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Le Cacheux C, Daneman A, Pierro A, Tomlinson C, Amirabadi A, Faingold R. Association of new sonographic features with outcome in neonates with necrotizing enterocolitis. Pediatr Radiol 2023; 53:1894-1902. [PMID: 37079037 DOI: 10.1007/s00247-023-05641-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND We have recently noted some sonographic features in necrotizing enterocolitis that have received little or no attention in the current literature. These include thickening of the mesentery, hyperechogenicity of intraluminal intestinal contents, abnormalities of the abdominal wall, and poor definition of the intestinal wall. It has been our impression that the above four sonographic findings are generally seen in neonates with more severe necrotizing enterocolitis and may be useful in predicting outcome. OBJECTIVES The aim of this study is, firstly, to review a large series of neonates, known to have clinical NEC, to document how frequently the above four sonographic features occur in neonates with necrotizing enterocolitis and, secondly, to determine whether they are predictive of outcome. MATERIALS AND METHODS We retrospectively analyzed the clinical, radiographic, sonographic, and surgical findings in neonates with necrotizing enterocolitis between 2018 and 2021. The neonates were categorized into two groups based on outcome. Group A included neonates with a favorable outcome defined as successful medical treatment with no surgical intervention. Group B included neonates with an unfavorable outcome defined as failed medical treatment requiring surgery (for acute complications or late strictures) or death because of necrotizing enterocolitis. The sonographic examinations were reviewed with attention to the features of mesenteric thickening, hyperechogenicity of intraluminal intestinal contents, abnormalities of the abdominal wall, and poor definition of the intestinal wall. We then determined the association of these four findings with the two groups. RESULTS We included 102 neonates with clinical necrotizing enterocolitis: 45 in group A and 57 in group B. Neonates in group B were born at a significantly earlier gestational age (median 25 weeks, range 22-38 weeks) and had a significantly lower birth weight (median 715.5 g, range 404-3120 g) than those in group A (median age 32 weeks, range 22-39 weeks, p = 0.003; median weight 1190 g, range 480-4500 g, p = 0.002). The four sonographic features were present in both study groups but with different frequency. More importantly, all four were statistically significantly more frequently present in neonates in group B compared to group A: (i) mesenteric thickening, A = 31 (69%), B = 52 (91%), p = 0.007; (ii) hyperechogenicity of intestinal contents, A = 16 (36%), B = 41 (72%), p = 0.0005; (iii) abnormalities of the abdominal wall, A = 11 (24%), B = 35 (61%), p = 0.0004; and (iv) poor definition of the intestinal wall, A = 7 (16%), B = 25 (44%), p = 0.005. Furthermore, the proportion of neonates with more than two signs was greater in group B compared to group A (Z test, p < 0.0001, 95% CI = 0.22-0.61). CONCLUSION The four new sonographic features described were found to occur statistically significantly more frequently in those neonates with an unfavorable outcome (group B) than in those with a favorable outcome (group A). The presence or absence of these signs should be included in the sonographic report to convey the radiologists concern regarding the severity of the disease in every neonate, suspected or known to have necrotizing enterocolitis, as the findings may impact further medical or surgical management.
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Affiliation(s)
- Catalina Le Cacheux
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Alan Daneman
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Agostino Pierro
- Division of General and Thoracic Surgery, Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Canada
| | - Chris Tomlinson
- Division of Neonatology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Afsaneh Amirabadi
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Ricardo Faingold
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Valverde-Pérez E, Olea E, Obeso A, Prieto-Lloret J, Rocher A, Gonzalez-Obeso E. Intermittent Hypoxia and Diet-Induced Obesity on the Intestinal Wall Morphology in a Murine Model of Sleep Apnea. Adv Exp Med Biol 2023; 1427:89-97. [PMID: 37322339 DOI: 10.1007/978-3-031-32371-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This work analyzes the impact of two conditions, intermittent hypoxia exposure and high-fat diet in rats as models of sleep apnea. We studied the autonomic activity and histological structure of the rat jejunum and whether the overlapping of both conditions, as often observed in patients, induces more deleterious effects on the intestinal barrier. We found alterations in jejunum wall histology, predominantly in HF rats, based on increased crypt depth and submucosal thickness, as well as decreased muscularis propria thickness. These alterations were maintained with the IH and HF overlap. An increase in the number and size of goblet cells in the villi and crypts and the infiltration of eosinophils and lymphocytes in the lamina propria suggest an inflammatory status, confirmed by the increase in plasma CRP levels in all experimental groups. Regarding the CAs analysis, IH, alone or combined with HF, causes a preferential accumulation of NE in the catecholaminergic nerve fibers of the jejunum. In contrast, serotonin increases in all three experimental conditions, with the highest level in the HF group. It remains to be elucidated whether the alterations found in the present work could affect the permeability of the intestinal barrier, promoting sleep apnea-induced morbidities.
