Fish oil-rich lipid emulsion modulates neuroinflammation and prevents long-term cognitive dysfunction after sepsis.

OBJECTIVES: Sepsis is a severe organic dysfunction caused by an infection that affects the normal regulation of several organ systems, including the central nervous system. Inflammation and oxidative stress play crucial roles in the development of brain dysfunction in sepsis. The aim of this study was to determine the effect of a fish oil (FO)-55-enriched lipid emulsion as an important anti-inflammatory compound on brain dysfunction in septic rats. METHODS: Wistar rats were subjected to sepsis by cecal ligation and perforation (CLP) or sham (control) and treated orally with FO (600 µL/kg after CLP) or vehicle (saline; sal). Animals were divided into sham+sal, sham+FO, CLP+sal and CLP+FO groups. At 24 h and 10 d after surgery, the hippocampus, prefrontal cortex, and total cortex were obtained and assayed for levels of interleukin (IL)-1ß and IL-10, blood-brain barrier permeability, nitrite/nitrate concentration, myeloperoxidase activity, thiobarbituric acid reactive species formation, protein carbonyls, superoxide dismutase and catalase activity, and brain-derived neurotrophic factor levels. Behavioral tasks were performed 10 d after surgery. RESULTS: FO reduced BBB permeability in the prefrontal cortex and total cortex of septic rats, decreased IL-1ß levels and protein carbonylation in all brain structures, and diminished myeloperoxidase activity in the hippocampus and prefrontal cortex. FO enhanced brain-derived neurotrophic factor levels in the hippocampus and prefrontal cortex and prevented cognitive impairment. CONCLUSIONS: FO diminishes the negative effect of polymicrobial sepsis in the rat brain by reducing inflammatory and oxidative stress markers.

A case report of a rare ramification pattern and distribution area of the mesenteric arteries in a Japanese White rabbit (Oryctolagus cuniculus).

The rabbit intestinal tract is supplied by the cranial and caudal mesenteric arteries. Generally, the cranial mesenteric artery supplies the duodenum, jejunum, ileum, cecum, proximal colon and ascending and transverse distal colon, whereas the caudal mesenteric artery supplies the descending distal colon and rectum. The present study describes an abnormal branching pattern of the cranial and caudal mesenteric arteries in a Japanese White rabbit, where the caudal mesenteric artery but not the cranial mesenteric artery supplied the distal ileum, cecum, proximal colon and ascending and transverse distal colon. Such a rare mesenteric arterial ramification pattern may be explained by anomalies of the remaining anastomotic branches between the primitive mesenteric arteries and regressed their parent arteries during the developmental process.

A Case of Isolated Cecal Necrosis Preoperatively Diagnosed with Perforation of Cecum.

Isolated cecal necrosis (ICN) is a rare condition which is developed under decreased mesenteric perfusion. Only a few dozen cases of ICN have been reported previously. The patient was a 59-year-old male with a previous history of atrial fibrillation. He presented to our emergency room with the chief complaint of lower abdominal pain. Computed tomography imaging revealed a dilated cecum and presence of free air. With a preoperative diagnosis of perforation of the cecum; an urgent surgery was conducted. Intraoperative findings revealed an ischemic change of the cecum and a laparoscopic-assisted ileocecal resection was performed. The pathological findings showed transmural ischemic change on the anti-mesenteric side of the cecum, and the diagnosis of ICN was achieved. Preoperative diagnosis of ICN is difficult because of its non-specific radiological features. In patients with right lower abdominal pain, ICN should be considered as a differential diagnosis especially if the patient has a comorbidity causing hypotension attack.

Counteraction of perforated cecum lesions in rats: Effects of pentadecapeptide BPC 157, L-NAME and L-arginine.

