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Regional distribution of immunoreactive dynorphin A in the human gastrointestinal tract.

Immunoreactive dynorphin A (ir-Dyn A) was detected throughout the human gastrointestinal tract by a validated radioimmunoassay. Moreover, the stability of 125I-Dyn A during extraction procedures was confirmed by high performance liquid chromatography. Levels of ir-Dyn A were higher in the stomach and in the small bowel. In tissue samples separated into the main layers composing the gut wall (muscularis externa, submucosa and mucosa) ir-Dyn A was uniformly distributed. An exception was the colon, where concentrations were higher in the muscular portion. Gel permeation chromatography on samples of mucosa and muscularis externa extracts of ileum and gastric fundus, showed immunoreactive material eluting in several forms of apparently higher molecular weight than Dyn A, while only a minor peak was found to coelute with authentic Dyn A.

Digestive System↗

The ecology and immunology of the gastrointestinal tract in health and critical illness.

Interactions between the indigenous flora of the gastrointestinal tract and immunologically competent cells in the gut mucosa, gut-associated lymphoid tissues and liver play an important role in normal immune homeostasis. The microbial flora of the normal gut is complex, yet remarkably constant over time. The relative sterility of the upper gut is maintained by multiple factors including gastric acid, bile salts, normal motility and mucosal IgA, while the lower gut is densely colonized with a complex flora. An intact Gram-negative flora is a prerequisite for normal immunological maturation. On the other hand, overgrowth of the gut, particularly by Gram-negative bacteria or fungi, facilitates the translocation of bacteria into the host, and results in suppression of T-cell responses and altered hepatic Kupffer cell function. Bacterial overgrowth and the consequences of the interactions of this potentially pathogenic flora with the gut immune system may contribute to the septic state in critical illness, and to the syndrome of multiple organ failure.

Critical Illness↗

The enterochromaffin cells in the mouse gastrointestinal tract after streptozotocin treatment.

Effects of 5 weeks streptozotocin treatment on the mouse gastrointestinal tract were studied with special emphasis on enterochromaffin (EC) cells. In the streptozotocin-treated animals the frequency of EC cells was reduced in the antral area and in the small intestine, but increased in the colon. The length of the intestinal tract and the mucosal thickness were increased in these animals. Possible mechanisms underlying these abnormalities of the EC cell system are discussed.

Animals↗

Final results of a phase III clinical trial on adjuvant intraportal infusion with heparin and 5-fluorouracil (5-FU) in resectable colon cancer (EORTC GITCCG 1983-1987). European Organization for Research and Treatment of Cancer. Gastrointestinal Tract Cancer Cooperative Group.

In this phase III clinical trial conducted by the Gastrointestinal Tract Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer (GITCCG-EORTC), we evaluated the effect of adjuvant intraportal infusion of heparin (HEP) and 5-fluorouracil (5-FU) on overall survival, disease-free survival and time to progression in patients with resectable colon cancer. From January 1983 to June 1987, 235 patients were randomised from 14 institutions in seven European countries: 79 patients made up the control group (control): 72 the portal vein infusion group given heparin alone (5000 IU daily x 7 consecutive days) (HEP); 84 the portal vein infusion group given heparin (5000 IU daily x 7 consecutive days) and 5-FU (500 mg/m2 daily x 7 consecutive days) (HEP/5-FU); 34 patients were considered ineligible. The 199 patients considered eligible were well balanced for age, sex, Karnofsky index, tumour location, surgery, surgical procedure and Dukes' stage. Four patients (2 control, 1 HEP, 1 HEP/5-FU) died of surgical complications. No differences were observed between control group and treatment groups (HEP, HEP/5-FU) for postoperative complications and number of hospitalisation days. Severe toxicity (grade 3-4, WHO) was found in 12% of patients in the HEP group and 8% in the HEP/5-FU group. After a median follow-up of 9 years, disease progression was reported in 40% of patients in the control group, 40% in the HEP group and 29% in the HEP/5-FU group. Five-year survival, time to progression and disease-free survival were 69%, 58% and 56%, respectively, in the control arm, 61%, 58% and 56% in the HEP arm, and 71%, 69% and 65% in the HEP/5-FU arm. Based on all randomised patients, the effect of treatment was not statistically significant with respect to any of the endpoints. It is confirmed that intraportal 5-FU infusion is safe and has a tolerable toxicity, but cannot be considered standard treatment for patients with resectable colon cancer.

Adult↗

Mitochondrial enteropathy: the primary pathology may not be within the gastrointestinal tract.