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Affiliation(s)
- Esther Valverde-Pérez
- Departamento de Bioquímica y Biología Molecular y Fisiología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Instituto de Biomedicina y Genética Molecular (IBGM), UVa-CSIC, Valladolid, Spain
| | - Elena Olea
- Instituto de Biomedicina y Genética Molecular (IBGM), UVa-CSIC, Valladolid, Spain
- Departamento de Enfermería, Facultad de Enfermeria, Universidad de Valladolid, Valladolid, Spain
| | - Ana Obeso
- Departamento de Bioquímica y Biología Molecular y Fisiología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Instituto de Biomedicina y Genética Molecular (IBGM), UVa-CSIC, Valladolid, Spain
| | - Jesús Prieto-Lloret
- Departamento de Bioquímica y Biología Molecular y Fisiología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
- Instituto de Biomedicina y Genética Molecular (IBGM), UVa-CSIC, Valladolid, Spain
| | - Asunción Rocher
- Departamento de Bioquímica y Biología Molecular y Fisiología, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain.
- Instituto de Biomedicina y Genética Molecular (IBGM), UVa-CSIC, Valladolid, Spain.
| | - Elvira Gonzalez-Obeso
- Instituto de Biomedicina y Genética Molecular (IBGM), UVa-CSIC, Valladolid, Spain
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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N Cavallone I, Santos SK, Oliveira KS, D Passero LF, D Laurenti M, Jesus JA, P Marinsek G, Chucri TM, Mari RB. Histological and neuronal changes in the duodenum of hamsters infected with Leishmania (Leishmania) infantum. Exp Parasitol 2022; 239:108315. [PMID: 35780863 DOI: 10.1016/j.exppara.2022.108315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/07/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
Visceral leishmaniasis is a neglected tropical disease caused by parasites belonging to the Leishmania genus that infect macrophages in different tissues such as the spleen, liver, lymph nodes, bone marrow, and intestine. Therefore, this study aimed to investigate the integrity of the intestinal tract and the nitrergic (NADPH-dp) and metabolically active (NADH-dp) myenteric neurons of the duodenum of golden hamsters infected with L. (L.) infantum. Therefore, thirty golden hamsters were divided into six groups (n = 5); three of them were infected with 2 × 107 promastigote forms of L. (L.) infantum by intraperitoneal route (Infected Group - IG) and three were inoculated with saline solution (control group - CG). After 30, 60 and 90 days post-infection (DPI) infected animals were euthanized and the liver, spleen and duodenum were collected to analyze tissue parasitism. The duodenum was processed using usual histological techniques to analyze the main changes that occurred during infection and histochemical techniques to phenotype myenteric neurons. Amastigote forms were observed in the spleen, liver, and duodenum during all experimental periods, and tissue parasitism in these organs increased significantly over time. At 30 DPI, reduction in muscle tunic, increase in the total intestinal wall and the number of goblet cells PAS+ was observed. At 60 DPI, an increase in intestinal crypts and intraepithelial lymphocytes was observed, and a reduction in intestinal villi was observed at 90 DPI, along with an increase in crypt size. Regarding neurons, an increase in the density of the NADPH-dp population was observed at 30 DPI, but at 60 and 90 DPI a significant reduction of this population was observed. In general, infection progression was observed to cause significant morphofunctional changes in the duodenum of infected hamsters.
