailed discussion of the pathology of celiac disease. Particular emphasis is given to those conditions that cause intraepithelial lymphocytosis in the setting of preserved villous architecture, although other important entities, such as peptic injury, idiopathic inflammatory bowel disease, medication injury, eosinophilic (allergic) gastroenteritis, autoimmune enteropathy, common variable immunodeficiency, and infections are also reviewed. PMID:24815938

Pai, Rish K

2014-03-01

182

Radiation-induced small bowel disease: latest developments and clinical guidance  

PubMed Central

Ionizing radiation is commonly used to treat a number of malignancies. Although highly effective and now more targeted, many patients suffer side effects. The number of cancer survivors has increased and so there are more patients presenting with symptoms that have arisen as a result of radiotherapy. Radiation damage to small bowel tissue can cause acute or chronic radiation enteritis producing symptoms such as pain, bloating, nausea, faecal urgency, diarrhoea and rectal bleeding which can have a significant impact on patient’s quality of life. This review outlines the pathogenesis of radiation injury to the small bowel along with the prevention of radiation damage via radiotherapy techniques plus medications such as angiotensin-converting enzyme inhibitors, statins and probiotics. It also covers the treatment of both acute and chronic radiation enteritis via a variety of medical (including hyperbaric oxygen), dietetic, endoscopic and surgical therapies.

Stacey, Rhodri

2014-01-01

183

Diagnosis and management of small bowel and mesentery injury following blunt abdominal trauma in 12 cases.  

PubMed

Over four years (April 2004 to December 2008) 12 patients with blunt small bowel and mesenteric injuries were treated at three hospi-tals dealing with trauma. Ten cases were victims of traffic accidents, of whom 70% wore seat belts. There were 11 small bowel injuries (4 full-thickness & 7 seromuscular) and 9 mesenteric injuries (3 with & 6 without a de-vascularized bowel segment). All were managed initially following the Advanced Trauma Life Support (ATLS) guidelines. Emergency room ultrasound was positive for blood in 5/7 cases (71%) and CT scan in 2/4 (50%). Diagnostic peritoneal lavage (DPL) was performed in one case and was positive for blood. PMID:19530607

Helmy, Mohamed A; Alafifi, Aser M; Ali, Ahmed H

2009-04-01

184

Small bowel intussusception causing a postoperative bowel obstruction following laparoscopic low anterior resection in an adult.  

PubMed

Adult intussusception usually presents with nonspecific symptoms such as abdominal pain, bloating, nausea, vomiting, and a change in bowel habits. Although postoperative intussusception has been described in the pediatric population, there has been little description of it in the adult population. Postoperative intussusception has unique challenges, as hydrostatic reduction may compromise bowel anastomoses. Surgery is the universal treatment in these patients. In adults, delay in diagnosis and definitive treatment may be a direct result of common symptomatology between postoperative ileus and intussusception. We present a case of an adult patient who underwent laparoscopic low anterior resection for rectal cancer and developed a small bowel intussusception causing obstruction requiring surgery. To our knowledge, this is the first report of a small bowel intussusception masquerading as a postoperative ileus in an adult. While most postoperative delayed bowel function is attributed to ileus, abscess formation, or anastomotic leak, other uncommon etiologies, including intussusception, may occur and are important to include in the differential diagnosis. PMID:24688199

Hussain, Ahmad S; Warrier, Rajalakshmi; Papaconstantinou, Harry T

2014-04-01

185

Intraluminal migration of a spacer with small bowel obstruction: a case report of rare complication  

PubMed Central

The spacer placement is a prevalent procedure to separate the surrounding normal tissues from locally recurrent rectal tumor before the application of radiotherapy. However, complications could occur due to the foreign nature of the spacer. This report describes a case of 60-year-old man who had undergone radiotherapy two years earlier for a recurrent rectal tumor and presented with small bowel obstruction. A spacer was used before radiotherapy. Radiological assessment and laparotomy revealed the presence of the spacer inside the small bowel lumen. It is possible that the spacer established contact with the intestine, elicited local inflammatory reaction that facilitated the complete penetration of the intestinal wall without causing any clinical symptoms.

2012-01-01

186

Small bowel perforation caused by a sharp bone: laparoscopic diagnosis and treatment.  

PubMed

Small bowel perforation caused by sharp or pointed foreign bodies rarely is diagnosed preoperatively because clinical symptoms usually are nonspecific and can mimic other surgical conditions such as appendicitis and cecal diverticulitis. We report the case of a 57-year-old man who underwent diagnostic laparoscopy for abdominal pain of unknown etiology. Swelling and erythema were noted in a segment of small bowel in the right lower abdomen. A tiny sharp-pointed object was found penetrating the inflamed portion of the bowel. This foreign body was removed and the perforation immediately repaired under laparoscopic guidance. The postoperative course was uneventful. We believe that in cases of lower abdominal pain with peritoneal irritation, laparoscopy can provide not only a wide field of examination to localize intraabdominal pathology, but in some instances it can aid in case management. PMID:10804008

Yao, C C; Yang, C C; Liew, S C; Lin, C S

1999-06-01

187

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)

2010-03-01

188

Oral versus intravenous premedication for small bowel biopsy in children: effect on procedure and fluoroscopy times.  

PubMed

Oral alimemazine and cisapride, or diazepam and cisapride, or iv midazolam and metoclopramide were given as premedication for small bowel biopsy to three groups of children from a total population of 185 individuals. The biopsy procedures were performed under intermittent fluoroscopy and times for both were recorded. The median biopsy procedure time was significantly shorter in children given iv midazolam and metoclopramide (6 min) compared to those given oral premedication (10 min) (p < 0.001). The median fluoroscopy time was very short in all groups, ranging between 3 and 6 s. It is concluded that iv premedication is superior to oral premedication for small bowel biopsy in children because more effective sedation is obtained. PMID:8453221

Stenhammar, L; Wärngård, O; Lewander, P; Nordvall, M

1993-01-01

189

Small bowel incarceration in the umbilical artery following total laparoscopic radical hysterectomy  

Microsoft Academic Search

Total laparoscopic radical hysterectomy (TLRH) has demonstrated to be a feasible and safe technique for patients affected\\u000a of early cervical cancer. Small bowel obstruction resulting from a loop volvulus represents a very uncommon postoperative\\u000a complication in gynecological laparoscopic surgery. We report a case of a patient who presented an intestinal obstruction\\u000a following a TLRH for cervical cancer. The obstruction was

Juan Gilabert-Estelles; Riccardo Favero; Vicente Paya; Sergio Costa; Francisco Coloma; Juan Gilabert-Aguilar

2010-01-01

190

Small Bowel Ischemia due to Jejunum Volvulus in Pregnancy: A Case Report  

PubMed Central

The diagnosis of intestinal obstruction in pregnancy is difficult, as the symptoms may mimic pregnancy-associated complaints. The surgical management is challenging, as the mortality rate of midgut volvulus in pregnancy is high. We report the case of a 35-year-old woman at 21 weeks and 5 days of gestation with small bowel obstruction who presented to our institution with a 24?h history of colicky abdominal pain and nausea and who finally had a successful open repair.

Vassiliou, Ioannis; Tympa, Aliki; Derpapas, Michalis; Kottis, Georgios; Vlahos, Nikolaos

2012-01-01

191

In vitro allograft irradiation prevents graft-versus-host disease in small-bowel transplantation  

SciTech Connect

In small-bowel transplantation, the transfer of large numbers of donor lymphocytes with the intestinal allograft may provoke a lethal graft-versus-host reaction. The effectiveness of allograft irradiation in vitro as a method of preventing graft-versus-host disease (GVHD) was studied in a rat model of small-bowel transplantation, with the Lewis----Lewis X Brown Norway F1 hybrid strain combination. Cold harvested small-bowel allografts were irradiated immediately prior to heterotopic or orthotopic transplantation. Animals that had received heterotopic allografts irradiated with 0, 250, or 500 rad all died of GVHD after 14.4 +/- 3.0, 15.0 +/- 1.3, and 14.2 +/- 1.9 days, respectively. None of the animals that had received allografts treated with 1000 rad developed clinical or pathologic evidence of GVHD, however, and all survived for more than 6 months (P less than 0.001). Allograft function was studied in animals that underwent orthotopic transplantation. Recipients of nonirradiated orthotopic allografts all died of GVHD after 14.0 +/- 0.7 days, whereas recipients of allografts irradiated with 1000 rad all survived for more than 5 months (P less than 0.001). After 120 days, weight gain (51.8 +/- 11.7%), serum albumin (3.9 +/- 0.7 g/dl), serum triglycerides (67.0 +/- 24.3 mg/dl), CBC, and differential in these animals were not statistically different from those in either age-matched isograft recipients or normal animals, and when the rats were sacrificed, irradiated allografts showed no changes suggestive of radiation injury. These results indicate that irradiation of small-bowel allografts in vitro prevents development of GVHD, and that this can be achieved at a dose which does not cause injury to or malfunction of the allograft.

Lee, K.K.; Schraut, W.H.

1985-04-01

192

Clinical application of wireless capsule endoscopy in pediatric patients for suspected small bowel diseases  

Microsoft Academic Search

Capsule endoscopy (CE) has been demonstrated to be safe and well tolerated in adults with suspicion of small intestinal diseases\\u000a with negative results of gastroscopy and colonoscopy. However, its value in pediatric patients has not yet been well studied.\\u000a This study aimed to evaluate the results and safety of CE in pediatric patients with suspicion of small bowel disorders. There

Zhi-Zheng Ge; Hai-Ying Chen; Yun-Jie Gao; Jing-Li Gu; Yun-Biao Hu; Shu-Dong Xiao

2007-01-01

193

Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy  

PubMed Central

AIM: To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in patients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. METHODS: Seven consecutive asymptomatic pts (age 15-38 years) with PJS have been collected; six underwent polypectomy using single balloon enteroscopy (Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit (OBCU Olympus Balloon Control Unit) and a disposable silicone splinting tube with balloon (ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endoscopy (WCE). Prophylactic polypectomy was reserved mainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from -6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure. RESULTS: Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm (range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgical resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussusceptions. No gastrointestinal tumors were found in subsequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper endoscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps (> 15 mm). CONCLUSION: The effective of prophylactic polypectomy of small bowel large polyps (> 15 mm) could be the first line treatment for conservative approach in management of PJS patients.

Torroni, Filippo; Romeo, Erminia; Rea, Francesca; Angelis, Paola De; Foschia, Francesca; Faraci, Simona; Abriola, Giovanni Federici di; Contini, Anna Chiara; Caldaro, Tamara; Dall'Oglio, Luigi

2014-01-01

194

Reduction in Adhesive Small-Bowel Obstruction by Seprafilm ® Adhesion Barrier After Intestinal Resection  

Microsoft Academic Search

INTRODUCTION: Although Seprafilm has been demonstrated to reduce adhesion formation, it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction. METHODS: This was a prospective, randomized, multicenter, multinational, single-blind, controlled study. This report focuses on those patients who underwent intestinal resection (n = 1,701). Before closure of the abdomen, patients were randomized to receive

Victor W. Fazio; Zane Cohen; James W. Fleshman; Harry van Goor; Joel J. Bauer; Bruce G. Wolff; Marvin Corman; Robert W. Beart; Steven D. Wexner; James M. Becker; John R. T. Monson; Howard S. Kaufman; David E. Beck; H. Randolph Bailey; Kirk A. Ludwig; Michael J. Stamos; Ara Darzi; Ronald Bleday; Richard Dorazio; Robert D. Madoff; Lee E. Smith; Susan Gearhart; Keith Lillemoe; Jonas Göhl

2006-01-01

195

Metastatic squamous cell carcinoma from hand skin causing small bowel obstruction: an unusual case presentation  

PubMed Central

The small bowel rarely suffers from metastatic tumors from outside the abdomen. Small bowel obstructions caused by the metastatic spread of squamous cell carcinoma (SCC) of the hand to the intestines are even rarer. A 71-year-old man with intermittent abdominal distension and pain for 4 months was diagnosed with partial bowel obstruction. The patient underwent a video capsule endoscopic examination; however, the patient was unable to pass the capsule, which worsened the abdominal distension. He was transferred to our department for acute intestinal obstruction, and an emergency exploratory laparotomy was performed. Intraoperatively, a tumoral stricture of the intestine at a distance of 150 cm from the ileo-cecum and dilation of the proximal bowel was found. The involved segment was resected, and ileo-ileal anastomosis was performed. The pathological sections confirmed the lesion to be a moderately differentiated SCC with whole bowel layer infiltration. Immunohistochemical staining showed positive expression of cytokeratin 5/6 and p63. The patient had an uneventful recovery. However, 6 months later, he was hospitalized again with intestinal obstruction. Reoperation was performed and revealed multiple metastases in the small bowel. He died 4 months later. In this unusual case, metastasizing SCC of the hand skin led to intestinal obstruction and poor prognosis. Therefore, follow-up procedures regarding intestinal spread should be performed in patients with SCC who present with abdominal symptoms.

2014-01-01

196

Multifocal small bowel stromal tumours presenting with peritonitis in an HIV positive patient  

PubMed Central

INTRODUCTION The most common mesenchymal tumour of the gastrointestinal tract is stromal tumours (GISTs). Symptomatic GISTs can present with complications such as haemorrhage, obstruction and perforation. Complete surgical resection with negative margins is the mainstay of treatment but may be imprudent on emergent occasion. Tyrosine-kinase inhibitors (TKIs) have been revolutionary in the treatment of GISTs and have resulted in improved outcomes. PRESENTATION OF CASE A 41 year old HIV positive male presented with an acute history of abdominal pain and obstructive symptoms. Clinical examination revealed sepsis and peritonitis. One of the several small bowel tumours discovered at exploratory laparotomy was necrotic and perforated. The perforated tumour alone was resected and a small bowel internal hernia reduced. The patient made an uneventful recovery and will be considered for TKI therapy with a view to later re-operation. DISCUSSION GISTs very rarely perforate. The pathophysiology of stromal tumour necrosis is poorly understood. Multifocality and small bowel location are poor prognosticators and may occur in the setting of familial GISTs, specific syndromes and sporadic cases. There is no established association between HIV and GISTs. CONCLUSION Perforation occurs infrequently in ?8% of symptomatic cases and poses increased risk of local recurrence. The surgical management of perforation takes precedence in an emergency. The surgeon must however take cognisance of the adherence to ideal oncologic principles where feasible. TKI therapy is invaluable if a re-exploration is to be later considered.

Mansoor, Ebrahim

2014-01-01

197

Crohn's disease complicated by multiple stenoses and internal fistulas clinically mimicking small bowel endometriosis  

PubMed Central

We report a 31-year-old woman with Crohn’s disease complicated by multiple stenoses and internal fistulas clinically misdiagnosed as small bowell endometriosis, due to the patient’s perimenstrual symptoms of mechanical subileus for 3 years; at first monthly, but later continuous, and gradually increasing in severity. We performed an exploratory laparotomy for small bowel obstruction, and found multiple ileal strictures and internal enteric fistulas. Because intraoperative findings were thought to indicate Crohn’s disease, a right hemicolectomy and partial distal ileum resection were performed for obstructive Crohn’s ileitis. Histopathology of the resected specimen revealed Crohn’s disease without endometrial tissue. The patient made an uneventful recovery from this procedure and was discharged home 10 d post-operatively. The differential diagnosis of Crohn’s diease with intestinal endometriosis may be difficult pre-operatively. The two entities share many overlapping clinical, radiological and pathological features. Nevertheless, when it is difficult to identify the cause of intestinal obstruction in a woman of child-bearing age with cyclical symptoms suggestive of small bowel endometriosis, Crohn’s disease should be included in the differential diagnosis.

Teke, Zafer; Aytekin, Faruk Onder; Atalay, Ali Ozgur; Demirkan, Nese Calli

2008-01-01

198

Jejunal diverticular disease with unborn enterolith presenting as a small bowel obstruction: a case report.  

PubMed

Jejunal diverticuli are rare and usually asymptomatic. More commonly, they are seen as incidental findings on CT images, enteroclysis, or during surgery. Complications such as bleeding, perforation, obstruction, malabsorption, diverticulitis, blind loop syndrome, volvulus, and intussusception may warrant surgical intervention. An interesting case of an unborn enterolith (enclosed calculus) from a jejunal diverticulum presenting as a small bowel obstruction is presented. The patient is a 66-year- old woman with no prior history of abdominal surgery who presented with a high-grade bowel obstruction. CT with intravenous barium contrast confirmed the presence of a transition point from dilated to decompressed small bowel in the mid jejunum. At laparotomy, a freely mobile mass was found in this area leading to the bowel obstruction. The mass was removed by making a small enterotomy in the jejunum. While running the small bowel proximally, a small segment of jejunum, approximately 8 cm, containing several diverticuli was found. This bowel obstruction was the result of an unborn enterolith from this segment of bowel. The patient's hospitalization was benign and she was discharged home on postoperative day 4. PMID:17674945

Crace, Phillip P; Grisham, Andre; Kerlakian, George

2007-07-01

199

Metastatic squamous cell carcinoma from hand skin causing small bowel obstruction: an unusual case presentation.  

PubMed

The small bowel rarely suffers from metastatic tumors from outside the abdomen. Small bowel obstructions caused by the metastatic spread of squamous cell carcinoma (SCC) of the hand to the intestines are even rarer. A 71-year-old man with intermittent abdominal distension and pain for 4 months was diagnosed with partial bowel obstruction. The patient underwent a video capsule endoscopic examination; however, the patient was unable to pass the capsule, which worsened the abdominal distension. He was transferred to our department for acute intestinal obstruction, and an emergency exploratory laparotomy was performed. Intraoperatively, a tumoral stricture of the intestine at a distance of 150 cm from the ileo-cecum and dilation of the proximal bowel was found. The involved segment was resected, and ileo-ileal anastomosis was performed. The pathological sections confirmed the lesion to be a moderately differentiated SCC with whole bowel layer infiltration. Immunohistochemical staining showed positive expression of cytokeratin 5/6 and p63. The patient had an uneventful recovery. However, 6 months later, he was hospitalized again with intestinal obstruction. Reoperation was performed and revealed multiple metastases in the small bowel. He died 4 months later. In this unusual case, metastasizing SCC of the hand skin led to intestinal obstruction and poor prognosis. Therefore, follow-up procedures regarding intestinal spread should be performed in patients with SCC who present with abdominal symptoms. PMID:24885006

Li, Ruixin; Chen, Zihua; Wen, Qiaocheng; Chen, Zhikang

2014-01-01

200

Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding  

PubMed Central

AIM: To report the incidence of non-small-bowel bleeding pathologies encountered during double-balloon enteroscopy (DBE) procedures and to analyse their significance. METHODS: A retrospective study of a prospective DBE database conducted in a tertiary-referral center was conducted. A total of 179 patients with obscure gastrointestinal bleeding (OGIB) referred for DBE from June 2004 to November 2008 were analysed looking for the incidence of non-small-bowel lesions (NSBLs; all and newly diagnosed) encountered during DBE. RESULTS: There were 228 (150 antegrade and 78 retrograde) DBE procedures performed in 179 patients. The mean number of DBE procedures was 1.27 per patient. The mean age (SD) of the patients was 62 ± 16 years old. There were 94 females (52.5%). The positive yield for a bleeding lesion was 65.9%. Of the 179 patients, 44 (24.6%) had NSBLs (19 of them had dual pathology with small-bowel lesions and NSBLs); 27 (15.1%) had lesions not detected by previous endoscopies. The most common type of missed lesions were vascular lesions. CONCLUSION: A significant proportion of patients (24.6%) had lesions within reach of conventional endoscopy. Careful repeat examination with gastroscopy and colonoscopy might be required.

Tee, Hoi-Poh; Kaffes, Arthur J

2010-01-01

201

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

PubMed

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. PMID:21785584

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

2012-01-01

202

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.

2012-01-01

203

Decompression of the small bowel by endoscopic long-tube placement  

PubMed Central

AIM: To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement. METHODS: Seventy-eight patients with small bowel obstruction requiring decompression were enrolled in the study and divided into two groups. Intubation of a long tube was guided by fluoroscopy in one group and by endoscopy in the other. The duration of the procedure and the success rate for each group were evaluated. RESULTS: A statistically significant difference in the mean duration of the procedure was found between the fluoroscopic group (32.6 ± 14.6 min) and the endoscopic group (16.5 ± 7.8 min) among the cases classified as successful (P < 0.05). The success rate was significantly different between the groups: 88.6% in the fluoroscopic group and 100% in the endoscopic group (P < 0.05). CONCLUSION: For patients with adhesive small bowel obstruction, long-tube decompression is recommended and long-tube insertion by endoscopy was superior to fluoroscopic placement.

Guo, Shi-Bin; Duan, Zhi-Jun

2012-01-01

204

Angiosarcoma of Small Bowel Presenting with Obstruction: Novel Observations on a Rare Diagnostic Entity with Unique Clinical Presentation  

PubMed Central

We present a case of angiosarcoma in small bowel, presenting with partial small bowel obstruction in a 79-year-old man with no history of radiation, chemotherapy, toxin exposure, or previous operative intervention. Angiosarcoma of small bowel is a rare entity which may present with nausea, abdominal pain, recurrent bleeding, and usually a history of prior radiation or exposure to specific toxins (polyvinyl chloride). Angiosarcoma of small bowel tends to spread rapidly and has a poor prognosis. We review the surgical and oncologic challenges. We report unique macroscopic findings of raised hyperemic margins, which are suggestive of a vasogenic lesion and the histologic feature of a partially retiform pattern with dense basement membrane material in an otherwise poorly differentiated lesion.

Siderits, Richard; Poblete, Frederick; Saraiya, Biren; Rimmer, Cheryl; Hazra, Anup; Aye, Le

2012-01-01

205

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.

2013-01-01

206

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

2002-01-01

207

Complete response and prolonged disease-free survival in a patient with recurrent duodenal adenocarcinoma treated with bevacizumab plus FOLFOX6  

PubMed Central

Small bowel adenocarcinoma is an uncommon gastrointestinal malignancy with limited data on effective chemotherapy in the adjuvant setting, as well as for advanced disease. We present a case report of a patient with recurrent duodenal adenocarcinoma after resection and adjuvant chemotherapy who experienced a complete response to bevacizumab with oxaliplatin and 5FU (FOLFOX) followed by bevacizumab/capecitabine maintenance therapy for 2 years. The patient continues to be disease-free 8 years after his recurrence. This case highlights the potential of vascular endothelial growth factor (VEGF) inhibitors to enhance chemotherapeutic regimens for advanced small bowel adenocarcinoma.

Nagaraj, Gayathri; Zarbalian, Yousef; Flora, Karin

2014-01-01

208

Aminoguanidine Alleviates Radiation-Induced Small-Bowel Damage Through Its Antioxidant Effect  

SciTech Connect

Purpose: To evaluate the effect and its mechanism of aminoguanidine (AG) on small-bowel protection after whole-abdominal irradiation (WAI) in rats. Methods and Materials: Male Sprague-Dawley rats (300-400 g) subjected to 12 Gy WAI were used for the study. Aminoguanidine at a dose of 50-800 mg/kg was administered by the gavage route 2 h before WAI. Mucosal damage of small bowel was evaluated by the grade of diarrhea and crypt survival; oxidative stress was determined by the level of 8-hydroxy 2'-deoxyguanosine (8-OHdG) with immunohistochemistry (IHC). Nitrosative stress was evaluated by the expression of inducible nitric oxide synthase (iNOS) and 3-nitrotyrosine (3-NT) with IHC, and systemic and portal vein NOx (nitrite + nitrate) levels were measured and compared with and without AG treatment after WAI. Results: Aminoguanidine showed a dose-dependent effect against WAI-induced diarrhea. Aminoguanidine at a dose of 400 mg/kg had the best protective effect, from 92% to 17% (p = 0.002). Aminoguanidine increased crypt survival from 23% to 46% (p = 0.003). It also significantly attenuated 8-OHdG expression but not 3-NT and iNOS expression at both 4 and 8 h after 12-Gy WAI. Aminoguanidine did not alter the portal vein NOx levels 4 and 8 h after 12-Gy WAI. Conclusion: Aminoguanidine has a radioprotective effect against radiation-induced small-bowel damage due to its antioxidant effect but not inhibition of nitric oxide production. Dietary AG may have a potentially protective effect on the small intestine of patients subjected to pelvic and abdominal radiotherapies.

Huang, E.-Y. [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); Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Wang, F.-S. [Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Department of Medical Research, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Lin, I-H. [Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Yang, Kuender D. [Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China); Department of Medical Research, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan (China)], E-mail: yangkd@adm.cgmh.org.tw

2009-05-01

209

CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease  

PubMed Central

Objective The aim of the study is to compare CT enterography with polyethylene glycol solution (PEG-CT) with CT enteroclysis (CT-E) in patients with suspected small bowel disease. Methods 145 patients underwent abdominal contrast-enhanced 16-row multidetector CT after administration of 2000 ml of PEG by mouth (n = 75) or after administration of 2000 ml of methylcellulose by nasojejunal tube (n = 70). Small bowel distension, luminal and extraluminal findings were evaluated and compared with small bowel follow-through examination in 60 patients, double contrast enema in 50, surgery in 25 and endoscopy in 35. Statistical evaluation was carried out by ?2 testing. For both techniques we have also calculated the effective dose and the equivalent dose in a standard patient. Results Crohn's disease was diagnosed in 64 patients, neoplasms in 16, adhesions in 6. Distension of the jejunum was better with CT-E than PEG-CT (p<0.05: statistically significant difference). No significant difference was present for others sites (p>0.05). Evaluation of pathological ileal loops was good with both techniques. The values of sensitivity, specificity and diagnostic accuracy were respectively 94%, 100% and 96% with CT-E, and 93%, 94% and 93% with PEG-CT. The effective dose for PEG-CT was less than the dose for the CT-E (34.7 mSv vs 39.91 mSv). Conclusion PEG-CT shows findings of Crohn's disease as well as CT-E does, although CT-E gives better bowel distension, especially in the jejunum, and has higher specificity than PEG-CT.

Minordi, L M; Vecchioli, A; Mirk, P; Bonomo, L

2011-01-01

210

Transient small bowel intussusception in adults: an overlooked feature of coeliac disease.  

PubMed

Coeliac disease is the commonest immunological gastrointestinal disorder in the Western world. The symptoms of coeliac disease in adults are often non-specific, and a high index of suspicion may be required for timely diagnosis. We describe the case of a 46-year-old woman, with known dilated cardiomyopathy and pulmonary hypertension, who presented with non-specific abdominal symptoms, not initially attributed to gastrointestinal disease. Radiological investigations demonstrated transient small bowel intussusception without other abnormality, leading to the suggestion of coeliac disease as a cause, which was subsequently confirmed as the diagnosis. PMID:24951596

Briggs, James Henry; McKean, David; Palmer, Jonathan S; Bungay, Helen

2014-01-01

211

Disruption of interstitial cells of Cajal networks after massive small bowel resection  

PubMed Central

AIM: To investigate the disruptions of interstitial cells of Cajal (ICC) in the remaining bowel in rats after massive small bowel resection (mSBR). METHODS: Thirty male Sprague-Dawley rats fitting entry criteria were divided randomly into three experimental groups (n = 10 each): Group A rats underwent bowel transection and re-anastomosis (sham) and tissue samples were harvested at day 7 post-surgery. Group B and C rats underwent 80% small bowel resection with tissue harvested from Group B rats at day 7 post-surgery, and from Group C rats at day 14 post-surgery. The distribution of ICC at the site of the residual small bowel was evaluated by immunohistochemical analysis of small intestine samples. The ultrastructural changes of ICC in the remnant ileum of model rats 7 and 14 d after mSBR were analyzed by transmission electron microscopy. Intracellular recordings of slow wave oscillations were used to evaluate electrical pacemaking. The protein expression of c-kit, ICC phenotypic markers, and membrane-bound stem cell factor (mSCF) in intestinal smooth muscle of each group were detected by Western blotting. RESULTS: After mSBR, immunohistochemical analysis indicated that the number of c-kit-positive cells was dramatically decreased in Group B rats compared with sham tissues. Significant ultrastructural changes in ICC with associated smooth muscle hypertrophy were also observed. Disordered spontaneous rhythmic contractions with reduced amplitude (8.5 ± 1.4 mV vs 24.8 ± 1.3 mV, P = 0.037) and increased slow wave frequency (39.5 ± 2.1 cycles/min vs 33.0 ± 1.3 cycles/min, P = 0.044) were found in the residual intestinal smooth muscle 7 d post mSBR. The contractile function and electrical activity of intestinal circular smooth muscle returned to normal levels at 14 d post mSBR (amplitude, 14.9 ± 1.6 mV vs 24.8 ± 1.3 mV; frequency, 30.7 ± 1.7 cycles/min vs 33.0 ± 1.3 cycles/min). The expression of Mscf and c-kit protein was decreased at 7 d (P = 0.026), but gradually returned to normal levels at 14 d. The ICC and associated neural networks were disrupted, which was associated with the phenotype alterations of ICC. CONCLUSION: Massive small bowel resection in rats triggered damage to ICC networks and decreased the number of ICC leading to disordered intestinal rhythmicity. The mSCF/c-kit signaling pathway plays a role in the regulation and maintenance of ICC phenotypes.

Chen, Jie; Du, Lei; Xiao, Yong-Tao; Cai, Wei

2013-01-01

212

Preliminary mechanical characterization of the small bowel for in vivo robotic mobility.  

