Biomedical subjects
I Eizaguirre
Publications and source records attributed to I Eizaguirre.
[Severe primary vesicoureteral reflux in infants. A follow-up of 203 cases].
OBJECTIVE: The aim of our study is to analyze the clinic characteristics and evolution of the primary reflux in infants. METHODS: We studied retrospectively 203 infants in our hospital, diagnosed of severe primary renal reflux. Renal ecography and cyclic mictional cystography were practiced in all cases. DMSA was carried out in 181 patients. RESULTS: Renal reflux was unilateral in the 23% of the patients, and bilateral in the remaining cases; 72% of the renal reflux were grade IV and 28% grade V. The renal injuries affected to male infants and reflux grade V. The renal injury was focal (27%), global (44%) and atrophic (29%). The 79% of the patients had conservative treatment, while 21% had surgical treatment. 100% infants with surgical treatment and 94.2% infants with conservative treatment were recovered (Test of Kaplan-Meier). The 27% of patients developed one or several urinary infections, but progression of old renal injuries or formation of new ones, were exceptional (3 cases): While the time the study lasted none of the patients developed chronic renal failure nor arterial hypertension. CONCLUSIONS: 1) The fetal severe primary reflux of the patients was characterized by the following features: to be bilateral reflux, to affect mainly to male infants and to be associated in 33% of cases with a severe renal injury of congenital origin (renal displasia) most of them unilateral. 2) The natural evolution of the reflux goes to spontaneous recovery, so treatment must be conservative. 3) Some patients underwent urinary infections, but progression or formation of new renal injuries were inusual. None of the patients had terminal renal failure nor hypertension and 4) Risk patients would be male infants with bilateral injuries although these are infrequent.
[Incidence of bacterial translocation in four different models of experimental short bowel syndrome].
UNLABELLED: The outcome of patients with short bowel syndrome is influenced for factors such as the length of remnant intestine or the presence or absence of ileocecal valve (ICV). Gram-negative sepsis, the main cause of mortality in this group of children, is probably due to bacterial translocation (BT), because after gut resection there are a number of circumstances that favour its occurrence, being the most known intestinal dismotility, bacterial overgrowth, loss of gut-associated lymphoid tissue, total parenteral nutrition (TPN) and fasting related mucosal atrophy. The aim of this experimental controlled study was to test the incidence of BT after four different types of gut resection, in animals fed orally or receiving TPN. Hundred and three adult Wistar rats bred and raised in our facilities according to European Union Regulations were randomly divided in six groups:--Group 1 (n = 26): non-manipulated animals, served as a control.--Group 2 (n = 14): 80% non-lethal small bowel resection, fed orally.--Group 3 (n = 15): same resection as group 2 but including ICV. Rat chow ad libitum.--Group 4 (n = 27): non-resected fasting animals receiving all-in-one TPN solution.--Group 5 (n = 11): same resection as group 2, but fasting and receiving TPN--Group 6 (n = 10): 90% small bowel resection, including cecum and ICV, fasting and TPN. The animals were maintained for 10 days in individual metabolic cages, and, at the end of the experiment, were bled by portal and cardiac puncture. Mesenteric lymph nodes, peripheral and portal blood samples were cultured for BT. Non-manipulated rats (group 1) had lower BT incidence (8%) than resected ones (groups 2, 3, 5 and 6, 93%, 60%, 91%, 60%, p < 0.05) or animals non-resected, receiving TPN (group 4.51%, p < 0.05). When resection included ICV in orally fed rats BT index was also lower (group 3 vs group 2.60% vs 91%, p < 0.05). In TPN resected animals a drop was also found in BT when ICV and cecum were added to small bowel resection (group 6 vs group 5.60% vs 91%, p < 0.05). IN CONCLUSION: 1. Gut resection is associated to a high degree of BT, even if the animals are fed orally. 2. Resection including ICV, produced less BT. 3. TPN-related BT was shown in half of the animals non resected. 4. TPN-resected rats had also less BT when ICV and cecum were removed.
Probiotic supplementation reduces the risk of bacterial translocation in experimental short bowel syndrome.
