Neonatal necrotizing enterocolitis rat model attenuated by a remote ischemic preconditioning in the pregnant

Abstract Purpose: To evaluate the effect of remote ischemic preconditioning (r-IPC) administered to pregnant rats, in the ileum of newborn rats subjected to hypoxia and reoxygenation. Methods: We used three pregnant rats and their newborn rats distributed in three groups: 1) Control (C) - Newborn rats born from a pregnant rat which did not undergo any intervention; 2) Hypoxia-Reoxygenation (H/R) - Newborn rats born from a pregnant rat which did not undergo any intervention, and were subjected to hypoxia-reoxygenation; 3) Remote Ischemic Preconditioning (r-IPC) - newborn rats born from a pregnant rat which was subjected to remote ischemic preconditioning twenty-four hours before giving birth and the newborn rats were subjected to hypoxia-reoxygenation. Segments of ileum were prepared for histological analysis by HE and immunohistochemistry by the Ki67 to evaluate cell proliferation, crypt depth and villus height and evaluation of apoptosis by cleaved caspase-3. Results: The intensity of the lesions was lower in the r-IPC than in the H/R group, showing significant difference (p<0.01). The r-IPC group showed a higher proliferative activity compared to the H/R group (p<0.01), with deeper crypts (r-IPC > H/R - p < 0.05), and higher villi, showing significant difference (r-IPC > H/R - (p <0.01). The occurrence of apoptosis in the H/R group was lower in comparison to groups C and r-IPC, with significant difference (H/R < r-IPC; p<0.05). Conclusion: The remote ischemic preconditioning applied to the pregnant rat protected the ileum of newborn rats subjected to hypoxia and reoxygenation, with decreased intensity of the lesions in the ileum mucosa and preservation of proliferative activity, keeping the villus height and crypt depth similar to group C.

Temporal profile of intestinal tissue expression of intestinal fatty acid-binding protein in a rat model of necrotizing enterocolitis

OBJECTIVES: Necrotizing enterocolitis is a severe multifactorial intestinal disorder that primarily affects preterm newborns, causing 20-40% mortality and morbidity. Intestinal fatty acid-binding protein has been reported to be a biomarker for the detection of intestinal injuries. Our aim was to assess intestinal tissue injury and the molecular expression of intestinal fatty acid-binding protein over time in a necrotizing enterocolitis model. METHODS: A total of 144 Newborn rats were divided into two groups: 1) Control, which received breastfeeding (n=72) and 2) Necrotizing Enterocolitis, which received formula feeding and underwent hypoxia and hypothermia (n=72). A total of six time points of ischemia (2 times a day for 3 days; 12 pups for each time point) were examined. Samples were collected for analysis of body weight, morphological and histological characteristics, intestinal weight, intestinal weight/body weight ratio, injury grade, and intestinal fatty acid-binding protein levels. RESULTS: Body and intestinal weights were lower in the Necrotizing Enterocolitis group than in the Control group (p<0.005 and p<0.0005, respectively). The intestinal weight/body weight ratio was higher in the Necrotizing Enterocolitis group than in the Control group (p<0.005) only at the sixth ischemia time point. The Necrotizing Enterocolitis group displayed higher expression of intestinal fatty acid-binding protein (p<0.0005) and showed greater tissue damage than the Control group. CONCLUSION: Intestinal fatty acid-binding protein was an efficient marker of ischemic injury to the intestine and a good correlation was demonstrated between the time of ischemic injury and the grade of intestinal injury.

Malformación vascular venosa intestinal: una rara causa de hemorragia digestiva en pediatría. Presentación de un caso / Intestinal venous vascular malformation: Unusual etiology of gastrointestinal bleeding in pediatrics. Case report

Las malformaciones vasculares intestinales, en especial las del colon derecho, son causa frecuente de sangrado digestivo en adultos mayores, pero son raras en pediatría. Se pueden manifestar como hemorragia aguda, obstrucción intestinal o como anemia crónica de etiología incierta; esta es la presentación más frecuente, pero también la de mayor dificultad diagnóstica y terapéutica. Se presenta un niño de 11 años, que ingresó por Guardia con vómitos, dolor abdominal y descompensación hemodinámica, que requirió expansión y transfusión sanguínea. Entre sus antecedentes, figuraban episodios recurrentes de hemorragia intestinal baja desde los primeros años de vida, con estudios endoscópicos y centellograma Tc99 normales e historia de anemia persistente, a pesar del tratamiento. En la última internación, con la videocolonoscopía, se logró identificar una malformación venosa intestinal en la zona ileocecal. La angiografía digital y la enterotomografía multislice resultaron de suma utilidad en el proceso diagnóstico y en la elección de la conducta quirúrgica.