PubMed

In this work we present test methods, devices, and preliminary results for the mechanical characterization of the small bowel for intra luminal robotic mobility. Both active and passive forces that affect mobility are investigated. Four investigative devices and testing methods to characterize the active and passive forces are presented in this work: (1) a novel manometer and a force sensor array that measure force per cm of axial length generated by the migrating motor complex, (2) a biaxial test apparatus and method for characterizing the biomechanical properties of the duodenum, jejunum, and ileum, (3) a novel in vitro device and protocol designed to measure the energy required to overcome the self-adhesivity of the mucosa, and (4) a novel tribometer that measures the in vivo coefficient of friction between the mucus membrane and the robot surface. The four devices are tested on a single porcine model to validate the approach and protocols. Mean force readings per cm of axial length of intestine that occurred over a 15?min interval in vivo were 1.34?±?0.14 and 1.18?±?0.22?N cm(-1) in the middle and distal regions, respectively. Based on the biaxial stress/stretch tests, the tissue behaves anisotropically with the circumferential direction being more compliant than the axial direction. The mean work per unit area for mucoseparation of the small bowel is 0.08?±?0.03 mJ cm(-2). The total energy to overcome mucoadhesion over the entire length of the porcine small bowel is approximately 0.55?J. The mean in vivo coefficient of friction (COF) of a curved 6.97 cm(2) polycarbonate sled on live mucosa traveling at 1?mm s(-1) is 0.016?±?0.002. This is slightly lower than the COF on excised tissue, given the same input parameters. We have initiated a comprehensive program and suite of test devices and protocols for mechanically characterizing the small bowel for in vivo mobility. Results show that each of the four protocols and associated test devices has successfully gathered preliminary data to confirm the validity of our test approach. PMID:22010745

Terry, Benjamin S; Lyle, Allison B; Schoen, Jonathan A; Rentschler, Mark E

2011-09-01

213

A Rare Cause of Small Bowel Obstruction in Adults: Left Paraduodenal Internal Hernia  

PubMed Central

A 47 years old lady presented with repeated intermittent, colicky, left upper, and periumblical abdominal pain associated with nausea and vomiting since two years prior to admission. Each episode of the pain spontaneously subsided after bilious vomiting. The patient had no history of surgery, abdominal trauma or intra-abdominal infection, weight loss or previous history for small bowel obstruction (SBO). MRI enterography was suggestive of internal hernia and surgery documented left paraduodenal (mesocolic) internal hernia (LPDIH). After surgery the patient was followed for three months without any abdominal symptoms.

Sardarian, Hossein; Maleki, Iradj; Mortazian, Meisam; Jafari, Ramezan; Tayebi, Pouya; Saberifiroozi, Mehdi

2012-01-01

214

[Nonimmune hydrops fetalis associated with congenital small bowel atresia--a case study].  

PubMed

Nonimmune hydrops fetalis is observed with the frequency of 1:3000 cases diagnosed pre- and postnatally. In the following paper the authors analyzed the course of pregnancy complicated by fetal ascites and polyhydramnios with the appearance of colonic ileus and they presented the postnatal condition of the baby The preliminary diagnosis was confirmed after birth and the newborn was operated in the second day of his life. The congenital small bowel atresia was qualified as a III B type (Grossfeld qualification), which is called the "pagoda" syndrome [3]. The colonic atresia is located then around the superior mesenteric vessels, which leads to colonic necrosis (Figure 1). PMID:22379934

Pietryga, Marek; Murlewska, Julia; Pietrzycka, Dorota; Becela, Piotr; Brazert, Jacek; Gadzinowski, Janusz; Jankowski, Andrzej

2011-09-01

215

A rare complication of small bowel intussusception: report of a case and review of literature.  

PubMed

Volvulus and intussusception are rare conditions in children. We describe an unusual case of intussusception due to a solitary Peutz-Jeghers type hamartomatous polyp complicated by volvulus, which occurred in an 11-year-old girl. A laparotomy allows to successfully treat the pathology. The postoperative course was favourable. We discuss the clinical findings and the values of the preoperative instrumental diagnosis. The literature is reviewed. Identifying a midgut volvulus, as complication of a small bowel intussusception, during the diagnostic phase could help in choosing the most appropriate surgical approach. PMID:24469494

Pietro, Impellizzeri; Astra, Borruto Francesca; Simona, Montalto Angela; Carmelo, Romeo

2013-01-01

216

[Recurrent small-bowel intussusceptions revealing a disseminated BCG infection related to severe combined immunodeficiency].  

PubMed

Infant small-bowel intussusceptions, most of the time idiopathic, may exceptionally reveal a severe digestive disease. We report the case of a 4-month-old infant who presented multiple and simultaneous ileal intussusceptions associated with severe acute gastroenteritis. Initially, the infant showed a protein-losing enteropathy with a clear alteration of the general state of health and undocumented fever, resistant to broad-spectrum antibiotic therapy. Skin and splenic nodules associated with hepatosplenomegaly and pancytopenia set in progressively. The etiologic evaluation led to the diagnosis of a Mycobacterium bovis BCG infection related to severe combined immune deficiency. The treatment consisted in anti-tuberculosis quadruple therapy in association with immunoglobin supplementation. Secondarily, the patient underwent gene therapy in a clinical trial. An early BCG vaccine in the first weeks of life, before the outbreak of infection revealing the immune deficiency, is a risk factor in triggering a disseminated BCG infection in immunodepressed infants. This clinical case is the first reported of severe combined immune deficiency revealed by small-bowel intussusceptions related to a disseminated BCG infection. PMID:24962783

Venaille, A; Viola, S; Peycelon, M; Grand d'Esnon, A; Fasola, S; Audry, G; Ducou Le Pointe, H; Tounian, P

2014-08-01

217

Phytobezoar in Meckel's diverticulum: A rare cause of small bowel obstruction  

PubMed Central

Introduction Meckel's diverticulum (MD) is the prevailing anomaly of the gastrointestinal tract, found in about 2% of the population; it rarely gives rise to symptoms and its discovery is usually accidental. Phytobezoar is a concretion of poorly digested fruit and vegetable fibres that is found in the alimentary tract and rarely can be the cause of small intestinal obstruction. Herein we report a rare case of intestinal obstruction due to phytobezoar formation into a MD. Presentation of case A 50 year-old patient, was admitted to author's institution with an history of abdominal pain, nausea and multiples episodes of vomiting. Plain X-ray showed dilated small-bowel loops. Computed tomography (CT) revealed jejunal loops with air-fluid levels. The patient underwent explorative laparotomy where we found a giant Meckel's diverticulum, filled by a phytobezoar that caused small bowel compression. We performed a segmental ileal, resection, containing the MD. The histological exam confirmed Meckel's diverticulum. Discussion Bowel obstruction due to a phytobezoar in a Meckel's diverticulum is rare: only 7 cases have been reported in literature. MD complications are rare and phytobezoar is one of them with only few cases described in literature. Conclusion The conventional x rays studies were inconclusive whereas abdominal contrast enhanced CT led to a definitive diagnosis. Explorative laparotomy or laparoscopy is mandatory in these cases.

Bini, Roberto; Quiriconi, Fabrizio; Tello, Aurelio; Fusca, Marcella; Loddo, Franca; Leli, Renzo; Addeo, Alfredo

2012-01-01

218

Increased activity of digestive enzymes in ileal enterocytes adapting to proximal small bowel resection.  

PubMed Central

The ability of adapting ileal enterocytes to express different digestive enzymes in their brush border membranes was tested in young female Wistar rats (n = 72) receiving 60% proximal small bowel resection. In control rats with intestinal transection both neutral aminopeptidase and alpha-glucosidase activities were shown, by quantitative cytochemistry, to increase during enterocyte migration over the lower part of the villus; thereafter enzyme activities declined or remained approximately constant. Proximal enterectomy increased the amount of alpha-glucosidase but not neutral aminopeptidase activity appearing during early enterocyte development. Thymidine labelled autoradiography showed that the rate of enterocyte migration along the ileal villus nearly doubled after jejunal resection (19.3 v 11.1 microns/h). Nevertheless, the time taken for both peptidase and saccharidase activities to appear at maximal rates in the brush border membrane was diminished by about five hours. Thus ileal enterocytes adapt to proximal small bowel resection by selective increments in enzyme expression, findings that contradict the previous hypothesis of simple metabolic immaturity.

Chaves, M; Smith, M W; Williamson, R C

1987-01-01

219

Small bowel polypectomy by double balloon enteroscopy: Correlation with prior capsule endoscopy  

PubMed Central

AIM: To investigate the feasibility of small bowel polypectomy using double balloon enteroscopy and to evaluate the correlation with capsule endoscopy (CE). METHODS: This is a retrospective review of a single tertiary hospital. Twenty-five patients treated by enteroscopy for small bowel polyps diagnosed by CE or other imaging techniques were included. The correlation between CE and enteroscopy (correlation coefficient of Kendall for the number of polyps, intra-class coefficient for the size and coefficient of correlation kappa for the location) was evaluated. RESULTS: There were 31 polypectomies and 12 endoscopic mucosal resections with limited morbidity and no mortality. Histological analysis revealed 27 hamartomas, 6 adenomas and 3 lipomas. Strong agreement between CE and optical enteroscopy was observed for both location (Kappa value: 0.90) and polyp size (Kappa value: 0.76), but only moderate agreement was found for the number of polyps (Kendall value: 0.47). CONCLUSION: Double balloon enteroscopy is safe for performing polypectomy. Previous CE is useful in selecting the endoscopic approach and to predicting the difficulty of the procedure.

Rahmi, Gabriel; Samaha, Elia; Lorenceau-Savale, Camille; Landi, Bruno; Edery, Joel; Maniere, Thibault; Canard, Jean-Marc; Malamut, Georgia; Chatellier, Gilles; Cellier, Christophe

2013-01-01

220

Small bowel obstruction secondary to Meckel diverticulum detected and treated laparoscopically--case report.  

PubMed

A 13-year-old man with no history of abdominal surgery was admitted to Saisei Kai Sendai Hospital complaining of acute abdominal pain. Abdominal computed tomography revealed distal small bowel obstruction of unknown etiology. Abdominal symptoms worsened and emergency surgery was performed. To determine the cause of bowel obstruction, laparoscopy was performed. At Trendelenburg position using endoscopic bowel forceps, the focus of the obstruction was explored. The dilated ileum was incarcerated at 10 cm proximal to the ileocecal region. Laparoscopic exploration revealed that the appendix was tightly attached to Meckel diverticulum (MD) and comprised an internal hernia orifice, in which the small bowel was incarcerated. Intra-abdominal surgical space was insufficient to release the bowel obstruction intracorporally. After a 5 cm of midline incision was made in the lower abdomen, a LAP-Disc (Hakko Co, Japan) was applied. Opening of the internal hernia orifice, normograde appendectomy, and resection of MD with a suturing instrument were performed. The hernia orifice between MD and the appendix was released and the incarcerated bowel was normalized. The patient was discharged without postoperative complications. Laparoscopic procedures are useful in identifying rare causes of bowel obstruction and to determine an appropriate access point for treatment. PMID:17057578

Ishigami, Sumiya; Baba, Kenji; Kato, Kenji; Nakame, Kazuhiko; Okumura, Hiroshi; Matsumoto, Masataka; Natsugoe, Shoji; Aikou, Takashi

2006-10-01

221

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

2011-01-01

222

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

PubMed

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

2008-11-01

223

Prostate Adenocarcinoma  

MedlinePLUS

What is prostate adenocarcinoma? Prostate adenocarcinoma accounts for 95 percent of all prostate cancers. It starts in the prostate gland and, ... Cancer Society. Who is most likely to have prostate adenocarcinoma? Prostate adenocarcinoma becomes more common in men ...

224

The Dose-Volume Relationship of Small Bowel Irradiation and Acute Grade 3 Diarrhea During Chemoradiotherapy for Rectal Cancer  

SciTech Connect

Purpose: Previous work has found a highly significant relationship between the irradiated small-bowel volume and development of Grade 3 small-bowel toxicity in patients with rectal cancer. This study tested the previously defined parameters in a much larger group of patients. Methods and Materials: A total of 96 consecutive patients receiving pelvic radiation therapy for rectal cancer had treatment planning computed tomographic scans with small-bowel contrast that allowed the small bowel to be outlined with calculation of a small-bowel dose-volume histogram for the initial intended pelvic treatment to 45 Gy. Patients with at least one parameter above the previously determined dose-volume parameters were considered high risk, whereas those with all parameters below these levels were low risk. The grade of diarrhea and presence of liquid stool was determined prospectively. Results: There was a highly significant association with small-bowel dose-volume and Grade 3 diarrhea (p {<=} 0.008). The high-risk and low-risk parameters were predictive with Grade 3 diarrhea in 16 of 51 high-risk patients and in 4 of 45 low-risk patients (p = 0.01). Patients who had undergone irradiation preoperatively had a lower incidence of Grade 3 diarrhea than those treated postoperatively (18% vs. 28%; p = 0.31); however, the predictive ability of the high-risk/low-risk parameters was better for preoperatively (p = 0.03) than for postoperatively treated patients (p = 0.15). Revised risk parameters were derived that improved the overall predictive ability (p = 0.004). Conclusions: The highly significant dose-volume relationship and validity of the high-risk and low-risk parameters were confirmed in a large group of patients. The risk parameters provided better modeling for the preoperative patients than for the postoperative patients.

Robertson, John M. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)], E-mail: jrobertson@beaumont.edu; Lockman, David; Yan Di; Wallace, Michelle [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)

2008-02-01

225

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.

LV, LIQIONG; ZHAO, YUN; LIU, HUI; PENG, ZHONGYI

2013-01-01

226

Perforation of metastatic melanoma to the small bowel with simultaneous gastrointestinal stromal tumor.  

PubMed

The gastrointestinal tract (GIT) is a common site of metastases for malignant melanoma. These metastatic tumors are often asymptomatic. We describe a case of a 58-year-old male who presented with a sudden onset of generalized abdominal pain. The patient's past medical history was significant for lentigo melanoma of the right cheek. Laparotomy was performed and two segments of small bowel, one with a perforated tumor, the other with a non-perforated tumor, were removed. Histology and immunohistochemical staining revealed the perforated tumor to be a metastatic malignant melanoma and the non-perforated tumor was found to be a gastrointestinal stromal tumor (GIST). The patient was discharged 7 d postoperatively. To the best of our knowledge, this is the first reported case in the literature of a simultaneous metastatic malignant melanoma and a GIST. Surgical intervention is warranted in patients with symptomatic GIT metastases to improve the quality of life or in those patients with surgical emergencies. PMID:15849837

Brummel, Nathan; Awad, Ziad; Frazier, Shellaine; Liu, Jiafan; Rangnekar, Nitin

2005-05-01

227

Unusual Presentation of Intussusception of the Small Bowel with Peutz Jeghers Syndrome: Report of a Case  

PubMed Central

The Peutz Jeghers syndrome (PJS) is an autosomal dominant disorder which is characterised by hamartomatous polyposes of the gastrointestinal tract, melanin pigmentation of the skin and mucous membranes, and an increased risk for cancer. We are reporting a case of a 15-year-old male with Peutz Jeghers syndrome, who presented to us with features of chronic intestinal obstruction and anaemia. Initially, patient was managed conservatively, but later on, an elective exploratory laparotomy was done for definitive management of intussusception. Laparotomy revealed a jejuno-jejunal intussusception with spontaneous recanalisation of gut which contained a long segment of gangrenous small bowel in the lumen. Resection and anastomosis of the jejunal segment was done. To the best of our knowledge, this might be the first case report on spontaneous recanalisation of small intestine.

Shrivastava, Ashish; Gupta, Akshara; Gupta, Achal; Shrivastava, Jyoti

2013-01-01

228

Unusual presentation of intussusception of the small bowel with peutz jeghers syndrome: report of a case.  

PubMed

The Peutz Jeghers syndrome (PJS) is an autosomal dominant disorder which is characterised by hamartomatous polyposes of the gastrointestinal tract, melanin pigmentation of the skin and mucous membranes, and an increased risk for cancer. We are reporting a case of a 15-year-old male with Peutz Jeghers syndrome, who presented to us with features of chronic intestinal obstruction and anaemia. Initially, patient was managed conservatively, but later on, an elective exploratory laparotomy was done for definitive management of intussusception. Laparotomy revealed a jejuno-jejunal intussusception with spontaneous recanalisation of gut which contained a long segment of gangrenous small bowel in the lumen. Resection and anastomosis of the jejunal segment was done. To the best of our knowledge, this might be the first case report on spontaneous recanalisation of small intestine. PMID:24298508

Shrivastava, Ashish; Gupta, Akshara; Gupta, Achal; Shrivastava, Jyoti

2013-10-01

229

A rare case of blunt thoracoabdominal trauma with small bowel perforation from air bags.  

PubMed

Vehicle collisions represent more than 75% of mechanism of blunt abdominal trauma. In spite of the incomparable improvement of car safety devices, recent studies pointed out that the air bags might cause injuries, specially when it is not associated with seatbelt. In fact, some studies pointed out that crash victims using air bags alone have increased injury severity, hospitalisations, thoracoabdominal procedure, and rehabilitation. Some of the most frequently injured organs reported from air bag deployment are the liver (38%), the spleen (23%) and digestive system (17%). Injury of the hollow viscera are far less common. In particular, blunt abdominal trauma resulting in small bowel perforation is an infrequent lesion. These injuries are difficult to diagnose because specific signs are poor and a delay in treatment increases mortality and morbidity of the patients. We describe a case of thoracoabdominal trauma that occurred during a head-on collision after an air bag deployment without seatbelt use. PMID:19505417

Liverani, A; Pezzatini, M; Conte, S; Mari, F; Milillo, A; Gasparrini, M; Marino, G; Catracchia, V; -Favi, F

2009-05-01

230

MDCT of Small Bowel Obstruction: How Reliable Are Oblique Reformatted Images in Localizing Point of Transition?  

PubMed Central

The goal of this study is to prospectively assess the additional value of oblique reformatted images for localizing POT, having surgery as a reference standard. Materials and Methods. 102 consecutive patients with suspected small bowel obstruction (SBO) underwent 64-slice multidetector row CT (MDCT) using surgical findings as reference standard. Two independent GI radiologists reviewed the CT scans to localize the exact POT by evaluating axial images (data set A) followed by axial, coronal, and oblique MPR images. CT findings were compared to surgical findings in terms of diagnostic performance. McNemar's test was used to detect any statistical difference in POT evaluation between datasets A and B. Kappa statistics were applied for measuring agreement between two readers. Results. There was a diagnostic improvement of 9.9% in the case of the less experienced radiologist in localizing POT by using oblique reformatted images. The more experienced radiologist showed diagnostic improvement by 12.9%.

Memon, Wasim; Khattak, Yasir Jamil; Alam, Tariq; Anwar, Shayan Sirat Maheen

2014-01-01

231

Misoprostol in the intestinal lumen protects against radiation injury of the mucosa of the small bowel  

SciTech Connect

Systemically administered misoprostol, a PGE analog, has been shown to be an intestinal radioprotector. The purpose of this study was to determine if administration of misoprostol into the intestinal lumen can also reduce the severity of acute radiation enteritis. The rat small bowel was operatively exteriorized and segmented by means of suture ties. The remainder of the intestine and the rat were shielded in a lead box. Misoprostol was introduced into the lumen in various doses. After 30 min exposure to misoprostol, the isolated, exteriorized, segmented bowel was subjected to 11 Gy X irradiation. Five days later the animals were sacrificed and the intestines harvested for evaluation. Surviving crypt numbers per circumference and mucosal height were the criteria used for quantification of damage. Mucosa exposed to misoprostol at the time of radiation delivery showed significantly increased crypt numbers and mucosal height compared to adjacent saline-filled intestine. 24 refs., 2 figs., 2 tabs.

Delaney, J.P.; Bonsack, M.E.; Felemovicius, I. (Univ. of Minnesota Medical School, Minneapolis, MN (United States))

1994-03-01

232

Small intestinal adenocarcinoma in Peutz-Jeghers syndrome.  

PubMed

Peutz-Jeghers syndrome (PJS) is characterized by intestinal hamartomatous polyposis (usually affecting the jejunum) and mucocutaneous melanin spots. Though malignant changes are not common, PJS can predispose to carcinoma in the GI tract and elsewhere. We report a 25-year-old man with PJS who developed small intestinal adenocarcinoma and presented with small bowel obstruction due to jejuno-ileal intussusception. PMID:16567896

Mehta, M V; Porecha, Mehul M; Mehta, Purvi J

2006-01-01

233

Characterization of binding of Escherichia coli strains which are enteropathogens to small-bowel mucin.  

PubMed Central

Before an enteropathogen binds to the small bowel, it must interact with the small-bowel mucus (SBM) layer. To determine whether this interaction involves specific binding of diarrheagenic Escherichia coli, we used a quantitative assay with labeled, purified rabbit SBM. Binding of SBM from an adult rabbit was significantly greater to strain 162, an agglutinating E. coli strain, than it was to RDEC-1, a rabbit pathogen, and was significantly greater to strain 2348/PMAR, an enteropathogenic E. coli strain, than it was to strains 1392+ and 1392-, which are enterotoxigenic E. coli strains with and without colonizing fimbriae, respectively. Binding of strains RDEC-1, 2348/PMAR, and 162-4 was significantly greater to SBM than to bovine serum albumin. Binding of all strains increased in a linear fashion with increasing amounts of SBM and was reproducible (r = 0.85). Binding was significantly greater at pH 5.7 than at pH 7.4 or 8.0 for all five strains. Temperature did not alter the binding of any strain. Strains 162-4 and RDEC-1 bound significantly more to proximal SBM than to rabbit distal SBM, while strains 1392+ and 1392- bound significantly more to distal SBM. Oxidation of sugars from SBM significantly decreased the binding of all strains. Each pathogenic E. coli strain bound distinctively to SBM; the SBM sugars appeared to mediate this binding for all E. coli strains. Binding was also dependent on mucin characteristics, as binding varied by region of the gut (increased for proximal SBM for strains 162-4 and RDEC-1 and for distal SBM for strains 1392+ and 1392-). The developmental age of the gut significantly affected binding only of the rabbit pathogen RDEC-1.

Wanke, C A; Cronan, S; Goss, C; Chadee, K; Guerrant, R L

1990-01-01

234

[Malignant small bowel ileus caused by local recurrence after colorectal cancer surgery].  

PubMed

We assessed 5 consecutive patients operated for local recurrence of small bowel obstruction after previous operation for colorectal cancer. Case 1 involved a 71-year-old man who presented with local recurrence with invasion of the ileum after low anterior resection( D3) for rectal cancer( Rb[rectum/below the peritoneal reflection]). Case 2 involved a 51-year-old woman; case 3, a 54-year-old woman; and case 4, a 60-year-old woman, all showing local recurrence with invasion of the jejunum and ureter after high anterior resection (D3) for rectal cancer (Ra[rectum/above the peritoneal reflection]). Case 5 involved a 58-year-old man who showed local recurrence of descending colon cancer with invasion of the jejunum, liver metastasis, and brain metastasis after left hemicolectomy( D3) for descending colon cancer. For the treatment of local recurrence in the patient referred to in case 1, amputation recti with partial resection of the ileum was performed. Partial resection of the ileum was performed in the patients referred to in cases 2 and 3. Nephrostomy was performed in patients referred to in cases 2, 3, and 4. Partial resection of the anastomotic colon and jejunum was performed in the patient referred to in case 5. The patient involved in case 5 underwent radiotherapy for brain metastasis. In the patient referred to in case 1, only radical surgery was performed, which is associated with a good prognosis. The estimated survival after the operation for local recurrence, except for the patient referred to in case 1, was 2 to 15 months( mean, 11.5 months). Oral intake periods, except for the patient referred to in case 1, were 0 to 4 months (mean, 2.3 months). Postoperative complication rates were 80%( 4/5). Our findings suggest that radical operation leads to a good quality of life( QOL) in patients with malignant small bowel obstruction. PMID:24393973

Tomita, Ryouichi; Fujisaki, Shigeru; Sakurai, Kenichi; Sugito, Kiminobu; Koshinaga, Tsugumichi; Shibata, Masahiko

2013-11-01

235

Spiral enteroscopy: prospective U.S. multicenter study in patients with small-bowel disorders  

PubMed Central

Background The performance characteristics of spiral enteroscopy have not been well-described. Objective To determine the technical performance, diagnostic and therapeutic yields, and safety of oral spiral enteroscopy in patients with suspected or established small-bowel pathology. Design Prospective, multicenter, cohort study, with centralized database. Setting Ten U.S. tertiary-care medical centers. Patients This study involved 148 participants, of whom 101 were referred for obscure bleeding. All participants referred for antegrade deep enteroscopy were considered eligible. Intervention Spiral enteroscopy. Main Outcome Measurements Examination duration, depth of insertion, spiral enteroscopy findings, mucosal assessment upon withdrawal, and patient symptom assessment (day 1 and day 7 after the procedure). Results Spiral enteroscopy was successful in 93% of patients, with a median depth of insertion beyond the angle of Treitz of 250 cm (range 10–600 cm). The mean (± standard deviation) total procedure time was 45.0 ± 16.2 minutes for all procedures, and 35.4 minutes for diagnostic procedures. The diagnostic yield was 65%, of which 48% revealed more than one abnormality. The most common findings were angiectasias (61.5%), inflammation (7.5%), and neoplasia (6.8%). Argon plasma coagulation ablation accounted for 64% of therapeutic interventions. Limitations This was not a randomized, controlled trial of deep enteroscopy modalities. Conclusion Spiral enteroscopy appears to be safe and effective for evaluation of the small bowel. The procedure duration, depth of insertion, and diagnostic and therapeutic yields compare favorably with previously published data on other deep enteroscopy techniques such as single-balloon and double-balloon enteroscopy. Comparative studies are warranted. (Gastrointest Endosc 2010;72:992–8.)

Morgan, Douglas; Upchurch, Bennie; Draganov, Peter; Binmoeller, Kenneth F.; Haluszka, Oleh; Jonnalagadda, Sreeni; Okolo, Patrick; Grimm, Ian; Judah, Joel; Tokar, Jeff; Chiorean, Michael

2011-01-01

236

Mesenchymal stem cell therapy in patients with small bowel transplantation: Single center experience  

PubMed Central

AIM: To study the effects of mesenchymal stem cell (MSC) therapy on the prevention of acute rejection and graft vs host disease following small bowel transplantation. METHODS: In our transplantation center, 6 isolated intestinal transplants have been performed with MSC therapy since 2009. The primary reasons for transplants were short gut syndrome caused by surgical intestine resection for superior mesenteric artery thrombosis (n = 4), Crohn’s disease (n = 1) and intestinal aganglionosis (n = 1). Two of the patients were children. At the time of reperfusion, the first dose of MSCs cultured from the patient’s bone marrow was passed into the transplanted intestinal artery at a dose of 1000000 cells/kg. The second and third doses of MSCs were given directly into the mesenteric artery through the arterial anastomosis using an angiography catheter on day 15 and 30 post-transplant. RESULTS: The median follow-up for these patients was 10.6 mo (min: 2 mo-max: 30 mo). Three of the patients developed severe acute rejection. One of these patients did not respond to bolus steroid therapy. Although the other two patients did respond to anti-rejection treatment, they developed severe fungal and bacterial infections. All of these patients died in the 2nd and 3rd months post-transplant due to sepsis. The remaining patients who did not have acute rejection had good quality of life with no complications observed during the follow-up period. In addition, their intestinal grafts were functioning properly in the 13th, 25th and 30th month post-transplant. The patients who survived did not encounter any problems related to MSC transplantation. CONCLUSION: Although this is a small case series and not a randomized study, it is our opinion that small bowel transplantation is an effective treatment for intestinal failure, and MSC therapy may help to prevent acute rejection and graft vs host disease following intestinal transplantation.

Dogan, Sait Murat; K?l?nc, Selcuk; Kebapc?, Eyup; Tugmen, Cem; Gurkan, Alp; Baran, Masallah; Kurtulmus, Yusuf; Olmez, Mustafa; Karaca, Cezmi

2014-01-01

237

Development of a numerical index quantitating small bowel damage as detected by ultrasonography in Crohn's disease.  

PubMed

Small intestine contrast ultrasonography (SICUS) has emerged as a valuable tool in the detection of intestinal damage in Crohn's disease (CD). Our aim was to develop a numerical index quantitating small bowel damage as detected by SICUS in patients with an established diagnosis of CD. One hundred and ten patients with ileal or ileocolonic CD were prospectively enrolled and followed up for one year. Disease activity was assessed by CDAI and CRP levels. Study variables included bowel wall thickness, lumen diameter, lesion length and number of lesion site. Fistula, mesenteric adipose tissue alteration, abscess and lymphnodes were also considered. Bowel segments were considered as a hollow cylinder. Standardized variations of variables were combined into a statistical and mathematical model to create an algorithm scoring an index value ranging from 0 to 200. Index was subdivided into a severity scale with 5 classes from the lower (A) to the higher score (E). Median lesion index value was significantly higher (p<0.005) in patients with a CDAI>150 and in patients with CRP>5 mg/l (p=0.003). Patients classified in class E and D at SICUS underwent surgery within one year follow up more frequently than those in class C, B and A (p<0.0001). We propose a new index for assessment of small bowel lesions in CD (SLIC: sonographic lesion index for CD) developed by using SICUS. This index may turn ultrasonography in CD from a descriptive qualitative assessment to a quantitative numerical index suitable for comparison studies. PMID:22398077

Calabrese, Emma; Zorzi, Francesca; Zuzzi, Sara; Ooka, Shinya; Onali, Sara; Petruzziello, Carmelina; Lasinio, Giovanna Jona; Biancone, Livia; Rossi, Carla; Pallone, Francesco

2012-09-01

238

Jejunal intussusception and small bowel transmural infarction in a baboon (Papio hamadryas anubis).  