AIM: To study the counteraction of perforated cecum lesion using BPC 157 and nitric oxide (NO) system agents. METHODS: Alongside with the agents' application (after 1 min, medication (/kg, 10 mL/2 min bath/rat) includes: BPC 157 (10 µg), L-NAME (5 mg), L-arginine (100mg) alone or combined, and saline baths (controls)) on the rat perforate cecum injury, we continuously assessed the gross reappearance of the vessels (USB microcamera) quickly propagating toward the defect at the cecum surface, defect contraction, bleeding attenuation, MDA- and NO-levels in cecum tissue at 15 min, and severity of cecum lesions and adhesions at 1 and 7 d. RESULTS: Post-injury, during/after a saline bath, the number of vessels was significantly reduced, the defect was slightly narrowed, bleeding was significant and MDA-levels increased and NO-levels decreased. BPC 157 bath: the vessel presentation was markedly increased, the defect was noticeably narrowed, the bleeding time was shortened and MDA- and NO-levels remained normal. L-NAME: reduced vessel presentation but not more than the control, did not change defect and shortened bleeding. L-arginine: exhibited less vessel reduction, did not change the defect and prolonged bleeding. In combination, mutual counteraction occurred (L-NAME + L-arginine) or the presentation was similar to that of BPC 157 rats (BPC 157 + L-NAME; BPC 157 + L-arginine; BPC 157 + L-NAME + L-arginine), except the defect did not change. Thereby at day 1 and 7, saline, L-NAME, L-arginine and L-NAME + L-arginine failed (defect was still open and large adhesions present). CONCLUSION: The therapeutic effect was achieved with BPC 157 alone or in combination with L-NAME and L-arginine as it was able to consolidate the stimulating and inhibiting effects of the NO-system towards more effective healing recruiting vessels.

Cecal infarction in neonatal calves.

Cecal infarction is an uncommon lesion in calves that results in localized peritonitis and, on occasion, perforation with secondary diffuse peritonitis and death. This lesion in calves has not been described previously. We reviewed the postmortem cases of cecal infarction in dairy calves ≤30 d of age that had been submitted over the course of 5 y to the Tulare branch of the California Animal Health and Food Safety Laboratory System. The area of cecal infarction and the associated lesion margins were examined histologically. Ischemic necrosis of the mucosal side of the cecal wall with various degrees of neutrophilic inflammation of subjacent tissues was found consistently, and thrombosis and vascular occlusion within the areas of necrosis and inflammation was found in 21 of 34 cases. Cecal infarction cases were then compared to controls using a retrospective matched case-control study design. Cases ( n = 34) and controls ( n = 86) were compared with respect to bacteremia (as defined by pure culture of a single bacterial agent from lung and/or liver), species of bacteria isolated, and for the presence of K99 Escherichia coli (calves ≤5 d), attaching and effacing E. coli, Cryptosporidium (calves ≥5 d of age), Salmonella isolation from the intestine, rotavirus, Bovine coronavirus, and Bovine viral diarrhea virus. In addition, the presence of rumenitis or abomasitis, and omphalitis were compared between cases and controls. There were no significant differences in ruminal, abomasal, or umbilical cord tissue inflammation, or pathogen test-positive status between cases and controls.

Rare and unusual case of polyarteritis nodosa involving the gastrointestinal tract leading to bowel gangrene.

Polyarteritis nodosa (PAN) is a systemic necrotising vasculitis preferentially targeting medium-sized arteries and not related with glomerulonephritis or small vessel involvement. Clinical manifestations of PAN are multisystem. The gastrointestinal, renal, cardiac, musculoskeletal, skin and central nervous systems may be involved. The aetiology remains unknown, and the ensuing vasculitis may lead to aneurysm formation and thrombosis in any organs of the body with resultant ischaemia. PAN of the intestines is a relatively common manifestation of this disease but rarely causes bowel ischaemia resulting in necrosis. Here we report a case of a young Chinese patient who presented with an acute abdomen requiring surgery and made good recovery post operatively. He remains free of symptoms while on steroid therapy.

Colonic manifestation of a haematologic disorder.

A 32year-old female presenting with right lower quadrant pain was found to have caecal varices. Extensive work-up revealed underlying protein C deficiency.

Varizes de ceco não hemorrágicas / Variceal bleending not cecum

Introdução: paciente do sexo masculino, branco, com 54 anos, etilista crônico, assintomático, foi submetido à colonoscopia como método diagnóstico para prevenção de doença neoplásica, evidenciando-se a presença de varizes de ceco de médio e grosso calibre. O encontro de varizes no ceco associado à hipertensão portal é raro, sendo observado em 3,4% e está frequentemente associado ao acometimento difuso dos demais segmentos cólicos, além da esclerose ou trombose das veias mesentéricas ou mesmo à atresia do trato biliar.

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.

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

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.

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.