[State of specific and natural immunobiological resistance in patients with colorectal cancer in conditions of obturation of the colon].

Estimation of the immune state was performed in 57 patients, suffering colorectal cancer (CRC) with impassability of large bowel (ILB) in compensated stage (in 30) and subcompensated (in 27). In all the patients immunosuppression was revealed, in ILB in a compensation stage activation of proinflammatory and antiinflammatory citokines--mediators of immune system, while in LIL in a subcompensation stage and in progressing of CRC--inhibition of antiblastomic mediators on background of significant rising of the problastomic citokines, what may have a prognostic significance for optimization of pathogenetic therapy in such patients.

Protection against increased intestinal permeability and bacterial translocation induced by intestinal obstruction in mice treated with viable and heat-killed Saccharomyces boulardii.

BACKGROUND: There are substantial evidences suggesting that probiotics can protect the gastrointestinal tract against inflammatory or infectious episodes. The effects of oral treatment with viable or heat-killed cells of Saccharomyces boulardii (Sb) on bacterial translocation, intestinal permeability, histological aspect of the ileum, and some immunological parameters were evaluated in a murine intestinal obstruction (IO) model. RESULTS: Bacterial translocation and intestinal permeability in the IO group were significantly higher when compared to a Sham group (p < 0.05). Pretreatment with both viable and heat-killed S. boulardii prevented these increases, and the data obtained for IO + Sb and IO + heat-killed Sb groups were similar to those observed in the Sham group (p > 0.05). Histological analysis showed preservation of the ileum mucosa in mice that received both forms of the yeast when compared to the lesions observed in the IO group. The levels of serum interleukin (IL)-10 and intestinal secretory immunoglobulin A (sIgA) were higher in the animals that received both yeast treatments when compared to those from IO and Sham groups. CONCLUSION: Oral treatment with viable or heat-killed cells of S. boulardii maintained intestinal integrity and modulated the immune system in a murine IO model, preventing bacterial translocation and intestinal lesions.

Beyond gastrointestinal graft-versus-host disease. A lesson to learn.

The authors present a child with severe GvHD of GI tract with typical presentation of ileus and abdominal pain. However, the severe GvHD has led to multiple intermittent intussusceptions with resultant ischemic segments of the small bowel leading to sub-acute mechanical intestinal obstruction. The clinical presentation of the mechanical intestinal obstruction was identical to the preceding ileus GvHD presentation. This has led to continuation of the conservative management with immunosuppressant therapy and delaying further investigation and surgical intervention. Once a barium study demonstrated the severe bowel constriction, laparoscopic surgical resection was necessary with excellent results. The resected small bowel showed multiple segments of ischemic ileitis leading to ulceration and severe stricture. The resection margins showed regenerating mucosa with no ulceration, but with focal evidence of mild GvHD.

Saccharomyces cerevisiae strain UFMG 905 protects against bacterial translocation, preserves gut barrier integrity and stimulates the immune system in a murine intestinal obstruction model.

Probiotic is a preparation containing microorganisms that confers beneficial effect to the host. This work assessed whether oral treatment with viable or heat-killed yeast Saccharomyces cerevisiae strain UFMG 905 prevents bacterial translocation (BT), intestinal barrier integrity, and stimulates the immunity, in a murine intestinal obstruction (IO) model. Four groups of mice were used: mice undergoing only laparotomy (CTL), undergoing intestinal obstruction (IO) and undergoing intestinal obstruction after previous treatment with viable or heat-killed yeast. BT, determined as uptake of (99m)Tc-E. coli in blood, mesenteric lymph nodes, liver, spleen and lungs, was significantly higher in IO group than in CTL group. Treatments with both yeasts reduced BT in blood and all organs investigated. The treatment with both yeasts also reduced intestinal permeability as determined by blood uptake of (99m)Tc-DTPA. Immunological data demonstrated that both treatments were able to significantly increase IL-10 levels, but only viable yeast had the same effect on sIgA levels. Intestinal lesions were more severe in IO group when compared to CTL and yeasts groups. Concluding, both viable and heat-killed cells of yeast prevent BT, probably by immunomodulation and by maintaining gut barrier integrity. Only the stimulation of IgA production seems to depend on the yeast viability.