PubMed

A 4.3-y-old, colony-bred female baboon (Papio hamadryas anubis) of low social rank and exhibiting no clinically significant signs of illness or distress was found dead at the Oklahoma University Health Sciences Center baboon breeding facility at El Reno, OK. Prior to death she exhibited excessive grooming behavior both toward herself and other baboons. In addition, she was consistently shy, timid, reclusive, and prone to minimal sustained movement (that is, generally lethargic behavior). Animals of low social rank typically exhibit some degree of these behaviors in order to avoid surplus interactions with other animals within their groups, which can lead to conflict and injury. Accordingly, her death was surprising in view of the apparent lack of clinical signs. Necropsy established the cause for death as systemic shock with resultant cardiovascular collapse resulting from a massive jejunal intussusception. This intussusception and resulting entrapment of the jejunal mesenteric vasculature caused total occlusion of the small bowel blood supply, with resulting hemorrhage and ischemic necrosis (small bowel infarction). Jejunal intussusceptions generally are considered to be uncommon and therefore are rarely reported in either the veterinary or human literature. Of special interest was the cause for this intussusception, determined to have been a large hairball located at the most proximal portion of the jejunum. Extending from this hairball and traversing essentially the entire length of the jejunum was a braided strand of hair acting as a string foreign body about which the intussusception formed. In light of our findings we suggest that animals of low social rank exhibiting excessive grooming behavior and lethargy might merit clinical evaluation to rule out possible abdominal disorders. PMID:16542042

Cary, Max E; Suarez-Chavez, Maria; Wolf, Roman F; Kosanke, Stanley D; White, Gary L

2006-03-01

239

Glutamine reduces bacterial translocation after small bowel transplantation in cyclosporine-treated rats.  

PubMed

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 of transplanted intestinal isograft and examined whether Gln-enriched diet reversed CsA-induced intestinal toxicity. Thirty-three adult Lewis rats underwent resection of the distal 60% of small bowel and received an orthotopic jejunal isograft. Rats received either elemental diet with 2% Gln or the same diet with balanced nonessential amino acids (non-Gln) by gastrostomy for 10 days. CsA (15 mg/kg, im) or olive oil was injected daily. Rats were assigned to four groups: non-Gln with vehicle, non-Gln with CsA, Gln with vehicle, and Gln with CsA. Mucosal villous height, surface area, crypt depth, 14C glucose absorption, BT to mesenteric lymph nodes (MLN), and body weight change were evaluated. The non-Gln with CsA group had the highest incidence of BT (P < 0.001). Gln groups had significantly decreased BT (P < 0.01) and increased crypt depth and villous surface area (P < 0.01) when compared to non-Gln groups. Body weight significantly decreased in CsA groups when compared to non-CsA groups (P < 0.01). These results indicate at CsA significantly decreased body weight and increased BT without decreasing mucosal structure and glucose absorption of intestinal isografts.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7861767

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

1995-02-01

240

Usefulness of Intestinal Fatty Acid-Binding Protein in Predicting Strangulated Small Bowel Obstruction  

PubMed Central

Background The level of intestinal fatty acid-binding protein (I-FABP) is considered to be useful diagnostic markers of small bowel ischemia. The purpose of this retrospective study was to investigate whether the serum I-FABP level is a predictive marker of strangulation in patients with small bowel obstruction (SBO). Methods A total of 37 patients diagnosed with SBO were included in this study. The serum I-FABP levels were retrospectively compared between the patients with strangulation and those with simple obstruction, and cut-off values for the diagnosis of strangulation were calculated using a receiver operating characteristic curve. In addition, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results Twenty-one patients were diagnosed with strangulated SBO. The serum I-FABP levels were significantly higher in the patients with strangulation compared with those observed in the patients with simple obstruction (18.5 vs. 1.6 ng/ml p<0.001). Using a cut-off value of 6.5 ng/ml, the sensitivity, specificity, PPV and NPV were 71.4%, 93.8%, 93.8% and 71.4%, respectively. An I-FABP level greater than 6.5 ng/ml was found to be the only independent significant factor for a higher likelihood of strangulated SBO (P?=? 0.02; odds ratio: 19.826; 95% confidence interval: 2.1560 – 488.300). Conclusions The I-FABP level is a useful marker for discriminating between strangulated SBO and simple SBO in patients with SBO.

Kittaka, Hirotada; Akimoto, Hiroshi; Takeshita, Hitoshi; Funaoka, Hiroyuki; Hazui, Hiroshi; Okamoto, Masao; Kobata, Hitoshi; Ohishi, Yasuo

2014-01-01

241

The challenge of segmental small bowel motility quantitation using MR enterography.  

PubMed

Objective: Analysis of "cine" MRI using segmental regions of interest (ROIs) has become increasingly popular for investigating bowel motility; however, variation in motility in healthy subjects both within and between scans remains poorly described. Methods: 20 healthy individuals (mean age, 28 years; 14, males) underwent MR enterography to acquire dynamic motility scans in both breath hold (BH) and free breathing (FB) on 2 occasions. Motility data were quantitatively assessed by placing four ROIs per subject in different small bowel segments and applying two measures: (1) contractions per minute (CPM) and (2) Jacobian standard deviation (SD) motility score. Within-scan (between segment) variation was assessed using intraclass correlation (ICC), and repeatability was assessed using Bland-Altman limits of agreement (BA LoA). Results: Within-scan segmental variation: BH CPM and Jacobian SD metrics between the four segments demonstrated ICC R?=?0.06, p?=?0.100 and R?=?0.20, p?=?0.027 and in FB, the CPM and Jacobian SD metrics demonstrated ICC R?=?-0.26, p?=?0.050 and R?=?0.19, p?=?0.030. Repeatability: BH CPM for matched segments ranged between 0 and 14 contractions with BA LoA of ±8.36 and Jacobian SD ranged between 0.09 and 0.51 with LoA of ±0.33. In FB data, CPM ranged between 0 and 10 contractions with BA LoA of ±7.25 and Jacobian SD ranged between 0.16 and 0.63 with LoA?=?±0.28. Conclusion: The MRI-quantified small bowel motility in normal subjects demonstrates wide intersegmental variation and relatively poor repeatability over time. Advances in knowledge: This article presents baseline values for healthy individuals of within- and between-scan motility that are essential for understanding how this process changes in disease. PMID:24919500

Menys, A; Plumb, A; Atkinson, D; Taylor, S A

2014-08-01

242

Effects of Parenteral Arginine Supplementation on the Intestinal Adaptive Response after Massive Small Bowel Resection in the Rat  

Microsoft Academic Search

Background. Arginine (ARG) and its metabolic products (polyamines and nitric oxide) are known to affect gut function and protein synthesis in various tissues. The aim was to study the effect of parenteral ARG supplementation on intestinal adaptation and intestinal function in rats after massive small bowel resection (SBR).Methods. Fasted rats (275 g) were studied 24 h after 80% SBR. At

Carlo F. M. Welters; Cornelis H. C. Dejong; Nicolaas E. P. Deutz; Erik Heineman

1999-01-01

243

Small Bowel Obstruction after Laparoscopic Roux-en-Y Gastric Bypass Caused by an Intraluminal Blood Clot  

Microsoft Academic Search

We report a rare case of acute early postoperative small bowel obstruction after laparoscopic Roux-en-Y gastric bypass due\\u000a to an intraluminal blood clot at the site of the jejuno-jejunostomy. Patient was treated successfully with enterotomy and\\u000a removal of the clot. A review of literature showed three similar publications.

G. Peeters; T. Gys; T. Lafullarde

2009-01-01

244

Effects of dexamethasone on small bowel and kidney oxidative stress and histological alterations in bile duct-ligated rats  

Microsoft Academic Search

Oxidative stress plays an important role in the pathogenesis of toxic liver diseases and other hepatic alterations including obstruction of bile flow. It has been shown that the gastrointestinal tract and renal tissue is particularly affected during obstruction of bile flow. In this study, we aimed to evaluate the effects of dexamethasone on small bowel and kidney oxidative stress and

Hayrettin Ozturk; Halil Eken; Hulya Ozturk; Huseyin Buyukbayram

2006-01-01

245

Small bowel obstruction secondary to internal hernia through a defect of the broad ligament: preoperative multi-detector CT diagnosis.  

PubMed

We report a case of small bowel obstruction secondary to internal hernia through a defect in the broad ligament diagnosed by MDCT and confirmed at surgery. The CT findings that allow the diagnosis of this very rare cause of SBO are presented here. PMID:22274751

Quiroga, Sergi; Sarrias, Manuel; Sánchez, José Luis; Rivero, Joaquín

2012-12-01

246

A double isotope technique for the evaluation of drug action on gastric evacuation and small bowel propulsion studied in the rat  

Microsoft Academic Search

A method to measure simultaneously gastric evacuation and small bowel propulsion in the rat is presented. The value of the method in testing drug action is described. The effect of an antidiarrhoeal agent, diphenoxylate, was analysed and it was shown that it retarded small bowel propulsion without influencing gastric evacuation.

Folke Nilsson; Henry Johansson

1973-01-01

247

Small Bowel Obstruction Following Restorative Proctocolectomy: Affected by a Laparoscopic Approach?  

PubMed Central

Background Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the gold standard surgical treatment for chronic ulcerative colitis. More recently, this procedure is being performed laparoscopically assisted. Postoperatively, small bowel obstruction (SBO) is one of the more common associated complications. However, it is unknown whether the addition of a laparoscopic approach has changed this risk. This study aims to assess and compare the incidence of SBOs after both open and laparoscopic restorative proctocolectomy. Methods All subjects who underwent restorative proctocolectomy from 1998–2008 were identified from a prospective Colorectal Surgery Database. Medical records were reviewed for all cases of SBO, confirmed by a combination of clinical symptoms and radiologic evidence. Comparisons were made between laparoscopic and open approaches. The incidence of SBO was also subdivided into pre-ileostomy takedown, early post-ileostomy takedown (30 d post), and late post-ileostomy takedown (30 d to 1 y post). Several potential risk factors were also evaluated. Statistical analysis was performed utilizing Fisher’s exact (for incidence) or t-tests (for means). Significance was defined as P < 0.05 Results A total of 290 open cases and 100 laparoscopic cases were identified during this time period. The overall incidence of SBO at 1 y post-ileostomy takedown was 14% (n = 42) in the open group and 16% (n = 16) laparoscopic (P = NS). In the pre-ileostomy takedown period the incidence of SBO was 7% (n = 21) open and 13% (n = 13) laparoscopic (P = NS). While in the post-takedown period, the early incidence was 4% (n = 12) open and 1% (n = 1) laparoscopic and late incidence was 3% (n = 9) open and 2% (n = 2) laparoscopic (P = NS). Factors associated with an increased risk of SBO include coronary artery disease, prior appendectomy and W and J pouch configurations. Conclusions The burden of postoperative small bowel obstruction after restorative proctocolectomy is not changed with a laparoscopic approach. Most cases occur in the early postoperative period, especially prior to ileostomy reversal.

Dolejs, Scott; Kennedy, Greg; Heise, Charles P.

2012-01-01

248

Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery  

PubMed Central

AIM: To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm (AAA) repair surgery. METHODS: Nine patients (aged 35-78 years; body mass index (BMI) range: 23-36 kg/m2) post-surgery for AAA repair, and seven healthy control subjects (20-50 years; BMI range: 21-29 kg/m2) were studied. Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding (Nutrison®). Recordings were analyzed for the frequency, origin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the 13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200 ?L 13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for 13CO2 concentration. RESULTS: The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions (P?

Fraser, Robert J; Ritz, Marc; Matteo, Addolorata C Di; Vozzo, Rosalie; Kwiatek, Monika; Foreman, Robert; Stanley, Brendan; Walsh, Jack; Burnett, Jim; Jury, Paul; Dent, John

2006-01-01

249

Duodenal adenocarcinoma might be the cause of intractable nausea and vomiting in patient with coeliac disease  

PubMed Central

Coeliac disease (CD) is an autoimmune disorder which leads to chronic inflammation of the gut. Untreated CD is associated with upper gastrointestinal malignancies, Small-bowel lymphoma and adenocarcinoma are recognized complications of untreated coeliac disease (CD). We report the case of a 43-year-old male suffering from CD who was treated with a gluten-free diet one year, presenting with complaints of intractable nausea and vomiting. After several studies, He underwent push enteroscopy, which identified one large mass lesion in the third part of duodenum. However, histopathological examination showed adenocarcinoma. Subsequently, a duodenal segment resection was performed. After surgery, the patient recovered well and left our hospital in good condition. Clinicians should take into small bowel adenocarcinoma is rare but associated with CD particularly in CD patients with worrying symptoms such as nausea and vomiting unresponsiveness to treatment and these patients should be screened for long term complications like malignancy.

Rajabalinia, Hassan; Dabiri, Reza; Shahbazi, Shahin; Ghobakhlou, Mehdi; Bahreiny, Rasoul; Molaei, Mahsa; Nejad, Mohammad Rostami

2012-01-01

250

Microbeam studies of soft X-ray induced bystander cell killing using microbeam X-ray cell irradiation system at CRIEPI.  

PubMed

The radiation induced bystander response is defined as a response in cells which have not been directly targeted by radiation, but which are in the neighborhood of cells which have been directly exposed. In many cases, the bystander response is saturated with increasing dose and is observed when only one cell in a population is targeted by high-LET particle radiations or ultrasoft X-rays (278 eV). However, in our studies using synchrotron X-ray microbeams (5.35 keV), the bystander cell killing effect in normal human fibroblast WI-38 cells had a parabolic relationship to the irradiating dose and was detected if 5 or more cell nuclei were irradiated. To evaluate the feature of the X-ray-induced bystander cell killing effect at a wider dose range and the existence of photon energy dependence, the effects were assessed by irradiating cell nuclei in confluent WI-38 cells with AlK X-ray microbeams (1.49 keV). The surviving fraction decreased when only a single cell nucleus was irradiated, suggesting the minimal number of targeted cells to induce the effect may depend on the energy of photons used. In this study, we found that the bystander cell killing effect showed a biphasic relationship to the irradiating dose. The decrease in bystander cell survival at the doses higher than 0.23 Gy was partially suppressed between 2.3 and 7.0 Gy, followed by level-off around 90% above 14 Gy, suggesting that the X-ray-induced bystander response is dose dependent. In addition, NO is one of chief initiators/mediators of the effect at least 0.47 Gy. PMID:22510578

Tomita, Masanori; Kobayashi, Katsumi; Maeda, Munetoshi

2012-01-01

251

Wireless capsule endoscopy and proximal small bowel lesions in Crohn's disease  

PubMed Central

AIM: To investigate the prevalence of proximal small bowel (SB) lesions detected by wireless capsule endoscopy (WCE) in Crohn’s disease (CD). METHODS: WCE was performed in 64 patients: 32 with CD of the distal ileum, and 32 controls with iron-deficiency anemia (IDA) or diarrhea. WCE was performed using the Given SB-WCE, followed by small intestine contrast ultrasonography (SICUS). Findings compatible with CD by using WCE included erosions, aphthoid or deep ulcers, and strictures/stenosis. RESULTS: WCE detected proximal SB lesions in 16/32 (50%) patients (14 aphthoid ulcers, 2 deep ulcers, one stricture), which appeared not to be related to clinical parameters [epigastric pain, age, smoking, non-steroidal anti-inflammatory drugs (NSAIDs), IDA]. Among patients with proximal SB lesions, 6 (37%) were smokers, 3 (19%) NSAID users, 3 (19%) had epigastric pain and 4 (25%) had IDA. SICUS detected proximal SB lesions in 3/32 patients (19%) also showing lesions with WCE. No correlations were observed between proximal SB lesions assessed by WCE or by SICUS (?2 = 1.5, P = 0.2). CONCLUSION: The use of WCE allows the detection of previously unknown upper SB lesions in a high proportion of patients with a previous diagnosis of CD involving the distal ileum.

Petruzziello, Carmelina; Onali, Sara; Calabrese, Emma; Zorzi, Francesca; Ascolani, Marta; Condino, Giovanna; Lolli, Elisabetta; Naccarato, Paola; Pallone, Francesco; Biancone, Livia

2010-01-01

252

CT Findings of Patients with Small Bowel Obstruction due to Bezoar: A Descriptive Study  

PubMed Central

Purpose. The aim of this study was to present the computed tomography (CT) findings of bezoars that cause obstruction in the small bowel and to emphasize that some CT findings can be considered specific to some bezoar types. Materials and Methods. The records of 39 patients who underwent preoperative abdominal CT and subsequent operation with a diagnosis of intestinal obstruction due to bezoars were retrospectively analyzed. Results. In total, 56 bezoars were surgically removed from 39 patients. Bezoars were most commonly located in the jejunum (n = 26/56, 46.4%). Sixteen (41.0%) patients had multiple bezoar locations in the gastrointestinal tract. Common CT findings in all patients were a mottled gas pattern and a focal ovoid or round intraluminal mass with regular margins and a heterogeneous internal structure. Furthermore, some CT findings were determined to be specific to bezoars caused by persimmons. Conclusions. Preoperative CT is valuable in patients admitted with signs of intestinal obstruction in geographic regions with a high bezoar prevalence. We believe that the correct diagnosis of bezoars and the identification of their number and location provide a great advantage for all physicians and surgeons. In addition, some types of bezoars have unique CT findings, and we believe that these findings may help to establish a diagnosis.

Altintoprak, Fatih; Degirmenci, Bumin; Dikicier, Enis; Cakmak, Guner; Kivilcim, Taner; Akbulut, Gokhan; Dilek, Osman Nuri; Gunduz, Yasemin

2013-01-01

253

Bacterial translocation in cirrhosis is not caused by an abnormal small bowel gut microbiota.  

PubMed

Sepsis is common in liver cirrhosis, and animal studies have shown the gut to be the principal source of infection, through bacterial overgrowth and translocation in the small bowel. A total of 33 patients were recruited into this study, 10 without cirrhosis and 23 with cirrhotic liver disease. Six distal duodenal biopsies were obtained and snap frozen for RNA and DNA extraction, or frozen for FISH. Peripheral venous bloods were obtained from 30 patients, including 17 chronic liver disease patients. Samples were analysed by real-time PCR, to assess total bacteria, bifidobacteria, bacteroides, enterobacteria, staphylococci, streptococci, lactobacilli, enterococci, Helicobacter pylori and moraxella, as well as TNF-?, IL-8 and IL-18. There was no evidence of bacterial overgrowth with respect to any of the individual bacterial groups, with the exception of enterococci, which were present in higher numbers in cirrhotic patients (P = 0.04). There were no significant differences in any of the cytokines compared to the controls. The small intestinal mucosal microbiota in cirrhotic patients was qualitatively and quantitatively normal, and this shifts the focus of disease aetiology to factors that reduce gut integrity, failure of mechanisms to remove translocating bacteria, or the large bowel as the source of sepsis. PMID:22092561

Steed, Helen; Macfarlane, George T; Blackett, Katie L; Macfarlane, Sandra; Miller, Michael H; Bahrami, Bahram; Dillon, John F

2011-12-01

254

Small bowel transplantation complicated by cytomegalovirus tissue invasive disease without viremia.  

PubMed

We report on a small bowel transplant patient, donor/recipient seropositive (D+/R+) for cytomegalovirus (CMV), with a clinical course complicated by CMV disease. Anti-CMV prophylaxis was given for 100 days. Immunosuppression consisted of alemtuzumab, tacrolimus, mycophenolate mofetil and prednisolone. Five months posttransplant, CMV tissue invasive disease of the upper gastrointestinal tract was evident without the presence of viremia, tested by quantitative polymerase chain reaction (PCR). Complete viral load suppression was achieved with intravenous ganciclovir, followed by valganciclovir for secondary prophylaxis. Mycophenolate mofetil and prednisolone were discontinued. Shortly thereafter the patient presented with recurrent CMV and candida esophagitis. While on ganciclovir and caspofungin, the patient developed CMV tissue invasive disease of the ileal graft, with persistent absence of viremia. Foscarnet and CMV immunoglobulin were added. Viral load declined to undetectable levels; however, clinical improvement did not occur due to occurrence of graft rejection. Despite infliximab and high dose prednisolone, graft rejection was progressive, requiring surgical explantation of the graft. This case highlights the importance of additional diagnostic tools such as endoscopy including PCR analysis of tissue samples. Extension of primary antiviral prophylaxis interval up to 6 months and prolonged retreatment for recurrent CMV disease may be useful to avoid severe CMV-related complications. PMID:24703746

Avsar, Yesim; Cicinnati, Vito R; Kabar, Iyad; Wolters, Heiner; Anthoni, Christoph; Schmidt, Hartmut H J; Beckebaum, Susanne

2014-06-01

255

MALT lymphoma of the small bowel with protein-losing enteropathy.  

PubMed

Mucosa-associated lymphoid tissue (MALT) lymphoma usually arises from chronic inflammation. We herein report a case of small intestinal MALT lymphoma with protein-losing enteropathy (PLE). A 73-year-old woman presented with lower leg edema and severe hypoalbuminemia. She had a medical history of pylorus-preserving pancreaticoduodenectomy with Billroth II reconstruction. Oral and anal route double-balloon enteroscopies revealed irregular nodular mucosal lesions with erosion extending from the jejunum to terminal ileum. Histopathological evaluation of the biopsied mucosa showed proliferation of small-to-medium-sized lambda light chain-restricted B cells. Plasmacytic differentiation and lymphoepithelial lesions were present, leading to the diagnosis of MALT lymphoma. Tc-99m albumin scintigraphy indicated tracer exudation in the small bowel, suggesting the presence of PLE. Combination immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) regimen improved both MALT lymphoma and PLE, whereas rituximab monotherapy was not successful. This case is considered to be common type of MALT lymphoma at an uncommon site and is distinct from immunoproliferative small intestinal disease (IPSID). To our knowledge, this is the first case of non-IPSID-type small intestinal MALT lymphoma complicated by PLE. Gastrointestinal reconstruction may be responsible for underlying chronic inflammation via small intestinal bacterial overgrowth. PMID:24395281

Tsukamoto, Ayato; Nakamura, Fumihiko; Nannya, Yasuhito; Kobayashi, Yuka; Shibahara, Junji; Ichikawa, Motoshi; Fukayama, Masashi; Koike, Kazuhiko; Kurokawa, Mineo

2014-02-01

256

The rebound excitation triggered by anticholinergic drugs from ovine pyloric antrum, small bowel and gallbladder.  

PubMed

The effect of anticholinergic drugs on gastrointestinal motility is complex and incompletely recognized. Accordingly, in 6 adult sheep bipolar electrodes and strain gage force transducers were surgically attached to the antral, small intestinal and gallbladder wall at the serosal side. During chronic experiments the myoelectric and mechanical recordings were performed in fasted and non-fasted animals before and after various doses of hexamethonium, atropine and pirenzepine given intravenously. Hexamethonium administration triggered rebound excitation after an inhibitory period almost in all the recording sites. Administration of atropine and pirenzepine evoked these secondary contractions mostly in the small intestine and gallbladder. No rebounds were observed when the anticholinergic drugs were given during feeding. In fasted animals, rebound excitation arrived later but more frequently than in non-fasted animals. The excitatory changes were dose-dependent. In the gallbladder, these values were lower than in the small intestine. The frequency of the recurrent pattern was dependent upon the dose of the anticholinergic drug used. It is concluded that nicotinic receptors are more important than muscarinic receptors in the initiation of the rebound excitation in pyloric antrum while in the small bowel and gallbladder the role of both cholinergic receptors is similar. The anticholinergic drugs should be used with caution in all these clinical situations, where the enhancement of gastrointestinal motility must be avoided. PMID:12674224

Roma?ski, K W

2003-03-01

257

[The diagnostic significance of the small bowel enema in lesions of the small intestine requiring surgery].  

PubMed

Given its anatomical location the small intestine is the section of the digestive tract most inaccessible to objective clinical and instrumental examination. For this reason, traditional investigation methods provide inadequate data. In the barium meal X-ray, images are superimposed and the barium excessively fragmented due to the tortuosity and length of the intestinal loop. Access problems limit the value of endoscopy. The indications to angiography are fairly restrictive. Ultrasound and CT scans provide no conclusive evidence in this area. The so-called Small Bowel Enema technique based on the direct infusion of an opaque contrast medium after duodenal intubation remains the only way to obtain images with a satisfactory diagnostic value and should be the method of choice in examinations of the small intestine. Introduced in the twenties, the value of the technique was long questioned, mainly because it was difficult to perform correctly and it is only quite recently that several decisive technological innovations have made it highly reliable. The present paper describes its use on a series of patients with suspected pathologies of the small intestine requiring surgical treatment. The aim is to specify the correct indications to this technique as well as its limitations with a view to promoting its appropriate use in routine practice. MATERIALS AND METHODS. The study covers 42 small bowel enemas performed on 29 male and 13 female patients aged 12-85 years. Indications to the enema included chronic abdominal pain in 28.5%, chronic diarrhea in 21.4%, pain+diarrhea in 14%, subocclusion in 16.5%, faecal blood in 11.9%, abdominal pain+diarrhea+intestinal haemorrhage in 4.7%, anaemia in 2.4%. We adopted the Sellink technique involving intubation with a French 14 Bilbao-Dotter probe and the infusion of 200-350 cc barium sulphate in a 90%-70% P/V concentration at a speed of 100 ml/min, followed by the infusion of 1000-1500 cc 0.5-1% methylcellulose in a 50-50 mixture with water for double contrast purposes. Mean duration of procedure 35-40 mins. RESULTS. We found lesions of the small intestine in 18 cases or 45% (true positives) and no alterations in 18 or 42.8% (true negatives). In 3 cases (7%) the examination was inconclusive. One false positive and one false negative complete the series, making a diagnostic accuracy of 89.1%. In 23.8% of the total series the diagnosis of Crohn's disease was confirmed; cancerous lesions were found in 11.9% and adhesions following earlier surgery in 9.7%. Surgery confirmed this diagnosis in 10 cases (5 tumours, 3 stenoses caused by adhesion fragments, 2 Crohn's disease) and disproved it in one case. Biopsy was used, for objective confirmation in 5 cases (2 Crohn's disease, 3 negatives). In the other cases reliance was placed on clinical course and the patients' response to treatment. DISCUSSION AND CONCLUSIONS. Examination of our results reveals that in most clinical cases the small bowel enema was used to confirm suspected Crohn's disease (31 cases out of 42) and with a very high degree of diagnostic accuracy (96.7%). In line with data in the literature we decided to base the indication to this examination on certain primary symptoms such as chronic abdominal pain, diarrhea, blood in the faeces, whether in isolation or in combination. On this rather general basis the diagnosis of Crohn's disease concerned only 23.8% of the cases studied, an incidence that rose dramatically in the few cases in which the indications were made more specific. We therefore conclude that the adoption of more restrictive criteria will improve the cost-benefit ratio for this test. Another major pathology in which small bowel enema possesses a high diagnostic value is partial obstruction of the small intestine.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7970036

Racalbuto, A; Trombatore, G; Greco, L; Gresta, S; De Luca, B; Scilletta, B; Puleo, S; Licata, A

1994-05-01

258

Effect of intravenous amino acids on interdigestive antroduodenal motility and small bowel transit time  

PubMed Central

Background—Patients on total parenteral nutrition have an increased risk of developing gallstones because of gall bladder hypomotility. High dose amino acids may prevent biliary stasis by stimulating gall bladder emptying. ?Aims—To investigate whether intravenous amino acids also influence antroduodenal motility. ?Methods—Eight healthy volunteers received, on three separate occasions, intravenous saline (control), low dose amino acids (LDA), or high dose amino acids (HDA). Antroduodenal motility was recorded by perfusion manometry and duodenocaecal transit time (DCTT) using the lactulose breath hydrogen test. ?Results—DCTT was significantly prolonged during LDA and HDA treatment compared with control. The interdigestive motor pattern was maintained and migrating motor complex (MMC) cycle length was significantly reduced during HDA compared with control and LDA due to a significant reduction in phase II duration. Significantly fewer phase IIIs originated in the gastric antrum during LDA and HDA compared with control. Duodenal phase II motility index was significantly reduced during HDA, but not during LDA, compared with control. ?Conclusions—Separate intravenous infusion of high doses of amino acids in healthy volunteers: (1) modulates interdigestive antroduodenal motility; (2) shortens MMC cycle length due to a reduced duration of phase II with a lower contractile incidence both in the antrum and duodenum (phase I remains unchanged whereas the effect on phase III is diverse: in the antrum phase III is suppressed and in the duodenum the frequency is increased); and (3) prolongs interdigestive DCTT. ?? Keywords: amino acids; antroduodenal motility; small bowel transit time; total parenteral nutrition

Gielkens, H; van den Biggelaar, A; Vecht, J; Onkenhout, W; Lamers, C; Masclee, A

1999-01-01

259

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

2011-03-01

260

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

PubMed Central

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

Scherubl, Hans; Jensen, Robert T; Cadiot, Guillaume; Stolzel, Ulrich; Kloppel, Gunter

2010-01-01

261

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.

