Loop Of Colon Research Articles

Clinical application of a new colonoscope with variable insertion tube rigidity: A pilot study

Background: Colonic loop formation can prolong colonoscopy, increase patient discomfort, and preclude complete examination. A colonoscope with variable insertion tube rigidity may facilitate colonoscopy. Our aim was to determine whether the use of a colonoscope with variable insertion tube rigidity reduces insertion time and improves patient acceptance of colonoscopy. Methods:Fifty patients were randomly assigned to undergo colonoscopy with a conventional colonoscope or a variable rigidity colonoscope (VRC). Patient acceptance, dosage of medication, use of abdominal pressure, and patient repositioning were assessed. Statistical analysis was performed by the 2-sample Wilcoxon rank sum test and an extension of Fisher exact test. Results:The groups were comparable with respect to age, gender, and medications required during colonoscopy. The cecum was reached in all 25 patients who underwent colonoscopy with the VRC, including 1 patient in whom the cecum was not reached at a previous colonoscopy with a conventional instrument. In the conventional colonoscopy group, the cecum was not reached in 4 patients (2 poor preparation, 2 loop formation). There was no significant difference between the 2 groups with respect to insertion time. In the group that underwent colonoscopy with the variable rigidity instrument, less abdominal pressure was required ( p = 0.05), and nursing assessment of patient discomfort was more favorable ( p = 0.05). There were no complications and no significant differences in the intubation time to cecum or in repositioning, patient acceptance, or patient assessment of abdominal pain. Conclusion:The use of a variable rigidity colonoscope reduced the frequency of abdominal pressure but did not affect intubation time to cecum, repositioning, patient acceptance, or patient assessment of abdominal pain.

Extrinsic Neural Innervation Mediates Absorption of Water and Electrolytes in Canine Proximal Colon in Vivo

Introduction. Extrinsic innervation mediates a proabsorptive effect in small intestine. Our aim was to determine whether extrinsic neural input modulates similar effects in the proximal colon in vivo.Methods. Ten adult dogs underwent enteric isolation of a 50-cm proximal colon loop; five each were randomized to undergo extrinsic denervation (Ext Den) of the isolated colonic segment or to serve as neurally innervated controls. After recovery, a 38°C electrolyte solution (Na+ 125 meq/L, K+ 9 meq/L, Cl− 75 meq/L, HC0−3 65 meq/L) was infused at 4 ml/min into the segment. Effluent was collected in 30-min intervals for 2 h after achieving steady state (determined by 14C nonabsorbable marker recovery); four studies were conducted at 1 and 12 weeks postoperatively. Net flux of H20, Na+, K+, and Cl− was determined. Colon morphometry was evaluated at 0 and 14 weeks. Data are presented as x̄ ± SEM. Unpaired t test was applied for comparisons.Results. Net absorptive flux of H20 (μL/min/cm) was decreased in Ext Den vs controls at 1 week (4.40 ± 0.63 vs 7.92 ± 0.92, P = 0.03) but was not different at 12 weeks (4.70 ± 1.20 vs 5.97 ± 0.69; P > 0.05). Na+ and Cl− followed the trends in H20 absorption (P ≤ 0.05). Crypt depth (μm) decreased in controls at 14 weeks vs 0 week (915 ± 20 vs 740 ± 07, P = 0.01) but remained unchanged in Ext Den.Conclusions. Loss of extrinsic neural input decreases colonic absorption. This observation suggests that extrinsic neural innervation provides net proabsorptive mechanisms for absorption of water and electrolytes in the proximal canine colon.

