[The morphofunctional characteristics of the cecum in experimental escherichiosis]

Using the model of experimental escherichiosis in mice by means of morphological, immunomorphological, morphometrical and electron microscopy methods, the authors give morphofunctional characteristics of caecum 15 minutes to 2 weeks after inoculation. The authors show the dynamics of infectious process, characterized by changes of microcirculation, increasing lymphoplasmocellular infiltration, dystrophic changes in cells of neuroplexes and degranulation of mast and endocrine cells. The data obtained show that pathological process in caecum during experimental escherichiosis has an immune character, that the above portion of the intestine is a part of endocrine system.

Analgesic and spasmolytic effects of dipyrone, hyoscine-N-butylbromide and a combination of the two in ponies

The analgesic and spasmolytic effects of dipyrone (Novalgin) (2500 mg/100 kg bodyweight) hyoscine-N-butylbromide (Buscopan) (20 mg/100 kg bodyweight) and a combination of both drugs were evaluated in a balloon-induced model of colic, using five ponies with caecal fistulae. The drugs were given intravenously and 0.9 per cent sodium chloride solution (5 ml/100 kg bodyweight) was used as a control. The physiological saline solution and dipyrone had no effect on caecal contractions. After the injection of hyoscine-N-butylbromide and the drug combination caecal contractions ceased within 30 seconds and for 20 and 24 minutes, respectively (P less than 0.05). The results on pain relief were not statistically significant for any of the drugs. Dipyrone had a good analgesic effect in only two of the ponies, starting after eight to 10 minutes and lasting for 50 minutes. The drug combination relieved pain within 30 seconds after injection and the relief lasted for 50 minutes in three of the ponies and for 20 minutes in the other two. Hyoscine-N-butylbromide alone produced an analgesic effect within 30 seconds after injection which lasted for 20 minutes.

Delayed stomach to caecum transit time in the diabetic rat. Possible role of hyperglucagonaemia

Disturbances of gastrointestinal motility are a common feature of diabetes mellitus and are usually ascribed to autonomic neuropathy. In order to assess the role of other factors on changes in motility in diabetes we have studied the stomach to caecum transit time (SCTT) during the progression of streptozotocin induced diabetes in the rat. Rats were used one, two, four, and eight weeks after a single injection of streptozotocin and age matched animals were used as controls. In further experiments non-diabetic rats received a bolus injection of pancreatic glucagon (50 or 75 micrograms intraperitoneally) or its diluent. SCTT was estimated using the non-invasive hydrogen excretion method. SCTT was unaffected by the age of the animal (mean (SEM) value: 101 (5) min), but was significantly delayed at one week (139 (11) min, p less than 0.01), two weeks (163 (16) min, p less than 0.01), four weeks (148 (9) min, p less than 0.01), and eight weeks (171 (13) min, p less than 0.01) after streptozotocin. SCTT was also slower during hyperglucagonaemia (control 96 (6) min; glucagon treated 50 micrograms: 120 (7) min, p less than 0.05 and 75 micrograms: 127 (8), p less than 0.05). Since autonomic neuropathy is not a recognised feature of the initial stages of diabetes hyperglucagonaemia may be responsible, at least in part, for diabetes induced changes in gastrointestinal motility.

Small bowel transit time measured by hydrogen breath test in patients with anorexia nervosa

The gastrocecal transit time was measured in 10 patients suffering from anorexia nervosa, using a lactulose hydrogen breath test, and was compared with the orocecal transit time in 11 healthy controls. One of the 10 patients and one of the 11 controls were excluded from this study because of no discernible increase in hydrogen excretion. The transit time was significantly prolonged in patients with anorexia nervosa compared with controls (117 min +/- 31 SD vs 81 min +/- 33 SD, P less than 0.02). In addition to delayed gastric emptying, which has hitherto been well known, the small bowel transit time was considered to be prolonged in patients with anorexia nervosa. Both these abnormalities seem to contribute to the development of various gastrointestinal symptoms in patients with anorexia nervosa.

