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Sample records for x-ray-induced small-bowel adenocarcinoma

  1. Small Bowel Adenocarcinoma.

    PubMed

    Aparicio, Thomas; Zaanan, Aziz; Mary, Florence; Afchain, Pauline; Manfredi, Sylvain; Evans, Thomas Ronald Jeffry

    2016-09-01

    Small bowel adenocarcinomas (SBAs) are rare tumors, but their incidence is increasing. The most common primary location is the duodenum. Even though SBAs are more often sporadic, some diseases are risk factors. Early diagnosis of small bowel adenocarcinoma remains difficult, despite significant radiologic and endoscopic progress. After R0 surgical resection, the main prognostic factor is lymph node invasion. An international randomized trial (BALLAD [Benefit of Adjuvant Chemotherapy For Small Bowel Adenocarcinoma] study) will evaluate the benefit of adjuvant chemotherapy. For metastatic disease, retrospectives studies suggest that platinum-based chemotherapy is the most effective treatment. Phase II studies are ongoing to evaluate targeted therapy in metastatic SBA.

  2. Crohn enteritis-associated small bowel adenocarcinomas exhibit gastric differentiation.

    PubMed

    Whitcomb, Emma; Liu, Xiuli; Xiao, Shu-Yuan

    2014-02-01

    Primary small bowel adenocarcinoma is rare. Although generally similar to colonic adenocarcinoma, some small bowel adenocarcinomas exhibit unique morphologic features, particularly those arising in association with Crohn disease. In this study, 15 sporadic small bowel adenocarcinomas and 11 Crohn enteritis-associated small bowel adenocarcinomas were examined for histology and immunohistochemical profile including cytokeratins (CK) 7 and 20, intestinal markers CDX2 and MUC2, and gastric epithelial markers MUC5AC and MUC6. We found that Crohn enteritis-associated small bowel adenocarcinomas frequently resemble gastric tubular adenocarcinoma histologically. In addition, when compared to sporadic small bowel adenocarcinoma, the former expressed MUC5AC and MUC6 with much higher frequency (82% vs. 7% and 73% vs. 0%, respectively). Ten of 11 Crohn enteritis-associated small bowel adenocarcinomas (91%) were positive for at least one gastric-type marker (MUC5AC or MUC6). Expression of CK7 was also more frequent in Crohn enteritis-associated small bowel adenocarcinoma (73% versus 27%) while expression of CK20 was less frequent (64% vs. 100%). There was no difference between sporadic and Crohn enteritis-associated small bowel adenocarcinoma in expression of CDX2 (100% vs. 91%) and MUC2 (93% vs. 73%). These observations suggest that there is a difference in the morphologic and immunohistochemical characteristics of sporadic versus Crohn enteritis-associated small bowel adenocarcinoma, particularly in their expression of gastric-type mucin. The findings also suggest that gastric differentiation in Crohn enteritis-associated small bowel adenocarcinoma is related to gastric metaplasia, a common phenomenon in Crohn disease.

  3. Small bowel adenocarcinomas--existing evidence and evolving paradigms.

    PubMed

    Raghav, Kanwal; Overman, Michael J

    2013-09-01

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

  4. Small bowel adenocarcinoma in Lynch syndrome: A case report

    PubMed Central

    Sun, Ke-Kang; Liu, Gang; Shen, Xiaojun; Wu, Xiaoyang

    2016-01-01

    Small bowel adenocarcinoma is part of the tumor spectrum of Lynch syndrome, which is caused by germline mutations in the mismatch repair genes. The present study describes the case of a 51-year-old man fulfilling the Amsterdam II criteria for Lynch syndrome, who had a 15-mm early-stage colorectal cancer resected endoscopically from the ascending colon. Due to upper abdominal discomfort after eating and consequent anorexia, a computed tomography scan performed 1 month later showed a tumoral mass of the upper jejunum with local lymphadenopathy. The laparotomy revealed a completely obstructing mass. Intraoperative frozen section showed a small bowel adenocarcinoma. Subsequent genetic testing confirmed the germline mutation of mutL homolog 1. The patient received 6 cycles of an adjuvant folinic acid, fluorouracil and ocaliplatin chemotherapy regimen. The latest CT scan, 16 months after the chemotherapy, did not show any recurrence. This case highlights the importance of considering the possibility of small bowel adenocarcinoma in patients with upper bowel obstruction, particularly for patients with Lynch syndrome. PMID:27446478

  5. Small bowel adenocarcinoma phenotyping, a clinicobiological prognostic study

    PubMed Central

    Aparicio, T; Svrcek, M; Zaanan, A; Beohou, E; Laforest, A; Afchain, P; Mitry, Emmanuel; Taieb, J; Di Fiore, F; Gornet, J-M; Thirot-Bidault, A; Sobhani, I; Malka, D; Lecomte, T; Locher, C; Bonnetain, F; Laurent-Puig, P

    2013-01-01

    Background: Small bowel adenocarcinoma (SBA) is a rare tumour with a poor prognosis. Molecular biology data on SBA carcinogenesis are lacking. Methods: Expression of HER2, β-catenin, p53 and mismatch repair (MMR) protein was assessed by immunohistochemistry. KRAS, V600E BRAF mutations and microsatellite instability were investigated. Results: We obtained samples from 63 SBA patients (tumour stages: I–II: 30% III: 35% IV: 32% locally advanced: 3%). HER2 overexpression (3+) was observed in 2 out of 62 patients, overexpression of p53 in 26 out of 62, abnormal expression of β-catenin in 12 out of 61, KRAS mutation in 21 out of 49, BRAF V600E mutation in 1 out of 40 patients, MMR deficiency (dMMR) in 14 out of 61 and was consistent with Lynch syndrome in 9 out of 14 patients. All of the dMMR tumours were in the duodenum or jejunum and only one was stage IV. Median overall survival (OS) was 36.6 months (95% CI, 26.9–72.2). For all patients, in univariate analysis, stages I–II (P<0.001), WHO PS 0–1 (P=0.01) and dMMR phenotype (P=0.02) were significantly associated with longer OS. In multivariate analysis, disease stage (P=0.01) and WHO PS 0–1 (P=0.001) independently predicted longer OS. For stage IV patients, median OS was 20.5 months (95% CI: 14.6; 36.6 months). In multivariate analysis, WHO PS 0–1 (P=0.0001) and mutated KRAS status (P=0.02) independently predicted longer OS. Conclusion: This large study suggests that molecular alterations in SBA are closer to those in colorectal cancer (CRC) than those in gastric cancer, with low levels of HER 2 overexpression and high frequencies of KRAS mutations. The seemingly higher frequency of dMMR than in CRC may be explained by the higher frequency of Lynch syndrome in SBA patients. A dMMR phenotype was significantly associated with a non-metastatic tumour (P=0.02). A trend for a good prognosis and a duodenum or jejunum primary site was associated with dMMR. PMID:24196786

  6. Small bowel adenocarcinoma and Crohn's disease: any further ahead than 50 years ago?

    PubMed

    Cahill, Caitlin; Gordon, Philip H; Petrucci, Andrea; Boutros, Marylise

    2014-09-07

    This review of the literature on small bowel carcinoma associated with Crohn's disease specifically addresses the incidence, risk factors, and protective factors which have been identified. It also reviews the clinical presentation, the current modalities of diagnosis, the pathology, treatment, and surveillance. Finally, the prognosis and future direction are addressed. Our experience with small bowel adenocarcinoma in Crohn's disease is reported. Readers will be provided with a better understanding of this rare and often poorly recognized complication of Crohn's disease.

  7. Concurrent small bowel adenocarcinoma and carcinoid tumor in Crohn's disease--case report and literature review.

    PubMed

    Boltin, Doron; Levi, Zohar; Halpern, Marisa; Fraser, Gerald M

    2011-10-01

    Adenocarcinomas of the large and small bowel, as well as intestinal carcinoid tumors have been reported at increased rates in Crohn's disease. We herein report a rare case of concurrent adenocarcinoma and carcinoid tumor of the small bowel presenting as intestinal obstruction and found incidentally at laparotomy in a 55 year old male with longstanding ileal Crohn's disease. We performed a Medline Pubmed search for cases of synchronous or composite adenocarcinoma and carcinoid tumor in the setting of Crohn's disease and identified four similar cases. Concurrent adenocarcinoma and carcinoid tumor occurred both in newly diagnosed and longstanding Crohn's disease, most commonly involved the terminal ileum and presented with symptoms mimicking Crohn's disease. Diagnosis was made incidentally at laparotomy in all cases. Lymph node involvement was variable. Clinicians should be aware of this rare entity for expeditious surgical intervention.

  8. Comprehensive molecular pathology analysis of small bowel adenocarcinoma reveals novel targets with potential for clinical utility

    PubMed Central

    Kelly, Paul; Fuchs, Marc-Aurel; Alderdice, Matthew; McCabe, Clare M.; Bingham, Victoria; McGready, Claire; Tripathi, Shailesh; Emmert-Streib, Frank; Loughrey, Maurice B.; McQuaid, Stephen; Maxwell, Perry; Hamilton, Peter W.; Turkington, Richard; James, Jacqueline A.; Wilson, Richard H.; Salto-Tellez, Manuel

    2015-01-01

    Small bowel accounts for only 0.5% of cancer cases in the US but incidence rates have been rising at 2.4% per year over the past decade. One-third of these are adenocarcinomas but little is known about their molecular pathology and no molecular markers are available for clinical use. Using a retrospective 28 patient matched normal-tumor cohort, next-generation sequencing, gene expression arrays and CpG methylation arrays were used for molecular profiling. Next-generation sequencing identified novel mutations in IDH1, CDH1, KIT, FGFR2, FLT3, NPM1, PTEN, MET, AKT1, RET, NOTCH1 and ERBB4. Array data revealed 17% of CpGs and 5% of RNA transcripts assayed to be differentially methylated and expressed respectively (p < 0.01). Merging gene expression and DNA methylation data revealed CHN2 as consistently hypermethylated and downregulated in this disease (Spearman −0.71, p < 0.001). Mutations in TP53 which were found in more than half of the cohort (15/28) and Kazald1 hypomethylation were both were indicative of poor survival (p = 0.03, HR = 3.2 and p = 0.01, HR = 4.9 respectively). By integrating high-throughput mutational, gene expression and DNA methylation data, this study reveals for the first time the distinct molecular profile of small bowel adenocarcinoma and highlights potential clinically exploitable markers. PMID:26315110

  9. Comprehensive molecular pathology analysis of small bowel adenocarcinoma reveals novel targets with potential for clinical utility.

    PubMed

    Alvi, Muhammad A; McArt, Darragh G; Kelly, Paul; Fuchs, Marc-Aurel; Alderdice, Matthew; McCabe, Clare M; Bingham, Victoria; McGready, Claire; Tripathi, Shailesh; Emmert-Streib, Frank; Loughrey, Maurice B; McQuaid, Stephen; Maxwell, Perry; Hamilton, Peter W; Turkington, Richard; James, Jacqueline A; Wilson, Richard H; Salto-Tellez, Manuel

    2015-08-28

    Small bowel accounts for only 0.5% of cancer cases in the US but incidence rates have been rising at 2.4% per year over the past decade. One-third of these are adenocarcinomas but little is known about their molecular pathology and no molecular markers are available for clinical use. Using a retrospective 28 patient matched normal-tumor cohort, next-generation sequencing, gene expression arrays and CpG methylation arrays were used for molecular profiling. Next-generation sequencing identified novel mutations in IDH1, CDH1, KIT, FGFR2, FLT3, NPM1, PTEN, MET, AKT1, RET, NOTCH1 and ERBB4. Array data revealed 17% of CpGs and 5% of RNA transcripts assayed to be differentially methylated and expressed respectively (p < 0.01). Merging gene expression and DNA methylation data revealed CHN2 as consistently hypermethylated and downregulated in this disease (Spearman -0.71, p < 0.001). Mutations in TP53 which were found in more than half of the cohort (15/28) and Kazald1 hypomethylation were both were indicative of poor survival (p = 0.03, HR = 3.2 and p = 0.01, HR = 4.9 respectively). By integrating high-throughput mutational, gene expression and DNA methylation data, this study reveals for the first time the distinct molecular profile of small bowel adenocarcinoma and highlights potential clinically exploitable markers.

  10. A Retrospective Review of Chemotherapy for Patients with Small Bowel Adenocarcinoma in British Columbia

    PubMed Central

    Duerr, Donat; Ellard, Susan; Zhai, Yongliang; Taylor, Marianne; Rao, Sanjay

    2016-01-01

    Background: Small bowel adenocarcinoma (SBA) is associated with a poor prognosis. It is an uncommon malignancy and therefore difficult to study. Randomized phase III trials are not available to guide best approaches. The Provincial Cancer Registry of the British Columbia Cancer Agency contains long-term data on patients with SBA. The authors analyzed characteristics and treatment outcomes for SBA patients diagnosed between 1990 and 2008. Material and methods: Charts of 150 patients with a histological diagnosis of SBA were retrospectively analyzed. Epidemiological and treatment data were collected. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Results: Baseline characteristics, such as median age at diagnosis (64.5 years), tumor stage (I-II 33%, III-IV 58%, unknown 9%), and location (duodenum 48%, jejunum 31%, ileum 21%) were consistent with published data. 55% of patients had a positive family history of cancer. DFS and OS of 29 patients treated with adjuvant chemotherapy were not significantly different to that of 47 patients without (p = 1 and p = 0.211, respectively). In the palliative setting patients treated with polychemotherapy (21 patients) had statistically better OS than patients treated with monochemotherapy (12 patients) (p = 0.0228). Conclusions: Our study suggests a survival benefit for advanced-stage SBA patients treated with poly- versus monochemotherapy. This, however, was a retrospective analysis with several potential confounders. Nevertheless, our study adds to the evidence suggesting that chemotherapy may be beneficial for patients with SBA, at least in the palliative setting. PMID:27994666

  11. Small bowel resection - discharge

    MedlinePlus

    ... chap 26. Read More Colon cancer Crohn disease Intestinal obstruction Small bowel resection Patient Instructions Bland diet Crohn ... Editorial team. Related MedlinePlus Health Topics Intestinal Cancer Intestinal Obstruction Small Intestine Disorders Browse the Encyclopedia A.D. ...

  12. X-ray-induced water vaporization

    SciTech Connect

    Weon, B. M.; Lee, J. S.; Je, J. H.; Fezzaa, K.

    2011-09-15

    We present quantitative evidence for x-ray-induced water vaporization: water is vaporized at a rate of 5.5 pL/s with the 1-A-wavelength x-ray irradiation of {approx}0.1 photons per A{sup 2}; moreover, water vapor is reversibly condensed during pauses in irradiation. This result fundamentally suggests that photoionization induces vaporization. This phenomenon is attributed to surface-tension reduction by ionization and would be universally important in radiological and electrohydrodynamic situations.

  13. Small Bowel Transplant

    PubMed Central

    2003-01-01

    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

  14. X-ray induced photoacoustic tomography

    NASA Astrophysics Data System (ADS)

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

    2013-03-01

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

  15. Small Bowel Hamartoma: A Huge Diverticulum of Small Bowel

    PubMed Central

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

    2013-01-01

    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. PMID:24454405

  16. Small bowel obstruction- a surprise.

    PubMed

    Mathew, Jeffrey Daniel; Cp, Ganesh Babu; M, Balachandar; M, Ramanathan

    2015-01-01

    Trans - omental hernia is very rare, accounting to 1-4% of all internal hernias which is an unusual cause of small bowel obstruction. Here we present a case report of a small bowel obstruction in a female due to trans - omental hernia presenting with central abdominal pain, distension and bilious vomiting. She had no previous history of trauma, surgery. Plain X-ray abdomen erect showed multiple air fluid levels with dilated small bowel loops. Emergency laparotomy revealed a segment of congested small bowel loop (ileum) through a defect in greater omentum. On table the herniated bowel loop was reduced and the defect in greater omentum was closed primarily. There was no necessity for bowel resection as it regained normal colour after reduction. Postoperative period was uneventful with complete resolution of symptoms. This case is presented for its rarity and its importance in clinical differential diagnosis of acute abdomen due to small bowel obstruction.

  17. Primary malignant tumors of the small bowel.

    PubMed

    Mittal, V K; Bodzin, J H

    1980-09-01

    Primary malignant tumors of the small bowel are uncommon and are often diagnosed at an advanced stage. A 10 year survey (1967 to 1977) of the clinical records at one hospital revealed 39 cases of primary malignant tumors of the small bowel. The most common symptoms were abdominal pain (89.7 percent) and weight loss (77 percent). Six patients presented with complications of enterovesical fistula, bleeding and perforation. Preoperative diagnosis was suspected in 27 cases (69.2 percent). Adenocarcinoma was the most common tumor, followed by carcinoid tumor, lymphoma, leiomyosarcoma and melanoma. The treatment of choice was surgical resection whenever possible. Curative resection was attempted in 25 cases. Adjuvant radiotherapy and chemotherapy was used in four patients with lymphoma. Twenty-seven patients (69.2 percent) are alive from 1 to 6 years after diagnosis and treatment. The 5 year survival rate is 35 percent. Earlier diagnosis is essential if the prognosis for patients with small bowel malignancy is to be improved.

  18. Small bowel and colon perforation.

    PubMed

    Brown, Carlos V R

    2014-04-01

    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.

  19. Severe adhesive small bowel obstruction.

    PubMed

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

    2012-12-01

    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.

  20. Most small bowel cancers are revealed by a complication

    PubMed Central

    Negoi, Ionut; Paun, Sorin; Hostiuc, Sorin; Stoica, Bodgan; Tanase, Ioan; Negoi, Ruxandra Irina; Beuran, Mircea

    2015-01-01

    ABSTRACT Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. Methods A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. Results There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of the small bowel, and the prevalence of duodenal stromal tumors was 1.818 time greater than that of the small bowel. Obstruction was the complication in adenocarcinoma in 57.9% of cases, and perforation was the major local complication (47.8%) in stromal tumors. Conclusion Primary small bowel cancers are usually diagnosed at advanced stages, and revealed by a local complication of the tumor. Their surgical management in emergency setting is associated to significant morbidity and mortality rates. PMID:26676271

  1. High Resolution X-ray-Induced Acoustic Tomography

    PubMed Central

    Xiang, Liangzhong; Tang, Shanshan; Ahmad, Moiz; Xing, Lei

    2016-01-01

    Absorption based CT imaging has been an invaluable tool in medical diagnosis, biology, and materials science. However, CT requires a large set of projection data and high radiation dose to achieve superior image quality. In this letter, we report a new imaging modality, X-ray Induced Acoustic Tomography (XACT), which takes advantages of high sensitivity to X-ray absorption and high ultrasonic resolution in a single modality. A single projection X-ray exposure is sufficient to generate acoustic signals in 3D space because the X-ray generated acoustic waves are of a spherical nature and propagate in all directions from their point of generation. We demonstrate the successful reconstruction of gold fiducial markers with a spatial resolution of about 350 μm. XACT reveals a new imaging mechanism and provides uncharted opportunities for structural determination with X-ray. PMID:27189746

  2. X-ray induced photoconductivity in Vanadium Dioxide samples

    NASA Astrophysics Data System (ADS)

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

    2011-03-01

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

  3. High Resolution X-ray-Induced Acoustic Tomography.

    PubMed

    Xiang, Liangzhong; Tang, Shanshan; Ahmad, Moiz; Xing, Lei

    2016-05-18

    Absorption based CT imaging has been an invaluable tool in medical diagnosis, biology, and materials science. However, CT requires a large set of projection data and high radiation dose to achieve superior image quality. In this letter, we report a new imaging modality, X-ray Induced Acoustic Tomography (XACT), which takes advantages of high sensitivity to X-ray absorption and high ultrasonic resolution in a single modality. A single projection X-ray exposure is sufficient to generate acoustic signals in 3D space because the X-ray generated acoustic waves are of a spherical nature and propagate in all directions from their point of generation. We demonstrate the successful reconstruction of gold fiducial markers with a spatial resolution of about 350 μm. XACT reveals a new imaging mechanism and provides uncharted opportunities for structural determination with X-ray.

  4. High Resolution X-ray-Induced Acoustic Tomography

    NASA Astrophysics Data System (ADS)

    Xiang, Liangzhong; Tang, Shanshan; Ahmad, Moiz; Xing, Lei

    2016-05-01

    Absorption based CT imaging has been an invaluable tool in medical diagnosis, biology, and materials science. However, CT requires a large set of projection data and high radiation dose to achieve superior image quality. In this letter, we report a new imaging modality, X-ray Induced Acoustic Tomography (XACT), which takes advantages of high sensitivity to X-ray absorption and high ultrasonic resolution in a single modality. A single projection X-ray exposure is sufficient to generate acoustic signals in 3D space because the X-ray generated acoustic waves are of a spherical nature and propagate in all directions from their point of generation. We demonstrate the successful reconstruction of gold fiducial markers with a spatial resolution of about 350 μm. XACT reveals a new imaging mechanism and provides uncharted opportunities for structural determination with X-ray.

  5. Gastric bezoar with small bowel obstruction

    PubMed Central

    Urgancı, Ayvaz Ulaş; Akıncılar, Ebru

    2016-01-01

    In the operation performed on a patient with a history of abdominal surgery, a gastric bezoar and a small bowel bezoar were detected. Adhesive bowel obstruction was suspected; however, the patient was diagnosed with mechanical intestinal obstruction. Small bowel bezoar has resulted in intestinal obstruction. This case was discussed in accordance with the literature. PMID:28149129

  6. Studies in useful hard x-ray induced chemistry

    NASA Astrophysics Data System (ADS)

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

    2013-06-01

    The observed rapid decomposition of potassium chlorate (via 2KClO3 + h ν --> 2KCl +3O2) via synchrotron hard x-ray irradiation (>10 keV) has enabled experiments that are developing novel and useful hard x-ray chemistry. We have observed a number of radiation-induced in situ decomposition reactions in various substances which release O2, H2, N2, NH3, and H2O in a diamond anvil cell (DAC) at ambient and high pressures. These novel acatalytic and isothermal reactions represent a highly controllable, penetrating, and focused method to initiate chemistry (including x-ray induced combustion) in sealed and/or isolated chambers which maintain matter under extreme conditions. During our studies, we have typically observed a slowing of decomposition with pressure including phase dependent decomposition of KClO3. Energy dependent studies have observed an apparent resonance near 15 keV at which the decomposition rate is maximized. This may enable use of much lower flux and portable x-ray sources (e.g. x-ray tubes) in larger scale experiments. These developments support novel means to load DACs and control chemical reactions providing novel routes of synthesis of novel materials under extreme conditions.

  7. X-ray-induced cell death: Apoptosis and necrosis

    SciTech Connect

    Nakano, Hisako; Shinohara, Kunio

    1994-10-01

    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.

  8. Abdominal CT findings in small bowel perforation.

    PubMed

    Zissin, R; Osadchy, A; Gayer, G

    2009-02-01

    Small bowel perforation is an emergent medical condition for which the diagnosis is usually not made clinically but by CT, a common imaging modality used for the diagnosis of acute abdomen. Direct CT features that suggest perforation include extraluminal air and oral contrast, which are often associated with secondary CT signs of bowel pathology. This pictorial review illustrates the CT findings of small bowel perforation caused by various clinical entities.

  9. MR imaging of the small bowel.

    PubMed

    Masselli, Gabriele; Gualdi, Gianfranco

    2012-08-01

    Small-bowel radiology has undergone dramatic changes in the past 2 decades. Despite important recent advances in small-bowel endoscopy, radiologic imaging remains important for patients suspected of having or with established small-bowel disease. Cross-sectional imaging techniques (computed tomography and magnetic resonance [MR] imaging), used to investigate both extraluminal abnormalities and intraluminal changes, have gradually replaced barium contrast examinations, which are, however, still used to examine early mucosal disease. MR imaging techniques clearly highlight endoluminal, mural and extramural enteric details and provide vascular and functional information, thereby enhancing the diagnostic value of these techniques in small-bowel diseases. Two MR imaging based techniques are currently utilized: MR enteroclysis and MR enterography. In enteroclysis, enteric contrast material is administered through a nasoenteric tube, whereas in enterography, large volumes of enteric contrast material are administered orally. MR enteroclysis ensures consistently better luminal distention than does MR enterography in both the jejunum and the ileum and more accurately depicts endoluminal abnormalities and early disease, particularly at the level of the jejunal loops. Moreover, MR enteroclysis provides a high level of accuracy in the diagnosis and exclusion of small-bowel inflammatory and neoplastic diseases and can be used for the first radiologic evaluation, while MR enterography may effectively be used to follow up both Crohn disease patients without jejunal disease and in pediatric patients where nasogastric intubation might be a problem. MR enteroclysis may also reveal subtle transition points or an obstruction in the lower small bowel, which may escape detection when more routine methods, including enterography, are used. MR imaging offers detailed morphologic information and functional data of small-bowel diseases and provides reliable evidence of normalcy, thereby

  10. A room-temperature X-ray-induced photochromic material for X-ray detection.

    PubMed

    Wang, Ming-Sheng; Yang, Chen; Wang, Guan-E; Xu, Gang; Lv, Xiang-Ying; Xu, Zhong-Ning; Lin, Rong-Guang; Cai, Li-Zhen; Guo, Guo-Cong

    2012-04-02

    A color change: X-ray-induced photochromic species are rare and can be used for detection of X-rays. A highly robust X-ray-sensitive material with the discrete structure of a metal-organic complex has been found to show both soft and hard X-ray-induced photochromism at room temperature. A new ligand-to-ligand electron-transfer mechanism was proposed to elucidate this photochromic phenomenon.

  11. Small bowel imaging in managing Crohn's disease patients.

    PubMed

    Albert, Jörg G

    2012-01-01

    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.

  12. Small-bowel resection for metastatic melanoma

    PubMed Central

    Al-Sheneber, Ibrahim F.; Meterissian, Sarkis H.; Loutfi, Antoine; Watters, A. Kevin; Shibata, Henry R.

    1996-01-01

    Objective To determine whether complete resection of small-bowel metastases from melanoma improves patient survival. Design A computer-aided chart review. Setting Hospitals associated with McGill University. Patients Twenty patients (17 men, 3 women), identified from 1524 patients with melanoma, who underwent surgery to the small bowel for metastases. Patient age and clinical presentation, tumour site and stage were recorded. Intervention Exploratory laparotomy with complete or partial resection of involved small bowel. Main Outcome Measures Operative morbidity, mortality and length of survival related to the extent of small-bowel resection. Results Eleven patients had complete resection, 8 patients had partial resection and 1 patient had a palliative bypass only. Long-term survival (ranging from 2 to 10 years) was 36% in those who had complete resection and 0% in those who had partial resection; operative morbidity and mortality were 20% and 15% respectively. Conclusion Complete resection of small-bowel metastases in patients with metastatic melanoma can result in long-term survival. PMID:8640618

  13. Mushroom Bezoar Causing Small Bowel Obstruction.

    PubMed

    Hamzah, Azhar Amir; Keow, Chin Kim; Syazri, Azreen; Mallhi, Tauqeer Hussain; Khan, Amer Hayat; Khan, Yusra Habib; Adnan

    2017-03-01

    A bezoar is a concretion of foreign or indigestible matter in the alimentary canal and is usual cause of gastric obstruction. Bezoars can become fragmented and migrate downward leading to intestinal obstruction. Diagnosis of phytobezoar has become challenging in clinical practice due to lack of patient history and inability of patient to correlate preceding events with the episode of bowel obstruction. Bezoar associated small bowel obstruction rarely occurs and is usually found in patients with history of gastrointestinal surgery. Very few cases are reported of small bowel obstruction due to bezoar in healthy population without prior illness or surgery. We present a case of small bowel obstruction due to mushroom bezoar in a 62-year patient with no past history of medical illness or gastric surgery. Enterotomy was performed and a whole piece of undigested mushroom measuring 5 x 3 cm was successfully removed.

  14. Small Bowel Obstruction Secondary to Acute Pancreatitis

    PubMed Central

    Sunkara, Tagore; Etienne, Denzil; Caughey, Megan E.; Gaduputi, Vinaya

    2017-01-01

    While an uncommon occurrence, it is possible for patients diagnosed with acute pancreatitis to develop colonic ileus, obstruction, or perforation. By extension, it is also possible to develop a small bowel obstruction following an episode of acute pancreatitis. Here, we present the case of a 44-year-old male, who after repeated attacks of acute pancreatitis, came to the emergency department with continuous, non-bloody vomiting. This patient also complained of both left upper quadrant and epigastric pain, and was subsequently diagnosed with a small bowel obstruction involving the proximal jejunum. PMID:28270876

  15. Small Bowel Obstruction Secondary to Acute Pancreatitis.

    PubMed

    Sunkara, Tagore; Etienne, Denzil; Caughey, Megan E; Gaduputi, Vinaya

    2017-02-01

    While an uncommon occurrence, it is possible for patients diagnosed with acute pancreatitis to develop colonic ileus, obstruction, or perforation. By extension, it is also possible to develop a small bowel obstruction following an episode of acute pancreatitis. Here, we present the case of a 44-year-old male, who after repeated attacks of acute pancreatitis, came to the emergency department with continuous, non-bloody vomiting. This patient also complained of both left upper quadrant and epigastric pain, and was subsequently diagnosed with a small bowel obstruction involving the proximal jejunum.

  16. Role of computed tomography angiography in detection and staging of small bowel carcinoid tumors

    PubMed Central

    Bonekamp, David; Raman, Siva P; Horton, Karen M; Fishman, Elliot K

    2015-01-01

    Small-bowel carcinoid tumors are the most common form (42%) of gastrointestinal carcinoids, which by themselves comprise 70% of neuroendocrine tumors. Although primary small bowel neoplasms are overall rare (3%-6% of all gastrointestinal neoplasms), carcinoids still represent the second most common (20%-30%) primary small-bowel malignancy after small bowel adenocarcinoma. Their imaging evaluation is often challenging. State-of-the-art high-resolution multiphasic computed tomography together with advanced postprocessing methods provides an excellent tool for their depiction. The manifold interactive parameter choices however require knowledge of when to use which technique. Here, we discuss the imaging appearance and evaluation of duodenal, jejunal and ileal carcinoid tumors, including the imaging features of the primary tumor, locoregional mesenteric nodal metastases, and distant metastatic disease. A protocol for optimal lesion detection is presented, including the use of computed tomography enterography, volume acquisition, computed tomography angiography and three-dimensional mapping. Imaging findings are illustrated with a series of challenging cases which illustrate the spectrum of possible disease in the small bowel and mesentery, the range of possible appearances in the bowel itself on multiphase data and extraluminal findings such as the desmoplastic reaction in mesentery and hypervascular liver metastases. Typical imaging pitfalls and pearls are illustrated. PMID:26435774

  17. Acute small bowel ischemia: CT imaging findings.

    PubMed

    Segatto, Enrica; Mortelé, Koenraad J; Ji, Hoon; Wiesner, Walter; Ros, Pablo R

    2003-10-01

    Small bowel ischemia is a disorder related to a variety of conditions resulting in interruption or reduction of the blood supply of the small intestine. It may present with various clinical and radiologic manifestations, and ranges pathologically from localized transient ischemia to catastrophic necrosis of the intestinal tract. The primary causes of insufficient blood flow to the small intestine are various and include thromboembolism (50% of cases), nonocclusive causes, bowel obstruction, neoplasms, vasculitis, abdominal inflammatory conditions, trauma, chemotherapy, radiation, and corrosive injury. Computed tomography (CT) can demonstrate changes because of ischemic bowel accurately, may be helpful in determining the primary cause of ischemia, and can demonstrate important coexistent findings or complications. However, common CT findings in acute small bowel ischemia are not specific and, therefore, it is often a combination of clinical, laboratory and radiologic signs that may lead to a correct diagnosis. Understanding the pathogenesis of various conditions leading to mesenteric ischemia and being familiar with the spectrum of diagnostic CT signs may help the radiologist recognize ischemic small bowel disease and avoid delayed diagnosis. The aim of this article is to provide a review of the pathogenesis and various causes of acute small bowel ischemia and to demonstrate the contribution of CT in the diagnosis of this complex disease.

  18. Small bowel obstruction caused by dried apple

    PubMed Central

    Ooi, Sally; Hong, Khiem

    2015-01-01

    Introduction Small bowel obstruction in a virgin abdomen is an uncommon surgical condition. While malignancy, inflammatory bowel disease and foreign body are the main reported causes, undigested food bezoar causing bowel obstruction is a rare entity. We report a case of small bowel obstruction secondary to dried preserved apple having re-expanded within the gastrointestinal tract. Presentation of case A 69 year old male presented with severe abdominal distension, generalized abdominal tenderness and obstipation for 1 week. Small bowel obstruction (SBO) was confirmed on plain abdominal X-ray and CT imaging. An emergency explorative laparatomy identified a sausage-shaped intra-luminal foreign body obstructing the distal ileum. An enterotomy was performed which revealed a rehydrated, donut-shaped piece of dried apple. Discussion Swallowed items that pass through the pylorus rarely cause obstruction as they are usually small enough to pass through the rest of the bowel without difficulty. We postulate that in our patient that the dried apple was originally small enough to pass through the pylorus. However during small bowel, its’ highly absorbable nature resulted in an increase in size that prevented its’ passage through the ileocecal valve. A simple in-vitro experiment discovered that dried apple has a potential to reabsorb fluid and expand up to 35% of its initial size within 72 h. Conclusion This report illustrates the potential for dried food substances to cause intra-luminal SBO after significant expansion with rehydration. PMID:25841159

  19. Anatomy and Physiology of the Small Bowel.

    PubMed

    Volk, Neil; Lacy, Brian

    2017-01-01

    Comprehension of small intestine physiology and function provides a framework for the understanding of several important disease pathways of the gastrointestinal system. This article reviews the development, anatomy and histology of the small bowel in addition to physiology and digestion of key nutrients.

  20. Bisdemethoxycurcumin enhances X-ray-induced apoptosis possibly through p53/Bcl-2 pathway.

    PubMed

    Enomoto, Atsushi; Yamada, Junko; Morita, Akinori; Miyagawa, Kiyoshi

    2017-03-01

    Bisdemethoxycurcumin (BDMC), which is isolated from the rhizomes of Curcuma longa, has anti-inflammatory and anti-carcinogenic activities. Here we found that BDMC enhanced X-ray-induced apoptosis in human T-cell leukemia MOLT-4 cells. Knockdown of p53 significantly attenuated the radiosensitizing effect of BDMC. However, BDMC did not enhance X-ray-mediated activation of the p53 signaling pathway via p53's transactivation or mitochondrial translocation. On the other hand, BDMC promoted the X-ray-induced dephosphorylation at Ser 70 in Bcl-2's flexible loop regulatory domain and Bcl-2 binding to p53. Overexpressing Bcl-2 completely blocked the BDMC's radiosensitization effect. Our results indicate that BDMC stimulates the dephosphorylation and p53-binding activity of Bcl-2 and suggest that BDMC may induce a neutralization of Bcl-2's anti-apoptotic function, thereby enhancing X-ray-induced apoptosis.

  1. Small bowel endometriosis masquerading as regional enteritis.

    PubMed

    Minocha, A; Davis, M S; Wright, R A

    1994-05-01

    A 35-year-old female presented with recurrent right lower quadrant pain, nausea, and vomiting. She was afebrile with diffuse abdominal tenderness. Plain x-ray of abdomen revealed small bowel obstruction. A barium x-ray of the small bowel showed stricture of the terminal ileum. A CT scan of the abdomen showed a 6-cm mass in right lower quadrant. She was empirically managed as having Crohn's disease. She underwent laparotomy after failure of medical management with high-dose steroids. There was ulceration and narrowing of terminal ileum. Frozen sections revealed endometriosis. Ileocecectomy was performed. Histopathology of resected specimen confirmed the diagnosis of endometriosis, and there was no evidence of chronic inflammatory bowel disease or neoplasia. Ileal endometriosis should be considered in the differential diagnosis of Crohn's disease in menstruating females presenting with perimenstrual symptoms.

  2. Small bowel obstruction attributable to phytobezoar

    PubMed Central

    Razavianzadeh, Nasrin; Foroutan, Behzad; Honarvar, Farhad; Forozeshfard, Mohammad

    2016-01-01

    Small bowel obstruction (SBO) is a common condition encountered in surgical practice. Literature shows divers and many different etiologies for intestinal obstruction. However, bezoars are rarely reported as an etiological factor. A bezoar happens most commonly in patients with impaired gastrointestinal motility. There are four types of bezoars: phytobezoars, trichobezoars, pharmacobezoars and lactobezoars. The most common type is phytobezoars, which are composed of undigested fiber from vegetables or fruits especially persimmons. They are mostly composed of cellulose, tannin and lignin. The commonest phytobezoar reported worldwide is related to the persimmon fruit ingestion. The most common symptom of bezoar-induced SBO is abdominal pain (96–100%). Other common symptoms include nausea and vomiting. Primary small bowel phytobezoars almost always present as SBO. We present an unusual case of SBO caused by a phytobezoar in a 35-year-old patient. Many types of bezoar can be removed endoscopically, but some will require operative intervention. PMID:28031856

  3. Laparoscopic Management of Adhesive Small Bowel Obstruction

    PubMed Central

    Konjic, Ferid; Idrizovic, Enes; Hasukic, Ismar; Jahic, Alen

    2016-01-01

    Introduction: Adhesions are the reason for bowel obstruction in 80% of the cases. In well selected patients the adhesive ileus laparoscopic treatment has multiple advantages which include the shorter hospitalization period, earlier food taking, and less postoperative morbidity rate. Case report: Here we have a patient in the age of 35 hospitalized at the clinic due to occlusive symptoms. Two years before an opened appendectomy had been performed on him. He underwent the treatment of exploration laparoscopy and laparoscopic adhesiolysis. Dilated small bowel loops connected with the anterior abdominal wall in the ileocecal region by adhesions were found intraoperatively and then resected harmonically with scalpel. One strangulation around which a small bowel loop was wrapped around was found and dissected. Postoperative course was normal. PMID:27041815

  4. Surface studies of solids using integral X-ray-induced photoemission yield

    PubMed Central

    Stoupin, Stanislav; Zhernenkov, Mikhail; Shi, Bing

    2016-01-01

    X-ray induced photoemission yield contains structural information complementary to that provided by X-ray Fresnel reflectivity, which presents an advantage to a wide variety of surface studies if this information is made easily accessible. Photoemission in materials research is commonly acknowledged as a method with a probing depth limited by the escape depth of the photoelectrons. Here we show that the integral hard-X-ray-induced photoemission yield is modulated by the Fresnel reflectivity of a multilayer structure and carries structural information that extends well beyond the photoelectron escape depth. A simple electric self-detection of the integral photoemission yield and Fourier data analysis permit extraction of thicknesses of individual layers. The approach does not require detection of the reflected radiation and can be considered as a framework for non-invasive evaluation of buried layers with hard X-rays under grazing incidence. PMID:27874041

  5. Surface studies of solids using integral x-ray-induced photoemission yield

    DOE PAGES

    Stoupin, Stanislav; Zhernenkov, Mikhail; Shi, Bing

    2016-11-22

    X-ray induced photoemission yield contains structural information complementary to that provided by X-ray Fresnel reflectivity, which presents an advantage to a wide variety of surface studies if this information is made easily accessible. Photoemission in materials research is commonly acknowledged as a method with a probing depth limited by the escape depth of the photoelectrons. Here we show that the integral hard-X-ray-induced photoemission yield is modulated by the Fresnel reflectivity of a multilayer structure and carries structural information that extends well beyond the photoelectron escape depth. A simple electric self-detection of the integral photoemission yield and Fourier data analysis permitmore » extraction of thicknesses of individual layers. The approach does not require detection of the reflected radiation and can be considered as a framework for non-invasive evaluation of buried layers with hard X-rays under grazing incidence.« less

  6. Surface studies of solids using integral x-ray-induced photoemission yield

    SciTech Connect

    Stoupin, Stanislav; Zhernenkov, Mikhail; Shi, Bing

    2016-11-22

    X-ray induced photoemission yield contains structural information complementary to that provided by X-ray Fresnel reflectivity, which presents an advantage to a wide variety of surface studies if this information is made easily accessible. Photoemission in materials research is commonly acknowledged as a method with a probing depth limited by the escape depth of the photoelectrons. Here we show that the integral hard-X-ray-induced photoemission yield is modulated by the Fresnel reflectivity of a multilayer structure and carries structural information that extends well beyond the photoelectron escape depth. A simple electric self-detection of the integral photoemission yield and Fourier data analysis permit extraction of thicknesses of individual layers. The approach does not require detection of the reflected radiation and can be considered as a framework for non-invasive evaluation of buried layers with hard X-rays under grazing incidence.

  7. Small bowel bleeding: a comprehensive review

    PubMed Central

    Gunjan, Deepak; Sharma, Vishal; Bhasin, Deepak K

    2014-01-01

    The small intestine is an uncommon site of gastro-intestinal (GI) bleeding; however it is the commonest cause of obscure GI bleeding. It may require multiple blood transfusions, diagnostic procedures and repeated hospitalizations. Angiodysplasia is the commonest cause of obscure GI bleeding, particularly in the elderly. Inflammatory lesions and tumours are the usual causes of small intestinal bleeding in younger patients. Capsule endoscopy and deep enteroscopy have improved our ability to investigate small bowel bleeds. Deep enteroscopy has also an added advantage of therapeutic potential. Computed tomography is helpful in identifying extra-intestinal lesions. In cases of difficult diagnosis, surgery and intra-operative enteroscopy can help with diagnosis and management. The treatment is dependent upon the aetiology of the bleed. An overt bleed requires aggressive resuscitation and immediate localisation of the lesion for institution of appropriate therapy. Small bowel bleeding can be managed by conservative, radiological, pharmacological, endoscopic and surgical methods, depending upon indications, expertise and availability. Some patients, especially those with multiple vascular lesions, can re-bleed even after appropriate treatment and pose difficult challenge to the treating physician. PMID:24874805

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

    SciTech Connect

    Hoener, M.; Fang, L.; Murphy, B.; Berrah, N.; Kornilov, O.; Gessner, O.; Pratt, S. T.; Kanter, E. P.; Guehr, M.; Bucksbaum, P. H.; Cryan, J.; Glownia, M.; McFarland, B.; Petrovic, V.; Blaga, C.; DiMauro, L.; Bostedt, C.; Bozek, J. D.; Coffee, R.; Messerschmidt, M.

    2010-06-25

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

  9. Ultraintense x-ray induced ionization, dissociation and frustrated absorption in molecular nitrogen.

    SciTech Connect

    Hoener, M.; Fang, L.; Kornilov, O.; Gessner, O.; Pratt, S. T.; Guhr, M.; Kanter, E. P.; Blaga, C.; Bostedt, C.; Bozek, J. D.; Bucksbaum, P. H.; Buth, C.; Chen, M.; Coffee, R.; Cryan, J.; DiMauro, L.; Glownia, M.; Hosler, E.; Kukk, E.; Leone, S. R.; McFarland, B.; Messerschmidt, M.; Murphy, B.; Petrovic, V.; Rolles, D.; Berrah, N.; Chemical Sciences and Engineering Division; Western Michigan Univ.; LBNL; Ohio State Univ.; Louisiana State Univ.; LLNL; Univ. of Turku; Univ. of California at Berkeley; Max Planck Advanced Study Group, CFEL; LCLS

    2010-06-23

    Sequential multiple photoionization of the prototypical molecule N2 is studied with femtosecond time resolution using the Linac Coherent Light Source (LCLS). A detailed picture of intense x-ray induced ionization and dissociation dynamics is revealed, including a molecular mechanism of frustrated absorption that suppresses the formation of high charge states at short pulse durations. The inverse scaling of the average target charge state with x-ray peak brightness has possible implications for single-pulse imaging applications.

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

    PubMed

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

    2013-03-21

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

  11. Phytobezoar: a rare cause of small bowel obstruction.

    PubMed

    Pujar K, Anupama; Pai A, Sreekar; Hiremath V, Bharati

    2013-10-01

    Phytobezoar is an unusual cause of small bowel obstruction. It accounts for about 0.4%-4% of all mechanical bowel obstruction. However, the symptoms are not very different from those caused by usual aetiologies of small bowel obstruction. The commonest site of obstruction is terminal ileum. Treatment of small bowel obstruction due to Phytobezoar is surgery. Prevention includes avoidance of high fibre diet, prokinetics particularly in patients who have undergone gastric surgery. A 57-year-old male presented with symptoms and signs of small bowel obstruction. On exploratory laparotomy Phytobezoar in the ileum was found to be the cause of obstruction. Diagnosis was confirmed by histopathology.

  12. Ileal Fecaloma Presenting with Small Bowel Obstruction

    PubMed Central

    Yoo, Ha Yeong; Park, Hye Won; Chang, Seong-Hwan

    2015-01-01

    A fecaloma refers to a mass of accumulated feces that is much harder than a mass associated with fecal impaction. Fecalomas are usually found in the rectosigmoid area. A 10-year-old male with chronic constipation was admitted because of increasing abdominal pain. An abdominal computed tomography scan and a simple abdominal x-ray revealed rapidly evolving mechanical obstruction in the small intestine. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, surgical intervention may be needed. In this case, an emergency operation was performed and a 4×3×2.5 cm fecaloma was found in the distal ileum. We thus report a case of ileal fecaloma inducing small bowel obstruction in a patient with chronic constipation, who required surgical intervention. When symptoms of acute small intestinal obstruction develop in a patient with chronic constipation, a fecaloma should be considered in differential diagnosis. PMID:26473140

  13. Cytoprotective agents in experimental small bowel volvulus.

    PubMed

    Goldman, C D; Rudloff, M A; Ternberg, J L

    1987-03-01

    An accepted experimental model for midgut volvulus was used to produce small bowel strangulation obstruction of 48 hours duration in Sprague-Dawley rats. A 93% perioperative mortality rate resulted after release of the volvulus. Treatment with three cytoprotective agents at the time of volvulus release resulted in the following mortality rates: superoxide dismutase, 89%; ibuprofen, 50%; prostaglandin E1 (PGE1, 11%. The predominant cause of death in all treatment groups was bowel infarction, with a smaller number succumbing to either sepsis or circulatory collapse. Concomitant administration of ephedrine or indomethacin to suppress prostaglandin E1's splanchnic vasodilatory activity did not cause any increase in mortality. A trial of aspirin, to simulate PGE's antiplatelet actions, showed no reduction in mortality when compared with detorsion alone. Prostaglandin E1 and, to a lesser extent, ibuprofen, appear to have cytoprotective effects during reperfusion of bowel compromised by volvulus, independent of their influence on the mesenteric vasculature and thrombogenesis.

  14. An unusual case of small bowel obstruction post caesarean section

    PubMed Central

    Marchocki, Z; Brennan, DJ; Mak, C; O’Riordan, M; Greene, RA

    2011-01-01

    Small bowel obstruction (SBO) is a very rare complication post-caesarean section (CS). Herniation of small bowel through the rectus muscle with an intact sheath is extremely rare. We present a case of SBO after an uncomplicated c-section and an uneventful early postoperative course. PMID:24972397

  15. Principles of femtosecond X-ray/optical cross-correlation with X-ray induced transient optical reflectivity in solids

    SciTech Connect

    Eckert, S. E-mail: martin.beye@helmholtz-berlin.de; Beye, M. E-mail: martin.beye@helmholtz-berlin.de; Pietzsch, A.; Quevedo, W.; Hantschmann, M.; Ochmann, M.; Huse, N.; Ross, M.; Khalil, M.; Minitti, M. P.; Turner, J. J.; Moeller, S. P.; Schlotter, W. F.; Dakovski, G. L.; Föhlisch, A.

    2015-02-09

    The discovery of ultrafast X-ray induced optical reflectivity changes enabled the development of X-ray/optical cross correlation techniques at X-ray free electron lasers worldwide. We have now linked through experiment and theory the fundamental excitation and relaxation steps with the transient optical properties in finite solid samples. Therefore, we gain a thorough interpretation and an optimized detection scheme of X-ray induced changes to the refractive index and the X-ray/optical cross correlation response.

  16. Perforation of the mesenteric small bowel: etiologies and CT findings.

    PubMed

    Hines, John; Rosenblat, Juliana; Duncan, Dameon R; Friedman, Barak; Katz, Douglas S

    2013-04-01

    The purpose of this article is to illustrate and discuss the various etiologies of perforation of the mesenteric small bowel and associated findings on abdominal CT. Perforation of the mesenteric small bowel is an uncommon cause of an acute abdomen and can be due to various etiologies. In underdeveloped countries, infection is probably the most common cause, while in industrialized nations, perforation may be due to Crohn disease, diverticulitis, foreign body, trauma, tumor, mechanical obstruction, primary ischemic event, or iatrogenic causes. CT is usually the initial imaging examination in patients with an acute abdomen and is sensitive in diagnosing small bowel perforation. CT findings in the setting of small bowel perforation are often subtle, but when present, may help the radiologist determine a specific cause of perforation. The aims of this pictorial essay are to review the various causes of mesenteric small bowel perforation and to discuss and illustrate the CT findings that can help arrive at the diagnosis.

  17. Double-balloon enteroscopy in small bowel diseases

    PubMed Central

    Chen, Wen-Guo; Shan, Guo-Dong; Zhang, Hong; Yang, Ming; L, Lin; Yue, Min; Chen, Guang-Wu; Gu, Qing; Zhu, Hua-Tuo; Xu, Guo-Qiang; Chen, Li-Hua

    2016-01-01

    Abstract The aim of the study was to evaluate the diagnostic and therapeutic value of double-balloon entoroscopy (DBE) in small bowel diseases (SBDs) in China. A retrospective review of 674 consecutive patients who underwent DBE between January 2007 and November 2015 was conducted. Patients were divided into 3 groups by age, young group (<45 years), middle-aged group (45–65 years), and elderly group (>65 years). Data were collected with regard to demographics, clinical, endoscopic findings, complications, diagnostic yield, and management. A total of 729 DBE procedures were performed successfully in our series. More than 20 types of SBDs were found with the detection rate of 70.9%(517/729). The majority of patients were Crohn's disease (33.4%,225/674), followed by tumor (18.8%,127/674) and angioectasia (7.9%, 53/674). Endoscopic treatment was performed in 60 patients in which hemostasis (17,28.3%) and polypectomy (15,25%) were the predominant form of intervention used. Adverse events occurred in 6 patients (0.96%,6/729) including perforation, hemorrhage, aspiration pneumonia. No acute pancreatitis or other major complications occurred. Adenocarcinoma, GIST, and lymphoma were the most common tumor detected, the majority of tumors located in the jejunum (56.7%), The detection rate of angioectasia was also higher in the jejunum (54.7%),77.8% of Crohn's disease was located in the ileum. The positive rate of DBE in small bowel tumor and Crohn's disease were significantly higher than that of angioectasia (P<0.05). In young cohort, Crohn's disease (48.1%) was the most commonly diseases followed by tumor (10.4%) and nonspecific enteritis (7.1%). Yet in the elderly group, the majority of patients were tumor (27.6%); angioectasia (21.3%) was also detected frequently. The positive rate of capsule endoscopy was 75.44 %(202/268) which was a little high than DBE (67.9%, 182/268) (P > 0.05). The obscure gastrointestinal bleeding (OGIB) was the most common indication, and

  18. X-ray Induced Effects on Photocurrents in Amorphous Se Films

    NASA Astrophysics Data System (ADS)

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

    2007-03-01

    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.

  19. X-ray-induced shortwave infrared biomedical imaging using rare-earth nanoprobes.

    PubMed

    Naczynski, Dominik Jan; Sun, Conroy; Türkcan, Silvan; Jenkins, Cesare; Koh, Ai Leen; Ikeda, Debra; Pratx, Guillem; Xing, Lei

    2015-01-14

    Shortwave infrared (SWIR or NIR-II) light provides significant advantages for imaging biological structures due to reduced autofluorescence and photon scattering. Here, we report on the development of rare-earth nanoprobes that exhibit SWIR luminescence following X-ray irradiation. We demonstrate the ability of X-ray-induced SWIR luminescence (X-IR) to monitor biodistribution and map lymphatic drainage. Our results indicate X-IR imaging is a promising new modality for preclinical applications and has potential for dual-modality molecular disease imaging.

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

    SciTech Connect

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

    1987-02-01

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

  1. X-ray-Induced Shortwave Infrared Biomedical Imaging Using Rare-Earth Nanoprobes

    PubMed Central

    2015-01-01

    Shortwave infrared (SWIR or NIR-II) light provides significant advantages for imaging biological structures due to reduced autofluorescence and photon scattering. Here, we report on the development of rare-earth nanoprobes that exhibit SWIR luminescence following X-ray irradiation. We demonstrate the ability of X-ray-induced SWIR luminescence (X-IR) to monitor biodistribution and map lymphatic drainage. Our results indicate X-IR imaging is a promising new modality for preclinical applications and has potential for dual-modality molecular disease imaging. PMID:25485705

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

    SciTech Connect

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

    2011-12-14

    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.

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

    NASA Astrophysics Data System (ADS)

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

    2011-10-01

    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 (KClO3) 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.

  4. Primary small bowel melanomas: fact or myth?

    PubMed Central

    Hadjittofi, Christopher; Athanasopoulos, Panagiotis G.; Shah, Rahul; Ala, Aftab A.

    2016-01-01

    Small bowel melanoma (SBM) is a rare entity, which often evades diagnosis and therefore presents late. Its origin, whether arising primarily or metastatically from an unidentified or regressed primary cutaneous melanoma, remains debatable. In this report, we present a rare case of primary SBM and review the current literature. A 60-year-old man presented with melena and microcytic anemia. A series of investigations including abdominal ultrasonography (US), esophago-gastro-duodenoscopy (EGD) and colonoscopy were normal. Abdominal computed tomography revealed no specific pathology. Subsequent capsule endoscopy identified a jejunal mass, which was confirmed on laparotomy, was resected, and histologically diagnosed as melanoma. Extensive postoperative clinical examination revealed no cutaneous lesions. This report discusses gastrointestinal (GI) malignant melanoma, and examines the evidence both for and against the existence of true primary vs. metastatic disease. Furthermore, this case highlights the capabilities of capsule endoscopy in identifying an extremely rare GI tumor, which evaded other diagnostic modalities. Finally, the origins and pathophysiology of this rare cancer are evaluated, with the aim of promoting early diagnosis and treatment, and therefore improving current poor outcomes. PMID:27127766

  5. Small bowel imaging of inflammatory bowel disease

    PubMed Central

    Casciani, Emanuele; Vincentiis, Chiara De; Gualdi, Gianfranco

    2015-01-01

    The study of the small bowel (SB) has always been challenging both for clinicians and radiologist. It is a long and tortuous tube that can be affected by various pathologies whose signs and symptoms are usually non specific and can mimic other acute abdominal disorders. For these reasons, imaging plays a central role in the diagnosis of the different pathological conditions that can occur. They are important also in the management and follow up of chronic diseases. We expose and evaluate all the radiological methods that are now available for the study of the SB with particular emphasis on the technological improvement of cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI). These techniques have, infact, highly improved in terms of execution times (fast acquisitions images), patients discomfort and radiation dose, for CT, with consequent reduced biological risks. Moreover, the new post-processing options with multiplanar reconstruction and isotropic images have made significant changes in the evaluation of the exams. Especially MRI scans have been improved by the advent of new sequences, such as diffusion weighted imaging and cine-MRI, parallel imaging and breath-hold sequences and can provide excellent soft-tissue contrast without the use of ionizing radiations. PMID:26339463

  6. Capsule endoscopy of the small bowel

    PubMed Central

    Ching, Hey-Long; Yung, Diana; Sidhu, Reena; Koulaouzidis, Anastasios

    2016-01-01

    Capsule endoscopy (CE) is a first line small bowel investigative modality which provides more sensitive mucosal imaging than comparators. It is a non-invasive, non-irradiating tool well tolerated by patients. The risk of retention of the capsule can be minimised by ensuring luminal patency using the Agile patency device. Research continues into how to minimise missed pathology and variability in the identification of pathology or interpretation of images. The consensus is that bowel preparation using laxatives improves visibility and diagnostic yield. Research includes the development of image recognition software, both to eliminate sequentially identical images to improve viewing speed and to select or enhance images likely to represent pathology. However, careful reading by experienced capsule endoscopists remains the benchmark. This should be performed at a speed comfortable to the viewer, probably at a maximum of 15 frames per second. Some prior experience of endoscopy appears to be helpful for novice capsule endoscopists and formal training on a hands-on training course seems to improve pathology recognition, for novices and for those with CE experience. PMID:27826572

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

    SciTech Connect

    Miura, Masahiko; Sasaki, Takehito; Takasaki, Yoshinari

    1996-01-01

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

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

    SciTech Connect

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

    1987-01-01

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

  9. Small bowel capsule endoscopy in 2007: indications, risks and limitations.

    PubMed

    Rondonotti, Emanuele; Villa, Federica; Mulder, Chris J J; Jacobs, Maarten A J M; de Franchis, Roberto

    2007-12-14

    Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn's disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool (which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions). The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions (i.e. obscure GI bleeding), the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way (with capsule endoscopy) and to define and treat the lesions identified (with double balloon enteroscopy).

  10. Gastrointestinal Motility, Part 2: Small-Bowel and Colon Transit.

    PubMed

    Maurer, Alan H

    2016-03-01

    Because of the difficulty often encountered in deciding whether a patient's symptoms originate in the upper or lower gastrointestinal tract, gastrointestinal transit scintigraphy is a uniquely suited noninvasive, quantitative, and physiologic method of determining whether there is a motility disorder affecting the stomach, small bowel, or colon. Small-bowel and colon transit studies can be performed alone or together with gastric emptying studies after oral administration of an appropriately radiolabeled meal. It is hoped that newly published standards for performing these studies and the anticipated arrival of new Current Procedural Terminology codes in the United States for small-bowel and colon transit studies will increase their availability and use.

  11. Gastrointestinal Motility, Part 2: Small-Bowel and Colon Transit.

    PubMed

    Maurer, Alan H

    2015-09-01

    Because of the difficulty often encountered in deciding whether a patient's symptoms originate in the upper or lower gastrointestinal tract, gastrointestinal transit scintigraphy is a uniquely suited noninvasive, quantitative, and physiologic method of determining whether there is a motility disorder affecting the stomach, small bowel, or colon. Small-bowel and colon transit studies can be performed alone or together with gastric emptying studies after oral administration of an appropriately radiolabeled meal. It is hoped that newly published standards for performing these studies and the anticipated arrival of new Current Procedural Terminology codes in the United States for small-bowel and colon transit studies will increase their availability and use.

  12. Analysis of Non-Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Potential Small Bowel Bleeding

    PubMed Central

    Akin, Fatma Ebru; Yurekli, Oyku Tayfur; Demirezer Bolat, Aylin; Tahtacı, Mustafa; Koseoglu, Huseyin; Selvi, Eyup; Buyukasik, Naciye Semnur; Ersoy, Osman

    2016-01-01

    Gastrointestinal (GI) bleeding cases in whom source cannot be identified after conventional upper and lower GI endoscopy are defined as potential small bowel bleeding. We aimed to search for lesions in the reach of conventional endoscopy in patients to whom video capsule endoscopy (VCE) had been applied for potential small bowel bleeding. 114 patients who had VCE evaluation for potential small bowel bleeding between January 2009 and August 2015 were retrospectively evaluated. Mean age of the patients was 55 ± 17 years. Female/male ratio is 39/75. In 58 patients (50.9%) bleeding lesion could be determined. Among these 58 patients 8 patients' lesions were in the reach of conventional endoscopes. Overall these 8 patients comprised 7% of patients in whom VCE was performed for potential small bowel bleeding. Among these 8 patients 5 had colonic lesions (4 angiodysplasia, 1 ulcerated polypoid cecal lesion), 2 had gastric lesions (1 GAVE, 1 anastomotic bleeding), and 1 patient had a bleeding lesion in the duodenal bulbus. Although capsule endoscopy is usually performed for potential small bowel bleeding gastroenterologists should always keep in mind that these patients may be suffering from bleeding from non-small bowel segments and should carefully review images captured from non-small bowel areas. PMID:27092029

  13. Dose-rate plays a significant role in synchrotron radiation X-ray-induced damage of rodent testes

    PubMed Central

    Chen, Heyu; Wang, Ban; Wang, Caixia; Cao, Wei; Zhang, Jie; Ma, Yingxin; Hong, Yunyi; Fu, Shen; Wu, Fan; Ying, Weihai

    2016-01-01

    Synchrotron radiation (SR) X-ray has significant potential for applications in medical imaging and cancer treatment. However, the mechanisms underlying SR X-ray-induced tissue damage remain unclear. Previous studies on regular X-ray-induced tissue damage have suggested that dose-rate could affect radiation damage. Because SR X-ray has exceedingly high dose-rate compared to regular X-ray, it remains to be determined if dose-rate may affect SR X-ray-induced tissue damage. We used rodent testes as a model to investigate the role of dose-rate in SR X-ray-induced tissue damage. One day after SR X-ray irradiation, we determined the effects of the irradiation of the same dosage at two different dose-rates, 0.11 Gy/s and 1.1 Gy/s, on TUNEL signals, caspase-3 activation and DNA double-strand breaks (DSBs) of the testes. Compared to those produced by the irradiation at 0.11 Gy/s, irradiation at 1.1 Gy/s produced higher levels of DSBs, TUNEL signals, and caspase-3 activation in the testes. Our study has provided the first evidence suggesting that dose-rate could be a significant factor in SR X-ray-induced tissue damage, which may establish a valuable base for utilizing this factor to manipulate the tissue damage in SR X-ray-based medical applications. PMID:28078052

  14. Dose-rate plays a significant role in synchrotron radiation X-ray-induced damage of rodent testes.

    PubMed

    Chen, Heyu; Wang, Ban; Wang, Caixia; Cao, Wei; Zhang, Jie; Ma, Yingxin; Hong, Yunyi; Fu, Shen; Wu, Fan; Ying, Weihai

    2016-01-01

    Synchrotron radiation (SR) X-ray has significant potential for applications in medical imaging and cancer treatment. However, the mechanisms underlying SR X-ray-induced tissue damage remain unclear. Previous studies on regular X-ray-induced tissue damage have suggested that dose-rate could affect radiation damage. Because SR X-ray has exceedingly high dose-rate compared to regular X-ray, it remains to be determined if dose-rate may affect SR X-ray-induced tissue damage. We used rodent testes as a model to investigate the role of dose-rate in SR X-ray-induced tissue damage. One day after SR X-ray irradiation, we determined the effects of the irradiation of the same dosage at two different dose-rates, 0.11 Gy/s and 1.1 Gy/s, on TUNEL signals, caspase-3 activation and DNA double-strand breaks (DSBs) of the testes. Compared to those produced by the irradiation at 0.11 Gy/s, irradiation at 1.1 Gy/s produced higher levels of DSBs, TUNEL signals, and caspase-3 activation in the testes. Our study has provided the first evidence suggesting that dose-rate could be a significant factor in SR X-ray-induced tissue damage, which may establish a valuable base for utilizing this factor to manipulate the tissue damage in SR X-ray-based medical applications.

  15. Unique Presentation of Intra-Abdominal Testis: Small Bowel Obstruction

    PubMed Central

    Bassiouny, Ibrahim E.; Abbas, Tariq O.; Alansari, Amani N.; Ali, Mansour A.

    2011-01-01

    We describe here a two-year-old male who required urgent laparotomy to relieve a strangulated small bowel caused by internal herniation around an intra-abdominal testis. This clinical presentation has not been reported previously. PMID:22084802

  16. Sclerosing Mesenteritis: A Rare Cause of Small Bowel Obstruction.

    PubMed

    Harvin, Glenn; Graham, Adam

    2016-01-01

    Sclerosing mesenteritis falls within a spectrum of primary idiopathic inflammatory and fibrotic processes that affect the mesentery. The exact etiology has not been determined, although the following associations have been noted: abdominal surgery, trauma, autoimmunity, paraneoplastic syndrome, ischemia and infection. Progression of sclerosing mesentritis can lead to bowel obstruction, a rare complication of this uncommon condition. We report a case of a 66-year-old female with abdominal pain who was noted to have a small bowel obstruction requiring laparotomy and a partial small bowel resection. The pathology of the resected tissue was consistent with sclerosing mesenteritis, a rare cause of a small bowel obstruction. Sclerosing mesenteritis has variable rates of progression, and there is no consensus regarding the optimal treatment. Physicians should consider sclerosing mesenteritis in the differential diagnosis of a small bowel obstruction.

  17. Sclerosing Mesenteritis: A Rare Cause of Small Bowel Obstruction

    PubMed Central

    Harvin, Glenn; Graham, Adam

    2016-01-01

    Sclerosing mesenteritis falls within a spectrum of primary idiopathic inflammatory and fibrotic processes that affect the mesentery. The exact etiology has not been determined, although the following associations have been noted: abdominal surgery, trauma, autoimmunity, paraneoplastic syndrome, ischemia and infection. Progression of sclerosing mesentritis can lead to bowel obstruction, a rare complication of this uncommon condition. We report a case of a 66-year-old female with abdominal pain who was noted to have a small bowel obstruction requiring laparotomy and a partial small bowel resection. The pathology of the resected tissue was consistent with sclerosing mesenteritis, a rare cause of a small bowel obstruction. Sclerosing mesenteritis has variable rates of progression, and there is no consensus regarding the optimal treatment. Physicians should consider sclerosing mesenteritis in the differential diagnosis of a small bowel obstruction. PMID:27403104

  18. Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement

    PubMed Central

    Bourm, Kelsey; Pfeifer, Cory; Zarchan, Adam

    2016-01-01

    Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment. PMID:27761183

  19. Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement.

    PubMed

    Bourm, Kelsey; Pfeifer, Cory; Zarchan, Adam

    2016-06-01

    Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment.

  20. Note: Loading method of molecular fluorine using x-ray induced chemistry

    NASA Astrophysics Data System (ADS)

    Pravica, Michael; Sneed, Daniel; White, Melanie; Wang, Yonggang

    2014-08-01

    We have successfully loaded molecular fluorine into a diamond anvil cell at high pressure using the synchrotron x-ray induced decomposition of perfluorohexane (C6F14). "White" x-ray radiation from the Advanced Photon Source was used to initiate the chemical decomposition of C6F14, which resulted in the in situ production of F2 as verified via Raman spectroscopy. Due to the toxic nature of fluorine, this method will offer significant advantages in the ability to easily load a relatively nontoxic and inert substance into a chamber (such as a diamond anvil cell) that, when sealed with other reactants and irradiate with hard x-rays (>7 keV), releases highly reactive and toxic fluorine into the sample/reaction chamber to enable novel chemical synthesis under isolated and/or extreme conditions.

  1. X-ray-induced lysis of the Fe-CO bond in carbonmonoxy-myoglobin.

    PubMed

    Della Longa, Stefano; Arcovito, Alessandro

    2010-11-01

    By using X-ray absorption near edge structure (XANES) spectroscopy, we show that under prolonged exposure to Synchrotron X-rays, at T < 10 K, the Fe-heme in carbonmonoxy-myoglobin (MbCO) undergoes a slow two-state transition process. The final spectrum is nearly identical to that of the classical photoproduct (Mb*CO) obtained by UV-visible light illumination at 15 K. By increasing the temperature, the starting spectrum of MbCO is recovered at T > 100 K, demonstrating that the process is reversible and no damage occurred at the heme site in the time course of the experiment. Thus, the overall X-ray-induced process at low temperature is identical to the well-known (light-induced) photolysis of CO-hemeproteins.

  2. Note: Loading method of molecular fluorine using x-ray induced chemistry

    SciTech Connect

    Pravica, Michael Sneed, Daniel; White, Melanie; Wang, Yonggang

    2014-08-15

    We have successfully loaded molecular fluorine into a diamond anvil cell at high pressure using the synchrotron x-ray induced decomposition of perfluorohexane (C{sub 6}F{sub 14}). “White” x-ray radiation from the Advanced Photon Source was used to initiate the chemical decomposition of C{sub 6}F{sub 14}, which resulted in the in situ production of F{sub 2} as verified via Raman spectroscopy. Due to the toxic nature of fluorine, this method will offer significant advantages in the ability to easily load a relatively nontoxic and inert substance into a chamber (such as a diamond anvil cell) that, when sealed with other reactants and irradiate with hard x-rays (>7 keV), releases highly reactive and toxic fluorine into the sample/reaction chamber to enable novel chemical synthesis under isolated and/or extreme conditions.

