Ethanol Extract of Glycyrrhiza uralensis Fisch: Antidiarrheal Activity in Mice and Contraction Effect in Isolated Rabbit Jejunum / 中国结合医学杂志

OBJECTIVE@#To evaluate the antidiarrheal effect of ethanol extract of Glycyrrhiza uralensis Fisch root (GFR) in vivo and jejunal contraction in vitro.@*METHODS@#In vivo, 50 mice were divided into negative control, positive control (verapamil), low-, medium- and high-dose GFR (250, 500, 1,000 mg/kg) groups by a random number table, 10 mice in each group. The antidiarrheal activity was evaluated in castor oil-induced diarrhea mice model by evacuation index (EI). In vitro, the effects of GFR (0.01, 0.03, 0.1, 0.3, 1, 3, and 10 g/L) on the spontaneous contraction of isolated smooth muscle of rabbit jejunum and contraction of pretreated by Acetylcholine (ACh, 10 µmol/L) and KCl (60 mmol/L) were observed for 200 s. In addition, CaCl2 was accumulated to further study its mechanism after pretreating jejunal smooth muscle with GFR (1 and 3 g/L) or verapamil (0.03 and 0.1 µmol/L) in a Ca2+-free-high-K+ solution containing ethylene diamine tetraacetic acid (EDTA).@*RESULTS@#GFR (500 and 1,000 mg/kg) significantly reduced EI in castor oil-induced diarrhea model mice (P<0.01). Meanwhile, GFR (0.01, 0.03, 0.1, 0.3, 1, 3, and 10 g/L) inhibited the spontaneous contraction of rabbit jejunum (P<0.05 or P<0.01). Contraction of jejunums samples pretreated by ACh and KCl with 50% effective concentration (EC50) values was 1.05 (0.71-1.24), 0.34 (0.29-0.41) and 0.15 (0.11-0.20) g/L, respectively. In addition, GFR moved the concentration-effect curve of CaCl2 down to the right, showing a similar effect to verapamil.@*CONCLUSIONS@#GFR can effectively against diarrhea and inhibit intestinal contraction, and these antidiarrheal effects may be based on blocking L-type Ca2+ channels and muscarinic receptors.

Diverticulosis de intestino delgado, hallazgo intraoperatorio / Diverticulosis of the small bowell, intraoperative finding / Diverticulose do intestino delgado, achado intraoperatório

La diverticulosis puede presentarse en cualquier sector del tubo digestivo. La topografía de intestino delgado es infrecuente, se presenta sobre todo a nivel del yeyuno y en un 35% de los casos se asocia con diverticulosis colónica. Es más frecuente en mayores de 40 años. Los divertículos van disminuyendo de tamaño y número hacia el sector distal. Habitualmente el diagnóstico es incidental, sin embargo, pueden presentar complicaciones de las cuales se destacan por frecuencia el sangrado gastrointestinal y la diverticulitis. Se plantea que la deficiencia de fibra dietética generaría anomalías en el peristaltismo intestinal, lo que junto con fenómenos pseudo-obstructivos y alta presión intraluminal, actuaría en áreas de debilidad focal provocando la lesión. Presentamos el caso de una paciente de 88 años con una oclusión de colon a la cual se le realizó una cirugía de Hartmann, en el intraoperatorio se identificó divertículos de yeyuno sin elementos complicaciones.

Multiple Jejunal diverticulosis complicated by perforation: case report and a brief literature review

Background: Multiple small-bowel diverticulosis comprises a rare entity with probable underestimated incidence, and that may be the reason why it is sometimes overlooked when managing cases with peritonitis. Case report: In the present paper, we report the case of a 76-year-old male presenting abdominal pain and fever in an acute setting. Computed tomography (CT) scans revealed jejunal thickening and numerous images of saccular addition that were interpreted as jejunoileal diverticulitis. After an initial period of clinical treatment, surgical management was indicated based on a worsening clinical picture and the presence of an extraluminal focus of gas detected in a subsequent CT scan. Through a laparoscopic approach, multiple small-bowel diverticula and a tamponade perforation were found. A segmental intestinal resection was performed, and the patient was discharged after a ten days. Conclusions: Multiple jejunal diverticulosis is a rare condition that should be remembered in the setting of an acute abdomen. As it prevails among older patients, early diagnosis with radiological aid is crucial to establish the most adequate management, including intestinal resection, if necessary. (AU)

Estudo da permeabilidade de fármacos por meio do modelo de saco intestinal de ratos / Study of drug permeability through the rat gut sac model