Intestinal dysmotility syndromes in the elderly: measurement of orocecal transit time

Altered bowel habits are common symptoms in the elderly, yet the pathophysiology of age-related gastrointestinal dysmotility syndromes is poorly understood. The present study was designed to correlate changes in orocecal transit time (TT) in healthy elderly subjects with or without gastrointestinal dysmotility complaints. Twenty-two geriatric facility resident volunteers, mean age 82 yr (range 65-94 yr) participated, of whom 16 had gastrointestinal dysmotility symptoms. Orocecal TT in the elderly subjects did not differ from that in younger adult controls (100 +/- 11 min vs 93 +/- 20 min). However, orocecal TT was longer in geriatric females (112 +/- 14 min) than in males (70 +/- 6 min, p less than 0.01). We conclude that age alone does not prolong orocecal TT, except when dysmotility symptoms have been present for a prolonged period.

[What is new in the diagnosis of appendicitis? Borborygmi in the cecal region]

The author analysed a homogeneous prospective series of 200 appendectomies. He studied the reliability of various elements in the diagnosis of appendicitis, including a new physical sign: borborygmi in the cecal region, an objective element on clinical examination which was present in 65% of cases. Its association with pain on rectal examination allowed a diagnostic certainty of 98% to be obtained.

Mouth-to-cecum transit time in patients affected by chronic constipation: effect of glucomannan

Mouth-to-cecum transit time was studied in 13 patients affected by chronic idiopathic constipation and 18 control subjects matched with the constipation group for age, sex, and dietary habits. In a preliminary investigation, all patients showed a prolonged whole gut (oroanal) transit time as measured with radiopaque markers. Mouth-to-cecum transit time was studied through the serial determination of breath H2 after administration of 12 g lactulose diluted in 120 ml water. Breath H2 was measured with a gas analyzer and was determined in parts per million (ppm). Breath H2 after lactulose was also determined in the group with constipation after a 10-day diet that included either glucomannan (1 g tid orally) or placebo administered in a double-blind manner. The results show a statistically significant increase in mouth-to-cecum transit time in the group with constipation, compared with controls, and a return to within the normal range after the 10-day treatment with glucomannan. With placebo, no difference in transit time was noted. We therefore suggest that chronic idiopathic constipation is a disease that involves the whole gut.

The effect of Strongylus vulgaris larvae on equine intestinal myoelectrical activity

The myoelectrical activity of the ileum, caecum and large colon was monitored from Ag-AgCl bipolar recording electrodes in four conscious 'parasite-naive' weanling foals. All foals were inoculated with 1000 infective 3rd-stage Strongylus vulgaris larvae and alterations to the myoelectrical activity observed. The frequencies of caecal and colonic spike bursts increased significantly in all post infection periods coinciding with assumed larval penetration into the intestinal mucosa and migration through the vasculature. Peaks in caecal and colonic activity occurred at Days 1 to 5 post infection. In the caecum, peaks occurred again at Days 15 and 31 post infection, preceding similar rises in colonic spike burst frequency at Days 19 and 35. Longer term changes indicated a return towards pre-infection levels of activity suggesting smooth muscle adaptation to decreased blood flow. The analysis of caecal and colonic spike burst propagation indicated that the increases in burst frequency were not attributable to an increase in the propagation of spike bursts in any particular direction, but rather to proportional increases in all directions of activity. There was a slight decrease in the simple ileal spike burst frequency immediately post-infection. None of the experimental animals exhibited signs of abdominal pain during the trial, and there was no evidence of bowel infarction at post mortem examination despite the presence of severe parasite-induced arterial lesions. The results suggest that increased caecal and colonic motility is an important host response in susceptible foals exposed to S. vulgaris larvae.

Effect of atropine and terbutaline on motor activity of the continent caecal reservoir for urine

The effects of muscarinic receptor blockade (atropine) and of beta-adrenoceptor stimulation (terbutaline) on the motor activity of the continent caecal reservoir for urine were studied in 12 patients during continuous filling of the reservoir. Basal pressure was low at high level filling, but pressure waves with amplitudes of 40 to 50 cm H2O occurred every other minute. The reservoir's functional adaptation, revealed as a diminished amplitude of pressure waves and evident soon after its construction, remained stable at long-term follow-up. Subcutaneously injected atropine or terbutaline did not influence the basal pressure but increased the volume at which the first pressure wave appeared and decreased the wave amplitude and frequency at high filling levels. Intra-reservoir instillation of these drugs did not alter the dynamic behaviour of the reservoir. In selected patients, orally administered anticholinergic drugs or beta 2-adrenoceptor agonists may be useful in the management of hyperactivity in a colonic segment used as a continent reservoir or bladder substitute.

