Masaharu Nishi

Role of bile in intestinal barrier function and its inhibitory effect on bacterial translocation in obstructive jaundice in rats

BACKGROUND Our previous study using genetically labeled Escherichia coli strain JNW14 revealed that obstructive jaundice promotes bacterial translocation in rats and that the absence of bile in the intestinal tract is considered to be a factor inducing bacterial translocation. The aim of this study was to investigate the role of bile and bile acids in intestinal barrier function against bacterial translocation. MATERIALS AND METHODS Eight-week-old male specific-pathogen-free Wistar rats were subjected to ligation of their common bile ducts (CBDL). The CBDL rats were treated with bacitracin, neomycin sulfate, and streptomycin sulfate, and the intestinal tract was colonized with E. coli strain JNW14, which was genetically labeled with resistant markers against the above three antibiotics, to monitor the bacterial translocation. The rats were then administered saline, cholic acid (20 mg/100 g BW), taurocholic acid (TCA: 5-50 mg/100 BW), or bile (1.5-6 mL/day) via a duodenal catheter. The degree of bacterial translocation of E. coli strain JNW14 to the mesenteric lymph nodes was compared. Histopathological examination of the terminal ileum and intestinal permeability test using phenolsulfonphthalein was also performed. RESULTS Both cholic acid and TCA showed no inhibitory effect on bacterial translocation at any of the doses tested in CBDL rats, although TCA significantly decreased the numbers of E. coli strain JNW14 in the cecum. However, bile administration reduced the numbers of E. coli strain JNW14 in the cecum and mesenteric lymph nodes in CBDL rats although the inhibitory effect was weak. The integrity and permeability of the intestinal mucosa were kept at normal levels by bile administration in CBDL rats whereas the morphological changes, such as villous atrophy, villous edema, and lacteal canal dilatation, were observed in other CBDL rats. CONCLUSION Bile plays an important role in maintaining the intestinal barrier function to prevent the invasion of enteric bacteria to the underlying tissues, suggesting that the intestinal administration of bile to patients with obstructive jaundice is a useful way to reduce infectious complications by inhibiting bacterial translocation from the intestine to other organs.

Left diaphragmatic hernia associated with lower esophageal atresia

A case of combined left diaphragmatic hernia and lower esophageal atresia, which is an unusual occurrence, is described. The preoperative diagnosis was difficult because of the presence of an abnormal air bubble, thought to be the stomach, in the chest. The surgical management is discussed.

Promotion of bacterial translocation by major liver resection in obstructive jaundice in rats colonised predominantly with indigenous Escherichia coli

The influence of major liver resection in obstructive jaundice on bacterial translocation was evaluated in rats that were colonised predominantly with a genetically labelled strain of Escherichia coli. The strain, JNW14, originally isolated from rat faeces, was labelled with bacitracin, neomycin and streptomycin resistance markers. Fifty-two specific-pathogen-free male Wistar rats were divided into three experimental groups and were treated as follows: group 1 (n = 8), sham ligation of common bile duct; group 2 (n = 7), common bile duct ligation (CBDL); and group 3 (n = 37), 70% hepatectomy 7 days after CBDL. The rats were treated with the above antibiotics and then given E. coli strain JNW14 in their drinking water. Translocation of E. coli JNW14 from the gastrointestinal tract to the mesenteric lymph nodes (MLNs), lungs, liver, spleen and portal vein was evaluated in each group. In group 3 (CBDL plus hepatectomy), the incidence of translocation of E. coli JNW14 to the liver and spleen after hepatectomy was significantly higher than in groups 1 and 2. This result indicates that major liver resection in obstructive jaundice promotes bacterial translocation to systemic organs. Furthermore, the numbers of viable E. coli JNW14 in the MLNs in the lung culture-positive rats were significantly higher than those in the lung culture-negative rats, suggesting that lymphatic-thoracic duct systemic circulation is a major route of bacterial translocation.

Intra-operative total enteroscopy for the management of Peutz-Jegher's syndrome.

We present a case of Peutz‐Jeghers syndrome in an 18 year old female who was followed for gastrointestinal polyps for 13 years from the age of 5 years. The patient was treated four times with surgical or endoscopic polypectomy for gastrointestinal polyps. At the age of 14 years, a combined surgical and endoscopic approach for the management of Peutz‐Jeghers syndrome was carried out. A large polyp of the ileum required enterotomy for its removal, and another smaller polyp of the upper jejunum was identified and removed by intra‐operative total enteroscopy via the anus. Intra‐operative enteroscopy allows one to identify polyps that would previously have been missed. A more complete polypectomy can be performed using this technique, allowing the patient with Peutz‐Jeghers syndrome a longer interval between laparotomies and a reduction in symptoms attributed to polyps.

Nasal teratoma in a neonate associated with an acardiac amorphous twin

Nasopharyngeal teratomas are uncommon neoplasms found in neonates. A rare case of a teratoma arising from the nasal septum of a newborn associated with an acardiac amorphous twin is described. Antenatal ultrasonography suggested a fetal anomaly, for which a cesarean section was performed. Immediately after birth the tumor was excised, thereby eliminating life-threatening respiratory distress. The postoperative course was uneventful.

Investigations of Reoperated Cases of Congenital Disorders of the Esophagus in Children: Reports of Two Cases

Two pediatric cases of esophageal atresia, with or without a tracheoesophageal fistula (TEF), required secondary surgical intervention to the esophagus because of unexpected or unusual morbidities. Case 1 is an 8-year-old girl who required a reoperation for late recurrence of TEF 8 years after initial surgery at 1 day of age. Case 2 is a male newborn who was operated on at 3 days of age for left diaphragmatic hernia. He also underwent a second surgery 12 days later for lower esophageal atresia associated with a diverticulum-like abscess cavity, in which an abnormal air bubble was misinterpreted as being in the fundus of the herniated stomach. Patient 1 has had an uneventful course since surgery, but patient 2 died at 161 days of age due to severe aspiration pnuemonia caused by gastroesophageal reflux.

Clinical Study on Zinc Deficiency Receiving Total Parenteral Nutrition

During the past decade, 5 subjects with inflammatory bowel disease (1BD) and 3 with recurrent gastrointestinal cancer (RGC) developed symptomatic zinc deficiency during long term total parenteral nutrition (TPN). Characteristic skin lesions appeared earlier in IBD than in RGC (27.3 ± 13.6 vs 57.3 ± 4.9 days; p < 0.05). The plasma zinc levels at the onset were lower in RGC cases than those with IBD (12.0± 4.2 vs 23.8± 6.8µ g/dl). Doses Above 40 µ mol/day of parenteral zinc were necessary to improve plasma zinc levels.