2012-01-01

262

Computerized analysis of bowel sounds in normal and small bowel obstructed rats  

NASA Astrophysics Data System (ADS)

Small bowel obstruction (SBO) is a common surgical emergency which may be mimicked by ileus or other nonsurgical conditions. The aims of this work is to delineate gastrointestinal sound (GIS) correlates in a rat model. Seven rats were studied in paired SBO and control states. Computerized analysis of GIS was performed under continuous IV sedation. After adaptive filtering, every GIS event was isolated and analyzed for duration and dominant frequency. It was found that long duration sounds (greater than 100 ms) occurred in each of the obstructed, but in none of the nonobstructed cases (p=0.02). The overall mean event duration and dominant frequency in SBO compared to control states was both significantly longer and lower (22.42.6 vs 7.0+/-2.6 ms, p=0.001 for duration; and 296+/-34 vs 427+/-33, p=0.001 for frequency). Besides these mean differences, there was also a clear evolution with time in GIS characteristics, with lengthening of the duration (+0.56 ms/min, p=0.001) and lowering of the dominant frequency (-3.3 Hz/min, p=0.01). It is concluded that GIS analysis may prove useful in the noninvasive, rapid, and accurate diagnosis of SBO.

Sandler, Richard; Mansy, Hansen; Uhing, Michael; Meyer, Peter; Kimura, Robert

2003-04-01

263

Small bowel obstruction caused by an unusual variant of paraduodenal hernia. The "middle congenital mesocolic hernia": case report.  

PubMed

Internal hernias account for 0.2-0.9 % of all small bowel obstructions and are associated with a mortality rate of 50 % when strangulation is present. Congenital mesocolic hernias, traditionally called paraduodenal hernias, caused by an abnormal rotation of the primitive midgut, are the most common type of internal hernia. They can be divided into three types: the right and the left congenital mesocolic hernias, accounting for the 25 and 75 % of all cases, respectively, and the extremely rare transverse congenital mesocolic hernia. A high preoperative misdiagnosis rate has been reported and a surgical exploration is recommended to identify strangulation. The present case report describes a case of small bowel obstruction due to an unusual variant of congenital mesocolic hernia never previously reported in the literature. We discuss the clinical appearance, pathogenesis, diagnosis, and treatment of the case, with a brief review of the literature focused on the pathogenesis and management of mesocolic congenital hernias. PMID:24756927

Licciardello, Alessio; Rapisarda, Cristian; Conti, Pietro; Trombatore, Giovanni

2014-08-01

264

Changes of small bowel motility and noradrenaline content of the intestinal wall in response to alpha- and beta-adrenergic blockade in dog.  

PubMed

In experiments on dogs, the spontaneous movements of the small bowel were in all cases enhanced by the alpha 2-blocker phentolamine, while they were not influenced, or were slightly decreased, by the beta 1-blocker practolol. Neither drug caused a change in the noradrenaline content of the intestinal wall. In the same animals, the joint administration of phentolamine and practolol led to a considerable increased small bowel motility, and to a significant decrease in the noradrenaline level of the intestinal wall. The results are in agreement with experimental data indicating that presynaptic alpha-receptors play a primary role in the sympathetic regulation of small bowel motility. PMID:3751614

Tárnoky, K; Szenohradszky, J; Petri, G

1986-01-01

265

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

2001-01-01

266

Small bowel necrosis and enterocutaneous fistulae resulting from iatrogenic spillage of dermoid cyst contents at the time of laparoscopic surgery  

Microsoft Academic Search

A 38-year-old lady with a 14?×?8?×?13-cm dermoid cyst underwent a laparoscopic left salpingo-oophrectomy. Intra-operatively,\\u000a there was accidental spillage of the cyst contents into the peritoneal cavity. The spilled contents were completely sucked\\u000a out and a thorough peritoneal lavage was done to decrease the risk of chemical peritonitis. The patient developed disseminated\\u000a granulomatous chemical peritonitis, small bowel necrosis, multiple enterocutaneous fistulae,

T. Majmudar; H. Abdel-Rahman

2010-01-01

267

MRI of small bowel Crohn’s disease: determining the reproducibility of bowel wall gadolinium enhancement measurements  

Microsoft Academic Search

This study aims to determine inter- and intra-observer variation in MRI measurements of relative bowel wall signal intensity\\u000a (SI) in Crohn’s disease. Twenty-one small bowel MRI examinations (11 male, mean age 40), including T1-weighted acquisitions\\u000a acquired 30 to 120s post-gadolinium, were analysed. Maximal bowel wall SI (most avid, conspicuous contrast enhancement) in\\u000a designated diseased segments was measured by two radiologists

A. Sharman; I. A. Zealley; R. Greenhalgh; P. Bassett; S. A. Taylor

2009-01-01

268

Incidence of Small Bowel Injury Induced by Low-Dose Aspirin: A Crossover Study Using Capsule Endoscopy in Healthy Volunteers  

Microsoft Academic Search

Background and Aims: Small intestinal toxicity of low-dose aspirin remains unclear. The purpose of this capsule endoscopy study was to assess the incidence of small bowel injury in healthy volunteers treated with short-term low-dose aspirin. Methods: Healthy subjects were randomly assigned to receive low-dose aspirin for 14 days (Aspirin group) or no drugs for 14 days (Control group). The two

Hiroki Endo; Kunihiro Hosono; Masahiko Inamori; Shingo Kato; Yuichi Nozaki; Kyoko Yoneda; Tomoyuki Akiyama; Koji Fujita; Hirokazu Takahashi; Masato Yoneda; Yasunobu Abe; Hiroyuki Kirikoshi; Noritoshi Kobayashi; Kensuke Kubota; Satoru Saito; Nobuyuki Matsuhashi; Atsushi Nakajima

2009-01-01

269

Ileal absorptive adaptation to jejunal resection and extrinsic denervation: Implications for living-related small bowel transplantation  

Microsoft Academic Search

Net absorption of water, electrolytes, and simple nutrients decreases early after jejunoileal autotransplantation (extrinsic\\u000a denervation) in a canine model but recovers toward normal by 8 weeks. However, the ability of the extrinsically denervated\\u000a ileum to adapt after total jejunectomy, which would be relevant as a model of segmental small bowel transplantation, remains\\u000a unknown. Two groups of five dogs each were

Gregory G. Tsiotos; Michael L. Kendrick; Karen Libsch; Kirk Bierens; Petra Lankisch; Judith A. Duenes; Michael G. Sarr

2001-01-01

270

Effects of supplemental L-arginine on the intestinal adaptive response after massive small-bowel resection in rats  

Microsoft Academic Search

To evaluate whether L-arginine methyl ester (L-Arg) can improve the structure of the small intestine and enhance adaptation in an experimental model of short-bowel syndrome (SBS), 40 Sprague-Dawley rats were divided randomly into four groups of 10 each. In one group only a laparotomy was performed (G1). The remaining 30 rats underwent 90% small-bowel resection (SBR) and formed the three

Hayrettin Öztürk; Ali Dokucu; Yusuf Ya?mur; ?brahim Sari

2002-01-01

271

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.

LAI, CAN; ZHOU, HAI-CHUN; MA, MING; ZHANG, HONG-XI; JIA, XUAN

2013-01-01

272

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: mark.deridder@uzbrussel.be; 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)

2009-08-01

273

The influence of surgery, immunosuppressive drugs, and rejection, on graft function after small bowel transplantation: a large-animal study  

Microsoft Academic Search

In this study we assessed functional changes (motility and absorption) of intestinal allografts in a large-animal model of orthotopic small bowel transplantation in swine. Studies were performed on non-rejecting animals in the early and late stages after transplantation and after induction of different grades of acute rejection. Immunosuppression consisted of oral FK506 and mycophenolate mofetil. In each study group we

Mario Alessiani; Fabrizio De Ponti; Filiberto Fayer; Francesca Abbiati; Sandro Zonta; Ermanno Zitelli; Eloisa Arbustini; Patrizia Morbini; Nicoletta Poggi; Catherine Klersy; Ilaria Blangetti; Paolo Dionigi; Aris Zonta

2003-01-01

274

Small bowel stricture characterization and outcomes of dilatation by double-balloon enteroscopy: a single-centre experience  

PubMed Central

Background: There is little data on the role of balloon enteroscopy and small bowel strictures. We aim to characterize the diagnostic role of double balloon enteroscopy (DBE) in small bowel strictures and document the outcomes of dilatation. Methods: This is a retrospective review from a single tertiary referral centre DBE database from July 2004 to September 2012. All patients with suspected strictures in the small bowel undergoing DBE were included. The position of the small bowel strictures considered for dilatation was determined by diagnostic imaging, i.e. CT enterography, MR enterography or capsule endoscopy in the workup before DBE. Endpoints included stricture description, dilatation parameters and response to treatment. Main outcome measurements were the safety and efficacy of DBE and dilatation. Results: From our DBE database of 594 patients, a total of 32 patients underwent 44 DBE procedures for suspected or known strictures. Stricture aetiology included Crohn’s disease (CD), nonsteroidal anti-inflammatory drugs (NSAIDs), surgical, Beçhets disease and one unknown. A total of 17 patients did not undergo dilatation as the strictures were ulcerated, nonobstructing or of uncertain aetiology. From the total of 25 dilatations in 15 patients that were attempted, 8/15 (53%) patients had 1 dilatation, 5 patients had 2 dilatations, 1 had 3 dilatations and 1 had 4 dilatations. The mean dilatation diameter was 14 mm. Three patients underwent surgery post-dilatation (2 for perforation). Mean follow up was 16 months. Conclusion: DBE is a useful method in determining the need for dilatation by assessing for active ulceration. Dilatation is effective in the 10–18 mm range, however perforation does occur.

Gill, Raghubinder S.

2014-01-01

275

Reactivation of Arthritis Induced by Small Bowel Bacterial Overgrowth in Rats: Role of Cytokines, Bacteria, and Bacterial Polymers  

Microsoft Academic Search

Arthritisisoftenassociatedwithintestinaldiseases,buttheetiologyisnotknown.Wedevelopedaratmodel whereby arthritis was reactivated by experimental small bowel bacterial overgrowth (SBBO). Self-limited, monoarticular arthritis was induced by intra-articular injection of 2 mg of rhamnose peptidoglycan-polysac- charide 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 jejunalself-fillingblindloopsreactivatedarthritis,butSBBOinducedbycreationofself-emptyingblindloops, which minimally increases

STEVEN N. LICHTMAN; JIAN WANG; R. BALFOUR SARTOR; CHUAN ZHANG; D. BENDER; FRED G. DALLDORF; ANDJOHN H. SCHWAB

276

Effect of jejunal infusion of bile acids on small bowel transit and fasting jejunal motility in man  

Microsoft Academic Search

The effect of jejunal infusion of glycochenodeoxycholic acid and glycocholic acid on small bowel transit time, fasting jejunal motility and serum bile acid concentrations was investigated in groups of five to six healthy subjects. Glycochenodeoxycholic acid at a concentration of 15 mmol\\/l (total amount: 5 mmol) and glycocholic acid 15 mmol\\/l (total amount: 5 mmol), both with lecithin 2.5 mmol\\/l,

R Penagini; J J Misiewicz; P G Frost

1988-01-01

277

An unusual cause of small bowel obstruction caused by a Richter's-type hernia into the urinary bladder  

PubMed Central

INTRODUCTION The authors present an unusual case of small bowel obstruction in a 62-year-old man. PRESENTATION OF CASE A 62-year-old man with a background of transitional cell carcinoma (TCC) of the bladder presented to the emergency department with abdominal pain, distension, vomiting and had not opened his bowels for three days. 3 weeks previously he had a repeat Transurtheral resection of bladder tumour (TURBT), during which there was an iatrogenic perforation of the bladder. A CT scan of the abdomen and pelvis revealed small bowel obstruction but did not identify a cause. At laparotomy the cause of the obstruction was identified as a section of the small bowel that had partially herniated into the bladder, via the perforation. The defect was repaired and the patient made an uneventful recovery. DISCUSSION Herniation of the bowel into a defect in the bladder wall is a rare event with only 6 previous cases reported in the literature. It can cause signs and symptoms of bowel obstruction. CONCLUSION In patients with known bladder perforations who present with symptoms and signs of bowel obstruction, bowel herniation into the bladder should be considered. Early surgical intervention may be necessary if the patient is clinically unwell with appropriate symptoms and signs and imaging does not provide conclusive answer.

Sakai, Naomi S.; Acharya, Vikas; Mansour, Sami; Saleemi, Mohammed A.; Cheslyn-Curtis, Sarah

2014-01-01

278

Small bowel involvement in Crohn's disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis  

PubMed Central

Background: Wireless capsule endoscopy (WCE) offers endoscopic access to the small bowel and may therefore change diagnostic and therapeutic strategies in small bowel diseases. Aim: The aim of this prospective study was to validate the gain in information and therapeutic impact of WCE in patients with Crohn’s disease. Methods: Fifty six consecutive patients with Crohn’s disease underwent computed tomography (CT) enteroclysis, and if stenoses <10 mm were excluded, WCE was carried out. Results: In 15 patients (27%), WCE could not be performed due to strictures detected by CT enteroclysis. From the other 41 patients, jejunal or ileal lesions were found in 25 patients by WCE compared with 12 by CT enteroclysis (p?=?0.004). This gain in information was mainly due to detection of small mucosal lesions such as villous denudation, aphthoid ulcerations, or erosions. Both methods were not significantly different in the detection of lesions in the terminal/neoterminal ileum (WCE 24 patients, CT enteroclysis 20 patients). Therapy was changed due to WCE findings in 10 patients. Consecutively, all of them improved clinically. Conclusions: Capsule endoscopy improves the diagnosis of small bowel Crohn’s disease. This may have significant therapeutic impact.

Voderholzer, W A; Beinhoelzl, J; Rogalla, P; Murrer, S; Schachschal, G; Lochs, H; Ortner, M-A

2005-01-01

279

Capsule endoscopy versus magnetic resonance enterography for the detection of small bowel polyps in Peutz-Jeghers syndrome.  

PubMed

Our study aimed to assess the diagnostic utility of magnetic resonance enterography (MRE) compared to capsule endoscopy (CE) for the detection of small bowel polyps in patients with Peutz-Jeghers syndrome (PJS); with findings verified by balloon enteroscopy (BE). Adult patients were prospectively recruited across two tertiary centres and underwent MRE followed by CE, with a subsequent BE performed in patients with significant (?10 mm) polyps. The primary endpoint was the total number of significant (?10 mm) small bowel polyps detected. The number of patients with at least one significant polyp, correlation with BE findings, and patients' preferences were secondary endpoints. A total of 20 patients (7 male; mean age 34.9 years) underwent both investigations. The number of polyps ?10 mm detected by CE was greater than by MRE (47 vs 14 polyps, P = 0.02). The number of patients with at least one significant polyp identified by CE was 11 (55 %) compared with 7 (35 %) identified by MRE (P = 0.25). Subsequent BE in 12 patients identified a total of 26 significant polyps in 8 patients. The positive predictive value of finding a polyp at BE was higher for MRE (100 %) compared to CE (60 %). Overall patient preferences identified CE as the preferred modality. This prospective study demonstrated that CE identifies significantly more small bowel polyps compared with MRE in patients with PJS. Correlation between the two techniques and subsequent BE however was relatively poor. PMID:24509884

Urquhart, P; Grimpen, F; Lim, G J; Pizzey, C; Stella, D L; Tesar, P A; Macrae, F A; Appleyard, M A; Brown, G J

2014-06-01

280

Acute Small Bowel Hemorrhage in Three Patients with End-Stage Renal Disease: Diagnosis and Management by Angiographic Intervention  

SciTech Connect

Three patients who had undergone hemodialysis for end-stage renal disease, presented with acute small bowel hemorrhage,and were treated with superselective transcatheter arterial embolization via coaxial microcatheters. In all patients pre-procedure upper gastrointestinal (GI) endoscopy and colonoscopy had failed to demonstrate the source of the hemorrhage. Selective diagnostic angiography revealed frank extravasations of contrast from the small bowel arteries (one jejunal artery and two ileal arteries). After superselection of feeding arteries with a microcatheter, transcatheter embolization using Gelfoam and microcoils was performed in all three patients. Immediate hemostasis was achieved in all patients and the patients were discharged free from symptoms 3-5 days after embolization. No evidence of intestinal ischemia or infarction was noted, with the time from procedure to last follow-up ranging from 4 to 12 months. We conclude that superselective angiography is a valuable tool for diagnosing and treating acute small bowel hemorrhage inpatients with end-stage renal disease when endoscopic evaluation has failed.

Yoon, Woong; Kim, Jae Kyu [Department of Radiology, Chonnam National University Hospital, 8 Hak-1-dong, Dongku, Gwangju, 501-757 (Korea, Republic of); Kim, Heoung Kil [Departmentof Radiology, St. Carollo Hospital, 1742 Jo-Rye dong, Sun-Cheon, 540-320 (Korea, Republic of); Han, Young Min [Department of Radiology, ChunbukNational University Hospital, San 2-20 Keumamdong, Deokjingu, Chonju, 560-182 (Korea, Republic of); Kang, Heoung Keun [Department of Radiology, Chonnam National University Hospital, 8 Hak-1-dong, Dongku, Gwangju, 501-757 (Korea, Republic of)

2002-03-15

281

Small- bowel mucosal changes and antibody responses after low- and moderate-dose gluten challenge in celiac disease  

PubMed Central

Background Due to the restrictive nature of a gluten-free diet, celiac patients are looking for alternative therapies. While drug-development programs include gluten challenges, knowledge regarding the duration of gluten challenge and gluten dosage is insufficient. We challenged adult celiac patients with gluten with a view to assessing the amount needed to cause some small-bowel mucosal deterioration. Methods Twenty-five celiac disease adults were challenged with low (1-3 g) or moderate (3-5g) doses of gluten daily for 12 weeks. Symptoms, small-bowel morphology, densities of CD3+ intraepithelial lymphocytes (IELs) and celiac serology were determined. Results Both moderate and low amounts of gluten induced small-bowel morphological damage in 67% of celiac patients. Moderate gluten doses also triggered mucosal inflammation and more gastrointestinal symptoms leading to premature withdrawals in seven cases. In 22% of those who developed significant small- intestinal damage, symptoms remained absent. Celiac antibodies seroconverted in 43% of the patients. Conclusions Low amounts of gluten can also cause significant mucosal deterioration in the majority of the patients. As there are always some celiac disease patients who will not respond within these conditions, sample sizes must be sufficiently large to attain to statistical power in analysis.

2011-01-01

282

Effect of monoclonal antibodies to enteroglucagon on ileal adaptation after proximal small bowel resection.  

PubMed Central

On the basis of circumstantial clinical and experimental evidence, it has been suggested that enteroglucagon (EG) may act as an enterotrophic factor. This study was undertaken to evaluate the effects of long term in vivo immunoneutralisation of EG, using monoclonal antibodies to EG, on the hyperplastic ileal response after small bowel resection. Nineteen rats had a 70% proximal resection. A group of 10 rats was given iv 0.5 ml of undiluted hybridoma ascites immediately after the operation and on the 7th day postoperatively. Furthermore 0.025 ml/day of the same hybridoma ascitic fluid was continuously delivered ip for 14 days via mini-osmotic pumps. The hybridoma ascites was prepared from the clone 23.6B4 synthesising a monoclonal antibody directed toward the N-terminal to central region of the glucagon molecule which showed a marked crossreaction with EG. A control group of 9 rats was given a corresponding amount of antibody-free plasmacytoma ascites (Ag 8.653) by the same technique. Seven and 14 days postoperatively there was a plasma anti-EG-antibody excess with an excess binding capacity of 84.9 glucagon eq nM and 88.5 glucagon eq nM respectively. The three dimensional architecture and the proliferative activity of the ileal remnant were evaluated two weeks postoperatively. Despite a continuous immunoneutralisation of circulating endogenous EG by monoclonal antibodies, the adaptive response of the ileal remnants was of the same magnitude as that seen in the control group. These data do not support the hypothesis that EG is a circulating enterotrophic regulatory peptide.

Gregor, M; Menge, H; Stossel, R; Riecken, E O

1987-01-01

283

Methylisogermabullone isolated from radish roots stimulates small bowel motility via activation of acetylcholinergic receptors.  

PubMed

We have previously reported that extract of radish roots exhibits an increase in gastrointestinal motility through the activation of muscarinic acetylcholine (ACh) receptors. Based on the stimulatory activity-guided fractionation on rat ileal segments, this study isolated methylisogermabullone (MIGB, C23H31O5NS, MW 433) from methanol extracts of radish roots. MIGB caused a significant increase of the isolated rat ileal contraction in a concentration-dependent manner (23-693 microM), and the pattern of MIGB-induced ileal contraction was different in the time course to that produced by ACh. The EC50 value of MIGB, to produce 50% maximum ileal contraction, was estimated to be 45.5 microM. MIGB (230 microM)-induced ileal contractions were enhanced by pretreatment of segments with ACh (0.1 microM). Ileal contractions produced by MIGB (230 microM) or ACh (0.1 microM) at submaximal concentration were partially inhibited by pretreatment of hexamethonium (0.1 mM), a ganglionic blocker, whereas they were almost completely abolished by atropine (10 microM). Oral administration of MIGB to mice stimulated the small intestinal transit of charcoal in a dose-dependent manner (10-100 mg kg(-1)), and MIGB (100 mg kg(-1))-induced stimulation of small intestinal transit was significantly attenuated by co-administration of atropine (50 mg kg(-1)). Taken together, these results demonstrate that MIGB isolated from radish roots stimulates the small bowel motility through the activation of ACh receptors. These findings suggest that MIGB may become a potential regulatory agent for therapeutic intervention in dysfunction of gastrointestinal motility. PMID:16354410

Jeong, Seung Il; Lee, Seoul; Kim, Kang Ju; Keum, Kyung Soo; Choo, Yong Kug; Choi, Bong Kyu; Jung, Kyu Yong

2005-12-01

284

THE EFFECT OF SMALL BOWEL TRANSPLANTATION ON THE MORPHOLOGY AND PHYSIOLOGY OF INTESTINAL MUSCLE  

PubMed Central

The effects of acute (AR) and chronic rejection (CR) on intestinal smooth muscle that are responsible for the dysmotility following small bowel transplantation (SBTX) are incompletely understood. Jejunal and ileal specimens from normal control dogs (n=7), and auto-transplanted dogs were examined at 7 days (n=6) and 1 (n=7), 3 (n=6), 6 (n=6), and 12 months (n=6). Allo-transplanted dogs that developed AR (n=8) and CR (n=5) were examined for gross and microscopic morphology (muscle thickness, the number and size of myocytes, and inflammatory infiltrate), and for contractile and intracellular electrical function in vitro. Auto-SBTX did not alter morphology at any period, but contractile function was impaired at 7 days (73.6%) compared with normal intestine. Acute rejection did not influence myocyte number or size, but was associated with a prominent infiltrate of neutrophils and lymphocytes, and severely impaired contractile function (20.6%) compared with auto-SBTX controls. Acute rejection also significantly inhibited the amplitude of slow waves and of inhibitory junction potentials. Chronic rejection caused thickening of muscularis propria by both hyperplasia (175.5%) and hypertrophy (202.6%) accompanied by moderate inflammatory cell infiltrate compared with auto-SBTX controls. We conclude that the marked inflammatory infiltrate into the muscularis propria indicates that the graft muscle is injured by both acute and chronic rejection; impaired function of intestinal smooth muscle following SBTX results from both rejection and the injury associated with transplantation, and chronic rejection following SBTX is associated with both hyperplasia and hypertrophy of the muscularis propria.

Sugitani, Atsushi; Bauer, Anthony J.; Reynolds, James C.; Halfter, Willi M.; Nomoto, Minoru; Starzl, Thomas E.; Todo, Satoru

2011-01-01

285

Upregulation of Proapoptotic MicroRNA mir-125a After Massive Small Bowel Resection in Rats  

PubMed Central

Objective Short bowel syndrome remains a condition of high morbidity and mortality, and current therapeutic options carry significant side effects. To identify new treatments we focused on postresection changes in microRNAs—short noncoding RNAs, which suppress target genes—and suggest a previously undiscovered role for microRNA-125a (mir-125a) in intestinal adaptation. Methods Rats underwent either 80% massive small bowel resection or transection and were harvested after 48 hours. Jejunum was harvested for microRNA microarrays, laser capture microdissection, and RNA and protein analysis. Mir-125a was overexpressed in intestinal epithelium–6 (crypt-derived) cells (IEC-6) and effects on proliferation and apoptosis determined using MTS and flow cytometry. Expression of potential targets of mir-125a in rat jejunum and IEC-6 cells was determined using quantitative real-time polymerase chain reaction (RNA) and Western blotting (protein). Results Resection upregulated mir-125a and mir-214 by 2.4-folds and 3.2-folds, respectively. Highest levels of expression were noted in the crypt fraction. Mir-125a overexpression induced apoptosis and resultant growth arrest in IEC-6 cells. The expression of the prosurvival Bcl-2 family member Mcl-1 was downregulated in both mir-125a-overexpressing IEC-6 cells and in jejunum of resected rats, confirming Mcl-1 as a previously undiscovered target of mir-125a. Conclusions Upregulation of mir-125a suppresses the prosurvival protein Mcl1, producing the increase in apoptosis known to accompany the proliferative changes characteristic of intestinal adaptation. Our data highlight a potential role for microRNAs as mediators of the adaptive process and may facilitate the development of new therapeutic options for short bowel syndrome.

Balakrishnan, Anita; Stearns, Adam T.; Park, Peter J.; Dreyfuss, Jonathan M.; Ashley, Stanley W.; Rhoads, David B.; Tavakkolizadeh, Ali

2014-01-01

286

Isolated small bowel transplantation outcomes and the impact of immunosuppressants: Experience of a single transplant center  

PubMed Central

AIM: To investigate patient and graft outcomes in isolated small bowel transplant (SBTx) recipients and immunosuppressant induction agent impact on outcomes. METHODS: A retrospective review of the perioperative data of patients who underwent SBTx transplant during an 8-year period was conducted. The intraoperative data were: patient demographics, etiology of short gut syndrome, hemodynamic parameters, coagulation profiles, intraoperative fluid and blood products transfused, and development of post-reperfusion. The postoperative data were: hospital/intensive care unit stays, duration of mechanical ventilation, postoperative incidence of acute kidney injury, and 1-year patient and graft outcomes. The effects of the three immunosuppressant induction agents (Zenapax, Thymoglobulin, Campath) on patient and graft outcomes were reviewed. RESULTS: During the 8-year period there were 77 patients; 1-year patient and graft survival were 95% and 86% respectively. Sixteen patients received Zenapax, 22 received Thymoglobulin, and 39 received Campath without effects on patient or graft survival (P = 0.90, P = 0.14, respectively). The use of different immune induction agents did not affect the incidence of rejection and infection during the first 90 postoperative days (P = 0.072, P = 0.29, respectively). The Zenapax group received more intraoperative fluid and blood products and were coagulopathic at the end of surgery. Zenapax and Thymoglobulin significantly increased serum creatinine at 48 h (P = 0.023) and 1 wk (P = 0.001) post-transplant, but none developed renal failure or required dialysis at the end of the first year. CONCLUSION: One-year patient and graft survival were 95% and 86%, respectively. The use of different immunosuppressant induction agents may affect the intraoperative course and short-term postoperative morbidities, but not 1-year patient and graft outcomes.

Hilmi, Ibtesam A; Planinsic, Raymond M; Nicolau-Raducu, Ramona; Damian, Daniela; Al-Khafaji, Ali; Sakai, Tetsuro; Abu-Elmagd, Kareem

2013-01-01

287

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

2003-01-01

288

Effects of donor pretreatment with antilymphocyte serum and cyclosporin on rejection and graft-versus-host disease after small bowel transplantation in immunosuppressed and nonimmunosuppressed rats  

Microsoft Academic Search

After fully allogeneic small bowel transplantation, both graft-versus-host disease (GVHD) and rejection may occur. Donor pretreatment may prevent GVHD, but this sometimes leads to accelerated graft rejection. To study a possible balance between GVHD and rejection, fully allogeneic total orthotopic small bowel transplantation was performed in rats using the WAG-to-BN donorhost combination. Untreated control grafts were rejected in 16.6±2.7 days

R. W. E de Bruin; R. E. Saat; E. Heineman; J. Jeekel; R. L. Marquet

1993-01-01

289

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

SciTech Connect

The dynamics of the soft x-ray induced excited spin state trapping (SOXIESST) effect of Fe(phen){sub 2}(NCS){sub 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([Me{sub 2}Pyrz]{sub 3}BH){sub 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. [Institut de Physique et de Chimie des Matériaux de Strasbourg, Université de Strasbourg, CNRS UMR 7504 23 rue du Loess, 67034 Strasbourg (France) [Institut de Physique et de Chimie des Matériaux de Strasbourg, Université de Strasbourg, CNRS UMR 7504 23 rue du Loess, 67034 Strasbourg (France); Physikalisches Institut, Karlsruhe Institut of Technology, Wolfgang-Gaede-Str. 1, 76131 Karlsruhe (Germany); Miyamachi, T. [Institute for Solid State Physics, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwashi, Chiba 277-8581 (Japan)] [Institute for Solid State Physics, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwashi, Chiba 277-8581 (Japan); Da Costa, V.; Boukari, S.; Scheurer, F.; Joly, L.; Bowen, M.; Beaurepaire, E. [Institut de Physique et de Chimie des Matériaux de Strasbourg, Université de Strasbourg, CNRS UMR 7504 23 rue du Loess, 67034 Strasbourg (France)] [Institut de Physique et de Chimie des Matériaux de Strasbourg, Université de Strasbourg, CNRS UMR 7504 23 rue du Loess, 67034 Strasbourg (France); Ohresser, P.; Otero, E.; Choueikani, F. [Synchrotron SOLEIL, L’Orme des Merisiers, Saint-Aubin, BP48, 91192 Gif-sur-Yvette (France)] [Synchrotron SOLEIL, L’Orme des Merisiers, Saint-Aubin, BP48, 91192 Gif-sur-Yvette (France); Gaspar, A. B.; Real, J. A. [Institut of Molecular Science, Universitat de València, Edifici de Instituts de Paterna, Apartat de Correus 22085, 46071 València (Spain)] [Institut of Molecular Science, Universitat de València, Edifici de Instituts de Paterna, Apartat de Correus 22085, 46071 València (Spain); Wulfhekel, W. [Physikalisches Institut, Karlsruhe Institut of Technology, Wolfgang-Gaede-Str. 1, 76131 Karlsruhe (Germany)] [Physikalisches Institut, Karlsruhe Institut of Technology, Wolfgang-Gaede-Str. 1, 76131 Karlsruhe (Germany)

2013-08-21

290

Contrasting effects of Krüppel-like factor 4 on X-ray-induced double-strand and single-strand DNA breaks in mouse astrocytes.  

