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PubMed2000

[Clinical analysis of 224 cases of small intestine disease].

OBJECTIVE: To increase the knowledge of small intestine disease, improve the diagnostic rate and discusses the examination methods. METHODS: 224 cases of small intestine disease were studied and their major symptoms, etiology, diagnostic methods were analyzed. RESULTS: The major symptoms of small intestine disease were abdominal pain (58%), abdominal mass (18%), fever (17%) and hematochezia (12%). The most common disease of small intestine was malignant tumor (32%), others were diverticulum (29%), leiomyomas (7%), hemorrhagic necrotizing enteritis (6%), Crohn's disease (4%). Double-contrast enteroclysis and laparotomy were still the major diagnostic methods. CONCLUSION: Malignant tumor was the most common disease of small intestine. More attention should be paid to the diagnosis of small intestine disease.

Adolescent↗
PubMed1994

Leiomyosarcoma in leiomyomatosis of the small intestine.

Multiple leiomyomata of the small intestine are rare. We report one such case where a leiomyosarcoma had arisen from a leiomyoma in the small intestine 8 years after presentation. The possible origin of the leiomyomata is discussed and it is concluded that small intestinal leiomyomatosis should be regarded as a premalignant condition.

Adult↗
PubMed1993

Rat small intestinal cytochromes P450 probed by warfarin metabolism.

Small intestinal cytochromes P450 (P450s) provide potential first-pass metabolism of ingested xenobiotics. To investigate this system, this study addresses the procedure for elution of enterocytes from male rat small intestine, histological evaluation of the elution procedure, and assessment of the functional microsomal P450s in small intestine of untreated and induced rats, using warfarin metabolism as a probe. Histologically it was demonstrated that villous enterocytes are initially detached in sheets and are subsequently eluted without clear resolution into villous tip, midvillous, and lower villous cells, contrary to previous reports. Crypt cells are eluted after cells from the villus. The following functional P450s were identified, using stereo- and regioselectivity of warfarin metabolism, in small intestinal microsomes: P4502B1 in untreated rats, P4501A1 in beta-naphthoflavone-induced rats, P4502B1 in phenobarbital-induced rats, and P4503A1/2 in pregnenolone-16 alpha-carbonitrile-induced rats. In contrast to hepatic microsomes from untreated or induced rats, P4502C11 and -2C6 were not present or inducible by these inducing agents in rat intestine. Western immunoblots, warfarin assays, and P450 assays all indicated that beta-naphthoflavone induced P4501A1 in small intestinal villous and crypt cells, but in contrast to the liver neither apo-P4501A2 nor functional P4501A2 was induced.

Animals↗
PubMed1999

The characteristics of intestinal injury peripheral to strangulating obstruction lesions in the equine small intestine.

Recent studies suggest that horses requiring surgical correction of strangulating intestinal obstruction may develop post operative complications as a result of ischaemia/reperfusion injury. Therefore, the mucosal and serosal margins of resected small intestine from 9 horses with small intestinal strangulating lesions were examined for evidence of ischaemia/reperfusion injury. Severe mucosal injury and marked elevations in myeloperoxidase activity were detected at ileal resection margins (n = 4), whereas the mucosa from proximal jejunal (n = 9) and distal jejunal (n = 5) resection margins was normal. However, the serosa from jejunal resection margins had evidence of haemorrhage and oedema, and the proximal jejunal serosa had significantly increased numbers of neutrophils. Histological injury in ileal stumps is indicative of the inability fully to resect the ileum in horses with distal small intestinal strangulations. One of 4 horses subjected to ileal resection was subjected to euthanasia and found to have a necrotic ileal stump. Evidence of serosal injury and neutrophil infiltration in the proximal jejunal resection margins may predispose horses to post operative adhesions. Four of 8 horses discharged from the hospital suffered from recurrent colic in the post operative period.

Anastomosis, Surgical↗
PubMed1974

Primary tumours of the small intestine.

Tumours of the small intestine are not common. It is essential that an early diagnosis be made so that curative surgery can be carried out and the patient survive. The various clinical presentations and methods of investigation are discussed in order to create an awareness of this type of tumour. The methods of treatment are considered and also the prognosis of malignant growths, which, although poor, compares favourably with that of cancer of the stomach. The relative rarity of these tumours is probably due to the rapid passage of intestinal contents through the small bowel as compared with the stomach or colon.