BACKGROUND/PURPOSE: Probiotics are live organisms that survive passage through the gastrointestinal tract and have beneficial effects on the host. Lactobacillus and Bifidobacterium have been recommended for cholesterol lowering, acute diarrhea, prevention of cancer, or inflammatory bowel disease. On the other hand, after massive bowel resection, bacterial overgrowth is frequent and favors bacterial translocation (BT). The possible beneficial effects of Bifidobacterium lactis (BL) administration on BT in experimental short bowel syndrome (SBS), have not been investigated. The aim of this study was to test the hypothesis that BL administration decreases BT in SBS in animals fed orally. METHODS: One hundred twenty-eight adult Wistar rats fed orally with standard rat chow and tap water "ad libitum" were maintained in individual metabolic cages for 10 days and divided into 3 groups: control group (n = 71): nonmanipulated animals; RES group (n = 39): 80% gut resection from 10 cm beyond the angle of Treitz to 10 cm above the cecum; RES-PRO group (n = 18): same resection and daily 7.8 x 10(8) CFU B Lactis administration, after orogastric intubation. At the end of the experiment they were killed, and mesenteric lymph nodes (MLN) and peripheral and portal blood specimens were recovered and cultured. Bacterial identification in blood was made by conventional methods, and MLN culture was considered positive with a growth over 100 CFU/g. RESULTS: Bacterial translocation was detected in 6% of control group rats. The incidence of BT in the RES group was 87% (34 of 39), whereas only 50% (9 of 18) of RES-PRO animals had BT (P <.05). The relative risk reduction (RRR) was 0.43 (95% Cl 0.14 to 0.72), and the number needed to treat (NNT) was 3 (95% Cl 2 to 8). In other words, animals that received BL had the risk of BT reduced by 43% (RRR of 0.43), and of every 3 animals treated, 1 is expected to be free of BT (NNT of 3). CONCLUSION: Administration of B Lactis reduces the incidence of BT in adult Wistar rats after 80% gut resection.
[Tissue antioxidant capacity and bacterial translocation in parenteral nutrition. Experimental study].
Alterations in the antioxidant system (AS) has been observed during total parenteral nutrition (TPN). Light exposure or changes in the composition of TPN may affect this deleterious effect. On the other hand, bacterial translocation (BT) is frequent under TPN and may be related to AS. The aim of the study was to determine the adverse effect of standard and glutamine-enriched (GE) TPN, with or without light exposure, on the AS, and its relationship to BT. Forty-nine adult Wistar rats underwent central venous cannulation and were randomly assigned to one of five groups: Sham (n = 16): chow and water ad libitum and saline i.v. TPN (n = 10): had standard TPN. TPN(-) (n = 8): standard TPN without light-exposure. GTPN (n = 8): GE TPN. GTPN(-) (n = 7): GE TPN without light exposure. After 10 days, glutation reduced (GSH) was determined in liver and kidney. Mesenteric lymph nodes, peripheral and portal blood samples were cultured for BT. Comparing to Sham rats, TPN groups had statistically significant lower GSH levels, but there were no differences between standard or GE groups nor with or without light exposure groups. Sham animals had 12% BT. Significantly higher BT (p < 0.05) was found in TPN rats: 70% in TPN group, 88% in TPN(-) group, 86% in GTPN(-) animals and only 50% in GTPN group (p = 0.06 vs TPN group). To conclude: 1. TPN reduces antioxidant capacity and induces BT. 2. Glutamine supplementation or light protection do not improve tissue antioxidant capacity under TPN. 3. Glutamine supplementation tends to reduce BT only in the presence of light. 4. Absence of light exposure does not improve BT TPN-related.
[Beneficial effects of Bifidobacterium lactis in the prevention of bacterial translocation in experimental short bowel syndrome].
BACKGROUND: Probiotics are live organisms that survive passage through the gastrointestinal tract and have beneficial effects on the host. Lactobacillus and Bifidobacterium have been recommended in cholesterol lowering, acute diarrhea, prevention of cancer or inflammatory bowel disease. On the other hand, after massive bowel resection bacterial overgrowth is frequent and favours the occurrence of bacterial translocation (BT). The possible beneficial effects of Bifidobacterium lactis (BL) administration on BT in experimental short bowel syndrome (SBS), have not been investigated. AIM: To test the hypothesis that BL administration decreases BT in SBS in animals fed orally. METHODS: Thirty-two adult Wistar rats fed orally with standard rat chow and tap water "ad libitum" were maintained individual metabolic cages for ten days after 80% gut resection from the duodeno-jejunal angle to 10 cm above the cecum and divided in two groups: -Group A (n = 14): served as control. -Group B (n = 18): daily 7.8 x 109 CFU Bifidobacterium lactis administration, after orgastric intubation. At the end of the experiment they were sacrificed and mesenteric lymph nodes (MLN), and peripheral and portal blood specimens were recovered and cultured. Bacterial identification in blood was made by conventional methods and MLN culture was considered positive with a growth over 100 CFU/g. RESULTS: Bacterial translocation was detected in 93% of Group A rats. The incidence of BT in Group B was 44%. The relative risk reduction (RRR) was 0.52 (95% confidence interval 0.23-0.81) and the number needed to treat (NNT) was 2 (95% confidence interval between 1-5). CONCLUSION: Administration of Bifidobacterium lactis reduces the incidence of BT in adult Wister rats, after 80% gut resection.