PubMed

Astrocytes, the most common cell type in the brain, play a principal role in the repair of damaged brain tissues during external radiotherapy of brain tumours. As a downstream gene of p53, the effects of Krüppel-like factor 4 (KLF4) in response to X-ray-induced DNA damage in astrocytes are unclear. In the present study, KLF4 expression was upregulated after the exposure of astrocytes isolated from the murine brain. Inhibition of KLF4 expression using lentiviral transduction produced less double-strand DNA breaks (DSB) determined by a neutral comet assay and flow cytometric analysis of phosphorylated histone family 2A variant and more single-strand DNA breaks (SSB) determined by a basic comet assay when the astrocytes were exposed to 4?Gy of X-ray radiation. These data suggest that radiation exposure of the tissues around brain tumour during radiation therapy causes KLF4 overexpression in astrocytes, which induces more DSB and reduces SSB. This causes the adverse effects of radiation therapy in the treatment of brain tumours. Copyright © 2013 John Wiley & Sons, Ltd. PMID:24114958

Zhang, Ji; Cui, Fengmei; Li, Lei; Yang, Jiangtao; Zhang, Liyuan; Chen, Qiu; Tian, Ye

2014-04-01

291

Insights into the mechanism of X-ray-induced disulfide-bond cleavage in lysozyme crystals based on EPR, optical absorption and X-ray diffraction studies  

PubMed Central

Electron paramagnetic resonance (EPR) and online UV–visible absorption microspectrophotometry with X-ray crystallography have been used in a complementary manner to follow X-ray-induced disulfide-bond cleavage. Online UV–visible spectroscopy showed that upon X-irradiation, disulfide radicalization appeared to saturate at an absorbed dose of approximately 0.5–0.8?MGy, in contrast to the saturating dose of ?0.2?MGy observed using EPR at much lower dose rates. The observations suggest that a multi-track model involving product formation owing to the interaction of two separate tracks is a valid model for radiation damage in protein crystals. The saturation levels are remarkably consistent given the widely different experimental parameters and the range of total absorbed doses studied. The results indicate that even at the lowest doses used for structural investigations disulfide bonds are already radicalized. Multi-track considerations offer the first step in a comprehensive model of radiation damage that could potentially lead to a combined computational and experimental approach to identifying when damage is likely to be present, to quantitate it and to provide the ability to recover the native unperturbed structure.

Sutton, Kristin A.; Black, Paul J.; Mercer, Kermit R.; Garman, Elspeth F.; Owen, Robin L.; Snell, Edward H.; Bernhard, William A.

2013-01-01

292

Soft X-ray induced photoreduction of organic Cu(II) compounds probed by X-ray absorption near-edge (XANES) spectroscopy.  

PubMed

Photoreduction is a major obstacle for using the X-ray absorption near-edge structure (XANES) fingerprint to perform metal speciation at the molecular level in biological and environmental samples, especially for metalloproteins. In this study, soft X-ray induced photoreduction was observed in organic Cu(II) compounds during XANES measurements in a third-generation synchrotron source. Next Cu L(3)-edge, O K-edge, and C K-edge XANES spectroscopy, together with the scanning transmission X-ray microscopy (STXM), were used to probe the specific radiation damage processes of Cu acetate with similar local structures to Cu metalloproteins. Breakup of the Cu-Cu bond was hypothesized for the initial photoreduction of Cu acetate. The following radiation damage of Cu acetate produced CuO and an organic Cu(I) compound with a C?C bond, and the further photoreduction of the resulting CuO to Cu metal was also demonstrated. Our results indicated the importance of consideration of photoreduction during soft XANES measurements for the solid state compounds with high valence metals. Reducing the radiation dose to ~0.1 MGy effectively prevented the photoreduction of organic Cu(II) compounds during these measurements. This proposed radiation damage mechanism in Cu acetate may be generally useful in explaining the photoreduction process in Cu metalloproteins. PMID:21805976

Yang, Jianjun; Regier, Tom; Dynes, James J; Wang, Jian; Shi, Jiyan; Peak, Derek; Zhao, Yidong; Hu, Tiandou; Chen, Yingxu; Tse, John S

2011-10-15

293

Continuous-time photon-stimulated desorption spectroscopy studies on soft x-ray-induced reactions of CF3Br adsorbed on Si(111)-7×7  

NASA Astrophysics Data System (ADS)

Continuous-time core-level photon-stimulated desorption (PSD) spectroscopy was used to study the soft x-ray-induced reactions of CF3Br molecules adsorbed on Si(111)-7×7 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-CF3Br-covered surfaces show the production of surface SiF species, while those from the high-CF3Br-covered surfaces depict the formation of surface SiF, SiF2, and SiF3 species. The photolysis cross section of the submonolayer CF3Br-covered surface is determined as ~4.3×10-18 cm2. A comparison with the results on CF3Cl/Si(111)-7×7 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.

2011-10-01

294

Monochromatic soft X-ray-induced reactions of CCl2F2 adsorbed on Si(111)-7 × 7 near the Si(2p) edge  

NASA Astrophysics Data System (ADS)

Continuous-time photoelectron spectroscopy (PES) and continuous-time core-level photon-stimulated desorption (PSD) spectroscopy were used to study the monochromatic soft X-ray-induced reactions of CCl2F2 molecules adsorbed on Si(111)-7 × 7 at 30 K (CCl2F2 dose = 2.0 × 1014 molecules/cm2, ~ 0.75 monolayer) near the Si(2p) core level. Evolution of adsorbed CCl2F2 molecules was monitored by using continuous-time photoelectron spectroscopy at two photon energies of 98 and 120 eV to deduce the photolysis cross section as a function of energy. It was found that the photolysis cross sections for 98 and 120 eV photons are ~1.4 × 10- 18 and ~ 8.0 × 10- 18 cm2, respectively. Sequential F+ PSD spectra obtained by using continuous-time core-level photon-stimulated desorption spectroscopy in the photon energy range of 98-110 eV show the variation of their shapes with photon exposure and depict the formation of surface SiF species. The dissociation of CCl2F2 molecules adsorbed on Si(111)-7 × 7, irradiated by monochromatic soft X-ray in the photon energy range of 98-110 eV, is mainly due to dissociative electron attachment and indirect dipolar dissociation induced by photoelectrons emitted from the silicon surface.

Wang, S.-K.; Tsai, W.-C.; Chou, L.-C.; Chen, J.; Wu, Y.-H.; He, T.-M.; Feng, K.-S.; Wen, C.-R.

2012-07-01

295

Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissions.  

PubMed Central

The workload and costs of the emergency admissions and treatment of adhesive small bowel obstruction (ASBO) are unclear. This review details and costs the admission workload of ASBO. All admissions over a 2-year period for ASBO at two district general hospitals were identified through ICD10 diagnostic codes. Diagnostic investigations, treatment patterns, ward stay and outcome information for admissions were detailed from clinical records to develop mean cost estimates and assess the associated workload. Of the 298 admissions identified, 188 were not due to ASBO and were excluded from analysis. Of the 110 admissions detailed, 41 (37%) were treated surgically and 69 (63%) conservatively. Most admissions occurred through general practitioner referral (86.4%) to accident and emergency (90.0%). Mean (SD) length of stay was 16.3 days (11.0 days) for surgical treatment and 7.0 days (4.6 days) for conservative treatment. In-patient mortality was 9.8% for the surgical group and 7.2% for the conservative group. Costs were based on the mean values from both centres for surgical and conservative admissions and detailed according to the cost of referral and follow-up (100.98 Pounds surgical versus 102.61 Pounds conservative), hospital ward and ICU stay (3,327.48 Pounds versus 1,267.92 Pounds), theatre time (832.32 Pounds surgical only), investigations (282.73 Pounds versus 207.33 Pounds) and drug costs (133.90 Pounds versus 28.29 Pounds). Total treatment cost per admission for ASBO was 4,677.41 Pounds for surgically treated admissions and 1,606.15 Pounds for conservatively treated admissions. The impact of admissions for ASBO is considerable in terms of both costs and workload. Bed stay for these admissions represents the equivalent of almost one surgical bed per year and at least 2 days theatre time, impacting on surgical capacity and waiting lists. Adhesion prevention strategies may reduce the workload associated with ASBO. The review provides useful information for planning resource allocation.

Menzies, D.; Parker, M.; Hoare, R.; Knight, A.

2001-01-01

296

Pathobiological Implications of Mucin (MUC) Expression in the Outcome of Small Bowel Cancer  

PubMed Central

Mucins have been associated with survival in various cancer patients, but there have been no studies of mucins in small bowel carcinoma (SBC). In this study, we investigated the relationships between mucin expression and clinicopathologic factors in 60 SBC cases, in which expression profiles of MUC1, MUC2, MUC3, MUC4, MUC5AC, MUC6 and MUC16 in cancer and normal tissues were examined by immunohistochemistry. MUC1, MUC5AC and MUC16 expression was increased in SBC lesions compared to the normal epithelium, and expression of these mucins was related to clinicopathologic factors, as follows: MUC1 [tumor location (p?=?0.019), depth (p?=?0.017) and curability (p?=?0.007)], MUC5AC [tumor location (p?=?0.063) and lymph node metastasis (p?=?0.059)], and MUC16 [venous invasion (p?=?0.016) and curability (p?=?0.016)]. Analysis of 58 cases with survival data revealed five factors associated with a poor prognosis: poorly-differentiated or neuroendocrine histological type (p<0.001), lymph node metastasis (p<0.001), lymphatic invasion (p?=?0.026), venous invasion (p<0.001) and curative resection (p<0.001), in addition to expression of MUC1 (p?=?0.042), MUC5AC (p?=?0.007) and MUC16 (p<0.001). In subsequent multivariate analysis with curability as the covariate, lymph node metastasis, venous invasion, and MUC5AC and/or MUC16 expression were significantly related to the prognosis. Multivariate analysis in curative cases (n?=?45) showed that SBC with MUC5AC and/or MUC16 expression had a significantly independent high hazard risk after adjusting for the effects of venous invasion (hazard ratio: 5.6, 95% confidence interval: 1.8–17). In conclusion, the study shows that a MUC5AC-positive and/or MUC16-positive status is useful as a predictor of a poor outcome in patients with SBC.

Shibahara, Hiroaki; Higashi, Michiyo; Koriyama, Chihaya; Yokoyama, Seiya; Kitazono, Iwao; Kurumiya, Yasuhiro; Narita, Michihiko; Kuze, Shingo; Kyokane, Takanori; Mita, Saburo; Arai, Toshiyuki; Kato, Takehito; Yuasa, Norihiro; Yamaguchi, Ryuzo; Kubota, Hitoshi; Suzuki, Hideaki; Baba, Satoshi; Rousseau, Karine; Batra, Surinder K.; Yonezawa, Suguru

2014-01-01

297

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

2011-01-01

298

Effects of honey, glutamine and their combination on canine small bowel epithelial cell proliferation following massive resection.  

PubMed

The effects of honey, glutamine and honey/glutamine combination on the healing and adaptive process of the bowel following massive small bowel resection were studied in some Nigerian nondescript breeds of dogs. 24 dogs (3-4 months old) of mixed sexes with mean body weight of 4.42±0.70 kg were studied. They were randomized into four treatment groups following 70% small bowel resection. Group A dogs were placed on glutamine treatment, Group B on oral glutamine/honey and group C on honey and group D normal saline (control). Their body weights were evaluated for 15 days and the pre- and post-treatment gut biopsy samples were obtained and processed for morphometric evaluation. All groups exhibited signs of small bowel adaptation (Glutamine/honey>glutamine > honey > control) at the end of the experiment (4 weeks). Glutamine/honey combination, glutamine and honey had gradual increase in body weight from days 3-15 of weight evaluation. The control group, however, had a remarkable drop in body weight compared with other groups. Oral glutamine/honey combination showed the best overall effect based on body weight gain, intestinal mucosal growth and adaptation, evidenced by increased in residual bowel Villi height (27.71µm), Villi weight (14.51µm), Crypt depth (11.25µm), and Villi density (3.40µm). Glutamine showed a better result than honey with a significant increase in villi height (38.08µm), width (8.48µm) and crypt depth (40µm). Histologically, an improved villi branching was observed with glutamine/honey combination. Our results showed that honey/glutamine combination had comparative therapeutic advantage over glutamine or honey and may be a preferred treatment for short bowel syndrome patients. PMID:23652234

Eyarefe, O D; Emikpe, B O; Akinloye, S O; Alonge, T O; Fayemi, O E

2012-01-01

299

Small bowel herniation through subumbilical port site following laparoscopic surgery at the time of reversal of anesthesia.  

PubMed

Incisional hernias through laparoscopic trocar sites are unusual complications of laparoscopy. Two cases of small bowel herniation at subumbilical port site occurred at the time of withdrawal of the trocar sheath at the end of the laparoscopic procedure are reported. The herniations were precipitated by the coughing movements of the patients as a result of too early reversal of the general anesthesia. Awareness of the complication, precaution at time of sheath withdrawal and a well-timed reversal of the general anesthesia are important in avoiding such a complication. PMID:10729764

Leung, T Y; Yuen, P M

2000-01-01

300

The most characteristic lesions and radiologic signs of Crohn disease of the small bowel: air enteroclysis, MDCT, endoscopy, and pathology.  

PubMed

This pictorial essay describes the most characteristic lesions and radiologic signs of Crohn disease of the small bowel: nodular lymphoid hyperplasia, abnormal mucosal folds, villous pattern, aphthous ulcerations, linear ulcerations, cobblestone pattern, string sign, target sign, comb sign, creeping fat, sinus tracts, fistulas, and abscesses. Each description includes the definition, a correlation with the pathologic findings, an explanation of the possible physiopathologic mechanism, sample radiologic images with air enteroclysis or MDCT, the correspondence with the endoscopic findings when possible, and a list of differential diagnoses. PMID:24173609

Carbo, Alberto I; Reddy, Threta; Gates, Thomas; Vesa, Telciane; Thomas, Jaiyeola; Gonzalez, Enrique

2014-02-01

301

Internal hernia and small bowel obstruction caused by a linear cutter staple at appendiceal stump following laparoscopic appendectomy  

PubMed Central

Commonly linear staplers are used to perform laparoscopic appendectomies. We report a case of a small bowel obstruction caused by a staple on the appendiceal stump creating an internal hernia <1 week after laparoscopic appendectomy. We discuss the available literature on bowel obstructions caused by staples. Most of the discussed complications were caused by staples free in the abdomen, which were remote from the staple line. Generally, loose staples do not cause problems, but if noted during the operation, we recommend removal to prevent future obstruction.

Petersen, Lindsay F.; Nally, Mary C.; Agos, Andrew; Petty, Kyle

2013-01-01

302

Prospective Evaluation of Gastroenterologist-Guided, Nurse-Administered Standard Sedation for Spiral Deep Small Bowel Enteroscopy  

Microsoft Academic Search

Background  Sedation of patients for deep small bowel enteroscopy presents unique challenges and is traditionally provided by anesthesiologists.\\u000a No study has directly evaluated gastroenterologist-guided, nurse-administered sedation for deep enteroscopy. Further, no comparison\\u000a exists between gastroenterologist-guided versus anesthesiologist-guided sedation during deep enteroscopy.\\u000a \\u000a \\u000a \\u000a \\u000a Aims  To evaluate safety and efficacy of performing deep (spiral) enteroscopy using gastroenterologist-guided sedation and compare\\u000a outcomes between patients receiving gastroenterologist-guided

J. R. Judah; D. Collins; J. K. Gaidos; W. Hou; C. E. Forsmark; P. V. Draganov

2010-01-01

303

Phase distinction in semi-insulating polycrystalline silicon by pattern recognition of X-ray photoelectron spectroscopy/X-ray-induced Auger electron spectroscopy data  

NASA Astrophysics Data System (ADS)

X-ray photoelectron spectroscopy (XPS) and X-ray-induced Auger electron spectroscopy (XAES) supported with the lineshape analysis by the pattern recognition (PR) method and the fuzzy k-nearest neighbor rule ( kNN FR) were applied to study semiinsulating polycrystalline silicon layers (SIPOS). The aim of the present work was to obtain the qualitative and quantitative information about the surface region of as-received SIPOS layers. For the purpose of qualitative analysis the binding energies (BE), binding energy shifts (?BE), the half widths (FWHM) and the lineshapes of the Si 2p, O 1s and O KLL lines were analysed. The quantitative analysis was performed on the basis of the XPS using sensitivity factor method, multiline (ML) approach and the kNN FR. The performance of the kNN rule is possible after selecting the proper set of reference standard materials to which the rule refers during identification of an ambiguous chemical state. By selecting the reference samples supplying the information about the chemical state of Si, SiO x and SiO 2, the kNN rule allowed to distinguish qualitatively these three different phases in SIPOS samples. The particular application of the kNN FR makes possible the quantitative analysis by referring the fuzzy probability of classification for the given chemical state to the concentration of particular constituents in the investigated SIPOS. All the methods applied are consistent in revealing the quantitative results and show that SIPOS is a deeply non-homogeneous material, consisting of two phases: silicon and silicon oxide.

Lesiak, Beata; Zemek, Jozef; Jozwik, Adam

1998-09-01

304

Small bowel capsule endoscopy in patients with cardiac pacemakers and implantable cardioverter defibrillators: Outcome analysis using telemetry review  

PubMed Central

AIM: To determine if there were any interactions between cardiac devices and small bowel capsules secondary to electromagnetic interference (EMI) in patients who have undergone small bowel capsule endoscopy (SBCE). METHODS: Authors conducted a chart review of 20 patients with a cardiac pacemaker (CP) or implantable cardioverter defibrillator (ICD) who underwent continuous electrocardiographic monitoring during their SBCE from 2003-2008. authors searched for unexplained electrocardiogram (ECG) findings, changes in CP and ICD set parameters, any abnormality in transmitted capsule data, and adverse clinical events. RESULTS: There were no adverse events or hemodynamically significant arrhythmias reported. CP and ICD set parameters were preserved. The majority of ECG abnormalities were also found in pre- or post- SBCE ECG tracings and the CP behavior during arrhythmias appeared appropriate. Two patients seemed to have episodes of undersensing by the CP. However, similar findings were documented in ECGs taken outside the time frame of the SBCE. One patient was observed to have a low signal encountered from the capsule resulting in lack of localization, but no images were lost. CONCLUSION: Capsule-induced EMI remains a possibility but is unlikely to be clinically important. CP-induced interference of SBCE is also possible, but is infrequent and does not result in loss of images transmitted by the capsule.

Cuschieri, Justin R; Osman, Mohammed N; Wong, Richard CK; Chak, Amitabh; Isenberg, Gerard A

2012-01-01

305

Blue mode does not offer any benefit over white light when calculating Lewis score in small-bowel capsule endoscopy  

PubMed Central

AIM: To check the usefulness of blue mode (BM) review in lewis score (LS) calculation, by comparing it with respective LS results obtained by white light (WL) small-bowel capsule endoscopy (SBCE) review and mucosal inflammation as reflected by faecal calprotectin (FC) levels, considered as ‘gold standard’ for this study. METHODS: Computational analysis of our SBCE database to identify patients who underwent SBCE with PillCam® and had FC measured within a 30-day period from their test. Only patients with prior colonoscopy were included, to exclude any colon pathology-associated FC rise. Each small bowel tertile was reviewed (viewing speed 8 fps) with WL and BM, in a back-to-back mode, by a single experienced reviewer. LS were calculated after each WL and BM reviews. Pearson rank correlation (rho, r) statistic was applied. RESULTS: Twenty-seven (n = 27, 20F/7M) patients were included. Thirteen (n = 13) had SBCE with PillCam®SB1, and the remainder (n = 14) with PillCam®SB2. The median level of FC in this cohort was 125 ?g/g. LS (calculated in WL SBCE review) correlation with FC levels was r = 0.490 (P = 0.01), while for BM review and LS correlation with FC was r = 0.472 (P = 0.013). CONCLUSION: Although BM is believed to enhance mucosal details i.e., small mucosal breaks, it did not perform better than WL in the calculation of LS in our cohort.

Koulaouzidis, Anastasios; Douglas, Sarah; Plevris, John N

2012-01-01

306

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.

2010-01-01

307

Immediate Alterations in Intestinal Oxygen Saturation and Blood Flow Following Massive Small Bowel Resection As Measured By Photoacoustic Microscopy  

PubMed Central

Purpose Massive small bowel resection (SBR) results in villus angiogenesis and a critical adaptation response within the remnant bowel. Previous ex vivo studies of intestinal blood flow after SBR are conflicting. We sought to determine the effect of SBR on intestinal hemodynamics using photoacoustic microscopy, a non-invasive, label-free, high-resolution in vivo hybrid imaging modality. Methods Photoacoustic microscopy was used to image the intestine microvascular system and measure blood flow and oxygen saturation (sO2) of the terminal mesenteric arteriole and accompanying vein in C57BL6 mice (n=7) prior to and immediately following a 50% proximal small bowel resection. A p value of less than 0.05 was considered significant. Results Prior to SBR, arterial and venous sO2 were similar. Immediately following SBR, the venous sO2 decreased with an increase in the oxygen extraction fraction. In addition, the arterial and venous blood flow significantly decreased. Conclusion Massive SBR results in an immediate reduction in intestinal blood flow and increase in tissue oxygen utilization. These physiologic changes are observed throughout the remnant small intestine. The contribution of these early hemodynamic alterations may contribute to the induction of villus angiogenesis and the pathogenesis of normal intestinal adaptation responses.

Rowland, Kathryn J.; Yao, Junjie; Wang, Lidai; Erwin, Christopher R.; Maslov, Konstantin I.; Wang, Lihong V.; Warner, Brad W.

2012-01-01

308

A pedunculated polyp-shaped small-bowel lymphangioma causing gastrointestinal bleeding and treated by double-balloon enteroscopy  

PubMed Central

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.

Kida, Akihiko; Matsuda, Koichiro; Hirai, Satoshi; Shimatani, Akiyoshi; Horita, Yousuke; Hiramatsu, Katsushi; Matsuda, Mitsuru; Ogino, Hidero; Ishizawa, Shin; Noda, Yatsugi

2012-01-01

309

Synchronous small bowel and atypical primary leiomyosarcoma of inferior vena cava in a patient with RB1 mutation.  

PubMed

A 72-year-old Caucasian man presenting with non-specific upper abdominal pain had asymmetric soft tissue thickening of the small bowel wall on computed tomography (CT), which was pathologically proven to be leiomyosarcoma (LMS). At the same time point patient had incidentally but retrospectively detected lesion in IVC on CT scan which was subsequently imaged with PET/CT and MRI and was histologically proven to be also LMS. We present clinical and imaging features along with pedigree of this unique case of synchronous primary LMS involving the small bowel and inferior vena cava in a patient with RB1 gene mutation and a significant family history of multiple malignancies. To our knowledge, the synchronous primary LMS at two different sites has not been described. Clinicians and radiologists should keep in mind the possibility of a synchronous primary LMS in patients with genetic predisposition before making the diagnosis of a metastatic lesion or other malignancy as localized primary tumors remain potentially curable, whereas metastatic sarcoma is most often incurable. PMID:22581272

Saboo, Sachin S; Ramaiya, Nikhil; Jacene, Heather; Rainville, Irene; Diller, Lisa; Hornick, Jason L; George, Suzanne

2014-02-01

310

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

1997-01-01

311

Morphological evaluation of the radioprotective effects of melatonin against X-ray-induced early and acute testis damage in Albino rats: an animal model  

PubMed Central

Irradiation has profound effects on the reproductive function. Our knowledge about radioprotective effects of melatonin against X-ray-induced testis damage is rudimentary. In this investigation, we hypothesized that melatonin can minimize germ-cell depletion and morphological features of cell damage in testis following X-ray irradiation (XRI). To examine these effects, and to test our hypothesis, an animal model comprised of 60 Albino rats was established. The animals were divided into five groups: Group 1, non-irradiated; Group 2, X-ray irradiated (XRI, 8 Grays); Group 3, XRI pretreated with solvent (ethanol and phosphate-buffered saline); Group 4, non-irradiated group treated with melatonin and Group 5, XRI pretreated with melatonin. The testes were evaluated for both histological (light microscopy) and ultrastructural changes (transmission electron microscopy). Histologically, there were marked depletions (66%) of the germinal epithelial cells, in XRI group (Groups 2 and 3), whereas these changes were almost absent in XRI testis of animals pretreated with melatonin (Group 5). The number of spermatogenic cells in XRI testis of animals pretreated with melatonin (Group 5) was comparable (95%) to that of non-irradiated group (Groups 1 and 4) but significantly (P < 0.05) higher than those in XRI testis (34%, Groups 2 and 3). Ultrastructurally, XRI testis (Groups 2 and 3) showed features of apoptosis (condensation of the nuclei, vacuolization of the cytoplasm, increased cytoplasmic density and apoptotic bodies). These features were absent in XRI testis of animals pretreated with melatonin (Group 5). Also, this Group showed features of an increased metabolic activity (large acrosomal vesicle, prominent Golgi, increased mitotic activity, increased complement of cytoplasmic organelles and appearance of nucleoli-like bodies). There was a minimal depletion of the Sertoli and Leydig cells following XRI. Also, morphological features of apoptosis were infrequent in these cells. Administration of melatonin (MEL) prior to irradiation can protect testis against its destructive effects. The protective effects include amelioration of germ-cell depletion and apoptotic changes. The clinical ramifications of these observations mandate further studies.

Hussein, Mahmoud R; Abu-Dief, Eman E; Abou El-Ghait, Amal T; Adly, Mohamed A; Abdelraheem, Mohamad H

2006-01-01

312

Chronic graft versus host disease with small bowel obstruction after unrelated hematopoietic stem cell transplantation in a patient with acute myeloid leukemia  

PubMed Central

Chronic graft versus host disease (GVHD) is a frequent complication after allogeneic hematopoietic stem cell transplantation (HSCT), but simultaneous small bowel obstruction is rare. Here, we report a child with acute myeloid leukemia who received an allogeneic HSCT from an unrelated matched donor. After HSCT, the patient developed severe chronic GVHD involving the small intestine, leading to obstruction of the terminal ileum. Small bowel resection was performed, and the symptoms improved without severe complications. Bowel obstruction should be considered as a possible complication of chronic GVHD; surgery may be a valuable corrective measure.

Yoon, Ju Young; Kim, Hyery; Kang, Hyoung Jin; Park, Kyung Duk; Ahn, Hyo Seop

2012-01-01

313

Case report: transient small bowel intussusception presenting as right lower quadrant pain in a 6-year-old male  

PubMed Central

In children presenting to the emergency room with right lower quadrant pain, ultrasound is the preferred initial modality. In our patient, a 6-year-old male with a sudden onset of severe right lower quadrant pain, the differential is broad, including appendicitis and intussusception. In order to narrow our differential and secure the diagnosis, our first modality was ultrasonography. With the increased use of point-of-care ultrasound in the emergency department, the diagnosis of appendicitis and ileo-colic intussusception has been made more frequently. In addition, other entities such as transient small bowel intussusception may be identified. As in our case, obstruction secondary to intussusception must be ruled out with observation, serial abdominal exams, clinical improvement, or further imaging.

2014-01-01

314

Autoimmune enteropathy with a CD8+ CD7- T-cell small bowel intraepithelial lymphocytosis: case report and literature review  

PubMed Central

Background Adult onset autoimmune enteropathy (AIE) is a rare condition characterized by diarrhea refractory to dietary therapy diagnosed in patients with evidence of autoimmune conditions. Auto-antibodies to gut epithelial cells and other tissues are commonly demonstrated. Despite increasing awareness, the pathogenesis, histologic, immunologic and clinical features of AIE remain uncertain. There remains controversy regarding the diagnostic criteria, the frequency and types of auto-antibodies and associated autoimmune conditions, and the extent and types of histologic and immunologic abnormalities. CD4+ T-cells are thought to at least responsible for this condition; whether other cell types, including B- and other T-cell subsets are involved, are uncertain. We present a unique case of AIE associated with a CD8+CD7- lymphocytosis and review the literature to characterize the histologic and immunologic abnormalities, and the autoantibodies and autoimmune conditions associated with AIE. Case Presentation We present a case of immune mediated enteropathy distinguished by the CD8+CD7- intra-epithelial and lamina propria lymphocytosis. Twenty-nine cases of AIE have been reported. The majority of patients had auto-antibodies (typically anti-enterocyte), preferential small bowel involvement, and predominately CD3+ CD4+ infiltrates. Common therapies included steroids or immuno-suppressive agents and clinical response with associated with histologic improvement. Conclusions AIE is most often characterized (1) IgG subclass anti-epithelial cell antibodies, (2) preferential small bowel involvement, and (3) CD3+ alphabeta TCR+ infiltrates; there is insufficient evidence to conclude CD4+ T-cells are solely responsible in all cases of AIE.

