Plasma citrulline correlates with basolateral amino acid transporter LAT4 expression in human small intestine.

BACKGROUND & AIMS: Plasma citrulline, a non-protein amino acid, is a biochemical marker of small intestine enterocyte mass in humans. Indeed, citrulline is highly correlated with residual bowel length in patients with short bowel syndrome. It is known to be synthesised in epithelial cells of the small intestine from other amino acids (precursors). Citrulline is then released into systemic circulation and interconverted into arginine in kidneys. If plasma citrulline concentration depends on abundance of intestinal amino acid transporters is not known. The aim of the present study was to explore whether plasma citrulline concentration correlates with the expression of intestinal amino acid transporters. Furthermore, we assessed if arginine in urine correlates with plasma citrulline. METHODS: Duodenal samples, blood plasma and urine were collected from 43 subjects undergoing routine gastroduodenoscopy. mRNA expression of seven basolateral membrane amino acid transporters/transporter subunits were assessed by real-time PCR. Plasma and urine amino acid concentrations of citrulline, its precursors and other amino acids were analysed using High Performance Liquid Chromatography measurements. Amino acid transporter mRNA expression was correlated with blood plasma and urine levels of citrulline and its precursors using Spearman's rank correlation. Likewise, urine arginine was correlated with plasma citrulline. RESULTS: Plasma citrulline correlated with the mRNA expression of basolateral amino acid transporter LAT4 (Spearman's r = 0.467, p = 0.028) in small intestine. None of the other basolateral membrane transporters/transporter subunits assessed correlated with plasma citrulline. Plasma citrulline correlated with urinary arginine, (Spearman's r = 0.419, p = 0.017), but not with urinary citrulline or other proteinogenic amino acids in the urine. CONCLUSIONS: In this study, we showed for the first time that small intestinal basolateral LAT4 expression correlates with plasma citrulline concentration. This finding indicates that LAT4 has an important function in mediating citrulline efflux from enterocytes. Furthermore, urine arginine correlated with plasma citrulline, indicating arginine in the urine as possible additional marker for small intestine enterocyte mass. Finally, basolateral LAT4 expression along the human small intestine was shown for the first time.

Chronic pain and quality of life after inguinal hernia repair using the COMI-hernia score.

PURPOSE: The Core Outcome Measure Index (COMI) is a brief and multidimensional, patient-orientated outcome questionnaire that assesses chronic pain and quality of life after groin hernia repair. The primary aim of this study was to prospectively assess the COMI-hernia score, over an extended period of time in a single large cohort of patients. METHODS: Two hundred and twenty-eight male patients with inguinal hernia repair were included in the present study. Patients were recruited prospectively with an average follow-up of 3 years. RESULTS: COMI-hernia total and the COMI-hernia pain scores were significantly lower following surgery and remained unchanged over time. Young patients' age (p = 0.043), high preoperative COMI-hernia total score (p = 0.018), and bilateral hernias (p = 0.035) were identified as independent risk factors for adverse outcome after groin hernia repair. Both COMI-hernia total and the COMI-hernia pain scores significantly (p < 2.2*10-16 and p < 1.638*10-11) correlated with patient's satisfaction. CONCLUSIONS: The COMI score reflects a reliable tool to assess the outcome following groin hernia repair.

Five-year Follow-up and Recurrence Rates Following Surgery for Acute and Chronic Pilonidal Disease: A Survey of 421 Cases.

OBJECTIVE: The aim of the present study was to investigate the outcomes of different treatment options for acute and chronic pilonidal disease in a single large cohort of patients. MATERIALS AND METHODS: Four hundred and twenty-one consecutive patients (171 with chronic disease and 250 with acute abscess formation) who underwent surgery between 2003 and 2012 were included in the present study. Primary outcomes included symptomatic recurrence, time to wound healing, and time off from work. The median follow-up was 5.3 years. RESULTS: In patients with acute abscess formation, the relapse rate was significantly higher (P = 0.0001) if they were treated with abscess excision (38.9%) compared with a wide local excision (13.3%). Time to relapse was significantly longer (P = 0.0205) in patients treated with wide local excision (median 7 vs 3 months), whereas time to wound healing and the days off from work were similar among groups. In chronic disease, the relapse rate was similar in patients treated with wide local excision followed by secondary wound healing (11.3%) when compared with patients treated with limited excision (27.6%) or wide excision with primary wound closure (26.8%). The time to wound healing was shortest in patients with primary wound closure following wide local excision, and the time off from work was not significantly different between groups. CONCLUSION: Wide local excision with secondary wound healing seems to be the favorable operation method for acute and chronic pilonidal disease.

Patient satisfaction, hernia recurrence rate, and chronic pain 10 years after endoscopic total extraperitoneal inguinal hernia repair.

INTRODUCTION: Long-term outcome data after total endoscopic preperitoneal hernia repair are scarce. This study reports the 10-year results after endoscopic total extraperitoneal hernia repair in terms of recurrence rates and various patient-orientated indicators of quality of life. METHODS: Between July 1995 and April 2000, 107 consecutive patients underwent endoscopic total extraperitoneal inguinal hernia repair. The follow-up assessment between December 2007 and June 2008 included a clinical examination and a patient questionnaire. RESULTS: Sixty-three patients (64.3%) with 108 hernias attended follow-up, an average of 115.7 months (range 91 to 148 mo) after the index operation. The incidence of recurrence was 2.8%, of chronic pain 15.9%, and of foreign body sensation 33.3%. Patient satisfaction measured on the Visual Analogue Scale was high with a median of 9.6 (range 0.3 to 10). CONCLUSIONS: Endoscopic total extraperitoneal hernia repair is a safe and effective procedure with excellent long-term results and an extremely high rate of patient satisfaction.