Intestinal intussusception in adults: Location, causes, symptoms, and therapeutic management.

OBJECTIVE: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. MATERIALS AND METHODS: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged <16 years. Thus, 21 cases in adults (mean age, 57 years) were analyzed. RESULTS: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumours were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). CONCLUSIONS: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its aetiology and therapeutic management.

Invaginaciones intestinales en el adulto: localización, etiología, sintomatología y manejo terapéutico / Intestinal intussusception in adults: location, causes, symptoms, and therapeutic management

Objetivo: Las invaginaciones intestinales en adultos son de difícil diagnóstico debido a la inespecificidad de los síntomas. Sin embargo, la mayoría tienen una causa estructural que requiere tratamiento quirúrgico. El objetivo de este estudio es revisar sus características epidemiológicas, hallazgos en imagen y manejo terapéutico. Materiales y métodos: Estudio retrospectivo de las invaginaciones intestinales que precisaron ingreso hospitalario diagnosticadas en nuestro hospital entre 2016 y 2020. De un total de 73 casos fueron excluidos errores de codificación (n=6) y pacientes menores de 16 años (n=46), resultando 21 invaginaciones en adultos. Resultados: La edad media fue de 57 años, y el dolor abdominal fue la manifestación clínica más frecuente en el 38% de los casos (n=8). El diagnóstico mediante tomografía computarizada (TC), con la presencia “del signo de la diana”, alcanzó una sensibilidad del 100%, siendo la región ileocecal la localización más frecuente en un 38% de los pacientes (n=8). Un 85,7% de los casos (n=18) tenían una causa estructural y el 81% (n=17) requirió cirugía. Los resultados anatomopatológicos fueron concordantes con la TC en un 94,1%, siendo la etiología más frecuente la neoplásica: 35,3% benignas (n=6) y 64,7% malignas (n=9). Conclusiones: La TC es la prueba de elección en el diagnóstico de las invaginaciones intestinales y resulta determinante a la hora de identificar la etiología y decidir el manejo terapéutico.(AU)

Objective: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. Materials and methods: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. Results: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). Conclusions: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.(AU)

Small bowel angioedema. An unusual condition with an interesting differential diagnosis.

We present the case of a 35-year-old woman with a prior history of hereditary angioedema (HA) who was admitted to the emergency department with epigastric pain, vomiting and sweating. Laboratory tests showed raised APR levels (CRP and leukocytosis).

Intestinal intussusception in adults: location, causes, symptoms, and therapeutic management. / Invaginaciones intestinales en el adulto: localización, etiología, sintomatología y manejo terapéutico.

OBJECTIVE: Intestinal intussusception is difficult to diagnose in adults because the symptoms are nonspecific. However, most have structural causes that require surgical treatment. This paper reviews the epidemiologic characteristics, imaging findings, and therapeutic management of intussusception in adults. MATERIALS AND METHODS: This retrospective study identified patients diagnosed with intestinal intussusception who required admission to our hospital between 2016 and 2020. Of the 73 cases identified, 6 were excluded due to coding errors and 46 were excluded because the patients were aged<16 years. Thus, 21 cases in adults (mean age, 57 y) were analyzed. RESULTS: The most common clinical manifestation was abdominal pain, reported in 8 (38%) cases. In CT studies, the target sign yielded 100% sensitivity. The most common site of intussusception was the ileocecal region, reported in 8 (38%) patients. A structural cause was identified in 18 (85.7%) patients, and 17 (81%) patients required surgery. The pathology findings were concordant with the CT findings in 94.1% of cases; tumors were the most frequent cause (6 (35.3%) benign and 9 (64.7%) malignant). CONCLUSIONS: CT is the first-choice test for the diagnosis of intussusception and plays a crucial role in determining its etiology and therapeutic management.

Cecal bascule with secondary gastric outlet obstruction in addition to a large bowel closed obstruction: A case report.

We present a case of cecal bascule in a 60-year-old woman with abdominal pain and vomiting. Imaging tests revealed a cecal bascule causing mechanic obstruction of the stomach. Besides a small bowel dilatation was not seen, the distended cecum was extrinsically obstructing the antrum and therefore, the gastric outlet. Cecal bascule is a form of cecal volvulus without the axial twisted component. The cecum folds anterior or anteromedially on itself and, because of a valve mechanism, becomes distended. The pressure increases and it begins to compromise arterial blood flow so life-threatening complications, such as bowel ischemia and infarction can occur. Prompt diagnosis is therefore crucial and plain radiographs and computed tomography are the preferred imaging techniques for this purpose.

Role of Flavonoids in The Interactions among Obesity, Inflammation, and Autophagy.

Nowadays, obesity is considered as one of the main concerns for public health worldwide, since it encompasses up to 39% of overweight and 13% obese (WHO) adults. It develops because of the imbalance in the energy intake/expenditure ratio, which leads to excess nutrients and results in dysfunction of adipose tissue. The hypertrophy of adipocytes and the nutrients excess trigger the induction of inflammatory signaling through various pathways, among others, an increase in the expression of pro-inflammatory adipocytokines, and stress of the endoplasmic reticulum (ER). A better understanding of obesity and preventing its complications are beneficial for obese patients on two facets: treating obesity, and treating and preventing the pathologies associated with it. Hitherto, therapeutic itineraries in most cases are based on lifestyle modifications, bariatric surgery, and pharmacotherapy despite none of them have achieved optimal results. Therefore, diet can play an important role in the prevention of adiposity, as well as the associated disorders. Recent results have shown that flavonoids intake have an essential role in protecting against oxidative damage phenomena, and presents biochemical and pharmacological functions beneficial to human health. This review summarizes the current knowledge of the anti-inflammatory actions and autophagic flux of natural flavonoids, and their molecular mechanisms for preventing and/or treating obesity.