In-vitro motility of normal and pathological smooth muscle of colon

This study is based on the in-vitro analysis of the normal and pathological colon smooth muscle contraction. Two different methods, supported by computer analysis, are presented. This approach will probably help the physician and the surgeon to better understand the physiopathology of some characteristical diseases, such as Hirschsprung's disease.

Orocaecal transit time in health and in thyroid disease

Altered bowel habit commonly occurs in thyroid disease. We measured orocaecal transit in healthy volunteers and in hyperthyroid and hypothyroid patients before and after treatment, using the lactulose hydrogen breath test incorporating a standard liquid meal to obtain a more physiological assessment. Mean transit time in 12 control subjects was 85 (8) minutes (mean (SE)) (mean coefficient of variation between replicate studies, 8.6% (3%)). In eighteen hyperthyroid patients transit was more rapid at 49 (4) minutes (p less than 0.01). Ten hypothyroid patients had a transit time similar to controls at 91 (9) minutes. Transit time returned to normal in thyrotoxic patients after treatment but in eight hypothyroid patients retested, it remained unchanged. Our findings suggest that (a) the inclusion of a liquid meal provides a reproducible method of measuring orocaecal transit using the lactulose hydrogen breath test, (b) rapid small bowel transit in thyrotoxicosis may be one factor in the diarrhoea which is a feature of the disease and (c) if altered gut transit is the cause of sluggish bowel habit in hypothyroidism, delay in the colon, and not small bowel, is likely to be responsible.

Relationships between symptoms, menstrual cycle and orocaecal transit in normal and constipated women

Because severe constipation is a disorder largely confined to young women, the possibility that menstrually related factors contribute to disturbed gastrointestinal motor function has been raised. It has also been reported that normal menstruating women show changes in upper gut transit between the follicular and luteal phases of the menstrual cycle and that patients with constipation show prolonged transit. We therefore studied relationships between symptom severity and orocaecal transit during the menstrual cycle in a group of 14 constipated women and a series of control groups comprising seven normal menstruating women, five postmenopausal women, and eight normal men, to determine whether phases of the menstrual cycle were associated with alteration in symptoms or transit. A regular menstrual cycle was reported by 13 of the 14 patients (range 26-30 days) and by all the menstruating female volunteers. Seven patients noted variation in constipation during the menstrual cycle, in all cases this comprised an improvement in symptoms just before or during menstruation. No consistent relationship between symptom severity and follicular or luteal phase was noted. Repeated orocaecal transit measurements in the four study groups showed no consistent differences (greater than 0.05) between groups or during the menstrual cycle (mean change weeks 1-4, -10 +/- 20 min). These findings are inconsistent with the hypothesis of a progesterone related effect upon orocaecal transit in either normal or constipated women.

Intestinal microflora and gastrointestinal adaptation in the rat in response to non-digestible dietary polysaccharides

1. A comparison was made of the effect of a fibre-free diet and diets containing non-digestible polysaccharides on rat caecal and colonic physiology and microflora. 2. All polysaccharide-containing diets led to enlargement of the caecum and colon, associated with increased weight of contents, and of tissue. Carboxymethylcellulose (CMC) had the most marked effect and animals given this also had watery faeces. 3. The density of bacteria in the caecum and colon varied significantly with diet and the proportion of aerobic bacteria in the flora was increased by the CMC diet. 4. In vitro, CMC and hydroxypropylmethylcellulose were poorly fermented. 5. There was a high correlation (caecum r 0.93; colon r 0.94) between tissue weight and wet weight of organ contents but no correlation with bacterial density, number of bacteria per organ, moisture content or short-chain fatty acid content. 6. It is concluded that caecal and colonic enlargement is due to tissue hypertrophy in response to increased bulk of contents, irrespective of the nature of that bulk which varies with diet; it is unlikely that short-chain fatty acids or other microbial metabolites are the stimulus for the trophic response seen when non-digestible dietary polysaccharides are fed to rats.

