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PubMed1995

Increased intestinal permeability for the isosmolar contrast medium iodixanol during small-bowel ischaemia in rats.

BACKGROUND: Intestinal ischaemia may be difficult to recognize in the early stages. Increased urinary recovery of water-soluble contrast medium during and intestinal follow-through has been suggested as a sign of bowel ischaemia. METHODS: Urinary excretion of the isosmolar water-soluble X-ray contrast medium iodixanol was measured after instillation via an orogastric tube in 56 rats with occlusion of the mesenteric blood vessels. RESULTS: Mesenteric venous occlusion caused only minor histologic alterations of the mucosa. High-performance liquid chromatography (HPLC) and X-ray fluorescence analysis measured urinary iodixanol concentrations 10 and 13 times higher than in the groups with mesenteric arterial occlusion than in controls (p < 0.001), and 3 and 4 times higher than in the group with venous occlusion (p < or = 0.05). Correlation between HPLC and X-ray fluorescence measurements of contrast medium in urine was strong (r = 0.98). CONCLUSION: Measuring urinary contrast medium levels during intestinal follow-through may aid in distinguishing bowel ischaemia following mesenteric arterial occlusion from mesenteric venous occlusion and from the normal bowel.

Animals↗
PubMed1997

Hypertensive arteriolar necrosis revisited.

Arteriolar necrosis is the histopathological hallmark of malignant hypertension. In the period from 1940 to 1980, intensive studies of the pathogenesis of hypertensive fibrinoid necrosis were carried out. From studies of mesenteric vessels in animals with experimental hypertension it was discovered that arteriolar necrosis is preceded by an abnormal vascular reaction pattern consisting of alternating constriction and localized dilatations. The development of the abnormal reaction pattern is followed by endothelial hyperpermeability resulting in transsudation of plasma and macromolecules into the wall of the arteriole. The hyperpermeability, and, in turn, arteriolar necrosis, is exclusively found in the dilated segments of the vessel. The abnormal vascular reaction pattern can be induced experimentally by various techniques such as infusion of angiotensin II or stimulation of perivascular nerves, and it can be demonstrated in all target organs. Since 1980 a remarkable falling-off in the research on the pathogenesis of hypertensive arteriolar necrosis has been noted. Recent studies in this area utilizing current knowledge and major advances in microvascular research methods are very few in number. As of today, the chain of pathogenetic processes leading eventually to the all-important lesion of arteriolar fibrinoid necrosis remains poorly understood.

Animals↗
PubMed2004

Management of nonfunctioning islet cell tumors.

AIM: To more clearly define the clinical and pathological characteristics and appropriate diagnosis and treatment of nonfunctioning (NFICTs) islet cell tumors, and to review our institutional experience over the last 30 years. METHODS: The records of 43 patients confirmed to have nonfunctioning islet cell tumors of pancreas were retrospectively reviewed. Survival was estimated by the Kaplan-Meier methods and potential risk factors for survival were compared with the log-rank tests. RESULTS: The mean age was 31.63 years (range, 8 to 67 years). There were 7 men and 36 women. Twenty-eight patients had a confirmed diagnosis of nonfunctioning islet cell carcinoma (NFICC) and benign islet cell tumors were found in 15 patients. The most common symptoms in patients with NFICTs were abdominal pain (55.8%), nausea and/or vomiting (32.6%), fatigue (25.6%) and abdominal mass (23.3%). Preoperative ultrasonic and computed tomography localized the tumors in all patients. Forty-three NFICTs were distributed throughout the pancreas, with 21 located to the right of the superior mesenteric vessels, 10 in the body of the pancreas, 6 in the tail of the pancreas, and multiple tumors were found in one patient. Thirty-nine of 43 patients (91%) underwent surgical resection. Surgical treatment was curative in 30 patients (70%) and palliative in 9(21%). The resectability and curative resection rate in patients with NFICC of pancreas were 89% and 61%, respectively. The overall cumulative 5- and 10-year survival rates for patients with NFICC were 58.05% and 29.03%, respectively. Radical operation and diameter of cancer small than 10 cm were positive prognostic factors in females younger than 30 years old. Multivariate Cox regression analysis indicated that radical operation was the only independent prognostic factor, P=0.007. CONCLUSION: Nonfunctioning islet cell tumors of pancreas are found mainly in young women. The long-term results for patients undergone surgery, especially curative resection are good.