Intestinal vascular malformations, especially those in the right colon, are a frequent cause of lower gastrointestinal bleeding in adults, but they are a very rare condition in children. Symptoms include acute hemorrhage, intestinal obstruction, or chronic anemia of uncertain etiology, which is the most frequent form of presentation but the most difficult to diagnose and thus properly treat. We report the case of an 11 year old boy admitted to the Emergency Room with abdominal pain, vomits, hemodynamic decompensation, who required expansion and blood transfusion. With history ofrecurrent bloody stools since infancy with repeated normal endoscopies and Tc99 scintigraphy with chronic anemia and no improvement despite adequate treatment. In the last admission, the videocolonoscopy detected a venous vascular malformation in the ileocecal region. The angiography and the entero multislice computer tomography scanner were valuable tools to confirm the diagnosis and to select the appropriate surgical procedure for this rare condition.

Immediate postoperative evaluation of enteric anastomosis after the use of meloxicam in rats

ABSTRACT PURPOSE : To compare ileal anastomoses in the immediate postoperative healing period after meloxicam use. METHODS: Forty two male Wistar rats were randomly divided into two groups of 21, COX and control group. To COX meloxicam in combination with morphine was given in 3 days period. Control group received only morphine during the same period. Each group was divided into three sub-groups of 7, which were euthanized at 5, 10, and 21 days postoperatively. Comparison was based in histological evaluation of collagen type I and III using sirius red, immunohistochemical through vascular endothelial growth factor and matrix metalloproteinase-9. RESULTS: Healing process in scheduled periods did not show significant differences (p>0.05) between the COX and control groups during any of the periods. CONCLUSION: The use of meloxicam in the postoperative period following ileal anastomosis did not affect healing.

Importance of duration and number of ischemic postconditioning cycles in preventing reperfusion mesenteric injuries. Experimental study in rats

PURPOSE:To evaluate the effect of ischemic postconditioning(IPC) on intestinal mucosa of rats subjected to ischemia and reperfusion process comparing two cycles of reperfusion and ischemia lasting two minutes each and four cycles of reperfusion and ischemia lasting 30 seconds eachMETHODS: Thirty Wistar rats were distributed into three groups: group A (10 rats), ischemia (30 minutes) and reperfusion (60 minutes); group B (10 rats), ischemia and reperfusion plus IPC by two lasting two minutes each; and Group C (10 rats), ischemia and reperfusion plus IPC by four cycles lasting 30 seconds each. Finally, a segment of small intestine was resected for histological analysis. We analysed the results according to Chiu et al. classification and proceeded to the statistical treatment by Kruskal-Wallis test (p<0.05).RESULTS: The mean degree of tissue injury according to Chiu et al. classification were: Group A, 2.77; in group B, 1.4; and group C, 1.4. B X C (p<0.05).CONCLUSIONS: Ischemic postconditioning was able to minimize reperfusion injury of rats undergone mesenteric ischemia and reperfusion process. There was no difference in the effectiveness of the method comparing two cycles of two minutes with four cycles of 30 seconds by H&E histological evaluation of the ileum after 60-minute reperfusion.

Effect of protective solutions and hydroxyethyl starch in the attenuation of the injuries of ischemia and reperfusion of splanchnic organs

PURPOSE: Vogt´s antioxidant solution (red blood cells, Ringer's solution, sodium bicarbonate, mannitol, allopurinol and 50% glucose) or its modification including hydroxyethyl starch (HES) were tested for the prevention of splanchnic artery occlusion shock. METHODS: Seventy rats were distributed in treatment (3), control (1), and sham (3) groups. Ischemia and reperfusion were induced by celiac, superior mesenteric and inferior mesenteric arteries occlusion for 40 min, followed by 60 min reperfusion or sham procedures. Controls received saline, both treatment and sham groups received the Vogt's solution, modified Vogt's solution (replacing Ringer's solution by HES), or HES. Mean arterial blood pressure (MABP), ileal malondialdehyde (MDA) and plasmatic MDA were determined, and a histologic grading system was used. RESULTS: At reperfusion, MABP dropped in all I/R groups. Only HES treatment was able to restore final MABP to the levels of sham groups. Plasmatic MDA did not show differences between groups. Ileum MDA was significantly higher in the control and treatment groups as compared to the sham group. Histology ranking was higher in the only in control group. CONCLUSIONS: Hydroxyethyl starch was able to prevent hemodynamic shock but not intestinal lesions. Both treatments with Vogt's solutions did not show any improvement. .