  3. Note: Loading method of molecular fluorine using x-ray induced chemistry.

    PubMed

    Pravica, Michael; Sneed, Daniel; White, Melanie; Wang, Yonggang

    2014-08-01

    We have successfully loaded molecular fluorine into a diamond anvil cell at high pressure using the synchrotron x-ray induced decomposition of perfluorohexane (C6F14). "White" x-ray radiation from the Advanced Photon Source was used to initiate the chemical decomposition of C6F14, which resulted in the in situ production of F2 as verified via Raman spectroscopy. Due to the toxic nature of fluorine, this method will offer significant advantages in the ability to easily load a relatively nontoxic and inert substance into a chamber (such as a diamond anvil cell) that, when sealed with other reactants and irradiate with hard x-rays (>7 keV), releases highly reactive and toxic fluorine into the sample/reaction chamber to enable novel chemical synthesis under isolated and/or extreme conditions.

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

    SciTech Connect

    Hughes, E.N.; Boothman, D.A. )

    1991-03-01

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

  5. Small bowel review: normal physiology part 1.

    PubMed

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

    2001-12-01

    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 abundance, as well as by posttranscriptional processes including protein trafficking; (2) inducers of cytochrome P-450 decrease glucose and fructose absorption and increase glucose consumption in the intestine; (3) the regulated release of nutrients from the stomach into the upper intestine ensures that the modest intestinal transport reserve capacity is not exceeded; (4) hepatocyte growth factor and short-chain fatty acids may enhance intestinal adaptation and prevent the atrophy seen when total parenteral nutrition is infused; (5) inhibitors of pancreatic lipase and phospholipase H2 may be useful clinically to reduce absorption as part of a treatment program for obesity and hyperlipidemia; (6) several membrane-bound and cytosolic proteins have been identified in the enterocyte as well as in the hepatocyte and may be the target for the future therapeutic manipulation of bile acid metabolism and control of hyperlipidemia; (7) suspect bile acid malabsorption in the patient with otherwise unexplained chronic diarrhea; (8) a proportion of lipid absorption is protein-mediated, and this opens the way to targeting these proteins and thereby therapeutically modifying lipid absorption; (9) a high protein diet may be useful to increase the intestinal absorption of drugs transported by the H+/dipeptide cotransporter; (10) a metal transporter DCT1 has been identified, and this may open the way to a better understanding of disorders of, for example, iron and zinc metabolism; (11) the nutrient transporters such as SGLT1 are responsible for a portion of the intestinal absorption of

  6. CT enteroclysis in the diagnostics of small bowel diseases

    PubMed Central

    Kołodziej, Marian; Annabhani, Abdulhabib; Sąsiadek, Marek

    2010-01-01

    Summary Background: The role of CT enteroclysis is gaining on importance in the diagnostics of small bowel diseases. The aim of the study was to present own experiences in CT enteroclysis application, with the use of a 64-detector CT unit. Material/Methods: CT enteroclyses were performed in 60 patients: 53 with the suspicion of the Crohn’s disease, 2 suspected for carcinoid, 1 with suspicion of the fistula between the small bowel and the bladder, 2 suspected for the tumor of the ileo-caecal region, and in 1 case, the aim of examination was to carry out an evaluation of the postsurgical state of the bowel-bowel anastomosis. We used own endoscopic technique of catheter insertion into the bowel, which shortens the examination time and improves patient’s comfort. Results: The catheter was correctly introduced into the small bowel in 58 patients (endoscopy had to be repeated in 4 cases). Only 2 examinations failed, because patients refused repeated endoscopy. Radiological signs of the Crohn’s disease were found in 50 out of 53 patients. In the 3 remaining patients, the appearance of the small bowel was normal. In 5 non-Crohn’s disease patients, CT enteroclysis enabled a good visualization of the pathology (tumors, fistula). Conclusions: CT enteroclysis with the use of the 64-detector CT unit is a valuable method in the diagnostics of small bowel diseases. It could supplement or precede capsule endoscopy. PMID:22802779

  7. A Case of Small Bowel Ulcer Associated with Helicobacter pylori

    PubMed Central

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

    2012-01-01

    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. PMID:24010097

  8. Axial Torsion of Gangrenous Meckel's Diverticulum Causing Small Bowel Obstruction

    PubMed Central

    Sasikumar, K.; Noonavath, Ravinder Naik; Sreenath, G. S.; Maroju, Nanda Kishore

    2013-01-01

    Meckel's diverticulum (MD) is a commonly encountered congenital anomaly of the small intestine. We report an extremely unusual case of an axially torted, gangrenous MD presenting as acute intestinal obstruction. A 26-year-old male patient presented to our emergency department with 3 days history of abdominal pain, distention and bilious vomiting. On laparotomy, there was minimal hemorrhagic fluid localized in right iliac fossa and small bowel loops were dilated. A MD was seen attached to the mesentery of nonadjacent small bowel by a peritoneal band. The diverticulum was axially torted and gangrenous. In addition, there was compression of ileum by the peritoneal band resulting in intestinal obstruction, which was relieved on dividing the band. Resection and anastomosis of the small bowel including the MD was performed. We hereby report a rare and unusual complication of a MD. Although treatment outcome is generally good, pre-operative diagnosis is often difficult. PMID:24741431

  9. MR enterographic manifestations of small bowel Crohn disease.

    PubMed

    Tolan, Damian J M; Greenhalgh, Rebecca; Zealley, Ian A; Halligan, Steve; Taylor, Stuart A

    2010-03-01

    Magnetic resonance (MR) enterography is a clinically useful technique for the evaluation of both intraluminal and extraluminal small bowel disease, particularly in younger patients with Crohn disease. MR enterography offers the advantages of multiplanar capability and lack of ionizing radiation. It allows evaluation of bowel wall contrast enhancement, wall thickening, and edema, findings useful for the assessment of Crohn disease activity. MR enterography can also depict other pathologic findings such as lymphadenopathy, fistula and sinus formation, abscesses, and abnormal fold patterns. Even subtle disease manifestations may be detected when adequate distention of the small bowel is achieved, although endoscopic and double-contrast barium small bowel techniques remain superior in the depiction of changes in early Crohn disease (eg, aphthoid ulceration). Further research will be needed to determine whether MR imaging enhancement patterns may reliably help discriminate between active and inactive disease.

  10. X-Ray Induced Photodynamic Therapy: A Combination of Radiotherapy and Photodynamic Therapy

    PubMed Central

    Wang, Geoffrey D.; Nguyen, Ha T.; Chen, Hongmin; Cox, Phillip B.; Wang, Lianchun; Nagata, Koichi; Hao, Zhonglin; Wang, Andrew; Li, Zibo; Xie, Jin

    2016-01-01

    Conventional photodynamic therapy (PDT)'s clinical application is limited by depth of penetration by light. To address the issue, we have recently developed X-ray induced photodynamic therapy (X-PDT) which utilizes X-ray as an energy source to activate a PDT process. In addition to breaking the shallow tissue penetration dogma, our studies found more efficient tumor cell killing with X-PDT than with radiotherapy (RT) alone. The mechanisms behind the cytotoxicity, however, have not been elucidated. In the present study, we investigate the mechanisms of action of X-PDT on cancer cells. Our results demonstrate that X-PDT is more than just a PDT derivative but is essentially a PDT and RT combination. The two modalities target different cellular components (cell membrane and DNA, respectively), leading to enhanced therapy effects. As a result, X-PDT not only reduces short-term viability of cancer cells but also their clonogenecity in the long-run. From this perspective, X-PDT can also be viewed as a unique radiosensitizing method, and as such it affords clear advantages over RT in tumor therapy, especially for radioresistant cells. This is demonstrated not only in vitro but also in vivo with H1299 tumors that were either subcutaneously inoculated or implanted into the lung of mice. These findings and advances are of great importance to the developments of X-PDT as a novel treatment modality against cancer. PMID:27877235

  11. The role of metal ions in X-ray-induced photochemistry.

    PubMed

    Stumpf, V; Gokhberg, K; Cederbaum, L S

    2016-03-01

    Metal centres in biomolecules are recognized as being particularly sensitive to radiation damage by X-ray photons. This results in such molecules being both susceptible to an effective X-ray-induced loss of function and problematic to study using X-ray diffraction methods, with reliable structures of the metal centres difficult to obtain. Despite the abundance of experimental evidence, the mechanistic details of radiation damage at metal centres are unclear. Here, using ab initio calculations, we show that the absorption of X-rays by microsolvated Mg(2+) results in a complicated chain of ultrafast electronic relaxation steps that comprise both intra- and intermolecular processes and last for a few hundred femtoseconds. At the end of this cascade the metal reverts to its original charge state, the immediate environment becomes multiply ionized and large concentrations of radicals and slow electrons build up in the metal's vicinity. We conclude that such cascades involving metal ions are essential to our understanding of radiation chemistry and radiation damage in biological environments.

  12. Establishment of a Dose-response Curve for X-ray-Induced Micronuclei in Human Lymphocytes.

    PubMed

    Lusiyanti, Yanti; Alatas, Zubaidah; Syaifudin, Mukh; Purnami, Sofiati

    2016-01-01

    The cytokinesis-block micronucleus assay in peripheral blood lymphocytes is an established technique for biodosimetry. The aim of this project was to generate a X-ray induced micronuclei (MN) curve for peripheral blood lymphocytes taken from five healthy donors. The blood samples were irradiated with X-rays of 122 KeV at a dose rate of 0.652 Gy/min to doses of 0.5, 1, 2, 3, and 4 Gy. The blood samples were then cultured for 72 h at 37°C and processed following the International Atomic Energy Agency standard procedure with slight modifications. The result showed that the yields of MN frequencies were increased with the increase of radiation dose. Reconstruction of the relationship of MN with dose was fitted to a linear-quadratic model using Chromosome Aberration Calculation Software version 2.0. Due to their advantages, mainly, the dependence on radiation dose and dose rate, despite their limitation, these curves will be useful as alternative method for in vitro dose reconstruction and can support the preparedness for public or occupational radiation overexposure and protection. The results reported here also give us confidence to apply the obtained calibration curve of MN for future biological dosimetry requirements in Indonesia.

  13. Protective role of Aloe vera against X-ray induced testicular dysfunction.

    PubMed

    Bala, S; Chugh, N A; Bansal, S C; Garg, M L; Koul, A

    2016-09-13

    The present investigation was carried out to evaluate the possible radioprotective potential of an Aloe vera extract against whole-body X-ray irradiation-induced testicular alterations in mice. Male balb/c mice were divided into four groups: control, A. vera, X-ray and A. vera pre-treated + X-ray irradiated. Histopathological examination revealed significant structural alterations in testes after X-ray exposure, which was also associated with the presence of apoptotic cells as assessed by TUNEL assay. X-ray irradiation resulted in elevation in the levels of reactive oxygen species, lipid peroxidation, a reduction in glutathione concentration and enhanced activities of antioxidant enzymes such as glutathione reductase, glutathione peroxidase, catalase, superoxide dismutase and glutathione-S-transferase. Sperm count/motility and testosterone levels were significantly decreased in the irradiated group. Irradiated animals pre-treated with A. vera extract revealed an improvement in antioxidant status, inhibition of lipid peroxides, apoptotic cell formation and enhanced testicular parameters when compared to the X-ray-exposed group. These findings suggest that A. vera extract could ameliorate X-ray-induced damage due to its free radical scavenging properties and its potential to boost cellular antioxidant defence machinery.

  14. Establishment of a Dose-response Curve for X-ray-Induced Micronuclei in Human Lymphocytes

    PubMed Central

    Lusiyanti, Yanti; Alatas, Zubaidah; Syaifudin, Mukh; Purnami, Sofiati

    2016-01-01

    The cytokinesis-block micronucleus assay in peripheral blood lymphocytes is an established technique for biodosimetry. The aim of this project was to generate a X-ray induced micronuclei (MN) curve for peripheral blood lymphocytes taken from five healthy donors. The blood samples were irradiated with X-rays of 122 KeV at a dose rate of 0.652 Gy/min to doses of 0.5, 1, 2, 3, and 4 Gy. The blood samples were then cultured for 72 h at 37°C and processed following the International Atomic Energy Agency standard procedure with slight modifications. The result showed that the yields of MN frequencies were increased with the increase of radiation dose. Reconstruction of the relationship of MN with dose was fitted to a linear-quadratic model using Chromosome Aberration Calculation Software version 2.0. Due to their advantages, mainly, the dependence on radiation dose and dose rate, despite their limitation, these curves will be useful as alternative method for in vitro dose reconstruction and can support the preparedness for public or occupational radiation overexposure and protection. The results reported here also give us confidence to apply the obtained calibration curve of MN for future biological dosimetry requirements in Indonesia. PMID:28217283

  15. Protective effect of ethanol on X-ray-induced mitotic recombination in drosophilia melanogaster

    SciTech Connect

    Palermo, A.M.; Rey, M.; Munoz, E.R.

    1994-12-31

    The effect of ethanol treatment on X-ray-induced mitotic recombination in D. melanogaster females was investigated by means of the white/white{sup +} w/w{sup +} spot test. White females inseminated by yellow males were allowed to oviposit for 8 hr on medium containing 5%, 7.5% and 10% (v/v) ethanol and submitted to 10 Gy of X-rays 52 hr after the beginning of the egg laying period (chronic treatments). For acute treatments 56 {+-}4-hr-old larvae grown in regular medium were held in petri dishes containing filter paper soaked with 50% (v/v) ethanol for 30 min before being irradiated with 10 Gy. The emerging heterozygous w/w{sup +} females were inspected for the presence of white spots (LS) in their eyes. Acute ethanol pretreatments lead to a significant reduction in the frequency of LS. This is suggested to be due to the scavenging by ethanol of free radicals originating during irradiation. If so, the contribution of the indirect action of radiation to mitotic recombination induced by X-rays must be significant. Chronic ethanol pretreatments also resulted in a decrease of LS, though impairment of larval development by ethanol may have partly contributed to the effect observed. At the concentrations tested, ethanol by itself did not modify the frequency of LS observed in the control. 29 refs., 4 tabs.

  16. [Malabsorption is a leading clinical sign of small bowel disease].

    PubMed

    Parfenov, A I; Krums, L M

    The paper presents a variety of clinical manifestations of malabsorption syndrome (MAS) in celiac disease, collagenous sprue, Whipple's disease, Crohn's disease, intestinal lymphangiectasia, amyloidosis, common variable immune deficiency, and treatment of short bowel syndrome. It shows the specific features of the pathophysiology, diagnosis, and treatment of MAS in small bowel diseases.

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

    SciTech Connect

    Boothman, D.A.

    1992-01-01

    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.

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

    SciTech Connect

    Budd, M.E.

    1982-07-01

    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)

  19. Free radical scavenger edaravone suppresses x-ray-induced apoptosis through p53 inhibition in MOLT-4 cells.

    PubMed

    Sasano, Nakashi; Enomoto, Atsushi; Hosoi, Yoshio; Katsumura, Yosuke; Matsumoto, Yoshihisa; Shiraishi, Kenshiro; Miyagawa, Kiyoshi; Igaki, Hiroshi; Nakagawa, Keiichi

    2007-11-01

    Edaravone, a clinical drug used widely for the treatment of acute cerebral infarction, is reported to scavenge free radicals. In the present study, we investigated the radioprotective effect of edaravone on X-ray-induced apoptosis in MOLT-4 cells. Apoptosis was determined by the dye exclusion test, Annexin V binding assay, cleavage of caspase, and DNA fragmentation. We found that edaravone significantly suppressed the X-ray-induced apoptosis. The amount of intracellular ROS production was determined by the chloromethyl-2',7'-dichlorodihydro-fluorescein diacetate system. We found that the intracellular ROS production by X-irradiation was completely suppressed by the addition of edaravone. The accumulation and phosphorylation of p53 and the expression of p21(WAF1), a target protein of p53, which were induced by X-irradiation, were also suppressed by adding edaravone. We conclude that the free radical scavenger edaravone suppresses X-ray-induced apoptosis in MOLT-4 cells by inhibiting p53.

  20. [Small bowel neurofibromatosis in Von Recklinghausen's disease. A rare cause of emergency surgery].

    PubMed

    Ben Achour, Jamel; Hani, Mohamed Aziz; Bouasker, Ibtissem; Guesmi, Fethi; Zoghlami, Ayoub; Najah, Nabil

    2003-11-01

    Two cases of small bowel neurofibromatosis in patients with Von Recklinghausen's disease are reported. Diagnosis of small bowel neurofibromatosis was made on the occasion of a complication for the two cases. We insist on the difficulty of diagnosis as well as in presence or not of complications. Treatment of these most often benign tumours remains surgical based on a segmental small bowel resection.

  1. [Prenatal discovery of Joubert syndrome associated with small bowel volvulus].

    PubMed

    Aurégan, C; Donciu, V; Millischer, A-E; Khen-Dunlop, N; Deloison, B; Sonigo, P; Magny, J-F

    2016-03-01

    Joubert syndrome and prenatal volvulus are difficult to diagnose during pregnancy. Joubert syndrome and related diseases should be considered in case of prenatal abnormal features of the fourth ventricle. Small bowel volvulus is also a surgical emergency because of the risk of intestinal necrosis before or after delivery. This type of condition justifies the transfer of pregnant women to a specialized hospital where the newborn may receive appropriate care. We report the case of a 31-week and 4-day gestational-age fetus in whom intrauterine growth retardation and small-bowel volvulus were diagnosed. Additional imaging revealed associated Joubert syndrome. This highlights the need for regular ultrasound monitoring during pregnancy and the comanagement of obstetricians and pediatricians to provide appropriate care before and after delivery.

  2. An Uncommon Cause of a Small-Bowel Obstruction.

    PubMed

    Zakaria, Ali; Al Share, Bayan; Turk, Issam; Ahsan, Samira; Farra, Waseem

    2017-01-01

    Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by the formation of noncaseating granulomas. Gastrointestinal (GI) system involvement that is clinically recognizable occurs in less than 0.9% of patients with sarcoidosis, with data revealing small intestine involvement in 0.03% of the cases. A high index of suspension is required in patients presenting with small-bowel obstruction and previous history of sarcoidosis. Establishing a definitive diagnosis of GI sarcoidosis depends on biopsy evidence of noncaseating granulomas, exclusion of other causes of granulomatous disease, and evidence of sarcoidosis in at least one other organ system. Treatment of GI sarcoidosis depends on symptomatology and disease activity. Herein, we are presenting a case of 67-year-old female patient who had acute small-bowel obstruction at the level of jejunum with postoperative histopathologic evidence of noncaseating granulomatous inflammation with multinucleated giant cells, consistent with sarcoidosis.

  3. An Uncommon Cause of a Small-Bowel Obstruction

    PubMed Central

    Al Share, Bayan; Turk, Issam; Farra, Waseem

    2017-01-01

    Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by the formation of noncaseating granulomas. Gastrointestinal (GI) system involvement that is clinically recognizable occurs in less than 0.9% of patients with sarcoidosis, with data revealing small intestine involvement in 0.03% of the cases. A high index of suspension is required in patients presenting with small-bowel obstruction and previous history of sarcoidosis. Establishing a definitive diagnosis of GI sarcoidosis depends on biopsy evidence of noncaseating granulomas, exclusion of other causes of granulomatous disease, and evidence of sarcoidosis in at least one other organ system. Treatment of GI sarcoidosis depends on symptomatology and disease activity. Herein, we are presenting a case of 67-year-old female patient who had acute small-bowel obstruction at the level of jejunum with postoperative histopathologic evidence of noncaseating granulomatous inflammation with multinucleated giant cells, consistent with sarcoidosis. PMID:28386490

  4. Small Bowel Angioedema Secondary to Angiotensin-Converting Enzyme Inhibitors

    PubMed Central

    Hurairah, Abu

    2016-01-01

    Small bowel angioedema induced by angiotensin-converting enzyme (ACE) inhibitors is a rare clinicopathologic entity. It frequently poses a diagnostic challenge and is often not recognized before surgical exploration. The present study illustrates that clinical awareness for this condition and adequate use of radiologic investigations can help make the correct diagnosis of ACE inhibitor-associated angioedema, thus avoiding the cost and morbidity associated with unnecessary interventions. PMID:28133581

  5. Small bowel strangulation due to peritoneopericardial diaphragmatic hernia

    PubMed Central

    2014-01-01

    A 75-year-old Korean man was referred to our hospital with cramping abdominal pain. His chest X-ray showed an abnormal air shadow above the diaphragm, and computed tomography showed an abdominal viscera in the pericardium. We performed surgery and confirmed peritoneopericardial diaphragmatic hernia with small bowel strangulation. Postoperative course was uneventful. Peritoneopericardial diaphragmatic hernia is very rare in humans, so we report the case with a literature review. PMID:24694166

  6. Electrostimulation to move endoscopes in the small bowel

    NASA Astrophysics Data System (ADS)

    Mosse, Charles A.; Mills, Timothy N.; Appleyard, Mark; Swain, Paul

    2001-01-01

    Background: Methods are required for propulsion of endoscopes through the small bowel and for propelling capsule endoscopes without cables. Aim: To test the hypothesis that electrical stimulation could propel an endoscope by stimulating muscular contraction. Methods: Prototype acrylic devices of ovoid shape were constructed with two stainless steel electrodes mounted on the tapered section. Five devices of 13 to 23 mm diameter with a taper of 16 degree(s) to 20 degree(s) (half angle) were tested. When in contact with the bowel wall electrostimulation was applied causing circular muscle contraction which when applied to the taper of the ovoid resulted in forward propulsion of the device. The method does not induce peristalsis but works by stimulating local contraction. The device was tested in small bowel and oesophagus of anaesthetized pigs. Results: Electrostimulation caused the ovoid to advance rapidly (6 mm/sec) up and down the oesophagus by inducing circular esophageal muscle contraction. When stimulated at 15 Hz with 30 ms pulses the threshold for movement was 12 mA; at 20 mA the device moved reliably in both directions in the small bowel at speeds of up to 4.5 mm/s, negotiating tight curves.

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

    SciTech Connect

    Liu Qing; He Xiaoqing; Liu Yongsheng; Du Bingbing; Wang Xiaoyan; Zhang Weisheng; Jia Pengfei; Dong Jingmei; Ma Jianxiu; Wang Xiaohu; Li Sha; Zhang Hong

    2008-12-19

    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.

  8. MR enterography for assessment and management of small bowel Crohn disease.

    PubMed

    Allen, Brian C; Leyendecker, John R

    2014-07-01

    Magnetic resonance enterography (MRE) utilization has increased for the evaluation of small bowel diseases over the last several years. In addition to performing similarly to computed tomography enterography (CTE) in the evaluation of inflammatory bowel disease, MRE lacks ionizing radiation, can image the small bowel dynamically, and provides excellent soft tissue contrast resolution. This article reviews imaging protocols for MRE, normal MR imaging appearance of small bowel, and the imaging findings of small bowel Crohn disease. The importance of imaging findings for directing management in patients with small bowel Crohn disease is emphasized throughout.

  9. Large intraluminal ileal hematoma presenting as small bowel obstruction in a child.

    PubMed

    Lim, Yun Jung; Nam, So Hyun; Kim, Seon Jeong

    2015-04-01

    Intraluminal small bowel hematoma has been rarely reported in children, as a rare cause of small bowel obstruction. We present a case of an intraluminal ileal hematoma presenting as small bowel obstruction in a child. Computed Tomography (CT) indicated a large intraluminal hyperdense lesion in the distal ileum as the cause of small bowel obstruction. Abdominal ultrasonography (US) showed an echogenic mass-like lesion with multiple septa in the distal ileum. Small bowel obstruction due to a complicated cystic mass was provisionally diagnosed. Histopathologic examination of the resected mass suggested a submucosal ileal hematoma. Although intraluminal small bowel hematoma is rare in children, it can present as an intraluminal cystic mass and should be considered as a rare cause of small bowel obstruction. The US and CT findings of submucosal ileal hematoma could be useful for the diagnosis of such cases in the future.

  10. X-ray-induced cell death in the developing hippocampal complex involved neurons and requires protein synthesis

    SciTech Connect

    Ferrer, I.; Serrano, T.; Alcantara, S.; Tortosa, A.; Graus, F.

    1993-07-01

    Sprague-Dawley rats aged 1 or 15 days were irradiated with a single dose of 200 cGy X-rays and killed at different intervals from 3 to 48 hours (h). Dying cells were recognized by their shrunken and often fragmented nuclei and less damaged cytoplasm in the early stages. On the basis of immunocytochemical markers, dying cells probably represented a heterogeneous population which included neurons and immature cells. In rats aged 1 day the number of dying cells rapidly increased in the hippocampal complex with peak values 6 h after irradiation. This was following by a gentle decrease to reach normal values 48 h after irradiation. The most severely affected regions were the subplate and the cellular layer of the subiculum, gyrus dentatus and hilus, and the stratum oriens and pyramidale of the hippocampus (CA1 more affected than CA2, and this more affected than CA3). X-ray-induced cell death was abolished with an injection of cycloheximide (2 [mu]g/g i.p.) given at the time of irradiation. X-ray-induced cell death was not changed after the intraventicular administration of nerve growth factor (NGF; 10 [mu]g in saline) at the time of irradiation. Cell death was not induced by X-irradiation in rats aged 15 days. These results indicate that X-ray-induced cell death in the hippocampal complex of the developing rat is subjected to determinate temporal and regional patterns of vulnerability; it is an active process mediated by protein synthesis but probably not dependent on NGF. 60 refs., 5 figs.

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

    SciTech Connect

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

    1983-01-01

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

  12. Obturator hernia: An uncommon cause of small bowel obstruction

    PubMed Central

    Shreshtha, S

    2016-01-01

    A 70 year old lady presented to surgery emergency with small bowel obstruction without any obvious etiology. On exploration she was found to have an obstructed obturator hernia, which is a rare pelvic hernia with an incidence of 0.07-1.4% of all intra-abdominal hernias. Diagnosis is often delayed until laparotomy for bowel obstruction. Strangulation is frequent and mortality remains high (25%). Early diagnosis and surgical treatment contributes greatly to reduce the mortality and morbidity rates. A variety of techniques have been described, however surgical repair has not been standardized. It is an important diagnosis to be considered in elderly patients with intestinal obstruction. PMID:27763487

  13. Intestinal anisakiasis as a rare cause of small bowel obstruction.

    PubMed

    Kojima, Gotaro; Usuki, Shinichiro; Mizokami, Ken; Tanabe, Marianne; Machi, Junji

    2013-09-01

    Anisakiasis, a parasitic infection by larvae of the nematode Anisakis found in raw or undercooked saltwater fish, mostly involves stomach but rarely small intestine. We report a rare case of a 61-year-old man who presented with abdominal pain and developed small bowel obstruction caused by intestinal anisakiasis. Abdominal computed tomography revealed segmental edema of the intestinal wall with proximal dilatation. The patient underwent urgent laparotomy because strangulated small bowel obstruction was suspected. A localized portion of the intestine around jejunoileal junction was found to be erythematous, edematous, and hardened, which was resected. The resected specimen showed a linear whitish worm, Anisakis simplex, penetrating into the intestinal mucosa. It is often clinically challenging to consider intestinal anisakiasis in the differential diagnosis because of its nonspecific abdominal symptoms and findings. Although gastrointestinal anisakiasis is still rare in the United States, the incidence is expected to rise given the growing popularity of Japanese cuisine such as sushi or sashimi. Anisakiasis should be considered as one of the differential diagnoses in patients with nonspecific abdominal symptoms after consumption of raw or undercooked fish.

  14. Endoscopic band ligation for bleeding lesions in the small bowel

    PubMed Central

    Ikeya, Takashi; Ishii, Naoki; Shimamura, Yuto; Nakano, Kaoru; Ego, Mai; Nakamura, Kenji; Takagi, Koichi; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2014-01-01

    AIM: To investigate the safety and efficacy of endoscopic band ligation (EBL) for bleeding lesions in the small bowel. METHODS: This is a retrospective study evaluating EBL in six consecutive patients (three males, three females, 46-86 years of age) treated between May 2009 and February 2014: duodenal vascular ectasia; 1, jejunal bleeding diverticulum; 1, ileal Dieulafoy’s lesion; 1 and ileal bleeding diverticula; 3. The success of the initial hemostasis was evaluated, and patients were observed for early rebleeding (within 30 d after EBL), and complications such as perforation and abscess formation. Follow-up endoscopies were performed in four patients. RESULTS: Initial hemostasis was successfully achieved with EBL in all six patients. Eversion was not sufficient in four diverticular lesions. Early rebleeding occurred three days after EBL in one ileal diverticulum, and a repeat endoscopy revealed dislodgement of the O-band and ulcer formation at the banded site. This rebleeding was managed conservatively. Late rebleeding occurred in this case (13 and 21 mo after initial EBL), and re-EBL was performed. Follow-up endoscopies revealed scar formation and the disappearance of vascular lesions at the banded site in the case with a duodenal bleeding lesion, and unresolved ileal diverticula in three cases. Surgery or transarterial embolization was not required without any complications during the median follow-up period of 45 (range, 2-83) mo. CONCLUSION: EBL is a safe and effective endoscopic treatment for hemostasis of bleeding lesions in the small bowel. PMID:25324920

  15. Complicated Jejunal Diverticulosis: Small Bowel Volvulus with Obstruction

    PubMed Central

    Mohi, Rommel Singh; Moudgil, Ashish; Bhatia, Suresh Kumar; Seth, Kaushal; Kaur, Tajinder

    2016-01-01

    The incidence of the diverticulum of the small bowel varies from 0.2-1.3% in autopsy studies to 2.3% when assessed on enteroclysis. It occurs mostly in patients in the 6th decade of their life. Of all the small bowel diverticuli, jejunal diverticulum is the most common type. This rare entity is usually asymptomatic. However, they may cause chronic non-specific symptoms for a long period of time like dyspepsia, chronic postprandial pain, nausea, vomiting, borborgymi, alternating diarrhoea and constipation, weight loss, anaemia, steatorrhea or rarely lead to complications like haemorrhage, obstruction, perforation. Obstruction can be due to enterolith, adhesions, intussusception, and volvulus. The condition is difficult to diagnose because patients are generally presented with symptoms that mimic other diseases. It is important for clinicians to have awareness of this entity. Here, we present a case of multiple jejunal diverticuli with a history of repeated attacks of diverticulitis over past 20 years, which were misdiagnosed and now presented with intestinal obstruction due to volvulus of the involved segment along with mesentery around its axis. Resection of the diverticuli segment of jejunum was done with end-to-end jejuno-jejunal anastomosis. The patient is asymptomatic since 10 months of follow-up. PMID:27853337

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

    PubMed Central

    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

    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

  17. Percutaneous gastric drainage as a treatment for small bowel obstruction after gastric bypass.

    PubMed

    Hamoui, Nahid; Crookes, Peter F; Kaufman, Howard S

    2007-10-01

    The authors report the case of a patient who developed small bowel obstruction after laparoscopic gastric bypass. Imaging revealed an obstruction at the enteroenterostomy resulting in dilation of the bypassed stomach and proximal small bowel. The bypassed stomach was percutaneously drained using CT guidance, leading to resolution of the small bowel obstruction. Biliopancreatic limb obstructions can be successfully treated non-operatively after gastric bypass.

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

    PubMed Central

    2011-01-01

    Introduction Phytobezoars are concretions of poorly digested fruit and vegetable fibers found in the alimentary tract. Previous gastric resection, gastrojejunostomy, or pyloroplasty predispose people to bezoar formation. Small-bowel bezoars normally come from the stomach, and primary small-bowel bezoars are very rare. They are seen only in patients with underlying small-bowel diseases such as diverticula, strictures, or tumors. Primary small-bowel bezoars almost always present as intestinal obstructions, although it is a very rare cause, being responsible for less than 3% of all small-bowel obstructions in one series. Jejunal diverticula are rare, with an incidence of less than 0.5%. They are usually asymptomatic pseudodiverticula of pulsion type, and complications are reported in 10% to 30% of patients. A phytobezoar in a jejunal diverticulum is an extremely rare presentation. Case presentation A 78-year-old Pakistani man presented to our clinic with small-bowel obstruction. Upon exploration, we found a primary small-bowel bezoar originating in a jejunal diverticulum and causing jejunal obstruction. Resection and anastomosis of the jejunal segment harboring the diverticulum was performed, and our patient had an uneventful recovery. Conclusion Primary small-bowel bezoars are very rare but must be kept in mind as a possible cause of small-bowel obstruction. PMID:21951579

  19. Repeated Small Bowel Obstruction Caused by Chestnut Ingestion without the Formation of Phytobezoars.

    PubMed

    Satake, Ryu; Chinda, Daisuke; Shimoyama, Tadashi; Satake, Miwa; Oota, Rie; Sato, Satoshi; Yamai, Kiyonori; Hachimori, Hisashi; Okamoto, Yutaka; Yamada, Kyogo; Matsuura, Osamu; Hashizume, Tadashi; Soma, Yasushi; Fukuda, Shinsaku

    2016-01-01

    A small number of cases of small bowel obstruction caused by foods without the formation of phytobezoars have been reported. Repeated small bowel obstruction due to the ingestion of the same food is extremely rare. We present the case of 63-year-old woman who developed small bowel obstruction twice due to the ingestion of chestnuts without the formation of phytobezoars. This is the first reported case of repeated small bowel obstruction caused by chestnut ingestion. Careful interviews are necessary to determine the meal history of elderly patients and psychiatric patients.

  20. Effect of longer battery life on small bowel capsule endoscopy

    PubMed Central

    Ou, George; Shahidi, Neal; Galorport, Cherry; Takach, Oliver; Lee, Terry; Enns, Robert

    2015-01-01

    AIM: To determine if longer battery life improves capsule endoscopy (CE) completion rates. METHODS: A retrospective study was performed at a tertiary, university-affiliated hospital in Vancouver, Canada. Patients who underwent CE with either PillCam™ SB2 or SB2U between 01/2010 and 12/2013 were considered for inclusion. SB2 and SB2U share identical physical dimensions but differ in their battery lives (8 h vs 12 h). Exclusion criteria included history of gastric or small bowel surgery, endoscopic placement of CE, interrupted view of major landmarks due to technical difficulty or significant amount of debris, and repeat CE using same system. Basic demographics, comorbidities, medications, baseline bowel habits, and previous surgeries were reviewed. Timing of major landmarks in CE were recorded, and used to calculate gastric transit time, small bowel transit time, and total recording time. A complete CE study was defined as visualization of cecum. Transit times and completion rates were compared. RESULTS: Four hundred and eight patients, including 208 (51.0%) males, were included for analysis. The mean age was 55.5 ± 19.3 years. The most common indication for CE was gastrointestinal bleeding (n = 254, 62.3%), followed by inflammatory bowel disease (n = 86, 21.1%). There was no difference in gastric transit times (group difference 0.90, 95%CI: 0.72-1.13, P = 0.352) and small bowel transit times (group difference 1.07, 95%CI: 0.95-1.19, P = 0.261) between SB2U and SB2, but total recording time was about 14% longer in the SB2U group (95%CI: 10%-18%, P < 0.001) and there was a corresponding trend toward higher completion rate (88.2% vs 93.2%, OR = 1.78, 95%CI 0.88-3.63, P = 0.111). There was no statistically significant difference in the rates of positive findings (OR = 0.98, 95%CI: 0.64-1.51, P = 0.918). CONCLUSION: Extending the operating time of CE may be a simple method to improve completion rate although it does not affect the rate of positive findings. PMID

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

    NASA Astrophysics Data System (ADS)

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

    2001-09-01

    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. Fluorescence and scattered photons are collected by a cryogenic energy-resolving Ge detector. The high signal-to-noise spectra show strong fluorescence from Dy, Cs, and I, as well as elastic scattering from Hg. Radial distributions of the absolute elemental densities of Dy, Cs, and I are obtained.

  2. Inhibition of X-ray-induced DNA strand break repair in polyamine-depleted HeLa cells.

    PubMed

    Snyder, R D

    1989-05-01

    Treatment of HeLa cells with the polyamine biosynthesis inhibitors, alpha-difluoromethylornithine (DFMO) or methylglyoxal bis(guanylhydrazone) (MGBG), results in, depending on the conditions, partial or complete depletion of the cellular polyamines: putrescine, spermidine and spermine. In this compromised state cells exhibited a distinct deficiency in repair of X-ray-induced DNA strand breaks. The half-time for return of normal DNA sedimentation following 1.6 Gy was 9.5 min for untreated control cells and 22, 32 and 50 min for cells treated with MGBG, DFMO + MGBG and DFMO, respectively. Normal repair kinetics were restored to these cells upon a short incubation in media containing all three polyamines. The rapid early phase of repair following higher X-ray doses (16 Gy) was also delayed in polyamine-depleted cells but later repair occurring 1-4 h post-irradiation, representing chromatin reconstitution, was apparently normal.

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

    SciTech Connect

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

    2001-09-24

    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 DyI{sub 3} and CsI. Fluorescence and scattered photons are collected by a cryogenic energy-resolving Ge detector. The high signal-to-noise spectra show strong fluorescence from Dy, Cs, and I, as well as elastic scattering from Hg. Radial distributions of the absolute elemental densities of Dy, Cs, and I are obtained.

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

    SciTech Connect

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

    2012-03-15

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

  5. Benign Cystic Peritoneal Mesothelioma Revealed by Small Bowel Obstruction

    PubMed Central

    Bray Madoué, Kaimba; Boniface, Moifo; Annick Laure, Edzimbi; Pierre, Herve

    2016-01-01

    Benign cystic peritoneal mesothelioma is a rare tumor which frequently occurs in women of reproductive age. Abdominal pain associated with pelvic or abdominal mass is the common clinical presentation. We report the case of a 22-year-old woman with a pathological proved benign cystic mesothelioma of the peritoneum revealed by a small bowel obstruction and a painful left-sided pelvic mass with signs of psoitis. Contrast enhanced abdominal CT-scan demonstrated a large pelvic cystic mass with mass effect on rectosigmoid and pelvic organs. The patient underwent surgical removal of the tumor. Pathological examination revealed the diagnosis of benign cystic mesothelioma of the peritoneum. The outcome was excellent with a 12-month recoil. PMID:27066288

  6. Wernicke-Korsakoff syndrome following small bowel obstruction.

    PubMed

    Deb, S; Law-Min, R; Fearnley, D

    We report a case of a 64-year-old lady who developed clinical features of Wernicke-Korsakoff syndrome following a laparotomy for small bowel obstruction. Following the operation she developed paralytic ileus and required total parenteral nutrition for one month. A suspected history of average 40 units of weekly alcohol consumption prior to the operation could not be confirmed and the patient did not show any sign of alcohol dependence. Within a few months of treatment with a daily oral dose of thiamine 200 mgs supplemented by multivitamins the patient showed subjective evidence of improvement in confusion, confabulation, and anterograde amnesia, although objective tests showed residual deficits in many areas of cognitive functioning, including immediate and delayed recall of verbal and non-verbal materials, planning and switching of attention.

  7. [Acute small bowel obstruction: conservative or surgical treatment?].

    PubMed

    Schwenter, F; Dominguez, S; Meier, R; Oulhaci-de Saussure, W; Platon, A; Gervaz, P; Morel, P

    2011-06-22

    Small bowel obstruction (SBO) is a common clinical syndrome caused mainly by postoperative adhesions. In complement to clinical and biological evaluations, CT scan has emerged as a valuable imaging modality and may provide reliable information. The early recognition of signs suggesting bowel ischemia is essential for urgent operation. However appropriate management of SBO remains a common clinical challenge. Although a conservative approach can be successful in a substantial percentage of selected patients, regular and close re-assessement is mandatory. Any persistance or progression of the critical symptoms and signs should indeed lead to surgical exploration. Here we review the principles of adhesive SBO management and suggest a decision procedure for conservative versus surgical treatment.

  8. [Indications and results of small bowel transplantation in adults].

    PubMed

    Joly, Francisca; Panis, Yves

    2012-02-01

    immunosuppression to control rejection. By 1990, the development of tacrolimus-based immunosuppression, as well as improved surgical techniques, the increased array of potent immunosuppressive medications, infection prophylaxis, and better patient selection helped to improve actuarial graft and patient survival rates for all types of intestine transplantation. In adult intestinal transplantation, three kinds of graft can be proposed: isolated small bowel, combined liver and small bowel, and multivisceral transplantation. In isolated small bowel transplantation, the length of the graft ranges between 1.5 and 2 meters, but depends on the size of the recipient (and the abdominal cavity volume, which is reduced). The graft is anastomosed with the recipient's duodenum or remnant proximal jejunum. the distal part of the small bowel graft is on a temporary stoma, in order to allow biopsies for early detection of rejection. Vascular anastomoses are usually performed directly on the aorta for the superior mesenteric artery and either the recipient's portal vein or vena cava for the donor superior mesenteric vein. In combined liver and intestinal transplantation, one venous anastomosis is avoided because the graft is in one piece. Finally, one specificity of this transplantation is the fact that it usually concerns patients with numerous previous abdominal operations and with total or subtotal enterectomy. Thus, the residual abdominal cavity is usually very small, and this can be a major problem for graft insertion. For this reason, abdominal closure is performed with a temporary prosthesis, because even cutaneous closure remains impossible if a compartment syndrome is to be avoided.

  9. Primary Adenocarcinoma of an Ileostomy in Crohn's Disease

    PubMed Central

    Prasad, Meena A.; Lo, Amy; Bellaguarda, Emanuelle; Strong, Scott; Hanauer, Stephen B.

    2016-01-01

    Although Crohn's disease has been associated with an increased risk of small bowel adenocarcinoma, primary adenocarcinoma arising from an ileostomy is a complication that has been rarely documented in Crohn's disease. Chronic small bowel inflammation may lead to development of malignancy through the dysplasia-carcinoma sequence. We report a case of a 61-year-old woman with Crohn's ileocolitis diagnosed with a primary adenocarcinoma at the ileostomy with metastases to the liver 47 years after proctocolectomy, and review the literature. PMID:27622191

  10. Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding

    PubMed Central

    Tsibouris, Panagiotis; Kalantzis, Chissostomos; Apostolopoulos, Periklis; Zalonis, Antonios; Isaacs, Peter Edward Thomas; Hendrickse, Mark; Alexandrakis, Georgios

    2014-01-01

    AIM: To determine the frequency of small bowel ulcerative lesions in patients with peptic ulcer and define the significance of those lesions. METHODS: In our prospective study, 60 consecutive elderly patients with upper gastrointestinal bleeding from a peptic ulceration (cases) and 60 matched patients with a non-bleeding peptic ulcer (controls) underwent small bowel capsule endoscopy, after a negative colonoscopy (compulsory in our institution). Controls were evaluated for non-bleeding indications. Known or suspected chronic inflammatory conditions and medication that could harm the gut were excluded. During capsule endoscopy, small bowel ulcerative lesions were counted thoroughly and classified according to Graham classification. Other small bowel lesions were also recorded. Peptic ulcer bleeding was controlled endoscopically, when adequate, proton pump inhibitors were started in both cases and controls, and Helicobacter pylori eradicated whenever present. Both cases and controls were followed up for a year. In case of bleeding recurrence upper gastrointestinal endoscopy was repeated and whenever it remained unexplained it was followed by repeat colonoscopy and capsule endoscopy. RESULTS: Forty (67%) cases and 18 (30%) controls presented small bowel erosions (P = 0.0001), while 22 (37%) cases and 4 (8%) controls presented small bowel ulcers (P < 0.0001). Among non-steroidal anti-inflammatory drug (NSAID) consumers, 39 (95%) cases and 17 (33%) controls presented small bowel erosions (P < 0.0001), while 22 (55%) cases and 4 (10%) controls presented small bowel ulcers (P < 0.0001). Small bowel ulcerative lesions were infrequent among patients not consuming NSAIDs. Mean entry hemoglobin was 9.3 (SD = 1.4) g/dL in cases with small bowel ulcerative lesions and 10.5 (SD = 1.3) g/dL in those without (P = 0.002). Cases with small bowel ulcers necessitate more units of packed red blood cells. During their hospitalization, 6 (27%) cases with small bowel ulcers presented

  11. The use of effervescent agents in the small bowel meal examination.

    PubMed

    Griffiths, P D; Hufton, A P; Martin, D F

    1993-10-01

    Some perceived disadvantages of the small bowel meal examination are failure of adequate distension, lack of a double contrast effect and the duration of the procedure. A new use for effervescent granules during the small bowel meal is described which reduces the examination time by 70% and reduces the radiation dose to the patient.

  12. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

    PubMed

    Pennazio, Marco; Spada, Cristiano; Eliakim, Rami; Keuchel, Martin; May, Andrea; Mulder, Chris J; Rondonotti, Emanuele; Adler, Samuel N; Albert, Joerg; Baltes, Peter; Barbaro, Federico; Cellier, Christophe; Charton, Jean Pierre; Delvaux, Michel; Despott, Edward J; Domagk, Dirk; Klein, Amir; McAlindon, Mark; Rosa, Bruno; Rowse, Georgina; Sanders, David S; Saurin, Jean Christophe; Sidhu, Reena; Dumonceau, Jean-Marc; Hassan, Cesare; Gralnek, Ian M

    2015-04-01

    This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders. Main recommendations 1 ESGE recommends small-bowel video capsule endoscopy as the first-line investigation in patients with obscure gastrointestinal bleeding (strong recommendation, moderate quality evidence). 2 In patients with overt obscure gastrointestinal bleeding, ESGE recommends performing small-bowel capsule endoscopy as soon as possible after the bleeding episode, optimally within 14 days, in order to maximize the diagnostic yield (strong recommendation, moderate quality evidence). 3 ESGE does not recommend the routine performance of second-look endoscopy prior to small-bowel capsule endoscopy; however whether to perform second-look endoscopy before capsule endoscopy in patients with obscure gastrointestinal bleeding or iron-deficiency anaemia should be decided on a case-by-case basis (strong recommendation, low quality evidence). 4 In patients with positive findings at small-bowel capsule endoscopy, ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by capsule endoscopy (strong recommendation, high quality evidence). 5 ESGE recommends ileocolonoscopy as the first endoscopic examination for investigating patients with suspected Crohn's disease (strong recommendation, high quality evidence). In patients with suspected Crohn's disease and negative ileocolonoscopy findings, ESGE recommends small-bowel capsule endoscopy as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known stenosis (strong recommendation, moderate quality evidence).ESGE does not recommend routine small-bowel imaging or the use of the PillCam patency capsule

  13. Small bowel capsule endoscopy: Where are we after almost 15 years of use?

    PubMed Central

    Van de Bruaene, Cedric; De Looze, Danny; Hindryckx, Pieter

    2015-01-01

    The development of capsule endoscopy (CE) in 2001 has given gastroenterologists the opportunity to investigate the small bowel in a non-invasive way. CE is most commonly performed for obscure gastrointestinal bleeding, but other indications include diagnosis or follow-up of Crohn’s disease, suspicion of a small bowel tumor, diagnosis and surveillance of hereditary polyposis syndromes, Nonsteroidal anti-inflammatory drug-induced small bowel lesions and celiac disease. Almost fifteen years have passed since the release of the small bowel capsule. The purpose of this review is to offer the reader a brief but complete overview on small bowel CE anno 2014, including the technical and procedural aspects, the possible complications and the most important indications. We will end with some future perspectives of CE. PMID:25610531

  14. An undigested cherry tomato as a rare cause of small bowel obstruction.

    PubMed

    Mortezavi, A; Schneider, P M; Lurje, G

    2015-07-01

    Small bowel obstruction due to undigested fibre from fruits and vegetables is a rare but known medical condition. We report a case of small bowel obstruction caused by a whole cherry tomato in a patient without a past medical history of abdominal surgery. A 66-year-old man presented to the emergency department complaining of lower abdominal pain with nausea and vomiting. His last bowel movement had occurred on the morning of presentation. He underwent abdominal computed tomography (CT), which showed a sudden change of diameter in the distal ileum with complete collapse of the proximal small bowel segment. Laparoscopy confirmed a small bowel obstruction with a transition point close to the ileocaecal valve. An enterotomy was performed and a completely undigested cherry tomato was retrieved. To our knowledge, this is the first reported case of a small bowel obstruction caused by a whole cherry tomato.

  15. Review of small-bowel cleansing scales in capsule endoscopy: A panoply of choices

    PubMed Central

    Ponte, Ana; Pinho, Rolando; Rodrigues, Adélia; Carvalho, João

    2016-01-01

    Evaluation of the quality of small-bowel cleansing is required to assess the reliability of findings in capsule endoscopy (CE). Moreover, consensus regarding the need of intestinal preparation for CE remains to be achieved. The presence of multiple grading scales for small-bowel preparation in CE, which are time-consuming and complicated, adds difficulty to the comparison of different small-bowel cleansing regimens and their application in clinical practice. Nowadays, a validated scale universally accepted for grading small-bowel cleansing is lacking. In fact, there are numerous grading systems with very different technical characteristics, namely, the parameters and the portion of the CE video that are analyzed, the objectivity of the analysis, the lesser or greater dependency on the operator, and the validation of the score. The authors performed a review which aims to systematize and summarize currently available small-bowel grading scales in CE. PMID:27668070

  16. Perioperative endoscopy of the whole small bowel in Crohn's disease.

    PubMed Central

    Lescut, D; Vanco, D; Bonnière, P; Lecomte-Houcke, M; Quandalle, P; Wurtz, A; Colombel, J F; Delmotte, J S; Paris, J C; Cortot, A

    1993-01-01

    The aim of this study was to search for small bowel lesions by means of a perioperative endoscopy in 20 patients operated on for Crohn's disease. Seven women and 13 men (mean age 29 years) had a total retrograde exploration to the angle of Treitz during an ileocolectomy (16 of 20 patients) or a colonic or ileal resection (four of 20 patients). Endoscopic exploration was completed, through an enterotomy, from the surgical area to the angle of Treitz. Periendoscopic biopsy samples were taken on macroscopic lesions and every 20 cm systematically. In 13 of 20 cases, various lesions scattered over the whole small intestine were found. These were aphthoid ulcerations (10 patients), superficial ulcerations (seven patients), mucosal oedema (three patients), non-ulcerative stenosis (three patients), erythema (two patients), pseudopolyps (two patients), deep ulcerations (two patients), and ulcerative stenosis (one patient). In seven patients none of the lesions detected at perioperative endoscopy had been recognised by preoperative evaluation or surgical inspection of the serosal surface. A typical granuloma was found at biopsy of lesions identified by endoscopy in three cases and at biopsy of an apparently healthy area in one case. Thus 65% of patients operated on for Crohn's disease had lesions of the small intestine detected by endoscopy, which were unrecognised before surgery in more than half of the cases. PMID:8504965

  17. Integration between a percutaneous implant and the porcine small bowel.

    PubMed

    Johansson, Martin L; Thomsen, Peter; Hultén, Leif; Halvorsen, Per Steinar; Fosse, Erik; Edwin, Bjørn

    2011-07-01

    Inflammatory bowel diseases, cancer or trauma may require removal of all or part of the intestines, leaving the patient with a need to wear external stoma appliances for collection of bowel contents. By connecting the small bowel to a percutaneous port, equipped with a sealing lid, a fully continent and leak proof stoma can be created without a need for permanently wearing stoma appliance. The prerequisites for a connection between a permanent, transabdominal implant and a visceral organ are largely unexplored. Stoma ports made of titanium were implanted in the abdominal wall of domestic pigs and a branch of distal ileum was inserted through the ports. After being followed for 1-3 weeks, the ports were removed and subjected to histological evaluation to study the influence of their shape, structure, and position on the tissue response. Particular focus was attended to the attachment of the ileal serosal surface to the implants inner structure consisting of a titanium mesh. Macroscopic examination revealed fistulas and formation of abscesses in 4 of 11 the retrieved implants. Histological examination revealed regenerated and well-vascularized collagenous tissue around the mesh structure inside the implant. The integration was complete or partial for 10 of 11 ports. Despite various degrees of inflammation and tissue ingrowth, it was demonstrated for the first time that the serosal surface of ileum was firmly attached to the internal structure of the implant. These experiments provide a basis for optimization of the implant and surgical procedure before long-term functional animal experiments.

  18. Small bowel bacterial overgrowth in patients after total gastrectomy.

    PubMed

    Brägelmann, R; Armbrecht, U; Rosemeyer, D; Schneider, B; Zilly, W; Stockbrügger, R W

    1997-05-01

    The aim of this study was to elucidate the consequences of small bowel bacterial overgrowth (SBBO) after total gastrectomy. A total of 127 patients, evaluated for SBBO with a radiographically controlled H2-breath test (subgroup I, without SBBO, n = 80; subgroup II, with SBBO, n = 47) after potentially curative total gastrectomy for gastric malignancy, were uniformly evaluated. Mean time since operation was significantly shorter in subgroup II than in subgroup I [370 days, confidence interval (CI) 96-645 days, vs. 687 days, CI 397-976 days; P < 0.01]. Controlling for this difference, there were no other significant differences in symptoms and signs between the subgroups except for the medico-social functioning measured with the Edinburgh Rehabilitation Status Scale (ERSS). The mean ERSS showed significantly better medicosocial functioning in subgroup I than in subgroup II [3.7 (CI 2.2-5.2) vs. 5.1 (CI 3.0-7.0); P < 0.05]. After total gastrectomy, patients without SBBO did not differ significantly from patients with SBBO in most parameters. Medicosocial functioning was significantly poorer in the latter.

  19. Biomagnetic Techniques for Assessing Gastric and Small Bowel Electrical Activity

    NASA Astrophysics Data System (ADS)

    Bradshaw, L. Alan

    2004-09-01

    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.

  20. X-ray-induced electron cascades in dielectrics modeled with XCASCADE code: effect of impact ionization cross sections

    NASA Astrophysics Data System (ADS)

    Medvedev, Nikita A.

    2015-05-01

    Characterization of a free-electron laser (FEL) pulse can be done with a pump-probe scheme, using an FEL pump and a visible light probe on an optically transparent solid-state target. With such experimental scheme, pulse duration can be monitored on a shot-to-shot basis. It relies on the changes in optical properties induced by the FEL excitation of electrons. Here we analyze effects of different cross sections used in the modeling of electron kinetics. XCASCADE, a Monte Carlo toolkit for modeling x-ray-induced electron cascades (N. Medvedev, Appl. Phys. B 118 (2015) 417), is used for this purpose. Two different cross sections are compared: atomic BEB model vs complex-dielectric function formalism that accounts for collective effects in solids. It is shown that for photon and electron energies above a few tens of eV, the both models coincide very closely. For lower energies in the VUV regime, the difference in the cross sections become more significant, nevertheless producing qualitatively similar electron kinetics and increase in the density of excited electrons.

  1. Dopant concentration dependent optical and X-Ray induced photoluminescence in Eu3+ doped La2Zr2O7

    NASA Astrophysics Data System (ADS)

    Pokhrel, Madhab; Brik, Mikhail; Mao, Yuanbing

    2015-03-01

    Herein, we will be presenting the dopant (Eu) concentration dependent high density La2Zr2O7 nanoparticles for optical and X-ray scintillation applications by use of X - ray diffraction, Raman, FTIR, scanning electron microscope (SEM), transmission electron microscopy (TEM), optically and X-ray excited photoluminescence (PL). Several theoretical methods have been used in order to investigate the structural, electronic, optical, elastic, dynamic properties of Eu doped La2Zr2O7. It is observed that Eu: La2Zr2O7 shows an intense red luminescence under 258, 322, 394 and 465 nm excitation. The optical intensity of Eu: La2Zr2O7 depends on the dopant concentration of Eu3+. Following high energy excitation with X-rays, Eu: La2Zr2O7 shows an atypical Eu PL response (scintillation) with a red emission. The intense color emission of Eu obtained under 258 nm excitation, the X-ray induced luminescence property along with reportedly high density of La2Zr2O7, makes these nanomaterials attractive for optical and X-ray applications. The authors thank the support from the Defense Threat Reduction Agency (DTRA) of the U.S. Department of Defense (Award #HDTRA1-10-1-0114).

  2. Reduction of X-ray-induced radiation damage of macromolecular crystals by data collection at 15 K: a systematic study.

    PubMed

    Meents, A; Wagner, A; Schneider, R; Pradervand, C; Pohl, E; Schulze-Briese, C

    2007-03-01

    The cryocooling of protein crystals to temperatures of around 100 K drastically reduces X-ray-induced radiation damage. The majority of macromolecular data collection is therefore performed at 100 K, yielding diffraction data of higher resolution and allowing structure determination from much smaller crystals. However, at third-generation synchrotron sources radiation damage at 100 K still limits the useful data obtainable from a crystal. For data collection at 15 K, realised by the use of an open-flow helium cryostat, a further reduction of radiation damage is expected. However, no systematic studies have been undertaken so far. In this present study, a total of 54 data sets have been collected from holoferritin and insulin crystals at 15 and 90 K in order to identify the effect of the lower data-collection temperature on the radiation damage. It is shown that data collection at 15 K has only a small positive effect for insulin crystals, whereas for holoferritin crystals radiation damage is reduced by 23% compared with data collection at 90 K.

  3. Where are we at with short bowel syndrome and small bowel transplant

    PubMed Central

    Yildiz, Baris Dogu

    2012-01-01

    Intestinal failure can be defined as the critical reduction of functional gut mass below the minimal amount necessary for adequate digestion and absorption to satisfy body nutrient and fluid requirements in adults or children. Short bowel syndrome (SBS) is characterized by a state of malabsorption following extensive resection of the small bowel. SBS may occur after resection of more than 50% and is certain after resection of more than 70% of the small intestine, or if less than 100 cm of small bowel is left. Several treatment modalities other than total parenteral nutrition, including hormones (recombinant human growth hormone, glucagon-like peptide-2) and tailoring surgeries (Bianchi procedure, serial transverse enteroplasty), had been proposed, however these were either experimental or inefficient. Small bowel transplant is a rather new approach for SBS. The once feared field of solid organ transplantation is nowadays becoming more and more popular, even in developing countries. This is partially secondary to the developments in immunosuppressive strategy. In this regard, alemtuzumab deserves special attention. There are more complex surgeries, such as multivisceral transplantation, for multi-organ involvement including small bowel. This latter technique is relatively new when compared to small bowel transplant, and is performed in certain centers worldwide. In this review, an attempt is made to give an insight into small bowel syndrome, small bowel transplantation, and related issues. PMID:24175201

  4. Mesenteric Vasculature-guided Small Bowel Segmentation on 3D CT

    PubMed Central

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

    2014-01-01

    Due to its importance and possible applications in visualization, tumor detection and pre-operative planning, automatic small bowel segmentation is essential for computer-aided diagnosis of small bowel pathology. However, segmenting the small bowel directly on 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

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

    PubMed Central

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

    2013-01-01

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

  6. Small bowel obstruction in the emergency department: MDCT features of common and uncommon causes.

    PubMed

    Tirumani, Harika; Vassa, Ravi; Fasih, Najla; Ojili, Vijayanadh

    2014-01-01

    Small bowel obstruction is a common condition encountered by the radiologist in the emergency department. Though intestinal adhesions and obstructed hernias are the most common causes of acute small bowel obstruction, a variety of uncommon and rare conditions can cause acute and subacute bowel obstruction. Imaging plays a key role in the workup of bowel obstruction by identifying the cause, level, and degree of bowel obstruction. In this article, we present a comprehensive review of the multi-detector computed tomography features of common and uncommon causes of acute and subacute small bowel obstruction.

  7. Role of double-balloon enteroscopy in malignant small bowel tumors

    PubMed Central

    Robles, Enrique Pérez-Cuadrado; Delgado, Pilar Esteban; Conesa, Paloma Bebia; Andrés, Blanca Martínez; Guggiana, Milivoj Franulic; Mateos, Eduardo Alcaraz; Caballero, Mariana Fernández; Agudo, José Luis Rodrigo; Martínez, Silvia Chacón; Latorre, Rafael; Soria, Federico; Gutiérrez, Juan Manuel Herrerías; Martínez, Enrique Pérez-Cuadrado

    2015-01-01

    AIM: To assess the double-balloon enteroscopy (DBE) role in malignant small bowel tumors (MSBT). METHODS: This is a retrospective descriptive study performed in a single center. All consecutive patients who underwent a DBE with final diagnosis of a malignant neoplasm from 2004 to 2014 in our referral center were included. Patient demographic and clinical pathological characteristics were recorded and reviewed. MSBT diagnosis was achieved either by DBE directed biopsy with multiple tissue sampling, endoscopic findings or histological analysis of surgical specimen. We have analyzed double-balloon enteroscopy impact in outcome and clinical course of these patients. RESULTS: Of 627 patients, 28 (4.5%) (mean age = 60 ± 17.3 years) underwent 30 procedures (25 anterograde, 5 retrograde) and were diagnosed of a malignant tumor. Patients presented with obscure gastrointestinal bleeding (n = 19, 67.9%), occlusion syndrome (n = 7, 25%) and diarrhea (n = 1, 3.6%). They were diagnosed by DBE biopsy (n = 18, 64.3%), histological analysis of surgical specimen (n = 7, 25%) and unequivocal endoscopic findings (n = 2, 7.1%). Gastrointestinal stromal tumor (n = 8, 28.6%), adenocarcinoma (n = 7, 25%), lymphoma (n = 4, 14.3%), neuroendocrine tumor (n = 4, 14.3%), metastatic (n = 3, 10.7%) and Kaposi sarcoma (n = 1, 3.6%) were identified. DBE modified outcome in 7 cases (25%), delaying or avoiding emergency surgery (n = 3), modifying surgery approach (n = 2) and indicating emergency SB partial resection instead of elective approach (n = 2). CONCLUSION: DBE may be critical in the management of MSBT providing additional information that may be decisive in the clinical course of these patients. PMID:26078833

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

    SciTech Connect

    Froelich, J.W.; Juni, J.

    1984-04-01

    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.

  9. Small bowel evisceration through the anus – report of a case and review of literature

    PubMed Central

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

    2012-01-01

    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. PMID:22605863

  10. Optimization of oral contrast agents for MR imaging of the small bowel.

    PubMed

    Lauenstein, Thomas C; Schneemann, Herbert; Vogt, Florian M; Herborn, Christoph U; Ruhm, Stefan G; Debatin, Jorg F

    2003-07-01

    Effect on small-bowel distention of additives to water as contrast agents for magnetic resonance (MR) imaging was assessed. Oral contrast agents included water and water in combination with mannitol, a bulk fiber laxative, locust bean gum, and a combination of mannitol and locust bean gum. Filling of the small bowel was quantified on coronal images obtained with two-dimensional true fast imaging with steady-state precession sequence; bowel diameters were measured. Ingestion of water with locust bean gum and mannitol provided the best distention of the small bowel. MR imaging of the small bowel with oral administration of water can be improved with addition of osmotic and nonosmotic substances that lead to decreased water resorption.

  11. Intraoperative transillumination with water-filling of lumen for localizing lesions in occult small bowel bleeding

    PubMed Central

    Kong, Xiangheng; Cao, Yuning; Yang, Daogui; Li, Senlin

    2017-01-01

    Abstract Rationale: Occult small bowel bleeding is always difficult to locate by either radiological examination or endoscopy. When the site of bleeding cannot be found by nonsurgical measures, exploratory laparotomy becomes necessary. Patient concerns: A 63-year-old woman with a half-month history of occult gastrointestinal bleeding failed to many conservative therapies. Interventions: Intraoperative transillumination with water-filling of lumen was performed. Diagnoses: Small bowel bleeding was diagnosed intraoperatively. Outcomes: Segmental resection of the diseased small bowel with side-to-side anastomosis was performed while the histology showed no significant abnormality. Lessons: The technique of intraoperative transillumination with water-filling of lumen allows simple, accurate, and rapid localization of lesions in occult small bowel bleeding and facilitates precise and definitive surgery. PMID:28151907

  12. Differential mechanisms of x-ray-induced cell death in human endothelial progenitor cells isolated from cord blood and adults.

    PubMed

    Mendonca, Marc S; Chin-Sinex, Helen; Dhaemers, Ryan; Mead, Laura E; Yoder, Merv C; Ingram, David A

    2011-08-01

    Endothelial colony-forming cells (ECFCs) are endothelial progenitor cells that circulate at low concentration in human umbilical cord and adult peripheral blood and are largely resident in blood vessels. ECFCs not only appear to be critical for normal vascular homeostasis and repair but may also contribute to tumor angiogenesis and response to therapy. To begin to characterize the potential role of ECFCs during the treatment of tumors in children and adults with radiation, we characterized the X-ray sensitivity of cord and adult blood-derived ECFCs. We found both cord blood and adult ECFCs to be highly radiation sensitive (3 Gy resulted in >90% killing without induction of apoptosis). The X-ray survival curves suggested reduced potential for repair capacity, but X-ray fractionation studies demonstrated that all the ECFCs exhibited repair when the radiation was fractionated. Finally, the mechanisms of X-ray-induced cell death for cord blood and adult ECFCs were different at low and high dose. At low dose, all ECFCs appear to die by mitotic death/catastrophe. However, at high radiation doses (≥ 10 Gy) cord blood ECFCs underwent p53 stabilization and Bax-dependent apoptosis as well as p21-dependent G₁ and G₂/M cell cycle checkpoints. By contrast, after 10 Gy adult ECFCs undergo only large-scale radiation-induced senescence, which is a cellular phenotype linked to premature development of atherosclerosis and vasculopathies. These data demonstrate that the ECFC response to radiation is dose-dependent and developmentally regulated and may provide potential mechanistic insight into their role in tumor and normal tissue response after ionizing radiation treatment.

  13. Role of x-ray-induced transcripts in adaptive responses following x-rays. Progress report, year 1

    SciTech Connect

    Boothman, D.A.

    1992-09-01

    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.

  14. Exogenous Nitric Oxide Suppresses in Vivo X-ray-Induced Targeted and Non-Targeted Effects in Zebrafish Embryos

    PubMed Central

    Kong, E.Y.; Yeung, W.K.; Chan, T.K.Y.; Cheng, S.H.; Yu, K.N.

    2016-01-01

    The present paper studied the X-ray-induced targeted effect in irradiated zebrafish embryos (Danio rerio), as well as a non-targeted effect in bystander naïve embryos partnered with irradiated embryos, and examined the influence of exogenous nitric oxide (NO) on these targeted and non-targeted effects. The exogenous NO was generated using an NO donor, S-nitroso-N-acetylpenicillamine (SNAP). The targeted and non-targeted effects, as well as the toxicity of the SNAP, were assessed using the number of apoptotic events in the zebrafish embryos at 24 h post fertilization (hpf) revealed through acridine orange (AO) staining. SNAP with concentrations of 20 and 100 µM were first confirmed to have no significant toxicity on zebrafish embryos. The targeted effect was mitigated in zebrafish embryos if they were pretreated with 100 µM SNAP prior to irradiation with an X-ray dose of 75 mGy but was not alleviated in zebrafish embryos if they were pretreated with 20 µM SNAP. On the other hand, the non-targeted effect was eliminated in the bystander naïve zebrafish embryos if they were pretreated with 20 or 100 µM SNAP prior to partnering with zebrafish embryos having been subjected to irradiation with an X-ray dose of 75 mGy. These findings revealed the importance of NO in the protection against damages induced by ionizing radiations or by radiation-induced bystander signals, and could have important impacts on development of advanced cancer treatment strategies. PMID:27529238

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

    SciTech Connect

    Frazzini, V.I. Jr.; English, W.J.; Bashist, B.; Moore, E.

    1996-05-01

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

  16. Torsion of Meckel's diverticulum as a cause of small bowel obstruction: A case report.

    PubMed

    Murruste, Marko; Rajaste, Geidi; Kase, Karri

    2014-10-27

    Axial torsion and necrosis of Meckel's diverticulum causing simultaneous mechanical small bowel obstruction are the rarest complications of this congenital anomaly. This kind of pathology has been reported only eleven times. Our case report presents this very unusual case of Meckel's diverticulum. A 41-year-old man presented at the emergency department with complaints of crampy abdominal pain, nausea and retention of stool and gases. Clinical diagnosis was small bowel obstruction. Because the origin of obstruction was unknown, computer tomography was indicated. Computed tomography (CT)-scan revealed dilated small bowel loops with multiple air-fluid levels; the oral contrast medium had reached the jejunum and proximal parts of the ileum but not the distal small bowel loops or the large bowel; in the right mid-abdomen there was a 11 cm × 6.4 cm × 7.8 cm fluid containing cavity with thickened wall, which was considered a dilated bowel-loop or cyst or diverticulum. Initially the patient was treated conservatively. Because of persistent abdominal pain emergency laparotomy was indicated. Abdominal exploration revealed distended small bowel loops proximal to the obstruction, and a large (12 cm × 14 cm) Meckel's diverticulum at the site of obstruction. Meckel's diverticulum was axially rotated by 720°, which caused small bowel obstruction and diverticular necrosis. About 20 cm of the small bowel with Meckel's diverticulum was resected. The postoperative course was uneventful and the patient was discharged on the fifth postoperative day. We recommend CT-scan as the most useful diagnostic tool in bowel obstruction of unknown origin. In cases of Meckel's diverticulum causing small bowel obstruction, prompt surgical treatment is indicated; delay in diagnosis and in adequate treatment may lead to bowel necrosis and peritonitis.