Regulation of galectin-3 function in mucosal fibroblasts: potential role in mucosal inflammation.

Recently we identified galectin-3 (gal-3), which is secreted by colonic epithelial cells (CEC), to be a strong activator of colonic lamina propria fibroblasts (CLPF). Modulation of CLPF function may play a role during stricture and fistula formation in inflammatory bowel disease (IBD). Therefore, we investigated further the expression of gal-3 and effects on CLPF. The aim of this study is to perform a direct comparison of gal-3 between tissue from healthy controls and from patients with either Crohn's disease (CD) or ulcerative colitis (UC). CEC, CLPF and intestinal macrophages (IMAC) were isolated from control and IBD colonic tissue. Interleukin-8 secretion as a readout of CLPF activation was quantified by enzyme-linked immunosorbent assay. Gal-3 in cell cultures and tissue samples was evaluated by Western blot, immunofluorescence and immunohistochemistry. CLPF-migration was assayed in the 48-well modified Boyden chamber. Gal-3 expression was found in all segments of the colon. In the terminal ileum, less gal-3 was found compared with the colon. Immunohistochemistry and immunofluorescence revealed a homogenous distribution of gal-3 in CEC and IMAC of control mucosa and UC. However, significantly less gal-3 was found in IMAC from CD patients. In CD fistulae and stenoses, gal-3 expression was reduced significantly and barely detectable. In co-incubation studies lactose reduced significantly the CLPF-stimulatory potential of gal-3, indicating that the C-terminal domain of gal-3 is responsible for CLPF activation. Gal-3 stimulated CLPF migration in CLPF derived from fistulae. In conclusion, gal-3 expression is down-regulated in CD-fistulae and stenoses as well as in IMAC in CD patients. Gal-3 induces migration of CLPF derived from fistulae. Its role for stricture and fistula formation warrants further investigation.

Local and remote lesions in horses subjected to small colon distension and decompression.

The purpose of this study was to observe and characterize colonic and lung lesions in horses subjected to experimental distension and decompression of the small colon. Sixteen healthy adult horses were divided into 2 groups: 9 horses that were subjected to distension of the small colon by means of a latex balloon surgically implanted in the lumen and inflated to a pressure of 40 mm Hg for 4 h, and 7 horses in which the balloon was implanted but not inflated. Colonic biopsy specimens were collected before balloon implantation, at the end of the period of obstruction, and 1.5 and 12 h after decompression and were examined for hemorrhage, edema, and neutrophil infiltration; myeloperoxidase (MPO) activity and hemoglobin concentration were measured as well. At the end of the experiment, lung samples were also collected and examined for neutrophil accumulation and MPO activity. The mucosa was not affected by luminal distension; lesions were restricted to the seromuscular layer. Neutrophil accumulation and edema were observed in the samples from both groups of horses but were greater in those from the distension group, in which there was also hemorrhage, fibrin deposition, and increased MPO activity in the seromuscular layer. Similarly, there was greater accumulation of neutrophils in the lung samples from the distension group than in those from the sham-operated group, as determined by histologic evaluation and MPO assay. These findings provide new evidence of reperfusion injury and a systemic inflammatory response, followed by remote lesions, in horses with intestinal obstruction.

[Amyloidosis induced colonic stricture. The first symptom of myeloma multiplex. A case report]. / Amyloidosis okozta colonstrictura mint a myeloma multiplex elso tünete--Esetismertetés.