Adolescent↗
PubMed1977

The host antigen phenomenon in experimental murine schistosomiasis. III. Destruction of parasites transferred from mice to hamsters.

The surgical transfer of 23- to 28-day-old Schistosoma mansoni from donor mice to the mesenteric vessels of outbred hamsters is followed by recovery of 70% of the transferred trematodes 30 days later. Prior immunization of hamsters with mouse erythrocytes results in anti-mouse erythrocyte antibody titers of greater than 1:4,096 and death of 98% of the parasites. Destruction is correlated with evidence of the presence of mouse antigenic determinants on the surfaces of schistosomes from donor mice.

Animals↗
PubMed1989

Phagicola angrense (Digenea: Heterophyidae) as a cause of enteritis in a raccoon (Procyon lotor).

Numerous Phagicola angrense were associated with enteritis in a single male juvenile raccoon (Procyon lotor) live-trapped on Parramore Island, Virginia (USA). The raccoon was weak, ataxic and had melenic soft feces. The carcass was emaciated, pale and had ascites. Mesenteric vessels appeared prominent and the stomach and the intestines contained fetid bloody material. The small intestinal mucosa contained three locally extensive sites of necrosis. Histopathologically, there were numerous small digeneans both attached to the mucosa and free within the lumen. Digeneans were usually found deep within the crypts where the epithelium was markedly attenuated and devoid of epithelial cells at the point of parasite attachment. In the lamina propria there were areas of acute hemorrhage and infiltration with plasma cells and eosinophils. This appears to be the first record of severe enteritis in the raccoon caused by this digenean.

Animals↗
PubMed1991

New locality record for Heterobilharzia americana.

Thirty raccoons (Procyon lotor) from three counties in east-central and southeast Kansas (USA) were examined for schistosomiasis. Eleven (37%) of the raccoons had adult schistosomes identified as Heterobilharzia americana present in the mesenteric vessels, histopathological lesions compatible with schistosomiasis, or both. This represents the first report of H. americana in Kansas and in the central United States.

Animals↗
PubMedDate not supplied

Benign pancreatic tumor treated with duodenum-preserving resection of the head of the pancreas. Case report.

Cystic neoplasms of the pancreas constitute about 9% of all cystic lesions of the pancreas and less than 1% of all pancreatic neoplasms. Authors report the case of a 70 year-old woman with microcystic cystadenoma. Computed tomography (CT) scan of the abdomen diagnosed a 5 cm multilocular septated cyst, with calcifications in the context, localized in the head-uncinate process of the pancreas. The mass was well separated by a sharp cleavage plane with portal vein and superior mesenteric vessels. An endoscopic retrograde cholangiopancreatography (ERCP) showed cephalic symmetrical stenosis (diameter: 3 mm) of the main pancreatic duct (MPD), mildly dilated in the remaining tract (diameter: 6 mm). An intra-operative biopsy of the cystic wall had been performed. Therefore, it was decided to proceed with a duodenum-preserving resection of the head of the pancreas (DPPHR), including stenosis tract of the MPD in the surgical specimen. The reconstructive procedure consisted, by i.v. jejunal loop transposition, of a side-to-side pancreatico-jejunostomy, including in the anastomosis both corpocaudal stump and the resection cavity of the pancreatic head, and an end-to-side Roux-en-Y jejuno-jejunostomy. With respect to long-lasting pain relief and preservation of the endocrine and exocrine functions of the pancreas, duodenum-preserving resection of the head of the pancreas is a highly effective surgical procedure with low early and late morbidity and mortality due to limited surgical resections. This technique, introduced into surgical practice in 1972 by Beger, is indicated in patients with chronic pancreatitis with an inflammatory mass in the head of the pancreas. The authors conclude that this procedure can also be performed in cases of pancreatic benign tumors, such as microcystic cystadenoma. Advantages of this technique make DPPHR an attractive alternative to pylorus-preserving pancreatico-duodenectomy (PPPD).