Adenocarcinoma↗
PubMed2005

[Capsule endoscopy--a new method for the diagnosis of diseases of the small intestine].

BACKGROUND: Diseases of the small intestine are rare and often difficult to diagnose because of a lack of sensitive methods. A new technique called wireless capsule endoscopy has recently been developed; it allows visualisation of the entire small intestinal surface. MATERIAL AND METHODS: The patient swallows a capsule containing a small digital camera, a battery and a radio transmitter. The capsule takes 2 pictures per second during its passage through the intestines; pictures are transferred by radio signals that are detected by sensors on the abdominal skin, stored on a data recorder and later analysed on a PC. RESULTS: By the end of November 2003 we had performed 80 capsule endoscopies in 69 patients. All patients were referred because of suspected small bowel disease and had been through an extensive diagnostic workup before capsule endoscopy was performed. Most of them were referred because of obscure gastrointestinal bleeding or iron deficiency anaemia. Small bowel pathology was found in one third of the patients. INTERPRETATION: Capsule endoscopy seems to be a major improvement in the diagnosis of small intestinal diseases. It is a non-invasive and painless procedure.

Adult↗
PubMed1978

The quantitative assessment of mucosa in canine small intestinal malabsorption.

Histological sections from the small intestines of dogs showing clinical signs of small intestinal malabsorption have been examined using morphometric techniques. Weibel graticule measurements appear to be a useful adjunct to the subjective assessment of villus atrophy. Severe clinical signs of small intestinal malabsorption may be associated with a patchy distribution of lesions throughout the small bowel.

Animals↗
PubMed1999

Motility of the small intestine.

Motility of the small intestine is controlled by myogenic, neural, and hormonal mechanisms and is modulated by external influences such as meals, central nervous system activation, and immune factors. Small-bowel dysmotility is recognized in a number of diseases, but its precise role in symptom generation remains unclear in many instances. We review publications that in the year under review added to the basic understanding of small-intestinal motility as well as its alteration in disease.

Journal Article↗
PubMed1999

Monoclonal antibody Adnab-9 defines a preneoplastic marker in epithelium at risk for adenocarcinoma of the small intestine.

Unlike colorectal cancer, risk markers for adenocarcinoma of the small intestine (ASI) have not been identified. Because the demographic and pathological features of both of these diseases are similar, immunohistochemistry was performed using monoclonal antibodies for three colonic premalignant markers, Adnab-9 (recognizes a colonic adenoma epitope), CaCo3/61, and FBB2/29 (small intestine proteoglycans expressed ectopically in colonic neoplasms), in normal and neoplastic small intestinal epithelium, and the results were compared with normal controls. Adnab-9 was also examined in 20 familial adenomatous polyposis (FAP) patients, a population known to be at an increased risk for ASI. Immunohistochemistry in normal and neoplastic tissue (adenoma, adenocarcinoma) from 18 patients with primary adenocarcinoma of the small intestine was compared with normal small intestine from 10 nonneoplastic controls. Four of 10 (40%) cases of normal small intestinal epithelium from controls were mildly positive in less than 10% of crypts, versus strong staining (>50% of crypts) in 16 of 18 (89%) patients with adenocarcinoma, and in 17 of 20 (85%) patients with FAP (P<.05). Adnab-9 predominantly stained Paneth cells as well as rare crypt and basal villous goblet cells. Adenomatous epithelium from the adenocarcinoma cases and adenomas from the FAP patients showed staining of Adnab-9 in 63% and 78% of cases, respectively. Only 17% of adenocarcinomas were positive for Adnab-9. In contrast, neither CaCo3/61 nor FBB2/29 showed any significant differences in the degree of staining in normal small intestinal epithelium in patients with adenocarcinoma compared with controls. Enhanced Adnab-9 staining in normal small intestinal epithelium from patients who harbor adenocarcinoma, and in FAP patients, supports its role as a risk marker of small intestinal neoplasia.

Adenocarcinoma↗
PubMed1988

On the presence of intermediate cells in the small intestine.

