Enhanced cyclooxygenase-2 activity leads to intestinal dysmotility following hemorrhagic shock

ABSTRACT PURPOSE: To test whether hemorrhagic shock (HS) increases the Cyclooxygenase-2 (COX-2) expression in the intestine and whether this enhanced COX-2 expression mediates the intestinal dysmotility after HS. METHODS: Male Wistar rats were randomly divided into HS sham group and HS group. At 180 min following HS establishment, the duodenum samples were harvested to assess the motility function, protein expression of COX-2 and the downstream products of COX-2, prostaglandins. RESULTS: Examination of motility function ex vivo showed that the contractile response to acetylcholine of smooth muscle strips of rats subjected to HS was significantly suppressed. A COX-2 inhibitor, NS-398, abolished this depressed contractile response after HS. Western blotting revealed an increased protein expression of COX-2 in intestinal tissues of HS rats. Immunohistochemical examination indicated that intestine tissues of HS rats were manifested by part of villous expansion and disruption, a large amount of COX-2 positive cells appearance in lamina propria and submucosa. Furthermore, the contents of prostaglandin E2 was significantly increased in intestinal tissues of HS rats. CONCLUSION: The enhanced COX-2/ prostaglandin E2 involves in the hemorrhagic shock induced intestinal dysmotility.

Chronic effect of vagotomy in the morphometry of the myenteric plexus of rats' duodenum / Efeito crônico da vagotomia sobre a morfometria do plexo mioentérico do duodeno de ratos

BACKGROUND: The gastrointestinal disorders have been associated with morphological alterations in the myenteric nervous plexus. AIM: To evaluate, through morphometric studies, the chronic effects of the subdiaphragmatic trunk vagotomy on the nervous plexus. METHODS: Fifteen male exemplars of Wistar Rattus novergicus weighing about 150g, distributed into three groups, have been used: control (n=5), Sham (n=5) and vagotomized (n=5). The animals were sacrificed after 30 and 90 days post surgery. Fragments of duodenum were fixed in Bouin solution, embedded into paraffin and stained with HE and PAS. Morphometric analysis was performed by a Carl Zeiss KM 450 image system. The following aspects were observed: the density of nervous cells per linear micrometer (µm) (ND); the area of perikarya (µm²) (NA); the number of satellite cells per µm (SCD); and the number of satellite cells per neuron (SC/N). The averages were compared with the help of "software" program Sigma Plus through two way - ANOVA and Tuckey post-test. RESULTS: Denervation increased SC/N (p<0,05) and NA (p<0,05), in a time-dependent denervation way (p<0,05). However ND and SCD, decreased, which significantly with the animal's age (p<0,001). CONCLUSION: Vagotomy altered the myenteric plexus morphology in a time-dependent way.

RACIONAL: As disfunções gastrintestinais têm sido associadas à alterações morfológicas no plexo nervoso mioentérico. OBJETIVO: Avaliar através do estudo morfométrico, os efeitos crônicos da vagotomia troncular subdiafragmática sobre esse plexo nervoso. MÉTODOS: Foram utilizados 15 exemplares machos de Rattus novergicus da variedade Wistar, com cerca de 150 g, distribuídos nos grupos controle (n=5), Sham (n=5) e vagotomizados (n=5). Os animais foram sacrificados depois de 30 e 90 dias após as operações. Em seguida, fragmentos do duodeno foram fixados em solução de Bouin, incluídos em parafina e corados por HE e PAS. A análise morfométrica foi realizada por meio do sistema de análise de imagem Carl Zeiss KM 450. Foram observados: a densidade de células nervosas por micrômetro linear (µm); a área dos pericários (µm²); o número de células satélites por µm; e o número de células satélites por neurônio. As médias foram comparadas com o auxílio do programa de "software" Sigma Plus através do Two way - ANOVA e do pós-teste de Tukey. RESULTADOS: A desnervação aumentou o número de células satélites por neurônios (p<0,05) e a área média dos pericários (p<0,05), de maneira dependente do tempo de desnervação (p<0,05), mas diminuiu significativamente a densidade de neurônios (p<0,05) e de células satélites (p<0,05) em função da idade (p<0,001). CONCLUSÃO: A vagotomia alterou a morfologia do plexo mioentérico de maneira dependente do tempo.