  17. Small Bowel Neuroendocrine Tumors with Inguinal Metastases: A Diagnostic and Therapeutic Dilemma

    PubMed Central

    Daly, Kevin P; Askarian, Farhad; Saif, Muhammad W

    2016-01-01

    Small bowel neuroendocrine tumors (NETs) are frequently characterized by a strong propensity to metastasize to the liver, mesentery, and peritoneum. However, only a few extra-abdominal metastatic sites have been reported in the published literature. The present paper implicates that primary small bowel NETs may unusually metastasize to the inguinal lymph nodes. Furthermore, we discuss the formidable diagnostic and therapeutic challenges associated with the metastatic NETs. PMID:27555990

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

    PubMed Central

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

    2013-01-01

    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. PMID:24367646

  19. Small bowel transplantation induces adrenergic hypersensitivity in ileal longitudinal smooth muscle in rats.

    PubMed

    Ohtani, N; Balsiger, B M; Anding, W J; Duenes, J A; Sarr, M G

    2000-01-01

    Our aim was to determine the effects of small bowel transplantation on contractility of longitudinal muscle in the rat ileum. Full-thickness longitudinal muscle strips from four groups of rats (naive controls, sham-operated controls, and 1 week and 8 weeks after syngeneic orthotopic small bowel transplantation) were studied in vitro. Neither baseline contractility nor response to neural blockade (tetrodotoxin) or adrenergic/cholinergic blockade differed among the groups. Although the dose response to the cholinergic agonist bethanechol and to nitric oxide did not differ among groups, the ED50 (negative log of concentration giving half-maximal effect) for the adrenergic agonist norepinephrine was increased l week and 8 weeks after transplantation, indicating a hypersensitivity response not blocked by tetrodotoxin. Nonadrenergic, noncholinergic inhibitory responses to electrical field stimulation were of greater amplitude and occurred at lesser frequencies (>/=5 Hz) 1 week after small bowel transplantation, but returned to control values 8 weeks postoperatively. These inhibitory responses were blocked by the nitric oxide synthase inhibitor L-NMMA but not by methylene blue, a nonspecific inhibitor of guanylate cyclase. Small bowel transplantation induces a persistent adrenergic denervation hypersensitivity at the muscle and appears to upregulate, at least transiently, other inhibitory mechanisms mediated by neural release of nitric oxide. Small bowel transplantation does not alter muscle response to cholinergic pathways. These alterations in smooth muscle contractility may affect gut function early after clinical small bowel transplantation.

  20. Strangulated Small Bowel Obstruction After Renal Transplant With No History of Laparotomy: Case Report.

    PubMed

    Miura, Yuichi; Sato, Kazushige; Kawagishi, Naoki; Ohuchi, Noriaki

    2015-06-01

    Strangulated small bowel obstruction is a complication after abdominal surgery, which is rare in renal transplant patients. A 61-year-old man with a strangulated small bowel obstruction underwent renal transplant surgery 7 years before the current admission. He was admitted to our hospital for abdominal pain, nausea, and abdominal distention. An abdominal computed tomography and an ultrasound examination showed intestinal expansion and fluid collection without ascites. His disease was diagnosed as a small bowel obstruction and conservative treatment was begun. However, because of increasing abdominal pain and the collection of ascites, he underwent an emergency laparotomy and was diagnosed as having a strangulated small bowel obstruction. A fibrous cord had formed between the peritoneum (beside the transplanted kidney) and the root of the sigmoid mesocolon, strangulating the looped ileum and causing bleeding necrosis and hemorrhagic ascites collection. The cord and the necrotic ileum were resected, followed by an end-to-end anastomosis. He was discharged 17 days after the surgery in good condition. This is the first reported case of a person having a strangulated small bowel obstruction by a fibrous cord, who did not have a history of laparotomy after renal transplant. A strangulated small bowel obstruction after a renal transplant in a patient with no history of a laparotomy is a rare, but possible postoperative complications should be considered when making a differential diagnosis.

  1. Novel applications of diagnostic x-rays in activating photo-agents through x-ray induced visible luminescence from rare-earth particles: an in vitro study

    NASA Astrophysics Data System (ADS)

    Abliz, Erkinay; Collins, Joshua E.; Friedberg, Joseph S.; Kumar, Ajith; Bell, Howard; Waynant, Ronald W.; Tata, Darrell B.

    2010-02-01

    Photodynamic agents such as Photofrin II (Photo II) utilized in photodynamic therapy (PDT) possess a remarkable property to become preferentially retained within the tumor's micro-environment. Upon the photo-agent's activation through visible light photon absorption, the agents exert their cellular cytotoxicity through type II and type I mechanistic pathways through extensive generation of reactive oxygen species (ROS): singlet oxygen 1O2, superoxide anion O2 -, and hydrogen peroxide H2O2, within the intratumoral environment. Unfortunately, due to shallow visible light penetration depth (~2mm to 5mm) in tissues, the PDT strategy currently has largely been restricted to the treatments of surface tumors, such as the melanomas. Additional invasive strategies through optical fibers are currently utilized in getting the visible light into the intended deep seated targets within the body for PDT. In this communication, we report on a novel strategy in utilizing "soft" energy diagnostic X-rays to indirectly activate Photo II through X-ray induced luminescence from Gadolinium oxysulfide (20 micron dimension) particles doped with Terbium: Gd2O2S:Tb. X-ray induced visible luminescence from Gd2O2S:Tb particles was spectroscopically characterized and the ROS production levels from clinically relevant concentration (10 μg/ml) of Photo II was quantified through changes in the Vitamin C absorbance. ROS kinetics through X-ray induced luminescence was found to be similar to the ROS kinetics from red He-Ne laser exposures used in the clinics. Taken together, in-vitro findings herein provide the basis for future studies in determining the safety and efficacy of this non-invasive X-ray induced luminescence strategy in activating photo-agent in deep seated tumors.

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

    SciTech Connect

    Wertz, R.L.

    1982-07-01

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

  3. Factors affecting poor nutritional status after small bowel resection in patients with Crohn disease.

    PubMed

    Jang, Ki Ung; Yu, Chang Sik; Lim, Seok-Byung; Park, In Ja; Yoon, Yong Sik; Kim, Chan Wook; Lee, Jong Lyul; Yang, Suk-Kyun; Ye, Byong Duk; Kim, Jin Cheon

    2016-07-01

    In Crohn disease, bowel-preserving surgery is necessary to prevent short bowel syndrome due to repeated operations. This study aimed to determine the remnant small bowel length cut-off and to evaluate the clinical factors related to nutritional status after small bowel resection in Crohn disease.We included 394 patients (69.3% male) who underwent small bowel resection for Crohn disease between 1991 and 2012. Patients who were classified as underweight (body mass index < 17.5) or at high risk of nutrition-related problems (modified nutritional risk index < 83.5) were regarded as having a poor nutritional status. Preliminary remnant small bowel length cut-offs were determined using receiver operating characteristic curves. Variables associated with poor nutritional status were assessed retrospectively using Student t tests, chi-squared tests, Fisher exact tests, and logistic regression analyses.The mean follow-up period was 52.9 months and the mean patient ages at the time of the last bowel surgery and last follow-up were 31.2 and 35.7 years, respectively. The mean remnant small bowel length was 331.8 cm. Forty-three patients (10.9%) underwent ileostomy, 309 (78.4%) underwent combined small bowel and colon resection, 111 (28.2%) had currently active disease, and 105 (26.6%) underwent at least 2 operations for recurrent disease. The mean body mass index and modified nutritional risk index were 20.6 and 100.8, respectively. The independent factors affecting underweight status were remnant small bowel length ≤240 cm (odds ratio: 4.84, P < 0.001), ileostomy (odds ratio: 4.70, P < 0.001), and currently active disease (odds ratio: 4.16, P < 0.001). The independent factors affecting high nutritional risk were remnant small bowel length ≤230 cm (odds ratio: 2.84, P = 0.012), presence of ileostomy (odds ratio: 3.36, P = 0.025), and currently active disease (odds ratio: 4.90, P < 0.001).Currently active disease, ileostomy, and remnant small

  4. Factors affecting poor nutritional status after small bowel resection in patients with Crohn disease

    PubMed Central

    Jang, Ki Ung; Yu, Chang Sik; Lim, Seok-Byung; Park, In Ja; Yoon, Yong Sik; Kim, Chan Wook; Lee, Jong Lyul; Yang, Suk-Kyun; Ye, Byong Duk; Kim, Jin Cheon

    2016-01-01

    Abstract In Crohn disease, bowel-preserving surgery is necessary to prevent short bowel syndrome due to repeated operations. This study aimed to determine the remnant small bowel length cut-off and to evaluate the clinical factors related to nutritional status after small bowel resection in Crohn disease. We included 394 patients (69.3% male) who underwent small bowel resection for Crohn disease between 1991 and 2012. Patients who were classified as underweight (body mass index < 17.5) or at high risk of nutrition-related problems (modified nutritional risk index < 83.5) were regarded as having a poor nutritional status. Preliminary remnant small bowel length cut-offs were determined using receiver operating characteristic curves. Variables associated with poor nutritional status were assessed retrospectively using Student t tests, chi-squared tests, Fisher exact tests, and logistic regression analyses. The mean follow-up period was 52.9 months and the mean patient ages at the time of the last bowel surgery and last follow-up were 31.2 and 35.7 years, respectively. The mean remnant small bowel length was 331.8 cm. Forty-three patients (10.9%) underwent ileostomy, 309 (78.4%) underwent combined small bowel and colon resection, 111 (28.2%) had currently active disease, and 105 (26.6%) underwent at least 2 operations for recurrent disease. The mean body mass index and modified nutritional risk index were 20.6 and 100.8, respectively. The independent factors affecting underweight status were remnant small bowel length ≤240 cm (odds ratio: 4.84, P < 0.001), ileostomy (odds ratio: 4.70, P < 0.001), and currently active disease (odds ratio: 4.16, P < 0.001). The independent factors affecting high nutritional risk were remnant small bowel length ≤230 cm (odds ratio: 2.84, P = 0.012), presence of ileostomy (odds ratio: 3.36, P = 0.025), and currently active disease (odds ratio: 4.90, P < 0.001). Currently active disease, ileostomy, and

  5. Wortmannin-enhanced X-ray-induced apoptosis of human T-cell leukemia MOLT-4 cells possibly through the JNK/SAPK pathway.

    PubMed

    Tomita, Masanori; Suzuki, Norio; Matsumoto, Yoshihisa; Enomoto, Atsushi; Yin, Hong Lan; Hosoi, Yoshio; Hirano, Kazuya; Sakai, Kazuo

    2003-10-01

    We demonstrated that enhancement of X-ray-induced apoptosis/rapid cell death by wortmannin accompanied by increased activation of JNK/SAPK in human leukemia MOLT-4 cells. Rapid cell death/apoptosis was determined either by the dye exclusion test or by the appearance of Annexin V-positive cells and cleaved PARP fragments. Enhancement was observed only at higher concentrations of wortmannin, i.e. 1 microM or more. At these high concentrations, both DNA-PK and ATM were inhibited. X-ray-induced phosphorylation of Ser 15 of p53/TP53, accumulation of both p53/TP53 and p21/WAF1/CDKN1A, and phosphorylation of XRCC4 were all suppressed. The enhancement of apoptosis/rapid cell death by wortmannin was prevented by addition of caspase inhibitors, Z-VAD-FMK or Ac-DEVD-CHO, or by transfection and overexpression of mouse Bcl2, which is known as an anti-apoptosis protein. The requirement for a high concentration of wortmannin, i.e. 1 microM or more, indicates that inhibition of both DNA-PK and ATM was necessary for the enhanced apoptosis/rapid cell death. Phosphorylation of AKT/PKB was completely suppressed at a much lower concentration, i.e. 0.1 microM wortmannin, where no enhancement of X-ray-induced apoptosis/rapid cell death was observed. On the other hand, X-ray-induced phosphorylation of JNK and its kinase activity as well as apoptosis/rapid cell death were all significantly enhanced only at high concentrations of wortmannin, i.e. 1 microM or more. Furthermore, the extent of enhancement of both JNK phosphorylation and of apoptosis/rapid cell death by wortmannin was less in Rh1a cells, which are ceramide- and radiation-resistant variant cells compared to the parental MOLT-4 cells. Therefore, activation of the JNK pathway was considered important for the enhancement of X-ray-induced apoptosis/rapid cell death of MOLT-4 cells by wortmannin, because of the requirement for a higher concentration of wortmannin than that required for inhibition of AKT phosphorylation. The

  6. Reduction of irradiated small bowel volume with Trendelenburg position in gynecologic pelvic radiotherapy.

    PubMed

    Dirier, A; Adli, M; Andic, F; Cifci, S; Ors, Y; Kuzhan, A

    2010-04-01

    The aim of this study was to assess the effect of Trendelenburg position in comparison to prone position on small bowel volume and treatment dose in gynecologic pelvic external beam radiotherapy using three-dimensional conformal treatment plans. Eight patients with gynecologic cancers, treated with definitive or postoperative pelvic radiotherapy were investigated. Pelvic computerized tomography (CT) scans for treatment planning were performed in prone and 25 degree Trendelenburg positions for each patient. The dose-volume histograms of small bowel within the treatment fields were obtained and compared for both positions. The clinical target volume (CTV) and the planning target volume (PTV) were also defined and evaluated in the subjects. Treatment dose was 5040 cGy to PTV with 180 cGy daily fraction doses in both techniques for all patients. The average irradiated small bowel volume was 726 cc for prone position and 458 cc for the Trendelenburg position. The average irradiated small bowel volume reduction in the Trendelenburg position was 38.0% (95% CI 19.5 +/- 38%) compared with the prone position. The average small bowel percent dose was 25.4% (1280 cGy) for Trendelenburg position and 39.9% (2010 cGy) for prone position. PTV doses were similar in both techniques. The results of this dosimetric study suggest that gynecologic pelvic radiotherapy in the Trendelenburg position decreases the volume of irradiated small bowel compared to prone position and may decrease treatment related small bowel morbidity. Clinical benefit of this position should be evaluated in further clinical studies.

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

    SciTech Connect

    Burridge, Nichola . E-mail: nichola.burridge@physics.cr.man.ac.uk; Amer, Ali; Marchant, Tom; Sykes, Jonathan; Stratford, Julie; Henry, Ann; McBain, Catherine; Price, Pat; Moore, Chris

    2006-11-01

    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.

  8. Malignant Small Bowel Tumors: Diagnosis, Management and Prognosis.

    PubMed

    Cardoso, Hélder; Rodrigues, João Tiago; Marques, Margarida; Ribeiro, Armando; Vilas-Boas, Filipe; Santos-Antunes, João; Rodrigues-Pinto, Eduardo; Silva, Marco; Maia, José Costa; Macedo, Guilherme

    2015-01-01

    Introdução: Apesar de entidades raras, a incidência dos tumores malignos do intestino delgado parece estar a aumentar. O desenvolvimento da cápsula endoscópica e da enteroscopia assistida por balão permitiram um avanço na avaliação das lesões do intestino delgado. Temos como objetivo descrever as características clínicas e patológicas dos doentes com cancro do intestino delgado e averiguar o papel que estas técnicas endoscópicas assumem atualmente. Material e Métodos: Foi realizado um estudo retrospetivo dos doentes diagnosticados com cancro do intestino delgado, desde janeiro de 2010 até outubro de 2014. Os dados foram submetidos a análise estatística. Resultados: Dos 28 doentes diagnosticados, 54% eram do sexo feminino. A idade média ao diagnóstico foi de 61 anos. O tumor mais frequente foi o adenocarcinoma (n = 11), seguido do sarcoma (n = 6), linfoma (n = 6) e tumores neuroendócrinos (n = 3). A principal forma de apresentação esteve relacionada com perdas hemáticas ou obstrução intestinal. Ao diagnóstico, 46% dos doentes tinhammetástases distantes/tumor irressecável. A maioria dos tumores foi diagnosticada por técnicas endoscópicas (41%) ou imagiológicas (35%). No primeiro ano após o diagnóstico, 29% dos doentes faleceram. Na análise multivariada, o adenocarcinoma permaneceu fator independente para pior sobrevida. Discussão: Os doentes com adenocarcinoma apresentaram-se em estádios tardios e com tumores irressecáveis, contribuindo para um pior prognóstico. Ã necessário um elevado grau de suspeita clínica para o diagnóstico de cancro do intestino delgado. Conclusão: As características dos doentes foram globalmente consistentes com o descrito na literatura. A cápsula endoscópica e a enteroscopia assistida por balão são úteis no diagnóstico, gestão e vigilância do cancro do intestino delgado.

  9. From Capsule Endoscopy to Balloon-Assisted Deep Enteroscopy: Exploring Small-Bowel Endoscopic Imaging

    PubMed Central

    Cooley, D. Matthew; Walker, Andrew J.

    2015-01-01

    In the past 15 years, the use of endoscopic evaluations in patients with obscure gastrointestinal bleeding has become more common. Indications for further endoscopic interventions include iron deficiency anemia, suspicion of Crohn’s disease or small-bowel tumors, assessment of celiac disease or of ulcers induced by nonsteroidal anti-inflammatory drugs, and screening for familial adenomatous polyposis. Often, capsule endoscopy is performed in concert with other endoscopic studies and can guide decisions regarding whether enteroscopy should be carried out in an anterograde or a retrograde approach. Retrograde endoscopy is beneficial in dealing with disease of the more distal small bowel. Multiple studies have examined the diagnostic yield of balloon-assisted deep enteroscopy and have estimated a diagnostic yield of 40% to 80%. Some of the studies have found that diagnostic yields are higher when capsule endoscopy is performed before balloon-assisted deep enteroscopy in a search for small-bowel bleeds. Each of these procedures has a role when performed alone; however, research suggests that they are especially effective as complementary techniques and together can provide better-directed therapy. Both procedures are relatively safe, with high diagnostic and therapeutic yields that allow evaluation of the small bowel. Because both interventions are relatively new to the world of gastroenterology, much research remains to be done regarding their overall efficacy, cost, and safety, as well as further indications for their use in the detection and treatment of diseases of the small bowel. PMID:27099585

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

    PubMed

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

    2004-03-01

    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 12 healthy subjects (age range 31-55 years). Additionally, the grade of small bowel distension was rated qualitatively. Patient acceptance concerning nausea, vomiting, flatulence, and diarrhea was noted for each solution, and all results were compared by a Wilcoxon test or t test, respectively. The ingestion of water combined with LBG and either 2.5% mannitol or 2.0% sorbitol showed the best distension of the small bowel. The lowest side effect rate was observed following ingestion of sorbitol in a concentration of 2.0 and 1.5%. Based on these data, we recommend a combination of LBG and 2% sorbitol use for optimal bowel distension and minimal side effects resulting in enhanced patient acceptance.

  11. Nitric oxide pathways in circular muscle of the rat jejunum before and after small bowel transplantation.

    PubMed

    Balsiger, B M; Duenes, J A; Ohtani, N; Shibata, C; Farrugia, G; Anding, W J; Sarr, M G

    2000-01-01

    Previous studies suggest that nitric oxide synthase is upregulated after small bowel transplantation which may have implications in enteric dysfunction after small bowel transplantation. The aim of this study was to determine the role of nitric oxide in nonadrenergic, noncholinergic inhibitory function after small bowel transplantation in rat jejunal circular muscle. The following four groups of rats (n = >/=8 rats per group) were studied: Neurally intact control animals; 1 week after anesthesia and sham celiotomy, and either 1 week or 8 weeks after isogeneic, orthotopic small bowel transplantation. Full-thickness jejunal circular muscle strips were evaluated under isometric conditions for spontaneous contractile activity, response to electrical field stimulation, and effects of exogenous nitric oxide and nitric oxide antagonists. Spontaneous activity did not differ among groups. Electrical field stimulation inhibited activity similarly in all groups. Exogenous nitric oxide, NG-monomethyl L-arginine monoacetate salt (a nitric oxide synthase inhibitor), and methylene blue (cGMP antagonist) had no effect on spontaneous activity. Neither nitric oxide antagonist altered the inhibitory response to neural excitation by electrical field stimulation in any group. Nitric oxide, a known inhibitory neurotransmitter in other gut smooth muscle, has no apparent role in rat jejunal circular muscle before or after small bowel transplantation.

  12. Reduction of Acute Rejection by Bone Marrow Mesenchymal Stem Cells during Rat Small Bowel Transplantation

    PubMed Central

    Zhang, Wen; Wu, Ben-Juan; Fu, Nan-Nan; Zheng, Wei-Ping; Don, Chong; Shen, Zhong-Yang

    2014-01-01

    Background Bone marrow mesenchymal stem cells (BMMSCs) have shown immunosuppressive activity in transplantation. This study was designed to determine whether BMMSCs could improve outcomes of small bowel transplantation in rats. Methods Heterotopic small bowel transplantation was performed from Brown Norway to Lewis rats, followed by infusion of BMMSCs through the superficial dorsal veins of the penis. Controls included rats infused with normal saline (allogeneic control), isogeneically transplanted rats (BN-BN) and nontransplanted animals. The animals were sacrificed after 1, 5, 7 or 10 days. Small bowel histology and apoptosis, cytokine concentrations in serum and intestinal grafts, and numbers of T regulatory (Treg) cells were assessed at each time point. Results Acute cellular rejection occurred soon after transplantation and became aggravated over time in the allogeneic control rats, with increase in apoptosis, inflammatory response, and T helper (Th)1/Th2 and Th17/Treg-related cytokines. BMMSCs significantly attenuated acute cellular rejection, reduced apoptosis and suppressed the concentrations of interleukin (IL)-2, IL-6, IL-17, IL-23, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ while upregulating IL-10 and transforming growth factor (TGF)-β expression and increasing Treg levels. Conclusion BMMSCs improve the outcomes of allogeneic small bowel transplantation by attenuating the inflammatory response and acute cellular rejection. Treatment with BMMSCs may overcome acute cellular rejection in small bowel transplantation. PMID:25500836

  13. Methylene Blue Enteric Mapping for Intraoperative Localization in Obscure Small Bowel Hemorrhage: Report of a New Technique and Literature Review

    DTIC Science & Technology

    2012-07-12

    controlled hypertension and hyperlipidemia, a pri- or of laparoscopic cholecystectomy, and open small bowel resection. The patient reported melena and...ities. The site of previous small bowel resection was inspected and revealed dense adhesions. A self-retaining retractor was placed and small bowel...transillumi- nation, single or multiple enterotomy(ies) for mucosal inspec- tion, and blind resection are associated with failure in up to 50 % of cases

  14. Safety and efficacy of self-expandable metallic stents in malignant small bowel obstructions

    PubMed Central

    Tsuboi, Akiyoshi; Kuwai, Toshio; Nishimura, Tomoyuki; Iio, Sumio; Mori, Takeshi; Imagawa, Hiroki; Yamaguchi, Toshiki; Yamaguchi, Atsushi; Kouno, Hirotaka; Kohno, Hiroshi

    2016-01-01

    In this report, we present 3 cases of malignant small bowel obstruction, treated with palliative care using endoscopic self-expandable metallic stent (SEMS) placement, with the aim to identify the safety and efficacy of this procedure. Baseline patient characteristics, procedure methods, procedure time, technical and clinical success rates, complications, and patient outcomes were obtained. All 3 patients had pancreatic cancer with small bowel strictures. One patient received the SEMS using colonoscopy, while the other 2 patients received SEMS placement via double balloon endoscopy using the through-the-overtube technique. The median procedure time was 104 min. The technical and clinical success rates were 100%. Post-treatment, obstructive symptoms in all patients improved, and a low-residue diet could be tolerated. All stents remained within the patients until their deaths. The median overall survival time (stent patency time) was 76 d. SEMS placement is safe and effective as a palliative treatment for malignant small bowel obstruction. PMID:27833393

  15. Idiopathic Superior Mesenteric Vein Thrombosis Resulting in Small Bowel Ischemia in a Pregnant Woman

    PubMed Central

    Lin, Hao; Lin, Chih-Che; Huang, Wan-Ting

    2011-01-01

    Background. Small bowel ischemia due to superior mesenteric vein thrombosis (MVT) is rare during pregnancy. However, additional precipitating factors should usually be identified. Case. A 31-year-old woman, pregnant at 34 weeks, was sent to the emergency department because of acute peritonitis. An emergency exploration revealed a segmental gangrene of the small intestine without any mechanical obstruction. Together with the termination of pregnancy, resection of the damaged small bowel was performed, and an end-to-end enterostomy was followed. Based on the operative and pathological findings, small bowel ischemia might be attributed to superior mesenteric vein thrombosis. Conclusion. Hypercoagulation state normally found in pregnant women is believed to lead to this catastrophic condition without other precipitating factors. PMID:22567515

  16. [Volvulus of the small bowel due to ascaris lumbricoides package: about a case].

    PubMed

    Diouf, Cheikh; Kane, Ahmed; Ndoye, Ndeye Aby; Ndour, Oumar; Faye-Fall, Aimé Lakh; Fall, Mbaye; Alumeti, Désiré Munyali; Ngom, Gabriel

    2016-01-01

    We report an exceptional case of a 7 year-old patient with necrotic small bowel volvulus due to adult ascaris lumbricoides. At the admission, the child had intestinal obstruction evolving since two days with alteration of general state. Abdominal radiography without preparation showed small bowel air-fluid levels and tiger-stripe appearance evoking the diagnosis of acute intestinal obstruction associated with abdominal mass. After resuscitation, the surgical treatment consisted of laparotomy which showed necrotic volvulus of the terminal ileum containing adult ascaris lumbricoides. The patient underwent small bowel resection, approximately one meter of affected section was removed and then an ileostomy was performed. The evolution was favorable. The patient underwent ileorectal anastomosis four weeks later. After a 2 year follow-up period the child had no symptoms.

  17. Spontaneous reduction of small bowel herniation through the foramen of Winslow: importance of a timely approach

    PubMed Central

    Cho, Hyung-Gyo

    2017-01-01

    We present the case of young female patient presenting with acute onset abdominal pain. Abdominopelvic CT revealed herniation through the foramen of Winslow. The patient was transferred to our hospital and underwent laparoscopic exploration. Though spontaneous reduction was detected, segmental resection of the impacted small bowel was inevitable due to ischemic change. Our case suggests that reducing the time until surgery is very important to lower the probability of bowel resection in case of small bowel herniation through the foramen of Winslow. PMID:28203560

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

    PubMed Central

    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

    Purpose To determine in-vivo formation of x-ray induced γ-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 γ-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 γ-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. PMID:23936236

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

    SciTech Connect

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

    2013-12-01

    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, to confirm a multi-track radiation-damage process and to develop a model of that process. 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.

  20. Coffee Enema for Preparation for Small Bowel Video Capsule Endoscopy: A Pilot Study

    PubMed Central

    Kim, Eun Sun; Keum, Bora; Seo, Yeon Seok; Jeen, Yoon Tae; Lee, Hong Sik; Um, Soon Ho; Kim, Chang Duck; Ryu, Ho Sang

    2014-01-01

    Coffee enemas are believed to cause dilatation of bile ducts and excretion of bile through the colon wall. Proponents of coffee enemas claim that the cafestol palmitate in coffee enhances the activity of glutathione S-transferase, an enzyme that stimulates bile excretion. During video capsule endoscopy (VCE), excreted bile is one of the causes of poor preparation of the small bowel. This study aimed to evaluate the feasibility and effect of coffee enema for preparation of the small bowel during VCE. In this pilot study, 17 of 34 patients were assigned to the coffee enema plus polyethylene glycol (PEG) 2 L ingestion group, whereas the 17 remaining control patients received 2 L of PEG only. The quality of bowel preparation was evaluated in the two patient groups. Bowel preparations in the proximal segments of small bowel were not differ between two groups. In the mid and distal segments of the small intestine, bowel preparations tend to be better in patients who received coffee enemas plus PEG than in patients who received PEG only. The coffee enema group did not experience any complications or side effects. Coffee enemas may be a feasible option, and there were no clinically significant adverse events related to coffee enemas. More prospective randomized studies are warranted to improve small bowel preparation for VCE. PMID:25136541

  1. Safety and Efficacy of Small Bowel Examination by Capsule Endoscopy for Patients before Liver Transplantation

    PubMed Central

    Tetsuya, Yasunaka; Yoshiyasu, Kono; Kou, Miura; Toshihiro, Inokuchi; Yoshiro, Kawahara; Yuzo, Umeda; Takahito, Yagi; Hiroyuki, Okada

    2017-01-01

    Background and Aims. Gastrointestinal surveillance is a requirement prior to liver transplantation (LT), but small intestine examination is not generally undertaken. The aim of the present study was to evaluate the safety and efficacy of capsule endoscopy (CE) for patients with end-stage liver disease. Methods. 31 patients who needed LT were enrolled, and 139 patients who underwent CE over the same period of time acted as controls. Results. Frequency of successful achievement of evaluation of the full length of the small bowel, the mean gastric transit time, and the mean small bowel transit time were not significantly different between the two groups. Abnormalities in the small bowel were found in 26 patients. Comparative analysis revealed that history of EV rupture, history of EV treatment, red color sign of EV, and presence of PHG or HCC were significantly associated with patients with >2 two such findings (high score group). Conclusions. Small bowel examination by CE in patients before liver transplantation could be performed safely and is justified by the high rate of abnormal lesions detected particularly in patients with history of EV therapy or bleeding, red color sign, and presence of PHG or HCC. This study was registered in the UMIN Clinical Trial Registry (UMIN 000008672). PMID:28168199

  2. Effect of experimental stress on the small bowel and colon in healthy humans

    PubMed Central

    Pritchard, SE; Garsed, KC; Hoad, CL; Lingaya, M; Banwait, R; Thongborisute, W; Roberts, E; Costigan, C; Marciani, L; Gowland, PA; Spiller, RC

    2015-01-01

    Background Symptoms of irritable bowel syndrome (IBS) are frequently reported to be exacerbated by stress. Animal studies suggest that corticotrophin releasing hormone (CRH) mediates the effect of stress on the bowel. We have shown that stressed IBS patients with diarrhea have constricted small bowels. We hypothesized that we could mimic this effect by applying experimental stress in the form of either hand immersion in ice water or CRH injection in healthy volunteers (HV). Methods The postprandial effect of the cold pressor test (repeated hand immersion in ice cold water) and injection of CRH, were assessed vs control in two groups of 18 HVs. Key Results CRH produced a significant rise from baseline salivary cortisol levels (p = 0.004) not seen with the cold pressor test. Small bowel water content (SBWC) fell postprandially on all four treatments. SBWC was significantly reduced by both stressors but CRH caused a greater effect (anova, p < 0.003 vs p = 0.02). Ascending colon (AC) volume was greater after CRH injection compared with saline (p = 0.002) but no differences were seen with the cold pressor test vs warm water. Postprandial increase in colon volume was also reduced by CRH which also increased the sensations of distension and bloating. Conclusions & Inferences Two experimental stressors were shown to constrict the small bowel, mimicking the effect previously seen in IBS-D patients. CRH increased the volume of the AC. We speculate that stress accelerates transfer of water from the small bowel to the AC. PMID:25703609

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

    SciTech Connect

    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. )

    1990-08-01

    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.

  4. Inferior Vena Cava Repair Using Serosal Patch of Small Bowel: An Experimental Study

    PubMed Central

    Hodjati, Hossein; Hoseinzadeh, Ahmad; Mousavi, Seyed Masoud; Dehghani Nazhavi, Seifollah; Kumar, Viginda; Sehhatpour, Maryam

    2017-01-01

    Objective: To evaluate the feasibility and results of using serosal patch of small bowel for repair and replacement of inferior vena cava (IVC) after resection of a part of infra-renal IVC in an animal model, as it may be encountered in extensive tumors of retroperitoneal and trauma patients. Methods: Five healthy sheep of both sexes were prepared. After general anesthesia and laparotomy, a defect with 1 cm width and 4cm length was made on anterior aspect of infra-renal IVC, and then an adjacent loop of small bowel was brought and sutured continuously to cover the defect of IVC as a patch graft. The observation period was two months. Results: Three of five IVCs were macroscopically patent without stenosis and thrombosis. Pathologic assay revealed complete endothelialization of serosal surface of the patch of small bowel loop. One of IVCs was completely occluded in gross evaluation and fibrous formation in pathologist review. The sheep had no sign of venous hypertension and edema of limbs. One sheep died at the night of first operation due to internal bleeding.   Conclusion: Serosal patch of small bowel is an accessible and feasible alternative in repair and reconstruction of IVC especially when there is restriction for use of prosthetic material in a contaminated space of abdomen. PMID:28246620

  5. Intestinal prolapse through a persistent omphalomesenteric duct causing small-bowel obstruction.

    PubMed

    Pauleau, Ghislain; Commandeur, Diane; Andro, Christophe; Chapellier, Xavier

    2012-07-11

    Persistent omphalomesenteric duct as a cause of small-bowel obstruction is an exceptional finding. A neonate presented with occlusion due to intestinal prolapse through a persistent omphalomesenteric duct. Remnants of the duct were successfully resected, and the postoperative course was uneventful. We discuss the presentation of omphalomesenteric duct and its management.

  6. A rare cause of small bowel obstruction due to bezoar in a virgin abdomen

    PubMed Central

    Nasri, Baongoc; Calin, Marius; Shah, Ajay; Gilchrist, Brian

    2015-01-01

    Introduction Bezoar is an unusual cause of small bowel obstruction accounting for 0.4–4% of all mechanical bowel obstruction. The common site of obstruction is terminal ileum. Case report A 28-year-old male with no past surgical history, known to have severe mental retardation presented with anorexia. CT scan demonstrated dilated small bowel loops and intraluminal ileal mass with mottled appearance. At exploratory laparotomy, a bezoar was found impacted in the terminal ileum 5–6 inches away from the ileocecal valve and was removed through an enterotomy. Discussion Bezoars are concretions of fibers or foreign bodies in the alimentary tract. Small bowel obstruction is one of common clinical symptoms. The typical finding of well-defined intraluminal mass with mottled gas pattern in CT scan is suggestive of an intestinal bezoar. The treatment option of bezoar is surgery including manual fragmentation of bezoar and pushing it toward cecum, enterotomy or segmental bowel resection. Thorough exploration of abdominal cavity should be done to exclude the presence of concomitant bezoars. Recurrence is common unless underlying predisposing condition is corrected. Conclusions Bezoar-induced small bowel obstruction remains an uncommon diagnosis. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, a history suggestive of increased fiber intake, or patient with psychiatric disorders. CT scan is helpful for preoperative diagnosis. PMID:26764889

  7. Crohn disease of the small bowel: MR enteroclysis versus conventional enteroclysis.

    PubMed

    Masselli, G; Vecchioli, A; Gualdi, G F

    2006-01-01

    Enteroclysis has been suggested as the technique of choice for the evaluation of Crohn disease of the small intestine. Adequate distention of the entire small bowel with barium suspension allows the radiologic demonstration of mucosal abnormalities and provides functional information by defining distensibility or fixation of the small bowel loops. The principal disadvantage of conventional enteroclysis is the limited indirect information on the state of the bowel wall and extramural extension of Crohn disease, and its effectiveness may be hindered owing to overlapping bowel loops. Moreover, the radiation dose administered to patients, mostly at a young age, should be considered. Magnetic resonance (MR) enteroclysis is an emerging technique for small bowel imaging and was introduced to overcome the limitations of conventional enteroclysis and MR cross-sectional imaging by combining the advantages of both into one technique. MR enteroclysis has the potential to change how the small bowel is assessed because of the functional information, soft tissue contrast, direct multiplanar imaging capabilities, and lack of ionizing radiation.

  8. Laparoscopic versus open adhesiolysis for small bowel obstruction - a multicenter, prospective, randomized, controlled trial

    PubMed Central

    2014-01-01

    Background Laparoscopic adhesiolysis is emerging as an alternative for open surgery in adhesive small bowel obstruction. Retrospective studies suggest that laparoscopic approach shortens hospital stay and reduces complications in these patients. However, no prospective, randomized, controlled trials comparing laparoscopy to open surgery have been published. Methods/Design This is a multicenter, prospective, open label, randomized, controlled trial comparing laparoscopic adhesiolysis to open surgery in patients with computed-tomography diagnosed adhesive small bowel obstruction that is not resolving with conservative management. The primary study endpoint is the length of postoperative hospital stay in days. Sample size was estimated based on preliminary retrospective cohort, which suggested that 102 patients would provide 80% power to detect a difference of 2.5 days in the length of postoperative hospital stay with significance level of 0.05. Secondary endpoints include passage of stool, commencement of enteral nutrition, 30-day mortality, complications, postoperative pain, and the length of sick leave. Tertiary endpoints consist of the rate of ventral hernia and the recurrence of small bowel obstruction during long-term follow-up. Long-term follow-up by letter or telephone interview will take place at 1, 5, and 10 years. Discussion To the best of our knowledge, this trial is the first one aiming to provide level Ib evidence to assess the use of laparoscopy in the treatment of adhesive small bowel obstruction. Trial registration ClinicalTrials.gov identifier: NCT01867528. Date of registration May 26th 2013. PMID:25306234

  9. Mechanical small bowel obstruction due to an inflamed appendix wrapping around the last loop of ileum.

    PubMed

    Assenza, M; Ricci, G; Bartolucci, P; Modini, C

    2005-01-01

    Acute apendicitis rarely presents with a clinical picture of mechanical small-bowel obstruction. The Authors report a case of this inusual clinical occurrence, arised like a complication of a common disease, characterized by a chronically inflamed appendix (mucocele) wrapping around the last loop of ileum that produced volvolus and strangulation. The few similar cases reported in the literature are moreover reviewed.

  10. Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen

    PubMed Central

    Ashman, Zane W.; Plurad, David S.

    2016-01-01

    Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery. Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues. Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy. PMID:27900227

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

    SciTech Connect

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

    1983-08-01

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

  12. Small bowel obstruction and perforation attributed to tubo-ovarian abscess following 'D’ and 'C’

    PubMed Central

    2013-01-01

    We report the case of a young woman who was admitted because of small bowel obstruction and localized peritonitis following a dilatation and curettage ('D’ and 'C’) of uterus in abortion. As infection, like tubo-ovarian abscess may complicate any abortion, it seems wise to ensure that it does not exist prior to performing a 'D’ and 'C’. PMID:24107403

  13. Urachal Cyst Causing Small Bowel Obstruction in an Adult with a Virgin Abdomen.

    PubMed

    O'Leary, Michael P; Ashman, Zane W; Plurad, David S; Kim, Dennis Y

    2016-01-01

    Introduction. A patent urachus is a rare congenital or acquired pathology, which can lead to complications later in life. We describe a case of urachal cystitis as the etiology of small bowel obstruction in an adult without prior intra-abdominal surgery. Case Report. A 64-year-old male presented to the acute care surgery team with a 5-day history of right lower quadrant abdominal pain, distention, nausea, and vomiting. He had a two-month history of urinary retention and his past medical history was significant for benign prostate hyperplasia. On exam, he had evidence of small bowel obstruction. Computed tomography revealed high-grade small bowel obstruction secondary to presumed ruptured appendicitis. In the operating room, an infected urachal cyst was identified with adhesions to the proximal ileum. After lysis of adhesions and resection of the cyst, the patient was subsequently discharged without further issues. Conclusion. Although rare, urachal pathology should be considered in the differential diagnosis when evaluating a patient with small bowel obstruction without prior intraabdominal surgery, hernia, or malignancy.

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

    NASA Astrophysics Data System (ADS)

    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

    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.

  15. Fishbone perforation of the small bowel: laparoscopic diagnosis and laparoscopically assisted management.

    PubMed

    Law, Wai Lun; Lo, Chung Yau

    2003-12-01

    We report a patient with small bowel perforation caused by a piece of fishbone diagnosed by laparoscopy and treated with laparoscopically assisted surgery through a small incision. This uncommon cause of peritonitis and the role of laparoscopy for this condition are discussed.

  16. A case of small-bowel obstruction after insertion of a percutaneous endoscopic gastrostomy tube due to mesenteric penetration.

    PubMed

    Roos, J

    2015-07-01

    A case of small-bowel obstruction after insertion of a percutaneous endoscopic gastrostomy (PEG) tube is described. At laparotomy, the PEG tube was found to have penetrated the jejunal mesentery at two points, thereby acting as a focus for a volvulus. Direct injury and obstruction to the small bowel have been described but volvulus due to mesenteric penetration has not.

  17. Value of in vivo electrophysiological measurements to evaluate canine small bowel autotransplants.

    PubMed Central

    Meijssen, M A; Heineman, E; de Bruin, R W; Veeze, H J; Bijman, J; de Jonge, H R; ten Kate, F J; Marquet, R L; Molenaar, J C

    1991-01-01

    This study aimed to develop a non-invasive method for in vivo measurement of the transepithelial potential difference in the canine small bowel and to evaluate this parameter in small bowel autotransplants. In group 0 (control group, n = 4), two intestinal loops were created without disturbing their vascular, neural, and lymphatic supplies. In group I (successful autotransplants, n = 11), two heterotopic small bowel loops were constructed. Long term functional sequelae of vascular, neural, and lymphatic division were studied. Group II (n = 6) consisted of dogs with unsuccessful autotransplants suffering thrombosis of the vascular anastomosis, which resulted in ischaemic small bowel autografts. In group I, values of spontaneous transepithelial potential difference, an index of base line active electrolyte transport, were significantly lower compared with group 0 (p less than 0.05), probably as a result of denervation of the autotransplants. Both theophylline and glucose stimulated potential difference responses, measuring cyclic adenosine monophosphate mediated chloride secretion and sodium coupled glucose absorption respectively, showed negative luminal values in group I at all time points after transplantation. These transepithelial potential difference responses diminished progressively with time. From day 21 onwards both theophylline and glucose stimulated potential difference responses were significantly less than the corresponding responses at day seven (p less than 0.05). Morphometric analysis showed that the reduction of transepithelial potential difference responses preceded degenerative mucosal changes in the heterotopic small bowel autografts. In group II, potential difference responses to theophylline and glucose showed positive luminal values (p<0.01 v group I), probably as a result of passive potassium effusion from necrotic enterocytes. Images Figure 3 PMID:1752464

  18. Single-balloon enteroscopy efficacy and degree of concordance with noninvasive evaluation of small bowel

    PubMed Central

    Marques, Margarida; Antunes, João; Coelho, Rosa; Cardoso, Hélder; Vilas Boas, Filipe; Ribeiro, Armando; Macedo, Guilherme

    2017-01-01

    Background and study aims Clinical impact of single-balloon enteroscopy (SBE) is fairly known, as well as its diagnostic yield comparing with other small bowel gastrointestinal investigations. This study represents a contribution to better understand it and is designed to evaluate SBE efficacy and degree of concordance with previous evaluation of small bowel. Patients and methods This is a single-center retrospective study of patients that underwent SBE with suspected small bowel disease based on non-invasive imaging. Demographic, clinical, procedural and outcome data were collected for analysis. Agreement beyond positive findings was evaluated using κ-coefficient. Results A total of 197 SBEs were performed in 168 patients; mainly men (64.3 %) with mean age 53.3±17.6 years. Most SBEs (86.3 %) performed were preceded by a noninvasive evaluation: in 61.4 % (n = 119) of cases, capsule enteroscopy (CE) was performed, in 18.8 % (n = 37), computed tomography was performed, and in 6.1 % (n = 12) magnetic resonance enterography was performed. Fourty-three patients (25.6 %) underwent endoscopic treatments, mainly: argon plasma coagulation in angioectasias (53.4 %) and polypectomy (34.9 %). The most common diagnoses made with SBE were findings consistent with inflammatory small bowel disease (21.8 %) and vascular lesions (14.2 %). The diagnostic yield of SBE was of 69 %, confirming the suspicion of small bowel disease. The degree of concordance between CE and SBE for positive findings was substantial, κ-coefficient = 0.635 (P < 0.001). However, the degree of concordance between imaging examinations (CT or MR) and SBE was only moderate, κ-coefficient = 0.410 (P < 0.001). SBE had an immediate effect in 20 % of patients, changing diagnostic approaches, medical and surgical treatments. Conclusions Our study supports the idea that for suspected small bowel disease, CE and SBE have an overall good degree of

  19. Duodenal adenocarcinoma: Advances in diagnosis and surgical management

    PubMed Central

    Cloyd, Jordan M; George, Elizabeth; Visser, Brendan C

    2016-01-01

    Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma (DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as negative margins are achievable and an adequate lymphadenectomy can be performed. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients at high risk of recurrence. Further research would benefit from multi-institutional trials that do not combine DA with other periampullary or small bowel malignancies. The purpose of this article is to perform a comprehensive review of DA with special focus on the surgical management and principles. PMID:27022448

  20. Investigating the electron density of multi-MeV X-ray-induced air plasmas at low pressures based on electromagnetic resonant cavity analysis

    NASA Astrophysics Data System (ADS)

    Ribière, M.; d'Almeida, T.; Cessenat, O.; Maulois, M.; Pouzalgues, R.; Crabos, B.; Delbos, C.; Garrigues, A.; Azaïs, B.

    2016-12-01

    We investigate air plasmas generated by multi-MeV pulsed X-rays at pressures ranging from 10-5 to 10-1 mbar. The experimental approach used for these studies is based on measurements of resonant frequencies damping and shift for different electromagnetic modes within a cylindrical cavity. Time-integrated electron densities in X-ray-induced air plasmas are inferred from the damping rate of the measured magnetic fields and their corresponding frequency shifts. In the present study, electron densities ranging from 108 to 109 cm-3 at pressures ranging from 10-3 to 10-1 mbar have been measured. Experimental results were confronted to 3D Maxwell-Vlasov Particle-In-Cell simulations incorporating a radiation-induced electric conductivity model. The method used in this work enables determining microscopic and macroscopic physical quantities within low pressure air plasmas generated by pulsed X-ray.

  1. Radiation Dose-Volume Effects in the Stomach and Small Bowel

    SciTech Connect

    Kavanagh, Brian D.; Pan, Charlie C.; Dawson, Laura A.; Das, Shiva K.; Li, X. Allen; Ten Haken, Randall K.; Miften, Moyed

    2010-03-01

    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.

  2. Small bowel perforation in a hernia sac after TVT placement at the time of colpocleisis.

    PubMed

    Gurshumov, Emil L; Klapper, Allan S; Sierecki, Ava R

    2010-03-01

    Tension-free vaginal tape (TVT) is commonly considered as the first line of treatment for stress urinary incontinence (SUI) with demonstrated efficacy and limited complications. An 82-year-old woman with complete uterine procidentia and SUI underwent a Le Forte colpocleisis, TVT, posterior repair, and cystoscopy. A 4-cm bulge was noted over the site of the left TVT incision on postoperative day 1. On postoperative day 3, she developed bilious vomiting with slight abdominal distention. Computed tomography scan showed a strangulated left inguinal hernia. An immediate exploratory laparotomy noted an inguinal hernia displaced medially with loops of small bowel in the hernia sac. Although properly positioned, one loop of bowel was perforated by the sling mesh. A small bowel resection was performed and the mesh trimmed below the resection on involved side. At 2 months postoperative visit, the patient was asymptomatic, denied stress or urge incontinence. Vaginal examination noted well-supported vaginal walls.

  3. Superior Mesenteric Venous Thrombosis after Laparoscopic Exploration for Small Bowel Obstruction

    PubMed Central

    Kunizaki, Shozo; Shimaguchi, Mayu; Yoshinaga, Yasuo; Kanda, Yukihiro; Lefor, Alan T.; Mizokami, Ken

    2013-01-01

    Mesenteric venous thrombosis is a rare cause of intestinal ischemia which is potentially life-threatening because it can lead to intestinal infarction. Mesenteric venous thrombosis rarely develops after abdominal surgery and is usually associated with coagulation disorders. Associated symptoms are generally subtle or nonspecific, often resulting in delayed diagnosis. A 68-year-old woman underwent laparoscopic exploration for small bowel obstruction, secondary to adhesions. During the procedure, an intestinal perforation was identified and repaired. Postoperatively, the abdominal pain persisted and repeat exploration was undertaken. At repeat exploration, a perforation was identified in the small bowel with a surrounding abscess. After the second operation, the abdominal pain improved but anorexia persisted. Contrast enhanced abdominal computed tomography was performed which revealed superior mesenteric venous thrombosis. Anticoagulation therapy with heparin was started immediately and the thrombus resolved over the next 6 days. Although rare, this complication must be considered in patients after abdominal surgery with unexplained abdominal symptoms. PMID:24455391

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

    PubMed Central

    Stacey, Rhodri

    2014-01-01

    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. PMID:24381725

  5. Intestinal calcium-binding protein 3 months after massive small bowel resection in the piglet.

    PubMed

    Margolis, A; Ricour, C; Harouchi, A; Guyot, M; Laouari, D; Balsan, S

    1977-12-01

    Changes in intestinal calcium-binding protein and calcium binding activity were studied at resection and 3 months after 90% small bowel resection in piglets and one adult pig. A calcium-binding protein (MW congruent to 11.000) with calcium-dependent eletrophoretic mobility was partially purified from mucosal extract of proximal jejunum, mid-gut, and ileum. The concentration of calcium-binding protein and the calcium-binding activity of the intact animals were found highest in the proximal jejunal segment, lowest in the ileal segment. After resection in the four surviving animals out of nine, a significant increase in calcium-binding activity was observed in the proximal jejunum and in the distal ileal segment. The change in calcium-binding activity was much more marked in the ileum than the jejunum. These data demonstrate that pig intestinal mucosa possesses an adaptive capacity to increase the synthesis of calcium-binding protein after massive small bowel resection.

  6. Two cases of small bowel obstruction secondary to a swallowed potato.

    PubMed

    Castren, E; Hakeem, A; Mahmood, N S; Aryal, K

    2015-12-21

    Bowel obstruction due to bezoars (compaction of ingested material within the gastrointestinal tract) is a rare, but well documented occurrence. In this paper, we present two cases of potato-induced small bowel obstruction. Both patients were approximately 50 years old and had cerebral palsy and learning disabilities, respectively. They presented with abdominal pain and bilious vomiting, with no medical or surgical history. Diagnosis of small bowel obstruction was confirmed by CT prior to taking the patients to the operating theatre, where whole potatoes were found to be obstructing each patient's bowel lumen. Both patients underwent laparotomy with enterotomy and removal of the potato. They both made a good recovery. Through a literature review of bezoar-induced bowel obstruction, these cases highlight important diagnostic and management principles.

  7. Small Bowel Limb Lengths and Roux-en-Y Gastric Bypass: a Systematic Review.

    PubMed

    Mahawar, Kamal K; Kumar, Parveen; Parmar, Chetan; Graham, Yitka; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2016-03-01

    There is currently no consensus on the combined length of small bowel that should be bypassed as biliopancreatic or alimentary limb for optimum results with Roux-en-Y gastric bypass. A number of different limb lengths exist, and there is significant variation in practice amongst surgeons. Inevitably, this means that some patients have too much small bowel bypassed and end up with malnutrition and others end up with a less effective operation. Lack of standardisation poses further problems with interpretation and comparison of scientific literature. This systematic review concludes that a range of 100-200 cm for combined length of biliopancreatic or alimentary limb gives optimum results with Roux-en-Y gastric bypass in most patients.

  8. Perforation of the small bowel due to metastasis from tongue cancer.

    PubMed

    Aoyagi, Yoshiko; Matsuda, Keiji; Shimada, Ryu; Horiuchi, Atsushi; Shibuya, Hajime; Nakamura, Keisuke; Iinuma, Hisae; Hayama, Tamuro; Yamada, Hideki; Nozawa, Keijiro; Ishihara, Soichiro; Watanabe, Toshiaki

    2011-01-01

    Distant small bowel metastases from head and neck squamous cell carcinomas are extremely rare, and tongue cancer metastasizing to the small bowel has not been previously reported. We describe a 40-year-old male patient who underwent subtotal gross laryngectomy for squamous cell carcinoma of the tongue in February 2007 and then presented in November 2008 with severe abdominal pain. Abdominal computed tomography (CT) and X-rays revealed free air, suggesting intestinal perforation. Emergency surgery revealed a 10-mm perforation at the ileum and a palpable hard tumor at the perforation site. The ileum was resected, and pathologic findings showed squamous cell carcinoma at the perforation site, which was consistent with metastasis from tongue cancer.

  9. Small bowel intussusception caused by multiple intestinal metastases from a giant cell carcinoma of the lung: a case report.

    PubMed

    Mandeville, Y; de Gheldere, C; Vanclooster, P

    2015-01-01

    Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.

  10. Small Bowel Intussusception Caused by Multiple Intestinal Metastases from a Giant Cell Carcinoma of the Lung: a Case Report.

    PubMed

    Mandeville, Y; de Gheldere, C; Vanclooster, P

    2015-01-01

    Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.

  11. CT enteroclysis/enterography findings in drug-induced small-bowel damage

    PubMed Central

    Shimizu, K; Hashimoto, S; Onoda, H; Washida, Y; Sakaida, I; Matsunaga, N

    2014-01-01

    Objective: To evaluate the CT enteroclysis (CTE)/enterography findings of patients with small-bowel mucosal damage induced by aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) and to compare these findings with the duration of drug use and endoscopic findings. Methods: CTE findings of 11 patients (22 lesions) with drug-induced small-bowel damage were reviewed, including 8 NSAID users and 3 aspirin users. Three patients were short-term users (6 months or shorter) and eight were long-term users (3 years or longer). Nine patients also underwent videocapsule endoscopy (VCE) or double-balloon enteroscopy (DBE). Results: Small-bowel abnormalities were visible in 8 of 11 patients (73%) on CTE. Multiple lesions were seen in five patients, including all short-term users. Lesions were classified into three types. Type 1 (mucosal patchy enhancement) was found in four of eight patients (50%, 12 lesions) all were short-term users. Small erosions with mild oedema/redness were shown by DBE. Type 2 (homogeneous hyperenhancement) was found in two of eight patients (25%, four lesions) who were long-term users. Large ulcers with marked oedema/redness were shown by DBE. Type 3 (stratification enhancement) was found in four of eight patients (50%, six lesions), both short-term and long-term users. Annular or large ulcers with strictures were shown by VCE or DBE. Conclusion: On CTE, Type 1 lesions in patients with mostly short-term aspirin or NSAID use, Type 2 lesions in patients with long-term use and Type 3 lesions in both types of patients were detected. CTE may have usefulness for the detection of mild damage. Advances in knowledge: Small-bowel abnormalities owing to aspirin or NSAID present with three different patterns on CTE. PMID:25348282

  12. Small bowel involvement documented by capsule endoscopy in Churg-Strauss syndrome.

    PubMed

    Beye, Birane; Lesur, Gilles; Claude, Pierre; Martzolf, Lionel; Kieffer, Pierre; Sondag, Daniel

    2015-01-01

    Churg-Strauss syndrome is a small and medium vessel vasculitis and is also known as allergic granulomatous angiitis. Gastrointestinal involvement is common in patients with Churg-Strauss syndrome (20-50%). The most common symptoms are abdominal pain, diarrhoea and occasionally gastrointestinal bleeding and perforation. We present a case of Churg-Strauss syndrome with small bowel lesions documented by video capsule endoscopy.

  13. Biochemical prognostic indicators for pancreatic neuroendocrine tumors and small bowel neuroendocrine tumors

    PubMed Central

    Cavaness, Keith; Celinski, Scott; Preskitt, John

    2014-01-01

    Pancreatic neuroendocrine tumors (PNETs) and small bowel neuroendocrine tumors (SBNETs) are rare tumors that are frequently diagnosed late in the course of the disease. Several biomarkers have been proposed in the literature as prognostic factors for patients with these tumors. This article discusses a recent publication in Annals of Surgical Oncology from the University of Iowa analyzing the effect of different biomarkers on survival in patients with PNETs and SBNETs. PMID:25493250

  14. Pericecal hernia manifesting as a small bowel obstruction successfully treated with laparoscopic surgery

    PubMed Central

    Ogami, Takuya; Honjo, Hirotaka; Kusanagi, Hiroshi

    2016-01-01

    A pericecal hernia is a type of internal hernia, which rarely causes small bowel obstruction (SBO). At our institution, a 92-year-old man presented with vomiting and abdominal pain. He was conservatively treated with a diagnosis of SBO. After 2 weeks of copious drainage output, he was taken to the operating room. Laparoscopy revealed a pericecal hernia that was successfully reduced. We conclude that laparoscopic surgery is an effective way to treat SBOs secondary to pericecal hernias. PMID:26933000

  15. Does magnetically assisted capsule endoscopy improve small bowel capsule endoscopy completion rate? A randomised controlled trial

    PubMed Central

    Hale, Melissa F.; Drew, Kaye; Sidhu, Reena; McAlindon, Mark E.

    2016-01-01

    Background and study aims: Delayed gastric emptying is a significant factor in incomplete small bowel capsule examinations. Gastric transit could be hastened by external magnetic control of the capsule. We studied the feasibility of this approach to improve capsule endoscopy completion rates. Patients and methods: Prospective, single-center, randomized controlled trial involving 122 patients attending for small bowel capsule endoscopy using MiroCam Navi. Patients were randomized to either the control group (mobilisation for 30 minutes after capsule ingestion, followed by intramuscular metoclopramide 10 mg if the capsule failed to enter the small bowel) or the intervention group (1000 mL of water prior to capsule ingestion, followed by positional change and magnetic steering). Outcome measures were capsule endoscopy completion rate, gastric clarity and distention, relationship of body habitus to capsule endoscopy completion rate (CECR), and patient comfort scores. Results: 122 patients were recruited (61 each to the control and intervention groups: mean age 49 years [range 21 – 85], 61 females). There was no significant difference in CECR between the two groups (P = 0.39). Time to first pyloric image was significantly shorter in the intervention group (P = 0.03) but there was no difference in gastric transit times (P = 0.12), suggesting that magnetic control hastens capsular transit to the gastric antrum but does not influence duodenal passage. Gastric clarity and distention were significantly better in the intervention group (P < 0.0001 and P < 0.0001 respectively). Conclusions: Magnetic steering of a small bowel capsule is unable to overcome pyloric contractions to enhance gastric emptying and improve capsule endoscope completion rate. Excellent mucosal visualisation within the gastric cavity suggests this technique could be harnessed for capsule examination of the stomach. PMID:26878053

  16. Quantification, validation, and follow-up of small bowel motility in Crohn's disease

    NASA Astrophysics Data System (ADS)

    Cerrolaza, Juan J.; Peng, Jennifer Q.; Safdar, Nabile M.; Conklin, Laurie; Sze, Raymond; Linguraru, Marius George

    2015-03-01

    The use of magnetic resonance enterography (MRE) has become a mainstay in the evaluation, assessment and follow up of inflammatory bowel diseases, such as Crohn's disease (CD), thanks to its high image quality and its non-ionizing nature. In particular, the advent of faster MRE sequences less sensitive to image-motion artifacts offers the possibility to obtain visual, structural and functional information of the patient's small bowel. However, the inherent subjectivity of the mere visual inspection of these images often hinders the accurate identification and monitoring of the pathological areas. In this paper, we present a framework that provides quantitative and objective motility information of the small bowel from free-breathing MRE dynamic sequences. After compensating for the breathing motion of the patient, we create personalized peristaltic activity maps via optical flow analysis. The result is the creation of a new set of images providing objective and precise functional information of the small bowel. The accuracy of the new method was also evaluated from two different perspectives: objective accuracy (1.1 ± 0.6 mm/s of error), i.e., the ability of the system to provide quantitative and accurate information about the motility of moving bowel landmarks, and subjective accuracy (avg. difference of 0.7 ± 0.7 in a range of 1 to 5), i.e., the degree of agreement with the subjective evaluation of an expert. Finally, the practical utility of the new method was successfully evaluated in a preliminary study with 32 studies of healthy and CD cases, showing its potential for the fast and accurate assessment and follow up of CD in the small bowel.

  17. Effects of neurotensin on small bowel propulsion in intact and vagotomized rats.

    PubMed

    Wilén, T; Gustavsson, S; Jung, B

    1982-09-01

    The effects of intravenous infusion of neurotensin on small bowel motility was studied in conscious rats. During 1 h a standardized test meal of glucose, polyethyleneglycol (PEG) 3000, phenol red and 125I-labelled polyvinylpyrrolidone was administered via a permanent gastric catheter and simultaneously the bile-excreted radio-pharmaceutic 99Tcm-Solco-HIDA was infused intravenously. Immediately after the infusions the gastrointestinal specimen was excised and examined for distribution of radioactivity. Both doses of neurotensin (0.1 and 0.3 microgram . kg-1 . h-1) resulted in an increase in the neurotensin-like immunoreactivity (NTLI) of plasma to levels similar to that found after a fatty meal. Concurrently the small bowel transport pattern was changed from an interdigestive state to one similar to that found after a meal. In animals not receiving the gastric test meal, neurotensin (0.1-0.5 microgram . kg-1 . h-) had no effect on motility. Infusion of the gastric test meal alone did not change the interdigestive motility or the NTLI value. This indicates that the presence of gastric infusates potentiates the effect of neurotensin on small bowel motility. The motility response to neurotensin did not differ between intact and vagotomized animals. This contrasts to earlier findings that the small bowel motility response to a fatty meal is dependent on intact vagal function. Thus, a difference in the mechanism responsible for the motility responses between a fatty meal and neurotensin exists. In view of this finding it seems reasonable to assume that neurotensin cannot be the only factor responsible for the shift in motility found after a fatty meal.

  18. Effectiveness of MR enterography for the assessment of small-bowel diseases beyond Crohn disease.

    PubMed

    Amzallag-Bellenger, Elisa; Oudjit, Ammar; Ruiz, Ana; Cadiot, Guillaume; Soyer, Philippe A; Hoeffel, Christine C

    2012-01-01

    The use of cross-sectional imaging techniques for the noninvasive evaluation of small-bowel disorders is increasing. The effectiveness of magnetic resonance (MR) enterography for the evaluation of Crohn disease, in particular, is well described in the literature. In addition, MR enterography has an evolving though less well documented role to play in the evaluation of other small-bowel diseases, including various benign and malignant neoplasms arising in isolation or in polyposis syndromes such as Peutz-Jeghers, inflammatory conditions such as vasculitis and treatment-induced enteritis, infectious processes, celiac disease, diverticular disease, systemic sclerosis, and bowel duplication. MR enterography may be useful also for the evaluation of intermittent and low-grade small-bowel obstructions. Advantages of MR imaging over computed tomography (CT) for enterographic evaluations include superb contrast resolution, lack of associated exposure to ionizing radiation, ability to acquire multiplanar primary image datasets, ability to acquire sequential image series over a long acquisition time, multiphasic imaging capability, and use of intravenous contrast media with better safety profiles. MR enterography also allows dynamic evaluations of small-bowel peristalsis and distensibility of areas of luminal narrowing and intraluminal masses by repeating sequences at different intervals after administering an additional amount of the oral contrast medium. Limitations of MR enterography in comparison with CT include higher cost, less availability, more variable image quality, and lower spatial resolution. The advantages and disadvantages of MR enterography performed with ingestion of the oral contrast medium relative to MR enteroclysis performed with infusion of the oral contrast medium through a nasoenteric tube are less certain.

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

    SciTech Connect

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

    1985-04-01

    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.

  20. Small bowel involvement documented by capsule endoscopy in Churg-Strauss syndrome

    PubMed Central

    Beye, Birane; Lesur, Gilles; Claude, Pierre; Martzolf, Lionel; Kieffer, Pierre; Sondag, Daniel

    2015-01-01

    Churg-Strauss syndrome is a small and medium vessel vasculitis and is also known as allergic granulomatous angiitis. Gastrointestinal involvement is common in patients with Churg-Strauss syndrome (20-50%). The most common symptoms are abdominal pain, diarrhoea and occasionally gastrointestinal bleeding and perforation. We present a case of Churg-Strauss syndrome with small bowel lesions documented by video capsule endoscopy. PMID:26664542

  1. Prospective evaluation of oral gastrografin(®) in the management of postoperative adhesive small bowel obstruction.

    PubMed

    Rahmani, Nasrin; Mohammadpour, Reza Ali; Khoshnood, Peyman; Ahmadi, Amirhossein; Assadpour, Sara

    2013-06-01

    Oral Gastrografin®, a hyperosmolar water-soluble contrast medium, may have a therapeutic effect in adhesive small bowel obstruction. However, findings are still conflicting, as some authors did not find a therapeutic advantage. So, this prospective, randomized, and clinical trial study was designed to determine the value of Gastrografin in adhesive small bowel obstruction. The primary end points were the evaluation of the operative rate reduction and shortening the hospital stay after the use of Gastrografin. A total of 84 patients were randomized into two groups: the control group received conventional treatment, whereas the study group received in addition of 100 mL Gastrografin meal. Patients were followed up within 4 days after admission, and clinical and radiological (if needed) improvements were evaluated. Although the results showed that Gastrografin can decrease the need for surgical management by 14.5 %, no statistically significant differences were observed between the two groups (P = 0.07). Nevertheless, the length of hospital stay revealed a significant reduction from 4.67 ± 1.18 days to 2.69 ± 1.02 days (P = 0.00). The use of Gastrografin in adhesive small bowel obstruction is safe and reduces the length of hospital stay. As a result, the cost of hospital bed occupancy is reduced. Hence, if there was no indication of emergency surgery, administration of oral Gastrografin as a nonoperative treatment in adhesive small bowel obstruction is also recommended.

  2. Evaluation of different small bowel contrast agents by multi - detector row CT

    PubMed Central

    Wang, Yong-Ren; Yu, Xiao-Li; Peng, Zhi-Yi

    2015-01-01

    Objective: This study aims to evaluate the effects of different oral small bowel contrast agents towards the intestinal dilatation and intestinal wall structure exhibition by the abdominal multi - detector row CT (MDCT) examination. Methods: 80 patients were performed the whole abdominal CT examination, then randomly divided into four groups, with 20 patients in each group. 45 minutes before the CT examination, the patients were served with a total of 1800 ml pure water, pure milk, dilute lactulose solution and isotonic mannitol solution, respectively. Results: The images were blinded read by two experienced abdominal radiologists in the workstation, the cross-sectional diameters of duodenum, jejunum, proximal and terminal ends of ileum of each patient were measured, then the analysis of variance was performed to analyze the differences in the intestinal dilatation among the experimental groups. The scoring method was used to score the intestinal dilatation and intestinal structure exhibition. The diluted lactulose solution and 2.5% mannitol exhibited the best intestinal dilation degrees. Similarly, the diluted lactulose solution and 2.5% mannitol exhibited the highest scores in the entire small bowel dilatation degree and intestinal structure exhibition. Conclusions: 2.5% osmotic mannitol and the diluted lactulose solution enabled the full dilatation of small bowel, and could clearly exhibit the wall structure. PMID:26629131

  3. Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography

    PubMed Central

    Smith, Ethan A.; Sanchez, Ramon J.; DiPietro, Michael A.; DeMatos-Maillard, Vera; Strouse, Peter J.; Darge, Kassa

    2015-01-01

    Small bowel Crohn disease is commonly diagnosed during the pediatric period, and recent investigations show that its incidence is increasing in this age group. Diagnosis and follow-up of this condition are commonly based on a combination of patient history and physical examination, disease activity surveys, laboratory assessment, and endoscopy with biopsy, but imaging also plays a central role. Ultrasonography (US) is an underutilized well-tolerated imaging modality for screening and follow-up of small bowel Crohn disease in children and adolescents. US has numerous advantages over computed tomographic (CT) enterography and magnetic resonance (MR) enterography, including low cost and no required use of oral or intravenous contrast material. US also has the potential to provide images with higher spatial resolution than those obtained at CT enterography and MR enterography, allows faster examination than does MR enterography, does not involve ionizing radiation, and does not require sedation or general anesthesia. US accurately depicts small bowel and mesenteric changes related to pediatric Crohn disease, and US findings show a high correlation with MR imaging findings in this patient population. ©RSNA, 2015 PMID:25839736

  4. Treating Small Bowel Obstruction with a Manual Physical Therapy: A Prospective Efficacy Study.

    PubMed

    Rice, Amanda D; Patterson, Kimberley; Reed, Evette D; Wurn, Belinda F; Klingenberg, Bernhard; King, C Richard; Wurn, Lawrence J

    2016-01-01

    Small bowel obstructions (SBOs) caused by adhesions are a common, often life-threatening postsurgical complication with few treatment options available for patients. This study examines the efficacy of a manual physical therapy treatment regimen on the pain and quality of life of subjects with a history of bowel obstructions due to adhesions in a prospective, controlled survey based study. Changes in six domains of quality of life were measured via ratings reported before and after treatment using the validated Small Bowel Obstruction Questionnaire (SBO-Q). Improvements in the domains for pain (p = 0.0087), overall quality of life (p = 0.0016), and pain severity (p = 0.0006) were significant when average scores before treatment were compared with scores after treatment. The gastrointestinal symptoms (p = 0.0258) domain was marginally significant. There was no statistically significant improvement identified in the diet or medication domains in the SBO-Q for this population. Significant improvements in range of motion in the trunk (p ≤ 0.001), often limited by adhesions, were also observed for all measures. This study demonstrates in a small number of subjects that this manual physical therapy protocol is an effective treatment option for patients with adhesive small bowel obstructions as measured by subject reported symptoms and quality of life.