Aged↗
PubMedDate not supplied

Extended survival of carcinoma head of pancreas following palliative treatment.

A 48 year old woman presented with obstructive jaundice 10 years back. Upper gastrointestinal endoscopy revealed a growth infiltrating the ampulla of Vater, which was confirmed to be adenocarcinoma on cytology. At laparotomy, a large nodular growth was seen in the head of pancreas. Surgical resection could not be done because of encasement of superior mesenteric vessels, hence a cholecystojejunostomy was performed. The patient remained asymptomatic for 9 years, when she developed cholangitis. Duodenoscopy at this stage revealed an ulcerated growth at the ampulla and biopsy from the growth confirmed a well differentiated adenocarcinoma. A straight flap 10 F stent was placed in the common bile duct. Thereafter the patient has remained asymptomatic for more than a year.

Adenocarcinoma↗
PubMedDate not supplied

Intraabdominal panniculitis. Report of three cases and review of the literature.

Intraabdominal panniculitis is a rare, benign idiopathic disorder of the mesentery. Patients usually present with abdominal pain and a palpable mass. The cross-sectional imaging findings are characteristic and consist of a fibrofatty central mesenteric mass lesion encapsulating the mesenteric vessels with displacement of the bowel loops, that can suggest the diagnosis. Imaging is also important to establish a definitive diagnosis by an image-guided percutaneous biopsy, assess extent of the disease for selection of appropriate therapy, exclude associated abnormalities namely malignancies, and for follow-up.

Adult↗
PubMed2000

Controversy in the treatment of adult long ileocolic intussusception: case report.

Adult intussusception is an unusual cause of intestinal obstruction. In contrast to children, intussusception in adults is usually due to an identifiable cause. We present a case of an 81-year-old female who was diagnosed with a long intussusception on CT scan of the abdomen. Because of the likelihood of neoplasia, a right hemicolectomy was undertaken, after which the patient recovered well. The correct treatment of adult intussusception is not unanimously agreed upon. We present a case of long intussusception in which partial reduction of viable small bowel before the resection was done by applying gentle traction. This provided sufficient small bowel mesentery length, preventing any damage to superior mesenteric vessels and avoiding unnecessary excision of healthy bowel.

Adenoma, Villous↗
PubMed2002

CT diagnosis of afferent loop syndrome.

OBJECTIVE: To report the computed tomography (CT) features of afferent loop syndrome which is often clinically unsuspected. MATERIALS AND METHODS: The CT studies of five patients with afferent loop syndrome were reviewed. These patients had undergone gastroenterostomy and other surgical procedures, for malignant neoplasms in four and for peptic ulcer in one. Patients presented between 4 months and 15 years (average 5.5 years) after surgery. Symptoms were acute in all patients, the most common symptom being abdominal pain. In addition three of the patients had chronic symptoms including recurrent episodes of abdominal pain, recurrent ascending cholangitis, jaundice and bilious vomiting. RESULTS: The obstructed afferent loop appeared on CT as a fluid-filled tubular mass with an average diameter of 5.3cm. Valvulae conniventes were identified in all, and small intraluminal air bubbles in four. The dilated afferent loop was opacified with oral contrast material in only one patient. The loop was located in the subhepatic area in three patients and crossed the midline between the aorta and the superior mesenteric vessels in the other two. Additional findings included biliary dilatation in all five patients and signs of pancreatitis in one. Treatment was surgical in four patients (delayed for four months in one) and conservative in one. CONCLUSION: A fluid-filled tubular structure containing small air bubbles in the right upper quadrant or crossing the midline on CT in symptomatic patients after gastroenterostomy is characteristic of a dilated, possibly obstructed, afferent loop. The diagnosis is often not suspected clinically since patients may present many years after the initial surgery. Recognition of the characteristic CT findings will avoid both inappropriate procedures such as aspiration or drainage of an obstructed afferent loop and delay in treatment.