Os parâmetros de permeabilidade e solubilidade são fundamentais à absorção oral de fármacos e a partir dessas características, foi criado o Sistema de Classificação Biofarmacêutica, através do qual os fármacos são divididos em quatro classes. Atualmente, para a determinação da solubilidade de um fármaco, existem diversos métodos padronizados por agências regulatórias, no entanto, para a determinação da permeabilidade, os ensaios são passíveis de diversas variações em sua execução, diminuindo a confiabilidade dos resultados obtidos e impossibilitando a comparação dos mesmos quando realizados com técnicas diferentes umas das outras. O objetivo do presente trabalho é avaliar as variáveis experimentais do modelo do saco intestinal que podem influenciar nos resultados de permeabilidade aparente de fármacos e na viabilidade do tecido. O presente estudo foi aprovado pelo Comitê de Ética no Uso de Animais da FCF-USP (109.2018-P574). Foram utilizados 33 Rattus norvegicus da linhagem Wistar, machos, jovens adultos, com peso entre 200 g e 300 g. Para realização do procedimento, cada animal permaneceu em jejum por cerca de quatro horas e após adequada anestesia a porção do jejuno do intestino delgado foi retirada e dividida em seis segmentos de aproximadamente 8,5cm cada. Foram realizados experimentos com e sem inversão do saco intestinal, submetidos a diferentes tempos de banho de gelo após sua ressecção, na presença ou ausência de inibidor da glicoproteína-P (verapamil). Os fármacos naproxeno e famotidina foram empregados como marcadores de alta e baixa permeabilidade, respectivamente. A losartana foi utilizada como substrato da glicoproteína P. Cada um dos sacos intestinais foi colocado em um tubo de ensaio contendo tampão Krebs, a 37°C, saturado com gás carbogênio. Para avaliação da integridade e viabilidade dos segmentos intestinais, observou-se a presença de movimentos peristálticos e coletaram-se amostras do meio de incubação nos tempos 0, 30, 45, 60, 90 e 120 minutos para quantificação dos fármacos e de glicose, uma vez que esta é ativamente transportada para a serosa do intestino delgado. Determinou-se a permeabilidade aparente de cada fármaco e as concentrações de glicose nas diferentes condições experimentais, realizou-se planejamento fatorial multinível e os resultados foram analisados por análise variância (ANOVA), seguida de pós-teste de Tukey. Observou-se que as variáveis experimentais interferiram de forma significativa na viabilidade tecidual e na permeabilidade aparente dos fármacos. Não foram observadas diferenças significativas da permeabilidade de fármacos nos diferentes segmentos do jejuno. A glicose mostrou-se um bom marcador de viabilidade tecidual e foi constatado que a presença ou ausência de movimentos peristálticos não está relacionada diretamente com a viabilidade do tecido. Uma vez que foram constatadas tantas interferências nos resultados, é imprescindível que os procedimentos experimentais sejam padronizados, para que os resultados apresentem menor variabilidade e possam ser comparados entre si

The permeability and solubility parameters are fundamental to the oral absorption of drugs and from these characteristics, the Biopharmaceutical Classification System was created, through which drugs are divided into four classes. Currently, for the determination of the solubility of a drug, there are several methods standardized by regulatory agencies, however, for the determination of permeability, the tests are subject to several variations in their execution, reducing the reliability of the results obtained and making it impossible to compare the results obtained. same when performed with different techniques. The aim of this study is to evaluate if different experimental conditions can influence the results of apparent drug permeability and tissue viability on gut sac model. The present study was approved by the Ethics Committee for the Use of Animals of FCF-USP (109.2018-P574). Thirty-three male, young adult Rattus norvegicus were used, weighing between 200 g and 300 g. To perform the procedure, each animal fasted for about four hours and after adequate anesthesia, the portion of the jejunum of the small intestine was removed and divided into six segments of approximately 8.5 cm each. Experiments were performed with and without inversion of the gut sac, submitted to different times of ice bath after its resection, in the presence or absence of a P-glycoprotein inhibitor (verapamil). The drugs naproxen and famotidine were used as markers of high and low permeability, respectively. Losartan was used as a substrate for P-glycoprotein. Each of the gut sacs was placed in a test tube containing Krebs buffer, at 37°C, saturated with carbogen gas. To evaluate the integrity and viability of the intestinal segments, the presence of peristaltic movements was observed and samples of the incubation medium were collected at 0, 30, 45, 60, 90 and 120 minutes for quantification of drugs and glucose, as it is actively transported to the serosa of the small intestine. The apparent permeability of each drug and the glucose concentrations were determined under different experimental conditions, multilevel factorial design was performed and the results were analyzed by analysis of variance (ANOVA), followed by Tukey's post-test. It was observed that the experimental variables significantly interfered in the tissue viability and in the apparent permeability of the drugs. No significant differences in drug permeability were observed in the different segments of the jejunum. Glucose proved to be a good marker of tissue viability and it was found that the presence or absence of peristaltic movements is not directly related to tissue viability. Since so many interferences were found in the results, it is essential that the experimental procedures be standardized, so that the results show less variability and can be compared between different authors

Technical difficulties and countermeasures of digestive tract reconstruction in robotic radical gastrectomy for gastric cancer / 中华胃肠外科杂志

There still remain some problemsin digestive tract reconstruction after robotic radical gastrectomy for gastric cancer at present, such as great surgical difficulties and high technical requirements. Based on the surgical experience of the Gastric Surgery Department of Union Hospital, Fujian Medical University and the literatures at home and abroad, relevant issues are discussed in terms of robotic radical distal gastrectomy (Billroth I, Billroth II, and Roux-en-Y gastrojejunostomy), proximal gastrectomy (double-channel and double-muscle flap anastomosis), and total gastrectomy (Roux-en-Y anastomosis, functional end-to-end anastomosis, FEEA, π-anastomosis, Overlap anastomosis, and modified Overlap anastomosis with delayed amputation of jejunum, i.e. later-cut Overlap). This article mainly includes (1) The principles of digestive tract reconstruction after robotic radical gastrectomy for gastric cancer. (2) Digestive tract reconstruction after robotic radical distal gastrectomy: Aiming at the weakness of traditional triangular anastomosis, we introduce the improvement of the technical difficulty, namely "modified triangular anastomosis", and point out that because Billroth II anastomosis is a common anastomosis method in China at present, manual suture under robot is more convenient and safe, and can effectively avoid anastomotic stenosis. (3) Digestive tract reconstruction after robotic proximal gastrectomy: It mainly includes double channel anastomosis and double muscle flap anastomosis, but these reconstruction methods are relatively complicated, and robotic surgery has not been widely carried out at present. (4) Digestive tract reconstruction after robotic total gastrectomy: The most classic one is Roux-en-Y anastomosis, mainly using circular stapler for end-to-side esophagojejunal anastomosis and linear stapler for side-to-side esophagojejunal anastomosis, for which we discuss the solutions to the existing technical difficulties. With the continuous innovation of robotic surgical system and anastomosis instruments, and with the gradual improvement of anastomosis technology, it is believed that digestive tract reconstruction after robotic radical gastrectomy for gastric cancer will have a good application prospect in gastric cancer surgery.