UNLABELLED: Systemic amyloidosis often involves the gastrointestinal tract and usually presents as ulceration or polypoid lesions. However, annular stricture of the colon due to amyloidosis is very rare. Amyloidosis develops in appr. 10% of multiple myeloma patients with lambda light chain production, it is usually type AL and not a presenting symptom. CASE REPORT: A 73-year-old female patient appeared at our hospital with anaemia, abdominal pain and hematochezia. Colonoscopy revealed a circular narrowing of the sigmoid colon suggesting malignancy. The patient underwent sigmoid resection and rectosigmoidal anastomosis was prepared to relieve mechanical obstruction. Surprisingly the histological finding from the resected specimen was amyloidosis. Subcutaneous fat tissue biopsy established the diagnosis of systemic AA amyloidosis. Immunoelectrophoresis revealed an elevated gamma-globulin fraction with IgG lambda monoclonal component, as well as a different lambda light chain. Therefore bone marrow biopsy was carried out which confirmed the diagnosis of multiple myeloma. DISCUSSION: Our case is a rare example of the extraordinary tumor-mimicking colon amyloidosis that led to the diagnosis of multiple myeloma. Beside haematological treatment, strict follow-up of the colon process and reconsideration of surgical therapy or endoscopic stenting is of great importance.

Effects of herbal medicine Sijunzi decoction on rabbits after relieving intestinal obstruction.

Intestinal obstruction leads to blockage of the movement of intestinal contents. After relieving the obstruction, patients might still suffer with compromised immune function and nutritional deficiency. This study aimed to evaluate the effects of Sijunzi decoction on restoring the immune function and nutritional status after relieving the obstruction. Experimental rabbits (2.5±0.2 kg) were randomly divided into normal control group, 2-day intestinal obstruction group, 2-day natural recovery group, 4-day natural recovery group, 2-day treated group, and 4-day treated group. Sijunzi decoction was given twice a day to the treated groups. The concentration of markers was analyzed to evaluate the immune function and nutritional status. The concentration of interleukin-2, immunoglobulins and complement components of the treated groups were significantly higher than the natural recovery group (P<0.05). The levels of CD4+ and CD4+/CD8+ increased then decreased in the treated groups. The levels of tumor necrosis factor-α and CD8+ were significantly lower than the natural recovery group. The level of total protein in the treated groups also increased then decreased after relieving the obstruction. The levels of albumin, prealbumin and insulin-like growth factor-1 were significantly higher in the treated groups than in the natural recovery group (P<0.05). Transferrin level in the treated groups was significantly higher than the obstruction group (P<0.05). Sijunzi decoction can lessen the inflammatory response and improve the nutrition absorption after relieving the obstruction.

Cerebellar degeneration and hearing loss in a patient with idiopathic myenteric ganglionitis.

A 35-year-old male with an 11-year history of intestinal pseudo-obstruction associated with an idiopathic inflammatory insult of the myenteric plexus and the presence of circulating anti-Hu antibodies developed a neurological syndrome characterized by bilateral hearing loss, deteriorating balance, an unsteady gait and difficulty in estimating distances. A similar neurological syndrome has previously been described in older patients among the paraneoplasic syndromes associated with small-cell lung carcinoma and the presence of circulating anti-Hu antibodies, but never in the rare cancer-free patients with anti-Hu-associated chronic idiopathic intestinal pseudo-obstruction. The patient underwent a steroid treatment. No further episodes of functional intestinal obstruction were observed and, after an initial improvement, the neurological symptoms stabilized, leaving a permanent reduction in hearing function and an unsteady gait. The case shows that an idiopathic inflammatory insult of the myenteric plexus may precede (and perhaps lead to) central nervous system impairment in patients with anti-Hu-associated chronic idiopathic intestinal pseudo-obstruction.

The effects of caffeic acid phenethyl ester (CAPE) on bacterial translocation and inflammatory response in an experimental intestinal obstruction model in rats.

