Loss of intestinal integrity following small bowel transplant rejection in the rat.
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Animals↗
Biomedical subjects
D H Teitelbaum
Publications and source records attributed to D H Teitelbaum.
Effect of gut-associated lymphoid tissue and bacterial translocation in newborn rabbits.
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Aging↗
Rapid development of hyperbilirubinemia in infants with the short bowel syndrome as a correlate to mortality: possible indication for early small bowel transplantation.
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Analysis of Variance↗
Enterocolitis associated with Hirschsprung's disease: a clinical histopathological correlative study.
Enterocolitis associated with Hirschsprung's disease (HEC) remains a major source of morbidity and even mortality, both before and after definitive surgical treatment. This study was undertaken to investigate whether histopathologic mucosal changes, in the absence of clinical manifestations of HEC, could predict the subsequent development of this complication. The clinical data and histopathology of 25 patients who eventually developed clinical HEC were compared with a control group of 25 age- and sex-matched patients with Hirschsprung's disease (HD) but with no clinical HEC either preoperatively or postoperatively. The histopathologic findings of tissue obtained by rectal biopsy or during laparotomy were graded from 0 to V according to severity and compared with the eventual clinical course. This study showed that (1) histopathologic findings of HEC appear to predict the clinical development, but not the severity, of future episodes of clinical HEC; (2) a histological grade of > or = II (> or = 2 crypt abscesses per high power field) should raise suspicion for subsequent occurrence of HEC, whereas a grade of > or = III (multiple crypt abscesses) places a child at high risk for development of clinical HEC; and (3) contrary to what is generally thought, histopathologic changes of HEC occur in both ganglionic and aganglionic segments. Based on these findings, it is recommended that histopathologic documentation of HEC and its grade should be an integral part of the tissue diagnosis of HD.
Abscess↗
Treatment of parenteral nutrition-associated cholestasis with cholecystokinin-octapeptide.
The authors investigated whether parenteral nutrition-associated cholestasis (PNAC) in surgical neonates could be alleviated by the administration of cholecystokinin-octapeptide (CCK). Two groups of infants were studied, after major abdominal or cardiac surgery in the newborn period. The low-dose group consisted of three infants with PNAC who received cholecystokinin-octapeptide (Sincalide) at a dose of 0.02 micrograms/kg intravenously (IV), twice daily. The high-dose group comprised eight infants with PNAC who received an initial dose of 0.02 micrograms/kg IV or intramuscularly, three times daily on the first day, followed by a daily doubling of the dose up to as high as 0.32 micrograms/kg. In the low-dose group, direct bilirubin levels declined a mean of 50.2 +/- 14.5%. In the high-dose group, direct bilirubin levels declined a mean of 23.4 +/- 14.3%. In three patients in the high-dose group, no decline occurred. All three had clinical signs of overt liver failure and died of liver failure within 2 months after treatment with CCK. By excluding these patients from the high-dose group, the decline in bilirubin levels increased to 49.6 +/- 10.9%. Side effects from CCK occurred in two patients and consisted of abdominal pain and feeding intolerance. Treatment with CCK appears to be associated with a decline in direct bilirubin levels, provided overt liver failure has not developed.
Abdomen↗
Enterocolitis associated with Hirschsprung's disease: a clinical-radiological characterization based on 168 patients.
The enterocolitis associated with Hirschsprung's disease (HD) has not been clearly characterized. This study was undertaken to analyze the clinical and radiological findings of Hirschsprung's enterocolitis (HEC) in 168 patients treated from July 1974 through October 1992. HEC occurred in 57 patients (33.9%), either preoperatively (13; 7.7%) or postoperatively (36; 21.4%). In eight patients (4.8%), it occurred pre- and postoperatively. The number of bouts of HEC per patient ranged from one to six (mean, 2.2). The major presenting features were abdominal distension (83%), explosive diarrhea (69%), vomiting (51%), fever (34%), lethargy (27%), rectal bleeding (5%), and colonic perforation (2.5%). There were no deaths directly related to HEC. The analysis of 150 plain x-rays of the abdomen, taken at the onset of HEC or in between bouts, showed that colonic dilatation was the most sensitive radiological finding (90% sensitivity), but it had poor specificity (24%). However, an intestinal cutoff sign (gaseous intestinal distension with abrupt cutoff at the level of the pelvic brim) was both sensitive (74%) and specific (86%) for HEC. Barium enema was of limited value in the diagnosis of HEC bouts because most of the radiographic findings persisted for prolonged periods after cessation of such bouts. The authors conclude that (1) HEC can be characterized as abdominal distension and explosive diarrhea associated with the intestinal cutoff sign and (2) the occurrence of explosive diarrhea in any patient with HD is suggestive of HEC, even in the absence of systemic symptoms, and should be treated to avoid the morbidity and potential mortality of HEC.