Technical details of gastrointestinal reconstruction using linear stapler in totally laparoscopic total gastrectomy / 中华胃肠外科杂志

With the development of instrument, equipment and surgical skills, especially the emergence of a series of high-level medical evidence, the laparoscopic techniques in the field of gastric surgery has been further expanded. Totally laparoscopic total gastrectomy (TLTG) has certain technical difficulties, and more challenges are reflected in the digestive tract reconstruction. The use of linear staplers has reduced the difficulty of digestive tract reconstruction to a certain extent and has strongly promoted the transition from laparoscopic-assisted total gastrectomy to TLTG. However, for TLTG, there are still many details that should be carefully concerned, so as to effectively avoid the surgical pitfalls and ensure the fluency and safety of the procedure. In this article, we discuss the surgical details based on our own experiences, including how to obtain surgical field exposure well, how to manage specific accidents when using linear stapler for esophagojejunostomy, how to prevent intra-abdominal hernias and Roux stasis syndrome, and how to prevent the stapled lines of the esophageal or jejunal stumps from direct contact with aorta.

Anti-reflux gastrointestinal reconstruction techniques after laparoscopic proximal gastrectomy / 中华胃肠外科杂志

Laparoscopic techniques are more and more poplular in proximal gastrectomy. The traditional esophagogastric anastomosis may lead to severe reflux esophagitis after surgery, affecting patient's quality of life. In recent years, multiple methods of digestive tract reconstruction after laparoscopic proximal gastrectomy capable of resisting reflux have been applied to the clinic. Combining the results of the latest clinical studies and our clinical experience, we elaborate the views on digestive tract reconstruction after laparoscopic proximal gastrectomy. Esophagogastric anastomosis (posterior esophagogastric anastomosis, anterior esophagogastric anastomosis, gastric tube reconstruction, lateral esophagogastric anastomosis, Kamikawa anastomosis and modified Kamikawa anastomosis, etc.) and esophagojejunal anastomosis (interposition jejunum, interposition jejunum with pouch, and double-channel anastomosis, etc.) are mainly discussed. Of course, the anti-reflux mechanisms of different surgical procedures are not the same, the anti-reflux effects are variable, and the surgical difficulties under laparoscopy are also different. Therefore, how to choose a rational reconstruction method after proximal gastrectomy needs to be comprehensively considered based on patient's own situation and technical level of the surgeons.

Conducta actual frente la hemorragia digestiva alta: desde el diagnóstico al tratamiento / Current behavior against Upper Digestive Hemorrhage: from diagnosis to treatment

Resumen La hemorragia digestiva alta (HDA) es una emergencia médico-quirúrgica común que debe ser tratada precozmente por su alta morbimortalidad. Corresponde a sangrado del esófago, estómago o del duodeno proximal, y se divide en etiología no variceal y variceal. Dentro de las no variceales destaca la úlcera péptica como la más frecuente, siendo esta producida por un desbalance entre factores protectores y agresivos. Por otro lado, en las hemorragias variceales destacan las várices gastroduodenales, las cuales son consecuencia del aumento de la presión portal. La incidencia de la HDA a nivel mundial varía entre 37 a 172 casos por cada 100.000 habitantes por año y la mortalidad entre un 5 y un 14% según diferentes estudios. Lamentablemente, no existen cifras nacionales fidedignas de incidencia y prevalencia. El médico debe conocer bien la presentación clínica y la fisiopatología para ser asertivo en la sospecha, diagnóstico y manejo de esta patología. En cuanto al tratamiento, el enfrentamiento se divide en el manejo de urgencias y luego endoscópico, puesto que la resucitación temprana intensiva puede reducir la morbimortalidad en pacientes con HDA. A continuación se hará una revisión actualizada enfocada en los aspectos más relevantes del manejo de esta patología. Se obtuvieron los datos de Pubmed y Scielo, específicamente la búsqueda de artículos originales y de revisiones sistemáticas con las palabras "hemorragia digestiva alta", "úlcera péptica", "várices esofágicas" y otras relacionadas. Los criterios usados fueron artículos preferentemente menores a 5 años de publicación en revistas científicas de alto índice de impacto.

Upper gastrointestinal bleeding (UHD) is a common medical-surgical emergency that must be treated early due to its high morbidity and mortality. It corresponds to bleeding from the esophagus, stomach, or proximal duodenum, and is divided into non-variceal and variceal etiology. Among the non-variceal, the peptic ulcer stands out as the most frequent, being this produced by an imbalance between protective and aggressive factors. On the other hand, in variceal hemorrhages gastroduodenal varices stand out, are a consequence of increased portal pressure. The incidence of HDA worldwide varies between 37 to 172 cases per 100,000 inhabitants per year and mortality between 5 to 14% according to different studies. Unfortunately, there are no reliable national statistics of incidence and prevalence. The physician must have a good understanding of the clinical presentation and pathophysiology to be assertive in the suspicion, diagnosis, and management of this pathology. Regarding treatment, the confrontation is divided into emergency management and then endoscopic, because early intensive resuscitation can reduce morbidity and mortality in patients with UHD. This is an updated review which will be focused on the most relevant aspects of the management of this pathology. Data were obtained from Pubmed and Scielo, specifically searching for original articles and systematic reviews with the words "upper gastrointestinal bleeding", "peptic ulcer", "esophageal varices" and other related words. The criteria used were articles preferably less than 5 years old in scientific journals with a high impact index.