In the small intestine, the presence of transitional cells or cells intermediate between Paneth cells and goblet cells has been reported frequently for 100 years. Light microscopy and, more recently, fine structural studies have indicated that secretory granules observed in intermediate cells share some morphologic characteristics with those of granular goblet cells and of Paneth cells. In order to verify if intermediate cells in the jejunum and ileum of the adult mouse have functional similarities with either granular goblet or Paneth cells, we have studied the incorporation of sulfur-35 by radioautography and the localization of lysozyme by immunocytochemistry. After radioautography, goblet cells and, to a lesser extent, granular goblet cells had incorporated sulfur-35, whereas Paneth cells and intermediate cells were completely negative. Immunolocalization of lysozyme was done by using rabbit anti-rat lysozyme and protein A-peroxidase. After demonstration of peroxidase activity, only Paneth cells were stained and intermediate cells were negative. Therefore, intermediate cells do not contain sulfomucin or lysozyme, and they are functionally different from goblet and Paneth cells. Their function remains unknown.

Animals↗
PubMed2003

Efficacy of real-time monitoring to determine motility in porcine small intestinal transplantation.

Orthotropic small intestinal transplantation (SIT) was performed in outbred 20 pigs. The interdigestive motor patterns were evaluated using strain gage (SG) force transducers. Seven pigs without SIT were treated as control (C) group. Based on the obtained data, the group, which could be detected the migrating motor complex (MMC) in the graft and alive with adequate oral feeding, was regarded as functional graft (FG) group, whereas the group which had available data recorded within 10 days before the death due to rejection was regarded as rejection (R) group. The MMC was analyzed using following parameters: duration; amplitude; and interval. In group FG, all parameters were almost same as group C, thus suggesting that the allograft in group FG had a normal motor function. In contrast, all parameters in group R were significantly lower than those in group FG, suggesting that the motility in group R was impaired. The SG method could monitor the real-time motility and was efficient for detecting the rejection of SIT.

Anastomosis, Surgical↗
PubMed2005

The effect of choice of sterilisation method on the biocompatibility and biodegradability of SIS (small intestinal submucosa).

SIS (small intestinal submucosa) is a 3D extracellular matrix (ECM) material of porcine origin. It has a complex composition predominantly composed of collagen type I. SIS is rapidly absorbed, supports early and abundant new vessel growth, and serves as a template for the reconstructive remodelling of several body tissues. Currently SIS products are sterilised using ethylene oxide, gamma irradiation and e-beam irradiation. It is not known how they affect the materials properties such as structure, mechanical strength and biocompatibility. This study investigated the influence of each sterilisation method on the biocompatibility and biodegradation of SIS using L929 mouse fibroblasts. SIS samples were sterilised by each of the above methods under standard conditions. The samples were subjected to hydrolytic degradation conditions for specific periods of time. All sterilisation methods resulted in an increase in the rate of sample degradation. The study indicated that over time e-beam irradiation caused the greatest % weight loss. Applying sample extracts to L929 mouse fibroblasts assessed the biocompatibility of the degradation products. The % cellular protein and % metabolic activity were then assessed using the BCA assay and MTT assay, respectively. All SIS samples caused an increase in both cellular protein production and metabolic activity. Initially samples sterilised by ETO had the greatest effect but this decreased after 28 days. Unsterile samples were found to have a slower more prolonged influence. It is thought that the components released may include extractable growth factors and further studies are required to confirm this.

Absorbable Implants↗
PubMed1980

High order packing of DNA as revealed by autodigestion of chromatin in small intestine cell nuclei.

Small intestine cell nuclei incubated in sucrose media released large fractions of DNA into the culture medium. This effect was partially or completely suppressed when incubation was carried out in the presence of a protease inhibitor, 10 to 30 mM NaHSO3. The DNA released in sucrose media containing NaHSO3 was precipitated as a DNA-protein complex by increasing the bivalent ion concentration to 10 mM Ca2+ or 20 mM Mg2+. Most of the released DNA was not precipitated by Ca2+ or Mg2+ when incubation was performed without NaHSO3. As determined by viscosity measurements the mean molecular weight of the DNA released in the absence of NaHSO3 was from 3.5-8.0 x 10(5) and increased to about 11 x 10(5) (corresponding to 8 nucleosomes) when the incubation mixture contained NaHSO3. End group analysis indicated that the DNA segments were terminated by 3'-OH groups. It is suggested that fragmentation of DNA in chromatin was produced by a endogenous alkaline endonuclease activity which was present in the fraction of released DNA. The data support the view that the third-order repeat structure of chromatin consists of subunits containing 8 nucleosomes.