Study of acute pharmacologic effects of prolactin on calcium and water transport in the rat colon by an in vivo perfusion technique

We investigated the acute effect of intraperitoneally administered prolactin on calcium and water transport in colon of sexually mature female Wistar rats using an in vivo perfusion technique. Test solution containing (in mM) NaCl, 100; KCl, 4.7; MgSO4, 1.2; CaCl2, 20; D-glucose, 11; sodium ferrocyanide (Na4Fe(CN)6), an index of net water transport, 20; and 0.7 (microCi 45CaCl2 (1 Ci = 37 GBq) was perfused througth the 8-cm colonic loop for 60 min at perfusion rates of 0.5 or 1.0 mL x min(-1). Calcium and water transport was also studied under a no flow condition to stimulate the condition often found in the colon by in vivo ligated colonic loop for 30 min. Control results showed no correlation between calcium transport and water flux. Flow of luminal solution at 0.5 and 1.0 mL x min(-1) was found to reverse net calcium absorption from 0.04+/-0.01 nmol x g(-1) dry weight x h(-1) to net calcium secretion of 0.04+/-0.04 and 0.9+/-0.02 nmol x g(-1) dry weight x h(-1), respectively. Neither 0.4, 0.6, nor 1.0 mg x kg(-1) prolactin had any effect on calcium fluxes in the colon. On the other hand, at a perfusion rate of 1 mL x min(-1), 0.4 mg x kg(-1) prolactin significantly decreased net water absorption from 3.86+/-0.90 to 0.88+/-0.64 mL x g(-1) dry weight x h(-1) (P < 0.001), and the higher doses of 0.6 and 1.0 mg x kg(-1) prolactin reversed net water absorption to net water secretion of 2.20+/-0.63 and 2.33+/-0.89 mL x g(-1) dry weight x h(-1), respectively (P < 0.001). The stimulatory effect of prolactin on water transport was completely abolished by reducing the perfusion rate from 1.0 mL x min(-1) to zero. The stimulatory effect of prolactin on water secretion at perfusion rate of 1.0 mL x min(-1) was also abolished when luminal [Na+] was reduced from 180 to 80 mM. We concluded that, unlike in the small intestine, calcium fluxes in the colon are not related to water transport and did not respond at all to prolactin. Water transport, on the other hand, was reversed from net absorption to secretion by prolactin. We propose that this prolactin-induced water secretion is probably mediated by recycling of luminal sodium in the vicinity of tight junctions.

Sonographic diagnosis of ascaris‐induced cholecystitis and pancreatitis in a child

We describe the sonographic diagnosis of Ascaris-induced acute cholecystitis and pancreatitis in a 2-year-old girl. Abdominal sonography revealed a grossly distended gallbladder with a thick (0.5-cm) wall. The common bile duct was dilated to 0.6 cm without sludge or calculi. The pancreas was hypoechoic, with an enlarged, 3.3-cm pancreatic head. Sonography showed dilatation of the small- and large-bowel loops, with multiple roundworms in duodenal and colonic loops. Sonography has an important role not only in the diagnosis of this uncommon condition but also in the documentation of its unusual etiologic agent.

Modulation of colonic barrier function by the composition of the commensal flora in the rat

BACKGROUND AND AIMSAltered intestinal permeability is a key pathogenetic factor of idiopathic bowel inflammation. We investigated in the rat if changes in the composition of the bowel flora can alter...

Colon interposition for esophageal replacement: isoperistaltic or antiperistaltic? Experimental results

Background. Isoperistaltic colon is preferred to antiperistaltic colon for esophageal replacement, but experimental data do not exist to support this practice. Methods. In 7 dogs a 20 cm long colon loop was interposed between the skin and the small bowel, isoperistaltically in 3 dogs and antiperistaltically in 4 dogs. Three months later five strain-gauges were implanted and evacuation was investigated by motility testing, barium studies, and scintigraphy. Results. Motility recording showed normal colon motility in the excluded loops. Quiescent states (duration 40.2 ± 13.6 minutes) were followed by contractile states (duration 7.5 ± 2.4 minutes, frequency 3.3 ± 0.6 per minute). The main peristaltic direction of isoperistaltic loops was isoperistaltic, and the main peristaltic direction of antiperistaltic loops was antiperistaltic. Evacuation took place exclusively during the contractile status. Half time emptying was more rapid in isoperistaltic loops (35 ± 11 vs 69 ± 16 minutes). The content of antiperistaltic loops was held back by antiperistaltic activity. Application of oatmeal porridge into the loops shortened the quiescent status from 40.2 to 13.2 ± 4.8 minutes. Conclusions. The colon graft for esophageal replacement is an active system. Food is stored during the quiescent states and evacuated during the contractile states. The original peristaltic direction is preserved so that retroperistalsis in antiperistaltic loops may lead to patient discomfort and pulmonary complications.