BACKGROUND: Mitochondrial DNA (mtDNA) defects are an important cause of disease. Although gastrointestinal symptoms are common in these patients, their pathogenesis remains uncertain. AIM: To investigate the role of the mtDNA defect in the production of gastrointestinal dysfunction. PATIENT: A 20 year old woman who presented at 15 years of age with recurrent vomiting and pseudo-obstruction, who did not respond to conservative management and ultimately had subtotal gastrectomy and Roux-en-y reconstruction. She subsequently presented with status epilepticus and was found to have a mitochondrial respiratory chain disorder due to a pathogenic mtDNA point mutation (A3243G). METHODS: Resected bowel was studied using light and electron microscopy and mtDNA analysed from both mucosal and muscular layers using polymerase chain reaction generated RFLP analysis. RESULTS: Histological and electron microscopic studies revealed no morphological abnormalities in the resected stomach, and molecular genetic analysis failed to identify the genetic defect in either the mucosal or muscle layers. CONCLUSION: This study suggests that in some individuals with gastrointestinal symptoms associated with established mitochondrial DNA disease, the primary pathology of the mitochondrial enteropathy lies outside the gastrointestinal tract.

Adolescent↗

Histochemical observations on the mucins of the gastrointestinal tract in the toad (Bufo melanostictus).

The pattern of mucin secretion of the gastrointestinal tract of the toad (B. melanostictus) was investigated by histochemical methods. The goblet cells of the oesophagus secreted mainly acid mucins which were sialomucins, while the cells lining the surface of the stomach produced neutral mucins only. Goblet cells of the small intestine and cloaca secreted acid mucins, which were predominently sulphated mucins.

Animals↗

Distribution of prostaglandin-sensitive adenylate cyclase in human upper gastrointestinal tract.

The localization of the prostaglandin-sensitive adenylate cyclase in the upper gastrointestinal tract in human beings was studied. The prostaglandin-sensitive enzyme was almost evenly distributed throughout the fundic, antral and duodenal mucosa. The enhancement of enzyme activity in the presence of maximally effective prostaglandin concentrations exceeded basal levels by about 200%. The physiological role of the prostaglandin sensitive adenylate cyclase in gastric and duodenal function, however, remains to be established.

Adenylyl Cyclases↗

Clinical, controlled trial of somatostatin with ranitidine and placebo in the control of peptic hemorrhage of the upper gastrointestinal tract.

There are many controversies concerning the treatment of hemorrhages of the upper gastrointestinal tract. In order to determine whether some currently used drugs, such as somatostatin (SST) and ranitidine, may be useful in the control of hemorrhages, we have conducted a controlled (not blind) study with alternate assignment in 220 accurately selected patients affected with hemorrhage secondary to acute peptic ulcer disease. We divided the patients into three groups on the basis of the severity of disease (moderate, serious, massive); a subgroup of each group underwent one of the three studied treatments (SST, ranitidine, placebo). After careful clinical and laboratory assessment, we followed the patients over a period of 72 h. The criteria to assess the efficacy of the treatment were: number of patients who had stopped bleeding; time needed to stop the hemorrhage, and the number of recurrences of bleeding in every group and subgroup. At the end of the study, SST and ranitidine were more effective in the control of hemorrhage than placebo. SST was more effective than ranitidine, especially in patients with moderate and serious hemorrhages; it achieved a recovery of nearly 100% in the group with moderate bleeding.

Adult↗

[Chemo- and laser therapy of advanced tumors of the upper gastrointestinal tract].

Results of combined modality treatment of space occupying tumors of the upper gastrointestinal tract consisting in combined chemotherapy and endoscopically guided topical laser therapy have been presented. A majority of patients achieved complete relief of nutritional distress and a remarkable survival duration. Further development of such treatment by additional after loading treatment has been discussed.

Adenocarcinoma↗

[Length and weight of gastrointestinal tracts of pikas, suncus, millardias, mice and rats].

The length and weight of gastrointestinal tracts including contents of ten week old male pikas (Ochotona rufescens rufescens) and suncus (Suncus murinus) were measured and they were investigated and compared with those of millardias, ICR-mice and Wistar-rats. The length from the duodenum to the anus of pikas was much longer and the weight from the stomach to the anus was about 16g per 100g of body weight. The weight of cecum was about 7g per body weight and they were heavier than those of other species. The length from the duodenum to the anus of the suncus was short but the weight of the small intestine plus colon and rectum per body weight did not differ from that of other species. The suncus has no cecum but the weight from the stomach to the anus was almost the same as that of rats.

Animals↗

Proper use of gastrointestinal tract to achieve continent urinary diversion in 73 patients.