Midgut volvulus after laparoscopic appendectomy / Volvo de intestino delgado após apendicectomia laparoscópica

The authors report a case of a 13-year old child who was submitted to a laparoscopic appendectomy and developed, during the postoperative period, an intestinal obstruction caused by small bowel volvulus in the absence of a congenital malrotation.

Relato do caso de uma criança de 13 anos de idade submetida à apendicectomia laparoscópica e que, no pós-operatório, desenvolveu quadro de obstrução intestinal, decorrente de um volvo de intestino delgado, na ausência de má rotação intestinal.

Letter to the Editor: A Case of Behcet's Disease with Massive Lower Gastrointestinal Bleeding / 대한소화기학회지

No abstract available.

Avaliação do pós-condicionamento isquêmico no tratamento da isquemia mesentérica: estudo experimental em ratos / Evaluation of ischemic postconditioning effect on mesenteric ischemia treatment: experimental study in rats

OBJETIVO: Avaliar o efeito do pré e pós-condicionamento isquêmico sobre a lesão tecidual na mucosa intestinal de ratos submetidos ao processo de isquemia e reperfusão mesentérica. MÉTODOS: Foram estudados 30 ratos Wistar, distribuídos em três grupos: grupo A, em que se realizou isquemia (30 minutos) e reperfusão (60 minutos) mesentérica; grupo B, isquemia e reperfusão mesentérica precedidos pelo pré-condicionamento isquêmico por três ciclos de isquemia e reperfusão com duração de dois minutos cada; grupo C, isquemia e reperfusão mesentérica e, precedendo o início da reperfusão, foi realizado o pós-condicionamento isquêmico por três ciclos de reperfusão e isquemia com duração de dois minutos cada. Ao final, ressecou-se um segmento do intestino delgado para análise histológica. Avaliaram-se os resultados pela classificação de Chiu et al. e procedeu-se ao tratamento estatístico. RESULTADOS: As médias dos graus de lesão tecidual segundo a classificação de Chiu et al. foram: no grupo A, 3,5; grupo B, 1,2; grupo C, 1. A diferença entre o resultado do grupo A com os resultados dos grupos B e C foi considerada estatisticamente significativa (P < 0,05). CONCLUSÃO: O pré e pós-condicionamento isquêmico foram capazes de minimizar, com intensidade semelhante, a lesão tecidual na mucosa intestinal de ratos submetidos ao processo de isquemia e reperfusão mesentérica.

OBJECTIVE: To assess the preconditioning and postconditioning effect on intestinal mucosal lesions in rats undergone mesenteric ischemia and reperfusion procedure. METHODS: Thirty Wistar rats were studied and divided into three groups: Group A, 10 rats undergone mesenteric ischemia (30 minutes) and reperfusion (60 minutes); Group B, 10 rats undergone mesenteric ischemia and reperfusion preceded by ischemic preconditioning for three cycles of ischemia and reperfusion for two minutes each; Group C, 10 rats undergone mesenteric ischemia and reperfusion and, preceding the beginning of reperfusion, ischemic postconditioning was performed for three cycles of reperfusion and ischemia for two minutes each. Then, a segment of small intestine was resected for histological analysis. We assessed the results by Chiu et al. score and the statistical analysis was performed. RESULTS: According to Chiu et al. score, the means of lesion degree were: In the group A, 3.5; Group B, 1.2; Group C, 1. The difference between group A with the groups B and C was considered statistically significant (P < 0.05). CONCLUSION: Ischemic pre- and postconditioning were capable of minimizing - in a similar intensity - the tissue injury on the intestinal mucosa of rats undergone mesenteric ischemia and reperfusion process.