Study of acute pharmacologic effects of prolactin on calcium and water transport in the rat colon by an in vivo perfusion technique

We investigated the acute effect of intraperitoneally administered prolactin on calcium and water transport in colon of sexually mature female Wistar rats using an in vivo perfusion technique. Test solution containing (in mM) NaCl, 100; KCl, 4.7; MgSO4, 1.2; CaCl2, 20; D-glucose, 11; sodium ferrocyanide (Na4Fe(CN)6), an index of net water transport, 20; and 0.7 (microCi 45CaCl2 (1 Ci = 37 GBq) was perfused througth the 8-cm colonic loop for 60 min at perfusion rates of 0.5 or 1.0 mL x min(-1). Calcium and water transport was also studied under a no flow condition to stimulate the condition often found in the colon by in vivo ligated colonic loop for 30 min. Control results showed no correlation between calcium transport and water flux. Flow of luminal solution at 0.5 and 1.0 mL x min(-1) was found to reverse net calcium absorption from 0.04+/-0.01 nmol x g(-1) dry weight x h(-1) to net calcium secretion of 0.04+/-0.04 and 0.9+/-0.02 nmol x g(-1) dry weight x h(-1), respectively. Neither 0.4, 0.6, nor 1.0 mg x kg(-1) prolactin had any effect on calcium fluxes in the colon. On the other hand, at a perfusion rate of 1 mL x min(-1), 0.4 mg x kg(-1) prolactin significantly decreased net water absorption from 3.86+/-0.90 to 0.88+/-0.64 mL x g(-1) dry weight x h(-1) (P < 0.001), and the higher doses of 0.6 and 1.0 mg x kg(-1) prolactin reversed net water absorption to net water secretion of 2.20+/-0.63 and 2.33+/-0.89 mL x g(-1) dry weight x h(-1), respectively (P < 0.001). The stimulatory effect of prolactin on water transport was completely abolished by reducing the perfusion rate from 1.0 mL x min(-1) to zero. The stimulatory effect of prolactin on water secretion at perfusion rate of 1.0 mL x min(-1) was also abolished when luminal [Na+] was reduced from 180 to 80 mM. We concluded that, unlike in the small intestine, calcium fluxes in the colon are not related to water transport and did not respond at all to prolactin. Water transport, on the other hand, was reversed from net absorption to secretion by prolactin. We propose that this prolactin-induced water secretion is probably mediated by recycling of luminal sodium in the vicinity of tight junctions.

Strangulated inguinal hernia complicating colonoscopy

Colonoscopy is widely used as a primary investigation of terminal ileal and colorectal disease. Colonoscopy may be more difficult and dangerous in the presence of large inguinal hernias, as loops of bowel and the colonoscope may become incarcerated in the hernia.1, 2 Acute presentation of a strangulated inguinal hernia has not previously been reported as a complication of colonoscopy. A 64-year-old man attended for a colonoscopy as follow-up of previous adenomatous polyps. Colonoscopy was performed uneventfully by an experienced operator. Sedation was with 5 mg midazolam and 50 mg pethidine; air was used for insufflation. The terminal ileum was intubated and a 10 mm pedunculated tubulovillous adenoma was removed from the transverse colon by snare excision. Routine post-procedure care was uncomplicated. Six hours later the patient consulted his general practitioner because of sudden onset central abdominal pain and vomiting. He was referred back to hospital with a provisional diagnosis of colonic perforation. Examination showed a tender mass in the right inguinal region; radiography did not demonstrate any free subdiaphragmatic air. At surgery the diagnosis of a small right indirect inguinal hernia containing a segment of strangulated ileum was confirmed. The ischaemic segment was resected and repair of the hernial defect completed. Recovery was unremarkable. Colonoscopy is a generally safe procedure, with significant complications occurring in 0.3% of cases overall, although haemorrhage can complicate polypectomy in 1% of cases.3 Loops of sigmoid colon within a large left inguinal hernia may pose problems at colonoscopy. It may be difficult to traverse the segment, and the extraction of the endoscope may be problematical.4 This is the first report of strangulation in a previously unrecognised hernia arising as a result of colonoscopy. The temporal relationship between colonoscopy and presentation suggests that the increase in intra-abdominal pressure from insufflation of the bowel exacerbated any predisposing weakness in the abdominal wall and facilitated herniation of the small bowel mucosa. Although such acute complication of a previously unrecognised hernia may be rare, it is important that the possibility is considered. Health-care professionals and patients are aware of perforation as a complication of colonoscopy, but other causes of acute abdominal pain after colonoscopy should be included in the differential diagnosis.

