Partial Resection Of Small Intestine Research Articles

Early proliferative events following intestinal resection in the rat.

Partial resection of the small intestine results in compensatory proliferation and adaptation in the remaining small intestinal mucosa. The molecular mechanisms governing the proliferative response are not known, nor has the timing of events associated with proliferation been adequately defined, particularly during the period just after resection. We designed experiments to characterize early (within 24 h) proliferative events associated with proximal intestinal resection and sought to determine the cell type that first responds to proliferative stimuli. Twenty-one day old male Sprague-Dawley rats underwent a 70% proximal intestinal resection or transection (control). Poly(A) RNA was isolated from the distal (ileal) remnants. Northern blots showed a marked induction of the immediate early genes zif-268, nup-475, and c-myc 1-3 h following resection, but not following transection. Immunohistochemical analysis of c-myc expression in ileal crypt epithelial cells showed a biphasic induction that was most marked 6 h after resection and less prominent 24 h after resection. Immunostaining with 5-bromodeoxyuridine (5-BrdU) was restricted to ileal crypt nuclei and was maximal 24 h after resection. All these events were observed in the absence of nutrient intake. Taken together, these data show that a potent nutrient-independent stimulus for intestinal epithelial cell proliferation occurs within minutes of partial small intestinal resection and that the first targets of this stimulus are crypt epithelial cells in the residual intestine.

Glutamine Nutrition and Requirements

Glutamine is the most abundant free amino acid in plasma and tissue pools and an important intermediate in a number of metabolic pathways. Glutamine levels decline markedly in the course of many different catabolic disease states and it has recently been suggested that glutamine may be a conditionally essential dietary nutrient rather than a nonessential amino acid. Changes in tissue glutamine concentrations have been shown to correlate with net protein turnover, and there is evidence that glutamine may both stimulate protein synthesis and inhibit protein degradation. In experimental animals, we have shown that the fall in glutamine concentrations in plasma and tissue pools that occurs in the postoperative state can be prevented or reversed by providing large quantities of exogenous glutamine. In gastrointestinal tissues, the provision of glutamine-free total parenteral nutrition solutions is associated with atrophy of mucosal cells and pancreatic exocrine cells. Glutamine-supplemented parenteral formulas result in diminished atrophy of intestinal mucosal and pancreatic exocrine cells; both intravenous and enteral glutamine promote gastrointestinal tissue regeneration following toxic injury. In animals undergoing partial small intestine resection, glutamine feeding leads to increased adaptive hyperplasia in remaining intestinal segments and results in earlier postoperative weight gain. All of these trophic, anabolic effects of glutamine require the administration of quantities that exceed the glutamine content of normal dietary protein. These findings in experimental animals support the hypothesis that glutamine is a conditionally essential nutrient and suggest a potentially important role for glutamine-supplemented nutrition in catabolic disease states.

A CASE OF VASCULAR RECONSTRUCTION FOR OCCLUSION OF SUPERIOR MESENTERIC ARTERY

We describe a case in a 67-year-old male who underwent laparotomy under a preoperative diagnosis of ileus and could save his life by excision of a thrombus and partial resection of small intestine. The patient had been being treated for atrial fibrillation and hypertension for these 3 years. Beginning from 10 days before visiting our department for the present disease, he experienced nausea and abdominal pain, which gradually became worse. Examination revealed the abdomen to be flat and soft, accompanying with no tenderness and muscular defense. On the following day, bloody stool appeared, abdominal X-rays revealed sharp fluid levels, and muscular defense was seen. Thus, 46 hours after hospitalization, operation was performed. About 50cm of the small intestine was necrotic, the entire small intestine was pale and showed no peristalsis, and the root of the superior mesenteric artery had been occluded with a thrombus. The thrombus was removed with a Fogarty catheter, which resulted in an immediate improvement in color and peristalsia of the small intestine. Thus, only the necrotic region of the small intestine was resected. On the postoperative day 40, gastrectomy was performed for early gastric cancer. Postoperative clinical course was uneventful, and the patient is closely followed on ambulant basis.

SYNCHRONOUS DOUBLE CANCER INCLUDING PRIMARY JEJUNAL AND EARLY GASTRIC CANCER DIAGNOSED PREOPERATIVELY

A very rare case of synchronous double cancer including primary jejunal and early gastric cancer diagnosed preoperatively is reported. A 70-year-old woman visited our hospital complaining of sensation of abdominal fullness and vomiting. Clinical and histological examination revealed a primary jejunal and early gastric cancer. The jejunal cancer was like Borrmnn 2 type, located just below the ligament of Treitz, and was histologically a well-differentiated adenocarcinoma. While the early gastric cancer was a II a type locating on the lesser curvature of the middle gastric body and also histologically a well differentiated adenocarcinoma. Distal partial gastrectomy and resection of small intestine including the jejunal cancer were performed. A jejunal cancer is rare among all digestive tract, cancers, particularly that accompanied by a gastric cancer. Most of jejunal cancers are not diagnosed preoperatively, and already advanced at the time of operation. Every effort should be made to detect them in early stages.

Intestinal Resection in the Neonatal Rat

To investigate whether intestinal resection accelerates mucosal maturation in suckling rats, macromolecular absorption, sucrase and lactase activity, RNA/DNA ratios, and intestinal morphology were determined 5 days after partial small intestinal resection or intestinal transection in 15-day-old rats. Villous height and crypt depth, lactase and sucrase activity, and RNA/DNA ratios were significantly increased in remaining intestine in animals that underwent surgery. These animals, together with normal control animals, were also gavaged with 100 mg bovine serum albumin, and serum levels were determined after 2.5 h. Mean serum levels of bovine serum albumin were 0.135 +/- 0.034 micrograms/ml/cm of residual intestine after transsection, 0.257 +/- 0.078 micrograms/ml/cm after resection, and 0.404 +/- 0.030 micrograms/ml/cm in controls. These studies demonstrate that intestinal resection during the suckling period of the infant rat results in several morphologic and physiologic changes that resemble precocious maturation of the small intestine.

Intestinal Resection in the Neonatal Rat

SummaryTo investigate whether intestinal resection accelerates mucosal maturation in suckling rats, macromolec ular absorption, sucrase and lactase activity, RNA/DNA ratios, and intestinal morphology were determined 5 days after partial small intestinal resection or intestinal transection in 15 day old rats. Villous height and crypt depth, lactase and sucrase activity, and RNA/DNA ratios were significantly increased in remaining intestine in animals that underwent surgery. These animals, together with normal control animals, were also gavaged with 100 mg bovine serum albumin, and serum levels were determined after 2.5 h. Mean serum levels of bovine serum albumin were 0.135 ± 0.034 μg/ml/cm of residual intestine after trans section, 0.257 ± 0.078 μg/ml/cm after resection, and 0.404 ± 0.030 μg/ml/cm in controls. These studies demonstrate that intestinal resection during the suckling period of the infant rat results in several morphologic and physiologic changes that resemble precocious maturation of the small intestine.

A Case of Partial Resection of the Small Intestine

A Case of Partial Resection of the Small Intestine