Effects of reducing postprandial hyperglycemia and metabolism of acetate wheat starch on healthy mice

Abstract Recently, the acetate wheat starch (AWS) has been prepared by acetylation with an acetyl content of 2.42%, containing of rapidly digestible starch (RDS), slowly digestible starch (SDS) and resistant starch (RS) with 25.0%; 22.9% and 34.5%, respectively. In this study, this kind of starch was continuously evaluated with the postprandial blood glucose response and determined short-chain fatty acids (SCFAs) metabolized from AWS in the gastrointestinal tract of healthy mice by HPLC. The result showed that the mice fed with AWS exhibited a very limited increase in blood glucose level and remained stable for 2 hours after meals efficiently comparing with the control group fed with natural wheat starch (NWS). Simultaneously, the content of SCFAs produced in the caecum of the mice fed with AWS was significantly higher than mice fed with NWS, especially with acetic and propionic acids by 28% and 26%, respectively. Thus, AWS has shown to limit the postprandial hyperglycemia in mice effectively through the resistance to amylase hydrolysis in the small intestine. When going into the caecum, it is fermented to form SCFAs providing a part of energy for the body's activities, avoiding rotten fermentation causing digestive disorders which are inherent restrictions of normal high cellulose and fiber food.

Torsion of caecal appendices epiploicae: mimicking acute appendicitis

Acute appendicitis is a common cause for pain in the right iliac fossa, which requires urgent surgical intervention. However, at the time of surgery, if the appendix is normal, the surgeon has to search for other causes of acute abdominal pain including rare etiologies, such as torsion of appendices epiploicae and subsequently its gangrene. We report the case of a 45 years old female who presented with right lower abdominal pain, rebound tenderness and guarding in right iliac fosse, with regular menstrual cycles and no urinary complaints. Investigation revealed leucocytosis and ultra-sonography abdomen was suggestive of an inflamed appendix in the right iliac fossa with free fluid. Intra-operatively, we found a normal appendix with gangrene of the appendices epiploicae which had undergone torsion. She underwent excision off appendices epiploicae with appendicectomy with uneventful post-operative period. Histopathology of the appendices was suggestive of congestion.  Preoperative diagnosis of this condition is rarely made.

Taxonomic validation of Areolate grouper, Epinephelus areolatus (Perciformes: Serranidae) along the Nizampatnam coast, India

Groupers (Perciformes: Serranidae: Epinephelinae) are a significant group of marine and estuarine fishes havingecological and commercial importance in tropical and subtropical waters. The genus Epinephelus is identifiedbased on the color configuration and morphological characteristics. The homogeneity in the morphologicalcharacteristics has created confusion in the species identification of Epinephelus. Epinephelus areolatus withits delicious taste has high economic value; however, its population showed a remarkable decline in recenttimes due to overfishing. Due to morphological resemblance, it has often been confused with Epinepheluschlorostigma and Epinephelus bleekeri, which leads to misidentification. Hence, correct identification ofspecies is needed for the proper management of fish resources. This study aims to identify and validate E.areolatus by using morpho-meristic characteristics, including the number and pattern of pyloric caeca, vertebraecount through radiograph imaging, scale and otolith morphology, and DNA barcoding. The morphologicaland meristic characteristics of Epinephelus species observed in Nizampatnam coast are strikingly comparableto those reported earlier as E. areolatus. Comparative molecular analysis was also carried along with othermorphologically similar species, viz. E. chlorostigma and E. bleekeri, using mitochondrial cytochrome oxidaseI gene sequences. The mean interspecific genetic distance revealed high similarity with E. bleekeri (0.109 ±0.012) and low similarity with E. chlorostigma (0.079 ± 0.009). The neighbor-joining tree has shown distinctclades for three species with high bootstrap values. The partial DNA sequence of the mitochondrial cytochromeoxidase I was established for the first time for E. areolatus from the Nizampatnam coast in this study

Appendiceal intussusception presenting as a caecal mass

@#Introduction: The differential diagnosis of caecal mass is broad and the inclusion of appendiceal pathologies is an important element. Case Report: We report a 37-year-old woman with recurrent right iliac fossa pain. Computed tomography scan revealed a caecal mass suggesting complete inversion or intussusception of the appendix, which was confirmed by pathologic microscopic examination. This case report discusses appendiceal intussusception with emphasis on diagnosis and treatment options. Discussion: Appendiceal intussusception is a rare entity and the complete type typically presents as a polypoid lesion located at the appendiceal orifice in the caecum. It is imperative to include this entity in the differential diagnosis of caecal mass, especially during colonoscopy, as the removal of this polypoid lesion can result in a devastating caecal perforation or haemorrhage.