  5. Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography.

    PubMed

    Dillman, Jonathan R; Smith, Ethan A; Sanchez, Ramon J; DiPietro, Michael A; DeMatos-Maillard, Vera; Strouse, Peter J; Darge, Kassa

    2015-01-01

    Small bowel Crohn disease is commonly diagnosed during the pediatric period, and recent investigations show that its incidence is increasing in this age group. Diagnosis and follow-up of this condition are commonly based on a combination of patient history and physical examination, disease activity surveys, laboratory assessment, and endoscopy with biopsy, but imaging also plays a central role. Ultrasonography (US) is an underutilized well-tolerated imaging modality for screening and follow-up of small bowel Crohn disease in children and adolescents. US has numerous advantages over computed tomographic (CT) enterography and magnetic resonance (MR) enterography, including low cost and no required use of oral or intravenous contrast material. US also has the potential to provide images with higher spatial resolution than those obtained at CT enterography and MR enterography, allows faster examination than does MR enterography, does not involve ionizing radiation, and does not require sedation or general anesthesia. US accurately depicts small bowel and mesenteric changes related to pediatric Crohn disease, and US findings show a high correlation with MR imaging findings in this patient population.

  6. Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis.

    PubMed

    Kalra, N; Agrawal, P; Mittal, V; Kochhar, R; Gupta, V; Nada, R; Singh, R; Khandelwal, N

    2014-03-01

    Abdominal tuberculosis (TB) is the sixth most common extrapulmonary site of involvement. The sites of involvement in abdominal tuberculosis, in descending order of frequency, are lymph nodes, genitourinary tract, peritoneal cavity, and gastrointestinal tract. The radiological armamentarium for evaluating tuberculosis of the small bowel (SBTB) includes barium studies (small bowel follow-through, SBFT), CT (multidetector CT, CT enterography, and CT enteroclysis), ultrasound (sonoenteroclysis), and magnetic resonance imaging (MRI; enterography and enteroclysis). In this review, we illustrate the abnormalities at MDCT enterography in 20 consecutive patients with SB TB and also describe extraluminal findings in these patients. MDCT enterography allows non-invasive good-quality assessment of well-distended bowel loops and the adjacent soft tissues. It displays the thickness and enhancement of the entire bowel wall in all three planes and allows examination of all bowel loops, especially the ileal loops, which are mostly superimposed. The terminal ileum and ileocaecal junction are the most common sites of small bowel involvement in intestinal TB. The most common abnormality is short-segment strictures with symmetrical concentric mural thickening and homogeneous mural enhancement. Other findings include lymphadenopathy, ascites, enteroliths, peritoneal thickening, and enhancement. In conclusion, MDCT enterography is a comprehensive technique for the evaluation of SB TB.

  7. Duodenal adenocarcinoma presenting as a mass with aneurismal dilatation.

    PubMed

    Mama, Nadia; Ben Slama, Aïda; Arifa, Nadia; Kadri, Khaled; Sriha, Badreddine; Ksiaa, Mehdi; Jemni, Hela; Tlili-Graiess, Kalthoum

    2014-01-01

    Duodenal adenocarcinoma is frequent. Aneurysmal dilatation of the small bowel is reported to be a lymphoma characteristic imaging finding. A 57-year-old male was found to have a duodenal adenocarcinoma with aneurismal dilatation on imaging which is an exceptional feature. On laparotomy, the wall thickening of the dilated duodenum extended to the first jejunal loop, with multiple mesenteric lymph nodes and ascites. Segmental palliative resection with gastro-entero-anastomosis was done. Histopathology revealed a moderately differentiated adenocarcinoma with neuro-endocrine differentiation foci. Wide areas of necrosis and vascular emboli were responsible for the radiological feature of the dilated duodenum with wall thickening.

  8. Non-Meckel’s Small Bowel Diverticular Bleeding: Two Case Reports and a Review of the Literature

    PubMed Central

    Wild, Daniel

    2016-01-01

    Gastrointestinal bleeding from non-Meckel’s small bowel diverticulosis is uncommon. Depending on the diverticulum’s location, a patient’s presentation can suggest either an upper or lower gastrointestinal source. We present two cases of bleeding from non-Meckel’s small bowel diverticula. One patient was managed successfully with endoscopic therapy, and the second required surgical resection after two failed attempts at achieving hemostasis endoscopically. PMID:28008410

  9. Effect of parenteral nutrition supplemented with short-chain fatty acids on adaptation to massive small bowel resection.

    PubMed

    Koruda, M J; Rolandelli, R H; Settle, R G; Zimmaro, D M; Rombeau, J L

    1988-09-01

    After massive small bowel resection, total parenteral nutrition (TPN) is prescribed to maintain nutritional status. However, TPN reduces the mass of the remaining intestinal mucosa, whereas adaptation to small bowel resection is associated with increased mucosal mass. Short-chain fatty acids (SCFAs) have been shown to stimulate mucosal cell mitotic activity. This study determined whether the addition of SCFAs to TPN following small bowel resection would prevent intestinal mucosal atrophy produced by TPN. Adult rats underwent an 80% small bowel resection and then received either standard TPN or TPN supplemented with SCFAs (sodium acetate, propionate, and butyrate). After 1 wk, jejunal and ileal mucosal weights, deoxyribonucleic acid, ribonucleic acid, and protein contents were measured and compared with the parameters obtained at the time of resection. Animals receiving TPN showed significant loss of jejunal mucosal weight, deoxyribonucleic acid, ribonucleic acid, and protein and ileal mucosal weight and deoxyribonucleic acid after small bowel resection, whereas animals receiving SCFA-supplemented TPN showed no significant change in the jejunal mucosal parameters and a significant increase in ileal mucosal protein. These data demonstrate that SCFA-supplemented TPN reduces the mucosal atrophy associated with TPN after massive bowel resection and thys may facilitate adaptation to small bowel resection.

  10. Small bowel metastasis from pancreatic cancer in a long-term survival patient with synchronous advanced malignant pleural mesothelioma: A case report and literature review

    PubMed Central

    Fasano, Morena; Corte, Carminia Maria Della; Vicidomini, Giovanni; Scotti, Valerio; Rambaldi, Pier Francesco; Fiorelli, Alfonso; Accardo, Marina; De Vita, Ferdinando; Santini, Mario; Ciardiello, Fortunato; Morgillo, Floriana

    2016-01-01

    Diffuse malignant pleural mesothelioma (MPM) is an aggressive tumor that originates from the surface of the pleura. Approximately 70% of cases are associated with chronic asbestos exposure. MPM is regarded as an incurable disease, with a median survival of ~2 years following intensive multimodality treatment. Pancreatic cancer is a malignancy also associated with a poor prognosis, with only 2% of patients surviving for 5 years. The majority of patients with pancreatic cancer are diagnosed with an advanced stage of disease and experience a poor response to therapy. The development of synchronous MPM and other types of cancer is rare. The present study describes a patient with synchronous, biphasic MPM and pancreatic adenocarcinoma, who was treated with a multimodal therapeutic approach with stereotactic body radiation therapy. Due to a suspected diagnosis of ‘acute abdomen’, an emergency small intestine resection was performed and a subsequent diagnosis of moderately-differentiated adenocarcinoma was confirmed. During a further immunohistochemical examination, pathologists determined that the small bowel metastasis descended from pancreatic cancer. The onset of bowel metastasis is an event rarely associated with MPM, and has not been previously described in the literature for cases of pancreatic cancer. Therefore, to the best of our knowledge, the present study describes the first case of intestinal metastasis from pancreatic cancer in a long-term survival patient with biphasic MPM. PMID:28105159

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

    SciTech Connect

    Huang, E.-Y.; Wang, F.-S.; Lin, I-H.; Yang, Kuender D.

    2009-05-01

    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.

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

    PubMed Central

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

    2011-01-01

    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 χ2 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. PMID:20959377

  13. Adenovirus disease in six small bowel, kidney and heart transplant recipients; pathology and clinical outcome.

    PubMed

    Mehta, Vikas; Chou, Pauline C; Picken, Maria M

    2015-11-01

    Adenoviruses are emerging as important viral pathogens in hematopoietic stem cell and solid organ transplant recipients, impacting morbidity, graft survival, and even mortality. The risk seems to be highest in allogeneic hematopoietic stem cell transplant recipients as well as heart, lung, and small bowel transplant recipients. Most of the adenovirus diseases develop in the first 6 months after transplantation, particularly in pediatric patients. Among abdominal organ recipients, small bowel grafts are most frequently affected, presumably due to the presence of a virus reservoir in the mucosa-associated lymphoid tissue. Management of these infections may be difficult and includes the reduction of immunosuppression, whenever possible, combined with antiviral therapy, if necessary. Therefore, an awareness of the pathology associated with such infections is important in order to allow early detection and specific treatment. We reviewed six transplant recipients (small bowel, kidney, and heart) with adenovirus graft involvement from two institutions. We sought to compare the diagnostic morphology and the clinical and laboratory findings. The histopathologic features of an adenovirus infection of the renal graft and one native kidney in a heart transplant recipient included a vaguely granulomatous mixed inflammatory infiltrate associated with rare cells showing a cytopathic effect (smudgy nuclei). A lymphocytic infiltrate, simulating T cell rejection, with admixture of eosinophils was also seen. In the small bowel grafts, there was a focal mixed inflammatory infiltrate with associated necrosis in addition to cytopathic effects. In the heart, allograft adenovirus infection was silent with no evidence of inflammatory changes. Immunohistochemical stain for adenovirus was positive in all grafts and in one native kidney. All patients were subsequently cleared of adenovirus infection, as evidenced by follow-up biopsies, with no loss of the grafts. Adenovirus infection can

  14. Small bowel volvulus in pregnancy with associated superior mesenteric artery occlusion.

    PubMed

    Esterson, Yonah B; Villani, Robert; Dela Cruz, Ronald A; Friedman, Barak; Grimaldi, Gregory M

    Here we report the case of a pregnant 28-year-old who presented with acute upper abdominal pain. CT demonstrated midgut volvulus with short segment occlusion of the superior mesenteric artery (SMA). Emergent detorsion of the small bowel was performed, at which time underlying intestinal malrotation was discovered. Following detorsion, the SMA had a bounding pulse and did not require thrombectomy or revascularization. Fewer than 25 cases of midgut volvulus during pregnancy have been reported over the past 20years. To our knowledge, this is the first report of maternal midgut volvulus in which imaging captures the resultant occlusion of the SMA.

  15. Small bowel motor activity in response to physiological meals of different chemical composition in man.

    PubMed

    V Schönfeld, J

    2006-03-01

    Meals disrupt the interdigestive pattern of small bowel motor activity and convert it into the more irregular postprandial pattern. Previous animal studies suggest that the duration of and contractile activity within the postprandial period depend on the chemical composition of a meal. It is not clear whether this is also true for man. In 8 healthy volunteers I investigated how physiological and isocaloric meals of different chemical composition affect small bowel motor activity. Volunteers underwent two separate, ambulatory 24-hour small bowel manometry studies. Volunteers had a total of four meals on the two study days. They ingested two identical fish meals rich in protein, a pasta meal rich in carbohydrates, and a meat meal rich in fat. Records were analyzed visually for the reappearance of phase III of the migrating motor complex, and a validated computer program calculated the incidence of contractions during the postprandial period, as well as the amplitude and propagation of contractions. The durations of the postprandial periods were similar after the two protein meals (238 +/- 35 and 227 +/- 25 min), the carbohydrate (220 +/- 23 min) and the fat meal (242 +/- 43 min). The incidence of contractions was not significantly different after the protein meals (1.6 +/- 0.3 and 1.0 +/- 0.2 contractions per min), the carbohydrate meal (1.0 +/- 0.2 contractions per min) and the fat meal (1.5 +/- 0.2 contractions per min). The amplitude of contractions was similar after the protein meals (14 +/- 0.1 and 13 +/- 0.1 mmHg), the carbohydrate meal (14 +/- 0.1 mmHg) and the fat meal (14 +/- 0.1 mmHg). Propagation of contractions was similar after the protein meals (13 +/- 3 and 18 +/- 3 %), after the carbohydrate meal (15 +/- 2 %) and after the fat meal (13 +/- 2 %). Contractile activity within consecutive 30-min periods of the postprandial period was also not different between the meals. I conclude that physiological, isocaloric meals of different chemical composition

  16. Transvaginal Small Bowel Evisceration in Known Case of Uterine Prolapse Due to Trauma

    PubMed Central

    Gheewala, Umesh; Shukla, Radha; Bhatt, Ravi; Srivastava, Shirish

    2015-01-01

    Spontaneous transvaginal bowel evisceration is a rare surgical emergency with only a few cases reported and particularly postmenopausal, posthysterectomy, multiparous elderly women are considered to be at higher risk for development of bowel evisceration. It is difficult to manage such a patient for any surgeon and poses significant challenges especially intraoperatively. Here, we report a case of vaginal vault rupture with small bowel evisceration through the vagina in a known case of uterine prolapse and highlight the risk factors, clinical presentation, and treatment options for this rare surgical emergency PMID:25738028

  17. Small bowel bacterial overgrowth: a negative factor in gut adaptation in pediatric SBS.

    PubMed

    Cole, Conrad R; Ziegler, Thomas R

    2007-12-01

    Small bowel bacterial overgrowth (SBBO) is common in infants and children with short bowel syndrome (SBS). Its occurrence is due to alterations in anatomy, motility, and secretion, which promote the abnormal growth of bacteria. SBBO is associated with significant clinical problems, including prolonged dependence on parenteral nutrition, liver injury, and malabsorption. A major clinical challenge is in making the correct diagnosis of bacterial overgrowth. Management of this disorder is still poorly understood and should be evaluated adequately. This review addresses the current understanding of bacteria in the intestines and issues related to bacterial overgrowth in pediatric SBS.

  18. Evidence of internucleosomal DNA fragmentation and identification of dying cells in X-ray-induced cell death in the developing brain.

    PubMed

    Ferrer, I; Macaya, A; Blanco, R; Olivé, M; Cinós, C; Munell, F; Planas, A M

    1995-02-01

    Newborn Sprague-Dawley rats received a single dose of 2 Gy X-rays and were killed 6 hr later. Dying cells were characterized by extreme chromatin condensation and nuclear fragmentation. Dying cells were distributed in the primary and secondary germinal zones and in other brain regions. Among these latter, dying cells occurred in the cortical layers of the olfactory bulb, layers II-III and VIb of the neocortex, piriform and entorhinal cortex, stratum oriens and pyramidale of the hippocampus, striatum, thalamus, amygdala, brainstem, internal granular layer of the cerebellum, and cerebral and cerebellar white matter. Dying cells were immature cells, neurons and glial cells (including radial glia). In-situ labeling of nuclear DNA fragmentation identified individual cells bearing fragmented DNA. Since the number of cells stained with this method was larger than the number of dying cells, as revealed with current histological techniques, it is suggested that nuclear DNA fragmentation precedes chromatin condensation and nuclear fragmentation in X-ray-induced apoptosis. Furthermore, agarose gel electrophoresis of extracted DNA from irradiated brains showed a "ladder" pattern which is typical of internucleosomal DNA fragmentation and endonuclease activation.

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

    SciTech Connect

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

    2013-08-21

    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.

  20. 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

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

    2013-12-01

    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.

  1. The glucose breath test: a diagnostic test for small bowel stricture(s) in Crohn's disease.

    PubMed

    Mishkin, Daniel; Boston, Francis M; Blank, David; Yalovsky, Morty; Mishkin, Seymour

    2002-03-01

    The aim of this study was to determine whether an indirect noninvasive indicator of proximal bacterial overgrowth, the glucose breath test, was of diagnostic value in inflammatory bowel disease. Twenty four of 71 Crohn's disease patients tested had a positive glucose breath test. No statistical conclusions could be drawn between the Crohn's disease activity index and glucose breath test status. Of patients with radiologic evidence of small bowel stricture(s), 96.0% had a positive glucose breath test, while only one of 46 negative glucose breath test patients had a stricture. The positive and negative predictive values for a positive glucose breath test as an indicator of stricture formation were 96.0% and 97.8%, respectively. This correlation was not altered in Crohn's disease patients with fistulae or status postresection of the terminal ileum. The data in ulcerative colitis were nondiagnostic. In conclusion, the glucose breath test appears to be an accurate noninvasive inexpensive diagnostic test for small bowel stricture(s) and secondary bacterial overgrowth in Crohn's disease.

  2. Small Bowel Obstruction Secondary to Femoral Hernia; Case Report and Review of the Literature

    PubMed Central

    Akrami, Majid; Karami, MohamamdYasin; Zangouri, Vahid; Deilami, Iman; Maalhagh, Mehrnoush

    2016-01-01

    Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery.This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. To the best of our knowledge, there is few reports of strangulated femoral hernia.We herein present an 82-year-old lady who presented with a 5-day history of abdominal pain, nausea and vomiting. On examination, the patient had a generalized tenderness and distention. The working diagnosis at this time was a bowel obstruction. A computed tomography scan revealed the hernia occurring medial to the femoral vessels and below the inguinal ligament .Laparotomy was performed and patient was treated successfully with surgical therapy.Herniawas repaired and a small bowel resection was performed with end to end anastomosis. The postoperative course was uneventful, and the patient was doing well at a 12-month follow-up visit. Obstructing femoral hernia of the small bowel is rare and the physician should suspect femoral hernia as a bowel obstruction cause. PMID:27162928

  3. Small bowel entrapment and ureteropelvic junction disruption associated with L3 Chance fracture-dislocation

    PubMed Central

    Pesenti, Sebastien; Blondel, Benjamin; Faure, Alice; Peltier, Emilie; Launay, Franck; Jouve, Jean-Luc

    2016-01-01

    Paediatric Chance fracture are rare lesions but often associated with abdominal injuries. We herein present the case of a seven years old patient who sustained an entrapment of small bowel and an ureteropelvic disruption associated with a Chance fracture and spine dislocation following a traffic accident. Initial X-rays and computed tomographic (CT) scan showed a Chance fracture with dislocation of L3 vertebra, with an incarceration of a small bowel loop in the spinal canal and a complete section of the left lumbar ureter. Paraplegia was noticed on the initial neurological examination. A posterior L2-L4 osteosynthesis was performed firstly. In a second time she underwent a sus umbilical laparotomy to release the incarcerated jejunum loop in the spinal canal. An end-to-end anastomosis was performed on a JJ probe to suture the left injured ureter. One month after the traumatism, she started to complain of severe headaches related to a leakage of cerebrospinalis fluid. Three months after the traumatism there was a clear regression of the leakage. One year after the trauma, an anterior intervertebral fusion was done. At final follow-up, no neurologic recovery was noticed. In case of Chance fracture, all physicians should think about abdominal injuries even if the patient is asymptomatic. Initial abdominal CT scan and magnetic resonance imaging provide in such case crucial info for management of the spine and the associated lesions. PMID:27672641

  4. Resveratrol Attenuates Both Small Bowel and Liver Changes in Obstructive Jaundice

    PubMed Central

    Temi, Volkan; Okay, Erdem; Güneş, Abdullah; Şimşek, Turgay; Çekmen, Mustafa; Bilgili, Ümit; Gürbüz, Yeşim

    2014-01-01

    Background: It is well known that mucosal changes and alterations in liver function occur in the experimental obstructive jaundice model. Aims: We aimed to evaluate the effect of resveratrol on obstructive jaundice-induced changes in the small bowel mucosa and liver using ischaemia-modified albumin as a marker of oxidative damage. Study Design: Animal experimentation. Methods: The study used a rodent experimental model of obstructive jaundice, including a sham group (1), a control group (2), and a study group (3). Wistar albino rats were used. Jaundice was produced by ligation of the bile duct in Groups 2 and 3. In Group 3, resveratrol was administered intraperitoneally for 14 days. Results: In terms of the structure and the size of the mucosal villi, significant thickening and blunting were detected in Group 2 compared with Group 1. These changes were significantly less noticeable in Group 3 compared with Group 2. Levels of ischaemia-modified albumin were significantly higher in Group 2 compared with those in Group 1, and they were significantly decreased in Group 3 compared with Group 2. Conclusion: Resveratrol administration to obstructive jaundiced rats reduced the organic effects of obstructive jaundice on small bowel mucosa and liver oxidative stress. We believe that this reduction might attenuate bacterial translocation and systemic effects of secreted cytokines. PMID:25207176

  5. Left-sided transmesocolic herniation of small bowel in an otherwise unaffected abdomen.

    PubMed

    Agarwal, Akshay Anand; Sonkar, Abhinav Arun; Singh, Kul Ranjan; Rai, Anurag

    2015-05-15

    Transmesocolic hernia is an uncommon type of internal hernia with incidence ranging from approximately 5-10%. To the best of our knowledge, this is the first reported case of a transmesocolic hernia through a gap within the descending mesocolon presenting clinically as an intestinal obstruction. A 75-year-old man was admitted with clinical features of intestinal obstruction. An abdominal X-ray showed multiple small bowel loops with air fluid levels. Contrast-enhanced CT of the abdomen revealed small bowel obstruction not only on the right, but also on the left side of the collapsed descending colon. Emergency surgery was performed. Strangulated bowel loops with gangrenous changes were resected and double-barrel ileostomy was carried out. The postoperative period was uneventful. Restoration of bowel was performed after 6 weeks. Preoperative diagnosis of bowel obstruction caused by a transmesocolic hernia remains difficult despite the currently available imaging techniques. Prompt surgery can prevent serious complications such as peritonitis and sepsis.

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

    PubMed Central

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

    2011-01-01

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

  7. Endoscopic techniques to detect small-bowel neuroendocrine tumors: A literature review

    PubMed Central

    Conte, Dario; Elli, Luca; Branchi, Federica; Massironi, Sara

    2016-01-01

    Background The diagnosis of small-bowel neuroendocrine tumors (SbNETs) has improved with the advent of video capsule endoscopy (CE) and double-balloon enteroscopy (DBE). The data describing the efficacy of CE/DBE in the detection of SbNETs are scanty. Aim The aim of this article is to review the current evidence on the role of DBE and CE in the diagnosis of SbNETs. Material and methods A bibliographical search was performed in PubMed using the following keywords: “neuroendocrine tumors and enteroscopy/and capsule endoscopy” and “small bowel neuroendocrine tumors.” Results CE and DBE can be complementary and show a similar diagnostic yield. The number of false-negative results has not been established yet because of the “work-up bias” observed in the majority of the studies. Conclusions DBE and CE appear to be both safe and effective procedures useful in the diagnosis of SbNETs. Further studies are required to clarify their potential complications and relationship with other techniques, particularly nuclear imaging.

  8. Investigation of Small Bowel Abnormalities in HIV-Infected Patients Using Capsule Endoscopy

    PubMed Central

    Sakai, Eiji; Higurashi, Takuma; Ohkubo, Hidenori; Hosono, Kuhihiro; Ueda, Atsuhisa

    2017-01-01

    HIV infection is reportedly associated with an increased permeability of the intestinal epithelium and can cause HIV enteropathy, which occurs independently of opportunistic infections. However, the characteristics of small bowel abnormalities attributable to HIV infection are rarely investigated. In the present study, we assessed the intestinal mucosal changes found in HIV-infected patients and compared them with the mucosa of healthy control subjects using capsule endoscopy (CE). Three of the 27 HIV-infected patients harbored gastrointestinal opportunistic infections and were thus excluded from subsequent analyses. The endoscopic findings of CE in HIV-infected patients were significantly higher than those in control subjects (55% versus 10%, P = 0.002); however, most lesions, such as red spots or tiny erosions, were unlikely to cause abdominal symptoms. After validating the efficacy of CE for the diagnosis of villous atrophy, we found that the prevalence of villous atrophy was 54% (13/24) among HIV-infected patients. Interestingly, villous atrophy persisted in patients receiving long-term antiretroviral therapy, though most of them exhibited reconstituted peripheral blood CD4+ T cells. Although we could not draw any conclusions regarding the development of small bowel abnormalities in HIV-infected patients, our results may provide some insight regarding the pathogenesis of HIV enteropathy.

  9. Measurement of hepatic insulin sensitivity early after the bypass of the proximal small bowel in humans

    PubMed Central

    Herring, R.; Vusirikala, A.; Shojaee‐Moradi, F.; Jackson, N. C.; Chandaria, S.; Jackson, S. N.; Goldstone, A. P.; Hakim, N.; Patel, A. G.; Umpleby, A. M.; Le Roux, C. W.

    2016-01-01

    Summary Objective Unlike gastric banding or sleeve gastrectomy procedures, intestinal bypass procedures, Roux‐en‐Y gastric bypass in particular, lead to rapid improvements in glycaemia early after surgery. The bypass of the proximal small bowel may have weight loss and even caloric restriction‐independent glucose‐lowering properties on hepatic insulin sensitivity. In this first human mechanistic study, we examined this hypothesis by investigating the early effects of the duodeno‐jejunal bypass liner (DJBL; GI Dynamics, USA) on the hepatic insulin sensitivity by using the gold standard euglycaemic hyperinsulinaemic clamp methodology. Method Seven patients with obesity underwent measurement of hepatic insulin sensitivity at baseline, 1 week after a low‐calorie liquid diet and after a further 1 week following insertion of the DJBL whilst on the same diet. Results Duodeno‐jejunal bypass liner did not improve the insulin sensitivity of hepatic glucose production beyond the improvements achieved with caloric restriction. Conclusions Caloric restriction may be the predominant driver of early increases in hepatic insulin sensitivity after the endoscopic bypass of the proximal small bowel. The same mechanism may be at play after Roux‐en‐Y gastric bypass and explain, at least in part, the rapid improvements in glycaemia.

  10. The "Pavia model" of experimental small bowel transplantation in pigs: technical variations for ischemia reperfusion injury studies.

    PubMed

    Alessiani, M; Cobianchi, L; Viganò, J; Dominioni, T; Bottazzi, A; Zonta, S; Dionigi, P

    2014-01-01

    Ischemia reperfusion injury (IRI) is a major field of study in small bowel transplantation because of its implications regarding intestinal immunity. In this study, we have introduced some variations to the described models of IRI in pigs to make possible a complete isolation of the small bowel for IRI studies. In swine, two anatomical barriers make impossible a complete isolation of the small bowel at the origin of superior mesenteric artery (SMA) and vein (SMV): the main colic vessels, which originate distally to form SMA and SMV, and the blood supply of the distal portion of the duodenum and the cephalic part of the pancreas. In a group of Large White pigs (n = 5), we have performed a complete isolation of the small bowel, including sub-total colectomy and pancreaticoduodenectomy. Both SMA and SMV were isolated at the origin from the aorta and at the junction of the splenic vein, respectively. Intestinal continuity was restored with duodenojejunal anastomosis and with ileotransverse colon anastomosis. One pig died on postoperative day 5 from intestinal occlusion due to adhesions. The remaining four pigs were killed on postoperative day 7 after an uneventful postoperative course. No complications were found at autopsy. In swine, resection of part of the pancreas and duodenum and removal of the large bowel does not affect short-term survival, allowing a full isolation of the entire small bowel mimicking the transplantation procedure. Thus, this model appears to be attractive for IRI studies in the field of intestinal transplantation.

  11. Study on X-ray-induced apoptosis and chromosomal damage in G2 human lymphocytes in the presence of pifithrin-α, an inhibitor of p53.

    PubMed

    Ortenzi, Vincenza; Meschini, Roberta; Berni, Andrea; Mancinelli, Pierluigi; Palitti, Fabrizio

    2011-11-27

    The aim of this study is to investigate the role of the cell-cycle phase in cells exposed to radiation and chemicals in relation to the cellular response. The analysis was focused on the G2 cell-cycle phase, exploring the impact of p53 inhibition in human lymphocytes irradiated with X-rays in the presence or absence of pifithrin-α (PFT-α), a p53-specific inhibitor. Lymphocytes, 44h after stimulation to proliferate, were X-irradiated with 0.5Gy both in the presence or the absence of PFT-α and post-treated with a pulse of 5-bromodeoxyuridine (BrdUrd) to distinguish cells in the S- or G2-phase at the moment of irradiation. At early sampling times after X-ray exposure the following parameters were analysed: cellular proliferation, apoptosis, chromosomal aberrations and p53 expression. The results show an enhancement of apoptotic cells in G2 at early sampling times after irradiation and no differences in terms of chromosomal aberration induction both in cells treated with X-rays alone and in cells treated with X-rays plus PFT-α. Expression of p53 was not detectable at all recovery times. The results suggest a p53-independent apoptotic pathway acting at early times after X-ray exposure in G2 lymphocytes. Furthermore, the same yield of X-ray-induced chromatid breaks was observed both in the presence or absence of PFT-α implying that in G2 X-irradiated lymphocytes this inhibitor of the p53 protein does not affect DNA repair.

  12. X-ray-induced catalytic active-site reduction of a multicopper oxidase: structural insights into the proton-relay mechanism and O2-reduction states

    PubMed Central

    Serrano-Posada, Hugo; Centeno-Leija, Sara; Rojas-Trejo, Sonia Patricia; Rodríguez-Almazán, Claudia; Stojanoff, Vivian; Rudiño-Piñera, Enrique

    2015-01-01

    During X-ray data collection from a multicopper oxidase (MCO) crystal, electrons and protons are mainly released into the system by the radiolysis of water molecules, leading to the X-ray-induced reduction of O2 to 2H2O at the trinuclear copper cluster (TNC) of the enzyme. In this work, 12 crystallographic structures of Thermus thermophilus HB27 multicopper oxidase (Tth-MCO) in holo, apo and Hg-bound forms and with different X-ray absorbed doses have been determined. In holo Tth-MCO structures with four Cu atoms, the proton-donor residue Glu451 involved in O2 reduction was found in a double conformation: Glu451a (∼7 Å from the TNC) and Glu451b (∼4.5 Å from the TNC). A positive peak of electron density above 3.5σ in an F o − F c map for Glu451a O∊2 indicates the presence of a carboxyl functional group at the side chain, while its significant absence in Glu451b strongly suggests a carboxylate functional group. In contrast, for apo Tth-MCO and in Hg-bound structures neither the positive peak nor double conformations were observed. Together, these observations provide the first structural evidence for a proton-relay mechanism in the MCO family and also support previous studies indicating that Asp106 does not provide protons for this mechanism. In addition, eight composite structures (Tth-MCO-C1–8) with different X-ray-absorbed doses allowed the observation of different O2-reduction states, and a total depletion of T2Cu at doses higher than 0.2 MGy showed the high susceptibility of this Cu atom to radiation damage, highlighting the importance of taking radiation effects into account in biochemical interpretations of an MCO structure. PMID:26627648

  13. X-ray-induced catalytic active-site reduction of a multicopper oxidase: structural insights into the proton-relay mechanism and O2-reduction states.

    PubMed

    Serrano-Posada, Hugo; Centeno-Leija, Sara; Rojas-Trejo, Sonia Patricia; Rodríguez-Almazán, Claudia; Stojanoff, Vivian; Rudiño-Piñera, Enrique

    2015-12-01

    During X-ray data collection from a multicopper oxidase (MCO) crystal, electrons and protons are mainly released into the system by the radiolysis of water molecules, leading to the X-ray-induced reduction of O2 to 2H2O at the trinuclear copper cluster (TNC) of the enzyme. In this work, 12 crystallographic structures of Thermus thermophilus HB27 multicopper oxidase (Tth-MCO) in holo, apo and Hg-bound forms and with different X-ray absorbed doses have been determined. In holo Tth-MCO structures with four Cu atoms, the proton-donor residue Glu451 involved in O2 reduction was found in a double conformation: Glu451a (∼7 Å from the TNC) and Glu451b (∼4.5 Å from the TNC). A positive peak of electron density above 3.5σ in an Fo - Fc map for Glu451a O(ℇ2) indicates the presence of a carboxyl functional group at the side chain, while its significant absence in Glu451b strongly suggests a carboxylate functional group. In contrast, for apo Tth-MCO and in Hg-bound structures neither the positive peak nor double conformations were observed. Together, these observations provide the first structural evidence for a proton-relay mechanism in the MCO family and also support previous studies indicating that Asp106 does not provide protons for this mechanism. In addition, eight composite structures (Tth-MCO-C1-8) with different X-ray-absorbed doses allowed the observation of different O2-reduction states, and a total depletion of T2Cu at doses higher than 0.2 MGy showed the high susceptibility of this Cu atom to radiation damage, highlighting the importance of taking radiation effects into account in biochemical interpretations of an MCO structure.

  14. Differential sensitivity of a mouse myeloid leukemia cell line and normal mouse bone marrow cells to X-ray-induced chromosome aberrations

    SciTech Connect

    Aardema, M.J.; Au, W.W.; Hand, R.E. Jr.; Preston, R.J.

    1985-11-01

    Cell line ML-1 was established from a myelogenous leukemia of an RFM mouse. The ML-1 cells and in vitro normal mouse bone marrow cells were analyzed to determine if there was a differential sensitivity to X-ray-induced chromosome aberrations in G1 cells and/or differences in postirradiation cell cycle progression. Cells identified as being in G1 at the time of irradiation by their staining pattern after replication in 5-bromodeoxyuridine were analyzed for all types of chromosomal aberrations following X-ray doses of 0.5, 1.0, 1.5, and 2.0 Gy. ML-1 cells showed a greater sensitivity to the induction of both chromosome-type aberrations and chromatid-type aberrations compared to normal mouse bone marrow cells, which only contained chromosome-type aberrations. The presence of chromatid-type aberrations in the ML-1 cells and not normal bone marrow cells suggested a differential progression through the cell cycle for the two cell types after irradiation. Mitotic index and flow cytometric analyses were performed and showed that both cell types have a delay in progression from G2 into mitosis, but only the normal mouse bone marrow cells have a delay in progression from G1 into S, as well as delayed progression through the S phase following X-irradiation. These results indicate that the ML-1 leukemia cells have an increased radiosensitivity. These same characteristics have been observed in ataxia telangiectasia cells and may well represent a general feature of cells with increased radiosensitivity.

  15. A long-Segmental Vascular Malformation in the Small Bowel Presenting With Gastrointestinal Bleeding in a Preschool-Aged Child

    PubMed Central

    Lee, Yeoun Joo; Hwang, Jae-Yeon; Cho, Yong Hoon; Kim, Yong-Woo; Kim, Tae Un; Shin, Dong Hoon

    2016-01-01

    Gastrointestinal (GI) bleeding in pediatric patients has several causes. Vascular malformation of the small bowel is a rare disease leading to pediatric GI bleeding. To our knowledge, few reports describe ultrasound and computed tomography findings of venous malformations involving the small bowel. We present a case of long-segmental and circumferential vascular malformation that led to GI bleeding in a pre-school aged child, focusing on the radiologic findings. Although vascular malformation including of the GI tract is rare in children, it should be considered when GI bleeding occurs in pediatric patients. PMID:27110342

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

    PubMed Central

    Siddiky, AH; Gupta, P

    2012-01-01

    We describe a case of proximal small bowel obstruction caused by an occlusive thrombus as a result of bleeding from a duodenal ulcer, which is likely to be stress induced. Initial presentation was confused as a bleeding duodenal ulcer and resultant ileus. Such reports are incredibly rare in the literature and never has one been reported as a result of a stress ulcer. Obstructive symptoms in the acute postoperative patient may be confused for an ileus but mechanical causes must be excluded. The presence of upper gastrointestinal bleeding must not detract from that possibility. Future identification of an occlusive clot on endoscopy that is impossible to circumnavigate may benefit from intraluminal injection of thrombolytic agents to prevent obstruction but this must be weighed with the risk of exacerbating any bleeding. Clearly a risk versus benefit analysis will be necessary on an individual basis. PMID:24960721

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

    SciTech Connect

    Delaney, J.P.; Bonsack, M.E.; Felemovicius, I. )

    1994-03-01

    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.

  18. The problems of massive small bowel resection and difficulties encountered in management.

    PubMed Central

    Barros D'Sa, A. A.; Parks, T. G.; Roy, A. D.

    1978-01-01

    Massive small bowel resection is imperative in the management of several pathological conditions and is accompanied by high operative mortality. In those that survive, serious nutritional disturbances are inevitable. Intestinal adaptation is said to occur but cannot be relied upon. Long-term parenteral nutrition is problematical and often unsuccessful. Many surgical procedures have been adopted in an effort to improve prognosis and have been found wanting. Controlled experimental studies in the use of reversed segments and a limited number of reported clinical cases using the method after massive resection suggest that this technique may improve the function of the residual intestine to such an extent that other supportive measures are unnecessary. PMID:97646

  19. 131 I-MIBG Therapy in a Metastatic Small Bowel Neuroendocrine Tumor Patient Undergoing Hemodialysis.

    PubMed

    Rahimi, Behruz; Makis, William; Riauka, Terence A; McEwan, Alexander J B; Morrish, Don

    2017-02-24

    Systemic radioisotope therapy with I-metaiodobenzylguanidine (I-MIBG) is an effective form of targeted therapy for neuroendocrine tumors. One of the absolute contraindications to administering I-MIBG therapy listed in the 2008 European Association of Nuclear Medicine guidelines is renal insufficiency requiring dialysis, although this contraindication is not evidence based. We describe a 68-year-old woman with a metastatic small bowel neuroendocrine tumor who developed renal insufficiency requiring hemodialysis. Imaging and dosimetry with I-MIBG were performed and showed that the radiation doses to the whole body and lungs were within safe limits. She was treated with 1820 MBq of I-MIBG with no short-term adverse reactions.

  20. Transanal evisceration of the small bowel a rare complication of rectal prolapse

    PubMed Central

    Kornaropoulos, Michael; Makris, Marinos C.; Yettimis, Evripides; Zevlas, Andreas

    2015-01-01

    Introduction Transanal evisceration of small bowel is an extremely rare surgical emergency. Of the nearly 70 cases reported in the literature, rectal prolapse is the predisposing factor that has been most frequently related to this pathology. Presentation of case We report a 78-year-old female with history of chronic rectal prolapse who presented in our emergency department with evisceration of small intestinal loops through the anus. In surgery after complete reduction of the eviscerated bowel into the peritoneal cavity, almost 20 cm of the terminal ileum up to the ileocecal valve were necrotic and therefore a right hemicolectomy with primary anastomosis was performed. Additionally a 2 cm craniocaudally tear was revealed in the antimesenteric border of the upper rectum and a Hartman procedure was also performed. The patient was discharged after 10 days. Discussion Early recognition and timely surgical intervention offers the best prognosis, avoiding a fatal conclusion or an extensive intestinal resection. PMID:26708948

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

    PubMed

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

    2009-05-01

    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.

  2. Polyarthritis and massive small bowel bleed: An unusual combination in scrub typhus.

    PubMed

    Iqbal, Nayyar; Titus, Solomon; Basheer, Aneesh; George, Sanjoy; George, Sanjoy; Mookkappan, Sudhagar; Nair, Shashikala; Alexander, Thomas; Ramdas, Anita; Periyasamy, Sivakumar; Anitha, Patricia; Kanungo, Reba

    2015-01-01

    Scrub typhus is an acute febrile illness caused by the intracellular parasite Orientia tsutsugamushi. Although most cases present with mild symptoms and signs and recover spontaneously, some cases can be severe with multi-organ dysfunction and a protracted course, which may be fatal if left untreated. Apart from fever and constitutional symptoms, atypical presentations allow this disease to mimic several common conditions. We report a case of scrub typhus in an 18-year-old male who presented with severe polyarthritis involving all large joints and a massive lower gastrointestinal bleed from ulcers in the terminal ileum, secondary to vasculitis in the small bowel. This combination of pathologies has not previously been reported in cases of scrub typhus. The patient improved following surgical intervention and specific anti-rickettsial therapy with azithromycin.

  3. Laparoscopic surgery for small-bowel obstruction caused by Meckel’s diverticulum

    PubMed Central

    Matsumoto, Takatsugu; Nagai, Motoki; Koike, Daisuke; Nomura, Yukihiro; Tanaka, Nobutaka

    2016-01-01

    A 26-year-old woman was referred to our hospital because of abdominal distention and vomiting. Contrast-enhanced computed tomography showed a blind loop of the bowel extending to near the uterus and a fibrotic band connecting the mesentery to the top of the bowel, suggestive of Meckel’s diverticulum (MD) and a mesodiverticular band (MDB). After intestinal decompression, elective laparoscopic surgery was carried out. Using three 5-mm ports, MD was dissected from the surrounding adhesion and MDB was divided intracorporeally. And subsequent Meckel’s diverticulectomy was performed. The presence of heterotopic gastric mucosa was confirmed histologically. The patient had an uneventful postoperative course and was discharged 5 d after the operation. She has remained healthy and symptom-free during 4 years of follow-up. This was considered to be an unusual case of preoperatively diagnosed and laparoscopically treated small-bowel obstruction due to MD in a young adult woman. PMID:26981191

  4. Vomiting gallstones as a presenting feature of small bowel obstruction secondary to inflammatory stricture.

    PubMed

    McGowan, David Ross; Norris, Joseph M; Zia, Khawaja

    2013-04-22

    Patients presenting with symptoms caused by gallstones are common on a surgical take. Understanding the different ways in which this common condition can present is important to enable the correct diagnosis and thus management plan. The immediate management of gallstones depends on the presenting features and can range from analgesia to surgical intervention. Obstructive cases require intervention, either by ERCP or surgery; the non-obstructive cases are usually left to settle before an elective operation at a later date. In surgery, the presence of a clinical sign where it 'should not be' can be a sign of another underlying pathology and this is the embodiment of surgery-to assimilate seemingly disparate pieces of information and act in a way to treat the cause. This case study highlights a rare presentation of one disease state, in vomiting of gallstones, that raised the diagnosis of another pathology, a small bowel obstruction.

  5. [Laparoscopic diagnosis and treatment of early adhesive small bowel obstruction after gynecological surgery].

    PubMed

    Timofeev, M E; Breusenko, V G; Shapoval'iants, S G; Fedorov, E D; Larichev, S E; Kretsu, V N

    2015-01-01

    It is presented the results of diagnostic and curative laparoscopic interventions in 33 patients with acute early adhesive small bowel obstruction. Ileus developed after surgical treatment (laparotomy) of different gynecological diseases. Laparoscopy appeared as the most informative diagnostic method to confirm diagnosis in all patients, to estimate state of abdominal cavity and small pelvis organs what can help to determine method of surgical treatment. Contraindications for laparoscopic surgery were identified in 12 (36.4%) patients and conversion to laparotomy was applied in this group. Postoperative complications were diagnosed in 1 (8.3%) patient. 2 (16.6%) patients died. Early adhesive ileus was resolved laparoscopically in 21 (63.6%) of 33 patients. Recurrent acute early adhesive ileus was detected in 1 (4.7%) patient.

  6. Influence of PACAP on oxidative stress and tissue injury following small-bowel autotransplantation.

    PubMed

    Ferencz, Andrea; Racz, Boglarka; Tamas, Andrea; Reglodi, Dora; Lubics, Andrea; Nemeth, Jozsef; Nedvig, Klara; Kalmar-Nagy, Karoly; Horvath, Ors Peter; Weber, Gyorgy; Roth, Erzsebet

    2009-02-01

    Tissue injury caused by cold preservation and reperfusion remains an unsolved problem during small-bowel transplantation. Pituitary adenylate cyclase-activating polypeptide (PACAP) is present and plays a central role in the intestinal physiology. This study investigated effect of PACAP-38 on the oxidative stress and tissue damage in autotransplanted intestine. Sham-operated, ischemia/reperfusion, and autotransplanted groups were established in Wistar rats. In ischemia/reperfusion groups, 1 h (group A), 2 h (group B), and 3 h (group C) ischemia followed by 3 h of reperfusion was applied. In autotransplanted groups, total orthotopic intestinal autotransplantation was performed. Grafts were preserved in University of Wisconsin (UW) solution and in UW containing 30 microg PACAP-38 for 1, 2, 3, and 6 h. Reperfusion lasted 3 h in all groups. Endogenous PACAP-38 concentration was measured by radioimmunoassay. To determine oxidative stress parameters, malondialdehyde, reduced glutathione, and superoxide dismutase were measured in tissue samples. Tissue damage was analyzed by qualitative and quantitative methods on hematoxylin/eosin-stained sections. Concentration of endogenous PACAP-38 significantly decreased in groups B and C compared to sham-operated group. Preservation solution containing PACAP-38 ameliorated bowel tissue oxidative injury induced by cold ischemia and reperfusion. Histological results showed that preservation caused destruction of the mucous, submucous, and muscular layers, which were further deteriorated by the end of reperfusion. In contrast, PACAP-38 significantly protected the intestinal structure. Ischemia/reperfusion decreased the endogenous PACAP-38 concentration in the intestinal tissue. Administration of PACAP-38 mitigated the oxidative injury and histological lesions in small-bowel autotransplantation model.

  7. Early Adaptation of Small Intestine After Massive Small Bowel Resection in Rats

    PubMed Central

    Chen, Jie; Qin, Zhen; Shan, Hongmei; Xiao, Yongtao; Cai, Wei

    2015-01-01

    Background: It is important that the residual bowel adapts after massive resection. The necessary intestinal adaptation is a progressive recovery from intestinal failure through increase in absorptive surface area and functional capacity and includes both morphological and functional adaptations. Objectives: The aim of this study was to investigate intestinal morphological and functional adaptations of small bowel syndrome (SBS) model rats (SBS1W) 7 days after bowel resection. Materials and Methods: Male sprague–dawley rats (n = 20/group) underwent either a 75% proximal small bowel resection (SBS1W group) or a control operation (control group). Markers of morphological adaptation were revealed by TEM analysis of H&E-stained tissue samples. The intestinal barrier condition was assessed by BT, and sIgA concentration in intestinal mucus was measured by ELISA. Contractility and the slow wave rhythm of the entire intestinal remnant were measured and recorded. Results: The SBS1W group experienced more weight loss than control group and had a clearly different intestinal morphology as revealed in TEM images. Compared with control rats, the SBS1W group had a lower sIgA concentration in intestinal mucus and higher BT to lymph nodes (70% vs 40%; level I), portal blood (40% vs 10%; level II), and peripheral blood (60% vs 30%; level III). Disorder of spontaneous rhythmic contraction, irregular amplitude, and slow frequency were detected in the SBS1W group by a muscle strips test. Similarly, the slow wave of the entire intestinal remnant in the SBS1W group was irregular and uncoordinated. Conclusions: The finding of intestinal adaptation following massive SBR in SBS1W rats provides more understanding of the mechanisms of progressive recovery from the intestinal failure that underlies SBS. The mechanical, chemical, immunological, and biological barriers were all impaired at 7 days following bowel resection, indicating that the SBS model rats were still in the intestinal

  8. Essential role of small bowel capsule endoscopy in reclassification of colonic inflammatory bowel disease type unclassified

    PubMed Central

    Monteiro, Sara; Dias de Castro, Francisca; Boal Carvalho, Pedro; Rosa, Bruno; Moreira, Maria João; Pinho, Rolando; Saraiva, Miguel Mascarenhas; Cotter, José

    2017-01-01

    AIM To evaluate the role of small bowel capsule endoscopy (SBCE) on the reclassification of colonic inflammatory bowel disease type unclassified (IBDU). METHODS We performed a multicenter, retrospective study including patients with IBDU undergoing SBCE, between 2002 and 2014. SBCE studies were reviewed and the inflammatory activity was evaluated by determining the Lewis score (LS). Inflammatory activity was considered significant and consistent with Crohn’s disease (CD) when the LS ≥ 135. The definitive diagnosis during follow-up (minimum 12 mo following SBCE) was based on the combination of clinical, analytical, imaging, endoscopic and histological elements. RESULTS Thirty-six patients were included, 21 females (58%) with mean age at diagnosis of 33 ± 13 (15-64) years. The mean follow-up time after the SBCE was 52 ± 41 (12-156) mo. The SBCE revealed findings consistent with significant inflammatory activity in the small bowel (LS ≥ 135) in 9 patients (25%); in all of them the diagnosis of CD was confirmed during follow-up. In 27 patients (75%), the SBCE revealed no significant inflammatory activity (LS < 135); among these patients, the diagnosis of Ulcerative Colitis (UC) was established in 16 cases (59.3%), CD in 1 case (3.7%) and 10 patients (37%) maintained a diagnosis of IBDU during follow-up. A LS ≥ 135 at SBCE had a sensitivity = 90%, specificity = 100%, positive predictive value = 100% and negative predictive value = 94% for the diagnosis of CD. CONCLUSION SBCE proved to be fundamental in the reclassification of patients with IBDU. Absence of significant inflammatory activity in the small intestine allowed exclusion of CD in 94% of cases. PMID:28101306

  9. Laparoscopic management of mesh erosion into small bowel and urinary bladder following total extra-peritoneal repair of inguinal hernia

    PubMed Central

    Aggarwal, Sandeep; Praneeth, Kokkula; Rathore, Yashwant; Waran, Vignesh; Singh, Prabhjot

    2016-01-01

    Mesh erosion into visceral organs is a rare complication following laparoscopic mesh repair for inguinal hernia with only 15 cases reported in English literature. We report the first case of complete laparoscopic management of mesh erosion into small bowel and urinary bladder. A 62-year-male underwent laparoscopic total extra-peritoneal repair of left inguinal hernia at another centre in April 2012. He presented to our centre 21 months later with persistent lower urinary tract infection (UTI). On evaluation mesh erosion into bowel and urinary bladder was suspected. At laparoscopy, a small bowel loop was adhered to the area of inflammation in the left lower abdomen. After adhesiolysis, mesh was seen to be eroding into small bowel. The entire infected mesh was pulled out from the pre-peritoneal space and urinary bladder wall using gentle traction. The involved small bowel segment was resected, and bowel continuity restored using endoscopic linear cutter. The resected bowel along with the mesh was extracted in a plastic bag. Intra-operative test for leak from urinary bladder was found to be negative. The patient recovered uneventfully and is doing well at 12 months follow-up with resolution of UTI. Laparoscopic approach to mesh erosion is feasible as the plane of mesh placement during laparoscopic hernia repair is closer to peritoneum than during open hernia repair. PMID:26917927

  10. Bag and loop small bowel contouring strategies differentially estimate small bowel dose for post-hysterectomy women receiving pencil beam scanning proton therapy.

    PubMed

    Xu, Melody J; Kirk, Maura; Zhai, Huifang; Lin, Lilie L

    2016-07-01

    Background Small bowel (SB) dose-volume relationships established during initial computed tomography (CT) simulations may change throughout therapy due to organ displacement and motion. We investigated the impact of organ motion on SB dose-volume histograms (DVHs) in women with gynecologic malignancies treated with pencil beam scanning (PBS) proton therapy and compared PBS SB DVHs to intensity-modulated radiation therapy (IMRT). Material and methods Post-hysterectomy patients (n = 11) treated for gynecologic cancers were enrolled on an image-guided proton therapy protocol involving CT simulation with full (CTF) and empty (CTE) bladders and weekly/biweekly on-treatment scans. IMRT plans were generated for comparative analysis. SB was contoured as bowel loops or bowel bag. Wilcoxon signed-rank tests were used for matched-pair comparisons of SB, bladder, and rectum dose-volumes between CT scans and between PBS and IMRT plans. Results In PBS loops analysis, on-treatment DVH was significantly higher than CTF for doses <45 Gy (p < 0.05), and not significantly different than CTE. Specifically, V15 for loops was higher on-treatment (median 240 cm(3)) compared to CTF (median 169 cm(3), p = 0.03). In PBS bag analysis, on-treatment DVH was not significantly different from CTF across all dose ranges. Bowel bag V45 was not significantly different between on-treatment (median 540 cm(3)) and CTF (median 499 cm(3), p = 0.53). Decreasing bladder volume was associated with increasing V15 for loops and V45 for bowel bag (p < 0.005, both). Comparing PBS and IMRT, PBS resulted in significantly lower DVHs at low dose regions (<38 Gy) and higher DVHs at high dose regions (42.5-45.5 Gy) in both loops and bag analysis. IMRT plans demonstrated higher on-treatment SB loop DVHs and only minimal differences in bowel bag DVHs compared to CTF. Conclusions SB DVHs were well estimated by CTF bowel bag and underestimated by CTF loops in the setting of inconsistent

  11. Small-Bowel Obstruction Secondary to Adhesions After Open or Laparoscopic Colorectal Surgery

    PubMed Central

    Smolarek, Sebastian; Shalaby, Mostafa; Paolo Angelucci, Giulio; Missori, Giulia; Capuano, Ilaria; Franceschilli, Luana; Quaresima, Silvia; Di Lorenzo, Nicola

    2016-01-01

    Background and Objectives: Small-bowel obstruction (SBO) is a common surgical emergency that occurs in 9% of patients after abdominal surgery. Up to 73% are caused by peritoneal adhesions. The primary purpose of this study was to compare the rate of SBOs between patients who underwent laparoscopic (LPS) and those who had open (OPS) colorectal surgery. The secondary reasons were to evaluate the rate of adhesive SBO in a cohort of patients who underwent a range of colorectal resections and to assess risk factors for the development of SBO. Method: This was a retrospective observational cohort study. Data were analyzed from a prospectively collected database and cross checked with operating theater records and hospital patient management systems. Results: During the study period, 707 patients underwent colorectal resection, 350 of whom (49.5%) were male. Median follow-up was 48.3 months. Of the patients included, 178 (25.2%) underwent LPS, whereas 529 (74.8%) had OPS. SBO occurred in 72 patients (10.2%): 20 (11.2%) in the LPS group and 52 (9.8%) in the OPS group [P = .16; hazards ratio (HR) 1.4 95% CI 0.82–2.48] within the study period. Conversion to an open procedure was associated with increased risk of SBO (P = .039; HR 2.82; 95% CI 0.78–8.51). Stoma formation was an independent risk factor for development of SBO (P = .049; HR, 0.63; 95% CI 0.39–1.03). The presence of an incisional hernia in the OPS group was associated with SBO (P = .0003; HR, 2.85; 95% CI 1.44–5.283). There was no difference in SBO between different types of procedures: right colon, left colon, and rectal surgery. Patients who developed early small-bowel obstruction (ESBO) were more often treated surgically compared to late SBO (P = .0001). Conclusion: The use of laparoscopy does not influence the rate of SBO, but conversion from laparoscopic to open surgery is associated with an increased risk of SBO. Stoma formation is associated with a 2-fold increase in SBO. Development of ESBO is

  12. Effect of 50% distal small bowel resection on gastric emptying in Rhesus monkeys.

    PubMed Central

    Hall, A W; Moossa, A R; Skinner, D B

    1977-01-01

    The effect of bowel resection, sufficient to cause gastric secretory changes, on gastric emptying is unknown. Gastric evacuation was characterized in 8 Rhesus monkeys by a modification of George's double sampling test meal. Fifty per cent distal small bowel resection was then performed. Gastric emptying was again studied at 6 weeks and 6 months. The rate constant fell from -0.00289 +/- 0.000467 (+/-1 SEM) to -0.00232 +/- 0.00106 during the early phase, but role to -0.00308 +/- 0.00186 by 6 months, neither value being statistically different from the preoperative values. T1/2 rose from 125.2 +/- 19.2 mins to 367 +/- 173.4 mins by 6 weeks and to 380.9 +/- 161.6 mins by the end of the experiments. Corresponding values for T were: control period 425.8 +/- 63.2 mins, early phase 1223 +/- 589 mins and late phase 1245.9 +/- 529.6 mins. None of these changes were statistically significant. Alterations in emptying time within each animal were consistent at the two postoperative phases. Although the two animals showing acceleration of evacuation were those with least change in secretion, compensation for the observed increase in output of gastric juice did not materially alter the results. PMID:402124

  13. Oral distension methods for small bowel MRI: comparison of different agents to optimize bowel distension.

    PubMed

    Schmidt, Stefan A; Baumann, Julia A; Stanescu-Siegmund, Nora; Froehlich, Eckhart; Brambs, Hans-Juergen; Juchems, Markus S

    2016-12-01

    Background Different methods for bowel distension prior to magnetic resonance imaging (MRI) examinations were described in recent years. Purpose To compare orally administered psyllium or locust bean gum / mannitol (LBM) with tylose administered through a duodenal catheter for bowel distension in patients undergoing MRI examination of the small bowel. Material and Methods Three different methods of bowel distension prior to MRI were compared: tylose applied through a duodenal catheter and orally administered psyllium and LBM in three groups with 15 patients each. Datasets were blinded and reviewed independently by two experienced radiologists, who assessed the diagnostic value and the maximum luminal diameter. Results Tylose was superior to psyllium and LBM in the examination of the duodenum and proximal jejunum. LBM was superior to the other methods for distension of the ileum and terminal ileum. The greatest luminal diameter of the duodenum was achieved after tylose and distension of the terminal ileum was the best in patients receiving LBM. The psyllium group was inferior to the other two groups in all segments. Conclusion By using LBM as an oral method of bowel distension, many patients can avoid the unpleasant placement of a duodenal catheter without compromising the diagnostic value of the examination.

  14. IGF-2 is necessary for Retinoblastoma-mediated enhanced adaptation after small bowel resection

    PubMed Central

    Choi, Pamela M.; Sun, Raphael C.; Sommovilla, Josh; Diaz-Miron, Jose; Guo, Jun; Erwin, Christopher R.; Warner, Brad W.

    2014-01-01

    Background Previously, we have demonstrated that genetically disrupting retinoblastoma protein (Rb) expression in enterocytes results in taller villi, mimicking resection-induced adaption responses. Rb deficiency also results in elevated IGF-2 expression in villus enterocytes. We propose that postoperative disruption of Rb results in enhanced adaptation which is driven by IGF-2. Methods Inducible, intestine-specific Rb-null mice (iRbIKO) and wild-type littermates (WT) underwent a 50% proximal small bowel resection (SBR) at 7–9 weeks of age. They were then were given tamoxifen on POD 4–6, and harvested on POD 28. The experiment was then repeated on double knockouts of both IGF-2 and Rb (IGF-2 null/iRbIKO). Results iRbIKO mice demonstrated enhanced resection-induced adaptive villus growth after SBR and increased IGF-2 mRNA in ileal villus enterocytes compared to their WT littermates. In the IGF-2 null/iRbIKO double knockout mice, there was no additional villus growth beyond what was expected of normal resection-induced adaptation. Conclusions Adult mice in which Rb is inducibly deleted from the intestinal epithelium following SBR have augmented adaptive growth. IGF-2 expression is necessary for enhanced adaptation associated with acute intestinal Rb deficiency. PMID:25002022

  15. High-Protein Diet Improves Postoperative Weight Gain After Massive Small-Bowel Resection

    PubMed Central

    Sun, Raphael C.; Choi, Pamela M.; Diaz-Miron, Jose; Sommovilla, Joshua; Guo, Jun; Erwin, Christopher R.

    2016-01-01

    Introduction Short bowel syndrome (SBS) is a morbid clinical condition that results from massive small-bowel resection (SBR). After SBR, there is a dramatic weight loss in the acute postoperative period. Our aim was to determine the impact of a high-protein diet (HPD) on weight gain and body composition in mice after SBR. Methods C57BL/6 mice underwent 50 % proximal SBR. Postoperatively, mice were randomly selected to receive standard rodent liquid diet (LD) (n=6) or an isocaloric HPD (n=9) for 28 days. Mice weights were recorded daily. Body composition analyses were obtained weekly. Student's t test was used for statistical comparisons with p<0.05 considered significant. Results Mice that were fed HPD after SBR returned to baseline weight on average at postoperative day (POD) 8 versus mice that were fed LD that returned to baseline weight on average at POD 22. Total fat mass and lean mass were significantly greater by POD 14 within the HPD group. Both groups of mice demonstrated normal structural adaptation. Conclusion HPD results in greater weight gain and improved body composition in mice after SBR. This finding may be clinically important for patients with SBS since improved weight gain may reduce the time needed for parenteral nutrition. PMID:25519080

  16. Fat-reduced diet in the symptomatic treatment of small bowel disease

    PubMed Central

    Andersson, H.; Isaksson, B.; Sjögren, B.

    1974-01-01

    Thirteen patients suffering from Crohn's disease or subjected to small bowel resection were studied under metabolic ward conditions for an average of 32 days. Most of these patients had chronic, severe diarrhoea and varying degrees of steatorrhoea. All were studied at two levels of fat intake, 100 g and 40 g daily. After the introduction of the low-fat diet, there was a marked reduction in the faecal excretion of water and sodium in most patients and 10 of them passed solid faeces. Two other subjects improved only after the addition of cholestyramine. In one patient with an ileostomy, no improvement occurred. On the low-fat diet, there was a positive balance of nitrogen and potassium in many cases. Faecal fat excretion decreased, but there was no change in the fractional absorption of fat. The most gratifying improvement was seen in patients with a functioning gallbladder. Previous resection of the colon seemed to limit the reduction of faecal water and sodium excretion which followed the reduction in fat intake. A fat-reduced diet is recommended in the symptomatic therapy of chronic diarrhoea in patients suffering from diseases of the ileum. PMID:18668843

  17. Segmental small bowel necrosis associated with antiphospholipid syndrome: a case report.

    PubMed

    Wang, Qun-Ying; Ye, Xiao-Hua; Ding, Jin; Wu, Xiao-Kang

    2015-04-07

    Antiphospholipid syndrome is a multi-system disease characterized by the formation of thromboembolic complications and/or pregnancy morbidity, and with persistently increased titers of antiphospholipid antibodies. We report the case of a 50-year-old, previously healthy man who presented with fever and new-onset, dull abdominal pain. A contrast-enhanced computed tomography scan showed segmental small bowel obstruction, for which an emergency laparotomy was performed. Histopathologic examination of resected tissues revealed multiple intestinal and mesenteric thromboses of small vessels. Laboratory tests for serum antiphospholipid (anticardiolipin IgM) and anti-β2-glycoprotein I antibodies were positive. Despite proactive implementation of anticoagulation, steroid, and antibiotic therapies, the patient's condition rapidly deteriorated, and he died 22 d after admission. This case highlights that antiphospholipid syndrome should be suspected in patients with unexplainable ischemic bowel and intestinal necrosis presenting with insidious clinical features that may be secondary to the disease, as early diagnosis is critical to implement timely treatments in order to ameliorate the disease course.

  18. Diagnostic approach to small bowel involvement in inflammatory bowel disease: view of the endoscopist.

    PubMed

    Papadakis, Konstantinos A

    2009-01-01

    Recent advances in endoscopic small bowel (SB) techniques have revolutionalized the diagnostic approach of patients with suspected or known inflammatory bowel disease (IBD). Wireless capsule endoscopy (WCE) has become an important diagnostic tool for the evaluation of suspected CD of the SB or in patients with known IBD to rule out SB involvement. The greatest utility of WCE has been observed in cases of suspected CD, where the initial evaluation with traditional radiographic and endoscopic studies has failed to establish the diagnosis. WCE can detect early SB lesions that can be overlooked by traditional radiological studies. The sensitivity of diagnosing SB CD by WCE is superior to other endoscopic or radiological methods such as push enteroscopy, computed tomography or magnetic resonance enteroclysis. The utility of WCE in patients with known CD, IBD unclassified (IBDU) and a select group of patients with ulcerative colitis (UC) can better define the diagnosis and extent of the disease and may lead to reclassification of IBD from UC/IBDU to definitive CD. In addition, previously diagnosed patients with CD may be found to have more significant disease burden in the SB. This information may facilitate more targeted and effective therapies and potentially lead to better patient outcomes. A disadvantage of WCE is its low specificity and the risk of being retained in a strictured area of the SB. Balloon-assisted enteroscopy has essentially replaced push enteroscopy, and has been used to treat CD strictures, obtain biopsies from areas of SB involvement and even retrieving a retained capsule.

  19. Adhesions small bowel obstruction in emergency setting: conservative or operative treatment?

    PubMed Central

    ASSENZA, M.; DE GRUTTOLA, I.; ROSSI, D.; CASTALDI, S.; FALASCHI, F.; GIULIANO, G.

    2016-01-01

    Adhesions small bowel obstructions (aSBO) are among the leading causes of emergency operative intervention. About the 80% of aSBO cases resolve without a surgical treatment. It’s important to identify which patients could undergo a conservative treatment to prevent an useless surgery The aim of this study is to determine findings that can indicate whether patients with aSBO should undergo a conservative or a surgical treatment. 313 patients with diagnosis of submission of aSBO were restudied. Patients were divided into two groups based on the different type of treatment received, 225 patients who underwent surgical treatment within 24 hours after admission, 88 patients which underwent conservative treatment successfully. For each patient, clinical, hematochemical and radiological findings have been analysed. The treatment of aSBO should be, at the beginning, conservative except that cases that presents clinical and/or CT-scan findings predictive for a surgical treatment (free peritoneal fluid, mesenterial edema, transitional point) or a peritonitis (pneumatosis intestinalis, pneumoperitoneum). PMID:27938529

  20. Conservative treatment of adhesive small bowel obstruction in children: a systematic review

    PubMed Central

    Lin, Lung-Huang; Lee, Chee-Yew; Hung, Min-Hsuan; Chen, Der-Fang

    2014-01-01

    Objective To assess the effectiveness of conservative treatment for adhesive small bowel obstruction (ASBO) in children. Design Systematic review of studies involved children with ASBO who received initial conservative/non-operative treatment. Setting The search was performed in April 2013 using PubMed (see online supplementary file 1), current contents, and the Cochrane database. Participants Children with ASBO. Interventions Conservative treatment included nasogastric decompression, parenteral fluids and correction of electrolyte and fluid imbalance. Primary outcome Treatment success. Secondary outcomes Length of hospital stay and the time to first feeding after hospital admission. Results 7 studies (six retrospective, one prospective), involving 8–109 patients (age: 1 month to 16 years) treated conservatively, were included in the review. The nature of conservative treatment was generally consistent between studies (nasogastric decompression, parenteral fluids and correction of electrolyte and fluid imbalance), although patients in one study also received Gastrografin. The rate of conservative treatment success ranged from 16% to 75% among the five studies, but one trial showed 0% successful rate. The hospital length of stay ranged from 3 to 6.5 days for conservative treatment (vs 10.2–13 days for operative treatment). The time to first feeding ranged from 31 to 84 h for conservative treatment. Conclusions In conclusion, in the majority of cases, conservative treatment is an effective means of managing ASBO in children. PMID:25223569

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

    NASA Astrophysics Data System (ADS)

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

    2003-04-01

    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.

  2. The Effect of Impaired Angiogenesis on Intestinal Function Following Massive Small Bowel Resection

    PubMed Central

    Diaz-Miron, Jose; Sun, Raphael; Choi, Pamela; Sommovilla, Joshua; Guo, Jun; Erwin, Christopher R.; Mei, Junjie; Worthen, G. Scott; Warner, Brad W.