Barium Sulfate↗
Inhibitory activity of intestinal intraepithelial lymphocytes.
BACKGROUND: Intestinal intraepithelial lymphocytes (iIEL) are the first line of lymphoid cells exposed to orally absorbed foreign antigen. Because of this unique position, we hypothesized that the iIEL down-regulates the immune response to foreign antigen to prevent broad sensitization. METHODS: One-way mixed lymphocyte cultures (MLCs) were performed with Brown Norway (BN) as the responder and irradiated Lewis rats as the stimulator. BN iIEL or control cells (irradiated BN spleen-thymus cells) were added to the MLCs to assess their inhibitory function. RESULTS: When iIEL cells comprised 0.63% of well volumes, a significant (p < 0.05) decline in MLC proliferation was seen. To determine whether this inhibitory action was mediated by a soluble factor, supernatant from iIEL cultured with irradiated Lewis spleen-thymus cells was added to MLCs and was compared with the addition of culture medium as the control group. The iIEL group proliferated significantly less (p < 0.05) than the control group. To further define the mechanism of action, iIEL-conditioned supernatant was treated with neutralizing antibody to transforming growth factor-beta (25 micrograms/ml) or control immunoglobulin. Treated supernatant was then added to an MLC, resulting in a partial loss of inhibitory action. CONCLUSIONS: The iIEL appears to significantly suppress a response to allogeneic stimuli via a mechanism mediated by the action of one or more soluble factors. Transforming growth factor-beta may well be one of the mediators of this inhibitory action.
Animals↗
Hirschsprung's disease in children.
Several advances in understanding Hirschsprung's disease have developed in the past year. A greater understanding of the etiology of the disease has developed through the association of Hirschsprung's disease with a lack of neural cell adhesion molecule expression and nitric oxide in aganglionic portions of the bowel. It appears that a loss of neural cell adhesion molecule could be the cause of neurocytes failing to migrate to aganglionic regions, and a loss of nitric oxide could well explain the spasticity associated with the aganglionic region. Another advance has come from the analysis of genetic deletions associated with some forms of Hirschsprung's disease. Surgical advances have primarily been related to the increased use of a primary pull-through procedure in the newborn period. Results of this application have led to excellent outcomes without the need for a decompressive colostomy.
Child↗
Colonic strictures in children with cystic fibrosis.
PURPOSE: To determine the radiographic, clinical, surgical, and histologic findings in children with cystic fibrosis who develop strictures of the colon. MATERIALS AND METHODS: Ten children (five boys, five girls; age range, 2.5-9.0 years; mean age, 5.5 years), who were treated at the practices of the authors, were retrospectively identified and their medical records reviewed. RESULTS: Radiographic manifestations of the colonic disease included mucosal irregularity and spiculation with nodular thickening of the colonic wall and loss of normal colonic haustration. Luminal narrowing involved long segments of the colon. Longitudinal shortening of the colon was also a prominent feature. The decrease in caliber of the bowel ranged from mild narrowing to complete occlusion of the lumen. Histologic examination revealed severe submucosal fibrosis and fatty infiltration with transmural extension of the fibrosis to involve the serosa in some cases. Unlike in Crohn disease, however, acute inflammatory changes were minimal or absent. CONCLUSION: Colonic stricture in children with cystic fibrosis is due to irreversible and frequently progressive narrowing of the colonic lumen.
Child↗
Laparoscopic diagnosis and excision of Meckel's diverticulum.
Meckel's diverticulum is one of the primary concerns in the differential diagnosis of the pediatric patient with massive, acute gastrointestinal bleeding, intussusception, or abdominal pain of uncertain cause. The hospital course of two children with Meckel's diverticulum, successfully treated by laparoscopic excision, is presented, along with details of the operative procedure. Both patients recovered from the procedure without incident and were discharged at 24 and 48 hours after surgery. The authors believe a laparoscopic approach is safe and effective in the diagnosis and treatment of Meckel's diverticulum.
Adolescent↗
Lymphocyte immunologic interactions in intestinal transplantation.
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Animals↗
Rat jejunal absorptive function after intestinal transplantation. Effects of extrinsic denervation.
Jejunal absorptive function was evaluated following small intestinal transplantation to determine the effects of extrinsic denervation. In particular, water and sodium absorption were measured following transplantation (denervated) and compared to a control group (Thiry-Vella). Water flow was initially secretory two days after transplantation (-41 +/- 27 microliters/min/g dry tissue weight) but became absorptive at day 8 (25 +/- 25). Water flow in the Thiry-Vella group was not significantly different (P > 0.05) from the transplant group at days 8 (17 +/- 7) and 10 (47 +/- 42). Sodium flows were also initially secretory in the transplant group and became absorptive. This study refutes previous claims that small bowel transplants have a deficiency of water absorption due to extrinsic denervation of the bowel and suggests normal absorptive function of water, electrolytes, and protein.