Comparative study between ileo colic pedicle versus superior mesenteric pedicle division for mesenteric lengthening

Lengthening of the mesentery by vascular division may be necessary to perform an ileal pouch anal anastomosis without tension. Our objective is to compare the increase in mesentery length after division of ileo colic pedicle [ICP] and the superior mesenteric pedicle [SMP]. Was to compare the increase in length of the mesentery after division of the [ICP] and after division of the [SMP]. Total colectomy was performed in [14] patients. Which were then randomly divided into two groups. Pouch anal anastomosis was performed with division of the [ICP] in one group of seven patients and with division of the [SMP] in the other. The ileum was measured and the increase in length was recorded and compared statistically. The mean [s.d.] increase in length was 2.9 [0.8] cm. after [ICP] division and 6.5 [1.1] cm after [SMP] division [P<0.001]. The distance between the end of the ileum and the point giving the greatest length was 27.5 [4] cm in the [ICP] group and 46.8 [4.2] cm in [SMP] group [P<0.001]. The increase in mesenteric length was greater after [SMP] division than after [ICP] division, but if pouch-anal anastomosis is performed a short segment of small bowel must be removed

Massive Gastrointestinal Bleeding due to Aneurysmal Rupture of Ileo-colic Artery in a Patient with Behcet's Disease / 대한소화기학회지

Behcet's disease has been recognized as a systemic vasculitis characterized by the involvement of multiple organs such as orogenital ulcers, eye lesions including uveitis and optic neuritis, and skin lesions including folliculitis and erythema nodosum. Vascular involvement occurs occasionally and is classified into thrombosis and aneurysm. However, massive gastrointestinal bleeding from arterial aneurysm is a rare manifestation of intestinal Behcet's disease. Recently, we experienced a case of intestinal Behcet's disease presenting with massive gastrointestinal bleeding due to aneurysmal rupture of ileo-colic artery. A 30-year-old male with Behcet's disease was admitted because of massive gastrointestinal bleeding. A large ileo-cecal ulcer was revealed as a bleeding focus on colonoscopic examination. Celiac angiography showed aneurysm and stenosis of ileo-colic artery. After the failure of hemostasis with arterial embolization, ileocecectomy was performed. After the resection hematochezia was completely stopped.

Intraluminal injection of short chain fatty acids diminishes intestinal mucosa injury in experimental ischemia-reperfusion

OBJETIVO: Investigou-se o efeito de ácidos graxos de cadeia curta (SCFA) na mucosa intestinal na presença de lesão por isquemia e reperfusão (IRI). MÉTODOS: Foram criados seis sacos fechados no intestino delgado (três no jejuno e três no íleo) em 10 ratos Wistar. Ao sacos laterais de ambas as regiões intestinais foram submetidos a IRI (15/15 minutos) enquanto que o saco medial não sofreu interrupção do suprimento sanguíneo. Nos sacos laterais ambas as regiões injetou-se SCFA ou solução fisiológica na luz intestinal. Nos sacos mediais não se injetou nenhuma solução. RESULTADOS: Tanto no jejuno quanto no íleo o escore de injuria da mucosa intestinal foi mais alto nos sacos tratados com solução salina do que nos controles. Os sacos que receberam SCFA apresentaram menor escore inflamatório no íleo (p=0.03) porém sem diferença no jejuno (p=0.083) quando comparados com os sacos injetados com solução salina. Observou-se um significante maior acumulo de neutrófilos nos sacos tratados com solução salina (p < 0.01) do que nos outros dois sacos em ambas as regiões. CONCLUSAO: Os SCFA protegem a mucosa intestinal distal e diminuem o acumulo de neutrófilos na lamina própria após IRI.

Oxidized tissue proteins after intestinal reperfusion injury in rats

OBJETIVO: Analisar se a mensuração da proteína carbonilada pode ser validada como método capaz de permitir a identificação de um estresse oxidativo intestinal causado por lesões decorrentes da isquemia e reperfusão. MÉTODOS: Vinte e cinco ratos machos da linhagem Wistar, pesando entre 200 e 250g, foram divididos em três grupos. Grupo I – controle (n = 10). Grupo II – simulação (n = 5) e grupo III (n = 10) submetido a 60 minutos de isquemia intestinal e igual intervalo para reperfusão. Para este fim clampeou-se a artéria mesentérica superior no seu terço distal. Alterações histológicas e os níveis de proteínas carboniladas foram determinados em amostras obtidas em todos os grupos. No grupo III foram estudados segmentos ileais reperfundidos e normais. RESULTADOS: Em todos os segmentos reperfundidos houve edema da mucosa e submucosa, além de infiltrado inflamatório da lâmina própria. Os níveis de proteína carbonilada aumentaram no grupo III, inclusive nos segmentos não isquemiados. A sensibilidade e a especificidade da proteína carbonilada no tecido foram, respectivamente, de 94% e 88%. CONCLUSÃO: O procedimento da proteína carbonilada é útil como marcador biológico do estresse oxidativo após isquemia e reperfusão intestinal em ratos. Também foi relevante o efeito do estresse oxidativo, observado à distância do lócus da lesão primária.