Abdominal Pain↗
PubMed2002

[Pancreatectomy for adenocarcinoma: prognostic factors, recommendations for pathological reports].

The ductal adenocarcinoma of the pancreas is a tumor with very poor prognosis, often diagnosed at an advanced stage of evolution. The surgical resection of the tumor is performed in only 15% of the patients but only 10% of them are alive 5 years later. The bad prognostic factors individualized on surgical specimens are the tumor size (>2 cm), lymph node metastases, the poor differentiation of the tumor on microscopic examination, the infiltration of the portal vein and mesenteric vessels by the tumor, the infiltration of the surgical margins, especially the retroperitoneal margin of the tumor. We propose a pre-established form including these items for pathological reports of pancreatectomy for adenocarcinomas.

Adenocarcinoma↗
PubMed2002

Involvement of CD44 in leukocyte trafficking at the blood-retinal barrier.

In the present study, we investigated the involvement of CD44 in leukocyte trafficking in vivo at the blood-retinal barrier using experimental autoimmune uveoretinitis (EAU) as a model system. Leukocyte trafficking was evaluated using adoptive transfer of calcein-AM (C-AM)-labeled spleen cells harvested from syngeneic mice at prepeak severity of EAU to mice at a similar stage of disease. CD44 and its ligand hyaluronan were up-regulated in the eye during EAU. CD44-positive leukocytes were found sticking in the retinal venules and postcapillary venules but not in the retinal arterioles nor in mesenteric vessels. Preincubation of in vitro C-AM-labeled leukocytes with anti-CD44 monoclonal antibodies (mAb; IM7) or high molecular weight hyaluronic acid (HA) before transfer significantly suppressed leukocyte rolling but not sticking in retinal venules and also reduced cell infiltration in the retinal parenchyma. Administration of the HA-specific enzyme hyaluronidase to mice before cell transfer also reduced leukocyte infiltration, suggesting that CD44-HA interactions are involved in leukocyte recruitment in EAU. This was further supported by the observation that disease severity was reduced by administration of anti-CD44 mAb (IM7) at the early leukocyte-infiltration stage. Further studies also indicated that CD44 activation was associated with increased levels of apoptosis, and this may also be in part responsible for the reduction in disease severity. These findings demonstrate that CD44 is directly involved in leukocyte-endothelial interaction in vivo and influence the trafficking of primed leukocytes to the retina and their overall survival.

Animals↗
PubMedDate not supplied

Laparoscopic coloanal anastomosis for low rectal cancer.

OBJECTIVES: Low anterior resection with hand-sutured coloanal anastomosis for low rectal cancer is technically feasible, and it does not compromise oncologic results. We describe herein the effectiveness of the operation in treating low rectal cancer by a laparoscopic approach followed by intraanal canal dissection. METHODS: From February 1999 to October 1999, we used a laparoscopic procedure to divide the inferior mesenteric vessels and to dissect downward into the pelvic cavity as low as possible. A purse-string suture 1-cm distal to the lower margin of the tumor was secured and transection of the rectum was performed circumferentially via the anal canal near the dentate line. The specimen was removed by the pull-through method and coloanal anastomosis was completed with hand suture. A protective loop ileostomy was fashioned. RESULTS: We operated on 8 patients (4 males) with low tumor localization (average 4-cm above the dentate line). The age ranged from 45 to 83 years, with a median age of 64. The average operation time was 210 minutes (150 to 360 minutes), and the average blood loss was 250 cc (minimal to 750 cc). No operative mortalities occurred, but 2 patients had minor anastomotic slough complications. The average hospital stay was 13 days (7 to 26 days). The postoperative pathologic stage was T2N0M0 in 4 patients, T3N0M0 in 2 patients, T2N1M0 in 1 patient, and T3N2M0 in 1 patient. No local recurrence or distant metastasis occurred during the median 14 months (12 to 20 months) of follow-up. CONCLUSION: Laparoscopic coloanal anastomosis combined with intraanal canal dissection is safe and technically feasible. The oncologic results seem not to be compromised, but need further evaluation.