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Affiliation(s)
- Italo N Cavallone
- Animal Morphophysiology Laboratory, Department of Biological and Environmental Sciences, São Paulo State University (UNESP), São Vicente, 11.380-97, Brazil
| | - Sarah K Santos
- Animal Morphophysiology Laboratory, Department of Biological and Environmental Sciences, São Paulo State University (UNESP), São Vicente, 11.380-97, Brazil
| | - Karine S Oliveira
- Animal Morphophysiology Laboratory, Department of Biological and Environmental Sciences, São Paulo State University (UNESP), São Vicente, 11.380-97, Brazil
| | - Luiz Felipe D Passero
- Animal Morphophysiology Laboratory, Department of Biological and Environmental Sciences, São Paulo State University (UNESP), São Vicente, 11.380-97, Brazil
| | - Márcia D Laurenti
- Laboratory of Pathology and Infectious Diseases, Department of Pathology, FMUSP, São Paulo, 01246903, Brazil
| | - Jéssica Adriana Jesus
- Laboratory of Pathology and Infectious Diseases, Department of Pathology, FMUSP, São Paulo, 01246903, Brazil
| | - Gabriela P Marinsek
- Animal Morphophysiology Laboratory, Department of Biological and Environmental Sciences, São Paulo State University (UNESP), São Vicente, 11.380-97, Brazil
| | - Thaís M Chucri
- Animal Morphophysiology Laboratory, Department of Biological and Environmental Sciences, São Paulo State University (UNESP), São Vicente, 11.380-97, Brazil
| | - Renata B Mari
- Animal Morphophysiology Laboratory, Department of Biological and Environmental Sciences, São Paulo State University (UNESP), São Vicente, 11.380-97, Brazil.
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Sánchez-Rodríguez JJ, Utrillas-Martínez AC, Antón-Beranoaguirre JS, Moreno-Olivieri AA, Val-Gil JMD. [Neumatosis quística intestinal: reporte de un caso]. CIR CIR 2018; 86:370-373. [PMID: 30067713 DOI: 10.24875/ciru.m18000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antecedentes La neumatosis quística intestinal es una condición infrecuente, caracterizada por la formación de quistes de contenido gaseoso debajo de la mucosa y la serosa intestinales. Caso clínico Mujer de 84 años, con antecedente de artritis reumatoide en tratamiento inmunosupresor, intervenida hace 2 años por neumoperitoneo, con diagnóstico de diverticulosis yeyunal y enfisema mesentérico, acude con cuadro de dolor abdominal difuso de 2 días de evolución, sin otra sintomatología. En la radiografía de abdomen se observa neumoperitoneo con elevación del hemidiafragma derecho y distensión de asas del intestino delgado. Ante la sospecha de perforación de víscera hueca se decide intervención quirúrgica, en la cual se diagnostica a la paciente de neumatosis quística intestinal. Conclusión La neumatosis quística intestinal es de causa desconocida, aunque en un elevado porcentaje de pacientes se ha visto asociada a enfermedades pulmonares obstructivas, enfermedades del tejido conectivo, inmunosupresión o enfermedades gastrointestinales. Se localiza más frecuentemente en el colon y el intestino delgado. Se diagnostica principalmente mediante pruebas de imagen (radiografía o tomografía computarizada). El tratamiento es conservador, realizándose intervención quirúrgica si existe sospecha de necrosis intestinal. Es difícil el diagnóstico diferencial con un neumoperitoneo por perforación de víscera hueca. Background Pneumatosis cystoides intestinalis is an infrequent condition, characterized by the formation of gaseous content cysts under the mucosa and intestinal serous. Clinical case 84-year-old woman, with a history of rheumatoid arthritis under immunosuppressive treatment, operated 2 years ago by pneumoperitoneum, where she was diagnosed of jejunal diverticulosis and mesenteric emphysema, with diffuse abdominal pain of 2 days of evolution, without other symptoms. In abdominal radiography: pneumoperitoneum with elevation of right hemidiaphragm and distention of small intestine. Given the suspicion of perforation of the intestinal wall, surgical intervention was decided, in which the patient was diagnosed with pneumatosis cystoides intestinalis. Conclusion Pneumatosis cystoides intestinalis has an unknown etiology, although in a high percentage of patients it has been associated with obstructive pulmonary pathologies, connective tissue diseases, immunosuppression or gastrointestinal diseases. It is located more frequently in the colon and small intestine. It is diagnosed mainly through imaging tests (radiography or computed tomography). The treatment is conservative, performing surgical intervention if there is suspicion of intestinal necrosis; being difficult the differential diagnosis with a pneumoperitoneum by perforation of hollow viscera..