2011-01-01

315

The influence of a preserved colon on the absorption of medium chain fat in patients with small bowel resection  

PubMed Central

Background—Medium chain C8-C10 triglycerides (MCTs) improve fat absorption in short bowel patients. Effects on overall energy absorption remain unknown. ?Aims—To determine whether MCTs and medium chain fatty acids (MCFAs) are absorbed in the colon like the short chain fatty acids (SCFAs) or are lost in faeces similarly to long chain fatty acids (LCFAs). ?Methods—Nine small bowel resected patients without and 10 with a colon in continuity excreted 2-6 MJ/day and were randomised and crossed over between two high fat diets (10 MJ/day, 50% as fat), based on either long chain triglycerides (LCT) alone or equal quantities of LCT and MCT. ?Results—Patients with a colon absorbed C8-C10 fatty acids considerably better than patients without a colon at similar and extreme levels of LCFA malabsorption; the colonic impact on absorption of C14-18 fatty acids was negligible. MCT redoubled fat (MCT+LCT) absorption from 23% to 58% in patients with a colon, and increased overall bomb calorimetric energy absorption from 46% to 58%. The increase in fat absorption from 37% to 46% in patients without a colon did not improve overall energy absorption because malabsorption of carbohydrate and protein increased. ?Conclusion—In small bowel resected patients, the colon seems to serve as a digestive organ for medium chain fat, probably absorbed as MCFAs, perhaps because like the SCFAs, they are water soluble. Only patients with a colon gained from MCT treatment. ?? Keywords: absorption; medium chain fatty acid; colon; short bowel

Jeppesen, P; Mortensen, P

1998-01-01

316

Improved detectability of small-bowel lesions via capsule endoscopy with computed virtual chromoendoscopy: A pilot study  

PubMed Central

Objective. Real-time video capsule endoscopy (CE) with flexible spectral imaging color enhancement (FICE) improves visibility of small-bowel lesions. This article aims to clarify whether CE-FICE also improves detectability of small-bowel lesions. Patients and methods. A total of 55 patients who underwent CE at Hiroshima University Hospital during the period November 2009 through March 2010 were enrolled in the study. Five patients were excluded from the study because residues and transit delays prevented sufficient evaluation. Thus, 50 patients participated. Two experienced endoscopists (each having interpreted more than 50 capsule videos) analyzed the images. One interpreted conventional capsule videos; the other, blinded to interpretation of the conventional images, interpreted CE-FICE images obtained at settings 1-3 (setting 1: red 595 nm, green 540 nm, blue 535 nm; setting 2: red 420 nm, green 520 nm, blue 530 nm; setting 3: red 595 nm, green 570 nm, blue 415 nm). Lesions were classified as angioectasia, erosion, ulceration, or tumor. Detectability was compared between the two modalities. Time taken to interpret the capsule videos was also determined. Results. Seventeen angioectasias were identified by conventional CE; 48 were detected by CE-FICE at setting 1, 45 at setting 2, and 24 at setting 3, with significant differences at settings 1 and 2 (p = 0.0003, p < 0.0001, respectively). Detection of erosion, ulceration, and tumor did not differ statistically between conventional CE and CE-FICE, nor did interpretation time (conventional CE 36 ± 6.9 min; CE-FICE setting 1, 36 ± 6.4 min; setting 2, 38 ± 5.8 min; setting 3, 35 ± 6.7 min). Conclusions. CE-FICE is superior in the lesion detection in comparison with conventional CE and improves detection of angioectasia.

Imagawa, Hiroki; Oka, Shiro; Tanaka, Shinji; Noda, Ikue; Higashiyama, Makoto; Sanomura, Youji; Shishido, Takayoshi; Yoshida, Shigeto; Chayama, Kazuaki

2011-01-01

317

Aperistaltic effect of hyoscine N-butylbromide versus glucagon on the small bowel assessed by magnetic resonance imaging.  

PubMed

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

2009-06-01

318

Optimal Approach for Small Bowel Capsule Endoscopy Using Polyethylene Glycol and Metoclopramide with the Assistance of a Real-Time Viewer  

Microsoft Academic Search

Aim: Capsule endoscopy is limited by the poor image quality of the distal bowel and incomplete small bowel transit. The aim of this study was to establish an optimal medication protocol for capsule endoscopy performed using a real-time viewer. Methods: A total of 80 patients were prospectively recruited. The patients were randomized into two groups: the ‘conventional group’ (without any

Kunihiro Hosono; Hiroki Endo; Eiji Sakai; Yusuke Sekino; Takashi Uchiyama; Seitaro Watanabe; Hiroshi Iida; Yasunari Sakamoto; Tomoko Koide; Hirokazu Takahashi; Masato Yoneda; Chikako Tokoro; Yasunobu Abe; Masahiko Inamori; Noritoshi Kobayashi; Kensuke Kubota; Atsushi Nakajima

2011-01-01

319

Tolerance induction permits the development of graft-versus-host disease: donor-mediated attack following small bowel transplantation in mixed chimeras  

Microsoft Academic Search

The induction of tolerance to organ allografts would eliminate acute and chronic rejection as well as the need for nospecific immunosuppression. We have shown that tolerance induced through the creation of mixed allogeneic bone marrow chimeras allows for the long-term engraftment of cardiac and small bowel allografts across strong multiple major histocompatibility barriers. The possibility that tolerance might render the

Nicholas J Morrissey; Dennis Blom; Charlotte K Ryan; Terry Fisher; Oscar Bronsther; Mark S Orloff

1999-01-01

320

Glycyl-glutamine-supplemented long-term total parenteral nutrition selectively improves structure and function in heterotopic small-bowel autotransplantation in the pig  

Microsoft Academic Search

Marked atrophy and impaired absorptive and barrier function occur in transplanted small intestinal graft during total parenteral nutrition (TPN), TPN is required by all the patients after small bowel transplantation (SBT). Glutamine (Gln) is a conditional indispensable amino acid that is not included in regimens for parenteral nutrition because of its chemical instability in aqueous solution. Glutamine-containing dipeptide, however, is

Yousheng Li; Jieshou Li; Janwen Jiang; Ning Li; Xinbao Wang; Zhiming Wang; Bo Wu; Fangnan Liu

2002-01-01

321

Effect of Oral Administration of Freeze-Dried Lactobacillus acidophilus on Small Bowel Bacterial Overgrowth in Patients with End Stage Kidney Disease: Reducing Uremic Toxins and Improving Nutrition  

Microsoft Academic Search

Small bowel bacterial overgrowth (SBBO), a condition found in patients with advanced chronic kidney failure, contributes to pathophysiology and decreased nutrition in the chronic dialysis population. Elevated levels of toxins including dimethylamine (DMA) and a carcinogen, nitrosodimethylamine (NDMA) for which DMA is a precursor, are found in the blood and body fluids in patients with this condition, and are generated

Stephen R. Dunn; Michael L. Simenhoff; Kamal E. Ahmed; William J. Gaughan; Babikar O. Eltayeb; Mary-Ellen D. Fitzpatrick; Susan M. Emery; James W. Ayres; Kris E. Holt

1998-01-01

322

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

1995-01-01

323

Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome: Report of a case and review of literature  

Microsoft Academic Search

BACKGROUND: Blue rubber bleb naevus syndrome (BRBNS), is an uncommon condition characterised by cavernous haemangiomas of skin and gastrointestinal tract. The most common complication of this syndrome is gastrointestinal bleeding. Intussusception of bowel, although a known complication, has rarely been reported. CASE PRESENTATION: We report the case of a 37-year-old man who presented with multiple intussusceptions of small bowel. He

Clement Lee; Debasish Debnath; Tara Whitburn; Mark Farrugia; Federico Gonzalez

2008-01-01

324

Peritonitis as the primary manifestation of atypical T-cell lymphoma of the small bowel with unsuspected celiac disease: MDCT features  

Microsoft Academic Search

We report one case of jejunal free perforation as the initial manifestation of small bowel lymphoma in a 46 year-old man with unsuspected celiac disease. Perforation was the revealing feature of the lymphoma and led to recognition of latent, long standing celiac disease. Multidetector row computed tomography (MDCT) showed pneumoperitoneum, fluid effusion and findings suggestive for celiac disease including diffuse

Philippe Soyer; Judith Nemeth; Clarisse Eveno; Xavier Dray; Mourad Boudiaf

2011-01-01

325

A Meta-Analysis of the Yield of Capsule Endoscopy Compared to Other Diagnostic Modalities in Patients with Non-Stricturing Small Bowel Crohn's Disease  

Microsoft Academic Search

OBJECTIVES:Capsule endoscopy (CE) allows for direct evaluation of the small bowel mucosa in patients with Crohn's disease (CD). A number of studies have revealed significantly improved yield for CE over other modalities for the diagnosis of CD, but as sample sizes have been small, the true degree of benefit is uncertain. Additionally, it is not clear whether patients with a

Stuart L. Triester; Jonathan A. Leighton; Grigoris I. Leontiadis; Suryakanth R. Gurudu; David E. Fleischer; Amy K. Hara; Russell I. Heigh; Arthur D. Shiff; Virender K. Sharma

2006-01-01

326

The use of Seprafilm Adhesion Barrier in Adult Patients Undergoing Laparotomy to Reduce the Incidence of Post-Operative Small Bowel Obstruction  

Microsoft Academic Search

Background: Post-operative adhesions are an expected outcome with nearly every abdominal operation. Adhesions are not always symptomatic, but when they are, they can cause a variety of problems. Small bowel obstructions are a potential complication and are caused by abdominal adhesions in 75% of cases. This complication would be one best avoided, and as a result numerous prophylactic agents have

Erin Call

2012-01-01

327

Cervical Adenocarcinoma  

MedlinePLUS

... in a Pap test or biopsy by the primary care physician. How does a pathologist diagnose cervical adenocarcinoma? ... abnormal Pap test or has other symptoms, the primary care doctor will perform a colposcopy to remove a ...

328

The effect on the small bowel of 5-FU and oxaliplatin in combination with radiation using a microcolony survival assay  

PubMed Central

Background In locally advanced rectal cancer, 5-Fluorouracil (5-FU)-based chemoradiation is the standard treatment. The main acute toxicity of this treatment is enteritis. Due to its potential radiosensitizing properties, oxaliplatin has recently been incorporated in many clinical chemoradiation protocols. The aim of this study was to investigate to what extent 5-FU and oxaliplatin influence the radiation (RT) induced small bowel mucosal damage when given in conjunction with single or split dose RT. Methods Immune competent balb-c mice were treated with varying doses of 5-FU, oxaliplatin (given intraperitoneally) and total body RT, alone or in different combinations in a series of experiments. The small bowel damage was studied by a microcolony survival assay. The treatment effect was evaluated using the inverse of the slope (D0) of the exponential part of the dose-response curve. Results In two separate experiments the dose-response relations were determined for single doses of RT alone, yielding D0 values of 2.79 Gy (95% CI: 2.65 - 2.95) and 2.98 Gy (2.66 - 3.39), for doses in the intervals of 5-17 Gy and 5-10 Gy, respectively. Equitoxic low doses (IC5) of the two drugs in combination with RT caused a decrease in jejunal crypt count with significantly lower D0: 2.30 Gy (2.10 - 2.56) for RT+5-FU and 2.27 Gy (2.08 - 2.49) for RT+oxaliplatin. Adding both drugs to RT did not further decrease D0: 2.28 Gy (1.97 - 2.71) for RT+5-FU+oxaliplatin. A clearly higher crypt survival was noted for split course radiation (3 × 2.5 Gy) compared to a single fraction of 7.5 Gy. The same difference was seen when 5-FU and/or oxaliplatin were added. Conclusion Combining 5-FU or oxaliplatin with RT lead to an increase in mucosal damage as compared to RT alone in our experimental setting. No additional reduction of jejunal crypt counts was noted when both drugs were combined with single dose RT. The higher crypt survival with split dose radiation indicates a substantial recovery between radiation fractions. This mucosal-sparing effect achieved by fractionation was maintained also when chemotherapy was added.

2009-01-01

329

Capsule endoscopy with flexible spectral imaging color enhancement reduces the bile pigment effect and improves the detectability of small bowel lesions  

PubMed Central

Background Capsule endoscopy with flexible spectral imaging color enhancement (CE-FICE) has been reported to improve the visualization and detection of small-bowel lesions, however, its clinical usefulness is still not established. Therefore, we conducted a study to evaluate whether CE-FICE contributes to improve the detectability of small-bowel lesions by CE trainees. Methods Four gastroenterology trainees without prior CE experience were asked to read and interpret 12 CE videos. Each of the videos was read by conventional visualization method and under three different FICE settings. To evaluate whether the lesion recognition ability of the CE trainees could be improved by the FICE technology, the lesion detection rate under each of the three FICE settings was compared with that by conventional CE. CE trainees tend to miss small-bowel lesions in bile-pigment-positive condition, therefore we evaluated whether CE-FICE contributes to reducing the bile-pigment effect. The bile-pigment condition was determined by the color values around the small-bowel lesions according to the results of the receiver-operating-characteristic analysis. Moreover, we also evaluated whether poor bowel preparion might affect the accuracy of lesion recognition by CE-FICE. Results Of a total of 60 angioectasias, CE trainees identified 26 by conventional CE, 40 under FICE setting 1, 38 under FICE setting 2, and 31 under FICE setting 3. Of a total of 82 erosions/ulcerations, CE trainees identified 38 by conventional CE, 62 under FICE setting 1, 60 under FICE setting 2, and 20 under FICE setting 3. Compared with conventional CE, FICE settings 1 and 2 significantly improved the detectability of angioectasia (P?=?0.0017 and P?=?0.014, respectively) and erosions/ulcerations (P?=?0.0012 and P?=?0.0094, respectively). Although the detectability of small-bowel lesions by conventional CE (P?=?0.020) and under FICE setting 2 (P?=?0.0023) was reduced by the presence of bile-pigments, that under FICE setting 1 was not affected (P?=?0.59). Our results also revealed that in poor bowel visibility conditions, CE-FICE yielded a high rate of false-positive findings. Conclusions CE-FICE may reduce the bile-pigment effect and improve the detectability of small-bowel lesions by CE trainees; the reliability of CE-FICE may be improved by good bowel preparation.

2012-01-01

330

An Intestinal Occlusion Device for Prevention of Small Bowel Distention During Transgastric Natural Orifice Transluminal Endoscopic Surgery  

PubMed Central

Background and Objectives: Bowel distention from luminal gas insufflation reduces the peritoneal operative domain during natural orifice transluminal endoscopic surgery (NOTES) procedures, increases the risk for iatrogenic injury, and leads to postoperative patient discomfort. Methods: A prototype duodenal occlusion device was placed in the duodenum before NOTES in 28 female pigs. The occlusion balloon was inflated and left in place during the procedure, and small bowel distension was subjectively graded. One animal had no balloon occlusion, and 4 animals had a noncompliant balloon placed. Results: The balloon maintained its position and duodenal occlusion in 22 animals (79%) in which the bowel distention was rated as none (15), minor (4), moderate (3), or severe (0). The intestinal occlusion catheter failed in 6 animals (21%) because of balloon leak (5) or back-migration into the stomach (1), with distention rated as severe in 5 of these 6 cases. Conclusion: The intestinal occlusion catheter that maintains duodenal occlusion significantly improves the intra-abdominal working domain with enhanced visualization of the viscera during the NOTES procedure while requiring minimal time and expense.

Tomasko, Jonathan M.; Moyer, Matthew T.; Haluck, Randy S.; Pauli, Eric M.

2013-01-01

331

Up-regulation of hypoxia-inducible factor 1 alpha and hemodynamic responses following massive small bowel resection?,??  

PubMed Central

Purpose Massive small bowel resection (SBR) results in an adaptive response within the remnant bowel. We have previously shown an immediate reduction in intestinal blood flow and oxygen saturation (sO2) after SBR. We therefore sought to determine the duration of resection-induced intestinal hypoxia and expression of hypoxia-inducible factors (HIFs) following SBR. Methods C57B6 mice were subjected to 50% proximal SBR or a sham procedure. Photoacoustic microscopy (PAM) was used to measure blood flow and sO2 on postoperative days (PODs) 1, 3, and 7. Ileal tissue was harvested 6 h postoperatively and on PODs 1 and 2, and HIF1?, HIF2?, and VEGF mRNA expression were assessed via RT-PCR. A p value of less than 0.05 was considered significant. Results Following SBR, reduction in intestinal blood flow persists for 24 h and is followed with hyperemia by POD 3. The immediate reduction in venous sO2 and increased tissue oxygen utilization continued through POD 7. Enhanced expression of HIF1? was demonstrated 6 h following SBR. Conclusion Massive SBR results in an immediate relative hypoxic state within the remnant bowel with early enhanced expression of HIF1?. On POD 7, increased tissue oxygen extraction and elevated blood flow persist in the adapting intestine.

Rowland, Kathryn J.; Yao, Junjie; Wang, Lidai; Erwin, Christopher R.; Maslov, Konstantin I.; Wang, Lihong V.; Warner, Brad W.

2013-01-01

332

Role of Water Soluble Contrast Agents in Assigning Patients to a Non-Operative Course in Adhesive Small Bowel Obstruction  

PubMed Central

Objectives Adhesive small bowel obstruction (SBO) is a common surgical emergency. It is estimated that at least 60% of SBO are due to post-operative adhesions. Water soluble contrast agents (gastrografin) have been used to identify patients who might be treated non-operatively. This study aims to determine the role of gastrografin in adhesive intestinal obstruction patients. Methods In this prospective study, 27 patients admitted between 1st August 2004 and 1st July 2006 with clinical signs suggestive of postoperative adhesive SBO met the inclusion criteria. After intravenous hydration, nasogastric tube insertion and complete suctioning of the gastric fluid, 100 ml of gastrograsfin was given and plain abdominal radiography was taken 6 hours and 24 hours if the contrast is not seen in the colon. Those in whom the contrast reached the colon in 24 hours were considered to have partial SBO and started oral intake. If gastrografin failed to reach the colon in 24 hours and the patient did not improve in the following 24 hours, laparotomy was performed. Results Conservative treatment was successful in 31 cases (91%) and 3 (9%) required operation. Patients treated conservatively had short hospital stay (mean=4 days) and tolerated oral feeding with no morbidity or mortality. Conclusion Oral gastrografin helps in the management of patients with postoperative adhesive SBO.

Wadani, Hamid AI; Al Awad, Naif Ibrahim; Hassan, Khairi Ahmed; Zakaria, Hazem Mohamed; Alaqeel, Faten O.

2011-01-01

333

The Effect of Erythromycin on Bile Excretion and Proximal Small Bowel Motility Following Divided Gastric Bypass Surgery: A Prospective Randomized Placebo-Controlled Trial  

Microsoft Academic Search

Background: No conclusive data exists supporting the use of any prokinetic agent in the postoperative setting. The study was\\u000a designed to examine the effect of erythromycin on small bowel motility in a placebo-controlled trial of post gastric bypass\\u000a patients utilizing a standardized nuclear medicine test. Methods: A consecutive series of 21 patients undergoing elective\\u000a gastric bypass surgery for morbid obesity

Neal W. Wilkinson; Robert J. Gustafson; James D. Frizzi

2002-01-01

334

SYSTEMIC AND LOCAL SECRETIONS OF CYTOKINES AND NITRIC OXIDE IN MASSIVE BOWEL RESECTED RATS WITH OR WITHOUT SMALL BOWEL SEGMENT REVERSAL  

Microsoft Academic Search

Our previous study suggested that small bowel segment reversal stimulates jejunal hyperplasia, but that the elevated serum interleukin (IL-)6 eliminates whole-body anabolism in massive bowel resected rats. The aim of this study was to investigate systemic and local secretions of cytokines and nitric oxide (NO) in relation to whole-body and tissue responses in rats that underwent massive bowel resection with

Hui-Chen Lo; Fu-Ann Tsai; Su-Chen Lin; Hsiu-Fen Wang

2001-01-01

335

Automatic detection of small bowel contraction frequencies in motility plots using lomb-scargle periodogram and sinus-fitting method-initial experience.  

PubMed

PURPOSE: Contraction frequencies are an important parameter for the analysis of bowel motility in MRI. The contraction curve can be rather noisy and the frequency-evaluation might be difficult. The aim was to evaluate manual calculations of small bowel contraction frequency in comparison with automatic calculations using two mathematically established methods. METHODS: The institutional-review-board approved study consisted of 48 segmental small-bowel motility-plots out of a previous study with 25 patients (15 men/10 women; mean 39 years, standard deviation?±?14.67) undergoing MRI (1.5 T, GE-Medical Systems; two-dimensional-Fiesta, pulse repetition time 2.91, echo time 1.25, flip-angle 45°, matrix 256 × 256, slice thickness 10 mm) were evaluated. Calculations of contraction frequency was performed either manually or using Lomb-Scargle-periodograms and Sinus-Fitting method. The results were compared using intraclass correlation coefficient, Friedman's-test and Wilcoxon-matched-paired-signed-rank-test (P?small-bowel contraction frequencies even in noisy small bowel motility plots. Magn Reson Med, 2013. © 2013 Wiley Periodicals, Inc. PMID:23467927

Bickelhaupt, Sebastian; Cattin, Roger; Froehlich, Johannes M; Raible, Stephan; Bouquet, Hanspeter; Bill, Urs; Patak, Michael A

2013-03-01

336

A Comparison of Antibody Testing, Permeability Testing, and Zonulin Levels with Small-Bowel Biopsy in Celiac Disease Patients on a Gluten-Free Diet  

Microsoft Academic Search

Active celiac disease is associated with positive endomysial (EMA) and tissue transglutaminase (TTG) antibodies, elevated\\u000a zonulin levels, and increased intestinal permeability. There is little known about what happens to these immunologic and structural\\u000a abnormalities in patients on a gluten-free diet and their correlation with small-bowel biopsy changes. Adult patients previously\\u000a diagnosed with celiac disease and on a gluten-free diet for

D. R. Duerksen; C. Wilhelm-Boyles; R. Veitch; D. Kryszak; D. M. Parry

2010-01-01

337

Elemental enteral nutrition preserves the mucosal barrier and improves the trophism of the villi after small bowel transplantation in piglets.  

PubMed

The main goals for a successful small bowel transplantation (SBTx) are the control of acute rejection and maintenance of the mucosal barrier, which plays a key role in preventing bacterial translocation and preserving absorptive capacity. According to recent evidence that sustaining enteral nutrition (EN) as rehabilitative therapy improves the integrity of the mucosal barrier after SBTx, we studied the trophic effect of a new elemental enteral solution whose proteinic supply is represented by oligomeric-aminoacidic chains. In a swine SBTx model we studied three groups, divided by the different postoperative feeding: group 1 (n = 5): standard swine chow, group 2 (n = 5): polymeric enteral solution, group 3 (n = 5): elemental enteral solution (Peptamen, Nestlè Corp). All animals were immunosuppressed with a tacrolimus/FK778 combined oral therapy. The nutritional indices evaluated were: body weight, episodes of diarrhea, D-xylose absorption test, and histopatological and villi morphometric analysis. Three pigs died before the end of the study, two in group 1 (pneumonia and sepsis), one in group 2 (pneumonia). Mean days of diarrhea were 15, 10, and 3 in groups 1, 2, and 3, respectively (P < .05). The final/starting weight ratio was 1.08 for group 3 and 0.92 for group 2 (P < .05); the D-xylose curves showed a statistically significant difference for group 3 versus the groups 2 and 1 (P < .05), as well as for the villi height (P < .01) and width (P < .05). In conclusion, elemental enteral solution, with its basic protein supply, does not require a very complex enzymatic system to be metabolized. Thus, it may contribute to a faster recovery of the mucosal barrier and to limit the hypercatabolic state. PMID:17692682

Zonta, S; Doni, M; Alessiani, M; Lovisetto, F; Vigano, J; Mazzilli, M; Dominioni, T; Podetta, M; De Martino, M; Scaglione, M; Vicini, E; Bottazzi, A; Villa, C; Morbini, P; Dionigi, P

2007-01-01

338

Altered transcription of murine genes induced in the small bowel by administration of probiotic strain Lactobacillus rhamnosus HN001.  

PubMed

Lactobacillus rhamnosus HN001 is a probiotic strain reported to increase resistance to epithelium-adherent and -invasive intestinal pathogens in experimental animals. To increase understanding of the relationship between strain HN001 and the bowel, transcription of selected genes in the mucosa of the murine small bowel was measured. Mice previously naive to lactobacilli (Lactobacillus-free mice) were examined after daily exposure to HN001 in drinking water. Comparisons were made to results from matched Lactobacillus-free mice. Infant and adult mice were investigated to provide a temporal view of gene expression in response to exposure to HN001. Genes sgk1, angptl4, and hspa1b, associated with the apoptosis pathway, were selected for investigation by reverse transcription-quantitative PCR on the basis of a preliminary duodenal DNA microarray screen. Normalized to gapdh gene transcription, these three genes were upregulated after 6 to 10 days exposure of adult mice to HN001. Angptl4 was shown by immunofluorescence to be upregulated in duodenal epithelial cells of mucosal samples. Epithelial cell migration was faster in HN001-exposed mice than in the Lactobacillus-free controls. Transcriptional responses in infant mice differed according to bowel region and age. For example, sgk1 was upregulated in duodenal, jejunal, and ileal mucosa of mice less than 25 days old, whereas angptl4 and hspa1b were upregulated at 10 days in the duodenum but downregulated in the jejunal mucosa until mice were 25 days old. Overall, the results provide links between a probiotic strain, mucosal gene expression, and host phenotype, which may be useful in delineating mechanisms of probiotic action. PMID:24584241

Tannock, Gerald W; Taylor, Corinda; Lawley, Blair; Loach, Diane; Gould, Maree; Dunn, Amy C; McLellan, Alexander D; Black, Michael A; McNoe, Les; Dekker, James; Gopal, Pramod; Collett, Michael A

2014-05-01

339

Electronic structure studies of Ni-X (X: B, S, P) alloys using x-ray photoelectron spectroscopy, x-ray induced Auger electron spectroscopy and density functional theory calculations  

NASA Astrophysics Data System (ADS)

The electronic structure of Ni-X (X = B, S, P) alloys was studied using x-ray photoelectron spectroscopy, x-ray induced Auger electron spectroscopy and density functional theory. The spectroscopic data in the form of the Ni 2p shake-up satellite and the Ni 2p LMM, P 2p KLL and S 2p KLL Auger parameters combined with density of states (DOS) and charge difference plots suggest an overall charge transfer from the Ni sites towards the alloying addition sites. However, this is masked, with intra-atomic charge redistribution leading to an increased occupancy of the Ni 3d states in the alloys. The Ni 3d DOS shows strong similarity to that of Pt which is the best catalyst for hydrogen evolution.

Diplas, S.; Løvvik, O. M.

2009-06-01

340

Embolization for Acute Small-Bowel Bleeding from the Collateral Artery of the Superior Mesenteric Left Deep Circumflex Iliac Artery Associated with Narrowing of the Bilateral Common External Iliac Arteries  

SciTech Connect

We present a case of acute small-bowel bleeding from the collateral artery of the superior mesenteric-left deep circumflex iliac artery that was successfully managed by transarterial coil embolization.

Shimohira, Masashi, E-mail: m_shimohira@yahoo.co.jp; Ogino, Hiroyuki; Sasaki, Shigeru; Nishikawa, Hiroko; Shibamoto, Yuta [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan)

2009-03-15

341

Adenocarcinoma and lymphoma of the small intestine. Distribution and etiologic associations.  

PubMed Central

Malignant small-bowel tumors in 171 patients over 64 years included 68 with adenocarcinomas, 41 with primary lymphomas, 50 with carcinoids, and 12 with sarcomas. The distribution of the carcinomas showed approximately 80% preponderance in the duodenum and proximal jejunum. A similar distribution in the upper small bowel in small-bowel carcinomas induced in Fischer and Sprague-Dawley rats by azoxymethane (90-160 mg/kg) suggests defense mechanisms within ileal mucosa. The clinical series from 1958 to 1976 included two Crohn's carcinomas (jejunum, defunctioned ileum), two jejunal cancers (lymphoma, carcinoma) associated with celiac disease, two duodenal carcinomas arising in villous adenomas, and one jejunal lymphoma following exposure to irradiation. Multiple primary malignancies were found in 20 to 25% of enteric cancers. Hemorrhage was more common with carcinoma than lymphoma, but lymphomas predominated considering perforation or a palpable mass. Both carcinoma and lymphoma had 75 to 80% resectability rates and 14 to 15% five-year postoperative survival rates. The prognosis was least poor for carcinoma of the jejunum, one third of patients with "curative" resections surviving five years.