Uso de la enteroscopía intraoperatoria como método diagnóstico en pacientes con sangrado gastrointestinal de origen oscuro. Experiencia inicial / Use of intraoperative enteroscopy as a diagnostic method in patients with obscure gastrointestinal bleeding. Initial experience

Introducción: el sangrado gastrointestinal de origen oscuro es una entidad poco frecuente y se reserva a los casos en los que ya se ha realizado exploración del intestino delgado (endoscópica/radiológica) sin encontrar la causa. Actualmente el estándar de oro es la videocápsula, que se ha descrito como una técnica segura, útil y eficaz para el diagnóstico y tratamiento de las enfermedades del intestino delgado. Objetivo: describir variables demográficas, indicaciones, hallazgos, segmento explorado, tratamiento y tiempo de procedimiento quirúrgico de la enteroscopía transoperatoria en 15 pacientes con diagnóstico de sangrado de tubo digestivo de origen oscuro. Material y métodos: se incluyeron 15 pacientes adultos con el diagnóstico de sangrado de origen oscuro con panendoscopía y colonoscopía negativa a sangrado. A todos se les realizó laparotomía exploradora y enteroscopía transoperatoria con un gastroduodenoscopio. Resultados: se realizaron 15 enteroscopías transoperatorias con gastroduodenoscopio; 10 en mujeres y 5 en hombres, con promedio de edad de 67.2 años. Se exploró la tercera y cuarta porción del duodeno, yeyuno e íleon terminal. Los diagnósticos encontrados fueron enfermedad de Crohn en 1 paciente (6.66%), adenomas en 2 (13.3%), divertículo yeyunal en 6 (40%) y angiectasias en 6 casos (40%). La localización fue en yeyuno [12 casos (80%)] e íleon [3 casos (20%)]. Conclusiones: la enteroscopía intraoperatoria es una alternativa diagnóstica en el sangrado de origen oscuro cuando no se cuente con la enteroscopía doble balón o la videocápsula endoscópica.

Background: Bleeding of dark origin is a rare entity and it is reserved for cases in which exploration of the small intestine has already been performed (endoscopic / radiological) without finding the cause. Currently, the gold standard is the videocapsule which has been described as a safe, useful and effective technique for the diagnosis and treatment of diseases of the small intestine. Objective: The objective was to describe demographic variables, indications, findings, explored segment, treatment and time of the surgical procedure of the intraoperative enteroscopy in 15 patients with a diagnosis of gastrointestinal bleeding of dark origin. Material and methods: 15 adult patients with the diagnosis of bleeding of dark origin with panendoscopy and negative colonoscopy to bleeding were included. All of these underwent exploratory laparotomy and intraoperative enteroscopy with a gastroduodenoscope. Results: 15 intraoperative enteroscopies were performed with a gastroduodenoscope; 10 women and 5 men with an average age of 67.2 years. Third and fourth portions of the duodenum, jejunum, and terminal ileum were explored. The diagnoses found were Crohn's disease 1 (6.66%), Adenomas 2 (13.3%), jejunal diverticulum 6 (40%) and angiectasias in 6 cases (40%). The location was in jejunum, 12 cases (80%) and ileum, 3 cases (20%). Conclusions: Intraoperative enteroscopy is a diagnostic alternative in bleeding of dark origin when there is no double balloon enteroscopy or endoscopic video capsule.

Intususcepción yeyunogástrica retrógrada en un paciente con historia de gastroyeyunostomía hace 20 años: reporte de caso y revisión de la literatura / Retrograde jejunogastric intussusception in a patient with underlying history of gastrojejunostomy 20 years ago: Case report and literature review

Resumen La intususcepción yeyunogástrica es una complicación rara, pero potencialmente fatal de acuerdo con el momento de su diagnóstico e intervención. Debido a su baja incidencia, se requiere de una alta sospecha diagnóstica, basada en la clínica y los antecedentes quirúrgicos. En el presente reporte se expone el caso de un paciente de 74 años, con historia de gastroyeyunostomía y cerclaje duodenal realizados como parte del manejo de úlcera duodenal 20 años atrás. Se presentó por urgencias luego de 7 días de inicio de los síntomas caracterizados por dolor, intolerancia a la vía oral y hematemesis. Su diagnóstico se realizó mediante endoscopia de vías digestivas altas y su manejo definitivo, mediante gastrectomía subtotal y reconstrucción en Y de Roux transmesocólica por laparotomía.

Abstract Retrograde jejunogastric intussusception is a rare but potentially fatal complication, according to the time of diagnosis and intervention. Due to its low incidence, a high diagnostic suspicion is required, based on the clinical and surgical history. This study presents the case of a patient of 74 years old with a history of gastrojejunostomy and duodenal cerclage performed as part of duodenal ulcer treatment 20 years ago. The patient was admitted to the emergency unit, after 7 days of having symptoms such as pain, intolerance to oral intake, and hematemesis. Diagnosis was performed by upper digestive tract endoscopy and the final treatment by subtotal gastrectomy and transmesocolic Roux-en-Y reconstruction by laparotomy.

Adenocarcinoma de yeyuno proximal: a propósito de un caso / Proximal jejunal adenocarcinoma, a case report

Resumen El adenocarcinoma de yeyuno es el tumor primario del intestino delgado más infrecuente y raro, y representa el 3 % de todos los cánceres gastrointestinales, con una incidencia anual estimada de 0,3 a 2 casos por cada 100 000 personas. En Estados Unidos y España representa el 0,4 % de los cánceres gastrointestinales y el 0,2 % de las muertes asociadas a malignidad, con síntomas inespecíficos como anemia de etiología inexplicable, dolor abdominal y pérdida de peso; la mayoría de ellos son diagnosticados en etapas avanzadas de la enfermedad. A continuación, se presenta el caso de una paciente femenina de 46 años con síntomas inespecíficos, pérdida de peso, dolor abdominal y vómito, cuya tomografía abdominal computarizada evidenció el sitio y extensión de la lesión neoplásica, mientras que la cápsula endoscopia y enteroscopia mostró una lesión neoplásica en el yeyuno proximal. La histopatología reportó un adenocarcinoma de yeyuno moderadamente diferenciado que presentó resultados favorables gracias a la resección quirúrgica curativa, lo cual mejoró el pronóstico de vida a 5 años y tuvo un seguimiento favorable hasta la actualidad.