Tissue antioxidant capacity and bacterial translocation under total parenteral nutrition.
Alterations in the antioxidative system have been observed during total parenteral nutrition (TPN). Light exposure or changes in the composition of TPN formulas may affect this system. Bacterial translocation (BT) is frequent under TPN and may be related to oxidative status. The aim of this study was to determine the adverse effects of standard and glutamine-enriched TPN, with or without light exposure, on oxidative status (liver and kidney-reduced glutathione, GSH) and its relationship to BT. Thirty-three adult Wistar rats underwent central-venous cannulation and were randomly assigned to one of four groups receiving different TPN regimes for 10 days. The TPN group (n = 10) had standard TPN, the TPN(-) group (n = 8) standard TPN without light exposure, the GTPN group (n = 8) glutamine-enriched TPN, and the GTPN(-) group (n = 7) glutamine-enriched TPN without light exposure. A sham group (n = 16) receiving chow and water ad libitum and saline i.v. served as controls. At the end of the experiment, GSH was determined in liver and kidney tissue. Mesenteric lymph nodes and peripheral and portal blood samples were cultured for BT. Compared to sham rats, TPN groups had statistically significant lower GSH levels, but there were no differences between standard or glutamine-enriched groups or light-exposure groups. Sham animals had 12% BT. Significantly higher BT (P < 0.05) occurred in TPN rats: 70% in the TPN group, 88% in the TPN(-) group, 86% in GTPN (-) animals, and only 50% in the GTPN group (P = 0.06 vs TPN group). In conclusion, (1) TPN reduces antioxidant capacity; (2) glutamine supplementation or light protection does not improve tissue antioxidant capacity under TPN; (3) the absence of light exposure does not improve TPN-related BT; and (4) glutamine supplementation tends to reduce BT only in the presence of light.
[Effect of various trophic factors on bacterial translocation in experimental short bowel syndrome].
Massive bowel resection triggers an adaptive process in the remaining intestine in spite of which, bacterial translocation (BT) is frequent under these conditions. Several trophic factors, including growth hormone (GH), epidermal growth factor (EGF) and insuline (INS) are involved in the process of adaptation in short bowel syndrome (SBS). However, the effect of GH, EGF or INS on BT has not been investigated experimentally. The aim of the study was to test the hypothesis that GH, EGF or INS administration prevents BT in rats with SBS receiving only parenteral nutrition (PN). Thirty-seven adult Wistar rats underwent central venous cannulation and were randomly assigned to one of two groups receiving for ten days four treatment regimes: PN group (N = 10) fasting, all-in-one PN solution (300 mL/kg/24 h, 280 kcal/kg/24 h), 80% gut resection including ileo-cecal valve. GH group (N = 9) fasting, same PN regime and resection plus GH (1 mg/kg/d, s.c.). EGF group (N = 9): same PN regime and resection plus EGF (150 microgr/24 h, e.v.) INS group(N = 9): same PN regime and resection plus INS (1 U.I./100 g/24 h s.c.) At the end of the experiment the rats were exanguinated and mesenteric lymph nodes and samples of systemic and portal blood were obtained and cultured. Several samples of full-thickness jejunal wall were taken for measuring cell proliferation index (PCNA) and mucosal thickness. Jejunal mucosal thickness increased by 30%, 28% and 29% and PCNA index by 21%, 20% and 25% in GH, EGF and INS, treated rats respectively in comparison with those treated with PN alone. However, contrary to our expectations, BT expressed by positive culture of intestinal germs in systemic blood was demonstrated respectively in 44%, 40% and 28% of GH, EGF and INS animals, respectively, and in 0% of PN-only rats. Although exogenous GH, EGF or INS improves gut mucosal structure in rats with SBS treated with PN, it seems to increase rather than decrease mucosal permeability to intestinal germs in them.