Alanine↗
Bronchoscopy and esophagoscopy in children.
This review summarizes some of the most recent developments and areas of investigation in pediatric bronchoscopy and esophagoscopy. Applications of newer technology have allowed for improved diagnosis and therapy for many pediatric diseases. These applications include the use of bronchoscopy for the diagnosis of pulmonary diseases, assessment and therapy of airway obstruction, and management of the difficult intubation. Studies during the past year on esophagoscopy may change our approach to the diagnosis and management of esophageal varices and esophagitis, and evaluation after caustic ingestion.
Bronchoscopy↗
Intravascular calcium deposits in a critically ill patient. Light- and electron-microscopic findings.
We describe a case of a 2-year-old girl with an unusual finding of amorphous hematoxyphilic substance in the pulmonary and myocardial vascular lumina. The patient had a prolonged history of intestinal obstruction necessitating extended periods of total parenteral nutrition. The patient terminally had hypercalcemia with levels reaching 4.63 mmol/L. The intravascular substance stains strongly positive for calcium, and weakly positive for fibrin. Electron microscopy shows that the substance has a distinctive configuration suggestive of calcium hydroxyapatite crystals.
Blood Vessels↗
Cervical small bowel transplantation in the rat: a useful tool.
Orthotopic intestinal transplantation in the rat is highly successful, but circumstances may require an extraabdominal graft location. We describe a microsurgical technique for cervical intestinal transplantation in the rat, which has been used to investigate the immune status of hosts already bearing an intraabdominal bowel transplant. A 10 cm segment of donor jejunum is harvested on a pedicle of superior mesenteric artery and superior mesenteric vein. In the recipient, the carotid artery (CA) and external jugular vein (EJV) are isolated. The venous anastomosis is performed end to end to the medial EJV branch, and the arterial anastomosis is completed end to side to the CA. Both anastomoses are performed with interrupted 10-0 nylon. The bowel is placed in a subcutaneous pocket in the neck, with both ends exteriorized. The procedure was performed in 11 donor-recipient pairs planned to elicit rejection, graft-vs.-host disease (GVHD) or graft acceptance. No technical complications were encountered. All rats survived long term, and their grafts were monitored histologically. The expected immune responses were observed, but rejection and GVHD were not fatal to the host with this model. We conclude that this technique is feasible and reliable to monitor the progress of isolated intestinal transplants. The location in the neck does not disrupt normal intestinal function of the recipient and may have multiple applications in the study of intestinal transplant immunology and physiology.
Action Potentials↗
Management of Hirschsprung's disease in children with trisomy 21.
Thirteen infants and children with trisomy 21 have been treated for Hirschsprung's disease since 1975. Clinical presentation of Hirschsprung's disease included constipation (five); neonatal intestinal obstruction (four); enterocolitis (three); and meconium plug syndrome (one). Additional associated congenital anomalies occurred in 10 patients, of which complex cardiac disease accounted for 25% of the defects. Seven children underwent definitive operation: Duhamel pull-through (four); Soave pull-through (two); and anal myectomy (one). Satisfactory continence occurred in all but one child. Enterocolitis developed in seven patients (54%): two at diagnosis of Hirschsprung's disease; three after colostomy; and two after pull-through. Five children died (38%): one from enterocolitis, two from cardiorespiratory failure after recovery from enterocolitis, and two from end-stage cardiac disease. Children with trisomy 21 can safely undergo definitive operation for Hirschsprung's disease but are at high risk for developing enterocolitis and complications of associated cardiac disease.
Child↗
Monitoring of intestinal transplant rejection.
Our results show that maltase, sucrase, and lactase activity are present at a normal level in nonrejecting small bowel transplants after an initial postoperative decline. This confirms that the disaccharide absorbing capacity of these grafts is intact. In allogeneic bowel, however, the levels of maltase and sucrase decline as histologic rejection occurs. These results suggest that serial maltase, sucrase, and possibly lactase levels in allogeneic intestinal transplants may serve as a useful adjunct in the monitoring of small bowel transplant rejection.
Animals↗
Resolution of an infected intracardiac thrombus.
A 12-month-old patient had complete resolution of a central venous, catheter-related, infected intracardiac thrombus after 6 weeks of antibiotics, aspirin, and dipyridamole. Serial echocardiography documented the progressive decrease in thrombus size. Selected infants and children may safely undergo nonoperative management of infected intracardiac thrombi.
Anti-Bacterial Agents↗