Morphological variations of caecum and appendix in the central india: a cadaveric study

One of the important reasons of acute abdomen is appendicitis and emergency surgery is needed many times totreat the condition. Different clinical presentations of appendicitis are observed because of the variations inanatomical location of the appendix. Anatomical and topographical variations of the caecum are also known.These unusual positions and presentations land the surgeon in diagnostic and surgical challenges. In this study,the anatomical variations of the caecum and appendix have been observed. The present study is aimed to studythe variations in the size, shape, position and arterial supply of the caecum and appendix in individuals ofdifferent ages and sex, a thorough knowledge of which will aid surgeons in performing various abdominaloperations. The study was carried out on 30 adult cadavers in the department of Anatomy, Government medicalcollege, Nagpur, Maharashtra, India. Out of which 20 were male cadavers and 10 were female cadavers. TheAnatomy of 30 caecum and 30 appendix was studied in detail. In most of the cadavers, the caecum and appendixwere found in the right iliac fossa. The commonest shape of the caecum found, was adult (ampullary) type. Thecommonest position of the appendix found, was retro-caecal, followed by pelvic. This information is certainlyhelpful to the surgeons in locating the caecum and appendix during surgical interventions.

Sub-hepatic Caecum with Extra-pelvic Looped Sigmoid Colon: An Embryological and Clinical Perspective

Introduction: We encountered variation in the placementof large intestine in abdominal cavity of a 76-years-old malecadaver during dissection of abdominal cavity. The workwas performed in Department of Anatomy during routineMBBS teaching sessions. The aim of this paper is to reportco-existence of error of mid-gut development and alongwith variant topo-morphology of sigmoid colon in the samecadaver.Case Report: Sub-hepatic caecum with high riding vermiformappendix with absent ascending colon was seen on the rightside of abdominal cavity. Concomitantly on the left side of theabdominal cavity dilated, looped sigmoid colon occupied theleft hypochondrium, left lumbar region and left iliac fossa. Wereport these findings along with the embryological basis andclinical significance.Conclusion: An insight about the errors in development ofmid-gut resulting into the variant topography of caecum willfacilitate surgeons and radiologists in prompt diagnosis andquick modification of the protocol during invasive procedures.

A Study On The Morphology Of Ileo-caecal Region And Its Clinical Correlations

Background: The ileocaecal region is a juncture where the ileum enters the colon and the caecum is continuousproximally with terminal ileum and distally with the ascending colon. The ileocaecal orifice is guarded byileocaecal valve. The caecum and the ileocaecal valve show significant variations in the shape and dimensions.The ileocaecal region is the common site for clinical conditions like polyps, diverticulae, volvulus &intussusception. Use of ileocaecal segment in bladder reconstruction surgery also makes anatomy of this regionmore important. The aim of our study was to elucidate the morphological variations of caecum and ileocaecalvalve and their clinical importance.Materials and Methods: The present study was conducted on 100 human cadaveric specimens, during routinedissection for the undergraduate students in the department of Anatomy, K.A.P.V. Government medical college,Trichy. The size & shape of the caecum, level of its peritoneal attachment, position & shape of the ileocaecalvalve, its dimensions, the distance between the ileocaecal and appendicular orifices were noted and measured.Results: The length of the caecum ranged from 2to 7 cm. The breadth of caecum ranged from 4.5 to 7cm. The shapeof caecum was of Adult type in 97% of cases. The caecum was completely covered by peritoneum and not fusedto the posterior abdominal wall in 75% of cases. The ileum terminates into the posteromedial aspect ofcaecumin 58% ofcases. The shape of ileocaecal orifice was slit like in 49% of cases. The height of upper labia ofileocaecal valve was within the range of 0.5cm-2.5cm, and of lower labia ranged from 0.5cm to 1cm. Thediameter of ileocaecal orifice varied from 1.1 to 2.5 cm. The distance between the ileocaecal and appendicularorifices ranged between 1.7 – 5cm.Conclusion: This study focused on normal and variant anatomy of caecum and ileocaecal junction. This studywill be of help in radiological, ultrasonic and CT diagnosis of the ileocaecal region pathology and in planning forbetter therapeutic options.