Different segments of the gastrointestinal tract have been used to reconstruct the bladder and all have been reviewed in regard to achieving urinary continence. In 53 patients with detubularized ileocecal cystoplasty, the continence rate, both during the day and night, was 88%, while 95% of the patients were continent during the daytime. In nine patients in whom an ileocecal continent reservoir was made, 100% had dry stoma on intermittent catheterization, both during the day and night. We conclude that detubularization of the right colon has a significant effect in achieving urinary control and making a good low pressure pouch. This has helped us to avoid conduits with their inherent problems. Also, the right colon by virtue of the ileocecal valve has good versatility for use in both anti-incontinence or anti-reflux procedures as needed.

Adolescent↗

[The experimental and clinical effect of ciprofloxacin on the microflora of the gastrointestinal tract].

The study of the influence of cyprofloxacin on the microflora of the gastrointestinal tract has been made under experimental and clinical conditions. As revealed in this study, cyprofloxacin produces a corrective effect on the intestinal microflora; the action of this preparation, in contrast to that of other antimicrobial preparations, is retained for a long time. In patients having duodenal ulcer with bacteriosis caused by Campylobacter pylori and with intestinal dysbacteriosis the combination of cyprofloxacin and cimetidine yields a higher therapeutic effect than the use of cimetidine alone.

Adult↗

An immunohistochemical study on the distribution of endocrine cells in the gastrointestinal tract of domestic pigeon, (Columba livia var domestica).

The endocrine cells in the gastrointestinal tract of the domestic pigeon (Columba livia var domestica) were studied immunohistochemically, and their distribution and relative frequencies were determined. In the proventriculus, moderate numbers of somatostatin- and numerous gastrin-releasing polypeptide (GRP)-immunoreactive cells were found. No immunoreactive cells were detected in the gizzard. In the pyloric region, many motilin-immunoreactive cells were found in addition to numerous somatostatin- and gastrin-immunoreactive cells. In the intestine, somatostatin-, gastrin-, serotonin-, neurotensin-, pancreatic glucagon- and enteroglucagon-immunoreactive cells were found to have in differing distribution patterns.

Animals↗

Immunohistochemical antigenic expression and in vivo tumor uptake of monoclonal antibodies with specificity for tumors of the gastrointestinal tract.

Two monoclonal antibodies with specificity for carcinoembryonic antigen and Ca 19-9 gastrointestinal tract tumor associated antigens were infused after iodination with 125I and 131I, respectively, in six patients 3 days and in one patient 4 days before radical surgery for colon or rectal carcinoma. Biopsy specimens from tumor, normal colon, fat, muscle, and skin along with a blood sample were excised at surgery and counting was performed for gamma emission. Fragments were then studied by two independent pathologists for immunohistochemical expression of corresponding antigens using the avidin-biotin peroxidase complex. A correlation study was thereafter performed between the amount of antibody bound in vivo, expressed as the percentage of injected dose per gram of tissue and the quantitative expression of tumor associated antigens, taking into account both the percentage of cells expressing the antigen and intensity of staining. For this limited number of patients a good correlation was found between amount of targeted antibodies and amount of expressed antigens. For carcinoembryonic antigen, r values were 0.69 and 0.90 for each pathologist (with an r value of interobserver correlation of 0.74); for Ca 19-9, values of 0.78 and 0.84 were obtained for each observer, with an interobserver r value of 0.97. Based on this limited study, it may be assumed that the possibility of imaging a given tumor is in part correlated to intensity of antigenic expression at the tumor site; other parameters, like tumor vascularization and blood flow for instance, are, however, to be considered for accessibility of antibodies to corresponding antigens.

Antibodies, Monoclonal↗

Perforation of the gastrointestinal tract in infancy and childhood.

Eighty-eight patients with perforations of the gastrointestinal tract in infancy and childhood, excluding those caused by appendicitis, are presented. Fifty-five patients were four weeks of age or younger. Fourteen of the perforations occurred during the first year of life and 19 occurred between one and 15 years of age. The locations of perforations by order of frequency were the ileum, rectosigmoid, stomach and duodenum. The causes in order of frequency were necrotizing enterocolitis, ulcers, unknown causes, Hirschsprung's disease, atresia of the small intestine, volvulus, trauma, gastroschisis and ventriculoperitoneal shunts for hydrocephalus. A high index of suspicion, aided by roentgenograms, is essential for an early diagnosis. The over-all mortality was 49 of 88 patients. No reduction in mortality was observed in the last ten years, despite improved surgical techniques and better antimicrobial agents. Early recognition and rapid transport of the child to a pediatric intensive care unit with better supportive measures plus antimicrobial agents effective against both anaerobic and aerobis bacteria should reduce this high mortality.