Williamson, R C; Welch, C E; Malt, R A

1983-01-01

342

IMPAIRED SMALL BOWEL BARRIER INTEGRITY IN THE PRESENCE OF LUMENAL PANCREATIC DIGESTIVE ENZYMES LEADS TO CIRCULATORY SHOCK  

PubMed Central

In bowel ischemia, impaired mucosal integrity may allow intestinal pancreatic enzyme products to become systemic and precipitate irreversible shock and death. This can be attenuated by pancreatic enzyme inhibition in the small bowel lumen. It is unresolved, however, whether ischemically-mediated mucosal disruption is the key event allowing pancreatic enzyme products systemic access, and whether intestinal digestive enzyme activity in concert with increased mucosal permeability leads to shock in the absence of ischemia. To test this possibility, the small intestinal lumen of non-ischemic rats was perfused for two hours with either digestive enzymes, a mucin disruption strategy (i.e., mucolytics) designed to increase mucosal permeability, or both, and animals were observed for shock. Digestive enzymes perfused included trypsin, chymotrypsin, elastase, amylase and lipase. Control (n=6) and experimental animals perfused with pancreatic enzymes only (n=6) or single enzymes (n=3 for each of the five enzyme groups) maintained stable hemodynamics. After mucin disruption using a combination of enteral N-acetylcysteine, atropine, and increased flow rates, rats (n=6) developed mild hypotension (p<0.001 compared to groups perfused with pancreatic enzymes only after 90 minutes) and increased intestinal permeability to intralumenally perfused FITC-dextrans-20kD (p<0.05) compared to control and enzyme-only groups, but there were no deaths. All animals perfused with both digestive enzymes and subjected to mucin disruption (n=6) developed hypotension and increased intestinal permeability (p<0.001 after 90 minutes). Pancreatic enzymes were measured in the intestinal wall of both groups subjected to mucin disruption, but not in the enzyme-only or control groups. Depletion of plasma protease inhibitors was found only in animals perfused with pancreatic enzymes plus mucin disruption, implicating increased permeability and intralumenal pancreatic enzyme egress in this group. These experiments demonstrate that increased bowel permeability via mucin disruption in the presence of pancreatic enzymes can induce shock and increase systemic protease activation in the absence of ischemia, implicating bowel mucin disruption as a key event in early ischemia. Digestive enzymes and their products, if allowed to penetrate the gut wall may trigger multiorgan failure and death.

Kistler, Erik B.; Alsaigh, Tom; Chang, Marisol; Schmid-Schonbein, Geert W.

2012-01-01

343

Letting the sun set on small bowel obstruction: can a simple risk score tell us when nonoperative care is inappropriate?  

PubMed

Controversy remains as to which patients with small bowel obstruction (SBO) need immediate surgery and which may be managed conservatively. This study evaluated the ability of clinical risk factors to predict the failure of nonoperative management of SBO. The electronic medical record was used to identify all patients with SBO over one year. Clinical, laboratory, and imaging data were recorded. Univariate and multivariable analyses were performed to identify risk factors predicting need for surgery. Cox proportional hazards regression was used to identify risk factors that influence need and timing for surgery. Two hundred nineteen consecutive patients were included. Most patients did not have a prior history of SBO (75%), radiation therapy (92%), or cancer (70%). The majority had undergone previous abdominal or pelvic surgery (82%). Thirty-five per cent of patients ultimately underwent laparotomy. Univariate analysis showed that persistent abdominal pain, abdominal distention, nausea and vomiting, guarding, obstipation, elevated white blood cell count, fever present 48 hours after hospitalization, and high-grade obstruction on computed tomography (CT) scan were significant predictors of the need for surgery. Multivariable analysis revealed that persistent abdominal pain or distention (hazard ratio [HR], 3.04; P = 0.013), both persistent abdominal pain and distention (HR, 4.96; P < 0.001), fever at 48 hours (HR, 3.66; P = 0.038), and CT-determined high-grade obstruction (HR, 3.45; P = 0.017) independently predicted the need for surgery. Eighty-five per cent of patients with none of these four significant risk factors were successfully managed nonoperatively. Conversely, 92 per cent of patients with three or more risk factors required laparotomy. This analysis revealed four readily evaluable clinical parameters that may be used to predict the need for surgery in patients presenting with SBO: persistent abdominal pain, abdominal distention, fever at 48 hours, and CT findings of high-grade obstruction. These factors were combined into a predictive model that may of use in predicting failure of nonoperative SBO management. Early operation in these patients should decrease length of stay and diagnostic costs. PMID:24887795

O'Leary, Elizabeth A; Desale, Sameer Y; Yi, William S; Fujita, Kari A; Hynes, Conor F; Chandra, Suma K; Sava, Jack A

2014-06-01

344

Glycyl-glutamine-supplemented long-term total parenteral nutrition selectively improves structure and function in heterotopic small-bowel autotransplantation in the pig.  

PubMed

Marked atrophy and impaired absorptive and barrier function occur in transplanted small intestinal graft during total parenteral nutrition (TPN), TPN is required by all the patients after small bowel transplantation (SBT). Glutamine (Gln) is a conditional indispensable amino acid that is not included in regimens for parenteral nutrition because of its chemical instability in aqueous solution. Glutamine-containing dipeptide, however, is heat-stable. With this study, we determine whether the glycyl-glutamine-supplemented long-term TPN improves mucosal structure and function in heterotopic transplanted small intestinal graft in the pig. Ten outbred pigs, randomly divided into two groups, underwent heterotopic small bowel autotransplantation. In the STPN group, the animals received standard TPN without glycyl-glutamine (Gly-Gln) and in the GTPN group, the animals received isonitrogenous (0.3g kg day(-1)) and isocalories (nonprotein calories, 30 kcal kg day(-1)) TPN with Gly-Gln (3% Gln) for 28 days. At the end of TPN, there was no significant difference in the body weight loss between two groups ( P>0.05). The mucosal contents of Gln and protein were significantly higher in the GTPN group than in the STPN group ( P<0.05). The mucosal disaccharidase activities in the homogenate of the graft mucosa of the GTPN group were significantly higher than that of the STPN group ( P<0.05). The villous height, surface area, mucosal thickness were significantly higher in the GTPN group than in the STPN group ( P<0.05). There was no significant difference in crypt depth between the two groups ( P>0.05). These results suggest that glycyl-glutamine-supplemented long-term TPN improves graft mucosal structure in heterotopic autotransplanted small bowel grafts in the pig. Long-term (4 weeks) TPN supplemented with Gln could alleviate small intestinal graft atrophy, but could not completely eliminate atrophy. PMID:12915960

Li, Yousheng; Li, Jieshou; Jiang, Janwen; Li, Ning; Wang, Xinbao; Wang, Zhiming; Wu, Bo; Liu, Fangnan

2003-12-01

345

IgG4-related sclerosing disease of the small bowel presenting as necrotizing mesenteric arteritis and a solitary jejunal ulcer.  

PubMed

Since first described in the mid 1990s, there has been burgeoning literature on IgG4-related sclerosing disease. The number of sites that may be involved is ever increasing, with the pancreas, salivary glands, and lymph nodes being the most commonly affected organs. There are no well-documented cases arising in the gastrointestinal tract. In this report, we present the first case to our knowledge of IgG4-related sclerosing disease involving the small bowel with a distinctly unusual clinicopathologic presentation. A previously well 46-year-old woman presented with a 2-year history of intermittent abdominal pain with recent worsening due to small bowel obstruction. Following imaging, which showed jejunitis with surrounding mesenteric inflammatory changes, she proceeded to a segmental small bowel resection. The resected jejunum revealed an isolated, stenosing chronic ulcer associated with a necrotizing mesenteric arteritis. A transmural inflammatory infiltrate rich in IgG4 plasma cells was seen in the wall of the bowel and mesenteric artery. Abundant IgG4 interfollicular plasma cells were also identified in a mesenteric lymph node. The serum IgG4 level was elevated at >800 mg/dL (reference range 8 to 140 mg/dL). Although phlebitis is an almost constant feature of this disease, arteritis is not described other than in the lung and aorta. In this report, we also discuss the diagnostic pitfalls and the differential diagnoses that should be considered when this condition arises in the gastrointestinal tract. PMID:22367294

Wong, Daniel D; Pillai, Sooraj R; Kumarasinghe, Marian Priyanthi; McGettigan, Ben; Thin, Lena W Y; Segarajasingam, Dev S; Hollingsworth, Peter N; Spagnolo, Dominic V

2012-06-01

346

First case of isolated small bowel transplantation at the university of cologne: rejection-free course under quadruple immunosuppression and endoluminal monitoring with video-capsule.  

PubMed

Intestinal transplantation is the only curative form of treatment for fulminant short bowel syndrome. Results have been hampered by frequent rejection episodes as well as technical and infectious complications. We report the first case of complete small bowel transplantation performed at our institution. A 37-year-old male patient suffered from massive gut infarction due to a superior mesenteric artery embolus from a thrombus in the descending aorta resulting from hereditary protein S and C deficiency. The primary surgery resulted in a duodenocolostomy requiring total parenteral nutrition. The course was further complicated by multiple central line infections and pre-renal kidney failure induced by dehydration. After 17 months, we performed a cadaveric small bowel transplant using systemic venous drainage. The ileum was anastomosed end-to-end to the recipient ascending colon. The proximal jejunum was used to create a jejunostomy, with an end-to-side duodenojejunostomy. Immunosuppression consisted of a single-administration of antithymocyte globulin (ATG), tacrolimus, mycophenolate mofetil (MMF), and methylprednisolone given enterally from day 1. Biopsies of the upper jejunum showed no signs of rejection. The graft was monitored via capsule video endoscopy after 9 weeks and appeared normal. The patient was discharged on day 35, completely on an enteral diet and gaining weight with a good quality of life. Oral valganciclovir was given for the cytomegalovirus prophylaxis infection (donor-positive, recipient-negative constellation), with no clinical or serologic signs of infection. The early course after small bowel transplantation using a quadruple regimen was clinically successful. The use of video-capsules allows for noninvasive visual monitoring of bowel segments that cannot be reached endoscopically. PMID:15050152

Beckurts, K T E; Stippel, D; Schleimer, K; Schäfer, H; Benz, C; Dienes, H-P; Hölscher, A H

2004-03-01

347

Small bowel feeding and risk of pneumonia in adult critically ill patients: a systematic review and meta-analysis of randomized trials  

PubMed Central

Introduction This systematic review and meta-analysis aimed to evaluate the effect of small bowel feeding compared with gastric feeding on the frequency of pneumonia and other patient-important outcomes in critically ill patients. Methods We searched EMBASE, MEDLINE, clinicaltrials.gov and personal files from 1980 to Dec 2012, and conferences and proceedings from 1993 to Dec 2012 for randomized trials of adult critically ill patients in the intensive care unit (ICU) comparing small bowel feeding to gastric feeding, and evaluating risk of pneumonia, mortality, length of ICU stay, achievement of caloric requirements, duration of mechanical ventilation, vomiting, and aspiration. Independently, in duplicate, we abstracted trial characteristics, outcomes and risk of bias. Results We included 19 trials with 1394 patients. Small bowel feeding compared to gastric feeding was associated with reduced risk of pneumonia (risk ratio [RR] 0.70; 95% CI, 0.55, 0.90; P = 0.004; I2 = 0%) and ventilator-associated pneumonia (RR 0.68; 95% CI 0.53, 0.89; P = 0.005; I2 = 0%), with no difference in mortality (RR 1.08; 95% CI 0.90, 1.29; P = 0.43; I2 = 0%), length of ICU stay (WMD -0.57; 95%CI -1.79, 0.66; P = 0.37; I2 = 0%), duration of mechanical ventilation (WMD -1.01; 95%CI -3.37, 1.35; P = 0.40; I2 = 17%), gastrointestinal bleeding (RR 0.89; 95% CI 0.56, 1.42; P = 0.64; I2 = 0%), aspiration (RR 0.92; 95% CI 0.52, 1.65; P = 0.79; I2 = 0%), and vomiting (RR 0.91; 95% CI 0.53, 1.54; P = 0.72; I2 = 57%). The overall quality of evidence was low for pneumonia outcome. Conclusions Small bowel feeding, in comparison with gastric feeding, reduces the risk of pneumonia in critically ill patients without affecting mortality, length of ICU stay or duration of mechanical ventilation. These observations are limited by variation in pneumonia definition, imprecision, risk of bias and small sample size of individual trials.

2013-01-01

348

High chromosomal instability in adenocarcinoma of the ileum arising from multifocal gastric heterotopia with gastritis cystica profunda.  

PubMed

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

2011-12-01

349

X-ray induced Sm{sup 3+} to Sm{sup 2+} conversion in fluorophosphate and fluoroaluminate glasses for the monitoring of high-doses in microbeam radiation therapy  

SciTech Connect

Fluorophosphate and fluoroaluminate glasses doped with trivalent samarium were evaluated as sensors of x-ray radiation for microbeam radiation therapy at the Canadian Light Source using the conversion of trivalent Sm{sup 3+} to the divalent form Sm{sup 2+}. Both types of glasses show similar conversion rates and may be used as a linear sensor up to {approx}150 Gy and as a nonlinear sensor up to {approx}2400 Gy, where saturation is reached. Experiments with a multi-slit collimator show high spatial resolution of the conversion pattern; the pattern was acquired by a confocal fluorescence microscopy technique. The effects of previous x-ray exposure may be erased by annealing at temperatures exceeding the glass transition temperature T{sub g} while annealing at T{sub A} < T{sub g} enhances the Sm conversion. This enhancement is explained by a thermally stimulated relaxation of host glass ionic matrix surrounding x-ray induced Sm{sup 2+} ions. In addition, some of the Sm{sup 3+}-doped glasses were codoped with Eu{sup 2+}-ions but the results show that there is no marked improvement in the conversion efficiency by the introduction of Eu{sup 2+}.

Vahedi, Shahrzad; Okada, Go; Morrell, Brian; Muzar, Edward; Koughia, Cyril; Kasap, Safa [Department of Electrical and Computer Engineering, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5A9 (Canada); Edgar, Andy; Varoy, Chris [School of Chemical and Physical Sciences and MacDiarmid Institute, Victoria University of Wellington, Kelburn Parade (New Zealand); Belev, George; Wysokinski, Tomasz [Canadian Light Source, Inc., University of Saskatchewan, Saskatoon, Saskatchewan S7N 0X4 (Canada); Chapman, Dean [Department of Anatomy and Cell Biology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5 (Canada)

2012-10-01

350

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)

2008-08-15

351

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

1996-01-01

352

Absent smooth muscle actin immunoreactivity of the small bowel muscularis propria circular layer in association with chromosome 15q11 deletion in megacystis-microcolon-intestinal hypoperistalsis syndrome.  

PubMed

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS; OMIM%249210) is a rare and severe form of congenital intestinal and urinary dysfunction and malformation. Histologic studies suggest that the predominant intestinal manifestation is smooth muscle myopathy. Molecular observations have linked the disease to the neuronal nicotinic acetylcholine receptor (?AChR), namely the absence of a functional ?3 subunit of the ?AChR in patients with MMIHS. We describe a case of MMIHS in association with a de novo deletion of the proximal long arm of chromosome 15 (15q11.2). Histologic evaluation revealed an appropriate light microscopic appearance of both the circular and longitudinal layers of the small bowel muscularis propria. Immunohistochemical staining for smooth muscle actin, however, was selectively absent in the circular layer, demonstrating isolated absence in a unique and previously undescribed pattern. These observations raise the possibility that the proximal long arm of chromosome 15 (15q11) may be of clinical significance in MMIHS. PMID:20028211

Szigeti, Reka; Chumpitazi, Bruno P; Finegold, Milton J; Ranganathan, Sarangarajan; Craigen, William J; Carter, Beth A; Tatevian, Nina

2010-01-01

353

A report of disseminated adenocarcinoma presenting as thrombotic thrombocytopenic purpura  

PubMed Central

Thrombotic microangiopathies (TMAs) represent a heterogeneous group of diseases characterized by a microangiopathic hemolytic anemia, peripheral thrombocytopenia, and organ failure of variable severity. TMAs encompass thrombotic thrombocytopenic purpura (TTP), typically characterized by fever, central nervous system manifestations and hemolytic uremic syndrome (HUS), in which renal failure is the prominent abnormality. In patients with cancer TMAs may be related to various antineoplastic drugs or to the malignant disease itself. The reported series of patients with TMAs directly related to cancer are usually heterogeneous, retrospective, and encompass patients with hematologic malignancies with solid tumors or receiving chemotherapy, each of which may have distinct presentations and pathophysiological mechanisms. Patients with disseminated malignancy who present with microangiopathic hemolytic anemia and thrombocytopenia may be misdiagnosed as thrombotic thrombocytopenic purpura (TTP) Only a few cases of TTP secondary to metastatic adenocarcinoma are known in the literature. We present a case of a 34-year-old man with TTP syndrome secondary to metastatic small-bowel adenocarcinoma. Patients with disseminated malignancy had a longer duration of symptoms, more frequent presence of respiratory symptoms, higher lactate dehydrogenase levels, and more often failed to respond to plasma exchange treatment. A search for systemic malignancy, including a bone marrow biopsy, is appropriate when patients with TTP have atypical clinical features or fail to respond to plasma exchange.

Alonso, Joaquin Valle; Fonseca, Javier; Lopera, Elisa Lopera; Aguayo, Miguel Angel; Montes, Yelda Hernandez; Llamas, Jose Carlos

2011-01-01

354

Crohn's disease of the small bowel, complicated by primary biliary cirrhosis, Hashimoto thyroiditis, and Raynaud's phenomenon: favorable response of all disorders to adalimumab treatment  

PubMed Central

We describe the case of a male patient suffering from long-lasting Crohn's disease of the small bowel who developed thyroiditis Hassimoto, Raynaud's phenomenon, and primary biliary cirrhosis, during the course of the underlying bowel disease. It is not clear whether these co-morbidities appeared coincidentally, or because they share some common immunopathogenetic mechanisms. In this patient, Crohn's disease favorably responded to the treatment with an anti-TNF-? agent (adalimumab). The serum titers of antimitochondrial antibodyies and cholestatic enzymes considerably reduced during the 3-year treatment with the biologic agent. Raynaud's phenomenon, also, completely disappeared. Bearing in mind the possible involvement of TNF-? in the pathogenesis of primary biliary cirrhosis, it could be argued that the clinical and laboratory improvement of liver disease, as well as the reduction in serum titers of antimitochondrial antibodies, might be due to the anti-TNF-? action of adalimumab. We suggest that it would be worth further investigating the role of biologic agents in the treatment of patients with primary biliary cirrhosis.

Durakis, Spyros; Merikas, Emmanuel

2013-01-01

355

Role of small bowel capsule endoscopy in the diagnosis and management of iron deficiency anemia in elderly: A comprehensive review of the current literature  

PubMed Central

Iron deficiency anemia (IDA) is common and often under recognized problem in the elderly. It may be the result of multiple factors including a bleeding lesion in the gastrointestinal tract. Twenty percent of elderly patients with IDA have a negative upper and lower endoscopy and two-thirds of these have a lesion in the small bowel (SB). Capsule endoscopy (CE) provides direct visualization of entire SB mucosa, which was not possible before. It is superior to push enteroscopy, enteroclysis and barium radiography for diagnosing clinically significant SB pathology resulting in IDA. Angioectasia is one of the commonest lesions seen on the CE in elderly with IDA. The diagnostic yield of CE for IDA progressively increases with advancing age, and is highest among patients over 85 years of age. Balloon assisted enteroscopy is used to treat the lesions seen on CE. CE has some limitations mainly lack of therapeutic capability, inability to provide precise location of the lesion and false positive results. Overall CE is a very safe and effective procedure for the evaluation of IDA in elderly.

Muhammad, Adnan; Vidyarthi, Gitanjali; Brady, Patrick

2014-01-01

356

Small bowel obstruction caused by inflammatory cytomegalovirus tumor in a renal transplant recipient: report of a rare case and review of the literature.  

PubMed

Cytomegalovirus (CMV) infection in renal transplant recipients can present as asymptomatic viremia or CMV syndrome or, in more severe cases, as tissue-invasive disease. CMV enteritis, a common manifestation of CMV invasive disease, usually presents with fever, abdominal pain, anorexia, nausea, and diarrhea, and can be rarely complicated by colon perforation, hemorrhage, or megacolon. CMV infection occurs primarily in the first 6 months post transplantation, when immunosuppression is more intense. We describe the case of a female renal transplant recipient with small bowel obstruction caused by CMV disease 7 years post renal transplantation. The patient presented with diarrhea and abdominal pain. Because of elevated CMV viral load, she was initially treated with antiviral therapy with transient response. Endoscopy and imaging tests showed obstruction of the terminal ileum and, subsequently, the patient underwent exploratory laparotomy when a right hemicolectomy was performed. Biopsy results confirmed the diagnosis of CMV enteritis. Epidemiologic characteristics, clinical presentation, diagnostic workup, therapeutic options, and morbidity-mortality rates of CMV infection/disease, in renal transplant recipients, are reviewed. PMID:22931132

Papadimitriou, G; Koukoulaki, M; Vardas, K; Florou, E; Argyrakos, T; Lakiotis, G; Apostolou, T; Drakopoulos, S

2012-10-01

357

[Gerontological features of changes in indicators of lipid peroxidation and antioxidant enzymes in the wall of the small bowel in patients with acute severe peritonitis].  

PubMed

The aim of the work was to study age related changes of lipid peroxidation and antioxidant system in the wall of the small bowel in patients with severe secondary peritonitis. Group I, control (n=42) was consisted of patients from 30 to 89 years. Age of the group II patients (n=36) was from 30 to 59 years, III (n=43) from 60 to 74 years and IV (n=28) from 75 to 89 years. The obtained results of the study showed a significant increase in the concentration of conjugated dienes in the wall of the small intestine, especially in third grade enteric insufficiency as in patients of the second group, which amounted 0,34±0,03 s.u./mg of lipids, and in elderly patients - 0,38±0,03 cu./mg of lipids and senile patients 0,42±0,04 s.u./mg of lipids. On increasing the concentration of the toxic products of lipid peroxidation in the intestinal wall testified a negative accumulation of malondialdehyde from 6,91±0,38 nmol/g protein in patients of the second group, even with second degree enteral insufficiency to 7,49±0,51 nmol/g of protein for elderly patients (fourth group). PMID:23482355

Kerashvili, S; Slonetsky, B; Maksimenko, M; Lobanov, S; Batawil, A

2013-02-01

358

Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome: Report of a case and review of literature  

PubMed Central

Background Blue rubber bleb naevus syndrome (BRBNS), is an uncommon condition characterised by cavernous haemangiomas of skin and gastrointestinal tract. The most common complication of this syndrome is gastrointestinal bleeding. Intussusception of bowel, although a known complication, has rarely been reported. Case presentation We report the case of a 37-year-old man who presented with multiple intussusceptions of small bowel. He required an urgent laparotomy and bowel resections. He suffered from BRBNS. This is the first reported case of multiple synchronous intussusceptions affecting both jejunum and ileum, secondary to haemangiomas occurring in an adult with BRBNS. The underlying conditions of acute abdomen in patients with BRBNS may include intramural haemorrhage, infarction, volvulus or intussusception of bowel. Treatment options include pharmacological manipulation, bowel resection, and interventions such as sclerotherapy, angiographic embolisation, endoscopic ligation, electrocautery and laser photocoagulation for visceral lesions. Conclusion A high index of suspicion is required whilst dealing with acute abdomen in patients with BRBNS. Clinical trials may provide some answers as to the preference of treatment in individual cases, as the current level of evidence does not offer a clear choice of optimal treatment.

Lee, Clement; Debnath, Debasish; Whitburn, Tara; Farrugia, Mark; Gonzalez, Federico

2008-01-01

359

The effect of small bowel transplantation on the morphology and physiology of intestinal muscle: a comparison of autografts versus allografts in dogs.  

PubMed

The effects of acute (AR) and chronic rejection (CR) on intestinal smooth muscle that are responsible for the dysmotility following small bowel transplantation (SBTX) are incompletely understood. Jejunal and ileal specimens from normal control dogs (n=7), and autotransplanted dogs were examined at 7 days (n=6) and 1 (n=7), 3 (n=6), 6 (n=6), and 12 months (n=6). Allotransplanted dogs that developed AR (n=8) and CR (n=5) were examined for gross and microscopic morphology (muscle thickness, the number and size of myocytes, and inflammatory infiltrate), and for contractile and intracellular electrical function in vitro. Auto-SBTX did not alter morphology at any period, but contractile function was impaired at 7 days (73.6%) compared with normal intestine. Acute rejection did not influence myocyte number or size, but was associated with a prominent infiltrate of neutrophils and lymphocytes, and severely impaired contractile function (20.6%) compared with auto-SBTX controls. Acute rejection also significantly inhibited the amplitude of slow waves and of inhibitory junction potentials. Chronic rejection caused thickening of muscularis propria by both hyperplasia (175.5%) and hypertrophy (202.6%) accompanied by moderate inflammatory cell infiltrate compared with auto-SBTX controls. We conclude that the marked inflammatory infiltrate into the muscularis propria indicates that the graft muscle is injured by both acute and chronic rejection; impaired function of intestinal smooth muscle following SBTX results from both rejection and the injury associated with transplantation, and chronic rejection following SBTX is associated with both hyperplasia and hypertrophy of the muscularis propria. PMID:9020316

Sugitani, A; Bauer, A J; Reynolds, J C; Halfter, W M; Nomoto, M; Starzl, T E; Todo, S

1997-01-27

360

Adenocarcinoma following urinary diversion  

PubMed Central

The use of bowel segments in urinary diversions has been associated with an increased risk of neoplasia. This report describes three cases of intestinal adenocarcinoma following urinary diversion. In the first case, a 73-year-old woman developed moderately-differentiated colonic adenocarcinoma in her Indiana pouch 10.5 years after cystectomy. The second case involved a 77-year-old man with well-differentiated adenocarcinoma in his Indiana pouch 9 years after radical cystoprostatectomy and en bloc urethrectomy. The third case involved a 38-year-old man with moderately-differentiated adenocarcinoma arising in his ileal conduit 33 years after the creation of the conduit. These cases highlight the diagnostic signs of adenocarcinoma arising in urinary diversions and emphasize the importance of lifelong surveillance in these patients.

Jian, Peter Yicum; Godoy, Guilherme; Coburn, Michael; Lynch, Garrett; Ro, Jae Y.; Zhai, Qihui "Jim"; Nishino, Michiya; Lerner, Seth P.

2012-01-01

361

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: yangkd@adm.cgmh.org.tw

2007-11-01

362

Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of the World Society of Emergency Surgery  

PubMed Central

Background There is no consensus on diagnosis and management of ASBO. Initial conservative management is usually safe, however proper timing for discontinuing non operative treatment is still controversial. Open surgery or laparoscopy are used without standardized indications. Methods A panel of 13 international experts with interest and background in ASBO and peritoneal diseases, participated in a consensus conference during the 1st International Congress of the World Society of Emergency Surgery and 9th Peritoneum and Surgery Society meeting, in Bologna, July 1-3, 2010, for developing evidence-based recommendations for diagnosis and management of ASBO. Whenever was a lack of high-level evidence, the working group formulated guidelines by obtaining consensus. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT scan signs (free fluid, mesenteric oedema, small bowel faeces sign, devascularized bowel) patients with partial ASBO can be managed safely with NOM and tube decompression (either with long or NG) should be attempted. These patients are good candidates for Water Soluble Contrast Medium (WSCM) with both diagnostic and therapeutic purposes. The appearance of water-soluble contrast in the colon on X-ray within 24 hours from administration predicts resolution. WSCM may be administered either orally or via NGT (50-150 ml) both immediately at admission or after an initial attempt of conservative treatment of 48 hours. The use of WSCM for ASBO is safe and reduces need for surgery, time to resolution and hospital stay. NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution surgery is recommended. Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age <40 years and matted adhesions. WSCM does not affect recurrence rates or recurrences needing surgery when compared to traditional conservative treatment. Open surgery is the preferred method for surgical treatment of strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach can be attempted using open access technique. Access in the left upper quadrant should be safe. Laparoscopic adhesiolysis should be attempted preferably in case of first episode of SBO and/or anticipated single band. A low threshold for open conversion should be maintained. Peritoneal adhesions should be prevented. Hyaluronic acid-carboxycellulose membrane and icodextrin can reduce incidence of adhesions. Icodextrin may reduce the risk of re-obstruction. HA cannot reduce need of surgery.

2011-01-01

363

Management of gastric adenocarcinoma  

Microsoft Academic Search

Gastric adenocarcinoma is the second most common cause of cancer death worldwide. The prognosis for patients with gastric\\u000a adenocarcinoma depends on the stage of the disease at the time of diagnosis and treatment. Early gastric cancer, limited to\\u000a the mucosa and submucosa, is best treated surgically and has a five-year survival rate of 70–95%. Surgical resection remains\\u000a the primary curative

P. Khosravi Shahi; V. M. Díaz Muñoz de la Espada; P. García Alfonso; S. Encina García; Y. Izarzugaza Perón; J. L. Arranz Cozar; B. Hernández Marín; G. Pérez Manga

2007-01-01

364

Pancreatic Ductal Adenocarcinoma  

Cancer.gov

Because pancreatic cancer is often diagnosed at a late stage, surgical removal of the tumor or the organ is often difficult, if not impossible. Pancreatic ductal adenocarcinoma, or PDAC, is by far the most common type of pancreatic malignancy. PDAC is distinct from other cancers due to the biological barrier the tumor builds around itself.

365

Endometrial Adenocarcinoma in Pregnancy  

Microsoft Academic Search

Objective. The coexistence of endometrial adenocarcinoma and pregnancy is rare. Most cases are discovered in the first trimester due to irregular bleeding or spontaneous abortion.Case. A 44-year-old woman, gravida 3, para 2, was admitted due to abnormal vaginal bleeding. After complete history, physical examination, and laboratory evaluation, she was diagnosed with spontaneous abortion and underwent a suction curettage. Pathological examination

A. Ayhan; S. Gunalp; C. Karaer; A. Gokoz; U. Oz

1999-01-01

366

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

2004-01-01

367

Chemoprevention of Esophageal Adenocarcinoma  

PubMed Central

The incidence of esophageal adenocarcinoma (EAC) is rising rapidly in Western countries, and effective chemoprevention for this malignancy is lacking. Endoscopic surveillance of patients with Barrett's esophagus is currently employed to diagnose EAC at earlier stages, but this strategy has several limitations. Non-steroidal anti-inflammatory drugs and proton pump inhibitors are the most promising agents for prevention of EAC, and a randomized controlled trial of aspirin and esomeprazole is ongoing. Other agents under investigation include green tea, berries, and antioxidants. Cost-effectiveness analyses have shown that chemopreventive agents need to be highly effective at preventing EAC in order to have benefit beyond endoscopic surveillance.