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Affiliation(s)
| | - Ana C Utrillas-Martínez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Obispo Polanco, Teruel, España
| | | | | | - José M Del Val-Gil
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Obispo Polanco, Teruel, España
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Barceló A, Esquinas C, Robles J, Piérola J, De la Peña M, Aguilar I, Morell-Garcia D, Alonso A, Toledo N, Sánchez-de la Torre M, Barbé F. Gut epithelial barrier markers in patients with obstructive sleep apnea. Sleep Med 2016; 26:12-15. [PMID: 28007354 DOI: 10.1016/j.sleep.2016.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/14/2015] [Accepted: 01/16/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is now being recognized as an additional contributing factor to the pathogenesis of obesity-related comorbidities. At the same time, there is now increasing evidence to suggest that intestinal wall permeability plays a role in the development of metabolic syndrome. In the present study, circulating zonulin and fatty acid binding protein (I-FABP) were measured in association with metabolic, hepatic, and inflammatory parameters. RESULTS Compared with controls, plasma I-FABP levels were significantly higher in patients with OSA (571 pg/mL [IQR 290-950] vs 396 pg/mL [IQR 234-559], p = 0.04). Zonulin levels were similar between groups. Significant relationships were observed between zonulin levels and waist circumference (p < 0.05), glucose (p < 0.05), and insulin (p < 0.05). In addition, in the OSA group, zonulin levels correlated negatively with the mean nocturnal oxygenation saturation (p < 0.05) and positively with total cholesterol (p < 0.05), alanine aminotransferase (ALT) (p < 0.005), aminotransferase (AST) (p < 0.01), gamma glutamyltransferase (GGT) (p < 0.005), and high-sensitivity C-reactive protein (hs-CRP) (p < 0.05). Multivariate analysis showed that associations between zonulin and ALT, AST, and hs-CRP were attenuated, but not eliminated, after adjustment for other variables. CONCLUSIONS The results of this study suggest that OSA is a risk factor for intestinal damage, regardless of metabolic profile, and that intestinal permeability might be a possible contributor to nonalcoholic fatty liver disease in patients with OSA.
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Affiliation(s)
- Antonia Barceló
- Servei de Anàlisis Clíniques, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Institut de investigacio (IdISPa), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Cristina Esquinas
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Juan Robles
- Servei de Anàlisis Clíniques, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Javier Piérola
- Institut de investigacio (IdISPa), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Servei de Unitat de Investigació, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Mónica De la Peña
- Institut de investigacio (IdISPa), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain; Servei de Pneumologia, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Irene Aguilar
- Servei de Anàlisis Clíniques, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Daniel Morell-Garcia
- Servei de Anàlisis Clíniques, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
| | - Alberto Alonso
- Institut de investigacio (IdISPa), Hospital Universitari Son Espases, Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain; Servei de Pneumologia, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Nuria Toledo
- Servei de Pneumologia, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Manuel Sánchez-de la Torre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain; Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, IRBLleida, Lleida, Catalonia, Spain
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain; Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, IRBLleida, Lleida, Catalonia, Spain
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Trevizan AR, Vicentino-Vieira SL, da Silva Watanabe P, Góis MB, de Melo GDAN, Garcia JL, José de Almeida Araújo E, Sant'Ana DDMG. Kinetics of acute infection with Toxoplasma gondii and histopathological changes in the duodenum of rats. Exp Parasitol 2016; 165:22-9. [PMID: 26993084 DOI: 10.1016/j.exppara.2016.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 03/10/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