Adolescent↗

'Surgical mules': the smuggling of drugs in the gastrointestinal tract.

The presentation to surgical units of patients carrying illegal drugs in the gastrointestinal tract is a frequent occurrence at hospitals sited close to international airports. Drugs, usually heroin or cocaine, are wrapped in cellophane packets or condoms. The packages are intracorporeally concealed by being swallowed or passed into the rectum. The majority of drug traffickers carrying intracorporeal drug packages do not require any medical intervention. Recent reports have suggested that these patients are best treated expectantly avoiding any operative procedures. However, the quantity of drug in any one of the ingested packets is usually above the toxic dose and acute drug toxicity, as well as bowel obstruction, can result in fatalities. We report a series of five patients who presented over a period of 2 years to a hospital close to Heathrow International Airport, London. The presentation and treatment are reviewed and the management of such 'surgical mules' discussed. We have shown that conservative treatment is appropriate providing bowel obstruction or package perforation has not occurred.

Adult↗

Incidence, complications, treatment, and outcome of ulcers of the upper gastrointestinal tract after renal transplantation during the cyclosporine era.

BACKGROUND: Ulcers of the upper gastrointestinal tract after renal transplantation have been reported as a frequent and often lethal complication. Considering the continuous expansion of renal recipient criteria, we reviewed our experience with post-transplant ulcers after 1,034 renal transplants performed during the cyclosporine era. STUDY DESIGN: Our retrospective study analyzed only endoscopy-proven ulcers of the esophagus, stomach, and duodenum in 439 (42 percent) living related adult recipients and 595 (58 percent) cadaver or living unrelated adult recipients. For ulcer prophylaxis, only oral antacids were routinely given post-transplant. RESULTS: There were 41 ulcers in 33 patients (esophageal: n = 5, 12 percent; gastric: n = 17, 42 percent; duodenal: n = 19, 46 percent). Significant complications (n = 16) included 15 bleeding episodes and one perforation. The pathogenesis was viral in seven cases (gastric: n = 6, 15 percent; duodenal: n = 1, 2 percent). The ulcers occurred significantly earlier post-transplant in cadaver or living unrelated compared with living related recipients (median, 53 compared with 508 days, p = 0.02). Nonoperative treatment was successful for 96 percent of all ulcers. We found no ulcer-related mortality or graft loss. For living related recipients, the actuarial graft survival rate at three years was 69 percent for patients with ulcers compared with 86 percent for those without ulcers (p = 0.02); for cadaver or living unrelated recipients, it was 48 percent for patients with ulcers compared with 77 percent for those without ulcers (p = 0.9). For living related recipients, the actuarial patient survival rate at three years was 92 percent for patients with ulcers compared with 93 percent for those without ulcers (p = 0.8); for cadaver or living unrelated recipients, it was 59 percent for patients with ulcers compared with 88 percent for those without ulcers (p = 0.002). CONCLUSIONS: With more specific immunosuppression and more effective antiviral therapy, the incidence of post-transplant ulcers is low. Considering the excellent results of nonoperative ulcer therapy and a zero percent ulcer-related mortality rate, renal transplantation is safe for patients with specific (e.g., ulcer history) as well as nonspecific (e.g., chronic obstructive pulmonary disease) ulcer risk factors.

Adolescent↗

[Treatment of external postoperative fistulas of the gastrointestinal tract].

In the years 1985-1996 82 patients with postoperative external fistulas of gastrointestinal tract (pefgt) were treated in the Department of General Surgery of Hospital in Olsztyn. The age of the patient varied from 18 to 70 years. 37 patients were women and 45 man. Volume of excreted fluid fluctuated from 100 ml to 3000 ml per day. The most frequent cause of pefgt was dehiscence of the anastomosis of jejunum in 31 patients, and operations of complications of gastric or duodenal ulcer disease in 30 patients. 54 patients underwent medical treatment. It was based on compensation of disorders in water and electrolyte balance and acid-base equilibrium, nutritional treatment, protection of the skin, suction of the excreted fluid, controlling of foci of infection, rehabilitation. 7 patients were reoperated for the purpose of closing the fistula and 21 to drain abscess or to stop bleeding. 57 (70%) out of 82 patients recovered, 25 (30%) died. In this number 14 patients among 54 treated conservatively and 11 out from 28 operated. The most frequent cause of death was sepsis (15 patients). The conservative treatment including TPN is successful in majority of patients with pefgt and indispensable in patients treated operatively. Special attention should be given for coexisting intraperitoneal abscessa, peritonitis and sepsis.

Adult↗