OBJECTIVE: Intestinal obstruction (IO) is a disease which generates approximately 20% of emergency surgery and tends to with high mortality. Prevention of oxidative stress, bacterial translocation and tissue damage caused by IO is an important medical issue. Caffeic acid phenethyl ester (CAPE) is an anti-inflammatory, antioxidant, anti-bacterial and immunomodulatory agent. In this experimental study, we aimed to investigate the effects of CAPE on bacterial translocation, inflammatory response, oxidative stress and tissue injury caused by intestinal obstruction in a rat model. MATERIALS AND METHODS: Breafly, thirty Wistar albino rats divided into three groups as Sham (n=10), IO (n=10) and IO + CAPE (10 µmol/kg day, intraperitoneal) (n=10). The tissues from the study groups were examined biochemically, microbiologically and histopathologically. RESULTS: In CAPE treated group, decreased serum levels of proinflammatory cytokines (TNF-α, IL-6, IL-1ß) and CRP (p < 0.05), additionally increased serum levels of antioxidant parameters (PONS, TAS) (p < 0.05), were observed after IO. Microbiologically, the rates of positive cultures of the lymph node, spleen, liver and blood were significantly decreased in CAPE treated group compared to the IO group. Also histopathological examination showed that the intestinal mucosal injury score and hepatic portal inflammation score were significantly decreased in the CAPE treated group (p < 0.05). CONCLUSIONS: It is suggested that intraperitoneal administration of CAPE might has potential antibacterial, anti-inflammatory, antioxidant and immunomodulatory effects in IO. So, further studies on IO are needed to evaluate exact antibacterial, antiinflammatory, antioxidant and immunomodulatory effects of CAPE.

Autoaggressive inflammation of the myenteric plexus resulting in intestinal pseudoobstruction.

After a 3-year history of severe constipation, a 16-year-old girl required surgery to be relieved of impacted stools. Histologic examination showed ganglionitis in the myenteric plexus of the large bowel and ileum, whereas the submucosal plexus was spared. At this time, antineuronal nuclear antibodies (ANNA-1, anti-Hu) were found at high titer in the serum of the patient. One and a half years earlier, a paravertebral ganglioneuroblastoma had been removed. Histologic examination had shown undifferentiated neuroblasts and morphologically mature ganglion cells with both cell types embedded in an inflammatory infiltrate morphologically similar to the lymphoplasmocytic infiltration seen in the myenteric plexus. The patient's serum was found to bind to nuclei of mouse intestinal tract neurons, thus fulfilling defining criteria for ANNA-1. The serum also reacted with antigens of defined molecular weight in a Western blot, thus fulfilling defining criteria for anti-Hu. Expression of the Huantigen could be visualized in the nuclei of the patient's tumor cells by immunohistochemistry. These tests showed that an antitumor inflammatory response was the cause of the bowel disease. This is the first report of a tumor from the neuroblastoma group that caused paraneoplastic intestinal pseudoobstruction. Ganglionitis and subsequent aganglionosis are the hallmark of the morphologic diagnosis which cannot be obtained by suction biopsy in patients with intact submucosal plexus. Instead, serum testing for autoantibodies can reveal the etiology.

A case report of colonic ileus due to eosinophilic nodular lesions caused by Gnathostoma doloresi infection.

Gnathostomiasis is primarily a disease of the skin characterized as creeping eruption or mobile erythema. However, larval Gnathostoma sometimes migrate into an unexpected site to elicit serious illness. Here we describe a case of colonic ileus caused by Gnathostoma doloresi. The patient was a 57-year-old man living in Miyazaki Prefecture, Japan, which is known as an area endemic for this parasite. One week after having eaten a few slices of the flesh of a snake (Agkistrodon halys), he developed severe abdominal pain. An abdominal radiograph revealed multiple gas-fluid levels with a distended bowel of an inverted U shape. A barium enema revealed a tumor in the ascending colon near the hepatic flexure that was surgically removed by simple colonic resection. An oblique section of a parasite surrounded by massive infiltration of eosinophils was found by postoperative histopathologic examination. The entire body of the advanced third-stage larva of G. doloresi was dissected from a specimen-embedded paraffin block.

[Effect of shenfu injection on recovery of intestinal function, cellular immunity, serum interleukin-2 and tumor necrosis factor-alpha in children with intestinal obstruction after operation].