    2015-01-01

    Purpose Intestinal adaptation involves villus lengthening, crypt deepening, and increased capillary density following small bowel resection (SBR). Mice lacking the proangiogenic chemokine CXCL5 have normal structural adaptation but impaired angiogenesis. This work evaluates the impact of incomplete adaptive angiogenesis on the functional capacity of the intestine after SBR. Methods CXCL5 knockout (KO) and C57BL/6 wild-type (WT) mice underwent 50% SBR. Magnetic resonance imaging measured weekly body composition. Intestinal absorptive capacity was evaluated through fecal fat analysis. Gene expression profiles for select macronutrient transporters were measured via RT-PCR. Postoperative crypt and villus measurements assessed for structural adaptation. Submucosal capillary density was measured through CD31 immunohistochemistry. Results Comparable postoperative weight gain occurred initially. Diminished weight gain, impaired fat absorption, and elevated steatorrhea occurred in KO mice after instituting high-fat diet. Greater postoperative upregulation of ABCA1 fat transporter occurred in WT mice, while PEPT1 protein transporter was significantly downregulated in KO mice. KO mice had impaired angiogenesis but intact structural adaptation. Conclusion After SBR, KO mice display an inefficient intestinal absorption profile with perturbed macronutrient transporter expression, impaired fat absorption, and slower postoperative weight gain. In addition to longer villi and deeper crypts, an intact angiogenic response may be required to achieve functional adaptation to SBR. PMID:25818317

  3. Extent of Small Bowel Resection Does Not Influence the Magnitude of Intestinal Adaptation in the Mouse

    PubMed Central

    Wakeman, Derek; Longshore, Shannon W; McMellen, Mark E; Santos, Jethrina A; Guo, Jun; Erwin, Christopher R; Warner, Brad W

    2011-01-01

    Purpose The magnitude of intestinal adaptation is considered to correlate with the extent of small bowel resection (SBR). However, this association has never been tested in mice. We sought to test the hypothesis that a greater SBR will induce a greater adaptation response. Methods C57/B6 mice underwent 50% SBR, 75% SBR, or sham operation and were sacrificed on postoperative day 7. The magnitude of adaptation was compared between 50% SBR and 75% SBR as changes in villus height, crypt depth, as well as rates of apoptosis and proliferation. Results 75% SBR led to decreased survival and increased weight loss compared to 50% SBR. The remnant ileum of both 50% SBR and 75% SBR displayed similar crypt expansion, enhanced villi, and increased apoptotic indices. Proliferation rates increased after 50% and 75% SBR equally. Conclusion Models of resection greater than 50% in mice result in greater morbidity and mortality and do not magnify the adaptation response to massive SBR. The use of more extreme resection models does not appear to provide added benefit for investigating mechanisms of intestinal adaptation. PMID:20620331

  4. Parenteral nutrition supplemented with short-chain fatty acids: effect on the small-bowel mucosa in normal rats.

    PubMed

    Koruda, M J; Rolandelli, R H; Bliss, D Z; Hastings, J; Rombeau, J L; Settle, R G

    1990-04-01

    When enteral nutrition is excluded from animals maintained solely with total parenteral nutrition (TPN), atrophy of the intestinal mucosa is observed. Short-chain fatty acids (SCFAs) are produced in the colon by the fermentation of dietary carbohydrates and fiber polysaccharides and have been shown to stimulate mucosal-cell mitotic activity in the intestine. This study compared the effects of an intravenous and an intracecal infusion of SCFAs on the small-bowel mucosa. Rats received standard TPN, TPN with SCFAs (sodium acetate, propionate, and butyrate), TPN with an intracecal infusion of SCFAs, or rat food. After 7 d jejunal and ileal mucosal weights, DNA, RNA, and protein were determined. Standard TPN produced significant atrophy of the jejunal and ileal mucosa. Both the intracecal and intravenous infusion of SCFAs significantly reduced the mucosal atrophy associated with TPN. The intravenous and intracolonic infusion of SCFAs were equally effective in inhibiting small-bowel mucosal atrophy.

  5. Huge peripheral primitive neuroectodermal tumor of the small bowel mesentery at nonage: A case report and review of the literature

    PubMed Central

    Liu, Zhe; Xu, Yuan-Hong; Ge, Chun-Lin; Long, Jin; Du, Rui-Xia; Guo, Ke-Jian

    2016-01-01

    Extraskeletal Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (E-EWS/pPNET) is a rare aggressive malignant small round cell tumor. In this report, we present the case of a 15-year-old boy who suffered from acute abdominal pain accompanied by hematemesis and melena, and was eventually diagnosed with E-EWS/pPNET. To date, there have been only five reported cases of E-EWS/pPNET of the small bowel including the patient in this report. To the best of our knowledge, this is the first documentation of a pPNET of the small bowel mesentery at nonage. All these have made this report rare and significant. PMID:27672649

  6. Small bowel obstruction caused by self-anchoring suture used for peritoneal closure following robotic inguinal hernia repair.

    PubMed

    Khan, Faraz A; Hashmi, Asra; Edelman, David A

    2016-06-23

    Laparoscopic inguinal herniorraphy is a commonly performed procedure given the reported decrease in pain and earlier return to activity when compared with the open approach. Moreover, robotic assistance offers the operating surgeon considerable ergonomic advantages, making it an attractive alternative to conventional laparoscopic herniorraphy. Robotic herniorraphy utilizes the transabdominal preperitoneal approach where following repair peritoneal closure is necessary to avoid mesh exposure to the viscera. Self-anchoring sutures are frequently used to this end given the ease of use and knotless application. We present an unusual case of post-operative small bowel obstruction following robotic inguinal hernia repair caused by the self-anchoring suture used for peritoneal closure. This patient presented 3 days post-procedure with symptoms and cross-sectional imaging indicative of small bowel obstruction with a clear transition point. Underwent laparoscopic lysis of a single adhesive band originating from the loose intraperitoneal end of the suture leading to resolution of symptoms.

  7. Electrosurgery ignition of a pneumoperitoneum secondary to prior spontaneous perforation of the small bowel: a cautionary tale.

    PubMed

    Thomas, G P; Willson, P D

    2012-03-01

    We describe explosive combustion of a gas filled peritoneum from a handheld electrosurgery electrode used to enter the abdomen. The pneumoperitoneum was due to small bowel perforation and peritonitis had been established for at least two days. No injury was caused to either the patient or medical staff. This rare occurrence has only been described once before. Surgeons should be aware of the possible combustion of bowel gas, whether on opening bowel or the peritoneum after bowel perforation.

  8. A case report of small bowel perforation secondary to cytomegalovirus related immune reconstitution inflammatory syndrome in an AIDS patient.

    PubMed

    Gutiérrez-Delgado, Eva María; Villanueva-Lozano, Hiram; García Rojas-Acosta, Miguel J; Miranda-Maldonado, Ivett C; Ramos-Jiménez, Javier

    2017-01-01

    Non-traumatic small bowel perforation is rare in adults but carries a high morbidity and mortality. The diagnosis is made on clinical suspicion, and the most common causes in developing countries are infectious diseases, being cytomegalovirus infection in immunocompromised patients the main etiology. We describe a patient with a recently diagnosed advanced stage HIV infection and an intestinal perforation associated with cytomegalovirus immune reconstitution inflammatory syndrome after highly active antiretroviral therapy initiation.

  9. Ventriculoperitoneal shunt with a rare twist: small-bowel ischemia and necrosis secondary to knotting of peritoneal catheter.

    PubMed

    Tan, Lee A; Kasliwal, Manish K; Moftakhar, Roham; Munoz, Lorenzo F

    2014-09-01

    Small-bowel ischemia and necrosis due to knotting of the peritoneal catheter is an extremely rare complication related to a ventriculoperitoneal shunt (VPS). A 3-month-old girl, with a history of Chiari II malformation and myelomeningocele (MM) after undergoing right occipital VPS insertion and MM repair at birth, presented to the emergency department with a high-grade fever. Examination of a CSF sample obtained via shunt tap raised suspicion for the presence of infection. Antibiotic therapy was initiated, and subsequently the VPS was removed and an external ventricular drain was placed. Intraoperatively, as attempts at pulling the distal catheter from the scalp incision were met with resistance, the distal catheter was cut and left in the abdomen while the remainder of the shunt system was successfully removed. While the patient was awaiting definitive shunt revision surgery to replace the VPS, she developed abdominal distension due to small-bowel obstruction. An emergency exploratory laparotomy revealed a knot in the distal catheter looping around and strangulating the distal ileum, causing small-bowel ischemia and necrosis in addition to the obstruction. A small-bowel resection with ileostomy was performed, with subsequent placement of ventriculoatrial shunt for treatment of hydrocephalus. The authors report this exceedingly rare clinical scenario to highlight the fact that any retained distal catheter must be carefully managed with immediate abdominal exploration to remove the distal catheter to avoid bowel necrosis as pulling of a knotted peritoneal catheter may strangulate the bowel and cause ischemia, with significant clinical morbidity and possible mortality.

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

    PubMed Central

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

    1988-01-01

    Small bowel resection promotes the development of colonic tumours in azoxymethane treated rats. As high faecal bile acid concentrations are associated with colonic cancer and may be altered by resection, we have studied changes in faecal bile acid concentrations during promotion of colonic carcinogenesis by increasing small bowel resection. Twenty rats in each group underwent either jejunal transection or 20%, 50%, or 80% proximal small bowel resection. Tumours were induced with azoxymethane 10 mg/kg by 12 weekly subcutaneous injections, and faecal bile acid concentrations were measured at six and 16 weeks. Colonic tumour number rose from 0.6 per rat in the transection group to 1.6 per rat in the 50% resection group (p less than 0.01) but were not significantly different to transection values at 0.8 per rat in the 80% resection group. Total daily faecal bile acid excretion and bile acid concentrations fell with increasing resection from 14.2 (1.6) mg/rat/day and 5.8 (0.7) mg/g dry faeces respectively in the transection group to 6.5 (0.5) mg/rat/day and 2.9 (0.2) mg/g respectively in the 80% resection group (p less than 0.001). The greatest reduction was seen in the concentration of deoxycholic acid which has been particularly associated with the aetiology of colonic cancer. The promotion of colonic tumours following small bowel resection in carcinogen treated rats is unlikely to be mediated by changes in faecal bile acid concentration or composition. PMID:3371718

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

    PubMed Central

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

    2013-01-01

    Exogenous glucagon-like peptide-2 receptor (GLP-2R) activation elicits proliferative and cytoprotective responses in the gastrointestinal mucosa and ameliorates experimental small and large bowel gut injury. Nevertheless, the essential physiological role(s) of the endogenous GLP-2R remain poorly understood. We studied the importance of the GLP-2R for gut growth, epithelial cell lineage allocation, the response to mucosal injury, and host-bacterial interactions in Glp2r−/− and littermate control Glp2r+/+ mice. Glp2r−/− mice exhibit normal somatic growth and preserved small and large bowel responses to IGF-I and keratinocyte growth factor. However, Glp2r−/− mice failed to up-regulate intestinal epithelial c-fos expression in response to acute GLP-2 administration and do not exhibit changes in small bowel conductance or small or large bowel growth after administration of GLP-2R agonists. The crypt and villus compartment and the numbers and localization of Paneth, enteroendocrine, and goblet cells were comparable in Glp2r+/+ vs. Glp2r−/− mice. Although the severity and extent of colonic mucosal injury in response to 3% oral dextran sulfate was similar across Glp2r genotypes, Glp2r−/− mice exhibited significantly increased morbidity and mortality and increased bacterial translocation after induction of enteritis with indomethacin and enhanced mucosal injury in response to irinotecan. Moreover, bacterial colonization of the small bowel was significantly increased, expression of Paneth cell antimicrobial gene products was reduced, and mucosal bactericidal activity was impaired in Glp2r−/− mice. Although the Glp2r is dispensable for gut development and the response to colonic injury, Glp2r−/− mice exhibit enhanced sensitivity to small bowel injury, and abnormal host-bacterial interactions in the small bowel. PMID:22253424

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

    PubMed Central

    2010-01-01

    Background Familial adenomatous polyposis (FAP) is a hereditary disorder characterized by polyposis along the gastrointestinal tract. Information on adenoma status below the duodenum has previously been restricted due to its inaccessibility in vivo. Capsule Endoscopy (CE) may provide a useful adjunct in screening for polyposis in the small bowel in FAP patients. This study aims to evaluate the effectiveness of CE in the assessment of patients with FAP, compared to other imaging modalities for the detection of small bowel polyps. Method 20 consecutive patients with previously diagnosed FAP and duodenal polyps, presenting for routine surveillance of polyps at The Royal Melbourne Hospital were recruited. Each fasted patient initially underwent a magnetic resonance image (MRI) of the abdomen, and a barium small bowel follow-through study. Capsule Endoscopy was performed four weeks later on the fasted patient. An upper gastrointestinal side-viewing endoscopy was done one (1) to two (2) weeks after this. Endoscopists and investigators were blinded to results of other investigations and patient history. Results Within the stomach, upper gastrointestinal endoscopy found more polyps than other forms of imaging. SBFT and MRI generally performed poorly, identifying fewer polyps than both upper gastrointestinal and capsule endoscopy. CE was the only form of imaging that identified polyps in all segments of the small bowel as well as the only form of imaging able to provide multiple findings outside the stomach/duodenum. Conclusion CE provides important information on possible polyp development distal to the duodenum, which may lead to surgical intervention. The place of CE as an adjunct in surveillance of FAP for a specific subset needs consideration and confirmation in replication studies. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12608000616370 PMID:20361877

  13. Magnetic Resonance Imaging of the Small Bowel in Crohn's Disease: A Systematic Review and Meta-Analysis

    PubMed Central

    Ahmed, Osman; Rodrigues, David Mario

    2016-01-01

    Introduction. Crohn's disease is most commonly found in the terminal ileum and colonic region. Magnetic resonance has become a useful modality for assessing small bowel activity. In this study, we performed a systematic review and meta-analysis on the use of MR in detecting small bowel activity as well as extramural complications in Crohn's patients. Methods. Two independent reviewers sorted through articles until October 2, 2014. We included both studies providing raw data for pooling and studies without raw data. Sensitivity, specificity, likelihood ratios, and 95% confidence intervals were calculated for each study. Results. There were 27 included studies, of which 19 were included in the pooled analysis. Pooled analysis of the 19 studies (1020 patients) with raw data revealed a sensitivity of 0.88 (95% CI 0.86 to 0.91) and specificity was 0.88 (95% CI 0.84 to 0.91). In regard to detecting stenosis, pooled sensitivity was 0.65 (95% CI 0.53 to 0.76) and specificity was 0.93 (95% CI 0.89 to 0.96). Conclusion. MR imaging provides a reliable alternative in detecting small bowel activity in patients with Crohn's disease. Its advantages include high diagnostic accuracy and no radiation exposure while its disadvantages include high cost and limited availability. PMID:27446869

  14. Phytobezoar-induced small bowel obstruction associated with a concomitant gastric phytobezoar and ulcer in an elderly woman.

    PubMed

    De Cesare, Alessandro; Fiori, Enrico; Bononi, Marco; Ferraro, Daniele

    2015-01-01

    Bezoars are aggregates of indigested foreign material that accumulate in the gastroenteric tract, expecially in the stomach and in the narrowest points of the small bowel. They often occur in subjects who follow a diet rich in fruit and vegetables and in those one who previously underwent gastric resective surgery for peptic ulcer. Bezoar formation has even been observed in case of reduced gastric motility and secretion due to diabetes, hypothyroidism, pernicious anemia, myotonic syndromes, and Guillain-Barré syndrome. As they are an uncommon cause of small bowel obstruction, phytobezoars are often not considered in the differential diagnosis of occlusive intestinal syndromes and so frequently come as an intraoperative finding. A consequence of this missed diagnosis in the preoperative period is an unnecessary diagnostic delay that can significantly increase morbidity and mortality. This case report illustrates the need to include phytobezoars in the preoperative diagnostic workout of intestinal obstruction in order to rule out the presence of multiple bezoars and prevent recurrent obstruction. Now that phytobezoars are becoming a less infrequent cause of small bowel obstruction than previously thought, such a diagnostic possibility should always be considered.

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

    SciTech Connect

    Yoon, Woong; Kim, Jae Kyu; Kim, Heoung Kil; Han, Young Min; Kang, Heoung Keun

    2002-03-15

    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.

  16. Third place 1989 Alpha Cradle Award winner. Technical aspects in the use of "belly boards" for small bowel minimization.

    PubMed

    Frank, L E; Rowley, L A; Shanahan, T G; Mehta, M P

    1990-03-01

    The position in which a patient is treated for pelvic irradiation has been shown to have dramatic significance in regard to the volume of small bowel within the treatment field. Previous studies in the literature have repeatedly supported the fact that volume may be the leading factor in both acute and chronic morbidity. We have prospectively evaluated and treated 30 patients utilizing a custom-made polyurethane foam and styrofoam "belly board" with a dropout cut from the level of the xyphoid process to the superior border of the treatment field, specifically designed to allow maximal superior and anterior displacement of small bowel by bladder distention and gravity, while allowing reliable daily reproducibility, accurate immobilization and equally important, increased patient comfort and compliance. By evaluating all patients (in both the supine position alone, and prone in the "Belly Board") with a dedicated treatment planning CT scanner, we have been able to achieve 80-100% reduction in the volume of small bowel within the radiation portals. We will discuss data on the technical set-up, cost, and variations which allow the "Belly Board" to be specifically tailored for use when treating other intraabdominal sites. This technique is simple, inexpensive, highly reproducible, and permits maximal bowel displacement outside the treatment fields.

  17. Threshold level of NF-kB activation in small bowel ischemic preconditioning procedure.

    PubMed

    Ferencz, A; Rácz, B; Gasz, B; Kalmár-Nagy, K; Horváth, O P; Röth, E

    2006-01-01

    Ischemic preconditioning (IPC), which is obtained by exposure to brief periods of vascular occlusion, improves organ tolerance to prolonged ischemia. The aim of this study was to evaluate the threshold level of NF-kB activation in small intestine during an IPC procedure. Various intestinal IPC were performed on 20 Wistar rats in seven groups: group I (GI, nonpreconditioned); group II (GII, 1-minute ischemia and 1-minute reperfusion); group III (GIII, two cycles of 1-minute ischemia and 1-minute reperfusion); group IV (GIV, 2-minutes ischemia and 2-minutes reperfusion); group V (GV, two cycles of 2-minute ischemia and 2-minute reperfusion); group VI (GVI, 5-minute ischemia and 10-minute reperfusion); group VII (GVII, two cycles of 5-minute ischemia and 10-minute reperfusion). Bowel biopsies were collected after laparotomy (control) as well as at 30, 60, and 120 minutes following IPC. We determined the cytoplasmic and nuclear NF-kB by a chemiluminescence-based ELISA method. Our results showed low, constant NF-kB levels in GI. In the preconditioned groups (GII-GVII), NF-kB was significantly elevated at 30 minutes following IPC (P < .05 vs control). After 1 hour, NF-kB activity decreased to the control level. However, 2 hours after IPC both forms of NF-kB were elevated significantly again, which was independent of the number of IPC cycles (P < .05 vs control). Our experiments revealed that one cycle of 1-minute ischemia and 1-minute reperfusion is a critical threshold level for NF-kB activation during small bowel IPC. Longer and more IPC cycles did not result in further elevation of NF-kB activation.

  18. Gene expression accurately distinguishes liver metastases of small bowel and pancreas neuroendocrine tumors.

    PubMed

    Sherman, Scott K; Maxwell, Jessica E; Carr, Jennifer C; Wang, Donghong; Bellizzi, Andrew M; Sue O'Dorisio, M; O'Dorisio, Thomas M; Howe, James R

    2014-12-01

    Small bowel (SBNETs) and pancreatic neuroendocrine tumors (PNETs) often present with liver metastases. Although liver biopsy establishes a neuroendocrine diagnosis, the primary tumor site is frequently unknown without exploratory surgery. Gene expression differences in metastases may distinguish primary SBNETs and PNETs. This study sought to determine expression differences of four genes in neuroendocrine metastases and to create a gene expression algorithm to distinguish the primary site. Nodal and liver metastases from SBNETs and PNETs (n = 136) were collected at surgery under an Institutional Review Board-approved protocol. Quantitative PCR measured expression of bombesin-like receptor-3, opioid receptor kappa-1, oxytocin receptor, and secretin receptor in metastases. Logistic regression models defined an algorithm predicting the primary tumor site. Models were developed on a training set of 21 nodal metastases and performance was validated on an independent set of nodal and liver metastases. Expression of all four genes was significantly different in SBNET compared to PNET metastases. The optimal model employed expression of bombesin-like receptor-3 and opioid receptor kappa-1. When these genes did not amplify, the algorithm used oxytocin receptor and secretin receptor expression, which allowed classification of all 136 metastases with 94.1 % accuracy. In the independent liver metastasis validation set, 52/56 (92.9 %) were correctly classified. Positive predictive values were 92.5 % for SBNETs and 93.8 % for PNETs. This validated algorithm accurately distinguishes SBNET and PNET metastases based on their expression of four genes. High accuracy in liver metastases demonstrates applicability to the clinical setting. Studies assessing this algorithm's utility in prospective clinical decision-making are warranted.

  19. Smooth muscle adaptation and recovery of contractility after massive small bowel resection in rats.

    PubMed

    Chen, Jie; Wen, Jie; Cai, Wei

    2012-05-01

    Previous studies have suggested that massive small bowel resection (mSBR) compromises the normal intestinal processes of digestion and absorption, and requires an adaptive response to regain full function and reinstate coordinated contractile activity of the circular smooth muscle. This study was designed to investigate spontaneous contractile activity of circular smooth muscle using the mSBR rat model and to determine the functional role of M(2) and M(3) muscarinic acetylcholine receptors (mAChR) in this process. Male Sprague-Dawley rats underwent an 80% proximal SBR or sham operation. Markers of adaptation, including villus and microvillus height, were analyzed by hematoxylin and eosin staining and transmission electron microscopy. Contractility was measured by attaching the distal ileum strips to strain gauge transducers and exposing the tissue to varying doses of the cholinergic agonist carbachol. Protein expressions of M(2)- and M(3)-mAChR in intestinal smooth muscle (ISM) were detected by Western blot. Following mSBR, the ISM showed perturbed spontaneous rhythmic contraction, irregular amplitude and slow frequency by muscle strip test. However, by two weeks after mSBR, the contractile function of circular smooth muscle was found to have returned to normal levels. Protein expression of M(2)-mAChR was down-regulated following mSBR but up-regulated during the adaptive process when contractile activity of circular smooth muscle was regained. These results indicate that smooth muscle contractility was spontaneously restored in rats following mSBR, and involved the acetylcholine receptors M(2) and M(3). Thus, the disrupted contractile response of smooth muscle in short bowel syndrome may be corrected by therapeutic intervention to restore the expressions of M(2)- and M(3)-mAChR to pre-mSBR levels.

  20. Reporting small bowel dose in cervix cancer high-dose-rate brachytherapy.

    PubMed

    Liao, Yixiang; Dandekar, Virag; Chu, James C H; Turian, Julius; Bernard, Damian; Kiel, Krystyna

    2016-01-01

    Small bowel (SB) is an organ at risk (OAR) that may potentially develop toxicity after radiotherapy for cervix cancer. However, its dose from brachytherapy (BT) is not systematically reported as in other OARs, even with image-guided brachytherapy (IGBT). This study aims to introduce consideration of quantified objectives for SB in BT plan optimization and to evaluate the feasibility of sparing SB while maintaining adequate target coverage. In all, 13 patients were included in this retrospective study. All patients were treated with external beam radiotherapy (EBRT) 45Gy in 25 fractions followed by high dose rate (HDR)-BT boost of 28Gy in 4 fractions using tandem/ring applicator. Magnetic resonance imaging (MRI) and computed tomographic (CT) images were obtained to define the gross tumor volume (GTV), high-risk clinical target volume (HR-CTV) and OARs (rectum, bladder, sigmoid colon, and SB). Treatment plans were generated for each patient using GEC-ESTRO recommendations based on the first CT/MRI. Treatment plans were revised to reduce SB dose when the [Formula: see text] dose to SB was > 5Gy, while maintaining other OAR constraints. For the 7 patients with 2 sets of CT and MRI studies, the interfraction variation of the most exposed SB was analyzed. Plan revisions were done in 6 of 13 cases owing to high [Formula: see text] of SB. An average reduction of 19% in [Formula: see text] was achieved. Meeting SB and other OAR constraints resulted in less than optimal target coverage in 2 patients (D90 of HR-CTV < 77Gyαβ10). The highest interfraction variation was observed for SB at 16 ± 59%, as opposed to 28 ± 27% for rectum and 21 ± 16% for bladder. Prospective reporting of SB dose could provide data required to establish a potential correlation with radiation-induced late complication for SB.

  1. Double-illumination photoacoustic microscopy of intestinal hemodynamics following massive small bowel resection

    NASA Astrophysics Data System (ADS)

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

    2012-02-01

    Massive small bowel resection (SBR) results in villus angiogenesis and intestinal adaptation. The exact mechanism that causes intestinal villus angiogenesis remains unknown. We hypothesize that hemodynamic changes within the remnant bowel after SBR will trigger intestinal angiogenesis. To validate this, we used photoacoustic microscopy (PAM) to image the microvascular system of the intestine in C57B6 mice and to measure blood flow and oxygen saturation (sO2) of a supplying artery and vein. Baseline measurements were made 6 cm proximal to the ileal-cecal junction (ICJ) prior to resection. A 50% proximal bowel resection was then performed, and measurements were again recorded at the same location immediately, 1, 3 and 7 days following resection. The results show that arterial and venous sO2 were similar prior to SBR. Immediately following SBR, the arterial and venous sO2 decreased by 14.3 +/- 2.7% and 32.7 +/- 6.6%, respectively, while the arterial and venous flow speed decreased by 62.9 +/- 17.3% and 60.0 +/- 20.1%, respectively. Such significant decreases in sO2 and blood flow indicate a hypoxic state after SBR. Within one week after SBR, both sO2 and blood flow speed had gradually recovered. By 7 days after SBR, arterial and venous sO2 had increased to 101.0 +/- 2.9% and 82.7 +/- 7.3% of the baseline values, respectively, while arterial and venous flow speed had increased to 106.0 +/- 21.4% and 150.0 +/- 29.6% of the baseline values, respectively. Such increases in sO2 and blood flow may result from angiogenesis following SBR.

  2. Adrenergic denervation hypersensitivity in ileal circular smooth muscle after small bowel transplantation in rats.

    PubMed

    Shibata, C; Balsiger, B M; Anding, W J; Sarr, M G

    1997-11-01

    Effects of small bowel transplantation (SBT) on ileal motility are unknown. The aim of the present study was to investigate changes in spontaneous contractile activity and sensitivity to cholinergic and adrenergic agents in the ileal circular muscle after SBT in rats. Orthotopic SBT was performed in syngeneic rats to avoid immune phenomena. Distal ileal circular muscle strips from rats one week (N = 10) and eight weeks (N = 10) after SBT were stretched to optimal length (Lo), and basal spontaneous activity at Lo was measured. Dose-response experiments to the cholinergic agonist bethanechol (Be, 10(-8)-10(-4) M) were performed in the presence of tetrodotoxin (TTX, 10(-6) M) and to the adrenergic agonist norepinephrine (NE, 10(-8)-10(-4) M) with or without TTX. ED50 (negative log of drug-concentration that induced 50% effect) was calculated. We also studied rats with selective jejunoileal ischemia/ reperfusion, intestinal transection/reanastomosis, naive controls, and sham operated controls (N > or = 8/group). Spontaneous basal activity did not differ among groups. Sensitivity to Be was not different in rats after SBT or in other groups compared to control tissue. After SBT, hypersensitivity to NE was shown by a significant increase of ED50 at one and eight weeks after SBT (5.1 +/- 0.3 vs 6.2 +/- 0.4 and 6.2 +/- 0.2, respectively; P < 0.05) regardless of the presence of TTX. No hypersensitivity was observed after ischemia-reperfusion intestinal transection-reanastomosis, or sham operation. It is concluded that ileal hypersensitivity to NE was related to the extrinsic denervation obligated by the transplantation procedure, possibly mediated through an increase in number of receptors on smooth muscle, not on the enteric nerves.

  3. Automatic classification of small bowel mucosa alterations in celiac disease for confocal laser endomicroscopy

    NASA Astrophysics Data System (ADS)

    Boschetto, Davide; Di Claudio, Gianluca; Mirzaei, Hadis; Leong, Rupert; Grisan, Enrico

    2016-03-01

    Celiac disease (CD) is an immune-mediated enteropathy triggered by exposure to gluten and similar proteins, affecting genetically susceptible persons, increasing their risk of different complications. Small bowels mucosa damage due to CD involves various degrees of endoscopically relevant lesions, which are not easily recognized: their overall sensitivity and positive predictive values are poor even when zoom-endoscopy is used. Confocal Laser Endomicroscopy (CLE) allows skilled and trained experts to qualitative evaluate mucosa alteration such as a decrease in goblet cells density, presence of villous atrophy or crypt hypertrophy. We present a method for automatically classifying CLE images into three different classes: normal regions, villous atrophy and crypt hypertrophy. This classification is performed after a features selection process, in which four features are extracted from each image, through the application of homomorphic filtering and border identification through Canny and Sobel operators. Three different classifiers have been tested on a dataset of 67 different images labeled by experts in three classes (normal, VA and CH): linear approach, Naive-Bayes quadratic approach and a standard quadratic analysis, all validated with a ten-fold cross validation. Linear classification achieves 82.09% accuracy (class accuracies: 90.32% for normal villi, 82.35% for VA and 68.42% for CH, sensitivity: 0.68, specificity 1.00), Naive Bayes analysis returns 83.58% accuracy (90.32% for normal villi, 70.59% for VA and 84.21% for CH, sensitivity: 0.84 specificity: 0.92), while the quadratic analysis achieves a final accuracy of 94.03% (96.77% accuracy for normal villi, 94.12% for VA and 89.47% for CH, sensitivity: 0.89, specificity: 0.98).

  4. Implications of small-bowel transit time in the detection rate of capsule endoscopy: A multivariable multicenter study of patients with obscure gastrointestinal bleeding

    PubMed Central

    Girelli, Carlo Maria; Soncini, Marco; Rondonotti, Emanuele

    2017-01-01

    AIM To define the role of small-bowel transit time in the detection rate of significant small-bowel lesions. METHODS Small-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2 (significant findings) and P0-1 (normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance (outpatients vs inpatients), bowel cleanliness, and center volume. RESULTS We retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records (62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815 (57%) were males. In comparison with patients in the P0-1 group, those in the P2 group (n = 776, 54%) were older (P < 0.0001), had a longer small-bowel transit time (P = 0.0015), and were more frequently examined in low-volume centers (P < 0.001). Age and small-bowel transit time were correlated (P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations (54.5%), inflammatory (23.6%) and protruding (10.4%) lesions, and luminal blood (11.5%). CONCLUSION In this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor. PMID:28216977

  5. Pilot study of small bowel mucosal gene expression in patients with irritable bowel syndrome with diarrhea.

    PubMed

    Camilleri, Michael; Carlson, Paula; Valentin, Nelson; Acosta, Andres; O'Neill, Jessica; Eckert, Deborah; Dyer, Roy; Na, Jie; Klee, Eric W; Murray, Joseph A

    2016-09-01

    Prior studies in with irritable bowel syndrome with diarrhea (IBS-D) patients showed immune activation, secretion, and barrier dysfunction in jejunal or colorectal mucosa. We measured mRNA expression by RT-PCR of 91 genes reflecting tight junction proteins, chemokines, innate immunity, ion channels, transmitters, housekeeping genes, and controls for DNA contamination and PCR efficiency in small intestinal mucosa from 15 IBS-D and 7 controls (biopsies negative for celiac disease). Fold change was calculated using 2((-ΔΔCT)) formula. Nominal P values (P < 0.05) were interpreted with false detection rate (FDR) correction (q value). Cluster analysis with Lens for Enrichment and Network Studies (LENS) explored connectivity of mechanisms. Upregulated genes (uncorrected P < 0.05) were related to ion transport (INADL, MAGI1, and SONS1), barrier (TJP1, 2, and 3 and CLDN) or immune functions (TLR3, IL15, and MAPKAPK5), or histamine metabolism (HNMT); downregulated genes were related to immune function (IL-1β, TGF-β1, and CCL20) or antigen detection (TLR1 and 8). The following genes were significantly upregulated (q < 0.05) in IBS-D: INADL, MAGI1, PPP2R5C, MAPKAPK5, TLR3, and IL-15. Among the 14 nominally upregulated genes, there was clustering of barrier and PDZ domains (TJP1, TJP2, TJP3, CLDN4, INADL, and MAGI1) and clustering of downregulated genes (CCL20, TLR1, IL1B, and TLR8). Protein expression of PPP2R5C in nuclear lysates was greater in patients with IBS-D and controls. There was increase in INADL protein (median 9.4 ng/ml) in patients with IBS-D relative to controls (median 5.8 ng/ml, P > 0.05). In conclusion, altered transcriptome (and to lesser extent protein) expression of ion transport, barrier, immune, and mast cell mechanisms in small bowel may reflect different alterations in function and deserves further study in IBS-D.

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

    SciTech Connect

    Tho, Lye Mun . E-mail: l.tho@beatson.gla.ac.uk; Glegg, Martin; Paterson, Jennifer; Yap, Christina; MacLeod, Alice; McCabe, Marie; McDonald, Alexander C.

    2006-10-01

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

  7. Acquired Epidermodysplasia Verruciformis Associated with Human Papilloma Virus Type 14 in a Small Bowel Transplanted Child--A Case Report.

    PubMed

    Hirschman, Derek; Tacastacas, Joselin; Rady, Peter L; Tyring, Stephen K; Cooper, Kevin; Honda, Kord

    2016-01-01

    A 3-year-old African American girl taking sirolimus and tacrolimus for a small bowel transplantation presented with hypopigmented macules and papules throughout her trunk. A biopsy diagnosed epidermodysplasia verruciformis (EV) that was found to be associated with human papillomavirus (HPV) type 14 according to polymerase chain reaction analysis. There are few cases of acquired EV in the setting of organ transplantation. Although there is no standardized treatment for acquired EV, prevention and surveillance for transformation to squamous cell carcinoma are primary concerns.

  8. [Myeloid sarcoma of the small bowel with inversion of chromosome 16: a description of 3 clinical cases].

    PubMed

    Gavrilina, O A; Bariakh, E A; Parovichnikova, E N; Troitskaia, V V; Zvonkov, E E; Kravchenko, S K; Sinitsyna, M N; Obukhova, T N; Gitis, M K; Savchenko, V G

    2014-01-01

    Myeloid sarcoma (MS) is a rare malignant solid tumor presented with myeloid blast cells showing varying degrees of maturation. MS may have an extramedullary site, precede, or develop simultaneously with the clinical manifestations of acute myeloid leukemia (AML); it may also occur as an AML relapse. Besides AML, MS may be a manifestation of chronic myeloid leukemia or other chronic myeloproliferative diseases. Due to the fact that this disease is rare, the bulk of the literature on MS is presented with single descriptions of retrospective studies and clinical cases. The paper describes 3 cases of MS with inversion of chromosome 16 and small bowel lesion.

  9. Obscure Overt Gastrointestinal Bleeding Secondary to Ventral Hernioplasty Mesh Small Bowel Perforation Visualized With Video Capsule Endoscopy

    PubMed Central

    Mendez-Ishizaki, Yumi

    2016-01-01

    We report a case of a 79-year-old female presenting with hematemesis and melena 9 years after ventral hernioplasty with mesh. After initial normal endoscopy and colonoscopy, video capsule endoscopy revealed a metallic wire mesh perforating the jejunum. Abdominal computed tomography did not identify a perforation although metallic mesh was visualized close to the small bowel. We present the first ventral hernia mesh perforation diagnosed via video capsule endoscopy. Such a finding emphasizes the importance of a complete diagnostic workup when approaching a patient with obscure overt gastrointestinal bleeding. PMID:28008400

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

    PubMed

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

    2014-02-01

    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.

  11. [Laparoscopy as a method of final diagnosis of acute adhesive small bowel obstruction in a previously unoperated patients].

    PubMed

    Timofeev, M E; Shapoval'iants, S G; Fedorov, E D; Polushkin, V G

    2014-01-01

    The article presents the use of laparoscopic interventions in 38 patients with Acute Adhesive Small Bowel Obstruction (AASBO) in patients without previous history of abdominal surgery. Clinical, radiological and ultrasound patterns of disease are analyzed. The use of laparoscopy has proved itself the most effective and relatively safe diagnostic procedure. In 14 (36.8%) patients convertion to laparotomy was made due to contraindications for laparoscopy. In 24 (63.2%) patients laparosopic adhesyolisis was performed and AASBO subsequently treated with complications rate of 4.2%.

  12. GLP-1 and GLP-2 act in concert to inhibit fasted, but not fed, small bowel motility in the rat.

    PubMed

    Bozkurt, Ayhan; Näslund, Erik; Holst, Jens Juul; Hellström, Per M

    2002-07-15

    Small bowel motility was studied in rats at increasing (1-20 pmol/kg/min) intravenous doses of either glucagon-like peptide-1 (GLP-1) or glucagon-like peptide-2 (GLP-2) alone, or in combination in the fasted and fed state. There was a dose-dependent inhibitory action of GLP-1 on the migrating myoelectric complex (MMC), where the dose of 5 pmol/kg/min induced an increased MMC cycle length. No effect was seen with GLP-2 alone, but the combination of GLP-1 and GLP-2 induced a more pronounced inhibitory effect, with significant increase of the MMC cycle length from a dose of 2 pmol/kg/min. During fed motility, infusion of GLP-1 resulted in an inhibition of spiking activity compared to control. In contrast, infusion of GLP-2 only numerically increased spiking activity compared to control, while the combination of GLP-1 and GLP-2 resulted in no change compared to control. In summary, this study demonstrates an additive effect of peripheral administration of GLP-1 and GLP-2 on fasted small bowel motility. In the fed state, GLP-1 and GLP-2 seem to display counter-balancing effects on motility of the small intestine.

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

    PubMed Central

    2010-01-01

    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. PMID:20579372

  14. Effectiveness of polaprezinc for low-dose aspirin-induced small-bowel mucosal injuries as evaluated by capsule endoscopy: a pilot randomized controlled study

    PubMed Central

    2013-01-01

    Background Treatment of low-dose aspirin (LDA)-induced small-bowel injury has not been established. Polaprezinc, a chelate of zinc and L-carnosine, may be efficacious for such injury. We conducted a pilot randomized controlled study to investigate whether polaprezinc is effective against LDA-induced small-bowel injuries. Methods Consecutive patients under long-term (>3 months) LDA treatment and who agreed to participate in our study underwent initial capsule endoscopy (CE). Patients with LDA-induced small-bowel injury apparent upon initial CE (n = 20) were randomized into a polaprezinc (150 mg/day for 4 weeks) group and a control (no polaprezinc treatment) group. All underwent follow-up CE after 4 weeks. Changes in the number and characteristics of small-bowel mucosal injuries were compared within and between the two groups. Results The median number of reddened lesions and erosions/ulcers upon follow-up CE in the polaprezinc group significantly decreased (P < 0.05). However, there was no significant difference in the median number of reddened lesions and erosions/ulcers upon follow-up CE in the control group. Conclusions Co-administration of polaprezinc may be effective against small-bowel mucosal injury associated with long-term LDA therapy. Trial registration UMIN Clinical Trials Registry UMIN000003687. PMID:23826914

  15. Gastric emptying rate and small bowel transit time in patients with irritable bowel syndrome determined with 99mTc-labeled pellets and scintigraphy

    SciTech Connect

    Nielsen, O.H.; Gjorup, T.; Christensen, F.N.

    1986-12-01

    A new method employing 99mTc-labeled pellets for determination of the gastric emptying rate and small bowel transit time is described. The participants were six normal subjects and 16 patients with irritable bowel syndrome (eight with diarrhea and eight with obstipation as the primary complaint). The gastric emptying rate was the same in the three groups. The patients in the obstipation group had a significantly longer small bowel transit time than the normals (P less than 0.02) and the patients in the diarrhea group (P less than 0.01). There was no demonstrable difference between the small bowel transit time in the normals and in the patients in the diarrhea group.

  16. Effects of Bolus and Continuous Nasogastric Feeding on Gastric Emptying, Small Bowel Water Content, Superior Mesenteric Artery Blood Flow, and Plasma Hormone Concentrations in Healthy Adults

    PubMed Central

    Chowdhury, Abeed H.; Murray, Kathryn; Hoad, Caroline L.; Costigan, Carolyn; Marciani, Luca; Macdonald, Ian A.; Bowling, Timothy E.; Lobo, Dileep N.

    2016-01-01

    Objective: We aimed to demonstrate the effect of continuous or bolus nasogastric feeding on gastric emptying, small bowel water content, and splanchnic blood flow measured by magnetic resonance imaging (MRI) in the context of changes in plasma gastrointestinal hormone secretion. Background: Nasogastric/nasoenteral tube feeding is often complicated by diarrhea but the contribution of feeding strategy to the etiology is unclear. Methods: Twelve healthy adult male participants who underwent nasogastric intubation before a baseline MRI scan, received 400 mL of Resource Energy (Nestle) as a bolus over 5 minutes or continuously over 4 hours via pump in this randomized crossover study. Changes in gastric volume, small bowel water content, and superior mesenteric artery blood flow and velocity were measured over 4 hours using MRI and blood glucose and plasma concentrations of insulin, peptide YY, and ghrelin were assayed every 30 minutes. Results: Bolus nasogastric feeding led to significant elevations in gastric volume (P < 0.0001), superior mesenteric artery blood flow (P < 0.0001), and velocity (P = 0.0011) compared with continuous feeding. Both types of feeding reduced small bowel water content, although there was an increase in small bowel water content with bolus feeding after 90 minutes (P < 0.0068). Similarly, both types of feeding led to a fall in plasma ghrelin concentration although this fall was greater with bolus feeding (P < 0.0001). Bolus feeding also led to an increase in concentrations of insulin (P = 0.0024) and peptide YY (P < 0.0001), not seen with continuous feeding. Conclusion: Continuous nasogastric feeding does not increase small bowel water content, thus fluid flux within the small bowel is not a major contributor to the etiology of tube feeding-related diarrhea. PMID:25549202

  17. Small bowel intussusception by local recurrence of an inflammatory myofibroblastic tumor: report of a case and review of the literature.

    PubMed

    Zuccarello, C; Arena, F; Fazzari, C; Arena, S; Nicòtina, P A

    2006-10-01

    Inflammatory myofibroblastic tumor (IMT) of the ileum is a rare, usually solitary lesion, that frequently presents small-intestinal intussusception and obstruction. We describe an IMT of the ileum in a 4.5-year old child who presented a small bowel intussusception. During laparotomy, an annular mass around the ileum was resected, and the IMT was histologically diagnosed. Three months after the operation, the patients were hospitalized with the symptoms of intestinal obstruction. Laparotomy showed a ileal intussusception. Along the previous suture line of anastomosis, a smooth polypoid tumor was evident. Segmental resection of the ileum, including the tumor mass, was performed. The IMT was immunohistochemically diagnosed. The patient was asymptomatic at 3 year follow-up. A review of the literature for this rare entity emphasizes the importance of immunohistochemical confirmation of its benign nature. Because of the risk of local recurrence, IMT cases should have a long-term follow-up.

  18. Acute small bowel obstruction due to a large intraluminal blood clot after laparoscopic Roux-en-Y gastric bypass

    PubMed Central

    Green, Jessica; Ikuine, Tomoko; Hacker, Shoshana; Urrego, Hernan; Tuggle, Karleena

    2016-01-01

    Small bowel obstructions (SBOs) are a known perioperative complication of laparoscopic Roux-en-Y gastric bypass and common etiologies include internal hernia, port site hernia, jejunojejunostomy stricture, ileus and adhesions. Less commonly, SBO can be caused by superior mesenteric artery syndrome, intussusception and intraluminal blood clot. We present a case of SBO caused by intraluminal blood clot from jejunojejunostomy staple line bleeding in a patient with a normal coagulation profile. Computed tomography was used to elucidate the cause of perioperative SBO, and diagnostic laparoscopy was used to both diagnose and treat the complication. In this case, the intraluminal clot was evacuated laparoscopically by enterotomy, thrombectomy and primary closure without anastomotic revision since there was no evidence of continued bleeding. Administration of enoxaparin and Toradol post-operatively may have exacerbated mild intraluminal bleeding occurring at the stapled jejunojejunal anastomosis. Prompt recognition and treatment of perioperative SBO can prevent catastrophic consequences related to bowel perforation. PMID:27554828

  19. Enterocutaneous fistula in the setting of ventriculoperitoneal shunt extrusion through the skin and perforation through the small bowel.

    PubMed

    Voronovich, Zoya A; Albright, A Leland

    2014-10-01

    The authors report a case of a 2-year-old boy with postinfectious hydrocephalus, managed with a ventriculoperitoneal (VP) shunt and complicated by shunt extrusion through the cranial skin. The shunt was removed due to concern for infection, and the child was found to have an enterocutaneous fistula (ECF) communicating along the shunt track between the small bowel and a clavicular sinus. Self-closure of the ECF was anticipated. Thus, the fistula was managed expectantly with dressing changes of the clavicular sinus, while the patient's malnutrition was managed in accordance with World Health Organization protocols. The presentation, prognosis and management of ECFs, including the likelihood of self-resolution and the role of expectant management, are discussed. Additionally, proposed mechanisms of ECF formation in the setting of a VP shunt are discussed, with an emphasis on the roles of infection and malnutrition.

  20. Small bowel volvulus in mid and late pregnancy: can early diagnosis be established to avoid catastrophic outcomes?

    PubMed Central

    Cong, Qing; Li, Xilian; Ye, Xuping; Sun, Li; Jiang, Wei; Han, Zhigang; Lu, Weiqi; Xu, Huan

    2014-01-01

    Volvulus in pregnancy is rare and difficult to diagnose. Delayed diagnosis would result in high maternal and fetal mortality. Here we present an unusual case of small bowel volvulus in late pregnancy timely managed by emergency Cesarean section and derotation with excellent maternal and fetal outcomes. Volvulus should be considered in patients complaining ongoing abdominal pain, nausea, vomiting, constipation even diarrhea. Imaging is essential for early and precise diagnosis, including plain abdominal film, MRI and/or ultrasound. Once highly suspected or diagnosed of volvulus or ileus, emergency laparotomy should be performed immediately to avoid catastrophic outcomes, because the maternal and fetal prognosis is dependent on the interval from volvulus to operation apart from the degree of volvulus. PMID:25550984

  1. Usefulness of virtual chromoendoscopy in the evaluation of subtle small bowel ulcerative lesions by endoscopists with no experience in videocapsule

    PubMed Central

    Rimbaş, Mihai; Zahiu, Denise Carmen Mihaela; Voiosu, Andrei Mihai; Voiosu, Theodor Alexandru; Zlate, Alina Ana-Maria; Dinu, Roxana; Galasso, Domenico; Minelli Grazioli, Leonardo; Campanale, Mariachiara; Barbaro, Federico; Mateescu, Bogdan Radu; Busuioc, Bogdan; Iordache, Tiberiu; Dolofan, Oana; Popescu, Adelina Maria; Balaban, Vasile Daniel; Raducan, Mircea Mihai; Spada, Cristiano; Băicuş, Cristian Răsvan; Costamagna, Guido

    2016-01-01

    Background and study aims: In videocapsule endoscopy examination (VCE), subtle variations in mucosal hue or pattern such as those seen in ulcerations can be difficult to detect, depending on the experience of the reader. Our aim was to test whether virtual chromoendoscopy (VC) techniques, designed to enhance the contrast between the lesion and the normal mucosa, could improve the characterization of ulcerative mucosal lesions. Patients and methods: Fifteen trainees or young gastroenterologists with no experience in VCE were randomly assigned to evaluate 250 true ulcerative and 100 false ulcerative, difficult-to-interpret small bowel lesions, initially as white light images (WLI) and then, in a second round, with the addition of one VC setting or again as WLI, labeling them as real lesions or artifacts. Results: On the overall image evaluation, an improvement in lesion characterization was observed by adding any chromoendoscopy setting, especially Blue mode and FICE 1, with increases in accuracy of 13 % [95 %CI 0.8, 25.3] and 7.1 % [95 %CI – 17.0, 31.3], respectively. However, when only false ulcerative images were considered, with the same presets (Blue mode and FICE 1), there was a loss in accuracy of 10.7 % [95 %CI – 10.9, 32.3] and 7.3 % [95 %CI – 1.3, 16.0], respectively. The interobserver agreement was poor for both readings. Conclusions: VC helps beginner VCE readers correctly categorize difficult-to-interpret small bowel mucosal ulcerative lesions. However, false lesions tend to be misinterpreted as true ulcerative with the same presets. Therefore care is advised in using VC especially under poor bowel preparation. PMID:27227106

  2. Distinct Abnormalities of Small Bowel and Regional Colonic Volumes in Subtypes of Irritable Bowel Syndrome Revealed by MRI

    PubMed Central

    Lam, Ching; Chaddock, Gemma; Marciani Laurea, Luca; Costigan, Carolyn; Cox, Eleanor; Hoad, Caroline; Pritchard, Susan; Gowland, Penny; Spiller, Robin

    2017-01-01

    OBJECTIVES: Non-invasive biomarkers which identify different mechanisms of disease in subgroups of irritable bowel syndrome (IBS) could be valuable. Our aim was to seek useful magnetic resonance imaging (MRI) parameters that could distinguish each IBS subtypes. METHODS: 34 healthy volunteers (HV), 30 IBS with diarrhea (IBS-D), 16 IBS with constipation (IBS-C), and 11 IBS with mixed bowel habit (IBS-M) underwent whole-gut transit and small and large bowel volumes assessment with MRI scans from t=0 to t=360 min. Since the bowel frequency for IBS-M were similar to IBS-D, IBS-M and IBS-D were grouped together and labeled as IBS non-constipation group (IBS-nonC). RESULTS: Median (interquartile range): fasting small bowel water content in IBS-nonC was 21 (10–42), significantly less than HV at 44 ml (15–70), P<0.01 as was the postprandial area under the curve (AUC) P<0.01. The fasting transverse colon volumes in IBS-C were significantly larger at 253 (200–329) compared with HV, IBS-nonC whose values were 165 (117–255) and 198 (106–270) ml, respectively, P=0.02. Whole-gut transit time for IBS-C was prolonged at 69 (51–111), compared with HV at 34 (4–63) and IBS-D at 34 (17–78) h, P=0.03. Bloating score (VAS 0–10 cm) correlated with transverse colon volume at t=405 min, Spearman r=0.21, P=0.04. CONCLUSIONS: The constricted small bowel in IBS-nonC and the dilated transverse colon in IBS-C point to significant differences in underlying mechanisms of disease. PMID:27958282

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

    PubMed Central

    2011-01-01

    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. PMID:22126605

  4. Prediction of Small Bowel Obstruction Caused by Bezoars Using Risk Factor Categories on Multidetector Computed Tomographic Findings

    PubMed Central

    Kuang, Lian-qin; Cheng, Cheng

    2016-01-01

    Objectives. The aim of this study was to detect factors associated with small bowel obstruction (SBO) caused by bezoars on multidetector computed tomographic findings. Methods. We retrospectively reviewed 61 patients who had bezoars in the small bowels on MDCT. The patients were divided into SBO patients group and non-SBO patients group. The mean values of the diameter, volume, and CT attenuation as well as location and characteristics of the bezoars were compared between the two groups. Multivariate analysis was performed to determine factors associated with SBO. Results. There were 32 patients (52.5%) in the SBO group and 29 patients (47.5%) in the non-SBO group. The bezoars in the SBO group had greater values of each mean diameter and mean volume than those in the non-SBO group (3.2 ± 0.5 cm versus 1.6 ± 0.7 cm, P < 0.0001, 14.9 ± 6.4 cm3 versus 2.5 ± 2.7 cm3, P < 0.0001, resp.) and had a lower CT attenuation than the non-SBO group (55.5 ± 23.4 versus 173.0 ± 68.0, P < 0.0001). The SBO group had higher prevalence of phytobezoar appearance (75.0% versus 10.3%, P < 0.0001). Major diameters of bezoar and phytobezoar were significant independent risk factors associated with SBO (odds ratio = 36.09, 8.26, resp., and P = 0.0004, 0.044, resp.). Conclusions. Major diameter of bezoar or phytobezoar is a potential risk factor associated with SBO. PMID:27403434

  5. 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

    Vahedi, Shahrzad; Okada, Go; Morrell, Brian; Muzar, Edward; Koughia, Cyril; Kasap, Safa; Edgar, Andy; Varoy, Chris; Belev, George; Wysokinski, Tomasz; Chapman, Dean

    2012-10-01

    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+}.

  6. Electronic structure and soft-X-ray-induced photoreduction studies of iron-based magnetic polyoxometalates of type {(M)M5}12Fe(III)30 (M = Mo(VI), W(VI)).

    PubMed

    Kuepper, Karsten; Derks, Christine; Taubitz, Christian; Prinz, Manuel; Joly, Loïc; Kappler, Jean-Paul; Postnikov, Andrei; Yang, Wanli; Kuznetsova, Tatyana V; Wiedwald, Ulf; Ziemann, Paul; Neumann, Manfred

    2013-06-14

    Giant Keplerate-type molecules with a {Mo72Fe30} core show a number of very interesting properties, making them particularly promising for various applications. So far, only limited data on the electronic structure of these molecules from X-ray spectra and electronic structure calculations have been available. Here we present a combined electronic and magnetic structure study of three Keplerate-type nanospheres--two with a {Mo72Fe30} core and one with a {W72Fe30} core by means of X-ray absorption spectroscopy, X-ray magnetic circular dichroism (XMCD), SQUID magnetometry, and complementary theoretical approaches. Furthermore, we present detailed studies of the Fe(3+)-to-Fe(2+) photoreduction process, which is induced under soft X-ray radiation in these molecules. We observe that the photoreduction rate greatly depends on the ligand structure surrounding the Fe ions, with negatively charged ligands leading to a dramatically reduced photoreduction rate. This opens the possibility of tailoring such polyoxometalates by X-ray spectroscopic studies and also for potential applications in the field of X-ray induced photochemistry.

  7. Continuous-time photon-stimulated desorption spectroscopy studies on soft x-ray-induced reactions of CF{sub 3}Br adsorbed on Si(111)-7x7

    SciTech Connect

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

    2011-10-28

    Continuous-time core-level photon-stimulated desorption (PSD) spectroscopy was used to study the soft x-ray-induced reactions of CF{sub 3}Br molecules adsorbed on Si(111)-7x7 near the Si(2p) edge (98-110 eV). The monochromatic synchrotron radiation was employed as a soft x-ray light source in the photon-induced reactions and also as a probe for investigating the produced fluorination states of the bonding surface Si atom in the positive-ion PSD spectroscopy. Several different surface coverages were investigated. The PSD spectra from the low-CF{sub 3}Br-covered surfaces show the production of surface SiF species, while those from the high-CF{sub 3}Br-covered surfaces depict the formation of surface SiF, SiF{sub 2}, and SiF{sub 3} species. The photolysis cross section of the submonolayer CF{sub 3}Br-covered surface is determined as {approx}4.3x10{sup -18} cm{sup 2}. A comparison with the results on CF{sub 3}Cl/Si(111)-7x7 surface is discussed.

  8. Application of PIXE, RBS and high energy proton microbeams to the elemental analysis of coal and coal waste. [Proton and x-ray induced x-ray emission and Rutherford backscattering

    SciTech Connect

    Kraner, H.W.; Hanson, A.L.; Jones, K.W.; Oakley, S.A.; Duedall, I.W.; Woodhead, P.M.J.

    1980-01-01

    Proton and x-ray induced x-ray emission have proved to be sensitive and convenient methods to measure major trace element concentrations in bulk quantities of coal and coal waste materials. These techniques are complementary in their sensitivities as a function of atomic number, and both require little sample preparation. The PIXE measurements were made with the proton beam in air in a microprobe configuration. Collimated proton beam scans were made on several thin sections of fly ash/sludge block materials and good trace sensitivities were observed for small specific volumes; SEM scans showed a high degree of material homogeneity which precluded significant elemental variations at the approx. 100 ..mu..m spatial resolution used. Rutherford backscattering was used to directly observe major and minor elemental concentrations in coal waste materials and in several representative ranks of coals. RBS is useful for only trace concentrations of heavy elements, but it does provide a method independent of fluoresced x rays for detection of possible middle Z interferences. Arsenic, present in trace amounts in coal, is an element of concern and is enriched in fly ash. The form of As in fly ash is unknown. However, because of its volatility most of the As probably becomes attached to the surfaces of the fly ash particles during and subsequent to combustion processes. This view is supported by the fact that As is rapidly mobilized in aqueous solutions whose pH > 9.

  9. Successful treatment of early-stage jejunum adenocarcinoma by endoscopic mucosal resection using double-balloon endoscopy: a case report.

    PubMed

    Suzuki, Hirobumi; Yamada, Atsuo; Watabe, Hirotsugu; Kobayashi, Yuka; Hirata, Yoshihiro; Yamaji, Yutaka; Yoshida, Haruhiko; Koike, Kazuhiko

    2012-01-01

    Small bowel adenocarcinoma (SBA) has generally been considered to have a poor prognosis because of nonspecific presentations and difficulties in detection of the disease. The advent of capsule endoscopy (CE) and double-balloon endoscopy (DBE) makes it possible to access to the small intestine for endoscopic interventions. We describe a successful case of early jejunum adenocarcinoma completely resected by endoscopic mucosal resection (EMR) using double-balloon endoscopy (DBE). Early diagnosis and EMR using new technologies such as CE and DBE may improve the recognition of this disease that, at present, has a poor prognosis.

  10. Fecal occult blood testing for the prediction of small-bowel pathology detected by capsule endoscopy: a systematic review and meta-analysis

    PubMed Central

    Yung, Diana E.; Vijayan, Sanju; Avni, Tomer; Douglas, Sarah; Kopylov, Uri; Koulaouzidis, Anastasios

    2017-01-01

    Background Fecal occult blood testing (FOBT) has been suggested as a potential screening tool for small-bowel capsule endoscopy (CE). We conducted a meta-analysis of studies correlating FOBT and CE findings to examine the predictive value of positive FOBT for CE findings. Methods PubMed and Embase search. Sensitivity, specificity and diagnostic odds ratios (DORs) were calculated. Results Six studies were identified. Four used fecal immunochemical testing (FIT), one used FIT and guaiac FOBT, one used hemoglobin/haptoglobin complex testing (Hb/Hpt). Five of the 6 studies were suitable for statistical analysis. For all positive FOBT, sensitivity for small-bowel findings was 0.60 (95%CI 0.50-0.69), specificity was 0.72 (95%CI 0.52-0.86), and DOR was 3.96 (95%CI 1.50-10.4). For the 4 studies using only FIT, sensitivity was 0.48 (95%CI 0.36-0.61), specificity was 0.60 (95%CI 0.42-0.76), and DOR was 1.41 (95%CI 0.72-2.75). Conclusions Although a number of modalities have been suggested for screening small-bowel CE referrals, none of them, including FOBT, offer a comprehensive solution. Further work is required to refine screening methods for small-bowel CE referrals. PMID:28243039

  11. Small bowel capsule endoscopy for the investigation of obscure gastrointestinal bleeding: When we should do it and what should we expect.

    PubMed

    Viazis, N; Anastasiou, J; Karamanolis, D G

    2016-01-01

    Obscure gastrointestinal bleeding is defined as bleeding of unknown origin that persists or recurs (i.e. recurrent or persistent iron deficiency anemia, fecal occult blood test positivity or visible bleeding) after a negative initial workout that necessarily includes gastroscopy and colonoscopy. In clinical practice, small bowel capsule endoscopy is recommended as a third stage examination in these patients, since it is a simple, safe, non-invasive and reliable test. To date there are three available small bowel capsule systems that have gained FDA approval and their diagnostic yield has shown to be superior to other diagnostic modalities for the investigation of the small bowel in patients with obscure gastrointestinal bleeding. The test should be performed as close to the bleeding episode as possible and the administration of a purgative bowel preparation before the administration of capsule endoscopy is recommended by the European Society of Gastrointestinal Endoscopy (ESGE). Issues that still remain to be solved are the definition of bleeding lesions and what really represents a positive finding, as well as the question of whether the outcome of patients with obscure gastrointestinal bleeding is altered after the test, i.e. to better define subgroups of patients that will mostly benefit from capsule endoscopy. In the future small bowel capsule endoscopy might be able to get guided, while tissue samples might be available as well. (Acta gastro-enterol. belg., 2016, 79, 355-362).

  12. Effect of small bowel bacterial overgrowth on the immunogenicity of single-dose live oral cholera vaccine CVD 103-HgR.

    PubMed

    Lagos, R; Fasano, A; Wasserman, S S; Prado, V; San Martin, O; Abrego, P; Losonsky, G A; Alegria, S; Levine, M M

    1999-11-01

    Several live oral vaccines (polio, bovine rotavirus, CVD 103-HgR cholera) are less immunogenic in developing than in industrialized countries. It was hypothesized that proximal small bowel bacterial overgrowth (common in children in less developed countries but rare in industrialized settings) diminishes the vibriocidal antibody response to CVD 103-HgR. In total, 202 fasting Santiago schoolchildren aged 5-9 years had lactulose breath H2 tests to detect proximal small bowel bacteria 1 day before ingesting CVD 103-HgR. Florid small bowel overgrowth was observed in 10 (5.6%) of 178 analyzable children. In children with florid overgrowth, vibriocidal seroconversion differed little from other children (60% vs. 67%), but the geometric mean titer was lower (160 vs. 368; P=.25). By logistic regression, increased peak breath H2 at small bowel time points was associated with diminished seroconversion (P=.04), as was the interaction of H2 value and weight (children >25 kg had lower seroconversion rates among subjects with heaviest overgrowth).

  13. X-ray induced optical reflectivity

    NASA Astrophysics Data System (ADS)

    Durbin, Stephen M.

    2012-12-01

    The change in optical reflectivity induced by intense x-ray pulses can now be used to study ultrafast many body responses in solids in the femtosecond time domain. X-ray absorption creates photoelectrons and core level holes subsequently filled by Auger or fluorescence processes, and these excitations ultimately add conduction and valence band carriers that perturb optical reflectivity. Optical absorption associated with band filling and band gap narrowing is shown to explain the basic features found in recent measurements on an insulator (silicon nitride, Si3N4), a semiconductor (gallium arsenide, GaAs), and a metal (gold, Au), obtained with ˜100 fs x-ray pulses at 500-2000 eV and probed with 800 nm laser pulses. In particular GaAs exhibits an abrupt drop in reflectivity, persisting only for a time comparable to the x-ray excitation pulse duration, consistent with prompt band gap narrowing.

  14. Oxygen Insufflation in University of Wisconsin Solution Ameliorates Reperfusion Injury in Small Bowel after Cold Storage and Reperfusion.

    PubMed

    Glowka, Tim R; Wei, Lai; Hata, Koichiro; Afify, Mamdouh; Kalff, Jörg C; Minor, Thomas; Tolba, René H

    2015-08-13

    BACKGROUND Results in small bowel transplantation are inferior compared to other solid organ transplantations, among other reasons, due to a specific vulnerability to ischemia/reperfusion injury. New strategies are needed to improve organ storage. Here we compare static cold storage in University of Wisconsin solution to storage supplemented with molecular oxygen gas insufflation. MATERIAL AND METHODS Rat small bowel was retrieved and either stored unoxygenated (UW) or oxygenated (UW+O2) for 18 h at 4°C. Biochemical parameters, mucosal function, Toll-like receptor upregulation, and parameters of structural integrity were evaluated following isolated reperfusion in vitro for 30 min at 37°C. RESULTS Oxygenation showed: ATP concentration was 82 times higher; lactate dehydrogenase release was continuously lower over 30 min; malondialdehyde, a final product of lipid peroxidation (UW+O2 vs. UW; 2.7±0.92 nmol/mL vs. 17.22±10.1 nmol/mL; P<0.05) and nitric oxide concentration (0.87±0.27 µmol/L vs. 2.17±0.29 µmol/L; P<0.001) were significantly lower; whereas mucosal functional integrity (galactose uptake) was better preserved (0.47±0.18 mg/dL vs. 0.35±0.05 mg/dL). Amelioration of tissue damage could be demonstrated by reduced apoptosis (3.3±1.2 AU vs. 28.4±10 AU; P>0.05), and preserved subcellular integrity. Toll-like receptors were significantly less upregulated (TLR2 0.32±0.1 vs. 2.1±1.5-fold and TLR4 1.53±1.14 vs. 11.79±5.4-fold; P<0.05). CONCLUSIONS Oxygenated storage is superior to standard storage in University of Wisconsin solution in terms of energetics, tissue damage, and mucosal integrity.

  15. Clinical utility of capsule endoscopy with flexible spectral imaging color enhancement for diagnosis of small bowel lesions

    PubMed Central

    Sato, Yasushi; Sagawa, Tamotsu; Hirakawa, Masahiro; Ohnuma, Hiroyuki; Osuga, Takahiro; Okagawa, Yutaka; Tamura, Fumito; Horiguchi, Hiroto; Takada, Kohichi; Hayashi, Tsuyoshi; Sato, Tsutomu; Miyanishi, Koji; Takimoto, Rishu; Kobune, Masayoshi; Kato, Junji

    2014-01-01

    Background and study aims: The clinical utility of computed virtual chromoendoscopy with flexible spectral imaging color enhancement (FICE) in capsule endoscopy (CE) remains controversial. To clarify the clinical utility of FICE-enhanced CE in evaluating small bowel lesions, we quantitatively assessed white light (WL), FICE, and blue mode (BM) images and examined the sensitivity of these 3 imaging modes of small-bowel lesions from patients who underwent CE. Methods: The CIELAB color difference (∆E) and visual analogue scales (VAS) were measured in 261 CE images (3 different lesion categories) using WL and FICE set 1, 2, and 3, and BM images, respectively. Three endoscopists reviewed CE videos with WL, 3 FICE mode settings, and BM, and compared the sensitivity and detectability for small intestinal diseases from 50 patients who underwent CE. Results: In the assessment of visibility in the 152 vascular lesion images, the ∆E and VAS of FICE set 1, 2, and BM images were significantly higher than that of WL images. In 88 erosion/ulceration images, the ∆E and VAS of FICE set 1 and 2 images were significantly higher than that of WL images. In 21 tumor images, there were no significant differences in ∆E among these modalities. When analyzed on a per-patient basis, FICE settings 1 and 2 had the highest sensitivity (100 %) and specificity (97.3 – 100 %) for vascular lesions. As for erosive/ulcerative lesions, FICE setting 2 had the highest sensitivity (100 %) and specificity (97.2 %). For tumors or polyps, WL had the highest sensitivity (90.9 %) and specificity (87.1 %). In per-lesion analysis, FICE settings 1 and 2 showed significantly superior detection ability over WL for vascular lesions. In the detection of erosive/ulcerative lesions, FICE setting 2 was significantly superior to WL. In tumor images, there was no significant improvement with any of the settings relative to WL images. Conclusions: FICE is most useful for improving CE image

  16. The Lipophilic Vitamin C Derivative, 6-O-Palmitoylascorbate Protects Human Keratinocytes and 3D-Human Skin Equivalents Against X-Ray-Induced Oxidative Stress and Apoptosis More Markedly Than L-Ascorbic Acid.

    PubMed

    Xiao, Li; Miwa, Nobuhiko

    2017-02-01

    The aim of this study was to investigate preventive effects of the lipophilic vitamin C derivative, 6-O-palmitoylascorbate (PlmtVC) against X-ray radiation-induced harmful events. Free radical scavenging activity tests showed that both fresh and old (being kept at 37°C for 72 h) solutions of PlmtVC showed significantly higher abilities for scavenging both DPPH and peroxyl radical (ROO·) radicals than L-ascorbic acid (L-AA) under the same conditions, suggesting that PlmtVC is an antioxidant more efficient and stable than L-AA. Irradiation with X-ray (15 Gy) increased intracellular ROS production, lipid peroxidation and protein carbonylation, in human keratinocytes HaCaT, all of which were repressed, especially for intracellular ROS more markedly, by PlmtVC than by L-AA. After X-ray (15 Gy)-irradiation, caspase 3/7 activation and TUNEL-detected DNA-strand-breakages characteristic of apoptosis obviously increased in HaCaT cells or 3D-skin tissue equivalents, respectively, both of which were prevented more appreciably by PlmtVC than by L-AA. PlmtVC also noticeably prevented cumene hydroperoxide-induced generation of cellular ROS in epidermis parts of 3D-skin equivalents. Thus, PlmtVC prevents X-ray-induced diverse harmful effects, through its antioxidant activity and the palmitoyl moiety-based lipophilicity, more efficiently than L-AA. J. Cell. Biochem. 118: 318-329, 2017. © 2016 Wiley Periodicals, Inc.

  17. Initial experimental demonstration of the principles of a xenon gas shield designed to protect optical components from soft x-ray induced opacity (blanking) in high energy density experiments

    NASA Astrophysics Data System (ADS)

    Swadling, G. F.; Ross, J. S.; Manha, D.; Galbraith, J.; Datte, P.; Sorce, C.; Katz, J.; Froula, D. H.; Widmann, K.; Jones, O. S.; Divol, L.; Landen, O. L.; Kilkenny, J. D.; Moody, J. D.

    2017-03-01

    The design principles of a xenon gas shield device that is intended to protect optical components from x-ray induced opacity ("x-ray blanking") have been experimentally demonstrated at the OMEGA-60 Laser Facility at the Laboratory for Laser Energetics, University of Rochester. A volume of xenon gas placed in front of an optical component absorbs the incoming soft x-ray radiation but transmits optical and ultra-violet radiation. The time-resolved optical (532 nm) transmission of samples was recorded as they were exposed to soft x-rays produced by a gold sphere source (1.5 kJ sr-1, 250-300 eV). Blanking of fused silica (SiO2) was measured to occur over a range of time-integrated soft x-ray (<3 keV) fluence from ˜0.2-2.5 J cm-2. A shield test device consisting of a 30 nm silicon nitride (Si3N4) and a 10 cm long volume of 0.04 bar xenon gas succeeded in delaying loss of transmission through a magnesium fluoride sample; optical transmission was observed over a longer period than for the unprotected sample. It is hoped that the design of this x-ray shield can be scaled in order to produce a shield device for the National Ignition Facility optical Thomson scattering collection telescope, in order to allow measurements of hohlraum plasma conditions produced in inertial confinement fusion experiments. If successful, it will also have applications in many other high energy density experiments where optical and ultra-violet measurements are desirable.