[Bacterial translocation associated with short bowel: role of ileocecal valve and cecum].
Sepsis in short bowel syndrome (SBS) is due in part to bacterial translocation (BT). Parenteral nutrition (PN) is often necessary in SBS and promotes BT. The presence of ileocecal valve (ICV) has been considered as a good prognostic factor in the outcome of this children. The aim of this study was to asses the effect of the presence or absence of ICV and cecum in five different models of gut resection in the rat. Fifty-five adult Wistar rats were randomly assigned to one of five groups: Group 1 (N = 14): standard rat chow + 80% small bowel resection. Group 2 (N = 10): standard rat chow + 80% small bowel resection including cecum. Group 3 (N = 10): standard rat chow + 80% small bowel resection including ICV. Group 4 (N = 11): NP + 80% small bowel resection. Group 5 (N = 10): NP + 80% small bowel resection including ICV and cecum. Ten days after surgery they were sacrificed and mesenteric lymph nodes (MLN), spleen and peripheral (PBL) and portal blood (POBL) specimens were recovered and cultured. Groups 3 (without ICV, with cecum) and 5 (without ICV, without cecum) showed 60% BT in MLN and POBL, and groups 1 and 4 (with ICV, without cecum) 93% and 91% respectively (p < 0.05). In PBL, group 3 (without ICV, with cecum) showed also less BT than groups 1 and 4 (10% vs 43% and 55% respectively, p < 0.05) and group 5 (without ICV and cecum) had less BT than groups 1, 2 and 4 (0% vs 43%, 30% and 55%, p < 0.01). In conclusion, these results suggest that the absence of ICV decreases BT and that the cecum does not seems to play a role on his.
[Continuing medical education in pediatric surgery in the environment of the European Union].
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Effect of growth hormone, epidermal growth factor, and insulin on bacterial translocation in experimental short bowel syndrome.
BACKGROUND/PURPOSE: An adaptive process starts in the remaining intestine after massive resection, and several trophic factors including growth hormone (GH), epidermal growth factor (EGF), and insulin (INS) have been shown to have a positive effect on it. Bacterial translocation (BT) is frequent after extensive small bowel resection, but the effects of GH, EGF, or INS have not been investigated in experimental short bowel syndrome (SBS). This study tests the hypothesis that GH, EGF, or INS decrease BT in SBS in rats with parenteral nutrition (PN). METHODS: Thirty-eight adult Wistar rats underwent central venous cannulation and were assigned randomly to 1 of 4 groups receiving for 10 days 4 treatment regimes: (1) PN group (n = 10): fasting, all-in-one PN solution (300 mL/kg/24 h, 280 kcal/kg/24 h), 80% gut resection including ileo-cecal valve; (2) GH group (n = 9): fasting, same PN regime and resection, GH (1 mg/kg/d, subcutaneously); (3) EGF group (n = 9): fasting, PN, resection, EGF (150 microg/24 h intravenously); (4) INS group (n = 9): fasting, PN, resection, INS (1 UI/100 g/24 h subcutaneously). At the end of the experiment they were killed, and mesenteric lymph nodes (MLN) and peripheral and portal blood samples were recovered and cultured. Several fragments of intestine were taken to determine cell proliferation (PCNA index) and morphometric parameters (villous height, crypt depth). RESULTS: GH, EGF, and INS groups showed a 28%, 29%, and 30% increase in gut mucosal thickness, and PCNA index rose 21%, 20%, and 25%, respectively in comparison with PN controls. Bacterial translocation to peripheral blood was detected in 0% of PN animals and in 44%, 40%, and 28% of GH, EGF, or INS rats, respectively (P < .05). No differences were found in BT in MLN or portal blood among groups. CONCLUSION: Administration of GH, EGF, or INS improves gut mucosal structure in rats with SBS under PN, but, surprisingly, the incidence of BT detected in peripheral blood was increased rather than decreased in animals receiving these treatments.
Effect of growth hormone on bacterial translocation in experimental short-bowel syndrome.