Ulceras gástricas y duodenales / Gastric and duodenal ulcers

Se realiza un enfoque fundamentalmente diagnóstico y terapéutico de las hemorragias digestivas altas cuyo origen topográfico, etiológico han sido determinados y tratados por endoscopia. Quedan comprendidos en el tema los distintos estadios de las ulceras gastroduodenales de acuerdo a la clasificación de Forrest. Se afirman los conceptos de diagnósticos positivos y la importancia del tratamiento endoscópico temprano. El objetivo del estudio fue evaluar la eficacia del tratamiento endoscópico. A los pacientes se les realizo endoscopia alta en las primeras 24 hs del ingreso en el Servicio de Urgencias de Cirugía del Hospital Central del Instituto de Previsión Social (IPS), en caso de observarse sangrado activo, se les aplicó tratamiento endoscópico (escleroterapia con polidocanol mas adrenalina). El tratamiento mostró eficacia respecto a la hemostasia inicial, la necesidad de cirugía y la mortalidad. La hemostasia definitiva se logró en el 94% de los pacientes. Palabras claves: ulceras gastroduodenales, endoscopia digestiva alta.

Malabsorption syndrome due to various causes is associated with antroduodenal hypomotility.

BACKGROUND: Patients with celiac disease who present with symptoms of gastrointestinal hypomotility have abnormal antroduodenal manometry. There are no data on antroduodenal manometry in malabsorption syndrome (MAS) due to causes other than celiac disease. METHODS: Fasting, post-prandial and post-octreotide antroduodenal motility parameters were compared in 18 untreated patients with MAS presenting with chronic diarrhea (tropical sprue 10, small bowel bacterial overgrowth 3, celiac disease 2, common variable immunodeficiency 1, AIDS with isosporidiasis and bacterial overgrowth 1, giardiasis 1) and 8 healthy subjects. RESULTS: Number of patients with MAS and controls having spontaneous migratory motor complexes (MMC) during fasting was comparable (11/18 vs 7/8; p=ns). Fasting contraction amplitude was weaker in MAS than in controls in the gastric antrum (median 42 [range 17-90] vs 80 [31-120] mmHg; p=0.001), proximal duodenum (50 [18-125] vs 72 [48-107]; p=0.013) and distal duodenum (45 [20-81] vs 76 [51-98]; p=0.001). In the fed state too, contraction amplitudes were weaker in patients with MAS in the antrum (32 [15-110] vs 76 [61-103] mmHg, p=0.002), proximal duodenum (57 [20-177] vs 73 [56-113]; p=0.07) and distal duodenum (45 [24-87] vs 75 [66-97]; p<0.0001). Patients with MAS had lower fasting and post-prandial antral and duodenal motility indices than healthy subjects. Intravenous octreotide induced MMC in all patients and controls. CONCLUSIONS: MAS due to various causes is associated with antroduodenal hypomotility typical of myopathic disorders.

Divertículo intraluminal do duodeno: relato de caso / Intraluminal diverticulum of the duodenum: a case report

Os autores apresentam um caso de divertículo intraluminal do duodeno em uma paciente de 44 anos de idade, com sintomas escassos e incaracterísticos. O diagnóstico radiológico foi confirmado à cirurgia e houve controle pós-operatório. A anomalia, uma forma rara de duplicação, com diagnóstico radiológico unicamente pelo exame baritado convencional pré-operatório, consiste de uma estrutura em "fundo de saco", revestida de ambos os lados por mucosa normal, projetando-se na luz do duodeno. Após a revisão da literatura, os autores tecem considerações acerca do diagnóstico.

The authors present a case of intraluminal diverticulum of duodenum in a 44-year-old female with poor and uncharacteristic symptoms. The radiological diagnosis was confirmed by surgery. The patient was also followed up after surgery. This anomaly, a rare form of duplication, consists of a "pocket-like" structure lined on both sides by duodenal mucosa projecting into the duodenal lumen.