  18. Overtube-assisted enteroscopy and capsule endoscopy for the diagnosis of small-bowel polyps and tumors: a systematic review and meta-analysis

    PubMed Central

    Sulbaran, Marianny; de Moura, Eduardo; Bernardo, Wanderley; Morais, Cintia; Oliveira, Joel; Bustamante-Lopez, Leonardo; Sakai, Paulo; Mönkemüller, Klaus; Safatle-Ribeiro, Adriana

    2016-01-01

    Background and study aims: Several studies have evaluated the utility of double-balloon enteroscopy (DBE) and capsule endoscopy (CE) for patients with small-bowel disease showing inconsistent results. The aim of this study was to determine the sensitivity and specificity of overtube-assisted enteroscopy (OAE) as well as the diagnostic concordance between OAE and CE for small-bowel polyps and tumors. Patients and methods: We conducted a systematic review and meta-analysis of studies in which the results of OAE were compared with the results of CE for the evaluation of small-bowel polyps and tumors. When data for surgically resected lesions were available, the histopathological results of OAE and surgical specimens were compared. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the diagnosis of small-bowel polyps and tumors were analyzed. Secondarily, the rates of diagnostic concordance and discordance between OAE and CE were calculated. Results: There were 15 full-length studies with a total of 821 patients that met the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were as follows: 0.89 (95 % confidence interval [CI] 0.84 – 0.93), with heterogeneity χ2 = 41.23 (P = 0.0002) and inconsistency (I 2) = 66.0 %; 0.97 (95 %CI 0.95 – 0.98), with heterogeneity χ2 = 45.27 (P = 0.07) and inconsistency (I 2) = 69.1 %; 16.61 (95 %CI 3.74 – 73.82), with heterogeneity Cochrane’s Q = 225.19 (P < 0.01) and inconsistency (I 2) = 93.8 %; and 0.14 (95 %CI 0.05 – 0.35), with heterogeneity Cochrane’s Q = 81.01 (P < .01) and inconsistency (I 2) = 82.7 %, respectively. A summary receiver operating characteristic curve (SROC) curve was constructed, and the area under the curve (AUC) was 0.97. Conclusion: OAE is an accurate test for the detection of small-bowel polyps and tumors. OAE and CE

  19. Ménétrier disease manifested by polyposis and involved in both the small bowel and entire colon

    PubMed Central

    Ding, Qiang; Lu, Panpan; Ding, Shuping; Fan, Yuhui; Yan, Wei; Wang, Ying; Tian, Dean; Xia, Yujia; Liu, Mei

    2016-01-01

    Abstract Introduction: Ménétrier disease (MD) is rare that is involved in both the small bowel and entire colon. The main symptoms and the important clinical findings: We describe a case of a 76-year-old male patient whose clinical presentations include intermittent diarrhea, epigastric pain, nausea, vomiting, asitia, and weight loss. An endoscopy was performed showing a large number of irregular forms and different sizes of polypoid lesions in the gastrointestinal tract, which is rare for MD. The main diagnoses, therapeutics interventions, and outcomes: Herein, this case was diagnosed as MD, mainly dependent on endoscopic evaluation, typical clinical symptoms, and histopathological examination of biopsy. As this patient was also infected with Helicobacter pylori, the eradication of H pylori was administered. Meanwhile, a high-protein diet was enjoined, the aforementioned patient's symptoms were alleviated evidently after 1 month. Conclusion: Although the etiology of MD remained undetermined, we showed that eradication of H pylori in this case might contribute to the disease remission. This study enlarged the present understanding of MD. PMID:27603362

  20. High-Fat Diet Enhances Villus Growth During the Adaptation Response to Massive Proximal Small Bowel Resection

    PubMed Central

    Choi, Pamela M.; Sun, Raphael C.; Guo, Jun; Erwin, Christopher R.

    2015-01-01

    Previous studies have shown that high-fat diet (HFD) enhances adaptation if provided immediately following small bowel resection (SBR). The purpose of this study was to determine if HFD could further enhance villus growth after resection-induced adaptation had already taken place. C57/Bl6 mice underwent a 50 % proximal SBR or sham operation and were then provided a standard rodent liquid diet (LD) ad lib. After a typical period of adaptation (7 days), SBR and sham-operated mice were randomized to receive either LD or HFD (42 % kcal fat) for an additional 7 days. Mice were then harvested, and small intestine was collected for analysis. Adaptation occurred in both SBR groups; however, the SBR/HFD had significantly increased villus height compared to SBR/LD. Reverse transcription–polymerase chain reaction of villus enterocytes showed a marked increase in CD36 expression in the SBR/HFD group compared with SBR/LD mice. While exposure to increased enteral fat alone did not affect villus morphology in sham-operated mice, HFD significantly increased villus growth in the setting of resection-induced adaptation, supporting the clinical utility of enteral fat in augmenting adaptation. Increased expression of CD36 suggests a possible mechanistic role in dietary fat metabolism and villus growth in the setting of short gut syndrome. PMID:24002772

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

    PubMed Central

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

    2013-01-01

    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. PMID:23925026

  2. Barium sulfate aspiration: Severe chemical pneumonia induced by a massive reflux of contrast medium during small bowel barium enema.

    PubMed

    Zhang, Lin; Yang, Yi; Zhang, Ji; Zhou, Xiaowei; Dong, Hongmei; Zhou, Yiwu

    2015-08-01

    Barium contrast radiography is a conventional procedure aimed at revealing lesions of the alimentary tract using barium sulfate on X-ray irradiation. Although it is widely used in clinics, adverse effects and complications are observed, such as anaphylaxis, granuloma, fecalithes, abdomen-leaking, embolism, bacterial contamination, and aspiration. We report a case of death due to a massive barium sulfate aspiration resulted from an air-barium double contrast enema radiography. A 25-year-old female patient was hospitalized with symptoms of abdominal distention, nausea, vomiting and diarrhea for three days. A progressive respiratory distress presented only 1h after a small bowel air-barium double contrast enema. The patient died 11h later. The result of autopsy revealed the cause of death to be severe chemical pneumonitis induced by gastric fluid which was aspirated into her lungs. Barium sulfate is generally recognized to be chemically inert for the respiratory system, but a mixture of barium sulfate with gastric contents is fatal. Here we intend to suggest that, when determining the potential cause of death, medical examiners should consider a patient's status quo as well as the possible adverse effects and complications caused by the barium sulfate preparation during gastrointestinal radiography.

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

    PubMed Central

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

    1983-01-01

    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. PMID:6337568

  4. Single Cavernous Hemangioma of the Small Bowel Diagnosed by Using Capsule Endoscopy in a Child with Chronic Iron-Deficiency Anemia

    PubMed Central

    Bae, Soo Jin; Hwang, Geol; Kang, Hyun Sik; Song, Hyun Joo; Chang, Weon Young; Maeng, Young Hee

    2015-01-01

    Cavernous hemangiomas of the gastrointestinal tract are extremely rare. In particular, the diagnosis of small bowel hemangiomas is very difficult in children. A 13-year-old boy presented at the outpatient clinic with dizziness and fatigue. The patient was previously diagnosed with iron-deficiency anemia at 3 years of age and had been treated with iron supplements continuously and pure red cell transfusion intermittently. Laboratory tests indicated that the patient currently had iron-deficiency anemia. There was no evidence of gross bleeding, such as hematemesis or bloody stool. Laboratory findings indicated no bleeding tendency. Gastroduodenoscopy and colonoscopy results were negative. To obtain a definitive diagnosis, the patient underwent capsule endoscopy. A purplish stalked mass was found in the jejunum, and the mass was excised successfully. We report of a 13-year-old boy who presented with severe and recurrent iron-deficiency anemia caused by a cavernous hemangioma in the small bowel without symptoms of gastrointestinal bleeding. PMID:26240811

  5. Inhibition of upper gastrointestinal secretions by reinfusion of succus entericus into the distal small bowel. A clinical study of 30 patients with peritonitis and temporary enterostomy.

    PubMed Central

    Lévy, E; Palmer, D L; Frileux, P; Parc, R; Huguet, C; Loygue, J

    1983-01-01

    We prospectively studied peritonitis secondary to small bowel leakage in 30 critically ill patients, each of whom had complete diversion of intestinal continuity by stoma, fistula, or both. All patients received total parenteral nutrition during implementation of the protocol. The proximal intestinal effluent was collected and recycled into the distal small bowel. During reinfusion of succus entericus, a significant reduction in the output of the proximal stoma was observed (mean 30.2%, p less than 0.001). The reinfusion also significantly reduced the volume from isolated small bowel loops in six patients (32.6%, p less than 0.001). When isotonic dialysate solution was infused into the distal intestine, a lesser though significant reduction in stoma output occurred (mean 20.3%, p less than 0.001). These findings demonstrate a consistent inhibitory effect upon upper gastrointestinal secretions by reinfusion of succus entericus. Clinical benefits of this technique include simplified control of fluid and electrolyte balance in patients with high output stomas and optimal utilization of remaining absorptive capacity for enteral nutrition. PMID:6416191

  6. A single-center United States experience with bleeding Dieulafoy lesions of the small bowel: diagnosis and treatment with single-balloon enteroscopy

    PubMed Central

    Lipka, Seth; Rabbanifard, Roshanak; Kumar, Ambuj; Brady, Patrick

    2015-01-01

    Introduction: A Dieulafoy lesion (DL) of the small bowel can cause severe gastrointestinal bleeding, and presents a difficult clinical setting for endoscopists. Limited data exists on the therapeutic yield of treating DLs of the small bowel using single-balloon enteroscopy (SBE). Methods: Data were collected from Tampa General Hospital a 1 018-bed teaching hospital affiliated with University of South Florida in Tampa, Florida. Patients were selected from a database of patients that underwent SBE from January 2010 – August 2013. Results: Eight patients were found to have DL an incidence of 2.6 % of 309 SBE performed for obscure gastrointestinal bleeding. 7/8 were identified in the jejunum, with one found in the duodenum. The mean age of patients with DL was 71.5 years old. 6/8 patients were on some form of anticoagulant/antiplatelet agent. The primary modality of therapy employed was electrocautery, multipolar electrocoagulation in seven patients and APC (argon plasma coagulation) in one patient. In three patients, electrocoagulation was unsuccessful and hemostasis was achieved with clip placement. Three patients required repeat SBE with one found to have rebleeding from a failed clip with hemostasis achieved upon reapplication of one clip. Conclusion: In our United States’ experience, SBE offers a reasonable therapeutic approach to treat DL of the small bowel with low rates of rebleeding, no adverse events, and no patient requiring surgery. PMID:26356602

  7. Double-Balloon Endoscopy in Overt and Occult Small Bowel Bleeding: Results, Complications, and Correlation with Prior Videocapsule Endoscopy in a Tertiary Referral Center

    PubMed Central

    Hermans, Carlijn; Stronkhorst, Arnold; Tjhie-Wensing, Annemarie; Kamphuis, Jan; van Balkom, Bas; Dahlmans, Rob; Gilissen, Lennard

    2017-01-01

    Background/Aims Videocapsule endoscopy (VCE) and double-balloon endoscopy (DBE) allow deep exploration in patients with suspected small bowel pathology. VCE is often performed as an initial small bowel examination to explore whether an intervention by DBE is indicated and to determine insertion route. The study aim was to evaluate the correlation between DBE and VCE in patients with obscure or overt bleeding or anemia, as well as intervention frequency, and complications. Methods Retrospective observational study. Results DBE procedures (n=205) showed small bowel lesions in 64% cases. Antegrade DBE showed positive results in 79% cases, mostly angiodysplasias (63%). Retrograde DBE showed positive results in 22% cases. An intervention was performed in 64% of DBE procedures. The major complication rate was 0.5%, which was one case of perforation. Pancreatitis did not occur. The overall diagnostic agreement was 66% among the 134 DBEs with preceded VCE. Conclusions In cases of overt or occult bleeding or anemia, DBE was positive in 64%, with only a few complications. Positive correlation was 66% among initially performed VCEs and DBEs. Owing to the time-consuming and invasive character of DBE, performing VCE before DBE might still be clinically relevant. PMID:28076941

  8. Amifostine alleviates radiation-induced lethal small bowel damage via promotion of 14-3-3σ-mediated nuclear p53 accumulation.

    PubMed

    Huang, Eng-Yen; Wang, Feng-Sheng; Chen, Yu-Min; Chen, Yi-Fan; Wang, Chung-Chi; Lin, I-Hui; Huang, Yu-Jie; Yang, Kuender D

    2014-10-30

    Amifostine (AM) is a radioprotector that scavenges free radicals and is used in patients undergoing radiotherapy. p53 has long been implicated in cell cycle arrest for cellular repair after radiation exposure. We therefore investigated the protective p53-dependent mechanism of AM on small bowel damage after lethal whole-abdominal irradiation (WAI). AM increased both the survival rate of rats and crypt survival following lethal 18 Gy WAI. The p53 inhibitor PFT-α compromised AM-mediated effects when administered prior to AM administration. AM significantly increased clonogenic survival in IEC-6 cells expressing wild type p53 but not in p53 knockdown cells. AM significantly increased p53 nuclear accumulation and p53 tetramer expression before irradiation through the inhibition of p53 degradation. AM inhibited p53 interactions with MDM2 but enhanced p53 interactions with 14-3-3σ. Knockdown of 14-3-3σ also compromised the effect of AM on clonogenic survival and p53 nuclear accumulation in IEC-6 cells. For the first time, our data reveal that AM alleviates lethal small bowel damage through the induction of 14-3-3σ and subsequent accumulation of p53. Enhancement of the p53/14-3-3σ interaction results in p53 tetramerization in the nucleus that rescues lethal small bowel damage.

  9. Ileo-ileal intussusception caused by lymphangioma of the small bowel treated by single-incision laparoscopic-assisted ileal resection

    PubMed Central

    Kohga, Atsushi; Kawabe, Akihiro; Hasegawa, Yuto; Yajima, Kiyoshige; Okumura, Takuya; Yamashita, Kimihiro; Isogaki, Jun; Suzuki, Kenji; Komiyama, Akira

    2017-01-01

    Intraabdominal lymphangiomas are uncommon; additionally, those affecting the gastrointestinal tract are rare and account for less than 1% of cases. Intussusception caused by a cystic lymphangioma of the small bowel is extremely rare. The patient was a 20-year-old woman who visited our emergency room with a complaint of abdominal pain. A computed tomography image revealed ileo-ileal intussusception with a leading hypovascular mass measuring 1 cm in a diameter. Single-incision laparoscopic-assisted ileal resection was performed. The surgical specimen consisted of a soft polycystic mass. Macroscopically, a pedunculated polyp with a convolutional pattern was found. Microscopically, the inner surfaces of the cysts were covered with a single layer of endothelial cells. On immunohistochemical examination, the endothelial cells were partially positive for D2-40 and CD34. Smooth muscle cells were also found around the cysts. The lesion was diagnosed as a cystic lymphangioma. Dozens of cases of small bowel lymphangiomas have previously been reported. Of these, cases with intussusception were very rare. This is the first case of small bowel intussusception due to lymphangioma treated by single-incision laparoscopic-assisted surgery. PMID:28104992

  10. Lubiprostone decreases the small bowel transit time by capsule endoscopy: an exploratory, randomised, double-blind, placebo-controlled 3-way crossover study.

    PubMed

    Matsuura, Mizue; Inamori, Masahiko; Endo, Hiroki; Matsuura, Tetsuya; Kanoshima, Kenji; Inoh, Yumi; Fujita, Yuji; Umezawa, Shotaro; Fuyuki, Akiko; Uchiyama, Shiori; Higurashi, Takuma; Ohkubo, Hidenori; Sakai, Eiji; Iida, Hiroshi; Nonaka, Takashi; Futagami, Seiji; Kusakabe, Akihiko; Maeda, Shin; Nakajima, Atsushi

    2014-01-01

    The aim of this study was to investigate the usefulness of lubiprostone for bowel preparation and as a propulsive agent in small bowel endoscopy. Six healthy male volunteers participated in this randomized, 3-way crossover study. The subjects received a 24 μg tablet of lubiprostone 60 minutes prior to the capsule ingestion for capsule endoscopy (CE) and a placebo tablet 30 minutes before the capsule ingestion (L-P regimen), a placebo tablet 60 minutes prior to CE and a 24 μg tablet of lubiprostone 30 minutes prior to CE (P-L regimen), or a placebo tablet 60 minutes prior to r CE and a placebo tablet again 30 minutes prior to CE (P-P regimen). The quality of the capsule endoscopic images and the amount of water in the small bowel were assessed on 5-point scale. The median SBTT was 178.5 (117-407) minutes in the P-P regimen, 122.5 (27-282) minutes in the L-P regimen, and 110.5 (11-331) minutes in the P-L regimen (P = 0.042). This study showed that the use of lubiprostone significantly decreased the SBTT. We also confirmed that lubiprostone was effective for inducing water secretion into the small bowel during CE.

  11. Magnetic resonance enterography versus capsule endoscopy activity indices for quantification of small bowel inflammation in Crohn’s disease

    PubMed Central

    Kopylov, Uri; Klang, Eyal; Yablecovitch, Doron; Lahat, Adi; Avidan, Benjamin; Neuman, Sandra; Levhar, Nina; Greener, Tomer; Rozendorn, Noa; Beytelman, Arkadi; Yanai, Henit; Dotan, Iris; Chowers, Yehuda; Weiss, Batya; Ben-Horin, Shomron; Amitai, Marianne M.; Eliakim, Rami

    2016-01-01

    Background: Video capsule endoscopy (VCE) and magnetic resonance enterography (MRE) are the prime modalities for the evaluation of small bowel (SB) Crohn’s disease (CD). Mucosal inflammation on VCE is quantified using the Lewis score (LS). Diffusion-weighted (DW) magnetic resonance imaging (MRI) allows for accurate assessment of SB inflammation without administration of intravenous contrast material. The Magnetic Resonance Index of Activity (MaRiA) and the Clermont index are quantitative activity indices validated for contrast-enhanced MRE and DW-MRE, respectively. The aim of this study was to compare the quantification of distal SB inflammation by VCE and MR-related activity indices. Methods: Patients with known quiescent SB CD were prospectively recruited and underwent MRE and VCE. LS, MaRIA and Clermont scores were calculated for the distal SB. Results: Both MRI-based indices significantly correlated with the LS and the Clermont index (r = 0.50, p = 0.001 and r = 0.53, p = 0.001, respectively). Both MaRIA and Clermont scores were significantly lower in patients with mucosal healing (LS < 135). The area under the curve (AUC) with both MR scores was moderate for prediction of any mucosal inflammation (LS ⩾ 135) and excellent for prediction of moderate-to-severe inflammation (LS ⩾ 790) (0.71 and 0.74 versus 0.93 and 0.91 for MaRIA and Clermont score, respectively). Conclusions: Modest correlation between VCE- and MRE-based quantitative indices of inflammation in patients with quiescent SB CD was observed. Between-modality correlation was higher in patients with endoscopically severe disease. DW-MRE gauged by Clermont score was at least as accurate as contrast-enhanced MRE for quantification of SB inflammation. PMID:27582877

  12. Uncovering the uncertainty: Risk factors and clinical relevance of P1 lesions on small bowel capsule endoscopy of anemic patients

    PubMed Central

    Cúrdia Gonçalves, Tiago; Barbosa, Mara; Rosa, Bruno; Moreira, Maria João; Cotter, José

    2016-01-01

    AIM To identify risk factors for P1 lesions on small bowel capsule endoscopy (SBCE) and to describe the natural history of anemic patients with such type of lesions. METHODS One hundred patients were consecutively selected for a case-control analysis performed between 37 cases with P1 lesions and 63 controls with negative SBCE. Age, gender, comorbidities and regular medication were collected. Rebleeding, further investigational studies and death were also analyzed during the follow-up. RESULTS No significant differences on gender, median age or Charlson index were found between groups. Although no differences were found on the use of proton pump inhibitors, acetylsalicylic acid, anticoagulants or antiplatelet agents, the use of non-steroidal anti-inflammatory drugs (NSAID) was associated with a higher risk of P1 lesions (OR = 12.00, 95%CI: 1.38-104.1). From the 87 patients followed at our center, 39 were submitted to additional studies for investigation of iron-deficiency anemia (IDA), and this was significantly more common in those patients with no findings on SBCE (53.7% vs 30.3%, P = 0.033). A total of 29 patients had at least one rebleeding or IDA recurrence episode and 9 patients died of non-anemia related causes but no differences were found between cases and controls. CONCLUSION P1 lesions are commonly found in patients with IDA submitted to SBCE. The use of NSAID seems to be a risk factor for P1 lesions. The outcomes of patients with P1 lesions do not differ significantly from those with P0 lesions or normal SBCE. PMID:27784969

  13. Functional changes in nonadrenergic, noncholinergic inhibitory neurons in ileal circular smooth muscle after small bowel transplantation in rats.

    PubMed

    Shibata, C; Balsiger, B M; Anding, W J; Duenes, J A; Miller, V M; Sarr, M G

    1998-11-01

    This experiment was designed to determine mechanisms of change in nonadrenergic, noncholinergic (NANC) inhibitory neurons in the ileum after small bowel transplantation (SBT) in the rat and whether nitric oxide (NO) serves as an important NANC inhibitory neurotransmitter in the rat ileum. Eight groups of rats (N > or =8 rats/group) were studied: neurally intact unoperated controls; rats one week after anesthesia and sham celiotomy; and separate groups one and eight weeks after either 40 min of cold ischemia of the jejunoileum, combined jejunal and ileal intestinal transection/reanastomosis, or orthotopic SBT of the entire jejunoileum. Contractile activity was evaluated in full-thickness ileal circular muscle strips under isometric conditions. Spontaneous activity did not differ among groups. In all groups, exogenous NO, NG-monomethyl-L-arginine (L-NMMA, an NO synthase inhibitor), and methylene blue (soluble guanylate cyclase inhibitor) had no effect on spontaneous activity, while 8-bromocyclic guanosine monophosphate (8Br-cGMP) inhibited contractile activity in all groups. Low frequency (2-10 Hz) electrical field stimulation (EFS) inhibited contractile activity only in control and SBT groups; L-NMMA and methylene blue did not alter the response to EFS in any group. These results suggest that each aspect of the SBT procedure, ischemia/reperfusion injury, disruption of enteric neural continuity by intestinal transection, and extrinsic denervation, alter function of enteric ileal inhibitory neurons separately early (one week) after operation. NO, a known inhibitory neurotransmitter in other gut regions, does not affect ileal circular muscle in neurally intact tissue nor mediate functional changes in inhibitory nerve function nor smooth muscle contractility after SBT.

  14. Altered Transcription of Murine Genes Induced in the Small Bowel by Administration of Probiotic Strain Lactobacillus rhamnosus HN001

    PubMed Central

    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.

    2014-01-01

    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

  15. Small bowel resection

    MedlinePlus

    ... cause inflammation include regional ileitis , regional enteritis , and Crohn disease . Cancer Carcinoid tumor Injuries to the small intestine ... you have a chronic condition, such as cancer, Crohn disease or ulcerative colitis, you may need ongoing medical ...

  16. Small bowel tissue smear

    MedlinePlus

    ... Management by Laboratory Method s. 23rd ed. Philadelphia, PA: Elsevier; 2017:chap 64. Dupont HL. Approach to the ... eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 283. Fritsche TR, Pritt BS. ...

  17. Small bowel bacterial overgrowth

    MedlinePlus

    Overgrowth - intestinal bacteria; Bacterial overgrowth - intestine; Small intestinal bacterial overgrowth; SIBO ... intestine does not have a high number of bacteria. Excess bacteria in the small intestine may use ...

  18. Small Bowel Bleeding

    MedlinePlus

    ... for air and barium to be instilled. The advantage of this study is that pictures from enteroclysis ... these tests is perfect at finding abnormalities, the advantage of these tests is that they can sometimes ...

  19. Small Bowel Prolapse (Enterocele)

    MedlinePlus

    ... smokers may have problems with healing of damaged connective tissues, which can contribute to prolapse. Race. For unknown ... a woman with no family history of prolapse. Connective tissue disorders. You may be genetically prone to prolapse ...

  20. 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

    Shimohira, Masashi Ogino, Hiroyuki; Sasaki, Shigeru; Nishikawa, Hiroko; Shibamoto, Yuta

    2009-03-15

    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.

  1. Impaired small-bowel barrier integrity in the presence of lumenal pancreatic digestive enzymes leads to circulatory shock.

    PubMed

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

    2012-08-01

    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 nonischemic rats was perfused for 2 h 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 with groups perfused with pancreatic enzymes only after 90 min) and increased intestinal permeability to intralumenally perfused fluorescein isothiocyanate-dextran 20 kd (P < 0.05) compared with 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 min). 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

  2. A Simple Evaluation Tool (ET-CET) Indicates Increase of Diagnostic Skills From Small Bowel Capsule Endoscopy Training Courses

    PubMed Central

    Albert, J.G.; Humbla, O.; McAlindon, M.E.; Davison, C.; Seitz, U.; Fraser, C.; Hagenmüller, F.; Noetzel, E.; Spada, C.; Riccioni, M.E.; Barnert, J.; Filmann, N.; Keuchel, M.

    2015-01-01

    Abstract Small bowel capsule endoscopy (SBCE) has become a first line diagnostic tool. Several training courses with a similar format have been established in Europe; however, data on learning curve and training in SBCE remain sparse. Between 2008 and 2011, different basic SBCE training courses were organized internationally in UK (n = 2), Italy (n = 2), Germany (n = 2), Finland (n = 1), and nationally in Germany (n = 10), applying similar 8-hour curricula with 50% lectures and 50% hands-on training. The Given PillCam System was used in 12 courses, the Olympus EndoCapsule system in 5, respectively. A simple evaluation tool for capsule endoscopy training (ET-CET) was developed using 10 short SBCE videos including relevant lesions and normal or irrelevant findings. For each video, delegates were required to record a diagnosis (achievable total score from 0 to 10) and the clinical relevance (achievable total score 0 to 10). ET-CET was performed at baseline before the course and repeated, with videos in altered order, after the course. Two hundred ninety-four delegates (79.3% physicians, 16.3% nurses, 4.4% others) were included for baseline analysis, 268 completed the final evaluation. Forty percent had no previous experience in SBCE, 33% had performed 10 or less procedures. Median scores for correct diagnosis improved from 4.0 (IQR 3) to 7.0 (IQR 3) during the courses (P < 0.001, Wilcoxon), and for correct classification of relevance of the lesions from 5.0 (IQR 3) to 7.0 (IQR 3) (P < 0.001), respectively. Improvement was not dependent on experience, profession, SBCE system, or course setting. Previous experience in SBCE was associated with higher baseline scores for correct diagnosis (P < 0.001; Kruskal–Wallis). Additionally, independent nonparametric partial correlation with experience in gastroscopy (rho 0.33) and colonoscopy (rho 0.27) was observed (P < 0.001). A simple ET-CET demonstrated significant improvement of diagnostic

  3. Bezoar-induced small bowel obstruction: Clinical characteristics and diagnostic value of multi-slice spiral computed tomography

    PubMed Central

    Wang, Pei-Yuan; Wang, Xia; Zhang, Lin; Li, Hai-Fei; Chen, Liang; Wang, Xu; Wang, Bin

    2015-01-01

    AIM: To determine the possible predisposing factors of bezoar-induced small bowel obstruction (BI-SBO) and to discuss the diagnostic value of multi-slice spiral computed tomography, particularly contrast-enhanced scanning, in this condition. METHODS: A total of 35 BI-SBO cases treated at our hospital from January 2007 to December 2013 were retrospectively analysed. Complete clinical and computed tomography (CT) data of the patients were available and confirmed by surgery. SBO was clinically diagnosed on the basis of clinical manifestations. Of the 35 patients, 18 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT and 17 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT combined with contrast-enhanced examination. Original images were processed using a GE ADW4.3 workstation to obtain MPR, CPR, MIP and CTA images. The images of all patients were evaluated by two abdominal imaging experts. The main analytical contents of planar scanning included intestinal bezoar conditions, changes in the intestinal wall and changes in peri-intestinal conditions. Vascular hyperaemia and arterial blood supply conditions at a specific obstruction site and the distal end of the obstruction site were evaluated through contrast-enhanced examination. RESULTS: The proportion of males to females among the 35 cases was 1:1.69 (13:22); median age was 63.3 years. The following cases were observed: 29 (82.8%) cases occurred in autumn and winter and showed a history of consuming high amounts of persimmon and hawthorn; 19 (54.3%) cases revealed a history of gastrointestinal surgery; 19 exhibited incomplete dentition, with missing partial or whole posterior teeth; 26 suffered from obstruction at the ileum. A total of 51 bezoars were found in these patients, of whom 16 (45.7%) had multiple bezoars. CT planar scanning of bezoars showed lumps with mottled gas inside the intestinal cavity. Furthermore, 9 cases of bezoars had envelopes and 11 cases

  4. Inhibitory Effects and Sympathetic Mechanisms of Distension in the Distal Organs on Small Bowel Motility and Slow Waves in Canine.

    PubMed

    Song, Jun; Yin, Jieyun; Chen, Jiande D Z

    2015-12-01

    Rectal distension (RD) is known to induce intestinal dysmotility. Few studies were performed to compare effects of RD, colon distension (CD) and duodenal distension (DD) on small bowel motility. This study aimed to investigate effects and underlying mechanisms of distensions in these regions on intestinal motility and slow waves. Eight dogs chronically implanted with a duodenal fistula, a proximal colon fistula, and intestinal serosal electrodes were studied in six sessions: control, RD, CD, DD, RD + guanethidine, and CD + guanethidine. Postprandial intestinal contractions and slow waves were recorded for the assessment of intestinal motility. The electrocardiogram was recorded for the assessment of autonomic functions. (1) Isobaric RD and CD suppressed intestinal contractions (contractile index: 6.0 ± 0.4 with RD vs. 9.9 ± 0.9 at baseline, P = 0.001, 5.3 ± 0.2 with CD vs. 7.7 ± 0.8 at baseline, P = 0.008). Guanethidine at 3 mg/kg iv was able to partially block the effects. (2) RD and CD reduced the percentage of normal intestinal slow waves from 92.1 ± 2.8 to 64.2 ± 3.4 % (P < 0.001) and from 90 ± 2.7 to 69.2 ± 3.7 % (P = 0.01), respectively. Guanethidine could eliminate these inhibitory effects. (3) DD did not induce any changes in small intestinal contractions and slow waves (P > 0.05). (4) The spectral analysis of the heart rate variability showed that both RD and CD increased sympathetic activity (LF) and reduced vagal activity (HF) (P < 0.05). Isobaric RD and CD could inhibit postprandial intestinal motility and impair intestinal slow waves, which were mediated via the sympathetic pathway. However, DD at a site proximal to the measurement site did not seem to impair small intestinal contractions or slow waves.

  5. Intensity modulated radiation therapy (IMRT): differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma

    PubMed Central

    2011-01-01

    Background A strong dose-volume relationship exists between the amount of small bowel receiving low- to intermediate-doses of radiation and the rates of acute, severe gastrointestinal toxicity, principally diarrhea. There is considerable interest in the application of highly conformal treatment approaches, such as intensity-modulated radiation therapy (IMRT), to reduce dose to adjacent organs-at-risk in the treatment of carcinoma of the rectum. Therefore, we performed a comprehensive dosimetric evaluation of IMRT compared to 3-dimensional conformal radiation therapy (3DCRT) in standard, preoperative treatment for rectal cancer. Methods Using RTOG consensus anorectal contouring guidelines, treatment volumes were generated for ten patients treated preoperatively at our institution for rectal carcinoma, with IMRT plans compared to plans derived from classic anatomic landmarks, as well as 3DCRT plans treating the RTOG consensus volume. The patients were all T3, were node-negative (N = 1) or node-positive (N = 9), and were planned to a total dose of 45-Gy. Pairwise comparisons were made between IMRT and 3DCRT plans with respect to dose-volume histogram parameters. Results IMRT plans had superior PTV coverage, dose homogeneity, and conformality in treatment of the gross disease and at-risk nodal volume, in comparison to 3DCRT. Additionally, in comparison to the 3DCRT plans, IMRT achieved a concomitant reduction in doses to the bowel (small bowel mean dose: 18.6-Gy IMRT versus 25.2-Gy 3DCRT; p = 0.005), bladder (V40Gy: 56.8% IMRT versus 75.4% 3DCRT; p = 0.005), pelvic bones (V40Gy: 47.0% IMRT versus 56.9% 3DCRT; p = 0.005), and femoral heads (V40Gy: 3.4% IMRT versus 9.1% 3DCRT; p = 0.005), with an improvement in absolute volumes of small bowel receiving dose levels known to induce clinically-relevant acute toxicity (small bowel V15Gy: 138-cc IMRT versus 157-cc 3DCRT; p = 0.005). We found that the IMRT treatment volumes were typically larger than that covered by classic

  6. Primary adenocarcinoma of the jejunum and ileum: clinicopathological review of 25 cases.

    PubMed Central

    Lioe, T F; Biggart, J D

    1990-01-01

    Between 1954 and 1988 only a total of twenty five cases of primary adenocarcinoma of the small bowel (excluding periampillary tumours) were recorded at the Department of Histopathology, Belfast City Hospital. Of these, 14 tumours were located in the jejunum: the remainder arose in the ileum. The average age at presentation was 61.3 years and a slight female to male preponderance of 1:7:1 was noted. The adenocarcinoma arose from a preexisting villous adenoma in six cases. The overall prognosis was poor, with a five year survival of 15.7%. All the survivors had tumours located in the jejunum. The single most important prognostic indicator was the depth of tumour invasion or stage at the time of diagnosis. Tumour size and grade did not seem to correlate well with survival. It is concluded that the rarity of these tumours and their inaccessibility hinder detection and treatment and that surgical resection is more effective than chemotherapy. Images PMID:2380402

  7. Diagnosis and Treatment of Small Bowel Strangulation Due To Congenital Band: Three Cases of Congenital Band in Adults Lacking a History of Trauma or Surgery

    PubMed Central

    Nicolas, Gregory; Kfoury, Tony; Shimlati, Rasha; Koury, Elliott; Tohme, Maroon; Gharios, Elie; Wakim, Raja

    2016-01-01

    Case series Patients: Male, 33 • Male, 18 • Male, 19 Final Diagnosis: Congenital band causing a small bowel obstruction Symptoms: Progressive abdominal pain that eventually becomes excessive Medication: — Clinical Procedure: Laparoscopic band removal Specialty: Surgery Objective: Rare disease Background: Among the causes of constipation are bands and adhesions that lead to obstructions at different points in the intestinal tract. These can occur as a consequence of healing following surgery or trauma. However, an entity known as congenital band exists where a band is present from birth. Here we report three such cases of adults with symptoms of intestinal obstruction, in whom a congenital band was discovered through exploratory laparoscopy. Case Reports: All three of these patients presented lacking a history of any abdominal trauma or previous abdominal surgeries, a fact that is often used to exclude an adhesion as a differential. All three recovered quickly and had relief of their symptoms following surgical intervention. Conclusions: Bands and adhesions are common surgical causes of small bowel obstruction, leading to symptoms such as nausea, vomiting, constipation, and obstipation. These bands almost always result from a prior abdominal surgery or from a recent abdominal trauma. The three cases presented here show a far more unusual picture of a band, one that is congenitally present, as there was an absence of such a history. This is significant because clinical suspicion of a band is often very low due to a lack of distinguishing clinical and diagnostic features, and when the past history is negative. PMID:27713389

  8. p21waf1/cip1 deficiency does not perturb the intestinal crypt stem cell population after massive small bowel resection

    PubMed Central

    Longshore, Shannon W.; Nair, Rajalakshmi; Perrone, Erin E.; Erwin, Christopher R.; Guo, Jun; Warner, Brad W.

    2009-01-01

    Background After small bowel resection (SBR), adaptation is initiated in intestinal crypts where stem cells reside. Prior studies revealed SBR induced enterocyte proliferation requires the expression of p21waf1/cip1. Since deficient expression of p21waf1/cip1 has been shown to result in reduced numbers of hematopoietic stem cells, we sought to test the hypothesis that p21waf1/cip1 deficiency similarly perturbs the intestinal stem cell population after SBR. Methods Control (n=21; C57Bl/6) and p21waf1/cip1-null mice (n=30) underwent 50% proximal SBR or sham operation. After 3 days, the ileum was harvested and the crypt stem cell population evaluated by counting crypt base columnar (CBC) cells on histological sections, determining the expression of Musashi-1 and Lgr5, and profiling the transcriptional expression of 84 known stem cell genes. Results There were no significant differences in CBC cells, expression of Musashi-1 or Lgr5, or in stem cell gene expression after SBR in control mice. Further, there were no differences in these markers between controls and p21waf1/cip1-null mice. Conclusion In contrast with bone marrow stem cells, the stem cell population of the gut is unaffected by deficient expression of p21waf1/cip1. Additional mechanisms for the role of p21waf1/cip1 in small bowel proliferation and adaptation following massive SBR must be considered. PMID:19524718

  9. Effectiveness of Capsule Endoscopy Compared with Other Diagnostic Modalities in Patients with Small Bowel Crohn’s Disease: A Meta-Analysis

    PubMed Central

    Choi, Miyoung; Lim, Sungwon; Choi, Myung-Gyu; Shim, Ki-Nam; Lee, Seon Heui

    2017-01-01

    Background/Aims As a result of the rapid development of medical diagnostic tools, physicians require concrete evidence to evaluate the effectiveness of the tools. We aimed to investigate the effectiveness and additional diagnostic benefits of capsule endoscopy (CE) in patients with small bowel Crohn’s disease (CD). Methods We performed a systematic search of databases, including MEDLINE, EMBASE, and the Cochrane Library, as well as eight domestic databases. Two reviewers independently screened all references. Diagnostic data from the studies were collected, and a meta-analysis was performed. Results Twenty-four studies were included. In cases of suspected CD, CE demonstrated a superior diagnostic yield compared with small bowel follow-through (SBFT) and enteroclysis (EC); however, there was no difference compared with computed tomography enterography or magnetic resonance enterography. In cases with established CD, CE demonstrated a higher diagnostic yield only compared with EC. In the detection of terminal ileum lesions, CE exhibited a significantly increased detection rate compared with ileoscopy. Conclusions The findings of our meta-analysis indicate that CE is superior to SBFT and EC in the evaluation of suspected CD cases. CE is also a more effective diagnostic modality in patients with established CD compared with EC. PMID:27728963

  10. Incidence of bloodstream infections in small bowel transplant recipients receiving selective decontamination of the digestive tract: A single-center experience

    PubMed Central

    Galloway, David; Danziger-Isakov, Lara; Goldschmidt, Monique; Hemmelgarn, Trina; Courter, Joshua; Nathan, Jaimie D.; Alonso, Maria; Tiao, Greg; Fei, Lin; Kocoshis, Samuel

    2016-01-01

    Pediatric patients undergoing small bowel transplantation are susceptible to postoperative CLABSI. SDD directed against enteric microbes is a strategy for reducing CLABSI. We hypothesized that SDD reduces the frequency of CLABSI, infections outside the bloodstream, and allograft rejection during the first 30 days following transplant. A retrospective chart review of 38 pediatric small bowel transplant recipients at CCHMC from 2003 to 2011 was conducted. SDD antimicrobials were oral colistin, tobramycin, and amphotericin B. The incidence of CLABSI, infections outside the bloodstream, and rejection episodes were compared between study periods. The incidence of CLABSI did not difier between study periods (6.9 CLABSI vs. 4.6 CLABSI per 1000 catheter days; p = 0.727), but gram positives and Candida predominated in the first 30 days. Incidence of bacterial infections outside the bloodstream did not differ (p = 0.227). Rejection occurred more frequently during the first month following transplant (p = 0.302). SDD does not alter the incidence of CLABSI, bacterial infections outside the bloodstream, or allograft rejection in the immediate 30 days post-transplantation. However, SDD does influence CLABSI organism types (favoring gram positives and Candida) and Candidal infections outside the bloodstream. PMID:26332092

  11. Relationship of Bowel MR Imaging to Health-related Quality of Life Measures in Newly Diagnosed Pediatric Small Bowel Crohn Disease.

    PubMed

    Dillman, Jonathan R; Carlos, Ruth C; Smith, Ethan A; Davenport, Matthew S; De Matos Maillard, Vera; Adler, Jeremy

    2016-08-01

    Purpose To determine if utility measures of health-related quality of life (HRQOL) in pediatric small bowel Crohn disease (a) change in response to infliximab therapy, (b) correlate with proxy parent or guardian assessments, and (c) correlate with magnetic resonance (MR) imaging and laboratory markers of intestinal active inflammation. Materials and Methods This prospective single-center cohort study was approved by the institutional review board and was compliant with HIPAA. Parental informed consent and subject assent were obtained from all study participants. Twenty-six children with newly diagnosed small bowel Crohn disease receiving infliximab therapy were prospectively enrolled. All subjects underwent measurement of HRQOL utilities (visual analog scale [VAS], time trade-off [TTO], and standard gamble [SG]), MR enterography, and laboratory assessment at baseline and 6 months later. The Wilcoxon signed-rank test was used to compare paired nonparametric data; Spearman correlation (ρ) was used to assess bivariate relationships. Results The median VAS score was 47.5 (interquartile range [IQR]: 20.0-52.2) before infliximab therapy and 83.0 (IQR: 62.0-92.0) at follow-up (P = .0003). There was positive correlation between subject and parent or guardian change in VAS score between baseline and follow-up (ρ = 0.71; P = .0006). The authors identified significant negative correlations between VAS score and MR imaging bowel wall arterial phase enhancement after contrast material administration at baseline (ρ = -0.57, P = .0032) as well as between change in VAS score and change in bowel wall enhancement in the arterial phase at contrast-enhanced MR imaging over time (ρ = -0.51, P = .02). No correlations between VAS score and laboratory inflammatory markers were identified. Conclusion VAS assessment of HRQOL changes over time in response to infliximab therapy in children with small bowel Crohn disease. There are statistically significant correlations between child

  12. Adenocarcinoma of the ileum: A rare and challenging entity

    PubMed Central

    Nabais, Celso; Salústio, Raquel; Sousa, Francisco V.; Porto, Eusébio; Cardoso, Carlos; Fradique, Caldeira

    2015-01-01

    Introduction Primary small bowel malignancy is unusual and accounts for 1–3% of all gastrointestinal tract neoplasms. Adenocarcinoma is one of the most common histologic types, but its frequency decreases with more distal locations. Its clinical presentation is nonspecific and is usually associated with advanced disease, which contributes to delayed diagnosis. Presentation of case A 66-year-old woman was admitted to the hospital with a 6-day history of progressively worsening abdominal pain localized in the right lower quadrant, nausea, and vomiting. Investigation revealed an inflammatory appendiceal tumor. The patient underwent surgery and an unexpected tumor involving the distal ileal segment and ileocecal appendix was found. Right radical hemicolectomy with en bloc resection of the distal ileum was performed. Histopathological examination revealed adenocarcinoma of the ileum. Discussion This rare entity is associated with a nonspecific clinical presentation that contributes to delayed diagnosis and treatment, and consequently to a worse prognosis. Approximately half of the cases are only diagnosed at surgery. Primary treatment consists of wide resection with locoregional lymphadenectomy. The role of adjuvant chemotherapy has yet to be determined. Conclusion This case demonstrates an unusual condition characterized by late and challenging diagnosis. We highlight the importance of an earlier diagnosis and optimal treatment for improved patient outcomes. PMID:25973190

  13. Chronic rejection after combined liver and small bowel transplantation in a child with chronic intestinal pseudo-obstruction: a case report.

    PubMed

    Giovanelli, M; Gupte, G L; Sharif, K; Mayer, D A; Mirza, D F

    2008-06-01

    An 11-year-old boy with irreversible intestinal failure secondary to chronic intestinal pseudo-obstruction (CIPO) and intestinal failure-associated liver disease (IFALD) underwent a combined en bloc reduced liver and small bowel transplantation. He was discharged home after 9 weeks on full oral intake without requiring intravenous nutritional or fluid supplementation. The first episode of mild acute rejection, which occurred 18 months after transplantation, was successfully treated with steroids. An episode of rotavirus gastroenteritis led to severe exfoliative rejection of the bowel graft, which was resistant to steroid and Infliximab treatment but responded to OKT3. There was associated Epstein-Barr virus viremia with no evidence of posttransplant lymphoproliferative disease. Another episode of moderate to severe acute liver rejection occurred 5 months later. At the same time, multiple biliary strictures were diagnosed and treated. Persistent clinical symptoms of abdominal pain and increased stomal output as well as atrophy of the ileal mucosa on several biopsies, suggested the possibility of chronic rejection (CR). A second combined whole liver and small bowel transplant was performed. The diagnosis of CR was confirmed on histology of the explanted graft. The postoperative course was severely complicated and 71 days after the retransplantation, the boy died because of respiratory failure and multiorgan failure. In summary, intestinal transplantation can be successfully performed in children with CIPO, giving them the opportunity to be free from total parenteral nutrition. As survival following intestinal transplantation continues to improve, the problem of CR has become increasingly important and the only treatment available is retransplantation, which is associated with poor outcomes.

  14. Increased Expression of Toll-Like Receptors 4, 5, and 9 in Small Bowel Mucosa from Patients with Irritable Bowel Syndrome

    PubMed Central

    Zakikhany, Katherina; Acevedo, Nathalie; D'Amato, Mauro; Lindberg, Greger

    2017-01-01

    The aim of our study was to compare patients with irritable bowel syndrome (IBS) and healthy controls regarding the expression of toll-like receptors 2, 4, 5, and 9 (TLR2, TLR4, TLR5, and TLR9), the primary mucosal receptors of bacterial components, in small and large bowel mucosa. Methods. We analysed biopsies from jejunum and sigmoid colon of 22 patients (17 females) with IBS aged 18–66 (median: 39) years and 14 healthy volunteers (12 females) aged 22–61 (median: 42) years. Eight patients had constipation-predominant IBS (C-IBS), 7 had diarrhoea-predominant IBS (D-IBS), and 7 had IBS without predominance of constipation or diarrhoea. We analysed mRNA levels for TLRs using quantitative PCR and distribution of TLRs in mucosa using immunohistochemistry. Results. We found increased mRNA expression of TLR4 (mean fold change 1.85 ± 0.31 versus 1.0 ± 0.20; p < 0.05), TLR5 (1.96 ± 0.36 versus 1.0 ± 0.20; p < 0.05) and TLR9 (2.00 ± 0.24 versus 1.0 ± 0.25; p < 0.01) but not of TLR2 in the small bowel mucosa from patients with IBS compared to the controls. There was no significant difference in mRNA levels for TLRs in colon mucosa between patients and controls. Conclusion. Upregulation of TLR4, TLR5, and TLR9 suggests the involvement of bacteria or dysregulation of the immune response to commensal flora in small bowel mucosa in IBS patients. PMID:28246611

  15. 75Se HCAT test in the detection of bile acid malabsorption in functional diarrhoea and its correlation with small bowel transit.

    PubMed Central

    Sciarretta, G; Fagioli, G; Furno, A; Vicini, G; Cecchetti, L; Grigolo, B; Verri, A; Malaguti, P

    1987-01-01

    The purpose of this study was to evaluate whether bile acid malabsorption assessed by the 75SeHCAT test, had a pathogenetic role in functional chronic diarrhoea and to ascertain whether the small bowel transit time (SBTT) could be correlated with the 75SeHCAT test results. The test was based on the counting of the abdominal retention of a 75-selenium labelled homotaurocholic acid. The 75SeHCAT test was carried out in a control group of 23 healthy adults and in 46 patients, 38 of whom were suffering from irritable bowel syndrome (IBS) of diarrhoeic form and eight patients who had undergone cholecystectomy and were suffering from chronic diarrhoea. Faecal bile acid loss was determined in nine patients, and in 14, serum bile acid increase after a standard meal was measured. In 17, SBTT was studied by hydrogen breath test after lactulose administration (21 g in 300 ml water). In 15 patients, choledochocaecal transit time was estimated by Tc99m-HIDA (111 MBq) cholescintigraphy. In 20 of 46 subjects, 75SeHCAT retention was below normal level, and in 19 cholestyramine administration relieved diarrhoea. 75SeHCAT results were related to faecal bile acid loss, while no correlation was found with serum bile acids and SBTT. The data suggest a possible wider use of the 75SeHCAT test in chronic diarrhoea to estimate bile acid malabsorption in irritable bowel syndrome, diarrhoeic form, and provide an effective treatment. In our patients small bowel transit velocity does not seem to be a pathogenetic factor of bile acid malabsorption. PMID:3666565

  16. PET/MR Versus PET/CT Imaging: Impact on the Clinical Management of Small-Bowel Crohn’s Disease

    PubMed Central

    Pellino, Gianluca; Nicolai, Emanuele; Catalano, Onofrio A.; Campione, Severo; D’Armiento, Francesco P.; Salvatore, Marco; Cuocolo, Alberto

    2016-01-01

    Background and Aims: The aim of this study was to compare the accuracy and clinical impact of hybrid positron emission tomography [PET]/magnetic resonance-enterography [MR-E] and PET/computed tomography-enterography [CT-E] in patients with Crohn’s disease [CD]. Methods: A total of 35 patients with symptomatic small-bowel CD who were scheduled to undergo operation were evaluated before operation by same-day PET/CT-E and PET/MR-E. PET/MR-E was also compared with MR-E alone. Imaging accuracy for detecting pathological sites and discriminating between fibrotic and inflammatory strictures was assessed. Treatment was adjusted according to imaging findings and change in medical/surgical strategy was also evaluated. Results: PET/CT-E, PET/MR-E, and MR-E were equally accurate in detecting CD sites. PET/MR-E was more accurate in assessing extra-luminal disease [p = 0.002], which was associated with higher need for stoma [p = 0.022] and distant localisation [p = 0.002]. When the latter was observed, laparoscopy was started with hand-assisted device, reducing operative time [p = 0.022]. PET/MR-E was also more accurate in detecting a fibrotic component compared with PET/CT-E [p = 0.043] and with MR-E [p = 0.024]. Fibrosis was more frequently classified as inflammation with MR-E compared with PET/MR-E [p = 0.019]. Out of 8 patients with predominantly inflammatory CD who received medical treatment, 6 [75%] remained surgery free. Overall, 29 patients received surgery. At median follow-up of 9 [6–22] months, no recurrences occurred in either the medical or the surgical group. Conclusions: Preoperative PET/MR-E imaging is highly accurate for assessing CD lesions before operation and contributed to clinical management of patients with small-bowel CD more often than PET/CT-E. PMID:26574490

  17. Intussusception and volvulus secondary to jejunal adenocarcinoma in an adult Nigerian male: a case report.

    PubMed

    Okolo, C A; Afolabi, A O; Sahabi, S M

    2010-12-01

    A 31 year-old Nigerian man with jejuno-jejunal intussusception with the lead point being an adenocarcinoma complicated by small intestinal volvulus is presented. The subtle clinical features of an underlying small bowel malignancy were masked by the overwhelming clinical and radiological features of intussusception. rare case is reported to remind clinicians to have an increased index of suspicion of malignancy in patients who present with the usual features of chronic anemia, weight loss and loss of appetite with an intra-abdominal mass. The presentation of acute intestinal obstruction, with mesenteric vein thrombosis probably due to intussusception or volvulus should not however lower the suspicion. Histological evaluation of surgical biopsies is of immense importance.

  18. 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

    Muhammad, Adnan; Vidyarthi, Gitanjali; Brady, Patrick

    2014-07-14

    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.

  19. Early onset, EBV(-) PTLD in pediatric liver-small bowel transplantation recipients: a spectrum of plasma cell neoplasms with favorable prognosis.

    PubMed

    Perry, Anamarija M; Aoun, Patricia; Coulter, Donald W; Sanger, Warren G; Grant, Wendy J; Coccia, Peter F

    2013-02-21

    EBV(-) posttransplantation lymphoproliferative disorders (PTLDs) are rare compared with EBV(+) PTLDs, occur later after transplantation, and have a poor response to treatment. Few studies have reported EBV(-) PTLD in pediatric solid-organ transplantation recipients. We describe 5 cases of EBV(-) PTLD in recipients of combined liver and small bowel allografts ranging in age from 16 months to 7 years. EBV(-) PTLD developed 9-22 months (median, 15) after transplantation. Morphologically, the lesions ranged from atypical plasma cell hyperplasia (a term not currently included in the World Health Organization classification) to plasmacytoma like. In all cases, in situ hybridization for EBV was negative, and molecular studies demonstrated clonal IgH gene rearrangements. Protein electrophoresis showed multiple clonal paraproteins in 4 of 5 cases. In 2 cases with a donor-recipient sex mismatch, FISH cytogenetics demonstrated that the plasma cells were of mixed donor/recipient origin. One patient died before therapy. Four patients were treated with high-dose dexamethasone, and 1 patient subsequently required thalidomide. All 4 remain in remission 75-128 months (median, 86) after diagnosis. In contrast to reports of EBV(-) PTLD in adults, these plasma cell lesions occurred early after transplantation and resolved completely after minimal treatment.

  20. Low-Dose Radiotherapy as a Chemopotentiator of Gemcitabine in Tumors of the Pancreas or Small Bowel: A Phase I Study Exploring a New Treatment Paradigm

    SciTech Connect

    Regine, William F. . E-mail: wregine@umm.edu; Hanna, Nader; Garofalo, Michael C.; Doyle, Austin; Arnold, Susanne; Kataria, Ritesh; Sims, Jacqueline; Tan Ming; Mohiuddin, Mohammed

    2007-05-01

    Purpose: To determine the maximum tolerated dose of upper abdominal low-dose fractionated radiotherapy (<1.0 Gy per fraction) given in combination with, and as a chemopotentiator for, gemcitabine. Methods and Materials: Gemcitabine was given at 1,250 mg/m{sup 2} at 10 mg/m{sup 2}/min on Days 1 and 8 of a 3-week cycle. Low-dose fractionated radiotherapy was tested at two dose levels: 60 cGy per fraction and 70 cGy per fraction. Radiotherapy was given b.i.d. on Days 1, 2, 8, and 9. Four cycles were planned. Results: Twenty-seven patients have been put on study. Ten patients have been entered in Phase I: 6 with metastatic/recurrent pancreatic carcinoma and 4 with unresectable pancreatic/small bowel carcinoma. Two of four patients at Dose Level 2 experienced dose-limiting toxicity. The overall radiographic response was 30%, and median survival was 11 months (range, 4-37 months). Conclusion: Low-dose fractionated radiotherapy to the upper abdomen is well tolerated at 60 cGy per fraction when combined with gemcitabine. Phase II evaluation is ongoing.

  1. Contractile activity of circular smooth muscle in rats one year after small bowel transplantation: differing adaptive response of the jejunum and ileum to denervation.

    PubMed

    Shibata, C; Murr, M M; Balsiger, B; Anding, W J; Sarr, M G

    1998-01-01

    The aim of the present study was to determine the long-term effects of isogeneic small bowel transplantation (SBT) on jejunal and ileal circular smooth muscle contractile activity in the rat. Transmural strips of circular muscle were prepared from proximal jejunum and distal ileum of 1-year-old control rats and rats 1 year after SBT (SBT-1Y) to measure isometric force. Spontaneous contractile activity and the dose-responses to bethanechol and norepinephrine were studied. Electrical field stimulation (EFS) at varying frequencies (1 to 20 Hz) was evaluated under adrenergic and cholinergic blockade to investigate inhibitory nerves. Spontaneous activity both in the jejunum and ileum in SBT-1Y rats was not different compared to control rats. Sensitivity to bethanechol did not differ between control and SBT-1Y rats in the jejunum or ileum. Sensitivity to norepinephrine, however, was significantly increased after SBT in the ileum but not in the jejunum. During EFS, inhibition was seen at low frequencies, and contractions were induced at high frequencies in all groups. The degree of inhibition did not differ between control and SBT-1Y rats in the jejunum; however, it tended to be increased in the ileum after SBT. The long-term adaptive response of smooth muscle to the extrinsic denervation accompanying SBT differs between the jejunum and the ileum.

  2. Primary appendiceal mucinous adenocarcinoma.

    PubMed

    Behera, Prativa Kumari; Rath, Pramod Kumar; Panda, Rabiratna; Satpathi, Sanghamitra; Behera, Rajan

    2011-04-01

    Primary Adenocarcinomas of the appendix are extremely rare tumor. We report a case of primary mucinous adenocarcinoma in a 40 year old lady misdiagnosed as having acute appendicitis. All the routine investigations were within normal limit. USG of abdomen showed dilated appendix with little fluid collection adjacent to it and no other abnormality was seen which suggested acute appendicitis. Appendicectomy was done and excised appendix was sent for histopathological examination. Mucinous Adenocarcinoma of the appendix was confirmed after histopathological examination. Right hemicolectomy was done as a second stage procedure. As some cases are incidentally discovered, this case emphasizes that histological examination of all appendicectomy specimens is mandatory.

  3. Adenocarcinoma of the urinary bladder.

    PubMed

    Dadhania, Vipulkumar; Czerniak, Bogdan; Guo, Charles C

    2015-01-01

    Adenocarcinoma is an uncommon malignancy in the urinary bladder which may arise primarily in the bladder as well as secondarily from a number of other organs. Our aim is to provide updated information on primary and secondary bladder adenocarcinomas, with focus on pathologic features, differential diagnosis, and clinical relevance. Primary bladder adenocarcinoma exhibits several different growth patterns, including enteric, mucinous, signet-ring cell, not otherwise specified, and mixed patterns. Urachal adenocarcinoma demonstrates similar histologic features but it can be distinguished from bladder adenocarcinoma on careful pathologic examination. Secondary bladder adenocarcinomas may arise from the colorectum, prostate, endometrium, cervix and other sites. Immunohistochemical study is valuable in identifying the origin of secondary adenocarcinomas. Noninvasive neoplastic glandular lesions, adenocarcinoma in situ and villous adenoma, are frequently associated with bladder adenocarcinoma. It is also important to differentiate bladder adenocarcinoma from a number of nonneoplastic lesions in the bladder. Primary bladder adenocarcinoma has a poor prognosis largely because it is usually diagnosed at an advanced stage. Urachal adenocarcinoma shares similar histologic features with bladder adenocarcinoma, but it has a more favorable prognosis than bladder adenocarcinoma, partly due to the relative young age of patients with urachal adenocarcinoma.

  4. Adenocarcinoma of the urinary bladder

    PubMed Central

    Dadhania, Vipulkumar; Czerniak, Bogdan; Guo, Charles C

    2015-01-01

    Adenocarcinoma is an uncommon malignancy in the urinary bladder which may arise primarily in the bladder as well as secondarily from a number of other organs. Our aim is to provide updated information on primary and secondary bladder adenocarcinomas, with focus on pathologic features, differential diagnosis, and clinical relevance. Primary bladder adenocarcinoma exhibits several different growth patterns, including enteric, mucinous, signet-ring cell, not otherwise specified, and mixed patterns. Urachal adenocarcinoma demonstrates similar histologic features but it can be distinguished from bladder adenocarcinoma on careful pathologic examination. Secondary bladder adenocarcinomas may arise from the colorectum, prostate, endometrium, cervix and other sites. Immunohistochemical study is valuable in identifying the origin of secondary adenocarcinomas. Noninvasive neoplastic glandular lesions, adenocarcinoma in situ and villous adenoma, are frequently associated with bladder adenocarcinoma. It is also important to differentiate bladder adenocarcinoma from a number of nonneoplastic lesions in the bladder. Primary bladder adenocarcinoma has a poor prognosis largely because it is usually diagnosed at an advanced stage. Urachal adenocarcinoma shares similar histologic features with bladder adenocarcinoma, but it has a more favorable prognosis than bladder adenocarcinoma, partly due to the relative young age of patients with urachal adenocarcinoma. PMID:26309895

  5. Prostate Ductal Adenocarcinoma.

    PubMed

    Amin, Ali

    2017-03-30

    Prostate ductal adenocarcinoma (PDA) is a rare subtype of prostate adenocarcinoma that shows more aggressive behavior than conventional prostatic acinar adenocarcinoma. PDA demonstrates similar clinical and paraclinical features such as prostatic acinar adenocarcinoma; therefore, clinical distinction of the 2 entities is very difficult (if not impossible) and histopathology plays an important role in the diagnosis of the disease. This review discusses all the necessary information needed for the diagnosis and prognosis of PDA including the morphologic features of PDA, an introduction about the known variants of PDA with helpful hints in grading of each variant, tips on differential diagnosis of PDA from the common morphologic mimickers, a detailed discussion on the value of immunohistochemistry in the diagnosis of PDA, and pathologic features that are helpful in determining the outcome.

  6. Small Bowel Follow-Through

    MedlinePlus

    ... the area being examined by making it appear dark (or by electronically reversing the image contrast to ... understanding of the possible charges you will incur. Web page review process: This Web page is reviewed ...

  7. Small Bowel Follow-Through

    MedlinePlus

    ... real-time x-ray called fluoroscopy and a barium-based contrast material to produce images of the ... procedure, the patient drinks a liquid that contains barium or an iodine -based contrast, a contrast material ...

  8. X-ray induced demagnetization of single-molecule magnets

    SciTech Connect

    Dreiser, Jan; Westerström, Rasmus; Piamonteze, Cinthia; Nolting, Frithjof; Rusponi, Stefano; Brune, Harald; Yang, Shangfeng; Popov, Alexey; Dunsch, Lothar; Greber, Thomas

    2014-07-21

    Low-temperature x-ray magnetic circular dichroism measurements on the endohedral single-molecule magnet DySc{sub 2}N@C{sub 80} at the Dy M{sub 4,5} edges reveal a shrinking of the opening of the observed hysteresis with increasing x-ray flux. Time-dependent measurements show that the exposure of the molecules to x-rays resonant with the Dy M{sub 5} edge accelerates the relaxation of magnetization more than off-resonant x-rays. The results cannot be explained by a homogeneous temperature rise due to x-ray absorption. Moreover, the observed large demagnetization cross sections indicate that the resonant absorption of one x-ray photon induces the demagnetization of many molecules.

  9. X-ray induced modification of metal/fluoropolymer interfaces

    NASA Astrophysics Data System (ADS)

    Shi, Ming-Kun; Lamontagne, Boris; Martinu, Ludvik; Selmani, Amine

    1993-08-01

    Metal adhesion to polymers depends on the chemical structure at the interface. In the present work, we study the evaporation of Cr, Ti, and Au onto Teflon PFA (perfluoromethyl-vinyl-ether) substrates, and we modify the interface by post-deposition x-ray irradiation. In situ x-ray photoelectron spectroscopy shows that deposition of reactive metals such as Cr and Ti leads immediately to crosslinking and to the formation of carbide and fluoride species. Less reactive metals, such as Au, cause only small loss of fluorine without formation of any new species. The metal/PFA interface is strongly affected by x-ray irradiation in the case of Cr and Ti: remarkably enhanced crosslinking has been observed, which further increases with the metal coverage, while the carbides and fluorides remain basically unaffected. On the other hand, crosslinking increases only very slightly for pure PFA and for the Au/PFA interface, regardless of the Au thickness. These results suggest that radical recombination reactions are responsible for crosslinking at the interface between PFA and reactive metals.

  10. Assessment of Bowel Wall Enhancement for the Diagnosis of Intestinal Ischemia in Patients with Small Bowel Obstruction: Value of Adding Unenhanced CT to Contrast-enhanced CT.

    PubMed

    Chuong, Anh Minh; Corno, Lucie; Beaussier, Hélène; Boulay-Coletta, Isabelle; Millet, Ingrid; Hodel, Jérôme; Taourel, Patrice; Chatellier, Gilles; Zins, Marc

    2016-07-01

    Purpose To determine whether adding unenhanced computed tomography (CT) to contrast material-enhanced CT improves the diagnostic performance of decreased bowel wall enhancement as a sign of ischemia complicating mechanical small bowel obstruction (SBO). Materials and Methods This retrospective study was approved by the institutional review board, which waived the requirement for informed consent. Two gastrointestinal radiologists independently performed retrospective assessments of 164 unenhanced and contrast-enhanced CT studies from 158 consecutive patients (mean age, 71.2 years) with mechanical SBO. The reference standard was the intraoperative and/or histologic diagnosis (in 80 cases) or results from clinical follow-up in patients who did not undergo surgery (84 cases). Decreased bowel wall enhancement was evaluated with contrast-enhanced images then and both unenhanced and contrast-enhanced images 1 month later. Diagnostic performance of decreased bowel wall enhancement and confidence in the diagnosis were compared between the two readings by using McNemar and Wilcoxon signed rank tests. Interobserver agreement was assessed by using κ statistics and compared with bootstrapping. Results Ischemia was diagnosed in 41 of 164 (25%) episodes of SBO. For both observers, adding unenhanced images improved decreased bowel wall enhancement sensitivity (observer 1: 46.3% [19 of 41] vs 65.8% [27 of 41], P = .02; observer 2: 56.1% [23 of 41] vs 63.4% [26 of 41], P = .45), Youden index (from 0.41 to 0.58 for observer 1 and from 0.42 to 0.61 for observer 2), and confidence score (P < .001 for both). Specificity significantly increased for observer 2 (84.5% [104 of 123] vs 94.3% [116 of 123], P = .002), and interobserver agreement significantly increased, from moderate (κ = 0.48) to excellent (κ = 0.89; P < .0001). Conclusion Adding unenhanced CT to contrast-enhanced CT improved the sensitivity, diagnostic confidence, and interobserver agreement of the diagnosis of ischemia

  11. Comparative MiRNA Expressional Profiles and Molecular Networks in Human Small Bowel Tissues of Necrotizing Enterocolitis and Spontaneous Intestinal Perforation

    PubMed Central

    Tam, Yuk Him; Ma, Terence Ping Yuen; Lam, Hugh Simon; Cheung, Hon Ming; Lee, Kim Hung; To, Ka Fai; Li, Karen

    2015-01-01

    Background Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are acute intestinal conditions which could result in mortality and severe morbidity in preterm infants. Our objective was to identify dysregulated micro-RNAs (miRNAs) in small bowel tissues of NEC and SIP, and their possible roles in disease pathophysiology. Methods We performed differential miRNA arrays on tissues of NEC (n = 4), SIP (n = 4) and surgical-control (Surg-CTL; n = 4), and validated target miRNAs by qPCR (n = 10 each group). The association of target miRNAs with 52 dysregulated mRNAs was investigated by bioinformatics on functional and base-pair sequence algorithms, and correlation in same tissue samples. Results We presented the first miRNA profiles of NEC, SIP and Surg-CTL intestinal tissues in preterm infants. Of 28 validated miRNAs, 21 were significantly different between NEC or SIP and Surg-CTL. Limited overlapping in the aberrant expression of miRNAs between NEC and SIP indicated their distinct molecular mechanisms. A proposed network of dysregulated miRNA/mRNA pairs in NEC suggested interaction at bacterial receptor TLR4 (miR-31, miR-451, miR-203, miR-4793-3p), mediated via key transcription factors NFKB2 (miR-203), AP-1/FOSL1 (miR-194-3p), FOXA1 (miR-21-3p, miR-431 and miR-1290) and HIF1A (miR-31), and extended downstream to pathways of angiogenesis, arginine metabolism, cell adhesion and chemotaxis, extracellular matrix remodeling, hypoxia/oxidative stress, inflammation and muscle contraction. In contrast, upregulation of miR-451 and miR-223 in SIP suggested modulation of G-protein-mediated muscle contraction. Conclusions The robust response of miRNA dysregulation in NEC and SIP, and concerted involvement of specific miRNAs in the molecular networks indicated their crucial roles in mucosa integrity and disease pathophysiology. PMID:26274503

  12. 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

    2011-01-01

    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

  13. Villoglandular papillary adenocarcinoma: case report

    PubMed Central

    Salek, Ghizlane; Lalya, Issam; Rahali, Driss Moussaoui; Dehayni, Mohamed

    2016-01-01

    Villoglandular papillary adenocarcinoma (VPA) is a very rare subtype of adenocarcinoma of the uterine cervix, but a well-recognized variant of cervical adenocarcinoma with a favorable prognosis and generally occurring in women of child-bearing age. Herein, we report a case of VPA diagnosed and managed successfully with conservative measure. This management is particularly desirable in young women to preserve reproductive capability. PMID:28293348

  14. [Endoscopic diagnosis of Barrett's adenocarcinoma].