OBJECTIVE: To observe the effect of Shenfu injection (SFI) on recovery of intestinal function, T-lymphocyte subsets (CD4, CD8 and CD4/CD8), interleukin-2 (IL-2) and tumor necrosis factor-alpha (TNF-alpha) in children with intestinal obstruction after surgical operation. METHODS: Ninety-eight children suffering from intestinal obstruction after emergent surgical operation were divided into the SFI group (n = 50, treated with SFI after operation) and the control group (n = 48, treated with surgical operation alone). The intestinal function recovery rate (IFRR), T-lymphocyte subsets, serum levels of IL-2 and TNF-alpha in them were observed. RESULTS: After being treated for 7 days, the IFRR in the SFI group was 84.0%, which was significantly higher than that in the control group (62.5%, P < 0.05). CD4, CD4/CD8 levels increased in the SFI group after treatment (P < 0.05), while in the control group, CD8 increased significantly after treatment (P < 0.05) and higher than that in SFI group (P < 0.01). IL-2 level was much higher in the SFI group after treatment than that in the control group (P < 0.05). TNF-alpha level significantly lowered in both groups (P < 0.01), and the level in the SFI group was lower than that in the control group (P < 0.05). CONCLUSION: SFI could promote the recovery of intestinal function, improve and regulate the immune function of the children after operation for intestinal obstruction.

[The immuno-microbiological characteristics of the small intestine and the translocation of the enteral microflora in acute intestinal obstruction]. / Immuno-mikrobiologicheskaia kharakteristika tonkoi kishki i translokatsiia énteral'noi mikroflory pri ostroi neprokhodimosti kishechnika.

The complex examination of 72 patients with acute ileus (AI) of nontumor nature with different severity of endotoxicosis was carried out. The study revealed that AI was accompanied by deep suppression of the immunosecretory and motor evacuatory function of the small intestine, as well as by its pronounced bacterial contamination, mainly due to the significant quantitative prevalence of Gram-negative microflora. The combination of these factors played the key role in the increase of the permeability of the enteric barrier for symbiotic microflora and its massive translocation from the intestinal tract to the internal organs of the body (peritoneal exudate, portal bed), which directly correlated with the severity of endotoxicosis in AI patients. The deficiency of the barrier function of the liver was accompanied by the penetration of infective agents into the general blood stream, thus causing the development of endotoxic shock in AI patients. The analysis of the results thus obtained made it possible to determine the main ways for the elimination of intestinogenic intoxication in AI; they should be aimed at the bacterial decontamination of the small intestine, the restoration of its motor evacuatory and protective barrier functions, the liquidation of portal and systemic bacteremia, the correction of the functional deficiency of the liver.

[Detoxification function of the liver and body resistance in patients with acute intestinal obstruction]. / Detoksikatsionnaia funktsiia pecheni i rezistentnost' organizma u bol'nykh s ostroi kishechnoi neprokhodimost'iu.

The authors studied the unspecific resistance of the organism according to the ratio of the formed elements of the blood, the detoxification function of the liver by the antipyrine test and evaluation of the acetylation capacity, as well as the leukocyte intoxication index in 42 patients with various types of acute ileus (obstructive, strangulation, dynamic). Ileus was found to reduce the unspecific resistance and the acetylation capacity of the patient's organism with the increased leukocyte intoxication index. In patients with obstructive ileus the antipyrine half-life was increased and was not normalized during treatment. The postoperative period in patients with a marked diminution of unspecific resistance and acetylation capacity of the organism with an increase in the leukocyte intoxication index and antipyrine half-life was characterized by an unfavourable course and the development of various purulent complications.

[The immunity index changes in patients with acute adhesional ileus and possibilities for its correction]. / Izmenienie pokazatelei immuniteta u bol'nykh s ostroi spaechnoi neprokhodimost'iu kishechnika i vozmozhnosti ee korrektsii.