Abstract Jejunal adenocarcinoma is the rarest primary small bowel tumor and represents 3% of all gastrointestinal cancers, with an estimated annual incidence of 0.3 to 2 cases per 100 000 people. This disease accounts for 0.4% of gastrointestinal cancers and 0.2% of deaths associated with malignancy in the United States and Spain, with nonspecific symptoms, such as anemia of unexplained etiology, abdominal pain, and weight loss; most cases are diagnosed in advanced stages of the disease. The following is the case of a 46-year-old female with non-specific symptoms, weight loss, abdominal pain and vomiting. A computerized tomography scan of the abdomen allowed determining the site and extension of the tumor, while a capsule endoscopy and an enteroscopy showed a neoplastic lesion in the proximal jejunum. A histopathology analysis reported moderately differentiated adenocarcinoma of jejunum with favorable results after a curative surgical resection that improved the prognosis of life at 5 years and with favorable follow-up until to date.

Diagnóstico prenatal de atresia de yeyuno con ecografía 3D con reconstrucción en superficie (HDlive): reporte de caso y revisión de la literatura / Antenatal diagnosis of jejunal atresia by 3D HDlive ultrasound: Case report and literature review

Resumen Objetivos: Reportar el caso de una paciente con diagnóstico prenatal de atresia de yeyuno y hacer una revisión de la literatura en torno al resultado y al diagnóstico de esta entidad, implementando el uso de métodos no convencionales: ecografía tridimensional (3D) o resonancia magnética fetal (RM). Materiales y métodos: Se reporta el caso de una gestante de 18 años, remitida a la Unidad de Medicina Materno-Fetal, Genética y Reproducción del Hospital Virgen del Rocío de Sevilla (España), por feto con imagen quística abdominal, peristáltica, compatible con atresia de yeyuno, la cual se confirmó con ecografía 3D modo HDlive. Se realizó una búsqueda bibliográfica en Medline/PubMed, LILACS y Google Scholar, restringiendo por tipo de idioma (inglés y español) y fecha de publicación (enero de 1995 a junio de 2020). Se incluyeron estudios primarios de reportes y series de caso, que abordaran el resultado y el diagnóstico prenatal de esta patología. Resultados: La búsqueda identificó 1.033 títulos, de los cuales cuatro estudios cumplieron con los criterios de inclusión, estos fueron reporte o series de casos. En total se reportaron doce fetos con diagnóstico prenatal de atresia de yeyuno detectada con métodos no convencionales. Una gestación finalizó con óbito a la semana 26 de gestación y en todos los demás casos, el diagnóstico se ratificó durante el periodo neonatal, requiriendo la resección del segmento comprometido. Dos neonatos desarrollaron síndrome de intestino corto como consecuencia de una resección intestinal amplia. El resto experimentó una evolución posoperatoria favorable. Conclusión: La literatura disponible en torno al diagnóstico prenatal de atresia de yeyuno utilizando métodos no convencionales es escasa y se limita a reporte o series de casos. La literatura revisada sugiere que, en presencia de dilatación intestinal, la ecografía 3D y la resonancia magnética fetal podrían tener cierta utilidad a la hora de caracterizar la porción atrésica y establecer el diagnóstico diferencial. Se requieren más estudios que evalúen la utilidad diagnóstica de estas dos alternativas.

Abstract Objectives: To report the case of a patient with a prenatal diagnosis of jejunal atresia and to review the literature regarding the results and prenatal diagnosis of this entity, implementing the use of non-conventional methods (3D ultrasound or magnetic resonance imaging). Material and methods: Report of a case of an 18-year-old pregnant woman referred to the Maternal-Fetal Medicine, Genetics and Reproduction Unit of the Virgen del Rocío Hospital in Seville due to fetus with abdominal peristaltic cystic image, consistent with jejunal atresia, confirmed with 3D HDLive mode ultrasound. A bibliographic search was carried out in Medline/PubMed, Google Scholar and LILACS, restricting by type of language (English and Spanish) and date of publication (January 1995 to June 2020). Primary studies of reports and case series relating to the outcome and prenatal diagnosis of this pathology were included. Results: The search identified 1,033 titles, of which four studies met the inclusion criteria, these being reports or case series. A total of twelve fetuses with a prenatal diagnosis of jejunal atresia detected with unconventional methods were reported. In all cases, the prenatal diagnosis was confirmed during the neonatal period, which required resection of the compromised segment; one of them died and two neonates developed short bowel syndrome because of a wide bowel resection. The postoperative course in the remaining cases was favorable. Conclusion: The available literature on the prenatal diagnosis of jejunal atresia using non-conventional methods is scarce and is limited to case reports or case series. The literature reviewed suggests that, in the presence of intestinal dilation, 3D ultrasound and magnetic resonance imaging could be of some use in characterizing the atretic portion and establishing the differential diagnosis. More studies are required to evaluate the diagnostic utility of these two alternatives.

Acute blockade of endogenous melatonin by Luzindole, with or without peripheral LPS injection, induces jejunal inflammation and morphological alterations in Swiss mice