Diagnostic and Therapeutic Role of Water Soluble Contrast in Adhesive Small Bowel Obstruction

Background: Adhesive small bowel obstruction is one of the commonly encountered clinical problems associated with repeated hospitalization. Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need of operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. Aim: To evaluate the role of Gastrografin in predicting the need of surgery in post-operative intestinal obstruction and its therapeutic effect in management of adhesive intestinal obstruction. Methods: This prospective nonrandomized controlled trial study was conducted on 72 patients with a diagnosis of adhesive small bowel obstruction. All patients were divided into Groups A and B. In 36patients of Group A, Gastrografin dye was administered and serial abdominal X-rays were taken up to 24 hours. The patients, in whom contrast reached caecum within 24 hours, the result was positive for partial obstruction and they were treated conservatively. False positive included high-grade partial obstructions that ultimately required surgery. If the contrast failed to reach the large bowel within 24 hours, the patient was considered to have complete obstruction and was operated. In 36 patients of Group B, all these patients were treated conservatively and were operated when required. Qualitative data was analysed by Fisher exact test. Results: In our study, in gastrograffin group 83.3% of cases were managed conservatively and 16.6% were operated, whereas in control group 66.6% were managed conservatively and 33.3% were operated (P value=0.02). Further in case of patients who received dye 88.9% patients resolved within 24 to 48 hours were as in case of controls only 33.3 % patients resolved within 24 to 48 hours. Therefore, in our study gastrograffin had 100% sensitivity and 86.6 % specificity, 86.6% positive predictive value and 100% negative predictive value. Overall accuracy was calculated to be 88.88%. The mean hospital stay of group A patients was 4.4 days and in case of group B was 6.3 days (p value 0.009). Conclusions: Gastrografin was effective and safe for prediction of need for surgery in adhesive small bowel obstruction. Furthermore, it speeds the resolution of obstruction and reduces the need for operation.

Study on morphological variations of cadaveric vermiform appendix and caecum in Narayan Medical College and Hospital

Vermiform appendix is one of the most variable organs inside the abdomen. Unusual positions pose diagnostic and surgical challenges. The present study was conducted on 38 cadavers in Narayan Medical College and Hospital to find the morphological variations of vermiform appendix and caecum. It was seen that the most common position of appendix was retrocaecal (61%) while second most common position was pelvic (21%). Mean length of appendix was found to be 5.98 ± 1.67 cm. Mean outer girth was 2.87 ± 0.36 cm. Mean distance of Vermiform Appendix from ileocaecal junction was found to be 2.58 ± 0.46 cm. Adult type is the most common shape (71%) followed by exaggerated one (18%). Mean length of caecum was 7.61 ± 0.80 cm. and mean width being 8.49 ± 0.88 cm. Knowledge about morphological pattern of appendix and caecum is helpful in proper clinical management.

Morphological and Histological Study on Vermiform Appendix in Rabbit, Goat and Human Being.

Background: The vermiform appendix is a narrow blind tube projecting from the postero-medial wall of caecum. The name is derived from the Latin word "Vermiforma" meaning worm shaped or worm like. Anatomically, it is one of the mobile viscera of abdomen with an average length of 6-8cm. Microscopically, it consists of mucous, sub mucous, muscular and serous coats from inside out, and its surface epithelium being lined with a simple columnar type of cells including Goblet, Paneth and Argentaffine cells. Due to the presence of extensive lymphoid tissue in the mucous and submucous coats forming lymphoid follicles, it has been called 'Tonsil of the Abdomen'. This small structure without any known function in a human being has been regarded as a vestigial remnant of a better developed distal caecum in herbivores. However, in view of its rich blood supply and histological cyto differentiation, the vermiform appendix has been accepted as a complex and highly specialized organ rather than a degenerate vestigial structure. Aim: This study was performed to compare and contrast the morphology and histology of the vermiform appendix in three species of class mammalia with different dietary habits. Methods: Samples of fifty-three human vermiform appendices were collected out of which twenty-three were of human being, seventeen were of goats and thirteen were of rabbit. The samples were subjected to a naked eye examination along with routine histological staining and observation. Results: In man the range of length of vermiform appendix was from 5.4 -12.4 cm. histologically, all four layers were prominent. In goat the length of caecum was from 15 – 28 cm and microscopically all four layers were prominent. In the rabbit length of the vermiform appendix was from 8.5 – 12.5cm and all four layers were observed histologically. Conclusion: Morphological and histological differences as observed in vermiform appendix and caecum of three mammals in this study appear to be associated with their different dietary habits. Morphologically distinct vermiform appendix was found in human being and rabbit only as goat has a well-developed caecum. Rabbit revealed to possess a very large caecum acting as a fermentation tank but also a prominent and distinctive appendix with lymphoid aggregations.