Despite the adaptive process triggered in the remaining intestine by massive bowel resection, bacterial translocation (BT) is frequent under these conditions. Several trophic factors, including growth hormone (GH), are involved in the process of adaptation in short-bowel syndrome (SBS). However, the effect of GH on BT has not been investigated experimentally. The aim of this study was to test the hypothesis that GH administration prevents BT in rats with SBS receiving only parental nutrition (PN). Nineteen adult Wistar rats underwent central venous cannulation and were randomly assigned to one of two groups receiving for 10 days two treatment regimes: PN group (n = 10): fasting, all-in-one PN solution (300 ml. kg. 24 h, 280 kcal/kg. 24 h), 80% gut section including ileocecal valve; GH group (n = 9): fasting, same PN regime and resection plus GH 1 mg/kg s.c). At the end of the experiment, the rats were killed and mesenteric lymph nodes (MLN) and samples of systemic and portal blood were obtained and cultured. Several samples of full-thickness jejunal wall were taken for determining cell proliferation index (PCNA) and mucosal thickness. Jejunal mucosal thickness increased by 30% and PCNA index by 35% in GH-treated rats in comparison with those treated with PN alone. However, contrary to our expectations, BT expressed by positive culture of intestinal flora in portal blood, MLN, or systemic blood was found in 60% of PN and 87% of GH animals (P = 0.1). Translocation to the general circulation expressed by the presence of organisms in systemic blood was detected in 0% of PN and 44% of GH rats (P < 0.05). Although exogenous GH improves gut mucosal structure in rats with SBS treated with PN, it seems to increase rather than decrease mucosal permeability to intestinal bacteria.
Bacterial translocation is favored by the preservation of the ileocecal valve in experimental short bowel with total parenteral nutrition.
Sepsis in short-bowel syndrome (SBS) is in part due to bacterial translocation (BT). Parenteral nutrition (PN) is often necessary in SBS and promotes BT. The aim of this study was to asses the effect of the presence or absence of ileocecal valve (ICV) on BT in parenterally-fed rats with massive intestinal resection. Sixty-five adult Wistar rats underwent central venous cannulations and were randomly assigned to one of five groups receiving for ten days five treatment regimes: Sham (n = 17) standard rat chow + i.v. saline. PN (n = 17) fasting + PN. Res-Sham (n = 10) standard rat chow + i.v. saline + 80% gut resection. Res-PN (n = 11) fasting, PN + 80% gut resection. Res-ICV-PN (n = 10) fasting, PN + 80% gut resection including ICV. At the end of the experiment they were euthanized and mesenteric lymph nodes (MLN), spleen and peripheral and portal blood specimens were recovered and cultured. BT was found in 47% of PN animals, 91% of Res-PN rats, 100% of Res-Sham group and 60% of Res-ICV-PN animals, but not in Sham ones. 97% of BT+ animals had positive cultures in MLN and/or portal blood, whereas germs beyond liver were detected in 30% of Res-Sham, 37% of PN, 50% of Res-PN and 0% of Res-ICV-PN rats. The present study confirms that both massive intestinal resection and PN promote BT. In addition, it shows that animals deprived of ICV have lower incidence of BT in this setting than those with it and that the germs do not reach in them peripheral blood in the same proportions as in ICV-intact animals. These results suggest that the presence of an intact ICV favor BT in parenterally-fed rats with massive intestinal resection.
[Medicine based on evidence: a useful tool for the pediatric surgeon].
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Bacterial translocation and T-lymphocyte populations in experimental short-bowel syndrome.
Bacterial translocation (BT) accounts in part for sepsis in short-bowel syndrome in which total parenteral nutrition (TPN) is routinely necessary. TPN "per se" facilitates BT and it has been suggested that decreased T-lymphocyte populations (TLP) in newborn rabbits and nude mice promote BT as well. We have tested the hypothesis that BT and modifications in TLP are to be expected in rats subjected to TPN and gut resection. Forty-five adult Wistar rats underwent central venous cannulations and were randomly assigned to one of three groups receiving for ten days three treatment regimes: - Group Sham (n = 17) oral intake of rat chow + saline (300 ml/kg/24 h) through a jugular vein catheter. - Group TPN (n = 17) fasting + infusion of all-in-one TPN solution (300 ml/kg/24 h). - Group RES (n = 11) fasting, same TPN regime + 80% gut resection. At the end of the experiment they were sacrified and specimens (peripheral and portal blood, spleen and mesenteric lymph nodes) were recovered, cultured and/or assessed for CD4+ and CD8+. Bacterial translocation was found in 47% of TPN animals, 92% of RES rats, but not in SHAM ones. Lymphocyte populations were not different in BT+ (n = 8) or BT- (n = 9) rats in the TPN group. TPN and resected animals showed a rise in CD4+ and a drop in CD8+ (then a better CD4+/CD8 ratio) when comparing with SHAM group rats. From this data we may conclude that: 1) BT is frequent if TPN is administered, and constant in resected animals. 2) No apparent relationship between the proportions of CD4+ and CD8+ lymphocytes and BT could be shown in TPN group. 3) High CD4+/CD8+ ratio in TPN and RES groups demonstrate that BT is possible even having good TLP.