This study investigated the acute blockade of endogenous melatonin (MLT) using Luzindole with or without systemic lipopolysaccharide (LPS) challenge and evaluated changes in inflammatory and oxidative stress markers in the mouse jejunum. Luzindole is an MT1/MT2 MLT receptor antagonist. Both receptors occur in the small intestine. Swiss mice were treated with either saline (0.35 mg/kg, ip), Luzindole (0.35 mg/kg, ip), LPS (1.25 mg/kg, ip), or Luzindole+LPS (0.35 and 1.25 mg/kg, ip, respectively). Jejunum samples were evaluated regarding intestinal morphometry, histopathological crypt scoring, and PAS-positive villus goblet cell counting. Inflammatory Iba-1, interleukin (IL)-1β, tumor necrosis factor (TNF)-α, nuclear factor (NF)-kB, myeloperoxidase (MPO), and oxidative stress (NP-SHs, catalase, MDA, nitrate/nitrite) markers were assessed. Mice treated with Luzindole, LPS, and Luzindole+LPS showed villus height shortening. Crypt damage was worse in the LPS group. Luzindole, LPS, and Luzindole+LPS reduced the PAS-goblet cell labeling and increased Iba-1-immunolabelled cells compared to the saline group. Immunoblotting for IL-1β, TNF-α, and NF-kB was greater in the Luzindole group. The LPS-challenged group showed higher MPO activity than the saline and Luzindole groups. Catalase was reduced in the Luzindole and Luzindole+LPS groups compared to saline. The Luzindole group showed an increase in NP-SHs, an effect related to compensatory GSH activity. The acute blockade of endogenous MLT with Luzindole induced early changes in inflammatory markers with altered intestinal morphology. The other non-detectable deleterious effects of Luzindole may be balanced by the unopposed direct action of MLT in immune cells bypassing the MT1/MT2 receptors.

Brief topical and intraluminal use of Carolina rinse solution does not attenuate experimental ischemia and reperfusion injury in rabbit jejunum / [O uso tópico breve e intraluminal da solução de Carolina rinse não atenua a injúria de isquemia e reperfusão experimental no jejuno de coelhos ]

Fifteen New Zealand adult rabbits were randomly allocated into three groups: Sham-operated (group A), Ischemia and Reperfusion (group B) and Carolina Rinse Solution (CRS) (group C). Groups B and C were subjected to one hour of ischemia and two hours of reperfusion. In group C, ten minutes before reperfusion, the bowel lumen was filled with CRS, and the segment immersed in CRS. Necrosis and loss of integrity of the villi were visible in groups B and C. Edema of the submucosa and circular muscle was observed in all groups. Hemorrhage was observed in different layers for groups B and C, but group C showed more severe hemorrhage in different layers during reperfusion. All groups showed polymorphonuclear leukocyte infiltration on the base of the mucosa, submucosa, and longitudinal muscle, in addition to polymorphonuclear leukocytes margination in the mucosal and submucosal vessels. Necrosis of enterocytes, muscles, crypts of Lieberkühn and myenteric plexus was observed in groups B and C during reperfusion. Topical and intraluminal Carolina Rinse Solution did not attenuate the effects of ischemia and reperfusion in the small intestine of rabbits.(AU)

Quinze coelhos da raça Nova Zelândia foram alocados em três grupos: instrumentado (grupo A), isquemia e reperfusão (grupo B) e solução de Carolina rinse (CRS) (grupo C). Os grupos B e C foram submetidos a uma hora de isquemia e a duas horas de reperfusão. No grupo C, 10 minutos antes da reperfusão, o segmento isolado foi imerso e teve seu lúmen preenchido com CRS. Os grupos B e C apresentaram necrose e perda progressiva da integridade das vilosidades. Foi observado edema na submucosa e na camada muscular circular em todos os grupos. Nos grupos B e C, foi observada hemorragia em diferentes camadas, mas, no grupo C, a hemorragia foi mais intensa durante a reperfusão. Todos os grupos apresentaram infiltrado de PMN na base da mucosa, na submucosa e na camada muscular longitudinal e marginação de PMN nos vasos da mucosa e da submucosa. Durante a reperfusão, foi observada necrose dos enterócitos, das camadas musculares, das criptas de Lieberkühn e do plexo mioentérico nos grupos B e C. O uso tópico e intraluminal de CRS não atenuou os efeitos da isquemia e da reperfusão no intestino delgado de coelhos.(AU)

Várices yeyunales secundarias a trombosis de la vena mesentérica superior: una causa inusual de sangrado del intestino delgado / Jejunal varices secondary to superior mesenteric vein thrombosis: an unusual cause of bleeding from the small intestine

RESUMEN Las várices del intestino delgado, usualmente, están relacionadas con hipertensión portal. Las várices ectópicas secundarias a trombosis crónica aislada de la vena mesentérica superior son muy infrecuentes. El sangrado digestivo secundario a éstas representa un reto diagnóstico, dada la baja prevalencia y sospecha clínica, y terapéutico por la escasa evidencia científica existente con respecto a las opciones de tratamiento. Presentamos el caso de un hombre de 56 años, con sangrado digestivo secundario a várices yeyunales por trombosis crónica de la vena mesentérica superior, asociada a trombofilia; diagnosticadas mediante video cápsula endoscópica (VCE) y enterografía por tomografía (entero TC), sin posibilidades de manejo endoscópico ni radiológico dado el compromiso extenso, intervenido quirúrgicamente con éxito.

ABSTRACT Small bowel varices are usually associated with portal hypertension. Ectopic varices caused by isolated chronic superior mesenteric vein thrombosis are exceedingly rare. Gastrointestinal bleeding secondary to these represents a diagnostic challenge, given the low prevalence and clinical suspicion, and therapeutic dilemma due to the limited scientific evidence available regarding treatment options. We present the case of a 56-year-old man with gastrointestinal bleeding from jejunal varices due to chronic superior mesenteric vein thrombosis, associated with thrombophilia; diagnosed by video capsule endoscopic (VCE) and computed tomography enterography (CTE), with no possibility of endoscopic or radiological management given the extensive involvement, who underwent successful surgery.