Segmental wall thickening in the colonic loop distal to colonic carcinoma at CT: importance and histopathologic correlation.

To determine the importance of the finding of segmental wall thickening in the colonic loop distal to colonic carcinoma at computed tomography (CT) by means of histopathologic correlation. Thirteen consecutive patients whose helical CT scans showed segmental wall thickening (>1 cm in maximal width, >5 cm in length) in the colonic loop distal to colonic carcinoma were included. The thickness and length of an involved segment, location, morphologic tumor type, CT patterns of wall thickening, and pericolic changes were evaluated. Surgical pathologic findings in all 13 patients were correlated with CT findings. The involved segment distal to the colonic carcinoma showed circumferential wall thickening with a preserved wall layer pattern at CT. Pericolic changes of varying degrees were seen in 10 patients. Histopathologic examination revealed submucosal and subserosal edema (n = 6), chronic inflammation and fibrosis (n = 5), or both (n = 1), and no histopathologic alteration (n = 1). The tumors were mostly fungating (n = 11), larger than 5 cm in the greatest dimension (n = 12), located in the ascending colon (n = 10), and extended to pericolic adipose tissue (n = 11). Colonic carcinoma, especially a large fungating type involving the ascending colon with pericolic infiltration, can produce segmental wall thickening in the distal segment at CT, which represents edema or colitis at histopathologic examination.

The dose-related hypoglycemic effects of insulin emulsions incorporating highly purified EPA and DHA

The dose-related pharmacological effects of insulin emulsion incorporating highly purified eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were investigated. Water-in-oil-in-water multiple emulsions (insulin dose, 0, 10, 25 and 50 IU/kg) incorporating 2% DHA or EPA were administered directly into the colonic and rectal loops in situ. Serum insulin levels rose and serum glucose levels decreased in an insulin dose-related fashion. The relationship of insulin dose and C max or AUC insulin was linear at the rectum, but a non-linear relationship was observed at the colon. The trend was more predominant in DHA. In the in vivo rectal absorption experiment using emulsions incorporating 2% DHA, 5 IU/kg of insulin emulsion produced a rapid, transitory increase in serum insulin levels and strong reduction of serum glucose levels. The pharmacological availability determined from the dose–response curve by s.c. administration of insulin reached 43.2±26.3% (mean±S.D.). Mucosal irritation caused by administration of emulsions incorporating 2% EPA or DHA was evaluated by a lactate dehydrogenase (LDH) release study, and compared with those of the emulsion incorporating 2% oleic or linolenic acid. Only when emulsion incorporating 2% oleic acid was applied in the intestine did significant LDH release into the mesenteric veins occur. Our results indicate that emulsion incorporating highly purified long-chain polyunsaturated fatty acid, especially DHA, has the potential of becoming the formulation for enteral delivery of insulin.