    PubMed

    Yoshio, H; Takashi, Y; Mitsuyo, H; Nobuhiko, Y; Tatsurou, T; Kazuhiko, S; Yoko, H; Shigemasa, I; Hisanaga, M; Osamu, H; Katsuyoshi, S; Seishi, U; Matsushita, H; Masahiko, T

    1999-03-01

    Biopsy specimens can reveal that esophageal cancer is an adenocarcinoma but they cannot show that its origin is Barrett's mucosa. Therefore we must show during endoscopy that the tumor exists in Barrett's mucosa. We reported that Barrett's esophagus could be clearly diagnosed at endoscopy as the columnar mucosa lying on the longitudinal vessels in the lower esophagus. We define Barrett's esophagus as "the columnar mucosa in the esophagus which exists continuously more than 2 cm in circumference from the stomach." Short-segment Barrett's esophagus (SSBE) is "the columnar mucosa which exists in the esophagus continuously from the stomach but its length has a part under 2 cm in length." Endoscopically Barrett's adenocarcinoma is visualized as a lesion with a reddish and uneven mucosal surface. Barrett's adenocarcinomas occur in the SSBE as well. Endoscopic observation at periodic intervals is necessary not only for cases with Barrett's esophagus but also with SSBE. A further examination is necessary to determine the application of EMR for superficial Barrett's adenocarcinoma.

  15. Protocol for a phase III randomised trial of image-guided intensity modulated radiotherapy (IG-IMRT) and conventional radiotherapy for late small bowel toxicity reduction after postoperative adjuvant radiation in Ca cervix

    PubMed Central

    Chopra, Supriya; Engineer, Reena; Mahantshetty, Umesh; Misra, Shagun; Phurailatpam, Reena; Paul, Siji N; Kannan, Sadhna; Kerkar, Rajendra; Maheshwari, Amita; Shylasree, TS; Ghosh, Jaya; Gupta, Sudeep; Thomas, Biji; Singh, Shalini; Sharma, Sanjiv; Chilikuri, Srinivas; Shrivastava, Shyam Kishore

    2012-01-01

    Introduction External beam radiation followed by vaginal brachytherapy (±chemotherapy) leads to reduction in the risk of local recurrence and improves progression-free survival in patients with adverse risk factors following Wertheim's hysterectomy albeit at the risk of late bowel toxicity. Intensity Modulated Radiotherapy (IMRT) results in reduction in bowel doses and has potential to reduce late morbidity, however, needs to be confirmed prospectively in a randomised trial. The present randomised trial tests reduction if any in late small bowel toxicity with the use of IMRT in postoperative setting. Methods and analysis Patients more than 18 years of age who need adjuvant (chemo) radiation will be eligible. Patients with residual pelvic or para-aortic nodal disease, history of multiple abdominal surgeries or any other medical bowel condition will be excluded. The trial will randomise patients into standard radiation or IMRT. The primary aim is to compare differences in late grades II–IV bowel toxicity between the two arms. The secondary aims of the study focus on evaluating correlation of dose–volume parameters and late toxicity and quality of life. The trial is planned as a multicentre randomised study. The trial is designed to detect a 13% difference in late grades II–IV bowel toxicity with an α of 0.05 and β of 0.80. A total of 240 patients will be required to demonstrate the aforesaid difference. Ethics and dissemination The trial is approved by institutional ethics review board and will be routinely monitored as per standard guidelines. The study results will be disseminated via peer reviewed scientific journals, conference presentations and submission to regulatory authorities. Registration The trial is registered with clinicaltrials.gov (NCT 01279135). PMID:23242243

  16. Hepatoid Adenocarcinoma of the Urachus

    PubMed Central

    Jimenez, Carlos Andrés; Carrascal, Edwin

    2016-01-01

    Hepatoid adenocarcinoma of the urachus is a rare condition. We present the case of a 51-year-old female who developed abdominal pain and hematuria. Pelvic magnetic resonance imaging (MRI) reported an urachal mass with invasion to the bladder that was resected by partial cystectomy. On light microscopy the tumor resembled liver architecture, with polygonal atypical cells in nest formation and trabecular structures. Immunochemistry was positive for alfa-fetoprotein (AFP) and serum AFP was elevated. Hepatoid adenocarcinomas have been reported in multiple organs, being most commonly found in the stomach and the ovaries. Bladder compromise has been rarely described in the literature, and it has been associated with poor prognosis, low remission rates, and early metastasis. PMID:27803830

  17. Oncocytic Adenocarcinoma of the Orbit.

    PubMed

    Harris, Gerald J; Paul, Sean; Hunt, Bryan C

    Oncocytic adenocarcinoma of the orbit is a rare tumor, with 1 case of nonlacrimal sac, nonlacrimal gland origin, and a poor outcome previously reported. An 85-year-old man with a 2-month history of left-sided epiphora, enlarging eyelid nodules, and diplopia in left gaze was found on imaging to have a poorly circumscribed, nodular mass of uniform radiodensity in the inferomedial orbit. Incisional biopsy revealed morphologic and immunohistochemical features of oncocytic adenocarcinoma with origin in the caruncle suspected, and CT of the neck, chest, abdomen, and pelvis showed no metastases or remote primary tumor source. Based on multidisciplinary consensus, orbital exenteration with adjuvant radiation therapy was performed, and there was no evidence of residual or recurrent tumor 2 years after treatment.

  18. Optimal lymphadenectomy for esophageal adenocarcinoma.

    PubMed

    Oezcelik, A

    2013-08-01

    Recently published data have shown that an extended lymphadenectomy during the en bloc esophagectomy leads to a significant increased long-term survival for esophageal adenocarcinoma. On the other hand some studies indicate that the increased survival is based on stage migration and that the surgical complication rate is increased after extended lymphadenectomy. The aim of this review was to give an overview about all aspects of an extended lymphadenectomy in patients with esophageal adenocarcinoma. The review of the literature shows clearly that the number of involved lymph nodes is an independent prognostic factor in patients with esophageal adenocarcinoma. Furthermore, an extended lymphadenectomy leads to an increased long-term survival. Some studies describe that 23 lymph nodes should be removed to predict survival; other studies 18 lymph nodes or 15 lymph nodes. Opponents indicate that the survival benefit is based on stage migration. The studies with a large study population have performed a Cox regression analyzes and identified the number of lymph nodes removed as an independent factor for improved survival, which means it is significant independently from other parameters. Under these circumstances is stage migration not an option to explain the survival benefit. An important difficulty is, that there is no standardized definition of an extended lymphadenectomy, which means the localization and number of removed lymph nodes differ depending from the performing centre. The controversies regarding the survival benefit of the lymphadenectomy is based on the lack of standardisation of the lymphadenectomy. The main goal of further studies should be to generate a clear definition of an extended lymphadenectomy in patients with esophageal adenocarcinoma.

  19. Major Complications of Small Bowel Diverticula

    PubMed Central

    Donald, John W.

    1979-01-01

    Complications of diverticula of the duodenum, jejunum and ileum, exclusive of Meckel's diverticula are extremely rare but can produce major diagnostic and therapeutic problems. Major reported complications include hemorrhage, perforation, biliary and pancreatic obstruction, and inflammation with intestinal obstruction. The mortality of complicated duodenal diverticula is reported from 33 to 48%. Our experience with some of these complications is reported. This experience and a review of other reported cases have led to the following recommendations for surgical treatment. 1) Massively bleeding duodenal diverticulum. Precise localization of the bleeding point by endoscopy and/or arteriography is highly desirable. Excision or partial excision of the diverticulum with suture ligation of the bleeding point is necessary. 2) Perforated duodenal diverticulum. Excision or partial excision, secure closure and drainage are necessary. If peri-Vaterian, a probe should be passed through the ampulla of Vater via the common duct. Unless an entirely satisfactory closure is achieved, complete diversion of the enteric stream from the duodenum by vagotomy, antrectomy with closure of duodenal stump, and Billroth II anastomosis is recommended. 3) Choledochal obstruction due to duodenal diverticulum. Choledocho-duodenostomy. 4) Perforation, bleeding, or obstruction due to jejunal or ileal diverticulum. In rare cases, local excision of the diverticulum is feasible. Usually, resection of the involved segment with primary anastomosis is indicated. ImagesFig. 1.Fig. 2.Fig. 3.Fig. 4.Fig. 5.Fig. 6. PMID:111637

  20. Upper GI and small bowel series

    MedlinePlus

    ... Achalasia Diverticula Esophageal cancer Esophageal narrowing (stricture) - benign Hiatal hernia Ulcers Abnormal results in the stomach may indicate ... Esophageal stricture - benign Gastritis Gastroesophageal reflux ... obstruction Intestinal pseudo-obstruction Lower esophageal ring ...

  1. Abdominal apoplexy resulting in small bowel obstruction

    PubMed Central

    Le, Don; Guileyardo, Joseph; Casanova, Mark

    2016-01-01

    Abdominal apoplexy is a rare hemorrhagic condition involving the small arteries or veins within the abdominal cavity. A high degree of clinical suspicion, followed by appropriate diagnostic workup and therapeutic intervention, is critical, as nonoperative mortality approaches 100%. Contrary to most previously reported cases, which were associated with hemoperitoneum, we present a patient in which gastroduodenal artery dissection resulted in an organized retroperitoneal hematoma with local compression of the duodenum and subsequent bowel obstruction, resulting in vomiting, aspiration, and death. PMID:27695177

  2. [Small bowel perforation caused by magnetic toys].

    PubMed

    Schroepfer, E; Siauw, C; Hoecht, B; Meyer, T

    2010-06-01

    Accidental ingestion of foreign bodies is a common problem in infants and childhood, but ingestion of magnetic construction toys is very rare. In the case of ingestion of multiple parts of these magnetic construction toys, they may attract each other through the intestinal walls, causing pressure necrosis, perforation, fistula formation or intestinal obstruction. A 20-month-old boy presented with a three-day history of abdominal pain and bilious vomiting. Physical examination revealed a slighted distended abdomen. The -white blood cell count was increased, but the C-reactive protein was normal. Ultrasound and X-ray of the abdomen showed a distended bowel loop in the right upper quadrant, a moderate amount of free intraperitoneal liquid and 4 foreign bodies. Emergency laparotomy was performed and 2 perforations in the ileum were detected. The perforations were caused by a magnetic construction toy and 2 iron globes. The fourth foreign body was a glass marble. The foreign bodies were removed, both perforations were primarily sutured. The child was discharged on postoperative day 10 after an uneventful recovery. Parents should be warned against the potential dangers of children's constructions toys that contain these kinds of magnets.

  3. Metastatic adenocarcinoma of unknown primary origin.

    PubMed

    Hammar, S P

    1998-12-01

    Adenocarcinomas account for up to 60% of all metastatic neoplasms of unknown primary origin. In general, adenocarcinomas are the most difficult metastatic tumor to accurately identify the primary site. Some metastatic adenocarcinomas have distinctive histological features that allow for their site determination (eg, colonic adenocarcinoma, bronchioloalveolar cell carcinoma), although the majority of metastatic adenocarcinomas have histological features that are not distinctive enough to allow for a specific diagnosis of their origin. For this reason, electron microscopy and immunohistochemistry have been used to help identify the exact type (origin) of metastatic adenocarcinomas. Relatively specific ultrastructural features used to diagnose metastatic adenocarcinomas of unknown primary origin include tubular myelin, intranuclear surfactant apoprotein tubular inclusions, Clara cell granules, uniform short microvilli with filamentous cores and core rootlets, Langerhans cells associated with neoplastic cells, cytoplasmic hyaline globules, lipid droplets, glycogen, and cytoplasmic crystals. Only a few of these ultrastructural features are absolutely specific. Relatively specific immunohistochemical tests used to diagnose metastatic adenocarcinomas of unknown primary origin include prostate-specific antigen, thyroglobulin, estrogen and progesterone receptor proteins, thyroid transcription factor-I, and surfactant apoproteins. Of these, prostate-specific antigen and thyroglobulin are the most specific. The purpose of this article is to discuss the use of electron microscopy and immunohistochemistry in the site-specific diagnosis of metastatic adenocarcinomas of unknown primary origin.

  4. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

    PubMed Central

    2013-01-01

    Background In 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy. Recommendations In absence of signs of strangulation and history of persistent vomiting or combined CT-scan signs (free fluid, mesenteric edema, small-bowel feces sign, devascularization) patients with partial ASBO can be managed safely with NOM and tube decompression should be attempted. These patients are good candidates for Water-Soluble-Contrast-Medium (WSCM) with both diagnostic and therapeutic purposes. The radiologic appearance of WSCM in the colon within 24 hours from administration predicts resolution. WSCM maybe administered either orally or via NGT both immediately at admission or after failed conservative treatment for 48 hours. The use of WSCM 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 decrease recurrence rates or recurrences needing surgery. Open surgery is often used for strangulating ASBO as well as after failed conservative management. In selected patients and with appropriate skills, laparoscopic approach is advisable using open access technique. Access in left upper quadrant or left flank is the safest and only completely obstructing adhesions should be identified and lysed with cold scissors. Laparoscopic adhesiolysis should be attempted preferably if first episode of SBO and/or anticipated single band

  5. Transcriptomic Microenvironment of Lung Adenocarcinoma.

    PubMed

    Bossé, Yohan; Sazonova, Olga; Gaudreault, Nathalie; Bastien, Nathalie; Conti, Massimo; Pagé, Sylvain; Trahan, Sylvain; Couture, Christian; Joubert, Philippe

    2017-03-01

    Background: Tissues surrounding tumors are increasingly studied to understand the biology of cancer development and identify biomarkers.Methods: A unique geographic tissue sampling collection was obtained from patients that underwent curative lobectomy for stage I pulmonary adenocarcinoma. Tumor and nontumor lung samples located at 0, 2, 4, and 6 cm away from the tumor were collected. Whole-genome gene expression profiling was performed on all samples (n = 5 specimens × 12 patients = 60). Analyses were carried out to identify genes differentially expressed in the tumor compared with adjacent nontumor lung tissues at different distances from the tumor as well as to identify stable and transient genes in nontumor tissues with respect to tumor proximity.Results: The magnitude of gene expression changes between tumor and nontumor sites was similar with increasing distance from the tumor. A total of 482 up- and 843 downregulated genes were found in tumors, including 312 and 566 that were consistently differentially expressed across nontumor sites. Twenty-nine genes induced and 34 knocked-down in tumors were also identified. Tumor proximity analyses revealed 15,700 stable genes in nontumor lung tissues. Gene expression changes across nontumor sites were subtle and not statistically significant.Conclusions: This study describes the transcriptomic microenvironment of lung adenocarcinoma and adjacent nontumor lung tissues collected at standardized distances relative to the tumor.Impact: This study provides further insights about the molecular transitions that occur from normal tissue to lung adenocarcinoma and is an important step to develop biomarkers in nonmalignant lung tissues. Cancer Epidemiol Biomarkers Prev; 26(3); 389-96. ©2016 AACR.

  6. Uterine adenocarcinoma with feline leukemia virus infection.

    PubMed

    Cho, Sung-Jin; Lee, Hyun-A; Hong, Sunhwa; Kim, Okjin

    2011-12-01

    Feline endometrial adenocarcinomas are uncommon malignant neoplasms that have been poorly characterized to date. In this study, we describe a uterine adenocarcinoma in a Persian cat with feline leukemia virus infection. At the time of presentation, the cat, a female Persian chinchilla, was 2 years old. The cat underwent surgical ovariohystectomy. A cross-section of the uterine wall revealed a thickened uterine horn. The cat tested positive for feline leukemia virus as detected by polymerase chain reaction. Histopathological examination revealed uterine adenocarcinoma that had metastasized to the omentum, resulting in thickening and the formation of inflammatory lesions. Based on the histopathological findings, this case was diagnosed as a uterine adenocarcinoma with abdominal metastasis. To the best of our knowledge, this is the first report of a uterine adenocarcinoma with feline leukemia virus infection.

  7. Multicentre, open-label, randomised, parallel-group, superiority study to compare the efficacy of octreotide therapy 40 mg monthly versus standard of care in patients with refractory anaemia due to gastrointestinal bleeding from small bowel angiodysplasias: a protocol of the OCEAN trial

    PubMed Central

    van Geenen, E J M; Drenth, J P H

    2016-01-01

    Introduction Gastrointestinal angiodysplasias are an important cause of difficult-to-manage bleeding, especially in older patients. Endoscopic coagulation of angiodysplasias is the mainstay of treatment, but may be difficult for small bowel angiodysplasias because of the inability to reach them for endoscopic intervention. Some patients are red blood cell (RBC) transfusion dependent due to frequent rebleeding despite endoscopic treatment. In small cohort studies, octreotide appears to decrease the number of bleeding episodes in patients with RBC transfusion dependency due to gastrointestinal angiodysplasias. This trial will assess the efficacy of octreotide in decreasing the need for RBC transfusions and parenteral iron in patients with anaemia due to gastrointestinal bleeding of small bowel angiodysplasias despite endoscopic intervention. Study design Randomised controlled, superiority, open-label multicentre trial. Participants 62 patients will be included with refractory anaemia due to small bowel angiodysplasias, who are RBC transfusion or iron infusion dependent despite endoscopic intervention and oral iron supplementation. Intervention Patients will be randomly assigned (1:1) to standard care or 40 mg long-acting octreotide once every 4 weeks for 52 weeks, in addition to standard care. The follow-up period is 8 weeks. Main outcome measures The primary outcome is the difference in the number of blood and iron infusions between the year prior to inclusion and the treatment period of 1 year. Important secondary outcomes are the per cent change in the number of rebleeds from baseline to end point, adverse events and quality of life. Ethics and dissemination The trial received ethical approval from the Central Committee on Research Involving Human Subjects and from the local accredited Medical Research Ethics Committee of the region Arnhem-Nijmegen, the Netherlands (reference number: 2014-1433). Results will be published in a peer-reviewed journal and

  8. MLN0264 in Previously Treated Asian Participants With Advanced Gastrointestinal Carcinoma or Metastatic or Recurrent Gastric or Gastroesophageal Junction Adenocarcinoma Expressing Guanylyl Cyclase C

    ClinicalTrials.gov

    2017-02-08

    Advanced Gastrointestinal Carcinoma; Gastroesophageal Junction Adenocarcinoma; Recurrent Gastric Adenocarcinoma; Recurrent Gastroesophageal Junction Adenocarcinoma; Metastatic Gastric Adenocarcinoma; Metastatic Gastroesophageal Junction Adenocarcinoma; Recurrent Gastrointestinal Carcinoma

  9. [An unusual secondary localization of bronchial adenocarcinoma].

    PubMed

    Mirallie, E; Courant, O; Sagan, C; Letessier, E; Paineau, J; Visset, J

    1993-01-01

    The authors report a rare case of metastatic carcinoma of the large bowel, secondary to a primary bronchogenic adenocarcinoma. Abdominal pain developed in a 44-year old man 5 months after lobectomy for lung adenocarcinoma. The diagnosis of a large caecal extraluminal mass was established by means of sonography, scanner and laparoscopy. Palliative resection (brain metastases) was performed. Postoperative histological examination revealed the resected tumor to be identical to the lung adenocarcinoma. The patient eventually died 4 months after resection (complication of intracranial hypertension). Diagnosis and therapeutic features of metastatic extra-thoracic lung carcinoma are discussed.

  10. [Mesocolic excision for colonic adenocarcinoma].

    PubMed

    Debove, Clotilde; Lefèvre, Jérémie H; Parc, Yann

    2017-02-01

    On the same principle than total mesorectal excision in rectal cancer, the effect of complete mesocolic excision on short and long-term outcomes is actually evaluated for colonic adenocarcinoma. This method, usually performed for left colectomy, offers a surgical specimen of higher quality, with a larger number of lymph nodes harvested. For right colectomy, surgical specifications make it less common complete mesocolic excision and conventional surgery offer comparable outcomes, as regards to postoperative morbidity and mortality rates. No differences are identified between laparoscopic and open surgery. On oncologic outcomes, only two studies report a higher free-disease survival after complete mesocolic excision. Then, there is evidence that complete mesocolic excision offers a higher rate of specimen with extensive lymph node resection, without increased morbidity rate. However, there is limited evidence that it leads to improve long-term oncological outcomes.

  11. Colonic adenocarcinoma with metastasis to the gingiva.

    PubMed

    Alvarez-Alvarez, Carlos; Iglesias-Rodríguez, Begoña; Pazo-Irazu, Susana; Delgado-Sánchez-Gracián, Carlos

    2006-01-01

    Metastatic tumors involve the oral cavity, and the most common primary sites are the breast and lung. Most cases affect the mandible and maxilla in that order, although some of them can be located in the soft perioral tissues. We report the case of a 62-year-old male who had been diagnosed with sigmoid adenocarcinoma with nodal and liver metastasis, who presented 6 months later with a gingival polypoid tumor, at first considered as a primary neoplasm of gingiva, that was diagnosed in a biopsy as metastatic intestinal adenocarcinoma. The histological evaluation is essential to separate adenocarcinoma from the commoner in this site squamous cell carcinoma, and the immunohistochemical techniques are useful to distinguish metastatic tumor versus primary adenocarcinoma from the minor salivary glands of the area. The intraoral spread of a disseminated neoplasm is generally a sign of bad prognosis, although a longer survival can be expected if a radical surgical treatment of a solitary metastasis is carried out.

  12. Pathologic classification of adenocarcinoma of lung.

    PubMed

    Van Schil, Paul E; Sihoe, Alan D L; Travis, William D

    2013-10-01

    Recently, the 1999/2004 World Health Organization (WHO) classification of adenocarcinoma became less useful from a clinical standpoint as most adenocarcinomas belonged to the mixed subtype and the term bronchioloalveolar carcinoma (BAC) gave rise to much confusion among clinicians. For these reasons a new adenocarcinoma classification was introduced in 2011 by a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS). This represents an international, multidisciplinary effort joining pathologists, molecular biologists, pulmonary physicians, thoracic oncologists, radiologists, and thoracic surgeons. Currently, a distinction is made between pre-invasive lesions, minimally invasive and invasive lesions. The confusing term BAC is not used anymore and new subcategories include adenocarcinoma in situ and minimally invasive adenocarcinoma. Several aspects of this classification are discussed with main emphasis on its correlation with imaging techniques and its impact on diagnosis, treatment and prognosis. On chest computed tomography (CT) a distinction is made between solid and subsolid nodules, the latter comprising ground glass opacities (GGO), and partly solid lesions. Several studies incorporating CT and positron emission tomographic (PET) data show a good imaging-pathologic correlation. With the implementation of screening programs early lung cancer has become a hotly debated topic and sublobar resection is currently reconsidered for early lesions without lymph node involvement. This new classification will also have an impact on the TNM classification. Thoracic surgeons will continue to play a major role in the application, evaluation and further refinement of this new adenocarcinoma classification.

  13. Limited, local, extracolonic spread of mucinous appendiceal adenocarcinoma after perforation with formation of a malignant appendix-to-sigmoid fistula: Case report and literature review

    PubMed Central

    Hakim, Seifeldin; Amin, Mitual; Cappell, Mitchell S

    2016-01-01

    A 68-year-old man presented with progressive right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo. Abdomino-pelvic computed tomography and magnetic resonance imaging demonstrated a dilated appendix forming a fistula to the sigmoid colon. Open laparotomy revealed a bulky abdominal tumor involving appendix, cecum, and sigmoid, and extending up to adjacent viscera, without ascites or peritoneal implants. The abdominal mass was removed en bloc, including resection of sigmoid colon, cecum (with preservation of ileocecal valve), appendix, right vas deferens, testicular vessels, and minimal amounts of anterior abdominal wall; and shaving off of small parts of the walls of the urinary bladder and small bowel. Gross and microscopic pathologic examination revealed an appendix-to-sigmoid malignant fistula secondary to perforation of mucinous adenocarcinoma of the appendix with minimal local spread (stage T4). However, the surgical margins were clear, all 13 resected lymph nodes were cancer-free, and pseudomyxoma peritonei or peritoneal implants were not present. The patient did well during 1 year of follow-up with no clinical or radiologic evidence of local recurrence, metastases, or pseudomyxoma peritonei despite presenting with extensive stage T4 cancer that was debulked without administering chemotherapy, and despite presenting with malignant appendiceal perforation. This case illustrates the non-aggressive biologic behavior of this low-grade malignancy. The fistula may have prevented free spillage of cancerous cells and consequent distant metastases by containing the appendiceal contents largely within the colon. PMID:27784975

  14. Limited, local, extracolonic spread of mucinous appendiceal adenocarcinoma after perforation with formation of a malignant appendix-to-sigmoid fistula: Case report and literature review.

    PubMed

    Hakim, Seifeldin; Amin, Mitual; Cappell, Mitchell S

    2016-10-14

    A 68-year-old man presented with progressive right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo. Abdomino-pelvic computed tomography and magnetic resonance imaging demonstrated a dilated appendix forming a fistula to the sigmoid colon. Open laparotomy revealed a bulky abdominal tumor involving appendix, cecum, and sigmoid, and extending up to adjacent viscera, without ascites or peritoneal implants. The abdominal mass was removed en bloc, including resection of sigmoid colon, cecum (with preservation of ileocecal valve), appendix, right vas deferens, testicular vessels, and minimal amounts of anterior abdominal wall; and shaving off of small parts of the walls of the urinary bladder and small bowel. Gross and microscopic pathologic examination revealed an appendix-to-sigmoid malignant fistula secondary to perforation of mucinous adenocarcinoma of the appendix with minimal local spread (stage T4). However, the surgical margins were clear, all 13 resected lymph nodes were cancer-free, and pseudomyxoma peritonei or peritoneal implants were not present. The patient did well during 1 year of follow-up with no clinical or radiologic evidence of local recurrence, metastases, or pseudomyxoma peritonei despite presenting with extensive stage T4 cancer that was debulked without administering chemotherapy, and despite presenting with malignant appendiceal perforation. This case illustrates the non-aggressive biologic behavior of this low-grade malignancy. The fistula may have prevented free spillage of cancerous cells and consequent distant metastases by containing the appendiceal contents largely within the colon.

  15. Comparison of the Effects of Carbon Ion and Photon Irradiation on the Angiogenic Response in Human Lung Adenocarcinoma Cells

    SciTech Connect

    Kamlah, Florentine; Haenze, Joerg; Arenz, Andrea; Seay, Ulrike; Hasan, Diya; Gottschald, Oana R.; Seeger, Werner; Rose, Frank

    2011-08-01

    Purpose: Radiotherapy resistance is a commonly encountered problem in cancer treatment. In this regard, stabilization of endothelial cells and release of angiogenic factors by cancer cells contribute to this problem. In this study, we used human lung adenocarcinoma (A549) cells to compare the effects of carbon ion and X-ray irradiation on the cells' angiogenic response. Methods and Materials: A549 cells were irradiated with biologically equivalent doses for cell survival of either carbon ions (linear energy transfer, 170 keV/{mu}m; energy of 9.8 MeV/u on target) or X-rays and injected with basement membrane matrix into BALB/c nu/nu mice to generate a plug, allowing quantification of angiogenesis by blood vessel enumeration. The expression of angiogenic factors (VEGF, PlGF, SDF-1, and SCF) was assessed at the mRNA and secreted protein levels by using real-time reverse transcription-PCR and enzyme-linked immunosorbent assay. Signal transduction mediated by stem cell factor (SCF) was assessed by phosphorylation of its receptor c-Kit. For inhibition of SCF/c-Kit signaling, a specific SCF/c-Kit inhibitor (ISCK03) was used. Results: Irradiation of A549 cells with X-rays (6 Gy) but not carbon ions (2 Gy) resulted in a significant increase in blood vessel density (control, 20.71 {+-} 1.55; X-ray, 36.44 {+-} 3.44; carbon ion, 16.33 {+-} 1.03; number per microscopic field). Concordantly, irradiation with X-rays but not with carbon ions increased the expression of SCF and subsequently caused phosphorylation of c-Kit in endothelial cells. ISCK03 treatment of A549 cells irradiated with X-rays (6 Gy) resulted in a significant decrease in blood vessel density (X-ray, 36.44 {+-} 3.44; X-ray and ISCK03, 4.33 {+-} 0.71; number of microscopic field). These data indicate that irradiation of A549 cells with X-rays but not with carbon ions promotes angiogenesis. Conclusions: The present study provides evidence that SCF is an X-ray-induced mediator of angiogenesis in A549 cells, a

  16. Investigation of modification X-ray induced bystander effect in vitro.

    PubMed

    Shemetun, O V; Talan, O O

    2014-09-01

    Meta: doslidyty modyfikaciju radiacijno-indukovanogo efektu svidka, sprychynenogo rentgenivs'kym oprominennjam peryferychnoi' krovi ljudyny in vitro, shljahom zastosuvannja antyoksydantnogo vitaminnogo preparatu. Material doslidzhennja: limfocyty peryferychnoi' krovi ljudyny. Metody: modeljuvannja radiacijno-indukovanogo efektu svidka in vitro v zmishanyh kul'turah limfocytiv, oprominenyh v dozi 1 Gr, ta neoprominenyh limfocytiv krovi osib riznoi' stati, GTG-zabarvlennja metafaznyh hromosom ta i'h cytogenetychnyj analiz. Rezul'taty: pry vvedenni antyoksydantnogo preparatu v zmishanu kul'turu pered kul'tyvuvannjam chastota aberacij hromosom v klitynah-svidkah statystychno-dostovirno ne vidriznjalas' vid kontrol'noi' (r > 0,05). Vysnovky: vykorystannja antyoksydantnogo preparatu (vodorozchynni formy vitaminiv E, S i A) v koncentracii' 40 mkg/ml modyfikuje radiacijno-indukovanyj efekt svidka v neoprominenyh limfocytah peryferychnoi' krovi ljudyny pry i'h sumisnomu kul'tyvuvanni z limfocytamy, oprominenymy v dozi 1 Gr. Antyoksydant zapobigaje rozvytku vtorynnogo oksydatyvnogo stresu v neoprominenyh klitynah, niveljuje rozvytok v nyh radiacijno-indukovanogo efektu svidka ta zabezpechuje zberezhennja stabil'nosti i'h hromosomnogo aparatu.

  17. Low coercive field of polymer ferroelectric via x-ray induced phase transition

    SciTech Connect

    Lee, Hyeon Jun; Kim, Jihong; Lee, Hye Jeong; Kwak, Jeong Hun; Kim, Jae Myung; Lee, Sung Su; Kim, Dong-Yu; Jo, Ji Young; Kwon, Owoong; Kim, Yunseok

    2015-12-28

    We present an experimental strategy via X-ray irradiation combined with time-resolved X-ray diffraction to reduce a coercive field of ferroelectric thin films. We found in real-time that X-ray irradiation enables the irreversible phase transition from a polar to non-polar phase in ferroelectric poly(vinylidene fluoride-trifluoroethylene) thin films. The non-polar regions act as initial nucleation sites for opposite domains thus reducing the coercive field, directly related to the switching of domains, by 48%.

  18. X-ray induced alterations in the differentiation and mineralization potential of murine preosteoblastic cells

    NASA Astrophysics Data System (ADS)

    Hu, Yueyuan; Lau, Patrick; Baumstark-Khan, Christa; Hellweg, Christine E.; Reitz, Günther

    2012-05-01

    To evaluate the effects of ionizing radiation (IR) on murine preosteoblastic cell differentiation, we directed OCT-1 cells to the osteoblastic lineage by treatment with a combination of β-glycerophosphate (β-GP), ascorbic acid (AA), and dexamethasone (Dex). In vitro mineralization was evaluated based on histochemical staining and quantification of the hydroxyapatite content of the extracellular bone matrix. Expression of mRNA encoding Runx2, transforming growth factor β1 (TGF-β1), osteocalcin (OCN), and p21CDKN1A was analyzed. Exposure to IR reduced the growth rate and diminished cell survival of OCT-1 cells under standard conditions. Notably, calcium content analysis revealed that deposition of mineralized matrix increased significantly under osteogenic conditions after X-ray exposure in a time-dependent manner. In this study, higher radiation doses exert significant overall effects on TGF-β1, OCN, and p21CDKN1A gene expression, suggesting that gene expression following X-ray treatment is affected in a dose-dependent manner. Additionally, we verified that Runx2 was suppressed within 24 h after irradiation at 2 and 4 Gy. Although further studies are required to verify the molecular mechanism, our observations strongly suggest that treatment with IR markedly alters the differentiation and mineralization process of preosteoblastic cells.

  19. Simulation of ultrasoft X-rays induced DNA damage using the Geant4 Monte Carlo toolkit

    NASA Astrophysics Data System (ADS)

    Tajik, Marjan; Rozatian, Amir S. H.; Semsarha, Farid

    2015-01-01

    In this study, the total yields of SSB and DSB induced by monoenergetic electrons with energies of 0.28-4.55 keV, corresponding to ultrasoft X-rays energies, have been calculated in Charlton and Humm volume model using the Geant4-DNA toolkit and compared with theoretical and experimental data. A reasonable agreement between the obtained results in the present study and experimental and theoretical data of previous studies showed the efficiency of this model in estimating the total yield of strand breaks in spite of its simplicity. Also, it has been found that in the low energy region, the yield of the total SSB remains nearly constant while the DSB yield increases with decreasing energy. Moreover, a direct dependency between DSB induction, RBE value and the mean lineal energy as a microdosimetry quantity has been observed. In addition, it has become clear that the use of the threshold energy of 10.79 eV to calculate the total strand breaks yields results in a better agreement with the experiments, while the threshold of 17.5 eV shows a big difference.

  20. Proton-induces and x-ray induced fluorescence analysis of scoliotic tissue

    SciTech Connect

    Panessa-Warren, B J; Kraner, H W; Jones, K W; Weiss, L S

    1980-02-01

    Adolescent idiopathic scoliosis is characterized by a curvature or assymetry of the spine which may become progressively more severe, with clinical symptoms appearing just prior to, or during, puberty. The incidence for scoliosis in the age group from 12 to 14 years of age has been reported as high as 8 to 10%, with more than 80% of the cases occurring in females. Although pathologic changes exist in muscles from both sides of the spinal curvature, and no statistically significant side differences have been reported, morphologic changes suggest that the concanve side is the most affected. This paper reports our preliminary data on the elemental composition of individual muscle fibers derived from convex, concave and gluteal scoliotic muscle, and erythrocytes from scoliotic and normal patients, analyzed by proton induced x-ray emission (PIXE) and x-ray fluorescence spectroscopy (XRF). A new type of specimen holder was designed for this study which offers low x-ray background, minimal absorption and maintenance of a moist environment around the specimen.

  1. INVOLVEMENT OF P53 IN X-RAY INDUCED INTRACHROMOSOMAL RECOMBINATION IN MICE. (R825359)

    EPA Science Inventory

    The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

  2. Static magnetic fields modulate X-ray-induced DNA damage in human glioblastoma primary cells

    PubMed Central

    Teodori, Laura; Giovanetti, Anna; Albertini, Maria Cristina; Rocchi, Marco; Perniconi, Barbara; Valente, Maria Giovanna; Coletti, Dario

    2014-01-01

    Although static magnetic fields (SMFs) are used extensively in the occupational and medical fields, few comprehensive studies have investigated their possible genotoxic effect and the findings are controversial. With the advent of magnetic resonance imaging-guided radiation therapy, the potential effects of SMFs on ionizing radiation (IR) have become increasingly important. In this study we focused on the genotoxic effect of 80 mT SMFs, both alone and in combination with (i.e. preceding or following) X-ray (XR) irradiation, on primary glioblastoma cells in culture. The cells were exposed to: (i) SMFs alone; (ii) XRs alone; (iii) XR, with SMFs applied during recovery; (iv) SMFs both before and after XR irradiation. XR-induced DNA damage was analyzed by Single Cell Gel Electrophoresis assay (comet assay) using statistical tools designed to assess the tail DNA (TD) and tail length (TL) as indicators of DNA fragmentation. Mitochondrial membrane potential, known to be affected by IR, was assessed using the JC-1 mitochondrial probe. Our results showed that exposure of cells to 5 Gy of XR irradiation alone led to extensive DNA damage, which was significantly reduced by post-irradiation exposure to SMFs. The XR-induced loss of mitochondrial membrane potential was to a large extent averted by exposure to SMFs. These data suggest that SMFs modulate DNA damage and/or damage repair, possibly through a mechanism that affects mitochondria. PMID:24345558

  3. Evidence of Zinc in Affording Protection Against X-Ray-Induced Brain Injury in Rats.

    PubMed

    Sharma, Priyanka; Singla, Neha; Dhawan, D K

    2017-03-06

    In the present world, X-rays have been regarded as one of the most efficient tools in medicine, industry and research. On the contrary, extensive human exposure to these rays is responsible for causing detrimental effects on physiological system. The aim of the present study was to investigate the role of zinc (Zn), if any, in mitigating the adverse effects induced by fractionated X-irradiation on rat brain. Female Sprague-Dawley rats weighing 170-200 g were divided into four different groups viz.: (a) normal control, (b) X-irradiated (21Gy), (c) zinc treated (227 mg/L in drinking water) and (d) X-irradiated + zinc treated. The skulls of animals belonging to groups (b) and (d) were exposed to X-rays in 30 fractions. Each fraction delivered a radiation dose of 70 rads, and rats were exposed to two fractions every day for 15 days, consecutively. X-ray treatment resulted in significant alterations in the neurobehavior, neurotransmitter levels and neuro-histoarchitecture of rats, whereas zinc co-treatment with X-rays resulted in significant improvement in these parameters. X-ray exposure also caused a significant increase in the levels of lipid peroxidation as well as activities of catalase and superoxide dismutase, which however were decreased upon simultaneous Zn treatment. On the contrary, X-ray treatment down-regulated the glutathione system, which were found to be up-regulated by zinc co-treatment. Further, protein expressions of p53 and NF-ҚB were found to be significantly elevated after X-irradiation, which were reversed following Zn supplementation. Hence, Zn seems to be an effective agent in mitigating the detrimental effects caused by exposure to X-rays.

  4. Monochromatic X-Ray Induced Novel Synthesis of Plasmonic Nanostructure for Photovoltaic Application

    PubMed Central

    Bharti, Amardeep; Bhardwaj, Richa; Agrawal, Ashish K.; Goyal, Navdeep; Gautam, Sanjeev

    2016-01-01

    It has been universally delineated that the plasmonic metal nanoparticles can enhance the efficiency of photovoltaic cell by increasing the probability of energetic solar photons capturing phenomena using localized surface plasmonic resonance response. In this paper, we developed a novel in-situ simple approach to synthesize noble plasmonic silver nanoparticles (AgNP) from aqueous poly-vinyl-pyrrolidone solution of metal salt using radiolysis of water via synchrotron monochromatic X-ray irradiation without any chemical reducing agent. X-ray irradiation of water produces hydrated electrons , superoxide and atom radicals , which triggers the reaction and reduces metal salt. X-ray radiolysis based synthesis provides the control over the reaction and prevent the formation of secondary products as occurs in case of chemical reduction route. In the previous studies, synchrotron “white” X-rays had been examined for the synthesis of metal nanoparticles, but that technique limits only upto the material synthesis while in this work we explored the role of “monochromatic” X-rays for the production of bulk amount of nanoparticles which would also provide the feasibility of in-situ characterization. Transmission electron micrographs show that the synthesized AgNP appears spherical with diameter of 2–6 nm and is in agreement with the size estimation from uv-vis spectra by “Mie theory”. PMID:27094793

  5. X-ray induced photocurrent characteristics of CVD diamond detectors with different carbon electrodes

    NASA Astrophysics Data System (ADS)

    Schirru, F.; Lohstroh, A.; Jayawardena, K. D. G. I.; Henley, S. J.; Sellin, P. J.

    2013-12-01

    Diamond has unique properties which make it suitable for a broad range of radiation detection applications ranging from particle timing and spectroscopy, to neutron, UV and X-ray sensors. In X-ray dosimetry, the atomic number of diamond (Z = 6) close to that of the human tissues (Z = 7.42) allows to mimic the real absorbed dose avoiding off-line recalculations. Moreover, its low atomic number and the capability to withstand high radiation fluxes make possible its use as beam monitor without altering significantly the properties of the interacting beam. To preserve the tissue equivalence of the diamond and minimize the perturbation and absorption of the incident beam, diamond detectors based on low thickness and low atomic number electrodes become a requirement. In this paper we present the X-ray detection characteristics of electronic grade CVD diamond sensors prepared in house with thin amorphous carbon electrodes fabricated by Pulsed Laser Deposition (PLD) technique in the fluence range of 2.3-3.6 J·cm-2. The devices showed a linear dependence of the induced photocurrent respect to the dose rate. Also, best dynamic response and better stability of the signals were achieved for applied bias up to ±50 V with signal to noise ratio (SNR) of ~ 300.

  6. Static magnetic fields modulate X-ray-induced DNA damage in human glioblastoma primary cells.

    PubMed

    Teodori, Laura; Giovanetti, Anna; Albertini, Maria Cristina; Rocchi, Marco; Perniconi, Barbara; Valente, Maria Giovanna; Coletti, Dario

    2014-03-01

    Although static magnetic fields (SMFs) are used extensively in the occupational and medical fields, few comprehensive studies have investigated their possible genotoxic effect and the findings are controversial. With the advent of magnetic resonance imaging-guided radiation therapy, the potential effects of SMFs on ionizing radiation (IR) have become increasingly important. In this study we focused on the genotoxic effect of 80 mT SMFs, both alone and in combination with (i.e. preceding or following) X-ray (XR) irradiation, on primary glioblastoma cells in culture. The cells were exposed to: (i) SMFs alone; (ii) XRs alone; (iii) XR, with SMFs applied during recovery; (iv) SMFs both before and after XR irradiation. XR-induced DNA damage was analyzed by Single Cell Gel Electrophoresis assay (comet assay) using statistical tools designed to assess the tail DNA (TD) and tail length (TL) as indicators of DNA fragmentation. Mitochondrial membrane potential, known to be affected by IR, was assessed using the JC-1 mitochondrial probe. Our results showed that exposure of cells to 5 Gy of XR irradiation alone led to extensive DNA damage, which was significantly reduced by post-irradiation exposure to SMFs. The XR-induced loss of mitochondrial membrane potential was to a large extent averted by exposure to SMFs. These data suggest that SMFs modulate DNA damage and/or damage repair, possibly through a mechanism that affects mitochondria.

  7. X-ray-induced dominant lethal mutations in mouse oocytes detected by an in vitro assay

    SciTech Connect

    Goldstein, L.S.

    1987-11-01

    Female mice were X-irradiated with 0.5-4.5 Gy 2 h before mating to unirradiated males of the same strain. The dominant lethal frequencies (DLF) were determined by growing the embryos in vitro from the two-cell stage and determining the relative rates of successful embryogenesis to the blastocyst stage and to the trophectoderm outgrowth with proliferated inner cell mass stage. The DLF increased with increasing dose, the two linear aspects having a breakpoint at about 1.5 Gy. The nature of embryo failure was also dose dependent. At doses less than 2.0 Gy embryos failed predominantly after blastocyst formation, but at higher doses the embryos failed both before and after blastocyst formation. Over the dose range tested, the frequency with which lesions leading to dominant lethality were induced (i.e., -ln(1 - DLF)) increased linearly with increasing dose.

  8. Three-dimensional model of x-ray induced microchannel plate output

    SciTech Connect

    Harding, E. C.; Drake, R. P.

    2006-10-15

    Microchannel plates are an important component in a type of imaging diagnostic known as an x-ray framing camera, used in x-ray radiography of high-energy-density physics experiments. A microchannel plate is responsible for detecting x rays and then converting them into amplified bursts of electrons, which are then imaged onto a phosphor-coated fiber optic screen. We present the preliminary development of a three-dimensional model of a single microchannel plate channel in attempt to simulate the pulse height distribution of the microchannel plate electron output. Using a novel technique, initial simulations are compared with experimental data from an ungated x-ray framing camera.

  9. Distribution of X-ray-induced chromosome breakpoints in Down syndrome lymphocytes

    SciTech Connect

    Shafik, H.M.; Au, W.W.; Whorton, E.B. Jr.; Legator, M.S. )

    1990-01-01

    Down syndrome (DS) individuals are known to be predisposed to develop leukemia and their lymphocytes are highly sensitive to the induction of chromosome aberrations by X-rays. A study was conducted to identify the chromosome breakpoints and to evaluate whether site specificity for chromosome breakage and rearrangement may exist which may explain the predisposition phenomenon. DS lymphocytes at the G1 phase of the cell cycle were irradiated with 300, 450, and 600 rad of X-rays. Cells were harvested after 3 days in culture and 193 G-banded karyotypes were analyzed to identify the induced chromosome abnormalities. Out of 273 breakpoints identified, 122 were involved in the formation of stable chromosome rearrangements and 151 in the formation of unstable abnormalities. The Poisson analysis of these breakpoints demonstrated that 16 chromosome bands located in chromosomes 1, 3, 7, 12, 17, 19 and X were preferentially involved in breakage and rearrangement (P less than 0.05). These 16 bands are also found to be locations of cancer breakpoints, oncogenes, or fragile sites. Many abnormal cells were observed to carry stable chromosome rearrangements only. Therefore, these cells are presumed to be compatible with survival and to be initiated in the transformation process. We propose that similar stable and site-specific chromosome rearrangements may exist in proliferating cells in DS individuals after exposure to clastogens and that this abnormality predisposes them to develop leukemia.

  10. Defects in sodalite-group minerals determined from X-ray-induced luminescence

    NASA Astrophysics Data System (ADS)

    Finch, Adrian A.; Friis, Henrik; Maghrabi, Mufeed

    2016-07-01

    The luminescence spectra of a suite of natural sodium framework silicates including four different sodalite variants and tugtupite have been collected during X-ray irradiation as a function of temperature between 20 and 673 K. The origin of the emission bands observed in these samples is attributed to F-centres (360 nm), paramagnetic oxygen defects (400 and 450 nm), S2 - ions (620 nm) and tetrahedral Fe3+ (730 nm). Luminescence in the yellow (550 nm) is tentatively attributed to Mn2+, and red luminescence in Cr-rich pink sodalite is possibly from Cr3+ activation. Sudden reduction in luminescence intensities of emission centres was observed for all minerals in the 60-120 K range. Since it is common to all the sodalite-group minerals, we infer it is a feature of the aluminosilicate framework. Sodalite luminescence has responses from substitutions on the framework (e.g. paramagnetic oxygen defects, Fe3+) which give sodalite properties akin to other framework silicates such as feldspar and quartz. However, the presence of the sodalite cage containing anions (such as F-centres, S2 - ions) imparts additional properties akin to alkali halides. The possibility of coupling between Fe3+ and S2 - is discussed. The overall luminescence behaviour of sodalite group can be understood in terms of competition between these centre types.

  11. Thermoluminescence characteristics of X-ray induced kyanite mineral and its thermal quenching parameters

    NASA Astrophysics Data System (ADS)

    Kalita, J. M.; Wary, G.

    2014-04-01

    Thermoluminescence (TL) glow curves of X-ray irradiated micro-grain natural kyanite have been recorded under annealed and un-annealed condition at various heating rates (2, 4, 6, 8 and 10 K s-1). TL parameters such as activation energy, order of kinetic and pre-exponential frequency factor have been investigated from the glow peak by a computerized glow curve deconvolution technique. Variation of peak integrals, peak maximum temperatures, FWHM and activation energy with heating rates have been investigated and the glow curves at higher rates have been found to be influenced by presence of thermal quenching. For annealed sample value of thermal quenching activation energy ( W) and pre-exponential factor ( C) are found to be 0.86 ± 0.02 eV and 2.5 × 109 s-1 respectively and for un-annealed sample these values are 1.68 ± 0.03 eV and 3.1 × 1010 s-1 respectively. Experimentally measured value of W and C have been verified by estimating thermal quenching efficiencies η( T) with the help of calculated value of W and C; quenched glow curves have been successfully reconstructed for each heating rate. The dose sensitivity of both types of samples is also reported. Annealed sample shows improved dose response than un-annealed sample.

  12. Monochromatic X-Ray Induced Novel Synthesis of Plasmonic Nanostructure for Photovoltaic Application

    NASA Astrophysics Data System (ADS)

    Bharti, Amardeep; Bhardwaj, Richa; Agrawal, Ashish K.; Goyal, Navdeep; Gautam, Sanjeev

    2016-04-01

    It has been universally delineated that the plasmonic metal nanoparticles can enhance the efficiency of photovoltaic cell by increasing the probability of energetic solar photons capturing phenomena using localized surface plasmonic resonance response. In this paper, we developed a novel in-situ simple approach to synthesize noble plasmonic silver nanoparticles (AgNP) from aqueous poly-vinyl-pyrrolidone solution of metal salt using radiolysis of water via synchrotron monochromatic X-ray irradiation without any chemical reducing agent. X-ray irradiation of water produces hydrated electrons , superoxide and atom radicals , which triggers the reaction and reduces metal salt. X-ray radiolysis based synthesis provides the control over the reaction and prevent the formation of secondary products as occurs in case of chemical reduction route. In the previous studies, synchrotron “white” X-rays had been examined for the synthesis of metal nanoparticles, but that technique limits only upto the material synthesis while in this work we explored the role of “monochromatic” X-rays for the production of bulk amount of nanoparticles which would also provide the feasibility of in-situ characterization. Transmission electron micrographs show that the synthesized AgNP appears spherical with diameter of 2–6 nm and is in agreement with the size estimation from uv-vis spectra by “Mie theory”.

  13. Structural study of the X-ray-induced enzymatic reaction of octahaem cytochrome C nitrite reductase.

    PubMed

    Trofimov, A A; Polyakov, K M; Lazarenko, V A; Popov, A N; Tikhonova, T V; Tikhonov, A V; Popov, V O

    2015-05-01

    Octahaem cytochrome c nitrite reductase from the bacterium Thioalkalivibrio nitratireducens catalyzes the reduction of nitrite to ammonium and of sulfite to sulfide. The reducing properties of X-ray radiation and the high quality of the enzyme crystals allow study of the catalytic reaction of cytochrome c nitrite reductase directly in a crystal of the enzyme, with the reaction being induced by X-rays. Series of diffraction data sets with increasing absorbed dose were collected from crystals of the free form of the enzyme and its complexes with nitrite and sulfite. The corresponding structures revealed gradual changes associated with the reduction of the catalytic haems by X-rays. In the case of the nitrite complex the conversion of the nitrite ions bound in the active sites to NO species was observed, which is the beginning of the catalytic reaction. For the free form, an increase in the distance between the oxygen ligand bound to the catalytic haem and the iron ion of the haem took place. In the case of the sulfite complex no enzymatic reaction was detected, but there were changes in the arrangement of the active-site water molecules that were presumably associated with a change in the protonation state of the sulfite ions.

  14. X-ray induced luminescence properties of (Y,Eu)AlO3 single crystals

    NASA Astrophysics Data System (ADS)

    Kuro, Tomoaki; Nakauchi, Daisuke; Okada, Go; Kawaguchi, Noriaki; Yanagida, Takayuki

    2017-02-01

    We investigated photoluminescence, scintillation and dosimeter properties of (Y1-x Eux)AlO3 (x = 0.001, 0.5 and 1) single crystals (hereafter denoted as Eu:YAP for x = 0.001, EYAP for x = 0.5 and EAP for x = 1). The samples were prepared by the Floating Zone method. In photoluminescence (PL), we observed a broad emission around 300-400 nm due to host under excitation of 280 nm, and emissions due to the 4f state transitions of Eu3+ appeared around 590 nm and 615 nm. Scintillation spectra also show emission peaks around 590 and 615 nm due to the 4f state transitions of Eu3+ in all the samples. In addition, emissions around 300-400 nm due to YAP host and around 550-700 nm due to 5d-4f transitions of Eu2+ appeared in Eu:YAP. The PL and scintillation decay time profiles consisted of several exponential decay components. The fast (ns) component group was possibly due to host emission, and especially Eu:YAP demonstrated a very fast PL decay time of 16 ns. The intermediate (μs) component group was due to the 5d-4f transitions of Eu2+. The slow (ms) component group was ascribed to the 4f state transitions of Eu3+ ion. The Eu:YAP sample showed intense thermally-stimulated luminescence (TSL) with peaks at 46, 155, 255 and 443 °C. The intensity was much higher than those of EAP and EYAP. In particular, the peak at 254 °C, which showed the highest intensity, was due to doping with Eu. The TSL dose response function showed a good linearity (R2 > 0.99) over a wide dose range from 0.1 mGy to 100 mGy for Eu:YAP, which showed the highest sensitivity among the present samples.

  15. Hard X-ray-induced optical luminescence via biomolecule-directed metal clusters.

    PubMed

    Osakada, Yasuko; Pratx, Guillem; Sun, Conroy; Sakamoto, Masanori; Ahmad, Moiz; Volotskova, Olga; Ong, Qunxiang; Teranishi, Toshiharu; Harada, Yoshie; Xing, Lei; Cui, Bianxiao

    2014-04-07

    Here, we demonstrate that biomolecule-directed metal clusters are applicable in the study of hard X-ray excited optical luminescence, promising a new direction in the development of novel X-ray-activated imaging probes.

  16. X-ray-induced sterility in Aedes albopictus (Diptera: Culicidae) and male longevity following irradiation.

    PubMed

    Yamada, H; Parker, A G; Oliva, C F; Balestrino, F; Gilles, J R L

    2014-07-01

    The mosquito Aedes albopictus (Skuse, 1895) is a potent vector of several arboviral diseases, most notably chikungunya and dengue fever. In the context of the sterile insect technique (SIT), the sterilization of the male mosquitoes before their release can be achieved by gamma-ray irradiation. As gamma-ray irradiators are becoming increasingly problematic to purchase and transport, the suitability of an X-ray irradiator as an alternative for the sterilization of Ae. albopictus males was studied. The sterilization of up to 200,000 pupae at one time can be achieved with relative ease, and the sterility results obtained were comparable with those achieved by gamma irradiation, where 99% sterility is induced with a dose of 40 Gy. A significant reduction of longevity was observed in the latter stages of the males' life after irradiation treatments, especially at doses > 40 Gy, which is consistent with the negative effects on longevity induced by similar radiation doses using gamma rays. Females irradiated at 40 Gy were not only 100% sterile, but also failed to oviposit entirely, i.e., all of the females laid 0 eggs. Overall, it was found that the X-ray irradiator is generally suitable for the sterilization process for sterile insect technique programs, as it showed a high processing capacity, practicality, high effectiveness, and reproducibility.

  17. What Happens After Treatment for Small Intestine Adenocarcinoma?

    MedlinePlus

    ... After Treatment What Happens After Treatment for Small Intestine Adenocarcinoma? For some people with small intestine cancer, ... Small Intestine Adenocarcinoma Stops Working More In Small Intestine Cancer About Small Intestine Cancer Causes, Risk Factors, ...

  18. What Should You Ask Your Doctor About Small Intestine Adenocarcinoma?

    MedlinePlus

    ... What Should You Ask Your Doctor About Small Intestine Adenocarcinoma? It’s important to have honest, open discussions ... Doctor About Small Intestine Adenocarcinoma? More In Small Intestine Cancer About Small Intestine Cancer Causes, Risk Factors, ...

  19. Adenocarcinoma of Meckel's cave: case report.

    PubMed

    Tacconi, L; Arulampalam, T; Johnston, F; Symon, L

    1995-12-01

    A rare localization of adenocarcinoma in Meckel's cave is reported in a 58-year-old woman, who had a 5-month history of pain and altered sensation in the second division of the left trigeminal nerve. Removal of the lesion was achieved by a subtemporal route. Histology showed this to be an adenocarcinoma. The patient underwent investigations for a primary tumor; the investigations were all negative, and the patient was subsequently treated with a course of radiotherapy. At 4-month follow-up, there was no evidence of recurrence, and she remains symptomatically well. The various mechanisms of secondary localization are discussed.

  20. Aggressive digital papillary adenoma-adenocarcinoma.

    PubMed

    Keramidas, Evangelos G; Miller, Gavin; Revelos, Kyriakos; Kitsanta, Panagiota; Page, Robert E

    2006-01-01

    Aggressive digital papillary adenocarcinoma and aggressive digital papillary adenoma are rare tumours of the sweat glands. They are most common in the most distal part of the fingers and are locally aggressive with a 50% local recurrence rate; 14% of tumours metastasize. We present two cases.

  1. Adenocarcinoma - chest x-ray (image)

    MedlinePlus

    This chest x-ray shows adenocarcinoma of the lung. There is a rounded light spot in the right upper lung (left side ... density. Diseases that may cause this type of x-ray result would be tuberculous or fungal granuloma, and ...

  2. MicroRNA expression profiles associated with pancreatic adenocarcinoma and ampullary adenocarcinoma.

    PubMed

    Schultz, Nicolai A; Werner, Jens; Willenbrock, Hanni; Roslind, Anne; Giese, Nathalia; Horn, Thomas; Wøjdemann, Morten; Johansen, Julia S

    2012-12-01

    MicroRNAs have potential as diagnostic cancer biomarkers. The aim of this study was (1) to define microRNA expression patterns in formalin-fixed parafin-embedded tissue from pancreatic ductal adenocarcinoma, ampullary adenocarcinoma, normal pancreas and chronic pancreatitis without using micro-dissection and (2) to discover new diagnostic microRNAs and combinations of microRNAs in cancer tissue. The expression of 664 microRNAs in tissue from 170 pancreatic adenocarcinomas and 107 ampullary adenocarcinomas were analyzed using a commercial microRNA assay. Results were compared with chronic pancreatitis, normal pancreas and duodenal adenocarcinoma. In all, 43 microRNAs had higher and 41 microRNAs reduced expression in pancreatic cancer compared with normal pancreas. In all, 32 microRNAs were differently expressed in pancreatic adenocarcinoma compared with chronic pancreatitis (17 higher; 15 reduced). Several of these microRNAs have not before been related to diagnosis of pancreatic cancer (eg, miR-492, miR-614, miR-622). MiR-614, miR-492, miR-622, miR-135b and miR-196 were most differently expressed. MicroRNA profiles of pancreatic and ampullary adenocarcinomas were correlated (0.990). MicroRNA expression profiles for pancreatic cancer described in the literature were consistent with our findings, and the microRNA profile for pancreatic adenocarcinoma (miR-196b-miR-217) was validated. We identified a more significant expression profile, the difference between miR-411 and miR-198 (P=2.06 × 10(-54)) and a diagnostic LASSO classifier using 19 microRNAs (sensitivity 98.5%; positive predictive value 97.8%; accuracy 97.0%). We also identified microRNA profiles to subclassify ampullary adenocarcinomas into pancreatobiliary or intestinal type. In conclusion, we found that combinations of two microRNAs could roughly separate neoplastic from non-neoplastic samples. A diagnostic 19 microRNA classifier was constructed which without micro-dissection could discriminate pancreatic

  3. FOLFOX-6 Induction Chemotherapy Followed by Esophagectomy and Post-operative Chemoradiotherapy in Patients With Esophageal Adenocarcinoma

    ClinicalTrials.gov

    2016-09-15

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Adenocarcinoma of the Gastric Cardia; Stage IIIA Esophageal Cancer; Stage IIIB Esophageal Cancer; Stage IIIC Esophageal Cancer

  4. Pancreatic Adenocarcinoma, Version 2.2012

    PubMed Central

    Tempero, Margaret A.; Arnoletti, J. Pablo; Behrman, Stephen W.; Ben-Josef, Edgar; Benson, Al B.; Casper, Ephraim S.; Cohen, Steven J.; Czito, Brian; Ellenhorn, Joshua D. I.; Hawkins, William G.; Herman, Joseph; Hoffman, John P.; Ko, Andrew; Komanduri, Srinadh; Koong, Albert; Ma, Wen Wee; Malafa, Mokenge P.; Merchant, Nipun B.; Mulvihill, Sean J.; Muscarella, Peter; Nakakura, Eric K.; Obando, Jorge; Pitman, Martha B.; Sasson, Aaron R.; Tally, Anitra; Thayer, Sarah P.; Whiting, Samuel; Wolff, Robert A.; Wolpin, Brian M.; Freedman-Cass, Deborah A.; Shead, Dorothy A.

    2013-01-01

    The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Pancreatic Adenocarcinoma discuss the workup and management of tumors of the exocrine pancreas. These NCCN Guidelines Insights provide a summary and explanation of major changes to the 2012 NCCN Guidelines for Pancreatic Adenocarcinoma. The panel made 3 significant updates to the guidelines: 1) more detail was added regarding multiphase CT techniques for diagnosis and staging of pancreatic cancer, and pancreas protocol MRI was added as an emerging alternative to CT; 2) the use of a fluoropyrimidine plus oxaliplatin (e.g., 5-FU/leucovorin/oxaliplatin or capecitabine/oxaliplatin) was added as an acceptable chemotherapy combination for patients with advanced or metastatic disease and good performance status as a category 2B recommendation; and 3) the panel developed new recommendations concerning surgical technique and pathologic analysis and reporting. PMID:22679115

  5. [Atypical metastatic site of lung adenocarcinoma].

    PubMed

    Sakhri, L; Mennecier, B; Jacqmin, D; Di Marco, A; Schumacher, C; Chenard, M-P; Bergmann, E; Quoix, E

    2011-12-01

    The case concerns a 40 years old smoker male, treated for an adenocarcinoma of the left upper lobe, metastatic in muscle extended to the right femur cortex. The patient had first a surgical excision of the mass of the thigh, an intramedullary femoral nailing, and six courses of chemotherapy (cisplatin-vinorelbine) with concurrent thoracic radiotherapy. This treatment led to disease stability. One year later, hematuria revealed a bladder tumor. Cystoscopy with biopsy concluded to an adenocarcinoma pulmonary origin. The PET-scanner showed an uptake of the bladder mass, a hypermetabolic right adrenal gland and subcutaneous left shoulder nodule. The patient had a partial cystectomy associated with enterocystoplasty and left ureteral reimplantation, plus excision of the subcutaneous nodule located in the left shoulder and a right adrenalectomy during the same time. All of the sites were metastasis from adenocarcinoma of pulmonary origin. A salvage chemotherapy was initiated. In the vast majority of cases, bladder metastasis as primary bladder tumours is revealed by hematuria, cystitis or sometimes vague pelvic pain. Our case is a very unusual bladder metastatic site from lung cancer. We will discuss the different procedures and the therapeutic strategies on the basis of the published data.

  6. Laparoscopy in the management of gastric adenocarcinoma.

    PubMed Central

    Burke, E C; Karpeh, M S; Conlon, K C; Brennan, M F

    1997-01-01

    OBJECTIVE: The authors determined the accuracy of laparoscopy in detecting metastatic disease in patients with gastric adenocarcinoma. SUMMARY BACKGROUND DATA: The majority of patients with gastric adenocarcinoma in the United States present with advanced disease. They are at high risk for intraabdominal metastatic spread. METHODS: One hundred eleven patients with gastric adenocarcinoma underwent laparoscopy at Memorial-Sloan Kettering Cancer Center from December 1991 to December 1995. All were judged to be free of intra-abdominal metastatic disease on preoperative computed tomographic scan imaging. RESULTS: Laparoscopic exploration was successful in 110 of 111 patients and accurately staged 94% of the patients with respect to metastatic disease with a sensitivity of 84% and a specificity of 100%. The prevalence rate of metastatic disease was 37%. Twenty-four patients underwent laparoscopy only and were discharged in an average 1.4 days versus 6.5 days in patients undergoing exploratory laparotomy without resection (p < 0.05). No patients undergoing laparoscopy only have returned for palliative surgery. CONCLUSIONS: Laparoscopy should be performed in nonobstructed, nonbleeding patients with advanced gastric cancer in the United States. More than one third of these patients have unsuspected metastatic disease at time of operation. Laparoscopy is highly accurate in detecting occult metastases and identifies a unique population of stage IV patients who may benefit from newer induction chemotherapeutic approaches while avoiding unnecessary laparotomy. Images Figure 4. PMID:9060581

  7. Carcinogenesis of Pancreatic Adenocarcinoma: Precursor Lesions

    PubMed Central

    Gnoni, Antonio; Licchetta, Antonella; Scarpa, Aldo; Azzariti, Amalia; Brunetti, Anna Elisabetta; Simone, Gianni; Nardulli, Patrizia; Santini, Daniele; Aieta, Michele; Delcuratolo, Sabina; Silvestris, Nicola

    2013-01-01

    Pancreatic adenocarcinoma displays a variety of molecular changes that evolve exponentially with time and lead cancer cells not only to survive, but also to invade the surrounding tissues and metastasise to distant sites. These changes include: genetic alterations in oncogenes and cancer suppressor genes; changes in the cell cycle and pathways leading to apoptosis; and also changes in epithelial to mesenchymal transition. The most common alterations involve the epidermal growth factor receptor (EGFR) gene, the HER2 gene, and the K-ras gene. In particular, the loss of function of tumor-suppressor genes has been documented in this tumor, especially in CDKN2a, p53, DPC4 and BRCA2 genes. However, other molecular events involved in pancreatic adenocarcinoma pathogenesis contribute to its development and maintenance, specifically epigenetic events. In fact, key tumor suppressors that are well established to play a role in pancreatic adenocarcinoma may be altered through hypermethylation, and oncogenes can be upregulated secondary to permissive histone modifications. Indeed, factors involved in tumor invasiveness can be aberrantly expressed through dysregulated microRNAs. This review summarizes current knowledge of pancreatic carcinogenesis from its initiation within a normal cell until the time that it has disseminated to distant organs. In this scenario, highlighting these molecular alterations could provide new clinical tools for early diagnosis and new effective therapies for this malignancy. PMID:24084722

  8. Intraoperative molecular imaging to identify lung adenocarcinomas

    PubMed Central

    Newton, Andrew D.; Kennedy, Gregory T.; Predina, Jarrod D.; Low, Philip S.

    2016-01-01

    Intraoperative molecular imaging is a promising new technology with numerous applications in lung cancer surgery. Accurate identification of small nodules and assessment of tumor margins are two challenges in pulmonary resections for cancer, particularly with increasing use of video-assisted thoracoscopic surgery (VATS). One potential solution to these problems is intraoperative use of a fluorescent contrast agent to improve detection of cancer cells. This technology requires both a targeted fluorescent dye that will selectively accumulate in cancer cells and a specialized imaging system to detect the cells. In several studies, we have shown that intraoperative imaging with indocyanine green (ICG) can be used to accurately identify indeterminate pulmonary nodules. The use of a folate-tagged fluorescent molecule targeted to the folate receptor-α (FRα) further improves the sensitivity and specificity of detecting lung adenocarcinomas. We have demonstrated this technology can be used as an “optical biopsy” to differentiate adenocarcinoma versus other histological subtypes of pulmonary nodules. This strategy has potential applications in assessing bronchial stump margins, identifying synchronous or metachronous lesions, and rapidly assessing lymph nodes for lung adenocarcinoma. PMID:28066672

  9. Comprehensive molecular profiling of lung adenocarcinoma

    PubMed Central

    2014-01-01

    Adenocarcinoma of the lung is the leading cause of cancer death worldwide. Here we report molecular profiling of 230 resected lung adenocarcinomas using messenger RNA, microRNA and DNA sequencing integrated with copy number, methylation and proteomic analyses. High rates of somatic mutation were seen (mean 8.9 mutations per megabase). Eighteen genes were statistically significantly mutated, including RIT1 activating mutations and newly described loss-of-function MGA mutations which are mutually exclusive with focal MYC amplification. EGFR mutations were more frequent in female patients, whereas mutations in RBM10 were more common in males. Aberrations in NF1, MET, ERBB2 and RIT1 occurred in 13% of cases and were enriched in samples otherwise lacking an activated oncogene, suggesting a driver role for these events in certain tumours. DNA and mRNA sequence from the same tumour highlighted splicing alterations driven by somatic genomic changes, including exon 14 skipping in MET mRNA in 4% of cases. MAPK and PI(3)K pathway activity, when measured at the protein level, was explained by known mutations in only a fraction of cases, suggesting additional, unexplained mechanisms of pathway activation. These data establish a foundation for classification and further investigations of lung adenocarcinoma molecular pathogenesis. PMID:25079552

  10. Comprehensive molecular profiling of lung adenocarcinoma.

    PubMed

    2014-07-31

    Adenocarcinoma of the lung is the leading cause of cancer death worldwide. Here we report molecular profiling of 230 resected lung adenocarcinomas using messenger RNA, microRNA and DNA sequencing integrated with copy number, methylation and proteomic analyses. High rates of somatic mutation were seen (mean 8.9 mutations per megabase). Eighteen genes were statistically significantly mutated, including RIT1 activating mutations and newly described loss-of-function MGA mutations which are mutually exclusive with focal MYC amplification. EGFR mutations were more frequent in female patients, whereas mutations in RBM10 were more common in males. Aberrations in NF1, MET, ERBB2 and RIT1 occurred in 13% of cases and were enriched in samples otherwise lacking an activated oncogene, suggesting a driver role for these events in certain tumours. DNA and mRNA sequence from the same tumour highlighted splicing alterations driven by somatic genomic changes, including exon 14 skipping in MET mRNA in 4% of cases. MAPK and PI(3)K pathway activity, when measured at the protein level, was explained by known mutations in only a fraction of cases, suggesting additional, unexplained mechanisms of pathway activation. These data establish a foundation for classification and further investigations of lung adenocarcinoma molecular pathogenesis.

