[Importance of the direction of incision of the large intestine in anastomosis of the small and large intestines].
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The authors carried out experimental studies on 23 dogs to examine changes, which occurred in the wall of the anastomosed ileum and the large intestine as well as in some organs after performing traversed anastomoses. The results were evaluated on the basis of clinico-experimental observations, on the changes in laboratory indices (complete blood picture, proteinogram, ionogram, blood urea and cholesterol), in microflora and in bioelectrical, activity. They examined ionic absorption in the large intestine excluded from the passage. An analysis was made on the pathologo-histological finding in the colon, anastomised ileum, liver and spleen, kidneys, heart, pancreas. The authors come to conclusions, useful to the physicians performing large intestine surgery.
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Dependence of large intestinal calcium transport on vitamin D has been examined in vitro in colon only. The authors studied calcium fluxes in cecum and colon in vivo by perfusion with 1.6 mM calcium chloride in saline. Tracer 45Ca either was injected parenterally 24 hr before study or was added to the perfusates. For 8--10 wk after weaning, rats had been fed a rachitogenic diet; 48 and 24 hr before study, 50% of the animals were treated with 20,000 IU vitamin E2. In a separate set of animals, mucosal calcium binding protein was analyzed by the Chelex assay method. In comparison with vitamin D-deficient rats, the colon of vitamin D-treated rats showed higher lumen-to-plasma flux and lower plasma-to-lumen flux and net absorption instead of net secretion. In cecum, calcium transport was not significantly altered by vitamin D treatment. Mucosal calcium binding protein was higher in cecum than in colon in both groups and was higher in vitamin-D-treated than in vitamin D-deficient animals in both segments. The current study shows that in the rat colon calcium fluxes both into and out of the lumen as well as net transport are significantly by vitamin D treatment, but that cecal transport rates are not affected. In both cecum and colon, mucosal calcium binding protein increases with vitamin D treatment.
Two cases of large intestine endometriosis are presented. The disease was diagnosed during histological examination of samples taken during surgery. Clinically one case was diagnosed as Crohn's disease, while the second as cancer of the large intestine. The authors suggest, that an extent of surgery for, tumours of the large intestine should be carefully planned, specially if the tissue specimen was not examined histologically earlier.
Chronic diseases of the large intestine--catarrhal colitis, colonic stasis, unspecific ulcerative colitis, and amebiasis of the large intestine are attended by marked changes in the functional activity of blood platelets and factors of its regulation. They reflect the dynamics of the disease before and after operative and nonoperative treatment. A recurrence of the disease is linked with activation of blood platelets. Trental and contrycal are used for correction of the disorders, which improves the condition of some of the patients. The authors discuss the importance of biogenic amines, cAMP, and functional activity of the blood platelets as universal mechanisms of the development of chronic diseases of the large intestine.
In 5 cows, the mean length of the large intestine was only slightly greater than that of 21 sheep and 3 pigs. At about one-fifth of the way along the large intestine of the sheep and cows, corresponding to the end of the proximal colon and start of the spiral colon, there were marked reductions in the amount of digesta present and in the lumen diameter. In pigs these parameters decreased gradually along the large intestine. In all parts of the large intestine, the cows had more water in the digesta than did the sheep or the pigs. Nevertheless, the decrease in water content between the caecum and the rectum was similar for the cows and the sheep but less in the pigs. The rate of passage of digesta increased gradually along the large intestine of the pigs, but in the cows and sheep the rate was least in the caecum and proximal colon and greatest in the spiral colon. The total retention time for digesta in the large intestine was approximately 30, 20, and 9 h in the pigs, sheep, and cows respectively. The rate of water absorption from the large intestine was most rapid in the cows and slowest in the pigs. Differences in faecal water content between the species were not due to differences in retention times in the large intestine.
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Preparation of isolated large intestine of the frog was filled with Ringer's solution diluted with distilled water (1:5) and was placed into the glass with normal Ringer's solution. The preparation was weighed within every 30 min and the osmotic permeability was determined for water of the mucous and serous layers of the intestine. Then one of the peptides was added to Ringer's solution and the experiment continued. It is stated that bombesin, neurotensin, encephalins, substance P, somatostatin, pituitrin are able to change liquid absorption from the large intestine cavity when the concentration of Ringer's solution in the cavity and from its serous surface is the same. Bombesin and neurotensin inhibited while encephalins stimulated liquid absorption and these effects depended on the transport of ions. Liquid absorption by the osmotic gradient decreased using bombesin, substance P and increased using somatostatin. More complex peptide-peptide relations are observed if using pituitrin and other peptides. cAMP is shown to participate in bombesin effects.
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Obstructive symptoms due to small bowel tumors are the most common indication of primary malignant disease in the small intestine. Primary obstructing tumors of the small bowel are treated best by resection and primary anastomosis. Malignant lesions of the duodenum sometimes will require pancreaticoduodenectomy and those of the distal ileum, right hemicolectomy. Obstruction due to localized metastatic disease can be treated by resection and primary anastomosis but, more frequently, one or more side-to-side enteroenterostomies will be needed, especially in abdominal carcinomatosis. The complication of LBO due to colorectal cancer is an ominous sign. The less favorable prognosis is a result of the higher operative mortality, advanced stage of disease and lower resectability rate. Obstructing neoplasms of the right side of the colon are treated best by immediate resection and primary anastomosis. Left-sided colon obstruction due to malignancy traditionally is treated by preliminary diversion followed later by definitive resection. Insufficient data are available to evaluate any benefit on operative mortality and long-term survival with a more aggressive approach involving decompression and resection of the obstructing carcinoma at the initial operation. It is doubtful that any marked improvement in current mortality and survival figures will result from wide deviations of the current principles of operative managment. Early diagnosis of the cancer before obstruction occurs remains the primary means of improving survival rates. This involves not only primary means of improving survival rates. This involves not only patient education regarding presenting symptoms, but improvement of physician recognition and response to these complaints so that the appropriate tests are ordered and treatment is initiated.
A more complete diagnostic information can be obtained by "carrying" the contrast medium through the fibercoloscope to those sites of the bowel where neither radiology alone nor endoscopy alone succeed in solving the diagnostic problem. The indications for a selective perendoscopic contrast study during coloscopy are few, but well defined and certainly not negligible:--demonstration and assessment of stenoses (unclarified by radiology and endoscopy);--accurate evaluation of the last ileal loop;--diagnostic study of ileo-colic surgical anastomoses;--fistulous tracts. Seventy-six patients were examined, without complications. The method proved useful in 42% of cases, conclusive in 33%, useless or inconclusive in 17%, unsuccessful in 8% (technical difficulties). On this basis, selective endoscopic contrastography is considered of use whenever its specific indications apply.
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The capacity of the lymphatics to clear interstitial albumin was compared between the stomach, small intestine, and colon. The lymphatic and vascular transport in the stomach and colon was similar, clearing approximately 9 per cent of interstitially injected radioiodinated serum albumin by the thoracic duct lymph and 2 to 3 per cent by the blood in a five hour period. More than a third of the injected material remained at the site of injection. The small intestine was cleared of 37 per cent of the albumin by the lymph and more than 6 per cent by the blood, leaving less than 9 per cent at the injection site in the same period of time. Evidence that the small intestine was more effective and rapid in clearing interstitial albumin than either the stomach or colon was statistically significant.