Hydroalcoholic extract of leaves of Arrabidaea brachypoda (DC. ) Bureau present antispasmodic activity mediated through calcium influx blockage

Aim: Since other species of the Bignoniaceae Family presented of antispasmodic activity, it was decided, by chemotaxonomic criterion, to determine the antispasmodic activity of the leaves of Arrabidaea brachypoda. Methodology: the segments of the rat jejunum were suspended in glass vats containing specific saline solution, at an appropriate temperature, and after stabilization period, were stimulated by a contractile agent to observe the inhibitory or relaxing effect of EH-FAB. Results: EH-FAB showed the presence of 10 compounds, mainly rutin and it has an antispasmodic activity as it inhibits the phasic component and relaxes the tonic component of the contraction in isolated rat jejunum. To assess the mechanism of antispasmodic action, cumulative curves to the CCh were performed in which a non-competitive antagonism was observed, due to a displacement of the control curve to the right and reduction of the maximum contraction effect (Emax). Afterward, the participation of the calcium and/or potassium channels was evaluated by increasing the extracellular potassium, and it was observed that the EH-FAB relaxed the rat jejunum, suggesting the participation of the Ca2+ channels. To corroborate that hypothesis, the EH-FAB was tested against cumulative curves to Ca2+ in a free depolarizing solution of Ca2+, and it was observed that there was a shift of the curve to the right with a reduction in Emax. Conclusions: EH-FAB presents antispasmodic activity in isolated rat jejunum and it is suggested to block the influx of Ca2+ through voltage-gated calcium channels, signaling the therapeutic potential for the treatment of colic and/or diarrhea.(AU)

Could the intestinal epithelial alterations promoted by roux-en-y gastric bypass explain higher tendency for colonic diseases in bariatric patients? / As alterações epiteliais intestinais promovidas pelo bypass em y-de-roux podem explicar maior tendência a doenças colônicas em pacientes bariátricos?

ABSTRACT Background: Intestinal diversions have revolutionized the treatment of morbid obesity due to its viability and sustained response. However, experimental studies suggest, after these derivations, a higher risk of colon cancer. Aim: To analyze the histological and immunohistological changes that the jejunojejunal shunt can produce in the jejunum, ileum and ascending colon. Method: Twenty-four male Wistar rats were randomly divided into two groups, control (n=12) and experiment (n=12) and subdivided into groups of four. Nine weeks after the jejunojejunal shunt, segmental resection of the excluded jejunum, terminal ileum and ascending colon was performed. Histological analysis focused on the thickness of the mucosa, height of the villi, depth of the crypts and immunohistochemistry in the expression of Ki-67 and p53. Results: Significant differences were found between the experiment and control groups in relation to the thickness of the mucosa in the jejunum (p=0.011), in the ileum (p<0.001) and in the colon (p=0.027). There was also a significant difference in relation to the height of the villus in the ileum (p<0.001) and the depth of the crypts in the jejunum (p0.001). The results indicated that there is a significant difference between the groups regarding the expression of Ki-67 in the colon (p<0.001). No significant differences were found between the groups regarding the expression of Ki-67 in the jejunum and ileum. In the P53 evaluation, negative nuclear staining was found in all cases. Conclusion: The jejunojejunal deviation performed in the Roux-in-Y gastrojejunal bypass, predispose epithelial proliferative effects, causing an increase in the thickness of the mucosa, height of the villi and depth of the crypts of the jejunum, ileum and ascending colon.

RESUMO Racional: As derivações intestinais revolucionaram o tratamento da obesidade mórbida pela sua viabilidade e resposta sustentada. Porém, estudos experimentais sugerem, após estas derivações, risco maior de câncer de cólon. Objetivo: Analisar as alterações histológicas e imunoistológicas que a derivação jejunojejunal possa produzir no jejuno, íleo e cólon ascendente. Método: Foram utilizados 24 ratos Wistar machos randomicamente divididos em dois grupos, controle (n=12) e experimento (n=12) e subdivididos em grupos de quatro. Nove semanas após a derivação jejunojejunal procedeu-se a ressecção segmentar do jejuno excluso, íleo terminal e cólon ascendente. Análise histológica focou na espessura da mucosa, altura dos vilos, profundidade das criptas e a imunoistoquímica na expressão do Ki-67 e p53. Resultados: Foram encontradas diferenças significativas entre os grupos experimento e controle em relação à espessura da mucosa no jejuno (p=0,011), no íleo (p<0,001) e no cólon (p=0,027). Também houve diferença significativa em relação à altura dos vilos no íleo (p<0,001) e profundidade das criptas no jejuno (p<0,001). Os resultados indicaram que existe diferença significativa entre os grupos em relação à expressão do Ki-67 no cólon (p<0,001). Não foram encontradas diferenças significativas entre os grupos em relação à expressão do Ki-67 no jejuno e no íleo. Na avaliação do P53, foi encontrada coloração nuclear negativa em todos os casos. Conclusão: O desvio realizado na derivação gastrojejunal em Y-de-Roux, predispõem efeitos proliferativos epiteliais, causando aumento da espessura da mucosa, altura dos vilos e profundidade das criptas do jejuno, íleo e cólon ascendente.

The effect of probiotics on ıntestinal motility in an experimental short bowel model

Abstract Purpose To investigate the effect of probiotics on spontaneous contractions of smooth muscle isolated from jejunum and ileum of rat model. Methods Four rat groups were created (n=8, in each) including control (Group 1), control+probiotic (Group 2), short bowel (Group 3), and short bowel+probiotic (Group 4). Groups 1 and 2 underwent sham operation, Groups 3 and 4 underwent massive bowel resection. Bifidobacterium Lactis was administered in Groups 2 and 4 daily (P.O.) for three weeks. On postoperative week 3, rats were sacrificed, and jejunum and ileum smooth muscle were isolated for organ bath. Muscle contraction changes were analyzed before and after addition of antagonists. Results Short bowel group exhibited increased amplitude and frequency of spontaneous contractions. The addition of probiotics significantly decreased enhanced amplitude and frequency of bowel contraction in short bowel group and returned to control values. L-NNA increased amplitude and frequency of contractions in all groups. While indomethacin and nimesulide increased the amplitude in all groups, the frequency was only increased in jejunum. Hexamethonium and tetrodotoxin did not change the contraction characteristics in all groups. Conclusion We suggest that early use of probiotics may significantly regulate bowel motility, and accordingly improve absorption of nutrients in short bowel syndrome.

