Laparoscopic-assisted resection of giant sigmoid lipoma under colonoscopic guidance.

Colonic lipomata are rare and mostly asymptomatic lesions; but as they become larger they may produce abdominal pain, constipation, diarrhea, hemorrhage, and intussusception. We report the case of a 75-year-old man who suffered from nonspecific recurrent abdominal pain in the left upper and lower quadrants and had variable episodes of diarrhea and constipation of 4 weeks' duration. During colonoscopy, a giant intraluminal polyp was diagnosed at 35 cm. Abdominal helical computed tomography (CT) revealed a constipating colonic tumor with a diameter of >or=50 mm and density values equal to fat. During laparoscopic surgery in the lithotomy position, the sigmoid and the descending colon were mobilized using a Harmonic scalpel. The origin of the polyp was localized precisely under colonoscopic guidance. The former 12-mm incision in the left lower quadrant was expanded to approximately 70 mm for extracorporal tumor resection. The left and sigmoid colon resections were carried out, and the polyp was removed by full-wall excision. After closure with a single-layer suture, the colon was pushed back into the peritoneal cavity. The patient had an uneventful recovery and was discharged 10 days postoperatively. Histology confirmed a benign lipoma of the descending colon. Laparoscopic-assisted resection under endoscopic guidance proved to be suitable for the removal of large colonic polyps without complications.

[Significance of the absorption of macromolecules for the immune response of an organism]. / Bedeutung der Resorption von Makromolekülen für die Immunitätslage des Organismus.

Numerous antigens are offered to the living organism by the daily food. With these investigations the influence of orally administered human gammaglobulin (HGG) on the immunity of sensitized animals after systemic immunization should be clarified. Experiments were performed in rabbits. Changes of the circulation were measured by bloodpressure registration and measurements of the organ flow. Simultaneous investigations of the antibody content, complement C3 and histamin were performed in the peripheral blood. In orally fed animals as well as in non fed controls an i.v. antigen challenge was performed. The level of circulating antibodies could be significantly decreased (60%) by the oral administration of HGG. In control animals the parenteral antigen challenge resulted in a mortality rate of 50%. In these animals the bloodpressure decreased significantly and long lasting, whereas antigen fed animals showed only a slight change in bloodpressure with normalization after a short period. During oral absorption of antigen complement factor C3 remained unchanged. In the first hour after the oral antigen administration a significant increase of histamin in the peripheral blood could be observed. Investigation with regard to the fate of the antibodies which were decreased by antigen feeding showed a storage in the layers of the gut which was depending on the dosage. It could be demonstrated that it is possible to influence the systemic immune response by the enteral application of macromolecules and this is also relevant for reactions of the circulation.

Changes of the immune response due to the absorption of antigenic protein or peptides.

Rabbits immunized against human gammaglobulin (HGG) were fed with either intact HGG or pepsin-digested HGG. Circulating antibodies were determined over an absorption time of 4 h. The oral application of antigenic peptides reduced circulating antibodies from 550 micrograms/ml to 120 micrograms/ml. A further parenteral antigen exposure to 50 mg HGG revealed that orally pretreated animals are protected against a marked blood pressure decrease due to antigen antibody reactions. One possible explanation for this phenomenon is that circulating antibodies are fixed in the wall of the gut by enterally applied antigenic peptides and eliminated into the lumen of the gastrointestinal tract. If this phenomenon can be extrapolated to human beings it would be a new therapeutic concept for the treatment of diseases in which circulating antibodies are of importance.