Animals↗
PubMed1999

Importance of colonic bacterial fermentation in short bowel patients: small intestinal malabsorption of easily digestible carbohydrate.

The small intestine's large capacity for glucose absorption and for adaptation seems to contradict the reported importance of carbohydrate malabsorption in short bowel (SB) patients. The aim of the present study was to investigate the occurrence of malabsorption in these patients ingesting realistic amounts of carbohydrates. We performed a dose-response study [ingestion of increasing amounts of glucose and complex carbohydrates (boiled rice and wheat bread), and the nonabsorbable disaccharide lactulose] in SB patients with an intact colon. The hydrogen (H2) -breath test and changes in serum acetate were used to evaluate colonic fermentation and, thus, indirectly, the lack of small intestinal carbohydrate assimilation. Blood glucose and plasma insulin were measured to evaluate absorption. Plasma concentrations of the ileal brake hormones--glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine (PYY)--were measured to test whether release of these hormones was related to colonic fermentation. Significant amounts of 25 g and 50 g glucose, and of the bread and rice meals were fermented rather than absorbed, as judged by the increases in end-expiratory H2. Serum acetate concentrations were significantly higher in SB patients than in healthy controls. The orocecal transit times of all test meals ranged from 15 to 120 min. GLP-1 and PYY releases in SB patients were significantly higher than in healthy volunteers. They were mutually parallel and paralleled the increase in insulin. They were not related to ongoing fermentation or to intraluminal carbohydrate content per se, but most probably to absorption of glucose in the distal bowel. In conclusion, well-adapted SB patients had pronounced small intestinal malabsorption of carbohydrate, even after ingestion of small amounts of easily absorbable carbohydrates. A fast small intestinal spreading of carbohydrates, once in the small intestine, and a spill-over to the colon seem to explain the data best.

Adult↗
PubMed2000

Small intestine contrast ultrasonography.

The entire small bowel can be visualized on ultrasonography after ingestion of nonabsorbable, isosmotic polyethylene glycol electrolyte balanced oral solution, termed small intestine contrast ultrasonography. The aims of this study were to assess whether the ingestion of different volumes of sonographic contrast solution may differently affect (1) small bowel distention and thus its sonographic appearance and (2) the time to visualize the entire small intestine. An additional aim was to identify the minimal amount of contrast solution necessary to visualize the entire small bowel. An ultrasonographic examination of the abdomen was performed twice in six healthy subjects after the ingestion of the isosmotic polyethylene glycol solution. During the first investigation each subject was asked to drink increasing amounts of sonographic contrast solution until the jejunum was visualized at ultrasonography. During the second investigation each subject was asked to drink increasing amounts of sonographic contrast solution, not to exceed a total volume of 260 ml. At the first examination the entire small bowel was visualized 39.3 +/- 17 min after ingestion of 647 +/- 105 ml of contrast solution. At the second examination the entire small bowel was visualized 43.5 +/- 13.5 min (not significant with respect to the first study) after the ingestion of 239 +/- 32 ml of contrast solution (P < 0.01 versus the first study). The mean luminal diameter and wall thickness at three intestinal levels did not differ in the two studies and were not statistically related to the amount of ingested sonographic contrast solution. Loose stools were the only side effect and were reported after the ingestion of more than 600 ml. Ultrasonography offers reproducible information on the morphology of the contrast agent-filled small bowel after ingestion of a wide range of volumes (175 to 820 ml) of isosmotic polyethylene glycol electrolyte balanced solution. On average, the entire small intestine could be visualized on ultrasonography by about 45 min after the ingestion of 600 ml or less of contrast solution without any side effects.

Adult↗
PubMed1989

Peptide-YY and neuropeptide-Y inhibit vasoactive intestinal peptide-stimulated adenosine 3',5'-monophosphate production in rat small intestine: structural requirements of peptides for interacting with peptide-YY-preferring receptors.