Mucin discharge from the isolated vascularity perfused rat colon in response to bile salts

The intestinal mucus layer plays an important role in the protection of the mucosa. This function is performed mainly by mucins, which are high molecular-weight glycoproteins produced by goblet cells. Luminal factors that govern mucin secretion are poorly known. The hypothesis that bile salts could induce colonic mucin discharge was thus tested in a model of isolated vascularly perfused rat colon. Methods : Ligated loops (I O-cm length) of rat colon were separated from adjacent tissue, transferred to a saline bath and perfused through the superior mesenteric artery with a Krebs Henseleit buffer containing 25% washed bovine erythrocytes, 3% bovine albumin, amino acids and glucose. After a lO-min control period, loops were filled with Iml of prewarmed saline containing stimulants. After 30-min period of stimulation, mucus was assayed in luminal content by enzyme-linked immunosorbent assay. Tissue samples from perfused rat colon were also immersed in Karnovsky's fixative for subsequent staining of mucus cells with alcian blue followed by the periodic acid schiff reagent. Results : Luminal administration of deoxycholate (I-lOmM) produced a dose-dependent release of mucins (maximal response at 550 % of control loops) in the isolated perfused rat colon. Hyodeoxycholate (IOmM) and Chenodeoxycholate (I0mM) also induced an increase in mucin discharge (response at 310 % and 290 % of controls,respectively) whereas IOmM cholate, ursodeoxycholate and tween-20 were without effect. Taurine conjugated bile salts (deoxycholate,hyodeoxycholate, and chenodeoxycholate) were less potent mucus secretagogues than unconjugated forms. Tetrodotoxin, atropine, indomethacin, a mast cells stabilizer (ketotifen), H I histamine antagonist(pyrilamine) and 5-HT receptors antagonists (ketanserin, SDZ, Zophren) did not significantly modify deoxycholate-induced mucin secretion. Conclusions : The present study conducted with the isolated vascularly perfused rat colon suggests that some bile salts may playa role in the regulation of colonic mucin secretion by way of a direct action on mucus cells

Mucin secretion is modulated by luminal factors in the isolated vascularly perfused rat colon

BACKGROUNDMucins play an important protective role in the colonic mucosa. Luminal factors modulating colonic mucus release have been not fully identified.AIMTo determine the effect of some dietary compounds on mucus...

Evidence that colitis is initiated by environmental stress and sustained by fecal factors in the cotton-top tamarin (Saguinus oedipus).

Parallel changes in spontaneously occurring inflammation in colonic Thiry-Vella loops and the in-line colon of cotton-top tamarins were studied in a colitis-inducing environment at 8 and 15 months following surgical preparation of the loops. Gross disease severity and numbers of inflammatory/immune cells per unit area of lamina propria in histological sections from endoscopic biopsies were analyzed. Cell counts and severity of colitis declined over time in the Thiry-Villa loops while the disease followed its characteristic course in the remaining large bowel and in the colons of controls. Perfusion of the loops with the animals' feces increased the density of the cellular infiltrate in the lamina propria in parallel with increased severity of inflammation. Electron micrographs of the colonic mucosa showed invasion by microorganisms. The predominant microorganism had characteristics of Helicobacter sp. The results implicate the fecal stream as a factor in the persistence of colitis in the tamarin model. Nevertheless, fecal factors appear not to be the primary trigger, as evidenced by findings that the disease is not expressed in wild-living tamarins and that it enters remission when affected animals are transferred to natural conditions from a colitis-inducing environment. Both an adverse environment and the fecal contents appear to be required for expression of the disease.

Prostaglandin E 2 stimulates rat and human colonic mucin exocytosis via the EP 4 receptor