Abstract
Toxoplasma gondii crosses the intestinal barrier to spread into the body. We investigate the intestinal wall and epithelial cells of the duodenum of rats infected with T. gondii during different time points of acute infection. Male Wistar rats, 60 days of age, were assigned into groups that were orally inoculated with 5000 sporulated oocysts T. gondii for 6 h (G6), 12 h (G12), 24 h (G24), 48 h (G48), 72 h (G72), 7 days (G7d), and 10 days (G10d). The control group (CG) received saline. The rats were killed and the duodenum was processed to obtain histological sections stained with hematoxylin and eosin, Periodic Acid Schiff, and Alcian blue (pH 2.5 and 1.0). Morphometry was performed on the layers of the intestinal wall and enterocytes, and the number of goblet cells and intraepithelial lymphocytes was counted. The data were compared by ANOVA considering 5% as level of significance. The infection provoked an increase in the width of villi and crypts; decrease in enterocyte height; increase in the smaller-diameter and reduction in the larger-diameter of the enterocytes nuclei, increased number of goblet cells secreting neutral (G6, G12 and G7d) and acidic (G7d and G10d) mucus, and increase in the number of intraepithelial lymphocytes (G48). The infected groups showed atrophy of the submucosa and muscular layers and the total wall. Acute infection with T. gondii caused morphological changes in the intestinal wall and epithelial cells of the duodenum in rats.
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Affiliation(s)
- Aline Rosa Trevizan
- Biosciences and Physiopathology Program, State University of Maringá, Avenida Colombo, n° 5790, Bloco T-20, Maringá, PR, CEP 87020-900, Brazil
| | - Suellen Laís Vicentino-Vieira
- Biosciences and Physiopathology Program, State University of Maringá, Avenida Colombo, n° 5790, Bloco T-20, Maringá, PR, CEP 87020-900, Brazil
| | - Paulo da Silva Watanabe
- Biosciences and Physiopathology Program, State University of Maringá, Avenida Colombo, n° 5790, Bloco T-20, Maringá, PR, CEP 87020-900, Brazil
| | - Marcelo Biondaro Góis
- Biosciences and Physiopathology Program, State University of Maringá, Avenida Colombo, n° 5790, Bloco T-20, Maringá, PR, CEP 87020-900, Brazil
| | | | - João Luiz Garcia
- State University of Londrina, Rodovia Celso Garcia Cid, Pr 445 Km 380, Londrina, PR, CEP 86057-970, Brazil
| | | | - Débora de Mello Gonçales Sant'Ana
- Biosciences and Physiopathology Program, State University of Maringá, Avenida Colombo, n° 5790, Bloco T-20, Maringá, PR, CEP 87020-900, Brazil.
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Revelli M, Bacigalupo L, Cevasco L, Furnari M, Paparo F, Scopelliti L, Rosenberg I, Rollandi GA. Degree of colonic distension: intrapatient comparison between CT colonography and CT with water enema. Clin Imaging 2016; 40:425-30. [PMID: 27133680 DOI: 10.1016/j.clinimag.2015.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/13/2015] [Accepted: 11/18/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE Compare colonic distension using CT colonography (CTC) and CT with water enema (CTWE) in the same patients. METHODS AND MATERIALS Twenty-seven patients who underwent both CTC and CTWE, considering separately supine (CTC-S) and prone (CTC-P) acquisition of CTC were included. The colon was divided into six segments, performing both a qualitative and quantitative analysis. RESULTS Adequate distension of sigmoid colon was more frequently achieved with CTC-P and CTWE compared to CTC-S (P<.05). CTC-P and CTWE showed better distension of the left colon compared to CTC-S (P<.01 and P=.03 regarding sigmoid colon, respectively; P=.01 and P=.03 regarding descending colon, respectively). CONCLUSIONS Computed tomography (CT) studies of the colon should be customized to fulfill the clinical query.
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Tonelli F, Giudici F, Liscia G. Is lymphatic status related to regression of inflammation in Crohn's disease? World J Gastrointest Surg 2012; 4:228-33. [PMID: 23443404 PMCID: PMC3582160 DOI: 10.4240/wjgs.v4.i10.228] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 09/14/2012] [Accepted: 09/21/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the status of the lymphatic vessels in the small bowel affected by Crohn’s disease (CD) at the moment of surgery.