[Saliva in experimental gastroesophageal reflux].
Saliva, with a neutral pH, mucous content and inhibitory factors of the stomach acid secretion, can be considered a protecting element of the esophageal mucosa in the gastroesophageal reflux. 39 Wistar rats 175-225 g were used divided in seven groups: "C" control, "E-A" esophago-gastrostomy. "E-M" esophago-myectomy, "S-C" only sialoadenectomy, "S-EA" sialoadenectomy plus esophagogastrostomy, "S-EM" sialoadenectomy plus esophago-myectomy. 15 days later the rats were sacrificed, the esophagus was taken out for its histological examination and blood samples were drawn. The comparison between the control and treated groups, showed a significant deterioration of the EA, SEA and SEM groups regarding the final weight, and the SC group in the white series and ions. Many of the animals with esophagus operations showed vomit signs and general affectation. None of the groups showed esophageal lesions in the histology, from which it can be deduced that, in the rat, a 90% saliva absence doesn't produce negative effects on the esophageal mucosa either in acid presence or not.
[Gastroesophageal reflux and ventilation with continuous positive pressure. Experimental study].
Gastroesophageal reflux (GER) often occurs in babies receiving respiratory assistance for neonatal distress. The authors examined the lower esophageal sphincter and the thoracic and abdominal pressure conditions in rats under progressively higher continuous positive airway pressure (CPAP) to test the efficacy of the antireflux barrier under such conditions. Intrathoracic and intraabdominal pressures were recorded within the esophagus and within the inferior vena cava in 10 anesthesized 250-g male rats. Pull-through techniques were used for lower esophageal sphincter pressure (LESP) and length (LESL) studies, and the length of the intraabdominal segment of the esophagus (LIASE) was also determined. Measurements were performed in baseline conditions and at CPAP levels of 0, 1, 3, 5 and 7 cm H2O. The respiratory effort progressively increased with prolonged expiration and decreased frequency. LESP and LESL did not change significantly, but the antireflux barrier was weakened by a progressive shortening of LIASE. Successive CPAP increases led to increasingly negative thoracic pressures during inspiration, and increasingly positive abdominal pressure during expiration yielded progressively greater transdiaphragmatic pressure gradients. The authors suggest that CPAP weakens the antireflux barrier and, at the same time, increases the gastroesophageal pressure gradient, thus increasing the risk of GER. Although transpolation of experimental data to the clinical setting is always hazardous, the authors believe this issue should be investigates in infants.
Lymphocyte subpopulations after extensive small bowel resection in the rat.
The increased risk of infection after massive intestinal resection (MIR) may be attributable to impaired nutrition, loss of intestinal lymphoid tissue, or both. This study examines whether MIR itself changes the immune cell populations in laboratory animals when nutritional status is preserved. The authors studied cellular immunity (lymphocyte subsets T4 and T8 and the T4:T8 ratio) and humoral immunity (IgG, IgM, IgA, and B lymphocytes) in the blood, spleen, and mesenteric lymph nodes of unresected Wistar rats (control group, n = 6) and of animals that underwent 80% bowel resection followed by 7 days of either oral feeding (resection-oral group, n = 6) or parenteral nutrition (resection-TPN group, n = 6). The increase in body weight was similar among all groups, and the levels of total protein, albumin, prealbumin, and immunoglobulin remained unchanged. All resected animals, irrespective of their feeding route, had significantly lower proportions of T4 and B lymphocytes and T4:T8 ratio in blood, T4 and T8 in mesenteric lymph nodes, and T4 and T4:T8 ratio in the spleen. The author's results suggest that removal of large amounts of lymphoid tissue along with the bowel during MIR might lead to inadequate immune response even when the nutritional status is preserved.