Value of capsule endoscopy in children with small intestinal diseases with hematochezia as the chief complaint / 中国当代儿科杂志

OBJECTIVE@#To evaluate the value of capsule endoscopy in children with small intestinal diseases with hematochezia as the chief complaint.@*METHODS@#A retrospective analysis was performed on the clinical data and capsule endoscopy findings of 93 children with hematochezia who were admitted to Children's Hospital of Fudan University from May 2015 to January 2019 and underwent capsule endoscopy. According to the capsule endoscopy findings of the jejunum and the ileum, they were divided into a positive lesion group with 39 patients and a negative lesion group with 54 patients. Related clinical data and the features of lesion on capsule endoscopy were analyzed for the two groups.@*RESULTS@#There were no significant differences in age, sex, duration of capsule endoscopy, gastric transit time, and small intestinal transit time between the positive lesion and negative lesion groups (P>0.05). The positive lesion group had a significantly lower level of hemoglobin than the negative lesion group (P<0.05). Hemoglobin level was negatively correlated with the rate of positive lesions on capsule endoscopy (r=-0.342, P=0.001). Among the 39 patients with positive lesions on capsule endoscopy, the detection of Meckel's diverticulum was the highest (41%), followed by inflammatory bowel disease (21%).@*CONCLUSIONS@#Capsule endoscopy has a certain value in detecting small intestinal diseases, especially diseases in the jejunum and the ileum, in children with lower gastrointestinal hemorrhage.

A suplementação com quercetina previne mudanças em células imunorreativas à serotonina e caspase-3 do jejuno de ratos diabéticos / Quercetin supplementation prevents changes in the serotonin and caspase-3 immunoreactive cells of the jejunum of diabetic rats

ABSTRACT BACKGROUND: Serotonin (5-HT) is present in the epithelial enterochromaffin cells (EC), mast cells of the lamina propria and enteric neurons. The 5-HT is involved in regulating motility, secretion, gut sensation, immune system and inflammation. OBJECTIVE: Evaluate the effects of diabetes and quercetin supplementation on serotoninergic cells and its cell loss by apoptosis in jejunal mucosa of streptozotocin-induced diabetic rats (STZ-rats). METHODS: Twenty-four male Wistar rats were divided into four groups: normoglycemic (C), normoglycemic supplemented with 40 mg/day quercetin (Q), diabetic (D) and diabetic supplemented with 40 mg/day quercetin (DQ). After 120 days, the jejunum was collected and fixated in Zamboni's solution for 18 h. After obtaining cryosections, immunohistochemistry was performed to label 5-HT and caspase-3. Quantification of 5-HT and caspase-3 immunoreactive (IR) cells in the lamina propria, villi and crypts were performed. RESULTS: The diabetic condition displayed an increase of the number of 5-HT-IR cells in villi and crypts, while decreased number of these cells was observed in lamina propria in the jejunum of STZ-rats. In the diabetic animals, an increased density of apoptotic cells in epithelial villi and crypts of the jejunum was observed, whereas a decreased number of caspase-3-IR cells was observed in lamina propria. Possibly, quercetin supplementation slightly suppressed the apoptosis phenomena in the epithelial villi and crypts of the STZ-rats, however the opposite effect was observed on the 5-HT-IR cells of the lamina propria. Quercetin supplementation on healthy animals promoted few changes of serotoninergic function and apoptotic stimuli. CONCLUSION: These results suggest that quercetin supplementation mostly improved the serotonergic function affected by diabetes maybe due to antioxidant and anti-inflammatory properties of quercetin.

RESUMO CONTEXTO: A serotonina (5-HT) está presente nas células epiteliais enterocromafins (CE), nos mastócitos da lâmina própria e nos neurônios entéricos. A 5-HT está envolvida na regulação da motilidade, secreção, nocepção intestinal, sistema imunológico e inflamação. Objetivo: Avaliar os efeitos do diabetes e da suplementação de quercetina sobre a função serotoninérgica e a perda celular por apoptose na mucosa jejunal de ratos diabéticos induzidos por estreptozotocina (ratos STZ). MÉTODOS: Vinte e quatro ratos Wistar machos foram divididos em quatro grupos: normoglicêmico (C), normoglicêmico suplementado com quercetina 40 mg/dia (Q), diabético (D) e diabético suplementado com quercetina 40 mg/dia (DQ). Após 120 dias, o jejuno foi coletado e fixado na solução de Zamboni por 18 horas. Após a obtenção de cortes em criostato, a imuno-histoquímica foi realizada para marcar 5-HT e caspase-3. A quantificação de células imunorreativas (IR) à 5-HT e caspase-3 foram realizadas na lâmina própria, vilosidades e criptas. RESULTADOS: A condição diabética ocasionou um aumento do número de células 5-HT-IR nas vilosidades e criptas, enquanto que na lâmina própria houve uma redução dessas células, no jejuno de ratos STZ. Nos animais diabéticos, foi observada uma densidade aumentada de células apoptóticas no epitélio do jejuno, tanto nas vilosidades quanto nas criptas, por outro lado um número reduzido de células caspase-3-IR foi observado na lâmina própria. Possivelmente, a suplementação de quercetina suprimiu ligeiramente os fenômenos de apoptose no epitélio de vilosidades e criptas do jejuno de ratos STZ, no entanto, o efeito oposto foi observado nas células 5-HT-IR da lâmina própria. A suplementação com quercetina em animais saudáveis promoveu poucas alterações na função serotoninérgica e nos estímulos apoptóticos. CONCLUSÃO: Estes resultados sugerem que a suplementação de quercetina melhorou principalmente a função serotoninérgica afetada pelo diabetes, talvez devido às propriedades antioxidantes e anti-inflamatórias da quercetina.