In patients with an acute adhesional small intestinal ileus (AASII) the essential change of the organism immunoreactivity was noted, especially of the immunity cell link, the degree of which had depended on duration of intestinal obstruction, the presence of peritonitis and the disease course severity. The autoimmune reactions studying may be used as the prognosis marker for the recurrent adhesions forming occurrence. The immune reactions of postoperative period are correlating with presence of complications.

[Portal and systemic bacteremia as a manifestation of the functional failure of the enteral barrier in acute intestinal obstruction]. / Portal'naia i sistemnaia bakteriemiia kak proiavlenie funktsional'noi nesostoiatel'nosti énteral'nogo bar'era pri ostroi neprokhodimosti kishechnika.

A complex investigation of 72 patients, with acute bowel obstruction (ABO) having clinico-laboratory signs and symptoms of endotoxicosis (ET), was carried out. It was proven that ABO was accompanied by profound decrease of the immuno-secretory function of the small bowel and its extensive bacterial contamination as a result of significant increase in the concentration of gram-negative symbiotic microflora, which leads to increased permeability of bowel barrier. Consequently there is massive translocation of the internal medium of the organism by enteral microflora and most of all in the portal zone and in the presence of inadequate hepatic barrier function--the systemic blood supply which corresponds to the clinical picture of endotoxic shock.

[Clinical-morphological aspects of the adhesive disease progress in children]. / Kliniko-morfologicheskie aspekty techeniia spaechnoi bolezni u detei.

The results of treatment of 60 children with complete adhesive ileus (CAI), occurring from 6 mo till 10 yrs after appendectomy conduction, were analyzed. Complex biochemical and immunological examination was conducted in 30 patients. There were 10 biopsies of parietal peritoneum examined. The obtained clinical, biochemical, immunological and morphological features may be applied for reliable prognostication of the CAI occurrence, complications course and outcome. Long observation and rehabilitational measures conduction is indicated in the patients with high risk of the peritoneal adhesive disease occurrence.

Phasic study of intestinal homeostasis disruption in experimental intestinal obstruction.

AIM: To investigate the phasic alteration of intestinal homeostasis in an experimental model of intestinal obstruction. METHODS: A rabbit model of intestinal obstruction was established by transforming parts of an infusion set into an in vivo pulled-type locking clamp and creating a uniform controllable loop obstruction in the mesenteric non-avascular zone 8 cm from the distal end of the ileum. The phasic alteration of intestinal homeostasis was studied after intestinal obstruction. The changes in goblet cells, intraepithelial lymphocytes, lamina propria lymphocytes, and intestinal epithelium were quantified from periodic acid-Schiff-stained sections. Ornithine decarboxylase (ODC) activity and serum citrulline levels were measured by high-performance liquid chromatography. Claudin 1 mRNA expression was examined by real-time polymerase chain reaction analysis. Intestinal microorganisms, wet/dry weight ratios, pH values, and endotoxin levels were determined at multiple points after intestinal obstruction. Furthermore, the number and ratio of CD3(+), CD4(+) and CD8(+) T cells were determined by flow cytometry, and secretory IgA levels were measured with an enzyme-linked immunosorbent assay. RESULTS: A suitable controllable rabbit model of intestinal obstruction was established. Intestinal obstruction induced goblet cell damage and reduced cell number. Further indicators of epithelial cell damage were observed as reduced serum citrulline levels and claudin 1 gene expression, and a transient increase in ODC activity. In addition, the wet/dry weight ratio and pH of the intestinal lumen were also dramatically altered. The ratio of Bacillus bifidus and enterobacteria was reversed following intestinal obstruction. The number and area of Peyer's patches first increased then sharply decreased after the intestinal obstruction, along with an alteration in the ratio of CD4/CD8(+) T cells, driven by an increase in CD3(+) and CD8(+) T cells and a decrease in CD4(+) T cells. The number of lamina propria lymphocytes also gradually decreased with prolonged obstruction. CONCLUSION: Intestinal obstruction can induce disruption of intestinal homeostasis.