Role des lysosomes dans le comportement intracellulaire d'elements mineraux: cas du lanthane

The subcellular localization of lanthane was studied using two microanalytic methods.1]The election microprobe method showed that lanthane is concentrated in the lysosomes of the hepatocytes and the spleen associated with phosphorus. 2]The ion microanalysis showed that lanthane is selectively precipitated in the lysosomes of the enterocytes opical part. This mechanism of selective precipitation initially privents the diffusion of this toxic element in organism and then permits its elimination digestively after desquamation of enterocytes in apoptose in the interstinal lumen

Estenosis gastroduodenal por un adenoma de glándulas de Brünner: A propósito de una observación clínica y revisión de la literatura / Gastroduodenal stenosis caused by Brunner's glands adenoma

El adenoma o hiperplasia de las glándulas de Brünner es una rara lesión disembrioplásica o hiperplásica que se desarrolla habitualmente en la submucosa duodenal supravateriana. En más de la mitad de los casos es asintomático o presenta signos inespecíficos que llevan al estudio morfológico y endoscópicos, pero que pocas veces conducen al diagnóstico histológico. Complicaciones mayores como el sangrado y la obstrucción, sumado a la incertidumbre diagnóstica, suelen llevar a la exploración quirúrgica. El procedimento se adecuará al estado funcional gastroduodenal, volumen tumoral y estado general del paciente. Se presenta un caso de adenoma de glándula de Brünner de duodeno II-III que provocó un síndrome intermitente de estenosis gastroduodenal (SEGD), al que se le practicó una duodeno-pancreatectomía cefálica

Gastroenterological manifestations of sickle cell disease

Sickle cell hemoglobinopathy is a common genetic disorder which is prevalent in certain areas of the Kingdom of Saudi Arabia. it is characterized by repeated hemolytic and vasoocclusive crises which lead to widespread vascular occlusion and subsequent multiple organ infarctions, Affected individuals present with a wide variety of gastrointestinal disorders mimicking vasoocclusive episodes causing diagnostic confusion and delays that may catch the unwary clinician. This article briefly reviews the gastroenterological manifestations of sickle cell disease

Obstrucción intestinal neonatal / Neonatal intestinal obstruction

La obstrucción intestinal es una entidad ocasionalmente observada en los neonatos y con frecuencia sin diagnóstico oportuno. Se revisaron los expedientes de pacientes con obstrucción intestinal neonatal atendidos entre 1986 y 1993. Se encontró que 59 pacientes con 61 entidades obstructivas fueron atendidos entre 1986 y 1993. Se encontró que 59 pacientes con 61 entidades obstructivas fueron atendidos, con un ligero predominio de varones (62.7 por ciento). El segmento intestinal más afectado fue el duodeno (34.4 por ciento), seguido por el yeyuno-íleon (27.8 por ciento), el anorrecto (21.3 por ciento) y el colon (16.3 por ciento). La principal entidad responsable fue la malformación anorrectal (21.3 por ciento), seguida por la atresia duodenal (19.7 por ciento) y la enfermedad Hisrchsprung (16.4 por ciento); 36 pacientes curaron sin complicación (61 por ciento), 14 después de superar alguna (23.7 por ciento) y nueve fallecieron (14.7 por ciento), principalmente por falla multiorgánica. La obstrucción intestinal alta es la más frecuente en el recién nacido, la que se diagnostica más temprano y la que tiene mejor pronóstico. El diagnóstico más tardío y la mortalidad más alta correspondieron a la enfermedad de Hirschsprung. Los principales factores relacionados con morbimortaliad fueron el retraso en el tratamiento y la presencia de infección.

Leiomioma de duodeno como causa de hemorragia digestiva alta: relato de caso / Duodenum leiomyoma due to upper digestive bleeding

O leiomioma do duodeno se constitui numa causa muito rara de hemorragia digestiva alta. Relata-se aqui o caso de um paciente de 61 anos, que apresentou sangramento digestivo alto, devido a um liomioma situado na primeira porçäo do duodeno. Através da endoscopia houve a suspeita de um tumor mesenquimal benigno e por sua localizaçäo submucosa näo se procedeu a biópsia. Após compensado, o paciente foi operado eletivamente, sendo realizada a exrese do tumor, constatando tratar-se de um leiomioma duodenal

Induced immunological Vasculitis in duodenum of albino rats: an ultrastructure study