Cecal filling and defecation of chickens infected with Eimeria tenella

White Leghorn cockerels, 11 to 22 days old, were inoculated each with a single oral dose of 4-5 X 10(4) sporulated oocysts of Eimeria tenella. Radiographic study of urinary backflow in infected chickens injected with sodium iothalamate subcutaneously indicated that retrograde movement of ceca was impaired particularly 7, 10, and 14 days after infection. No inflow was noted 7 days after infection when barium sulfate was inoculated into cloaca. Weight of cecal contents examined 7 days after infection was significantly smaller than uninfected control. Number of cecal feces was counted every 24 h beginning 4 through 14 days after infection. The counts in infected birds were significantly fewer than uninfected control 8, 9, and 10 days after infection. Outflow of cecal contents was studied in chickens surgically injected with barium sulfate into cecum 7 days after infection. Radiographic study indicated that most of uninfected control ceca excreted or evacuated the medium between 10 and 24 h after injection, while a few infected birds cleared ceca during the same period.

Delayed postprandial plasma bile acid response in coeliac patients with slow mouth-caecum transit

Coeliac patients are known to have an expanded bile salt pool which recirculates slowly due, at least in part, to impaired gall bladder contractility. We have investigated the possibility that delayed small bowel transit of chyme and bile may also contribute to this sluggish recycling. Plasma cholylglycine, total bile acids and cholecystokinin concentrations were measured after a lactulose-labelled test meal whose mouth-caecum transit time (M-C TT) was assessed by the breath hydrogen technique. Overall there were no significant differences in plasma bile acid profiles between seven healthy controls and a group of 25 coeliac patients. However, when subjects were divided according to their M-C TT, the 10 with the slowest transit were found to have significant elevation of fasting levels when compared with the 10 with the fastest transit, fasting total bile acids being 3.4 +/- 1.3 versus 0.7 +/- 0.6 mumol/l (P less than 0.02) and fasting cholylglycine being 0.43 +/- 0.17 versus 0.06 +/- 0.04 mumol/l (P less than 0.05) respectively. Peak bile acid levels did not differ significantly between subjects with fast or slow transit. However, subjects with slow transit were found to have a delay in the return of plasma bile acid levels to fasting levels so that the 4 h postprandial levels were significantly elevated when compared with those observed in the subjects with fast transit (total bile acids 3.6 +/- 1.2 versus 0.19 +/- 0.1 mumol/l and cholylglycine 0.70 +/- 0.13 versus 0.24 +/- 0.07 mumol/l respectively, both P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Bloated irritable bowel syndrome defined by dynamic 99mTc bran scan

The motility of the ileocaecal region of the gut was studied in 10 women with irritable bowel syndrome (IBS) and bloating and in 8 normal women. Bran labelled with 37 MBq 99mTc was administered after fasting, and a dynamic scan was done after a standard meal 3 h later. Time-activity curves were plotted for the ileum and caecum. In controls, ileal emptying was faster, peak % counts in the caecum were higher, and ileocaecal clearance was greater than in those with IBS. The profound motor dysfunction seen in those with IBS may account for their symptoms, and the "bran scan" could become an important diagnostic aid.

Stimulation of colonic goblet cells by cecal filtrates from rabbits with experimental mucoid enteropathy

Mucoid enteropathy was induced experimentally by ligation of the cecum, and sterile filtrates were prepared from cecal contents of sick and control rabbits. Explants were prepared from the colons of normal rabbits and were maintained in a short-term organ culture system. Cecal filtrates from rabbits with experimental mucoid enteropathy when added to the culture medium, stimulated mucus secretion and discharge from goblet cells. This was exhibited by an increase in number of visible goblet cells, presence of mucus in crypt lumen and/or presence of a significant amount of mucus blanketing the surface epithelium. The results indicated that a mucus-stimulating substance, a goblet cell secretagogue, was produced in the cecum of affected rabbits.