Evidences for Expression and Location of ANGPTL8 in Human Adipose Tissue.

The metabolism of triglycerides (TGs) is regulated, among others, by the lipoprotein lipase (LPL) that hydrolyses the TGs on endothelial cells. In turn, LPL is inhibited by the ANGPTLs family of proteins, such as ANGPTL3, 4, and, 8; the latter is the least known. In this work, we have tried to establish the expression and localisation of the Angiopoietin-like 8 (ANGPTL8) protein in the visceral adipose tissue (VAT) of morbid-obese and non-obese patients. 109 subjects (66 women and 43 men) undergoing laparoscopic surgery participated in this study. A blood sample and a portion of the VAT were obtained, and the patients were classified according to their Body Mass Index (BMI) as non-obese (19.5-30 kg/m2) and morbid-obese (40-50 kg/m2). No significant changes in ANGPTL8 plasma levels were determined by EIA in obese patients. The immunocytochemistry and Western blotting showed the presence of increased ANGPTL8 in morbid-obese patients (p < 0.05). In-situ hybridisation and a real time polymerase chain reaction (RT-PCR) confirmed that the mRNA that encodes ANGPTL8 was present in adipocytes, without differences in their nutritional state (p = 0.89), and even in the endothelial cells. Our data suggests that ANGPT8 plasmatic levels do not change significantly in patients with morbid obesity, although there is a modest difference related to gender. Besides, we demonstrate that in visceral adipose tissue, ANGPTL8 is well defined in the cytoplasm of adipocytes coexisting with perilipin-1 and its mRNA, also is present in endothelial cells. These findings suggest the possibility that among other functions, ANGPTL8 could perform either a paracrine and/or an endocrine role in the adipose tissue.

Relation among Aromatase P450 and Tumoral Growth in Human Prolactinomas.

The pituitary gland is part of hypothalamic-pituitary-gonadal axis, which controls development, reproduction, and aging in humans and animals. In addition, the pituitary gland is regulated mainly by hormones and neurotransmitters released from the hypothalamus and by systemic hormones secreted by target glands. Aromatase P450, the enzyme responsible for the catabolization of aromatizable androgens to estrogens, is expressed in different parts of body, including the pituitary gland. Moreover, aromatase P450 is involved in sexual dimorphism where alteration in the level of aromatase can initiate a number of diseases in both genders. On the other hand, the direct actions of estrogens, mainly estradiol, are well known for stimulating prolactin release. Numerous studies have shown that changes in the levels of estrogens, among other factors, have been implicated in the genesis and development of prolactinoma. The pituitary gland can produce estradiol locally in several types of endocrine cells, and it is possible that aromatase could be responsible for the maintenance of the population of lactotroph cells and the modulation of the action of central or peripheral regulators. Aromatase overexpression due to inappropriate gene regulation has clinical effects such as the pathogenesis of prolactinomas. The present study reports on the synthesis of pituitary aromatase, its regulation by gonadal steroids, and the physiological roles of aromatase on pituitary endocrine cells. The involvement of aromatase in the pathogenesis of pituitary tumors, mainly prolactinomas, through the auto-paracrine production of estradiol is reviewed.

Dopamine modulates insulin release and is involved in the survival of rat pancreatic beta cells.

The local synthesis of dopamine and its effects on insulin release have been described in isolated islets. Thus, it may be accepted that dopamine exerts an auto-paracrine regulation of insulin secretion from pancreatic beta cells. The aim of the present study is to analyze whether dopamine is a regulator of the proliferation and apoptosis of rat pancreatic beta cells after glucose-stimulated insulin secretion. Glucose stimulated pancreatic islets obtained from male Wistar rats were cultured with 1 or 10 µM dopamine from 1 to 12 h. Insulin secretion was analyzed by RIA. The cellular proliferation rate of pancreatic islets and beta cells was studied with immunocytochemical double labelling for both insulin and PCNA (proliferating cell nuclear antigen), and active caspase-3 was detected to evaluate apoptosis. The secretion of insulin from isolated islets was significantly inhibited (p<0.01), by treatment with 1 and 10 µM dopamine, with no differences between either dose as early as 1 h after treatment. The percentage of insulin-positive cells in the islets decreased significantly (p<0.01) after 1 h of treatment up to 12 h. The proliferation rate of insulin-positive cells in the islets decreased significantly (p<0.01) following treatment with dopamine. Apoptosis in pancreatic islets and beta cells was increased by treatment with 1 and 10 µM dopamine along 12 h. In conclusion, these results suggest that dopamine could modulate the proliferation and apoptosis of pancreatic beta cells and that dopamine may be involved in the maintenance of pancreatic islets.