Does TAME induced contraction involve an endothelium dependent nitric oxide-cyclic GMP mediated pathway?

Two enzyme inhibitors namely L-NAME, a nitric oxide synthase (NOS) inhibitor and methylene blue, a guanylate cyclase inhibitor, were used to elucidate whether N-alpha-tosyl L-arginine methyl ester (TAME)-induced contractions in toad intestinal rings in vitro are mediated through a nitric oxide (NO)- cyclic GMP (c-GMP) pathway. Moreover, a NO precursor, L-arginine was also used to investigate its effect on TAME-induced contractions. Our findings provide evidence that TAME-induced contractions have both an endothelium-dependent and an endothelium-independent component. Based on our findings we now propose that TAME induced contraction involves an endothelium-dependent component mediated through NO and c-GMP.

A quantitative and comparative study of the ganglionic neurons in the myenteric and submucous plexuses of the small intestine, and in the intramural plexus of the gall bladder of the ginea-pig

Whole-mount preparations of guinea-pig small intestine and gall bladder stained using a modified Giemsa technique were used to estimate neuronal and ganglion density, and neuron area, within the wall of these organs. The myenteric ganglia were long and thin in the jejunum and ileum, and round, triangular, square, rectangular or distinctly elongated in the duodenum. Most of the myenteric neurons were also elongated. The submucosal plexus showed a remarkable regularity of pattern, and, compared with the myenteric plexus, had smaller ganglia which were variable in shape. The pattern of the intramural plexus resembles that of the submucosal plexus. In the myenteric plexus, there were no differences in ganglion density among the duodenum, jejunum and ileum. Neuronal density and the number of neurons/ganglion was greater in the duodenum. The mean ganglion and neuronal densities in the submucosal plexus were greater in the ileum and smaller in the jejunum. The number of neurons/ganglion decreased from the duodenum to the ileum. The intramural plexus of the gall bladder contained 1 ganglion/mm2 and 6 neuron/mm2. In the myenteric plexus, neuron area ranged from 101 to 250 mum2; in the submucous plexus, the value was from 51 to 250 mum2 while in the intramural plexus, the areas of most neurons lay in the ranges of 201 to 300 mum2 and 301 to 400 mum2. These results suggest significant differences in neuronal density in the myenteric plexus among the duodenum, jejunum and ileum, and significant differences between the submucosal and intramural plexuses.

Contribuiçäo para o estudo anatômico da existência e origem da artéria ileocólica / Contribution to the anatomical study about the existence and origin of the ileocolic artery

Os autores estudaram 116 cadáveres humanos pela técnica da dissecaçäo macroscópica da artéria ileocólica, com a finalidade de obterem informaçöes complementares sobre sua existência e origem. Compararam também peças anatómicas de adultos com outras de crianças, para verificarem se havia diferença com relaçäo a essa artéria, em adultos e crianças

Yeyunoíleon

Se describe la anatomía del yeyunoileón incluyendo tamaño, desarrollo, irrigación y pliegues. De las bridas y adherencias se indican sus causas y consecuencias, las mismas constituyen hoy día la primera causa de oclusión intestinal, pero no se manifiesta hasta que no se produce la obstrucción. Su tratamiento debe ser profiláctico. Se detallan, las manifestaciones clínicas, diagnósticas y tratamiento de los tumores intestinales, vólvulos, parásitos, divérticulo de Meckel, invaginación en el adulto, enfermedad de Crohn, cuerpos extraños, lesiones traumáticas, tuberculosis intestinal, fiebre tifoidea, úlcera y divertículos

Irrigación ileocecocólica

Esta investigación muestra la distribución arterial de la región ileocecal, encontrada al realizar la disección de 10 plastrones abdominales, tomados de cdadáveres de adultos en la Sección de Anatomía del departamento de Morfología de la Universidad Nacional. Los hallazgos se correlacionan y comparan con las descripciones que brindan los textos de anatomía y cirugía. Se concluye que la arteria cólica media derecha es casi constante (70 por ciento), por lo menos en nuestra raza. El origen de ésta arteria en el 60 por ciento de los casos aparece en la ileocecoapendiculocólica y termina anastomosada con la arterias cólicas derecha superior e inferior en todos los casos. Esta disposición refuerza la vascularización del colon ascendente en los casos estudiados. Adicionalmente se demuestra de dos a cinco anastomosis entre las ramas de la arteria ileocecoapendiculocólica. el arco yuxtacólico cecal está presente en un 50 por ciento de los casos demostrados, así que su ausencia no es la regla