METHODS: During the period January 2011-June 2011, 25 consecutive patients affected by CD were operated on in our Institution. During surgery, Patent Blue V was injected subserosally and the way it spread along the subserosa of the intestinal wall, through the mesenterial layers towards the main lymphatic collectors and eventually to the lymph nodes was observed and recorded. Since some patients had been undergone strictureplasty at previous surgery, we also examined the status of intestinal lymph vessels after previous strictureplasties. The same procedure was performed in a control group of 5 patients affected by colorectal cancer. Length of lesions, caliber, maximal thickness of the diseased intestinal wall, thickness of the wall at injection site and thickness of the mesentery were evaluated at surgery.
RESULTS: We observed three features after the injection of Patent Blue V in the intestinal loops: (1) Macroscopically healthy terminal ileum of patients with CD or colon cancer showed thin lymphatic vessels linearly directed toward the mesentery; (2) In mild lesions in which the intestinal wall did not reach 8 mm of thickness, we observed short, wide and tortuous lymphatic vessels directed longitudinally along the intestinal axis toward disease-free areas and then transversally toward the mesentery; and (3) Injection in the severely affected lesions, that had a thickness of the intestinal wall over 10 mm, did not show any feature of lymphatic vessels at least on the subserosal surface. There was a correlation between the thickness of the parietal wall and the severity of the lymphatic alterations. Normal lymphatic vessels were observed at previous strictureplasties in the presence of complete regression of the inflammation.
CONCLUSION: Injection of Patent Blue V in the intestinal wall could help distinguish healthy tracts of the small bowel from those macroscopically borderline.
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Affiliation(s)
- Francesco Tonelli
- Francesco Tonelli, Francesco Giudici, Gadiel Liscia, Department of Clinical Physiopathology, University of Florence, Surgical Unit, 50134 Florence, Italy
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Lindstedt S, Hlebowicz J. Blood flow response in small intestinal loops at different depths during negative pressure wound therapy of the open abdomen. Int Wound J 2012; 10:411-7. [PMID: 22698003 DOI: 10.1111/j.1742-481x.2012.00998.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
High closure rates of the open abdomen have been reported following negative pressure wound therapy (NPWT). However, the method has occasionally been associated with increased development of intestinal fistulae. We have previously shown that the application of NPWT to the open abdomen causes a decrease in microvascular blood flow in the small intestinal loop and the omentum adjacent to the visceral protective layer of the dressing. In this study we investigate whether the negative pressure affects only small intestinal loops lying directly below the dressing or if it also affects small intestinal loops that are not in direct contact with the dressing. Six pigs underwent midline incision and application of NPWT to the open abdomen. The microvascular blood flow was measured in four intestinal loops at different depths from the visceral protective layer, at two different locations: beneath the dressing and at the anterior abdominal wall, before and after the application of NPWT of -50, -70, -100, -120, -150 and -170 mmHg, using laser Doppler velocimetry. Negative pressures between -50 and -170 mmHg caused a significant decrease in the microvascular blood flow in the intestinal loops in direct contact with the visceral protective layer. A slight, but significant, decrease in blood flow was also seen in the intestinal loops lying beneath these loops. The decrease in microvascular blood flow increased with the amount of negative pressure applied. No difference in blood flow was seen in the intestinal loops lying deeper in the abdominal cavity. A decrease in blood flow was seen in the upper two intestinal loops located apically and anteriorly, but not in the lower two, indicating that this is a local effect and that pressure decreases with distance from the source. A long-term decrease in blood flow in the intestinal wall may induce ischaemia and secondary necrosis in the intestinal wall, which could promote the development of intestinal fistulae. We believe that NPWT of the open abdomen is a very effective treatment, but that it could be improved by gaining more knowledge on the mechanisms involved.
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Affiliation(s)
- Sandra Lindstedt
- Department of Cardiothoracic Surgery, Lund University Hospital, Lund, Sweden.
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