  11. Solitary Psoas Muscle Metastasis of Gastroesphageal Junction Adenocarcinoma

    PubMed Central

    Azadeh, Payam; Yaghobi Joybari, Ali; Sarbaz, Samaneh; Ghiasi, Hosein Ali; Farasatinasab, Maryam

    2016-01-01

    Metastasis of gastroesphageal junction (GEJ) adenocarcinoma in skeletal muscle is rare and primary sites for skeletal muscle metastases are usually lung, renal and colorectal cancer. We have encountered with the first case report of solitary psoas muscle metastasis of GEJ adenocarcinoma. Here we describe a 65 years old man was diagnosed with GEJ adenocarcinoma in Gastroenterology Department, Imam Hussein Hospital, Tehran, Iran in February 2014. We were not able to use PET techniques due to lack of access. Staging CT scans demonstrated a small mass lateral to right psoas muscle. A CT-guided core needle biopsy of right psoas muscle was performed that supported a diagnosis of adenocarcinoma consistent with primary adenocarcinoma of the GEJ. Distant metastasis to skeletal muscle rarely occurs in patients with GEJ adenocarcinoma, but heightened awareness to these soft tissue lesions is warranted. CT or MR imaging could show findings suggestive of metastatic disease, although PET is preferable modality. PMID:26870148

  12. Ductal Adenocarcinoma of the Prostate: A Case Report

    PubMed Central

    Hayashi, Yutaro; Kawahara, Takashi; Iwashita, Hiromichi; Shimokihara, Kota; Tsutsumi, Sohgo; Takamoto, Daiji; Mochizuki, Taku; Hattori, Yusuke; Teranishi, Jun-ichi; Miyoshi, Yasuhide; Yumura, Yasushi; Yao, Masahiro; Inayama, Yoshiaki; Uemura, Hiroji

    2016-01-01

    Ductal adenocarcinoma is an unusual variant of adenocarcinoma of the prostate. A 73-year-old male was referred to our hospital for the further examination of an elevated prostate-specific antigen level of 23.4 ng/mL. Radical prostatectomy (RP) was performed based on the diagnosis obtained by a prostate needle biopsy. The RP specimen revealed ductal adenocarcinoma of the prostate with positive capsular penetration. We herein report a rare case of ductal adenocarcinoma of the prostate. PMID:28101029

  13. Laparoscopic Diagnosis of Adenocarcinoma of the Appendix Mimicking Serous Papillary Adenocarcinoma of the Peritoneum

    PubMed Central

    Yoshimura, Mayumi; Terai, Yoshito; Konishi, Hiromi; Tanaka, Yoshimichi; Tanaka, Tomohito; Sasaki, Hiroshi; Ohmichi, Masahide

    2013-01-01

    Primary carcinoma of the vermiform appendix is a rare disease with few clinical symptoms. Accordingly, preoperative diagnosis of appendiceal cancer is challenging because of the lack of specific symptoms. We herein report a case of appendicular adenocarcinoma found unexpectedly during laparoscopic surgery in a 69-year-old Japanese female patient diagnosed with serous papillary adenocarcinoma, in order to determine whether optimal cytoreduction could successfully be achieved at the time of primary surgery. We performed diagnostic laparoscopic surgery in order to make a correct diagnosis based on the histological tissue. The vermiform appendix was found to contain a tumor measuring 1.5 cm wide and 4.5 cm long. Laparoscopic appendectomy, partial omentectomy, and partial resection of the lesion in the peritoneum were performed. The histological diagnosis was mucinous adenocarcinoma of the vermiform appendix, and the stage was T4NxM1. The patient received adjuvant chemotherapy with mFOLFOX 6 (5FU, leucovorin, and oxaliplatin). She achieved stable disease and was alive with disease eleven months after surgery. We therefore recommend that gynecologists should not rule out the possibility of appendiceal cancer, even in cases with preoperative findings similar to those of serous papillary adenocarcinoma of the peritoneum with peritoneal disseminated tumors. PMID:24383020

  14. Intensity-Modulated Radiotherapy for Pancreatic Adenocarcinoma

    SciTech Connect

    Abelson, Jonathan A.; Murphy, James D.; Minn, Ann Yuriko; Chung, Melody; Fisher, George A.; Ford, James M.; Kunz, Pamela; Norton, Jeffrey A.; Visser, Brendan C.; Poultsides, George A.; Koong, Albert C.; Chang, Daniel T.

    2012-03-15

    Purpose: To report the outcomes and toxicities in patients treated with intensity-modulated radiotherapy (IMRT) for pancreatic adenocarcinoma. Methods and Materials: Forty-seven patients with pancreatic adenocarcinoma were treated with IMRT between 2003 and 2008. Of these 47 patients, 29 were treated adjuvantly and 18 definitively. All received concurrent 5-fluorouracil chemotherapy. The treatment plans were optimized such that 95% of the planning target volume received the prescription dose. The median delivered dose for the adjuvant and definitive patients was 50.4 and 54.0 Gy, respectively. Results: The median age at diagnosis was 63.9 years. For adjuvant patients, the 1- and 2-year overall survival rate was 79% and 40%, respectively. The 1- and 2-year recurrence-free survival rate was 58% and 17%, respectively. The local-regional control rate at 1 and 2 years was 92% and 80%, respectively. For definitive patients, the 1-year overall survival, recurrence-free survival, and local-regional control rate was 24%, 16%, and 64%, respectively. Four patients developed Grade 3 or greater acute toxicity (9%) and four developed Grade 3 late toxicity (9%). Conclusions: Survival for patients with pancreatic cancer remains poor. A small percentage of adjuvant patients have durable disease control, and with improved therapies, this proportion will increase. Systemic therapy offers the greatest opportunity. The present results have demonstrated that IMRT is well tolerated. Compared with those who received three-dimensional conformal radiotherapy in previously reported prospective clinical trials, patients with pancreatic adenocarcinoma treated with IMRT in our series had improved acute toxicity.

  15. Endometrial Adenocarcinoma Presenting in a Premenopausal Patient with Tuberous Sclerosis

    ERIC Educational Resources Information Center

    Jaffe, J. S.; Chambers, J. T.

    2005-01-01

    Background: Endometrial adenocarcinoma is very uncommon in women under 40 years of age. Case: A 39-year-old woman with tuberous sclerosis and severe intellectual disability presented with irregular bleeding unresponsive to oral contraceptive therapy. She was subsequently found to have a deeply invasive endometrial adenocarcinoma. Conclusion:…

  16. Eccrine adenocarcinoma of the footpads in 2 cats.

    PubMed Central

    Fuentealba, I C; Illanes, O G; Haines, D M

    2000-01-01

    Adenocarcinoma of sweat glands of the footpads was diagnosed in 2 cats. Clinical signs included lameness and swelling of multiple digits. Pulmonary metastasis was detected in one case. Diagnosis was based on histopathological and immunohistochemical findings. Eccrine adenocarcinoma should be included in the differential diagnosis of footpads lesions in aged cats. Images Figure 1. Figure 2. PMID:10816835

  17. Laparoscopic treatment of mucinous urachal adenocarcinoma with mucocele.

    PubMed

    Oberndoerfer, Marine; Bucher, Pascal; Caviezel, Alessandro; Platon, Alexandra; Ott, Vincent; Egger, Jean-François; Morel, Philippe

    2009-02-01

    We present a case of an asymptomatic 76-year-old woman treated laparoscopically for an urachal mucocele owing to a nonmetastatic urachal mucinous adenocarcinoma. Since laparoscopic en bloc resection of the urachus and partial cystectomy, the patient has been healthy and disease-free for 12 months. Modern surgical treatment of urachal adenocarcinoma is discussed in the light of this case.

  18. Neoadjuvant treatment for resectable pancreatic adenocarcinoma

    PubMed Central

    Wong, John; Solomon, Naveenraj L; Hsueh, Chung-Tsen

    2016-01-01

    Pancreatic adenocarcinoma is the fourth leading cause of cancer mortality in the United States in both men and women, with a 5-year survival rate of less than 5%. Surgical resection remains the only curative treatment, but most patients develop systemic recurrence within 2 years of surgery. Adjuvant treatment with chemotherapy or chemoradiotherapy has been shown to improve overall survival, but the delivery of treatment remains problematic with up to 50% of patients not receiving postoperative treatment. Neoadjuvant therapy can provide benefits of eradication of micrometastasis and improved delivery of intended treatment. We have reviewed the findings from completed neoadjuvant clinical trials, and discussed the ongoing studies. Combinational cytotoxic chemotherapy such as fluorouracil, leucovorin, irinotecan, and oxaliplatin and gemcitabine plus nanoparticle albumin-bound (nab)-paclitaxel, active in the metastatic setting, are being studied in the neoadjuvant setting. In addition, novel targeted agents such as inhibitor of immune checkpoint are incorporated with cytotoxic chemotherapy in early-phase clinical trial. Furthermore we have explored the utility of biomarkers which can personalize treatment and select patients for target-driven therapy to improve treatment outcome. The treatment of resectable pancreatic adenocarcinoma requires multidisciplinary approach and novel strategies including innovative trials to make progress. PMID:26862486

  19. Aggressive papillary adenocarcinoma on atypical localization

    PubMed Central

    Balci, Mecdi Gurhan; Tayfur, Mahir; Deger, Ayse Nur; Cimen, Orhan; Eken, Huseyin

    2016-01-01

    Abstract Introduction: Aggressive digital papillary adenocarcinoma (ADPA) is a rare sweat gland tumor that is found on the fingers, toes, and the digits. To date, <100 cases have been reported in the literature. Apart from 1 case reported in the thigh, all of them were on digital or nondigital acral skin. Case presentation: A 67-year-old Caucasian woman was admitted to the hospital due to a mass on the scalp. This lesion was present for almost a year. It was a semimobile cyctic mass that elevated the scalp. There was no change in the skin color. Its dimensions were 1.5 × 1 × 0.6 cm. The laboratory, clinic, and radiologic findings (head x-ray) of the patient were normal. It was evaluated as a benign lesion such as lipoma or epidermal cyst by a surgeon due to a small semimobile mass and no erosion of the skull. It was excised by a local surgery excision. The result of the pathologic examination was aggressive papillary adenocarcinoma. This diagnosis is synonymous with ADPA. Conclusion: In our case, localization was scalp. This localization is the first for this tumor in the literature. In addition, another atypical localization of this tumor (ADPA) is thigh in the literature. This case was presented due to both the rare and atypical localizations. That is why, in our opinion, revision of “digital” term in ADPA is necessary due to seem in atypical localizations like thigh and scalp. PMID:27428196

  20. Metastasis of Prostate Adenocarcinoma to the Testis

    PubMed Central

    Campara, Zoran; Simic, Dejan; Aleksic, Predrag; Spasic, Aleksandar; Milicevic, Snjezana

    2016-01-01

    Introduction: Prostate carcinoma is the most frequently diagnosed carcinoma in the male population. The most typical places of the metastases are pelvic lymphatic glands, bones and lungs, and very rarely it metastasizes into a testis. The prognostic importance of testicular metastasis of prostate cancer is not yet well-known, due to a very few published cases. According to the known facts, it is certain that a metastasis of the prostate carcinoma into a testis is a sign of an advanced disease. Case report: This work presents a 48-year-old patient, to whom an adenocarcinoma of the prostate has been proven by the pathohistological finding of transrectal biopsy, performed due to the elevated level of prostate-specific antigen (PSA). Nine years after the initial diagnosis, due to a gradual rise of PSA and tumorous enlargement of the left testis, left inguinal orchectomy and right orchectomy were performed. Metastatic dissemination of prostate adenocarcinoma into a testis was determined by a pathohistological analysis of the left testis. Conclusion: The metastasis of the prostate carcinoma into a testis, as a rare localization of the metastatic dissemination, after additionally performed orchectomy along with further oncological therapy, can provide a continuation of a good life quality as well as a control of the disease in a longer time period. PMID:27703299

  1. Clinicopathologic features and prognosis of duodenal adenocarcinoma and comparison with ampullary and pancreatic ductal adenocarcinoma.

    PubMed

    Zenali, Maryam; Overman, Michael J; Rashid, Asif; Broaddus, Russell B; Wang, Hua; Katz, Matthew H; Fleming, Jason B; Abbruzzese, James L; Wang, Huamin

    2013-12-01

    Because of the rarity of duodenal adenocarcinoma (DAC), the clinicopathologic features and prognostication data for DAC are limited. There are no published studies directly comparing the prognosis of DAC to that of ampullary adenocarcinoma (AA) and of pancreatic ductal adenocarcinoma (PDA) after resection. In this study, we examined the clinicopathologic features of 68 patients with DAC, 92 patients with AA, and 126 patients with PDA who underwent resection. Patient clinicopathologic and survival information were extracted from medical records. Statistical analysis was performed using Statistical Package for the Social Sciences with 2-sided significance level of .05. Patients with DAC had higher American Joint Committee on Cancer (AJCC) stage than AA patients (P = .001). Lymph node metastasis (P = .013) and AJCC stage (P = .02) correlated with overall survival in DAC patients. Patients with DAC or AA had lower frequencies of lymph node metastasis and positive margin and better survival than those with PDA (P < .05). However, no differences in nodal metastasis, margin status, or survival were observed between DAC patients and those with AA. Our study showed that lymph node metastasis and AJCC stage are important prognostic factors for overall survival in DAC patients. Patients with DAC had less frequent nodal metastasis and better prognosis than those with PDA. There was no significant difference in prognosis between DAC and AA.

  2. Abiraterone Acetate and Castration Resistant Ductal Adenocarcinoma of the Prostate

    PubMed Central

    Linden-Castro, Edgar; Pelayo-Nieto, Marcela; Alias-Melgar, Alejandro; Espinosa-Perezgrovas, Daniel; Ramirez-Galindo, Ivan; Catalan-Quinto, Gabriel

    2014-01-01

    Ductal adenocarcinoma of the prostate is a rare histological variant that only represents <1% of prostate tumors. This histological variant has several important clinical implications with respect to their evolution, clinical prognosis, and treatment. We report the case of a 64-year-old patient with ductal adenocarcinoma of the prostate, which progresses to castration-resistant prostate cancer, that was treated with abiraterone acetate with good clinical response, to our knowledge, the first case of ductal adenocarcinoma of the prostate in treatment with abiraterone acetate. PMID:24891969

  3. [Secondary neoplasms of the larynx from a colonic adenocarcinoma].

    PubMed

    Dadkhah, Naser; Hahn, Christoffer

    2015-01-26

    Secondary neoplasms of the larynx are rare and account for 0.09-0,4% of all laryngeal tumours. Cutaneous melanomas are the preponderant primaries metastasizing to the larynx, followed by renal cell carcinomas, breast and lung carcinomas. Colonic adenocarcinoma metastases to the larynx are extremely rare. Tumours spreading to the larynx may be asymptomatic or may result in hoarseness, stridor or airway obstruction. Patients with metastasis of colonic adenocarcinoma to the larynx usually present with disseminated disease. We present a case of an isolated laryngeal metastasis from a colonic adenocarcinoma. The patient was treated with endoscopic surgery and radiation.

  4. Biomarkers in pancreatic adenocarcinoma: current perspectives

    PubMed Central

    Swords, Douglas S; Firpo, Matthew A; Scaife, Courtney L; Mulvihill, Sean J

    2016-01-01

    Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year survival rate of 7.7%. Most patients are diagnosed at an advanced stage not amenable to potentially curative resection. A substantial portion of this review is dedicated to reviewing the current literature on carbohydrate antigen (CA 19-9), which is currently the only guideline-recommended biomarker for PDAC. It provides valuable prognostic information, can predict resectability, and is useful in decision making about neoadjuvant therapy. We also discuss carcinoembryonic antigen (CEA), CA 125, serum biomarker panels, circulating tumor cells, and cell-free nucleic acids. Although many biomarkers have now been studied in relation to PDAC, significant work still needs to be done to validate their usefulness in the early detection of PDAC and management of patients with PDAC. PMID:28003762

  5. Preclinical models of pancreatic ductal adenocarcinoma.

    PubMed

    Hwang, Chang-Il; Boj, Sylvia F; Clevers, Hans; Tuveson, David A

    2016-01-01

    Pancreatic ductal adenocarcinoma (PDA) is one of the most difficult human malignancies to treat. The 5-year survival rate of PDA patients is 7% and PDA is predicted to become the second leading cancer-related cause of death in the USA. Despite intensive efforts, the translation of findings in preclinical studies has been ineffective, due partially to the lack of preclinical models that faithfully recapitulate features of human PDA. Here, we review current preclinical models for human PDA (eg human PDA cell lines, cell line-based xenografts and patient-derived tumour xenografts). In addition, we discuss potential applications of the recently developed pancreatic ductal organoids, three-dimensional culture systems and organoid-based xenografts as new preclinical models for PDA.

  6. Targeting Pancreatic Ductal Adenocarcinoma Acidic Microenvironment

    NASA Astrophysics Data System (ADS)

    Cruz-Monserrate, Zobeida; Roland, Christina L.; Deng, Defeng; Arumugam, Thiruvengadam; Moshnikova, Anna; Andreev, Oleg A.; Reshetnyak, Yana K.; Logsdon, Craig D.

    2014-03-01

    Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer death in the USA, accounting for ~40,000 deaths annually. The dismal prognosis for PDAC is largely due to its late diagnosis. Currently, the most sensitive diagnosis of PDAC requires invasive procedures, such as endoscopic ultrasonography, which has inherent risks and accuracy that is highly operator dependent. Here we took advantage of a general characteristic of solid tumors, the acidic microenvironment that is generated as a by-product of metabolism, to develop a novel approach of using pH (Low) Insertion Peptides (pHLIPs) for imaging of PDAC. We show that fluorescently labeled pHLIPs can localize and specifically detect PDAC in human xenografts as well as PDAC and PanIN lesions in genetically engineered mouse models. This novel approach may improve detection, differential diagnosis and staging of PDAC.

  7. Model predictions of myoelectrical activity of the small bowel.

    PubMed

    Miftakhov, R N; Abdusheva, G R; Wingate, D L

    1996-02-01

    A mathematical model for the periodic electrical activity of a functional unit of the small intestine is developed. Based on real morphological and electrophysiological data, the model assumes that: the functional unit is an electromyogenic syncytium; the kinetics of L, T-type Ca2+, mixed Ca(2+)-dependent K+, potential sensitive K+ and Cl- channels determines electrical activity of the functional unit; the basic neural circuit, represented by a single cholinergic neurone, provides an excitatory input to the functional unit via receptor-linked L-type Ca2+ channels. Numerical simulation of the model has shown that it is capable of displaying the slow waves and that slight modifications of some of the parameters result in different electrical responses. The effects of the variations of the main parameters have been analyzed for their ability to reproduce various electrical patterns. The results are in good qualitative and quantitative agreement with results of experiments conducted on the small intestine.

  8. Current Clinical Indications for Small Bowel Capsule Endoscopy.

    PubMed

    Rosa, Bruno; Cotter, José

    2015-01-01

    Introdução: A enteroscopia por cápsula é o exame de primeira linha no diagnóstico de diversas patologias do intestino delgado. Este artigo tem por objectivo rever e analisar criticamente as indicações actuais para enteroscopia por cápsula na prática clínica. Material e Métodos: Revisão bibliográfica suportada em artigos indexados na PubMed. Resultados e Discussão: A enteroscopia por cápsula permite a avaliação não invasiva da mucosa do intestino delgado, com elevado rendimento diagnóstico. Em doentes com hemorragia digestiva de causa obscura, o rendimento da enteroscopia por cápsula aumenta quando realizada precocemente após o evento hemorrágico. O tratamento das angiectasias com enteroscopia assistida por balão permite diminuir a recidiva hemorrágica, enquanto o risco de recidiva em doentes com enteroscopia por cápsula 'negativa' é controverso. A entero-TC/entero-RM podem superiorizar-se à enteroscopia por cápsula no diagnóstico de alguns tumores. O 'Smooth Protruding Index on Capsule Endoscopy' (score SPICE) auxilia na diferenciação entre verdadeiros tumores submucosos e abaulamentos não patológicos. A enteroscopia por cápsula é valiosa em doentes com suspeita de doença de Crohn quando a ileocolonoscopia não é diagnóstica, permitindo também estadiar a extensão e actividade das lesões em doentes com diagnóstico prévio de doença de Crohn, com potenciais implicações prognósticas e terapêuticas. A enteroscopia por cápsula permite ainda o diagnóstico de complicações em doentes com doença celíaca refractária. Conclusões: Actualmente, a importãncia da enteroscopia por cápsula é reconhecida no contexto da hemorragia digestiva de causa obscura e/ou suspeita de tumores do intestino delgado, bem como na suspeita de doença de Crohn ou em doentes com doença de Crohn conhecida para determinar a localização, extensão e actividade da doença, e ainda para a investigação de doentes com doença celíaca refractária.

  9. Recent advances in small bowel diseases: Part I

    PubMed Central

    Thomson, Alan BR; Chopra, Angeli; Clandinin, Michael Tom; Freeman, Hugh

    2012-01-01

    As is the case in all parts of gastroenterology and hepatology, there have been many advances in our knowledge and understanding of small intestinal diseases. Over 1000 publications were reviewed for 2008 and 2009, and the important advances in basic science as well as clinical applications were considered. In Part I of this Editorial Review, seven topics are considered: intestinal development; proliferation and repair; intestinal permeability; microbiotica, infectious diarrhea and probiotics; diarrhea; salt and water absorption; necrotizing enterocolitis; and immunology/allergy. These topics were chosen because of their importance to the practicing physician. PMID:22807604

  10. Isolated Small Bowel Mesentery Injury After Steering Wheel Trauma

    PubMed Central

    Wani, Imtiaz; Bhat, Rayees A; Wani, Shayiq; Khan, Nawab; Wani, Rauf A; Parray, Fazal Q

    2012-01-01

    Background Isolated small gut mesentery injury after blunt abdominal trauma from the steering wheel in road traffic accidents is rare. These are always challenging to diagnose and pose a diagnostic dilemma. Objectives To study the pattern of small gut mesenteric injury by steering wheel blunt abdominal trauma in road traffic accidents in patients who had laparotomy. Patients and Methods A 10-year retrospective study was done to study isolated small gut mesentery injury. Results All patients who had isolated mesenteric small gut injury were males. Jejunal mesentery was involved in 13 whereas 4 had ileal mesentery injury. Tear were longitudinal or transverse. Conclusions Isolated small mesentery injury after blunt abdominal trauma from the steering wheel in road traffic accidents is rare. Tears are either longitudinal or transverse. Suture repair is to be done. Delay in reaching hospital or reaching the diagnosis could lead to morbidity and mortality. Isolated mesenteric injury should be considered in any patient with blunt abdominal trauma from steering wheel injury with no evidence of any solid organ injury in unstable patients. PMID:24350106

  11. MR imaging of the small bowel in Crohn disease.

    PubMed

    Al-Hawary, Mahmoud M; Zimmermann, Ellen M; Hussain, Hero K

    2014-02-01

    MR enterography has an established role in evaluating patients with Crohn disease providing essential complementary information to clinical assessment, and as an indispensible adjunct to clinical tools such as colonoscopy. MR enterography examinations can establish the diagnosis of Crohn disease, evaluate disease activity and complications, and assess treatment response, thus providing support for clinical decision-making. Currently, MR imaging findings are highly predictive of tissue inflammation and can be used clinically to guide clinical care.

  12. Recent advances in small bowel diseases: Part II

    PubMed Central

    Thomson, Alan BR; Chopra, Angeli; Clandinin, Michael Tom; Freeman, Hugh

    2012-01-01

    As is the case in all areas of gastroenterology and hepatology, in 2009 and 2010 there were many advances in our knowledge and understanding of small intestinal diseases. Over 1000 publications were reviewed, and the important advances in basic science as well as clinical applications were considered. In Part II we review six topics: absorption, short bowel syndrome, smooth muscle function and intestinal motility, tumors, diagnostic imaging, and cystic fibrosis. PMID:22807605

  13. Differential permeability of the proximal and distal rabbit small bowel

    PubMed Central

    Ross, Allan; Rubin, Allen W.; Deren, Julius J.

    1972-01-01

    The permeability of the proximal and distal rabbit intestine for two to six carbon polyhydric alcohols was compared. Intestinal segments were mounted in chambers that permitted the measurement of the unidirectional flux across the brush border membrane. For both proximal and distal intestine, the permeability for a series of polyhydric alcohols decreased with increasing size. The proximal intestine was more permeable for four, five, and six carbon polyhydric alcohols than distal intestine. This regional permeability difference can be attributed to variations in the permeability characteristics of the brush border specifically. The uptake of alcohols was nonsaturable and was not inhibited by phlorizine or n-ethylmaleimide. The results are compatible with the concept that the brush border membrane has properties similar to artificial porous membranes and that the equivalent radius of the pores of the proximal intestine exceeds that of the distal gut. PMID:4639025

  14. A Minor Innovation in Constructing a Small Bowel Stoma in Neonates with Small Bowel Atresia to Reduce the Morbidity

    PubMed Central

    Khan, Naeem; Bakht, Saba; Zaheer, Nadia

    2016-01-01

    Background: Intestinal atresia has still significant morbidity in developing countries. Stomas are now not recommended in every case of intestinal atresia; primary anastomosis is the goal of surgery after resection of dilated adynamic gut. A new type of stoma formation along with primary anastomosis is being presented here. Materials and Methods: This report is based on our experience of many cases with this technique in last 12 years but all the details and long follow-up of each case is not available. However the method of surgical procedure, progress, complications, and advantages encountered have been highlighted. Results: Presently we have data of 7 patients; others are lost to follow up. Three had died with other associated problems, namely one with multiple atresias, two with septic shock and prematurity. Two stomas did not require formal closure because stoma shriveled and disappeared. Two other stomas had grown very long like a diverticulum when these were closed after 5 and 8 months. Conclusion: This technique is another attempt to decrease morbidity of patients of intestinal atresia especially in those cases where short bowel syndrome is feared after resection of proximal dilated gut. PMID:27896153

  15. Human chorionic gonadotropin and CA 15-3 producing adenocarcinoma.

    PubMed

    Uçkaya, G; Ozet, A; Arpaci, A; Kömürcü, S

    1998-01-01

    50 years old man suffering from primary lung adenocarcinoma presented with high levels of both beta subunit human chorionic gonadotropin (beta HCG) and cancer antigen 15-3 (CA 15-3) in the absence of elevated carcinoembrionic antigen (CEA), alfa fetoprotein (AFP) and carbohydrate antigen 19-9 (CA 19-9). Although beta HCG or CA 15-3 high levels were reported in adenocarcinoma of lung, this is the first report of a patient with high levels of both markers.

  16. Metachronous Colon Metastases from Gastric Adenocarcinoma: A Case Report

    PubMed Central

    Pace, Ugo; Contino, Gianmarco; Chiappa, Antonio; Bertani, Emilio; Bianchi, Paolo P.; Fazio, Nicola; Renne, Giuseppe; Di Meglio, Giovanni; Andreoni, Bruno

    2009-01-01

    The colon is a very rare metastatic localization. Here we report a case of colonic metastases from gastric adenocarcinoma whose clinical presentation was suggestive of a de novo adenocarcinoma of the ascending colon. The authors discuss that in the presence of a previous history of gastric cancer, immunohistochemical analysis on endoscopic biopsies may help in the definition of a differential diagnosis. Furthermore, this rare metastatic localization might suggest a poor prognosis and a more accurate diagnostic work-up. PMID:20740169

  17. [Gastric signet ring cell adenocarcinoma: A distinct entity].

    PubMed

    Tabouret, Tessa; Dhooge, Marion; Rouquette, Alexandre; Brezault, Catherine; Beuvon, Frédéric; Chaussade, Stanislas; Coriat, Romain

    2014-04-01

    Gastric signet ring cell carcinoma (GSRC) is a distinct entity. Their incidence is increasing. The pathologist plays a central role in the identification of this entity. Diagnosis is based on an adenocarcinoma containing a majority of signet ring cells (above 50 %). The prognosis of GSRC is the same as gastric adenocarcinoma while GSRC appeared more aggressive. Signet ring cells present a low sensitivity to chemotherapy. This review aimed to discuss the histological, the prognostic and the therapeutic aspect of this entity.

  18. The Management and Prognostic Prediction of Adenocarcinoma of Appendix

    PubMed Central

    Xie, Xin; Zhou, Zhangjian; Song, Yongchun; Li, Wenhan; Diao, Dongmei; Dang, Chengxue; Zhang, Hao

    2016-01-01

    Malignant tumours of the appendix are quite rare, especially appendiceal adenocarcinomas, which may be difficult to detect preoperatively or intraoperatively. We collected data for 1404 patients with adenocarcinoma of the appendix from the Surveillance, Epidemiology, and End Results Program (SEER) database to explore the potential associations between clinicopathological factors and overall survival. Furthermore, a novel nomogram for predicting prognosis was developed based on our analysis of the SEER data. The nomogram prediction model included seven prognostic factors derived based on different clinical estimates. When compared with the traditional tumour-node-metastasis (TNM) staging system, the nomogram prediction model showed superior discriminatory power (Harrell’s C-index, 0.741 vs. 0.686) and a greater degree of similarity to actual 5-year overall survival after calibration (Akaike Information Criterion index, 5270.781 vs. 5430.141). Finally, we provide recommendations for the management of patients with adenocarcinoma of the appendix. Notably, we found the depth of adenocarcinoma invasion may be used as an indicator to determine the optimal surgical approach. For mucinous adenocarcinomas of the appendix, because these tumours are characterized by unique biological behaviour, intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) is recommended. However, whether systematic chemotherapy should be administered to patients with adenocarcinoma of the appendix requires further investigation. PMID:27982068

  19. Ciliated adenocarcinomas of the lung: a tumor of non-terminal respiratory unit origin.

    PubMed

    Park, Won Young; Kim, Mi Hyun; Shin, Dong Hoon; Lee, Jung Hee; Choi, Kyung Un; Kim, Jee Yeon; Park, Do Youn; Lee, Chang Hun; Sol, Mee Young

    2012-09-01

    Whereas most carcinomas occur through a sequential step, atypical adenomatous hyperplasia and bronchioloalveolar carcinoma pathway is known for pulmonary adenocarcinoma. This type is known as terminal respiratory unit adenocarcinoma. Based on our observation of transitions from normal ciliated columnar cells to adenocarcinoma via dysplastic mucous columnar cells, we reviewed our archive of pulmonary adenocarcinoma. Terminal respiratory unit type adenocarcinoma was defined as adenocarcinoma with type II pneumocyte, Clara cell, or bronchiolar cell morphology according to previous reports. Among 157 cases, 121 cases have been identified as terminal respiratory unit type adenocarcinoma and 36 cases as non-terminal respiratory unit type adenocarcinoma. Among non-terminal respiratory unit type adenocarcinoma, 24 cases revealed mucous columnar cell changes that were continuous with bronchial ciliated columnar cells. The mucous columnar cells became dysplastic showing loss of cilia, disorientation, and enlarged nuclei. Adenocarcinoma arose from these dysplastic mucous columnar cells and, characteristically, this type of adenocarcinoma showed acute inflammation, and honeycombing changes in the background. TTF1 immunostaining was consistently negative. In a case study with 14 males and 10 females, including 12 smokers or ex-smokers, EGFR and KRAS mutations were detected in 3 and 6 patients, respectively. We think that this kind of adenocarcinoma arising through mucous columnar cell change belongs to non-terminal respiratory unit type adenocarcinoma, and mucous columnar cell change is a precursor lesion of pulmonary adenocarcinoma.

  20. Hepatoid adenocarcinoma of the stomach – a different histology for not so different gastric adenocarcinoma: a case report

    PubMed Central

    Gálvez-Muñoz, Elisa; Gallego-Plazas, Javier; Gonzalez-Orozco, Verónica; Menarguez-Pina, Francisco; Ruiz-Maciá, José A; Morcillo, Miguel A

    2009-01-01

    Hepatoid adenocarcinoma is an extrahepatic tumor characterized by morphological similarities to hepatocellular carcinoma. Hepatoid adenocarcinoma of the stomach is a cancer with an extremely poor prognosis with few cases reported. Here, we describe a 75-year-old Spanish man referred to our hospital with a history of abdominal pain, general fatigue, anorexia and sickness. Initial study revealed anemia, and computed tomography scan and abdominal ultrasonography showed multiple metastases to the liver with hepatocellular carcinoma characteristics in a liver with no cirrhotic change. Further study included a serum level of alpha-fetoprotein (AFP), which resulted markedly elevated, and a conclusive esophagogastroduodenoscopy describing an elevated tumour growing through the cardia and gastroesophageal junction with foci of necrosis and haemorrhage. Gastric biopsies of the tumor revealed poorly differenciated adenocarcinoma, with hepatoid differentiation. After a diagnosis of AFP-producing hepatoid adenocarcinoma of the stomach with multiple liver metastases was made, pallitive total gastrectomy, without liver resection, was performed. Patient recovered well after surgery, and entered into a palliative systemich chemotherapy protocol. Although this illness is recognized as having poor prognosis, the patient remains alive 8 months after the operation. Accurate diagnosis of hepatoid adenocarcinoma of the stomach is important, and should be suspected under certain circumstances. We describe this rare case of hepatoid adenocarcinoma of the stomach, and review the literature concerning the clinicopathological aspects. PMID:19674468

  1. Annexin A3 Knockdown Suppresses Lung Adenocarcinoma

    PubMed Central

    Liu, Qing-Qing; Zhang, Yue-Hua; Qiu, Jing-Hua

    2016-01-01

    Our previous study identified an elevated abundance of annexin A3 (Anxa3) as a novel prognostic biomarker of lung adenocarcinoma (LADC) through quantitative proteomics analysis. However, the biological functions of Anxa3 in LADC are not fully clear. In this study, in vitro and in vivo assays were performed to investigate the effects of Anxa3 downregulation on the growth, migration, invasion, metastasis, and signaling pathway activation of LADC cells. After Anxa3 downregulation, the growth of A549 and LTEP-a2 LADC cells was slowed and they showed decreased migration and invasion in vitro. Anxa3 knockdown significantly inhibited tumor formation by A549 cells in vivo; while many metastases were formed by control A549 cells, there were obvious reductions in the numbers of lung, liver, and brain metastases formed by Anxa3 knockdown in A549 cells. Furthermore, Anxa3 knockdown significantly decreased MMP-2 and N-cadherin expression and increased E-cadherin expression both in cell lines in vitro and in tumor nodules examined during in vivo tumorigenesis assays. Interestingly, Anxa3 downregulation reduced the phosphorylated levels of MEK and ERK. In summary, Anxa3 knockdown inhibited the growth, migration, invasion, and metastasis of LADC, decreased the activation of the MEK/ERK signaling pathway, and modulated the expression of MMP-2, E-cadherin, and N-cadherin. PMID:27995049

  2. Pancreatic adenocarcinoma pathology: changing “landscape”

    PubMed Central

    Brosens, Lodewijk A. A.; Hackeng, Wenzel M.; Offerhaus, G. Johan; Hruban, Ralph H.

    2015-01-01

    Pancreatic cancer is a devastating disease. At time of diagnosis the disease is usually advanced and only a minority of patients are eligible for surgical resection. The overall 5-year survival is 6%. However, survival of patients with early stage pancreatic cancer is significantly better. To improve the prognosis of patients with pancreatic cancer, it is essential to diagnose and treat pancreatic cancer in the earliest stage. Prevention of pancreatic cancer by treating noninvasive precursor lesions just before they invade tissues can potentially lead to even better outcomes. Pancreatic carcinogenesis results from a stepwise progression in which accumulating genetic alterations drive neoplastic progression in well-defined precursor lesions, ultimately giving rise to an invasive adenocarcinoma. A thorough understanding of the genetic changes that drive pancreatic carcinogenesis can lead to identification of biomarkers for early detection and targets for therapy. Recent next-generation sequencing (NGS) studies have shed new light on our understanding of the natural history of pancreatic cancer and the precursor lesions that give rise to these cancers. Importantly, there is a significant window of opportunity for early detection and treatment between the first genetic alteration in a cell in the pancreas and development of full-blown pancreatic cancer. The current views on the pathology and genetics of pancreatic carcinogenesis that evolved from studies of pancreatic cancer and its precursor lesions are discussed in this review. PMID:26261723

  3. Emerging therapeutic targets in esophageal adenocarcinoma

    PubMed Central

    Gaur, Puja; Hunt, Clayton R.; Pandita, Tej K.

    2016-01-01

    The incidence of gastro-esophageal disease and associated rate of esophageal adenocarcinoma (EAC) is rising at an exponential rate in the United States. However, research targeting EAC is lagging behind, and much research is needed in the field to identify ways to diagnose EAC early as well as to improve the rate of pathologic complete response (pCR) to systemic therapies. Esophagectomy with subsequent reconstruction is known to be a morbid procedure that significantly impacts a patient's quality of life. If indeed the pCR rate of patients can be improved and those patients destined to be pCR can be identified ahead of time, they may be able to avoid this life-altering procedure. While cancer-specific biological pathways have been thoroughly investigated in other solid malignancies, much remains unexplored in EAC. In this review, we will highlight some of the latest research in the field in regards with EAC, along with new therapeutic targets that are currently being explored. After reviewing conventional treatment and current changes in medical therapy for EAC, we will focus on unchartered grounds such as cancer stem cells, genetics and epigenetics, immunotherapy, and chemoradio-resistant pathways as we simultaneously propose some investigational possibilities that could be applicable to EAC. PMID:27102294

  4. Algenpantucel-L immunotherapy in pancreatic adenocarcinoma.

    PubMed

    Coveler, Andrew L; Rossi, Gabriela R; Vahanian, Nicholas N; Link, Charles; Chiorean, E Gabriela

    2016-02-01

    Pancreatic adenocarcinoma is the 4th leading cause of cancer death in the USA and the EU. A minority of patients presents with surgically resectable and potentially curable disease, but among these, 80% are destined to relapse and overall survival rates with adjuvant chemotherapy average 24 months. Immunotherapy is a promising therapeutic option and a potential paradigm shift in the treatment of patients with pancreatic cancer, and may be particularly effective when used early in the disease course to prevent metastatic spread. Algenpantucel-L (HyperAcute Pancreas, NewLink Genetics, Ames, IA, USA) is a whole-cell immunotherapy consisting of irradiated allogeneic pancreatic cancer cells genetically engineered to express the murine enzyme α-GT, which results in hyperacute rejection of the tumor cells with complement- and antibody-dependent cytotoxicity. Phase II clinical trial data has been encouraging, particularly for patients who demonstrated humoral immunologic responses. Here, we report preliminary results and biomarkers correlations with clinical activity of algenpantucel-L in pancreatic cancer.

  5. Biology and treatment of cervical adenocarcinoma

    PubMed Central

    Takeuchi, Satoshi

    2016-01-01

    Uterine cervical adenocarcinoma (ADC) has been increasing in its prevalence world widely despite the decrease of squamous cell carcinoma (SCC). It comprises nearly 20-25% of the all cervical malignancy in developed countries. The worse biological behavior had been reported in patients with intermediate- and high risk factors after surgery, and in advanced stage over Ⅲ, radiotherapy (RT) alone and concurrent chemo-radiotherapy (CCRT) with cisplatin was not always effective. As for chemotherapy (CT), the induction CT has not established, as well. Further molecular targeted therapy (MTT) has been studied. The targets of oncogenic driver mutations were vascular endothelial growth factor (VEGF) in SCC, or tyrosine kinase (TK) of endothelial growth factor receptor 2 (EGFR2, Her2/neu)-Ras-MAPK-ERK pathway. Bevacizumab (Bev, anti-VEGF monoclonal antibody) is considered as one of key agent with paclitaxel and carboplatin in SCC, but not for ADC. This article focuses on up-to-date knowledge of biology and possible specific therapeutic directions to explore in the management of cervical ADC. PMID:27198186

  6. Comprehensive molecular characterization of gastric adenocarcinoma

    PubMed Central

    Bass, Adam J.; Thorsson, Vesteinn; Shmulevich, Ilya; Reynolds, Sheila M.; Miller, Michael; Bernard, Brady; Hinoue, Toshinori; Laird, Peter W.; Curtis, Christina; Shen, Hui; Weisenberger, Daniel J.; Schultz, Nikolaus; Shen, Ronglai; Weinhold, Nils; Kelsen, David P.; Bowlby, Reanne; Chu, Andy; Kasaian, Katayoon; Mungall, Andrew J.; Robertson, A. Gordon; Sipahimalani, Payal; Cherniack, Andrew; Getz, Gad; Liu, Yingchun; Noble, Michael S.; Pedamallu, Chandra; Sougnez, Carrie; Taylor-Weiner, Amaro; Akbani, Rehan; Lee, Ju-Seog; Liu, Wenbin; Mills, Gordon B.; Yang, Da; Zhang, Wei; Pantazi, Angeliki; Parfenov, Michael; Gulley, Margaret; Piazuelo, M. Blanca; Schneider, Barbara G.; Kim, Jihun; Boussioutas, Alex; Sheth, Margi; Demchok, John A.; Rabkin, Charles S.; Willis, Joseph E.; Ng, Sam; Garman, Katherine; Beer, David G.; Pennathur, Arjun; Raphael, Benjamin J.; Wu, Hsin-Ta; Odze, Robert; Kim, Hark K.; Bowen, Jay; Leraas, Kristen M.; Lichtenberg, Tara M.; Weaver, Stephanie; McLellan, Michael; Wiznerowicz, Maciej; Sakai, Ryo; Getz, Gad; Sougnez, Carrie; Lawrence, Michael S.; Cibulskis, Kristian; Lichtenstein, Lee; Fisher, Sheila; Gabriel, Stacey B.; Lander, Eric S.; Ding, Li; Niu, Beifang; Ally, Adrian; Balasundaram, Miruna; Birol, Inanc; Bowlby, Reanne; Brooks, Denise; Butterfield, Yaron S. N.; Carlsen, Rebecca; Chu, Andy; Chu, Justin; Chuah, Eric; Chun, Hye-Jung E.; Clarke, Amanda; Dhalla, Noreen; Guin, Ranabir; Holt, Robert A.; Jones, Steven J.M.; Kasaian, Katayoon; Lee, Darlene; Li, Haiyan A.; Lim, Emilia; Ma, Yussanne; Marra, Marco A.; Mayo, Michael; Moore, Richard A.; Mungall, Andrew J.; Mungall, Karen L.; Nip, Ka Ming; Robertson, A. Gordon; Schein, Jacqueline E.; Sipahimalani, Payal; Tam, Angela; Thiessen, Nina; Beroukhim, Rameen; Carter, Scott L.; Cherniack, Andrew D.; Cho, Juok; Cibulskis, Kristian; DiCara, Daniel; Frazer, Scott; Fisher, Sheila; Gabriel, Stacey B.; Gehlenborg, Nils; Heiman, David I.; Jung, Joonil; Kim, Jaegil; Lander, Eric S.; Lawrence, Michael S.; Lichtenstein, Lee; Lin, Pei; Meyerson, Matthew; Ojesina, Akinyemi I.; Pedamallu, Chandra Sekhar; Saksena, Gordon; Schumacher, Steven E.; Sougnez, Carrie; Stojanov, Petar; Tabak, Barbara; Taylor-Weiner, Amaro; Voet, Doug; Rosenberg, Mara; Zack, Travis I.; Zhang, Hailei; Zou, Lihua; Protopopov, Alexei; Santoso, Netty; Parfenov, Michael; Lee, Semin; Zhang, Jianhua; Mahadeshwar, Harshad S.; Tang, Jiabin; Ren, Xiaojia; Seth, Sahil; Yang, Lixing; Xu, Andrew W.; Song, Xingzhi; Pantazi, Angeliki; Xi, Ruibin; Bristow, Christopher A.; Hadjipanayis, Angela; Seidman, Jonathan; Chin, Lynda; Park, Peter J.; Kucherlapati, Raju; Akbani, Rehan; Ling, Shiyun; Liu, Wenbin; Rao, Arvind; Weinstein, John N.; Kim, Sang-Bae; Lee, Ju-Seog; Lu, Yiling; Mills, Gordon; Laird, Peter W.; Hinoue, Toshinori; Weisenberger, Daniel J.; Bootwalla, Moiz S.; Lai, Phillip H.; Shen, Hui; Triche, Timothy; Van Den Berg, David J.; Baylin, Stephen B.; Herman, James G.; Getz, Gad; Chin, Lynda; Liu, Yingchun; Murray, Bradley A.; Noble, Michael S.; Askoy, B. Arman; Ciriello, Giovanni; Dresdner, Gideon; Gao, Jianjiong; Gross, Benjamin; Jacobsen, Anders; Lee, William; Ramirez, Ricardo; Sander, Chris; Schultz, Nikolaus; Senbabaoglu, Yasin; Sinha, Rileen; Sumer, S. Onur; Sun, Yichao; Weinhold, Nils; Thorsson, Vésteinn; Bernard, Brady; Iype, Lisa; Kramer, Roger W.; Kreisberg, Richard; Miller, Michael; Reynolds, Sheila M.; Rovira, Hector; Tasman, Natalie; Shmulevich, Ilya; Ng, Santa Cruz Sam; Haussler, David; Stuart, Josh M.; Akbani, Rehan; Ling, Shiyun; Liu, Wenbin; Rao, Arvind; Weinstein, John N.; Verhaak, Roeland G.W.; Mills, Gordon B.; Leiserson, Mark D. M.; Raphael, Benjamin J.; Wu, Hsin-Ta; Taylor, Barry S.; Black, Aaron D.; Bowen, Jay; Carney, Julie Ann; Gastier-Foster, Julie M.; Helsel, Carmen; Leraas, Kristen M.; Lichtenberg, Tara M.; McAllister, Cynthia; Ramirez, Nilsa C.; Tabler, Teresa R.; Wise, Lisa; Zmuda, Erik; Penny, Robert; Crain, Daniel; Gardner, Johanna; Lau, Kevin; Curely, Erin; Mallery, David; Morris, Scott; Paulauskis, Joseph; Shelton, Troy; Shelton, Candace; Sherman, Mark; Benz, Christopher; Lee, Jae-Hyuk; Fedosenko, Konstantin; Manikhas, Georgy; Potapova, Olga; Voronina, Olga; Belyaev, Smitry; Dolzhansky, Oleg; Rathmell, W. Kimryn; Brzezinski, Jakub; Ibbs, Matthew; Korski, Konstanty; Kycler, Witold; ŁaŸniak, Radoslaw; Leporowska, Ewa; Mackiewicz, Andrzej; Murawa, Dawid; Murawa, Pawel; Spychała, Arkadiusz; Suchorska, Wiktoria M.; Tatka, Honorata; Teresiak, Marek; Wiznerowicz, Maciej; Abdel-Misih, Raafat; Bennett, Joseph; Brown, Jennifer; Iacocca, Mary; Rabeno, Brenda; Kwon, Sun-Young; Penny, Robert; Gardner, Johanna; Kemkes, Ariane; Mallery, David; Morris, Scott; Shelton, Troy; Shelton, Candace; Curley, Erin; Alexopoulou, Iakovina; Engel, Jay; Bartlett, John; Albert, Monique; Park, Do-Youn; Dhir, Rajiv; Luketich, James; Landreneau, Rodney; Janjigian, Yelena Y.; Kelsen, David P.; Cho, Eunjung; Ladanyi, Marc; Tang, Laura; McCall, Shannon J.; Park, Young S.; Cheong, Jae-Ho; Ajani, Jaffer; Camargo, M. Constanza; Alonso, Shelley; Ayala, Brenda; Jensen, Mark A.; Pihl, Todd; Raman, Rohini; Walton, Jessica; Wan, Yunhu; Demchok, John A.; Eley, Greg; Mills Shaw, Kenna R.; Sheth, Margi; Tarnuzzer, Roy; Wang, Zhining; Yang, Liming; Zenklusen, Jean Claude; Davidsen, Tanja; Hutter, Carolyn M.; Sofia, Heidi J.; Burton, Robert; Chudamani, Sudha; Liu, Jia

    2014-01-01

    Gastric cancer is a leading cause of cancer deaths, but analysis of its molecular and clinical characteristics has been complicated by histological and aetiological heterogeneity. Here we describe a comprehensive molecular evaluation of 295 primary gastric adenocarcinomas as part of The Cancer Genome Atlas (TCGA) project. We propose a molecular classification dividing gastric cancer into four subtypes: tumours positive for Epstein–Barr virus, which display recurrent PIK3CA mutations, extreme DNA hypermethylation, and amplification of JAK2, CD274 (also known as PD-L1) and PDCD1LG2 (also knownasPD-L2); microsatellite unstable tumours, which show elevated mutation rates, including mutations of genes encoding targetable oncogenic signalling proteins; genomically stable tumours, which are enriched for the diffuse histological variant and mutations of RHOA or fusions involving RHO-family GTPase-activating proteins; and tumours with chromosomal instability, which show marked aneuploidy and focal amplification of receptor tyrosine kinases. Identification of these subtypes provides a roadmap for patient stratification and trials of targeted therapies. PMID:25079317

  7. Interventional Nanotheranostics of Pancreatic Ductal Adenocarcinoma

    PubMed Central

    Li, Junjie; Liu, Fengyong; Gupta, Sanjay; Li, Chun

    2016-01-01

    Pancreatic ductal adenocarcinoma (PDAC) accounts for over 90% of all pancreatic cancer. Nanoparticles (NPs) offer new opportunities for image-guided therapy owing to the unique physicochemical properties of the nanoscale effect and the multifunctional capabilities of NPs. However, major obstacles exist for NP-mediated cancer theranostics, especially in PDAC. The hypovascular nature of PDAC may impede the deposition of NPs into the tumor after systemic administration, and most NPs localize predominantly in the mononuclear phagocytic system, leading to a relatively poor tumor-to-surrounding-organ uptake ratio. Image guidance combined with minimally invasive interventional procedures may help circumvent these barriers to poor drug delivery of NPs in PDAC. Interventional treatments allow regional drug delivery, targeted vascular embolization, direct tumor ablation, and the possibility of disrupting the stromal barrier of PDAC. Interventional treatments also have potentially fewer complications, faster recovery, and lower cost compared with conventional therapies. This work is an overview of current image-guided interventional cancer nanotheranostics with specific attention given to their applications for the management of PDAC. PMID:27375787

  8. Modelling energy deposition in nanoscintillators to predict the efficiency of the X-ray-induced photodynamic effect

    NASA Astrophysics Data System (ADS)

    Bulin, Anne-Laure; Vasil'Ev, Andrey; Belsky, Andrei; Amans, David; Ledoux, Gilles; Dujardin, Christophe

    2015-03-01

    Scintillating nanoparticles (NPs) in combination with X-ray or γ-radiation have a great potential for deep-tissue cancer therapy because they can be used to locally activate photosensitizers and generate singlet oxygen in tumours by means of the photodynamic effect. To understand the complex spatial distribution of energy deposition in a macroscopic volume of water loaded with nanoscintillators, we have developed a GEANT4-based Monte Carlo program. We thus obtain estimates of the maximum expected efficiency of singlet oxygen production for various materials coupled to PS, X-ray energies, NP concentrations and NP sizes. A new parameter, ηnano, is introduced to quantify the fraction of energy that is deposited in the NPs themselves, which is crucial for the efficiency of singlet oxygen production but has not been taken into account adequately so far. We furthermore emphasise the substantial contribution of primary interactions taking place in water, particularly under irradiation with high energy photons. The interplay of all these contributions to the photodynamic effect has to be taken into account in order to optimize nanoscintillators for therapeutic applications.Scintillating nanoparticles (NPs) in combination with X-ray or γ-radiation have a great potential for deep-tissue cancer therapy because they can be used to locally activate photosensitizers and generate singlet oxygen in tumours by means of the photodynamic effect. To understand the complex spatial distribution of energy deposition in a macroscopic volume of water loaded with nanoscintillators, we have developed a GEANT4-based Monte Carlo program. We thus obtain estimates of the maximum expected efficiency of singlet oxygen production for various materials coupled to PS, X-ray energies, NP concentrations and NP sizes. A new parameter, ηnano, is introduced to quantify the fraction of energy that is deposited in the NPs themselves, which is crucial for the efficiency of singlet oxygen production but has not been taken into account adequately so far. We furthermore emphasise the substantial contribution of primary interactions taking place in water, particularly under irradiation with high energy photons. The interplay of all these contributions to the photodynamic effect has to be taken into account in order to optimize nanoscintillators for therapeutic applications. Electronic supplementary information (ESI) available. See DOI: 10.1039/c4nr07444k

  9. Role of x-ray-induced transcripts in adaptive responses following x-rays. Progress report, Year 2

    SciTech Connect

    Not Available

    1993-09-01

    I will describe our recent data in which we have extracted and purified a sufficient amount of RNA from primed and unprimed U1-Mel cells to begin the search for new genes which are modulated by priming or high dose irradiation during the establishment and/or challenge of adapted cells, respectively. Gene transcripts which are altered during ASRs now include alterations in xip5 (a gene with homology to human growth hormone), xipl2 (a gene with homology to human angiogenesis factor and a gene which may be involved in apoptosis due to its possible RNase activity), cyclin A (which is altered in primed cells only after a high dose of ionizing radiation), cyclin B (which is also altered in a similar manner as cyclin A), p53 (a tumor suppressor gene involved in cell division control in G{sub 1} following ionizing radiation), and glutathionine S transferase-pi (a gene product which has been demonstrated to be involved in DNA repair and redox cycling). In contrast, the remaining xip CDNA clones [i.e., xip1-4,6-11, which were isolated following high dose ionizing radiation exposure to human U1-Mel cells], Prad-1 (a gene involved in cell cycle controlling events at the G{sub 1} portion of the cell cycle), 36B4 (a gene involved in homeostasis), and cdc2 (a gene involved in the regulation of the S-phase portion of the cell cycle), were not altered following ionizing radiation, either during the establishment or challenge of adapted human cells.

  10. Combination Treatment of Hydrogen Peroxide and X-Rays Induces Apoptosis in Human Prostate Cancer PC-3 Cells

    SciTech Connect

    Kariya, Shinji Sawada, Ken; Kobayashi, Toshihiro; Karashima, Takashi; Shuin, Taro; Nishioka, Akihito; Ogawa, Yasuhiro

    2009-10-01

    Purpose: To study the effect of hydrogen peroxide (H{sub 2}O{sub 2}) on radiation-induced apoptosis in human prostate cancer PC-3 cells. Methods and Materials: At 4h before the irradiation, PC-3 cells were exposed to 10mM ammonium chloride (NH{sub 4}Cl) concentrations. Subsequently, cells were exposed to 0.1mM H{sub 2}O{sub 2} just before the irradiations, which were administered with 10-MV X-rays at doses of 10Gy. Results: The percentage of apoptotic cells at 48h after X-irradiation alone, H{sub 2}O{sub 2} alone, and combined X-irradiation and H{sub 2}O{sub 2} was 1.85%, 4.85%, and 28.4%, respectively. With use of combined X-irradiation and H{sub 2}O{sub 2}, production of reactive oxygen species (ROS) occurred 4h after the irradiation. This resulted in lysosomal rupturing, mitochondrial fragmentation, and the release of cytochrome c into the cytoplasm from the mitochondria. In contrast, when cells were exposed to NH{sub 4}Cl before the X-irradiation and H{sub 2}O{sub 2} administration, apoptosis was almost completely suppressed, ROS production did not occur, lysosomal rupture and mitochondrial fragmentation were blocked, and cytochrome c was not released. Conclusions: Hydrogen peroxide strongly enhanced lysosome-dependent radiation-induced apoptosis in human prostate cancer PC-3 cells. A combined use of X-rays and H{sub 2}O{sub 2} can also injure the mitochondrial cytoplasmic organelles and lead to the production of ROS that in and of itself might possibly induce apoptosis.

  11. Glutathione depletion by DL-buthionine-SR-sulfoximine (BSO) potentiates X-ray-induced chromosome lesions after liquid holding recovery

    SciTech Connect

    Bertsche, U.; Schorn, H.

    1986-03-01

    The impact of intracellular glutathione depletion on chromosome damage induced by X irradiation under aerobic conditions was investigated in two different cell lines, Ehrlich ascites tumor cells (EATC) and Chinese hamster ovary cells (CHO-K1). Thiol-depleted cell cultures in plateau phase were obtained by prolonged incubation in growth medium containing DL-buthionine-SR-sulfoximine (BSO), a specific inhibitor of gamma-glutamyl-cysteine synthetase. Cells were then assayed using the procedures of G. L. Ellmann and J. Sedlack and R.H. Lindsay for non-protein bound SH (NPSH), glutathione (GSH), and total SH (TSH). In both cell lines GSH was reduced to less than 10% of controls at higher BSO concentrations around 1 mM, whereas TSH and NPSH were affected to only 40-60%. In EATC pretreated with up to 1 mM BSO for 72 h, increased levels of spontaneously occurring micronuclei were found. At BSO concentrations above 200 microM, both cell lines showed a potentiation of chromosome lesions scored as micronuclei and induced under aerobic X irradiation when liquid holding recovery in the original nutrient-depleted medium was performed; the extent of chromosome damage eventually reached that which could be obtained by application of beta-arabinofuranosyladenine (beta-araA), known to inhibit DNA repair processes by blocking DNA polymerases. It is therefore suggested that GSH depletion causes impairment of repair of lesions leading to chromosome deletions and subsequently to micronuclei. In contrast to CHO cell cultures, EATC showed a reversion of the potentiation effect as indicated by a decrease in the micronucleus content during prolonged incubation in the presence of BSO in the millimolar range.

  12. Interactions between X-ray induced transient defects and pre-existing damage precursors in DKDP crystals

    SciTech Connect

    Negres, R A; Saw, C K; Demos, S G

    2008-10-24

    Large-aperture laser systems, currently designed to achieve high energy densities at the target location (exceeding {approx} 10{sup 11} J/m{sup 3}), will enable studies of the physics of matter and radiation under extreme conditions. As a result, their optical components, such as the frequency conversion crystals (KDP/DKDP), may be exposed to X-rays and other ionizing radiation. This in turn may lead to a change in the damage performance of these materials as they may be affected by radiation-induced effects by either forming new damage initiation centers or interacting with the pre-existing damage initiating defects (so-called damage precursors). We present an experimental study on the laser-induced bulk damage performance at 355-nm of DKDP crystals following X-ray irradiation at room temperature. Results indicate that the damage performance of the material is affected by exposure to X-rays. We attribute this behavior to a change in the physical properties of the precursors which, in turn, affect their individual damage threshold.

  13. EPR, ENDOR and HYSCORE study of X-ray induced centres in K2YF5 thermoluminescent phosphors.

    PubMed

    Zverev, Dmitry; Vrielinck, Henk; Callens, Freddy; Matthys, Paul; Van Doorslaer, Sabine; Khaidukov, Nicholas M

    2008-04-07

    X-Ray irradiation at room temperature produces several paramagnetic centres in rare-earth activated K2YF5 crystals, whose thermal annealing behaviour can be linked with the occurrence of thermoluminescence (TL) glow peaks. In this paper, continuous wave (CW) and pulsed paramagnetic resonance techniques are used to study the structure of a very stable radiation-induced centre, which may be involved in the TL peak at approximately 390 degrees C reported for Ce- and Tb-activated crystals. From the spectra the centre's g tensor and hyperfine (nuclear quadrupole) tensors for several 19F and 39K neighbouring nuclei are extracted, but no self-hyperfine interaction could be detected. Based on the analysis of the interaction tensors, a model is constructed consisting of an oxygen-related radical (e.g. O(-) or O2(-)) on a substitutional F(-) position in the mirror plane of the YF7 polyhedra. Such a centre most probably corresponds to a trapped-hole state.

  14. Control of X-ray Induced Electron and Nuclear Dynamics in Ammonia and Glycine Aqueous Solution via Hydrogen Bonding.

    PubMed

    Unger, Isaak; Hollas, Daniel; Seidel, Robert; Thürmer, Stephan; Aziz, Emad F; Slavíček, Petr; Winter, Bernd

    2015-08-20

    Recently, a new family of autoionization processes has been identified in aqueous phases. The processes are initiated by core-electron ionization of a solute molecule and involve proton transfer along the solute-solvent hydrogen bond. As a result, short-lived singly charged cations form with structures sharing a proton between solute and solvent molecules. These molecular transients decay by autoionization, which creates reactive dicationic species with the positive charges delocalized over the entire molecular entity. Here, we investigate the ultrafast electron and nuclear dynamics following the core ionization of hydrated ammonia and glycine. Both molecules serve as models for exploring the possible role of the nonlocal relaxation processes in the chemical reactivity at the interface between, for instance, a protein surface and aqueous solution. The nature of the postionization dynamical processes is revealed by high-accuracy Auger-electron spectroscopy measurements on liquid microjets in vacuum. The proton-transfer-mediated processes are identified by electron signals in the high-energy tail of the Auger spectra with no analogue in the Auger spectra of the corresponding gas-phase molecule. This high-energy tail is suppressed for deuterated molecules. Such an isotope effect is found to be smaller for aqueous ammonia as compared to the hydrated H2O molecule, wherein hydrogen bonds are strong. An even weaker hydrogen bonding for the hydrated amino groups in glycine results in a negligibly small proton transfer. The dynamical processes and species formed upon the nitrogen-1s core-level ionization are interpreted using methods of quantum chemistry and molecular dynamics. With the assistance of such calculations, we discuss the conditions for the proton-transfer-mediated relaxation processes to occur. We also consider the solvent librational dynamics as an alternative intermolecular ultrafast relaxation pathway. In addition, we provide experimental evidence for the umbrella-type motion in aqueous ammonia upon core ionization. This intramolecular channel proceeds in parallel with intermolecular relaxation processes in the solution.

  15. Synchrotron X ray induced axonal transections in the brain of rats assessed by high-field diffusion tensor imaging tractography.

    PubMed

    Serduc, Raphaël; Bouchet, Audrey; Pouyatos, Benoît; Renaud, Luc; Bräuer-Krisch, Elke; Le Duc, Géraldine; Laissue, Jean A; Bartzsch, Stefan; Coquery, Nicolas; van de Looij, Yohan

    2014-01-01

    Since approximately two thirds of epileptic patients are non-eligible for surgery, local axonal fiber transections might be of particular interest for them. Micrometer to millimeter wide synchrotron-generated X-ray beamlets produced by spatial fractionation of the main beam could generate such fiber disruptions non-invasively. The aim of this work was to optimize irradiation parameters for the induction of fiber transections in the rat brain white matter by exposure to such beamlets. For this purpose, we irradiated cortex and external capsule of normal rats in the antero-posterior direction with a 4 mm×4 mm array of 25 to 1000 µm wide beamlets and entrance doses of 150 Gy to 500 Gy. Axonal fiber responses were assessed with diffusion tensor imaging and fiber tractography; myelin fibers were examined histopathologically. Our study suggests that high radiation doses (500 Gy) are required to interrupt axons and myelin sheaths. However, a radiation dose of 500 Gy delivered by wide minibeams (1000 µm) induced macroscopic brain damage, depicted by a massive loss of matter in fiber tractography maps. With the same radiation dose, the damage induced by thinner microbeams (50 to 100 µm) was limited to their paths. No macroscopic necrosis was observed in the irradiated target while overt transections of myelin were detected histopathologically. Diffusivity values were found to be significantly reduced. A radiation dose ≤ 500 Gy associated with a beamlet size of < 50 µm did not cause visible transections, neither on diffusion maps nor on sections stained for myelin. We conclude that a peak dose of 500 Gy combined with a microbeam width of 100 µm optimally induced axonal transections in the white matter of the brain.

  16. Molecular characterization of X-ray-induced mutations at the HPRT locus in plateau-phase Chinese hamster ovary cells.

    PubMed

    Morgan, T L; Fleck, E W; Poston, K A; Denovan, B A; Newman, C N; Rossiter, B J; Miller, J H

    1990-10-01

    CHO-K1 cells were irradiated in plateau phase to determine the effect of dose, dose fractionation, and delayed replating on the type, location and frequency of mutations induced by 250 kVp X-rays at the hypoxanthine-guanine phosphoribosyl transferase (HPRT) locus. Independent HPRT-deficient cell lines were isolated from each group for Southern blot analysis using a hamster HPRT cDNA probe. When compared with irradiation with 4 Gy and immediate replating, dose fractionation (2 Gy + 24 h + 2 Gy) the entire gene. Since an increase in survival was noted under these conditions, these data suggest that repair of sublethal and potentially lethal damage acts equally on all premutagenic lesions, regardless of type or location. Differences in the mutation spectrum were noted when cells were irradiated at 2 Gy and replated immediately. The location of the deletion breakpoints was determined in 15 mutants showing partial loss of the HPRT locus. In 12 of these cell lines one or both of the breakpoints appeared to be located near the center of the gene, indicating a nonrandom distribution of mutations. These results indicate that damage induced by ionizing radiation results in a nonrandom distribution of genetic damage, suggesting that certain regions of the genome may be acutely sensitive to the mutagenic effects of ionizing radiation.

  17. Suppression of X-ray-induced dissociation of H2O molecules in dense ice under pressure

    PubMed Central

    Fukui, Hiroshi; Hiraoka, Nozomu; Hirao, Naohisa; Aoki, Katsutoshi; Akahama, Yuichi

    2016-01-01

    We investigated molecular dissociation induced by 10-keV X-ray irradiation in dense ice at pressures up to 40 GPa at 300 K. The dissociation yield estimated from the oxygen K-edge X-ray Raman spectra, showed that the molecular dissociation was enhanced up to 14 GPa and gradually suppressed on further compression to 40 GPa. The molecular dissociation was detected for a rather narrow pressure span of 2–40 GPa by the X-ray spectroscopy. The pressure variation of the dissociation yield was similar to that observed in the electric conductivity of ice VII and likely interpreted in terms of proton mobility. PMID:27221010

  18. Development and Use of an X-ray Induced Fluorescence System Designed to Measure Regional Myocardial Perfusion

    DTIC Science & Technology

    1989-08-01

    shock in the United States per year [ Braunwald 1976; Silber 1987, p. 1017]. Due to these impressive statistics, ischemic heart disease due to coronary...radiation dose and resolving power of commercial CT scanners. Am J Roentgenol 131:95-101, 1978. 112 Braunwald , E. Introductory remarks. in Protection of the...Ischemic Myocardium, ed. E. Braunwald , AHA Monograph Number 48: 1-2, 1976. Buckberg, G.D., Luck, J.C., Payne, B.D., Hoffman, J.I.E., Archie, J.P., and

  19. Au Lα x-rays induced by photons from 241Am: Comparison of experimental results and the predictions of PENELOPE.

    PubMed

    Gonzales, D; Requena, S; Williams, S

    2012-01-01

    The results of experiments performed, measuring the Lα x-rays emitted by Au due to excitation by photons of various energies from an (241)Am sample at forward-scattered angles in the range 0° to 65°, are compared to the predictions of the Monte Carlo code, PENELOPE. The experimental data are in good agreement with the predictions of the program. A comparison of the angular distributions of the probability densities (as predicted by the program) related to the Au Lα and Lβ x-rays suggests that PENELOPE does not simulate the phenomena described by Flügge et al. (1972).

  20. Influence of DMSO on Carbon K ultrasoft X-rays induced chromosome aberrations in V79 Chinese hamster cells.

    PubMed

    Natarajan, Adayapalam T; Palitti, Fabrizio; Hill, Mark A; Stevens, David L; Ahnström, Gunnar

    2010-09-10

    Ultrasoft X-rays have been shown to be very efficient in inducing chromosomal aberrations in mammalian cells. The present study was aimed to evaluate the modifying effects of DMSO (a potent scavenger of free radicals) on the frequencies of chromosome aberrations induced by soft X-rays. Confluent held G1 Chinese hamster cells (V79) were irradiated with Carbon K ultrasoft X-rays in the presence and absence of 1M DMSO and frequencies of chromosome aberrations in the first division cells were determined. DMSO reduced the frequencies of exchange types of aberrations (dicentrics and centric rings) by a factor of 2.1-3.5. The results indicate that free radicals induced by ultrasoft X-rays contribute to a great extent to the induction of chromosome aberrations. The possible implications of these results in interpreting the mechanisms involved in the high efficiency of ultrasoft X-rays in the induction of chromosome aberrations are discussed.