Adenocarcinoma↗
PubMed1976

[Stenosis of the small intestine of ischemic origin in the adult (segmental and transmural lesions)].

Focal ischemia of the small intestine does not always lead to necrosis and perforation, but may induce fibrous stenosis which is evidenced clinically by acute or chronic intestinal occlusion. Among 8 intestinal stenoses 5 were revealed by the presence of an intestinal occlusion whereas the others were manifested by intestinal occlusions complicated by subsequent perforation of the intestinal wall. Annulo-tubular stenoses of ischemic origin are frequently accompanied by inflammatory mesenteric adenopathies due to mucosal ulcerations in the septic environment of the intestinal lumen. Their aspect is reminiscent of Crohn's disease or annular carcinoma. Histological examination of the resected loop frequently reveals the primary oschemic origin of the stenotic lesion, characterized by the presence of macrophages loaded with hemosiderin in the thickened inflamed mucosa. The tissue alterations observed resemble those found in myocardial infarction, but the inflammatory response is more pronounced due to the septic medium. Although such stenoses are relatively rare, they should be distinguished from other lesions provoking a narrowing of the intestinal lumen, since their treatment calls for certain therapeutic precautions. In some cases, angioplastic intervention is required in order to improve perfusion of the vascular bed irrigated by the superior mesenteric artery following resection of the stenotic loop and termino-terminal anastomosis. Furthermore, during any operation requiring revascularization of the mesenteric vessels for intestinal angina, it is important to carry out a very careful examination of the state of the small intestine.

Adult↗
PubMed1976

The host antigen phenomenon in experimental murine schistosomiasis. II. Failure to demonstrate destruction of parasites transferred from hamsters to mice.

Adult Schistosoma monsoni grown in hamsters and transferred directly to the mesenteric vessels of C57BL10J mice previously immunized with hamster cells survive normally despite evidence of cytoxic and hemagglutinating antibodies directed against hamster cells. This finding indicates that species differences may play an important part in the manifestions of the host antigen phenomenon in experimental schistosomiasis.

Animals↗
PubMed2002

[Extended lymphadenectomy for carcinoma of pancreatic head. Personal experience].

Long-term survival in patients with cancer of the pancreatic head is disappointing. Surgery is the only curative therapy. Unfortunately the prognosis of patients resected (10-15%) is extremely poor due to loco-regional cancer recurrence (50%). Lymphatic and perineural invasion might account for local recurrence. Japanese studies reported the importance of an extended lymphadenectomy during the classic Whipple exeresis (40% of patients present lymph node metastases). During the period 1996-2000 at our Institution 20 patients (14 M, 6 F, mean age 62.4 years) with pancreatic head cancer (17 adenocarcinoma, 1 lymphoma, 2 carcinoma) underwent Whipple's exeresis with a regional (peripancreatic or R1) and juxta-regional (para-aortic or R2) lymphadenectomy according to Ishikawa technique. R1 nodes consisted of lymph nodes at the pylorus, superior head, common bile duct, anterior pancreaticoduodenal region, inferior head and superior mesenteric vessels. R2 nodes consisted of lymph nodes at the superior body, inferior body, mid colic region, common hepatic duct, coeliac truncus and para-aortic region. This wide dissection was quite easy also in patients with a serious cholestatic disease. Intraoperative mortality was 0%. Operative mortality was 5%. Postoperative complications (20%) were 1 sepsis, 1 hepato-renal syndrome with hepatic coma, 1 mechanical intestinal obstruction, 1 wound infection. Eight patients (40%) died in 6 months in average (neoplastic recurrence 40%). Notwithstanding the advanced disease (stage III 50%; N1+ 50%), twelve patients (60%) have a mean postoperative survival rate of 18.5 (range 1-48) months without neoplastic recurrence. Tumour diameter was less than 4 cm in 83.3% of cases. An earlier diagnosis (with tumour diameter < 4 cm) can improve pancreatic head cancer prognosis. A wide surgical exeresis with a R2 lymph nodes clearance together with surrounding connective and nervous tissue can remove micrometastases with a better control local recurrence.

Adenocarcinoma↗