Two groups of albino rats were included. The control group is formed of nine albino rats, divided into three subgroups: 1] Primed [sensitized] only by intraperitoneal injection of soybean protein emulsion, 2] duodenal tube feeding for 14 days by soybean protein hydrolysate only, and 3] oral feeding by soybean protein-free milk formula. The test group formed of nine albino rats were primed by intraperitoneal injection of soybean protein emulsion and challenged after one week by duodenal tube feeding of soybean protein hydrolysate for 14 days or till diarrhea developed. Results showed that all control groups showed no pathological abnormalities in their duodenum and did not develop diarrhea. The test group showed basically similar changes that varied in severity from mild, moderate to marked. The immunological findings were humoral and cellular immume reaction. Edema of the duodenum erythema and reduction in the size of the villi were seen morphologically. Ultrastructurally, deposition of immune complexes in the basement membrane leading to its thickening and irregularity, adhesion of leukocytes [PNLs, monocytes and lymphocytes] to the injured endothelium, edematous corium and inflammatory cellular infiltrate, increase in the number of lymphocytes going to the surface and congested plugged blood vessels were seen

Gastric emptying and anthroduodenal motility study of patients with functional ulcer like dyspepsia: correlation with histopathological findings and helicobacter pylori

13 patients complaining of functional ulcer like dyspepsia and 8 volunteers healthy persons with comparable age and sex were studied for gastric emptying tests by B-mode sonography and antroduodenal study by colored duplex. Gastro duodenoscopy was done for each patient, biopsies were taken from antrum and corpus. The results showed that there is a correlation between delayed gastric emptying and severity of symptoms. Histopathological examination of biopsies sowed chronic gastritis in all cases and H. pylori infection in 92.3%. So, it is concluded that H. pylori may play a role in the pathogenesis of functional ulcer like dyspepsia

Diafragma duodenal: A propósito de un caso

Se presenta el caso clínico de un paciente de 12 años de edad, atendido en lso servicios de gastroenterologia y cirugia pediátrica del Hospital de niños Baca Ortíz, que fue diagnosticado e intervenido quirúrgicamente de un diafragma mucoso intraluminal con orificio central entre la segunda y tercera porción del duodeno, lo cual constituye una causa infrecuente de obstrucción intestinal congénita. Destacamos además, la producción de una metapalasia gástrica en la mucosa duodenal y diafragma mencionados. La estenósis duodenal congénita debida a una diafragma mucoso intraluminal constituye una causa infrecuente de obstrucción intestinal. Se estima que aproximadamente 1 por cada 10.000 nacidos vivos presentan estenósis y/o atresias duodenales de las cuales al diafragma duodenal con orificio central o sin él le corresponde el 40 por ciento de los casos...

Ulcera gastroduodenal, su ubicación en estómago y duodeno: revisión endoscópica / Gastroduodenal ulcer, its place in the, stomach and duodenum: an endoscopic study

Se analizaron los resultados de 568 exámenes endoscópicos del tubo digestivo alto realizados en un periodo de 52 meses determinandose los sitios preferenciales de los asentameintos de las úlceras gastroduodenales. El gran porcentaje de las úlceras gástricas, se localiza hacia la curvatura menor ya sea en el ángulo o el la mucosa antral; en las úlceras duodenales la localización preferencial es un bulbo duodenal hacia la pared posterior. Existe una predisposición del sexo masculino a contraer la enfermedad respecto del femenino con una relación de 2,09; 1 La aparición en grupos etáreos, difiere en ambos grupos de ulcerosos siendo la úlcera duodenal de aparición más temprana respecto a la úlcera gastrica.

Acute gastroduodenal mucosal lesions in obstructive jaundice: an overview of clinical and pathogenic problems

Fourteen patients with obstructive jaundice were investigated. The mucous membrane [by fibrogastroduodenoscopy] of the stomach and the duodenum, the fasting gastric juice pH and level of serum gastrin [by radioimmunoassay method] were investigated. The study showed a high incidence [71.4%] of gastroduodenal mucosal changes; 57% had gastritis, 14% had duodenitis, mucosal hemorrhages were in 7%, and peptic ulceration of the stomach in 7%. However, 14% were symptomless. The level of fasting gastric juice pH was between 1-3 in this group. There were no any changes of stomach and duodenum in four patients, they had fasting gastric juice pH more than 3. Serum gastrin level, which is stimulated by gastric secretion, is high in 42.8% of patients and shows positive correlation [r = 0.639, p < 0.001] with the duration of the obstruction. Thus, patients with obstructive jaundice and with normal or increased acidity is the group of risk for acute lesions of mucous membrane of stomach and duodenum. This may be the result of preventing the flow of bile and the pancreatic juice into the intestine which plays a role in the pathogenesis of this defect. Particularly, this provokes the interaction in circuit of gastrointestinal hormones. These patients need early prophylaxis and treatment of these lesions