2008-01-01

368

Renal Adenocarcinoma in Young Adults  

Microsoft Academic Search

Renal adenocarcinoma is rare in young people. The prognosis of the condition would appear to be better in young people justifying a radical treatment rationale even in cases of advanced disease. This report describes a series of patients under the age of 30 with renal adenocarcinoma and a review of the literature. The possible mechanisms for the apparent improved survival

J. G. Noble; A. M. Parikh; C. R. Chapple; P. H. L. Worth; E. J. G. Milroy

1994-01-01

369

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)

2007-01-19

370

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.

1997-07-01

371

Biological identification of ampullary adenocarcinomas.  

PubMed

Ampullary adenocarcinomas have unique biologic and clinical features that result in its improved prognosis versus adenocarcinomas that arise from the distal bile ducts and pancreas. However the histological differentiation and identification of these tumors is not easily accomplished. Two abstracts at this year's ASCO Annual Meeting describe attempts to identify unique methods for distinguishing these tumors. Abstract #4141 described a 92 gene RT-PCR assay that was used for molecular classification of patients with ampullary adenocarcinomas while Abstract #e15175 looked at mutational status of K-ras in patients with these tumors. The results of their abstracts will be discussed. PMID:25076327

Relias, Valerie; Saif, Muhammad Wasif

2014-01-01

372

Pancreatic adenocarcinoma: epidemiology and genetics.  

PubMed Central

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 pancreatic adenocarcinoma can be a feature of cancer susceptibility syndromes associated with germline mutations in p16, BRCA1, BRCA2, and APC. This highlights the need for a full family history in apparently sporadic cases. Somatic mutations in p16, BRCA2, and APC have also been reported in pancreatic cancer; however, K-RAS mutations appear to be the commonest oncogenic alteration. Recent advances in our understanding of the basis of hereditary cancer syndromes may be applicable to the diagnosis, treatment, and possibly prevention of pancreatic adenocarcinoma in the future.

Flanders, T Y; Foulkes, W D

1996-01-01

373

Extended Resection for Pancreatic Adenocarcinoma  

Microsoft Academic Search

Adenocarcinoma of the pancreas presents a number of therapeutic challenges. Given the poor long-term out- comes after pancreaticoduodenectomy (PD), many sur- geons have sought to improve survival via a radical or \\

SRINEVAS K. REDDY; S. TYLER; N. PAPPAS; RYAN M. CLARY

374

Renal adenocarcinoma in young adults.  

PubMed

Renal adenocarcinoma is rare in young people. The prognosis of the condition would appear to be better in young people justifying a radical treatment rationale even in cases of advanced disease. This report describes a series of patients under the age of 30 with renal adenocarcinoma and a review of the literature. The possible mechanisms for the apparent improved survival of patients in this age group is discussed. PMID:7974885

Noble, J G; Parikh, A M; Chapple, C R; Worth, P H; Milroy, E J

1994-01-01

375

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

2013-01-01

376

Long-term follow-up of patients undergoing capsule and double-balloon enteroscopy for identification and treatment of small-bowel vascular lesions: a prospective, multicenter study.  

PubMed

Background and study aims: Few data are available concerning the long-term outcome of patients treated endoscopically for bleeding small-bowel vascular lesions (SBVL). The aim of this study was to evaluate the risk of rebleeding after endoscopic therapy for SBVLs detected by video capsule enteroscopy (VCE). The secondary aim was to assess risk factors for rebleeding. Patients and methods: A prospective, multicenter study (15 centers) was conducted, involving patients with obscure gastrointestinal bleeding and SBVL on VCE who were treated during double-balloon enteroscopy (DBE). The likelihood of bleeding was defined according to VCE findings, as high or low. Results: A total of 183 patients underwent endotherapy during DBE, and 64 (35?%) had rebleeding during the 1 year follow-up period. Multivariate analysis indicated that cardiac disease (hazard ratio [HR] 2.04, 95?% confidence interval [CI] 1.20?-?3.48; P?

Rahmi, Gabriel; Samaha, Elia; Vahedi, Kouroche; Delvaux, Michel; Gay, Gérard; Lamouliatte, Hervé; Filoche, Bernard; Saurin, Jean-Christophe; Ponchon, Thierry; Rhun, Marc Le; Coumaros, Dimitri; Bichard, Philippe; Manière, Thibault; Lenain, Emilie; Chatellier, Gilles; Cellier, Christophe

2014-07-01

377

Unusual presentation of metastatic adenocarcinoma  

PubMed Central

Background The most common tumours of the adrenal gland are adenoma, pheochromocytoma, adrenocortical carcinoma, and metastases. Although the imaging features of these tumours are established, the imaging characteristics of uncommon adrenal masses are less well known. In patients with extradrenal tumour, incidental discovery of an adrenal mass necessitates excluding the possibility of metastatic malignancy. Case presentation A 52 year-old female was diagnosed with oesophageal adenocarcinoma and treated with oesophagectomy and adjuvant chemotherapy. Sixteen months later on staging CT scan a 2 × 2 cm adrenal mass was detected, which increased in size over a period of time to 3 × 3 cm in size. Adrenalectomy was performed and histological examination revealed metastatic adenocarcinoma within an adrenal adenoma. Conclusion The present case highlights the unusual behaviour of an oesophageal adenocarcinoma causing metastasis to an adrenocortical adenoma.

Bagwan, Izhar N; Cook, Gary; Mudan, Satvinder; Wotherspoon, Andrew

2007-01-01

378

Pathology Case Study: Small Bowel Malabsorption  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a child developed bowel transplantation. Visitors are given the microscopic descriptions, including images, and have the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in pediatric pathology.

Agostini, Rocco; Kapali, Malathy

2008-05-20

379

NOTES: cadaveric rendezvous hybrid small bowel resection  

Microsoft Academic Search

Background  Natural orifice translumenal endoscopic surgery (NOTES) is an emerging field in minimally invasive surgery that is driving\\u000a the development of new technology and techniques [1–4]. Before NOTES gains widespread popularity, it must be proven to be\\u000a a safe and efficacious technique [5]. There are several proposed benefits to the NOTES approach, including potentially decreased\\u000a abdominal pain, wound infections, and hernia

Edward D. Auyang; Khashayar Vaziri; Eric Volckmann; John A. Martin; Nathaniel J. Soper; Eric S. Hungness

2008-01-01

380

Pancreatic adenocarcinoma in guinea fowl  

Microsoft Academic Search

Pancreatic adenocarcinoma is a rare neoplasm of poultry. This condition is hereby described in an adult male guinea fowl that died suddenly in a flock of apparently healthy birds. Necropsy showed severe ascites and nodular tissue growths on the serous membranes of some internal organs and in the parenchyma of the pancreas only. Histopathological sections of the organs had neoplastic

J. O. A. Okoye; C. C. Ilochi

1993-01-01

381

Clubbing associated with oesophageal adenocarcinoma.  

PubMed Central

A patient with an oesophageal adenocarcinoma, recent onset of digital clubbing, and evidence of increased oestrogen synthesis is presented. In the discussion, some of the theories of the pathogenesis of clubbing are reviewed, together with previous reports of clubbing in gastro-oesophageal disorders. A possible unifying theory is proposed for our case which we believe is the first report of this triple association.

Polkey, M. I.; Cook, G. R.; Thomson, A. D.; Taylor, N. F.

1991-01-01

382

Adenocarcinoma in the exstrophic bladder  

Microsoft Academic Search

We report 2 cases of cancerous transformation in an exstrophic bladder. The histology of these tumors, methods of surveillance, and treatment are discussed in conjunction with a review of published reports. These rare tumors are almost entirely adenocarcinomas. Their treatment is surgical (radical cystectomy) with or without associated radiation therapy. Surveillance for patients with bladder exstrophy, whether surgically corrected or

P Paulhac; F Maisonnette; S Bourg; J. P Dumas; P Colombeau

1999-01-01

383

Ovarian Adenocarcinoma of Mesonephric Type.  

National Technical Information Service (NTIS)

Ovarian adenocarcinoma of mesonephric type is a well-differentiated carcinoma composed of clear or hobnail-type cells resembling renal carcinoma. Forty cases were studied. Although there is no proof of origin from mesonephric remnants in or near the ovary...

H. J. Norris M. Robinowitz

1971-01-01

384

Hepatic granulomata associated with adenocarcinoma  

PubMed Central

A case is described in which extensive investigations failed to reveal the cause of hepatic granulomata, except that at post-mortem an adenocarcinoma of the lung was found; an association between the two is therefore suggested. ImagesFig. 1Fig. 2

Rebello, R.; Warnes, T. W.

1983-01-01

385

Adenocarcinoma of the Esophagogastric Junction  

PubMed Central

Objective To assess the outcome of surgical therapy based on a topographic/anatomical classification of adenocarcinoma of the esophagogastric junction. Summary Background Data Because of its borderline location between the stomach and esophagus, the choice of surgical strategy for patients with adenocarcinoma of the esophagogastric junction is controversial. Methods In a large single-center series of 1,002 consecutive patients with adenocarcinoma of the esophagogastric junction, the choice of surgical approach was based on the location of the tumor center or tumor mass. Treatment of choice was esophagectomy for type I tumors (adenocarcinoma of the distal esophagus) and extended gastrectomy for type II tumors (true carcinoma of the cardia) and type III tumors (subcardial gastric cancer infiltrating the distal esophagus). Demographic data, morphologic and histopathologic tumor characteristics, and long-term survival rates were compared among the three tumor types, focusing on the pattern of lymphatic spread, the outcome of surgery, and prognostic factors in patients with type II tumors. Results There were marked differences in sex distribution, associated intestinal metaplasia in the esophagus, tumor grading, tumor growth pattern, and stage distribution between the three tumor types. The postoperative death rate was higher after esophagectomy than extended total gastrectomy. On multivariate analysis, a complete tumor resection (R0 resection) and the lymph node status (pN0) were the dominating independent prognostic factors for the entire patient population and in the three tumor types, irrespective of the surgical approach. In patients with type II tumors, the pattern of lymphatic spread was primarily directed toward the paracardial, lesser curvature, and left gastric artery nodes; esophagectomy offered no survival benefit over extended gastrectomy in these patients. Conclusion The classification of adenocarcinomas of the esophagogastric junction into type I, II, and III tumors shows marked differences between the tumor types and provides a useful tool for selecting the surgical approach. For patients with type II tumors, esophagectomy offers no advantage over extended gastrectomy if a complete tumor resection can be achieved.

Rudiger Siewert, J.; Feith, Marcus; Werner, M.; Stein, Hubert J.

2000-01-01

386

Poorly Differentiated Colorectal Adenocarcinoma (Methodology)  

Microsoft Academic Search

Poorly differentiated adenocarcinoma (PDAC) constitutes ? 2–25% of all colorec-tal carcinomas (CRCs) (Riddle et al., 2003; Ueno et al., 2002). In Japan, the frequency of PDAC among CRCs has been reported to be>5%, whereas it is between 10–25% in Western countries\\u000a (Taniyama et al., 1991). Clinically, PDAC often penetrates deep through the bowel wall and frequ ently metastasizes to the

Seiichi Shinji; Zenya Naito; Toshiyuki Ishiwata; Matsuda Yoko; Tomoko Seya; Takashi Tajiri

387

Nucleolar organiser regions in adenocarcinoma in situ and invasive adenocarcinoma of the cervix  

Microsoft Academic Search

Silver binding nucleolar regions (AgNORs) were evaluated in normal endocervix, adenocarcinoma, and its potential precursor, adenocarcinoma in situ (AIS), in an attempt to increase an understanding of the natural history of cervical adenocarcinoma and to identify a marker for abnormal endocervical (atypical glandular) cells which could aid diagnosis and follow up of endocervical lesions. For every 50 cells the mean

J F Darne; S V Polacarz; E Sheridan; D Anderson; R Ginsberg; F Sharp

1990-01-01

388

Exclusively Endoscopic Resection of Nasopharyngeal Adenocarcinoma  

PubMed Central

We reported two patients with nasopharyngeal adenocarcinoma resected by using the exclusively endoscopic approach. Case reports and a review of the world literature concerning nasopharyngeal adenocarcinoma. The tumors were resected successfully via the exclusively endoscopic approach and no conversions to the conventional approach were necessary. The two patients were followed up for 26 and 18 months respectively, and no recurrence was noted without postoperative chemotherapy or radiotherapy. To the best of our knowledge, this is the first report of endoscopic resection of nasopharyngeal adenocarcinoma. Our experience revealed that not only for the early recurrent nasopharyngeal carcinoma, the exclusively endoscopic nasopharyngectomy can be expanded for the resection of selected nasopharyngeal adenocarcinoma.

Lai, Yu-Shih

2013-01-01

389

Neurological manifestation of colonic adenocarcinoma  

PubMed Central

Paraneoplastic neurologic disorders are extremely rare in cancer patients and are most commonly associated with certain tumors, such as ovarian cancer, small cell lung cancer, and breast cancer. We report here a paraneoplastic neurological syndrome in a 53-year-old man with colonic adenocarcinoma with a solitary liver metastasis. His paraneoplastic syndrome was successfully treated by methylprednisolone and primary oncologic therapies including neoadjuvant chemotherapy and definitive surgery. This is also the first documented case of simultaneous manifestation of a sensory neuropathy and limbic encephalitis with colon cancer.

Sio, Terence T.; Paredes, Mercedes; Uzair, Chaudhary

2012-01-01

390

?-fetoprotein produced by endometrioid adenocarcinoma of uterus  

PubMed Central

?-fetoprotein (AFP) producing adenocarcinoma of endometrium is a rare tumour. It is mostly high grade and has poor prognosis. Lung metastases are common. In this article, the authors present a case of a 57-year-old woman with AFP producing adenocarcinoma of endometrium and history of bilateral metachronous breast cancer, with lung, subcutaneous and brain metastases.

Akhavan, Ali; Karimi Zarchi, Mojgan; Akhavan Tafti, Mahmood; Navabii, Hossein

2012-01-01

391

Lactulose Breath Hydrogen Test for Small Bowel Bacterial Overgrowth and Small Bowel Transit Time.  

National Technical Information Service (NTIS)

The Office of Health Technology Assessment (OHTA) emphasizes three basic principles in its assessment activities: (1) broad and open participation both within and outside of the Federal Government, (2) reliance on the expertise and research abilities of o...

B. Lemperle

1983-01-01

392

[Endocervical adenocarcinoma--a current diagnostic problem].  

PubMed

Adenocarcinomas currently account for 15-20% of all invasive carcinomas of the uterine cervix in developed countries. The tumor is asymptomatic in up to 20% of the cases and is usually discovered as result of abnormal Pap smears. Cytology smears however are relatively ineffective in detecting of the cervical adenocarcinoma and its precursors. Today, more effective methods are being implemented for the obtaining and interpretation of cytology smears such as the "liquid based Pap", the "Thin Prep imaging syst". This is required also due to the paucity of trained cytotechnicians and cytopathologists. The introduction of computer assisted system for screening raises the effectiveness of detecting LSIL and HSIL to 37% and 42% respectively The problem however with the diagnosis of cervical adenocarcinoma remains more complicated even with the introduction of the above mentioned techniques for a number of reasons. For instance, there are some morphological differences which delineate it from the squamous carcinoma. In everyday practice the pathologist is faced with the following more important issues surrounding the histologic diagnosis of the cervical adenocarcinoma: (1) the recognition of preivasive glandular lesions; (2) the distinction of preinvasive from invasive adenocarcinoma; (3) the definition and significance of microinvasive adenocarcinoma; (4) the recognition of benign lesion that may mimic adenocarcinoma; (5) the identification and behavior of the most common types of invasive adenocarcinomas. To successfully carry out these tasks the pathologist needs: a good knowledge of the above mentioned problems and a good command of modern ancillary techniques. This paper discusses also some etiologic and risk factors such as sexual activity, parity, smoking and using of oral contraceptives. Particular attention is focused to HPV infection as etiological and diagnostic problem and to distinction of the preinvasive and microinvasive forms of adenocarcinoma. PMID:21434303

Marinova, P; Rampalova, G; Kolnikova, S; Orthova, S; Ondriasch, F

2010-01-01

393

Mucinous adenocarcinoma of the sublingual gland.  

PubMed

A case of mucinous (colloid) adenocarcinoma of the sublingual gland is reported. Adenocarcinomas associated with large pools of extracellular mucin are extremely rare in the major salivary glands. Analysis of the tumor for cytokeratin expression, estrogen and progesterone receptors was performed. Predominantly, the tumor expressed cytokeratins 7, 8, 18 and 19 that are commonly found in simple epithelia, and to a lesser degree cytokeratins 4 and 13 which are usually found in complex epithelia. Staining for estrogen and progesterone receptors was negative. No other cancer has been detected for three years after the first examination. The tumor is considered to be a primary mucinous adenocarcinoma of the sublingual gland. PMID:9176796

Krogdahl, A S; Schou, C

1997-04-01

394

[Recurrent adenocarcinoma of the uterus].  

PubMed

In a 60-year-old woman because of postmenopausal haemorrhage diagnostic curettage was performed. The histopathologic finding was the adenocarcinoma of the endometrium. The clinical stage was Ib, grade 2 or respectively presumptive stage IV with regard to ultrasound and radiographic findings. After radical hysterectomy and the resection of the sigmoid colon, chemotherapy with cytostatics was applied for 6 months. Three months after chemotherapy the recurrence of the tumour in the vaginal formix and superficial inguinal lymph nodes metastases appeared. Colpectomy with the extirpation of vaginal carcinoma and inguinal lymphadenectomy were performed, followed by irradiation. The course of the disease has shown that when the cancer is located near the point of entry of the uterine tube, the diagnosis and, if needed, therapy should be extended to inguinal regions too. PMID:1875722

Tuskan, E; Lovri?, B; Navratil, I; Tuskan, N

1991-01-01

395

Gastric adenocarcinoma has a unique microRNA signature not present in esophageal adenocarcinoma  

PubMed Central

Background MicroRNAs (miRNAs) play critical roles in tumor development and progression. The fact that a single miRNA can regulate hundreds of genes places miRNAs at critical hubs of signaling pathways. In this study, we investigated the miRNA expression profile in gastric adenocarcinomas and compared it to esophageal adenocarcinomas to better identify a unique miRNA signature of gastric adenocarcinoma. Methods and Results The miRNA expression profile was obtained using Agilent and Exiqon microarray platforms on primary gastric adenocarcinoma tissue samples. The cross comparison of results identified 17 up-regulated and 12 down-regulated miRNAs that overlapped in both platforms. Quantitative real-time RT-PCR was performed for independent validation of a representative set of 8 miRNAs in gastric and esophageal adenocarcinomas as compared to normal gastric mucosa or esophageal mucosa, respectively. The de-regulation of miR-146b-5p, -375, -148a, -31, and -451 was significantly associated with gastric adenocarcinomas. On the other hand, de-regulation of miR-21 (up-regulation) and miR-133b (down-regulation) was detectable in both gastric and esophageal adenocarcinomas. Interestingly, miR-200a was significantly down-regulated in gastric adenocarcinoma (p=0.04) but up-regulated in esophageal adenocarcinoma samples (p=0.001). In addition, the expression level of miR-146b-5p displayed a strong correlation with the tumor staging of gastric cancer. Conclusion Gastric adenocarcinoma displays a unique miRNA signature that distinguishes it from esophageal adenocarcinoma. This specific signature could reflect differences in the etiology and/or molecular signaling in these two closely related cancers. Our findings suggest important miRNA candidates that can be investigated for their molecular functions and possible diagnostic, prognostic, and therapeutic role in gastric adenocarcinoma.

Chen, Zheng; Saad, Rama; Jia, Peilin; Peng, DunFa; Zhu, Shoumin; Washington, M. Kay; Zhao, Zhongming; Xu, Zekuan; El-Rifai, Wael

2013-01-01

396

Catumaxomab for Treatment of Peritoneal Carcinomatosis in Patients With Gastric Adenocarcinomas  

ClinicalTrials.gov

Gastric Adenocarcinoma With Peritoneal Carcinomatosis; Siewert Type II Adenocarcinoma of Esophagogastric Junction With Peritoneal Carcinomatosis; Siewert Type III Adenocarcinoma of Esophagogastric Junction With Peritoneal Carcinomatosis

2014-04-08

397

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

2011-01-01

398

Periampullary Adenocarcinoma: Diagnosis and Survival After Pancreaticoduodenectomy  

Microsoft Academic Search

Periampullary adenocarcinomas arise within 2 cm of the major papilla in the duodenum. They arise from different tissues in\\u000a the periampullary region: the head\\/neck\\/uncinate process of the pancreas, the distal common bile duct, the duodenum, and the\\u000a ampulla of Vater. Pancreatic cancer is the most common periampullary adenocarcinoma, followed by distal bile duct cancers,\\u000a ampullary cancers, and duodenal cancers (Jemal

Kanika A. Bowen; Taylor S. Riall

399

Colonic type adenocarcinoma of male urethra.  

PubMed

A case of rare primary adenocarcinoma of the bulbomembranous portion of the male urethra is presented. The histological and immunohistochemical characteristics of this tumor are identical to those of colon adenocarcinomas. The pathogenesis can be explained either by neoplastic degeneration of globet cells found in the urethral epithelium or by malignant degeneration of persistent glandular elements that are embryonal residues. The patient was successfully treated with transurethral prostatectomy and with a high dose of radiation therapy. PMID:10945163

Baldi, A; Rossiello, R; Di Marino, M; Ferrara, N; Groeger, A M; Esposito, V; Santini, D; Kaiser, H E; Baldi, F

2000-01-01

400

[An atypical presentation of bronchial adenocarcinoma].  

PubMed

Currently, adenocarcinoma represents 41 % of primary lung cancers in women and 34 % in men. Thyroid metastases of lung cancer are rare and usually asymptomatic. We report the case of a patient presenting with stridor secondary to an enlarged multiple nodular thyroid accompanied by cervical lymphadenopathies accompanied by an enlarged and multiple nodular thyroid and by stridor. The final diagnosis was thyroid metastases of primary lung adenocarcinoma. PMID:23951859

Langouo Fontsa, M; Cstoth, I; Berghmans, T; Feoli, F; Meert, A-P

2013-01-01

401

Lung adenocarcinoma and human papillomavirus infection.  

PubMed

Over the past three decades, the incidence of lung adenocarcinoma has increased worldwide. Most individuals with lung adenocarcinoma (especially women) are nonsmokers. Reported risk factors for the development of lung adenocarcinoma include cigarette smoking; exposure to cooking fumes, air pollution, second-hand smoke, asbestos, and radon; nutritional status; genetic susceptibility; immunologic dysfunction; tuberculosis infection; and asthma. Human papillomavirus (HPV) infection is a known risk factor for the development of squamous cell carcinoma (SCC), but it has not been thoroughly assessed as a potential risk factor for the development of pulmonary adenocarcinoma. More than 50% of people are infected with HPV during their lifetimes, either via intrauterine or postnatal infection. Recent studies involving Taiwanese patients have demonstrated a possible association between HPV infection and the risk of developing pulmonary adenocarcinoma. HPV transmission pathways have not yet been conclusively identified. The observation of certain types of HPV in association with cervical and oral SCC raises the possibility of sexual transmission of HPV from the cervix to the oral cavity, with subsequent transmission to the larynx and then to the lung. HPV infection and metaplasia in lung tissue may increase an individual's susceptibility to the tumorigenesis of pulmonary adenocarcinoma. Further epidemiologic and pathologic investigations will be necessary to establish a causal relation. PMID:15368331

Chen, Yen-Ching; Chen, Jen-Hau; Richard, Kradin; Chen, Pao-Yang; Christiani, David C

2004-09-15

402

Recent developments in esophageal adenocarcinoma.  

PubMed

Answer questions and earn CME/CNE Esophageal adenocarcinoma (EAC) is characterized by 6 striking features: increasing incidence, male predominance, lack of preventive measures, opportunities for early detection, demanding surgical therapy and care, and poor prognosis. Reasons for its rapidly increasing incidence include the rising prevalence of gastroesophageal reflux and obesity, combined with the decreasing prevalence of Helicobacter pylori infection. The strong male predominance remains unexplained, but hormonal influence might play an important role. Future prevention might include the treatment of reflux or obesity or chemoprevention with nonsteroidal antiinflammatory drugs or statins, but no evidence-based preventive measures are currently available. Likely future developments include endoscopic screening of better defined high-risk groups for EAC. Individuals with Barrett esophagus might benefit from surveillance, at least those with dysplasia, but screening and surveillance strategies need careful evaluation to be feasible and cost-effective. The surgery for EAC is more extensive than virtually any other standard procedure, and postoperative survival, health-related quality of life, and nutrition need to be improved (eg, by improved treatment, better decision-making, and more individually tailored follow-up). Promising clinical developments include increased survival after preoperative chemoradiotherapy, the potentially reduced impact on health-related quality of life after minimally invasive surgery, and the new endoscopic therapies for dysplastic Barrett esophagus or early EAC. The overall survival rates are improving slightly, but poor prognosis remains a challenge. PMID:23818335

Lagergren, Jesper; Lagergren, Pernilla

2013-01-01

403

Mimics of pancreatic ductal adenocarcinoma.  

PubMed

Several uncommon primary pancreatic tumors, inflammatory conditions, metastasis to the pancreas and peripancreatic masses can mimic the appearance of pancreatic ductal adenocarcinoma (PDA). Differentiation between these lesions and PDA can be challenging, due to the overlap in imaging features; however, familiarity with their typical imaging features and clinical presentation may be helpful in their differentiation, as in some cases, invasive diagnostic tests or unnecessary surgery can be avoided. The different pathologies that can mimic PDA include inflammatory conditions such as the various forms of pancreatitis (chronic-focal mass-forming, autoimmune and groove pancreatitis), pancreatic neuroendocrine tumors, solid pseudopapillary tumors, metastasis (solid non-lymphomatous and hematologic), congenital variants (annular pancreas), as well as peripancreatic lesions (accessory spleen, adrenal masses, duodenal masses, lymph nodes and vascular lesions), and certain rare pancreatic tumors (e.g., acinar cell tumors, solid serous tumors, hamartoma and solitary fibrous tumors). The clinical presentation and imaging features of the most commonly encountered mimics of PDA are discussed in this presentation with representative illustrations. PMID:24060833

Al-Hawary, Mahmoud M; Kaza, Ravi K; Azar, Shadi F; Ruma, Julie A; Francis, Isaac R

2013-01-01

404

Gastric cardia adenocarcinoma pathway analysis  

PubMed Central

Gastric cardia adenocarcinoma (GCA)is one of the few malignancies with unexplained reasons that have increased sharply in developed countries. The purpose of this review was to determine the pathways in GCA to identify new biomarker. So by comparing gene expression in GCA group with normal control identified important pathways. Gene expression data were extracted from the beforehand investigations then differentially expressed genes utilized in DAVID program to explorer and find related pathways. Our findings contain 367 gene names. Out of these 367 proteins, 199 were found to be exclusively expressed in GCA; whereas 168 proteins were detected down-regulated or silenced. The GCA associated diseases based on the differently expressed genes made up of diseases pathway related colorectal cancer, small cell lung cancer, breast cancer and H. pylori infection stomach cancer. KEGG pathways related to GCA contained cell cycle, p53 signaling pathway, DNA replication, toll-like receptor signaling pathway and some other diseases. The GO-discovered categories also demonstrated most biological process and molecular function related to cancer. Up until now, there is no report to introduce influential biomarkers in GCA so, the deregulated genes identified in GCA patterns might be helpful for diagnosis, prognosis and therapies for gastric cancer but validation of these biomarkers is necessary.

Zali, Hakimeh; Vafaee, Reza; Rezaei-Tavirani, Majid

2013-01-01

405

Irinotecan, Cisplatin, and Bevacizumab in Treating Patients With Unresectable or Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma  

ClinicalTrials.gov

Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Recurrent Gastric Cancer; Stage IIIA Gastric Cancer; Stage IIIB Gastric Cancer; Stage IIIC Gastric Cancer; Stage IV Gastric Cancer

2013-06-03

406

Chromatin patterns associated with lung adenocarcinoma progression  

PubMed Central

The development and progression of lung adenocarcinoma, one of the most common cancers, is driven by the interplay of genetic and epigenetic changes and the role of chromatin structure in malignant transformation remains poorly understood. We used systematic nucleosome distribution and chromatin accessibility microarray mapping platforms to analyze the genome-wide chromatin structure from normal tissues and from primary lung adenocarcinoma of different grades and stages. We identified chromatin-based patterns across different patients with lung adenocarcinoma of different cancer grade and stage. Low-grade cancers had nucleosome distributions very different compared with the corresponding normal tissue but had nearly identical chromatin accessibility. Conversely, nucleosome distributions of high-grade cancers showed few differences. Substantial disruptions in chromosomal accessibility were seen in a patient with a high-grade and high-stage tumor. These data imply that chromatin structure changes during the progression of lung adenocarcinoma. We have therefore developed a model in which low-grade lung adenocarcinomas are linked to changes in nucleosome distributions, whereas higher-grade tumors are linked to large-scale chromosomal changes. These results provide a foundation for the development of a comprehensive framework linking the general and locus-specific roles of chromatin structure to lung cancer progression. We propose that this strategy has the potential to identify a new class of chromatin-based diagnostic, prognostic and therapeutic markers in cancer progression.

Druliner, Brooke R.; Fincher, Justin A.; Sexton, Brittany S.; Vera, Daniel L.; Roche, Michael; Lyle, Stephen; Dennis, Jonathan H.

2013-01-01

407