Variation in arterial supply of human vermiform appendix.

Precise knowledge of vascular variation and planning of conducting surgical and radiological procedures is important during appendectomy. During the routine medical undergraduate educational dissection of 63 year old male cadaver we found appendicular artery (AA) a branch of the inferior division of the ileocolic artery (ICA). The AA passed in front of the terminal part of the ileum, and entered the mesoappendix of the vermiform appendix. It runs near the free margin of the mesoappendix and ends in branches which supplied the appendix. The reminding of this type of variation is also important while performing the surgeries or dissections.

A Rare Case of Undescended Caecum Accompanied by Looped Retroperitoneal Appendix

Intestinal malrotations are associated with various anatomical anomalies. We report a unique case wherein the caecum was located in the right lumbar region instead of the right iliac fossa. The ileo-caecal junction was also placed higher up. The appendix was ‘uncinate’ shaped, highly coiled and retroperitoneal with the absence of mesoappendix. Both, the caecum and appendix were supplied by ascending branch of the ileocolic artery instead of the descending branch. Further, we also observed that the ascending colon was very short and sub-hepatic in position. Such type of variations is of clinical and surgical importance in diagnosis and treatment of appendicitis.

Effects of a soluble dietary fibre NUTRIOSE(R) on colonic fermentation and excretion rates in rats

The resistant dextrin NUTRIOSE(R), developed from starch, is expected to act as a prebiotic. The aim of this study was to determine the effects of NUTRIOSE(R) on cecal parameters, short-chain fatty acid (SCFA) concentrations, and fecal excretion in rats. In an initial experiment, twenty-four male Fischer F344 rats were randomly assigned to one of the following four treatments for 14 days: G0 (control diet), G2.5 (control diet + 2.5% of dextrin), G5 (control diet + 5% of dextrin), and G10 (control diet + 10% of dextrin). After 14 days, total cecal weight, cecal content, and cecal wall weight were significantly increased in G5 and G10 compared to G0. At the same time, cecal pH was significantly lower in G10 compared to G0. Total SCFA concentration was significantly higher in G10 than in G5, G2.5, and G0, and significantly higher in G5 than in G0. Acetate, butyrate, and propionate concentrations were significantly increased in G5 and G10 compared to the controls. In a second trial based on a similar design, eighteen male Fischer F344 rats were treated with a control diet supplemented with 5% of dextrin or 5% of fructo-oligosaccharide. The results obtained with NUTRIOSE(R) were similar to those obtained with the fructo-oligosaccharide. In a third experiment, two groups of 5 Fischer F344 rats were orally treated with 100 and 1,000 mg/kg NUTRIOSE(R), respectively, and from 18% to 25% of the dextrin was excreted in the feces. The results of these three studies show that the consumption of NUTRIOSE(R), by its effects on total cecal weight, cecal content, cecal wall weight, pH, and SCFA production, could induce healthy benefits since these effects are reported to be prebiotic effects.

Carcinoma Caecum coexistent with Tuberculosis : a case report.

Tubercular lesion may coexist with malignancy in various sites resulting in dfficulties in diagnosing the conditions. A case of carcinoma caecum associated with tubercular lesion in the same site is reported. The patient have completed the antitubercular therapy and is now on regular anticancer chemotherapy. Till now the patient is doing fine.

Undescended caecum and right-sided sigmoid colon with aberrant right hepatic artery: A case report.

Malrotation of the intestines in the third stage of intestinal rotation can be found in many studies and reports, but the incidence is variable. Aberrant right hepatic artery variations have been reported frequently in many series, but no report has described aberrant right hepatic arteries coming from the posterior branches of the superior and inferior pancreaticduodenal arteries. We report a case of undescended caecum and right-sided sigmoid colon with aberrant right hepatic artery in the cadaver of a 53-year-old male since it is important in some surgical arpects.