Background & Aims: Mucins form an integral part of innate host defenses against intestinal pathogens and irritants. However, the mechanisms whereby mucin secretion is regulated during inflammation are poorly understood. Because prostaglandin E 2 (PGE 2) is prominent during intestinal inflammation, we investigated its receptor-signaling pathway coupled to mucin exocytosis in the colonic epithelial cell line LS174T and rat colon. Methods: Reverse-transcription polymerase chain reaction (RT-PCR) and [ 3H]PGE 2 binding assays were used to identify the PGE 2 receptors (EP). Intracellular cyclic adenosine monophosphate ([cAMP] i) was quantified by enzyme immunoassay. Mucins were metabolically labeled with [ 3H]glucosamine, and mucin secretion was quantified by Sepharose 4B column chromatography, immunoblot analysis, and cesium chloride density gradient centrifugation. Results: RT-PCR and DNA sequence analysis identified EP 2, EP 3, and EP 4 receptors. Mucin secretion and [cAMP] i production by LS174T cells were stimulated dose-dependently by PGE 2, the EP 4-receptor agonist 1-OH-PGE 1, and the EP 3/EP 4 agonist M&B28767 and were inhibited with the adenylate cyclase inhibitor SQ22536. The EP 1, EP 2, and EP 3/EP 1-receptor agonists iloprost, butaprost, and sulprostone, respectively, had no effect. Similar results were obtained in rat colonic loop studies confirming that the EP 4 receptor is linked to mucin exocytosis in vivo. [ 3H]PGE 2 binding to cell membranes identified a high-affinity binding site that was competitively inhibited by M&B28767 (EP 3/EP 4) > 1-OH-PGE 1 (EP 4) > sulprostone (EP 3/EP 1) > butaprost (EP 2). Conclusions: PGE 2 coupling to the EP 4 receptor stimulates [cAMP] i-dependent mucin exocytosis. GASTROENTEROLOGY 1999;117:1352-1362

How often does ultrasound marking change the liver biopsy site?

OBJECTIVES: The aim of this study was to answer the question: How often does ultrasound change the liver biopsy position, when a percussion technique is applied, because of intervening structures? A secondary objective is to compare the performance of the hepatologist to a radiology technician to demonstrate safety of a self-training technique. METHODS: One hundred sixty-five consecutive outpatient liver biopsies were studied. Using a standard percussion technique, a biopsy site was chosen and marked. Ultrasound was applied to the marked site. An adequate site was determined to be one without intervening structure within 6 cm of liver depth. If an intervening structure was found, an alternative site was chosen by ultrasound. Data recorded included reason for change of position, distance of moved site from original site, and complications. The first third of liver biopsies were done with assistance of a certified radiology technician performing ultrasound, the last two-thirds were done by the hepatologist after observing the first 64 biopsies. RESULTS: Ultrasound changed the position in 21 of 165 patients. The ultrasound caused an abortion of the procedure in 4 of 165 patients. Ultrasound changed management in 15.1% of patients. Reasons for change were lung (10 patients), gallbladder (6), large central vessel (4), >4-cm rim of ascites (2), colonic loop (1), slim liver edge (1), and focal liver lesions (1 patient). There was a 1.8% multiple pass rate. No serious complications occurred. CONCLUSIONS: Ultrasound changed management 15.1% of patients. A hepatologist could perform ultrasound marking after a period of observation, without compromising results. A low multiple pass rate was observed when applying ultrasound and percussion. Avoided structures could explain decrease in pain when ultrasound is applied.

Comparison of the Effects ofClostridium perfringensType D Culture Supernates in Ligated Intestinal Loops of Goats and Sheep

The1999 W.B. Saunders Company Ltdeffects ofCopyright Clostridium perfringenstype D culture supernates were compared in ligated loops of the small intestine (ileum) and colon of four goat kids and four lambs, the loops being examined histopathologically and electron microscopically 7 h after inoculation. No lesions were observed in the small intestine of any animal, or in control colonic loops. In the caprine and ovine colonic loops treated with culture supernates, most goblet cells were empty and the lumina contained a layer of mucus, polymorphonuclear leucocytes, bacteria and sloughed epithelial cells. The apical cytoplasm of the superficial epithelial cells was lost. Moderate oedema was observed in the submucosa and muscular layer. The colonic lesions were more severe in kids than in lambs. No changes were seen in vascular endothelial cells in any loop.1999 W.B. Saunders and Company Ltd.

Adrenoceptors and colocolonic inhibitory reflex.