Previous binding studies indicated that peptide-YY (PYY) and neuropeptide-Y (NPY) shared a common PYY-preferring receptor site in rat small intestinal epithelium. We showed here that PYY and NPY inhibited vasoactive intestinal peptide (VIP)-stimulated cAMP production in epithelial cells isolated from rat small intestine and examined their structure-activity relationship. Inhibition of VIP-stimulated cAMP by PYY or NPY is time and dose dependent; half-maximal effects were observed for 10 and 107 nM, respectively. In contrast, the structurally related peptide, pancreatic polypeptide, was only active at 1 microM. PYY or NPY reduced the efficacy of VIP by about 50% without altering its potency. Both peptides also suppressed prostaglandin E1-, prostaglandin E2-, and forskolin-stimulated cAMP production and reduced basal cAMP levels. Their inhibitory effects were observed throughout the small intestine, including duodenum, jejunum, and ileum, but not in large intestine. PYY or NPY and epinephrine (through alpha 2-adrenergic receptors) did not exert additive inhibitory effects on intestinal cAMP production. Several fragments of PYY and NPY were used to characterize their structural requirement for inhibiting VIP-stimulated cAMP production and competing with [125I]PYY for binding to intestinal membranes. A highly significant correlation was observed between IC50 values measured in the two assays. No partial sequence of PYY retained the full activity of intact PYY, but the C-terminal portion of PYY was shown to be much more important than the N-terminal portion. Deletion of 21 amino acids from the N-terminus [PYY-(22-36)] only resulted in a 4- to 5-fold decrease in potency compared to that of PYY-(1-36). In contrast, PYY-(27-36) exhibited a drastic loss of potency. The N-terminal fragments PYY-(1-22) and PYY-(1-28) also had very low potencies. Similar results were obtained with NPY fragments. These results provide the first insight on the negative coupling of PYY-preferring receptors with the cAMP production system in small intestine and evidence of the crucial role of the C-terminal portion of PYY in interaction with these receptors.

Amino Acid Sequence↗
PubMed1998

Involvement of intestinal P-glycoprotein in the restricted absorption of methylprednisolone from rat small intestine.

The interaction between steroid hormones and intestinal P-glycoprotein was investigated by measuring intestinal absorption from rat small intestine in situ. Prednisolone and hydrocortisone were rapidly absorbed from the entire small intestine. In contrast, methylprednisolone absorption was significantly retarded in jejunum and ileum by an intestinal efflux system. In the presence of verapamil an quinidine, the retarded absorption of methylprednisolone was completely recovered, suggesting that P-glycoprotein is responsible for the unique features of methylprednisolone absorption. A requisite for the substrate of intestinal P-glycoprotein seemed to be 6 alpha-methyl group in the steroid structure. Substrate specificity of intestinal P-glycoprotein to steroid hormones was shown to be in part different from those in other tissues such as adrenal gland. Little of all three steroid hormones disappeared in the supernatant of mucosal homogenate from rat small intestine, indicating that intestinal metabolism of these steroid hormones was relatively small.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1996

The absorption and first-pass metabolism of [14C]-1,3-dinitrobenzene in the isolated vascularly perfused rat small intestine.

We tested the hypothesis that the small intestine is capable of the first-pass, reductive metabolism of xenobiotics. A simplified version of the isolated vascularly perfused rat small intestine was developed to test this hypothesis with 1,3-dinitrobenzene (1,3-DNB) as a model xenobiotic. Both 3-nitroaniline (3-NA) and 3-nitroacetanilide (3-NAA) were formed and absorbed following intralumenal doses of 1,3-DNB (1.8 or 4.2 mumol) to isolated vascularly perfused rat small intestine. Dose, fasting, or antibiotic pretreatment had no effect on the absorption and metabolism of 1,3-DNB in this model system. The failure of antibiotic pretreatment to alter the metabolism of 1,3-DNA indicated that 1,3-DNB metabolism was mammalian rather than microfloral in origin. All data from experiments initiated with lumenal 1,3-DNB were fit to a pharmacokinetic model (model A). ANOVA analysis revealed that dose, fasting, or antibiotic pretreatment had no statistically significant effect on the model-dependent parameters. 3-NA (1.5 mumol) was administered to the lumen of isolated vascularly perfused rat small intestine to evaluate model A predictions for the absorption and metabolism of this metabolite. All data from experiments initiated with 3-NA were fit to a pharmacokinetic model (model B). Comparison of corresponding model-dependent pharmacokinetic parameters (i.e. those parameters which describe the same processes in models A and B) revealed quantitative differences. Evidence for significant quantitative differences in the pharmacokinetics or metabolism of formed versus preformed 3-NA in rat small intestine may require better definition of the rate constants used to describe tissue and lumenal processes or identification and incorporation of the remaining unidentified metabolites into the models.

Acetanilides↗