The colocolonic inhibitory reflex is characterized by inhibition of proximal colonic motility induced by distal colonic distension. The aim of this study was to investigate the underlying neural mechanisms of this reflex, in vivo, using an isolated loop of canine colon. In five beagle dogs, motility was recorded from an exteriorized colonic loop via a serosal strain gauge connected to a digital data logger and chart recorder. Inflation of a balloon in the distal colon resulted in inhibition of motility in the isolated loop. Inhibition of motor activity persisted following injection of propranolol (100 microg/kg intravenously), a beta-adrenoceptor antagonist, but was abolished following administration of the alpha2-adrenoceptor antagonist yohimbine (200 microg/kg intravenously). This study confirms that the colocolonic inhibitory reflex is mediated via the extrinsic nerves to the colon. As the reflex was abolished by alpha2-, but not beta-adrenoceptor blockade, this indicates that the reflex pathway involves alpha2-adrenoceptors.

Development of an oral formulation of azetirelin, a new thyrotropin-releasing hormone (TRH) analogue, using n-lauryl-beta-D-maltopyranoside as an absorption enhancer.

The effects of formulation factors on the enhancement of colonic absorption of azetirelin by n-lauryl-beta-maltopyranoside (LM) were studied in rats. Coadministration of LM with a small volume of azetirelin solution to the proximal colon increased the AUC of the drug by 8.7-fold. There were no significant differences in the LM-induced absorption profiles of azetirelin between unligated and ligated colon. The addition of a viscous polymer to the drug solution, which delayed the in vitro release of both azetirelin and LM, reduced the promoting effects of LM. These results suggest that the action of LM is not affected by sample spreading in the colonic lumen, whereas a rapid release of both azetirelin and LM from the formulation is necessary to maximize the efficacy of LM. Utilizing the balloon sonde method, the effects of LM were also confirmed in the colonic loop of dogs. Based on these results, an enteric capsule formulation of azetirelin containing LM and citric acid (CA), a potential inhibitor of the bacterial degradation of azetirelin in the distal intestine, was prepared and its performance was evaluated in fasted dogs. The bioavailability of azetirelin after the oral administration of this enteric capsule with LM and CA was 43.5% compared with a bioavailability of 14.9% in capsules without LM and CA. Therefore, the delivery of azetirelin and LM to the lower intestine, together with a rapid release of capsule contents, are feasible for the improved peroral bioavailability of azetirelin.

Diaphragmatic rupture presenting forty years after injury

A previously healthy 59-year-old man was brought to the hospital by ambulance because of a l-day history of severe shortness of breath and abdominal pain, which had progressed until he could no longer lie recumbent or speak. At the age of 18 (1955) he had sustained severe chest trauma in a motorcycle accident after which he had convalesced at home (he refused hospitalization at that time). His pulse was 124/min, blood pressure 90/50, temperature 38”C, respirations 48/min (laboured) and 0, saturation (FiO, = 0.45) was 70%. The abdomen was distended, rigid and silent. The patient was urgently intubated because of respiratory failure and systemic acidosis. Chest radiograph demonstrated the bowel occupying the left hemithorax (Figure 1). An emergency laparotomy was perform&d. The left hemi-diaphragm was found to be ruptured, with multiple adhesions to ribs and spleen. A long loop of strangulated transverse colon was removed from the thorax and resected. The diaphragm was surgically repaired. The patient made a full recovery and remains symptom free 1 year later.

Surgical Treatment of the Redundant Interposed Colon After Retrosternal Esophagoplasty

Redundancy of the interposed colon used as an esophageal substitute is a common finding in the long-term follow-up of these patients. When symptoms caused by food retention in the colonic loop occur, surgical correction is necessary to improve quality of life and to prevent aspiration. We report a technique to straighten the redundant colon that consists of a side-to-side colocolic anastomosis using a linear stapler. This obviates the need for a redo cologastric anastomosis. Compared with resection of the loop, the operation is quick, safe, and easy to perform, and it may decrease the risk of injury to the marginal vessels of the colon graft.