Acute pseudo-obstruction of the colon (Ogilvie's syndrome). An analysis of 400 cases

This study analyzes 400 cases of acute pseudo-obstruction of the colon (Ogilvie's syndrome). Seven cases were reported at St. Elizabeth Hospital Medical Center between October 1982 and February 1985; 393 cases were reported in the literature from 1970-1985. Ogilvie's syndrome is most commonly reported in patients in the sixth decade, and is more predominant in men. It is caused by an unknown disturbance to the autonomic innervation of the distal colon, and is associated with different conditions. Plain abdominal roentgenogram is the most useful diagnostic test. If the cecal diameter is 12 cm or greater, or conservative management is unsuccessful, colonoscopic or operative decompression is needed. The mode of treatment, age, cecal diameter, delay in decompression, and status of the bowel significantly influence the mortality rate, which is approximately 15 percent with early appropriate management, compared with 36 to 44 percent in perforated or ischemic bowel.

Dynamics of a continent caecal reservoir for urinary diversion

Motor activity of the caecal reservoir for urine, and of the intussuscepted nipple valve in the ileal outlet, was studied in seven continent and two incontinent patients by means of a catheter equipped with two microtransducers. The basal pressure was low in the reservoir even at large-volume filling. In the continent patients the basal pressure was always higher in the ileal outlet than in the reservoir. No high-pressure zone was present in the outlet in the incontinent patients. Intermittent pressure waves occurred in the reservoir, and they increased in frequency, duration and amplitude with increasing filling. Pressure waves with higher amplitude arose simultaneously in the outlet. Increasing time from construction of the reservoir was accompanied by decreasing amplitude of the pressure waves, indicating adaptation towards the larger functional capacity of the reservoir. The recorded dynamics seemed to reflect the functional state of the reservoir.

Mobile cecum syndrome

Five cases of mobile cecum syndrome are presented. These patients all presented with chronic right lower quadrant abdominal pain with associated abdominal distention and symptomatic relief after passing flatus or having a bowel movement. Three patients had preoperative barium enemas demonstrating abnormal mobility of the cecum. On exploration, all patients were found to have the cecum and ascending colon unattached to the lateral peritoneum for 15 to 18 cm. All patients were treated by cecopexy, using a lateral peritoneal flap for fixation, and all have had relief of their pain. This technique is described and illustrated. Cecopexy is an effective method of fixing the cecum and prevents subsequent cecal volvulus. The diagnosis of mobile cecum syndrome should be considered in patients with chronic right lower quadrant pain.

Renal function after urinary diversion. A study of continent caecal reservoir, ileal conduit and colonic conduit

Total and separate renal function, renal parenchymal thickness and dilatation of the upper urinary tract were studied in 40 patients preoperatively and 24 to 67 months after urinary diversion, using 51Cr-EDTA clearance test, scintillation camera renography and urography. In ten patients a continent caecal reservoir was used for diversion. In the other patients, an ileal or a colonic conduit (15 patients with each method) was used, one ureter being implanted with an anti-reflux method and the other with direct technique. Renal function following urinary diversion showed little or no deterioration in most patients. The functional outcome was not related to the method of diversion or, in the conduit groups, to the mode of ureteral implantation. Serum creatinine tests and urography were not adequate for determining loss of renal function. Radionuclide studies proved to be valuable for assessing renal function after urinary diversion.

Acute effects of full urinary bladder and full caecal urinary reservoir on regional renal function. A study with scintillation camera renography

Scintillation camera renograms were recorded in six patients without a history of bladder function disturbances and in eight patients with caecal urinary reservoir. Each patient was studied once with empty bladder/reservoir and once with full bladder/reservoir. Renograms were obtained from parenchyma, pelvis and whole kidney. Time was measured from injection of isotope to peak of the renogram curve (Tmax) and to the point corresponding to the centre of gravity of the area under the curve (Tg). A full reservoir gave longer Tmax and Tg for both parenchyma and pelvis than an empty reservoir. With full bladder the only significant change was Tg increase for renal pelvis. In the patients with full caecal reservoir, the elimination of radioisotope from the renal pelvis was significantly slower, reflected as longer Tmax and Tg, than in the subjects with full bladder. In comparisons between empty and full bladder/reservoir, Tg permitted clearer separation between the groups than did Tmax. The higher Tmax and Tg values for full than for empty reservoir indicated obstruction to urinary flow and could be ascribed to the high intrareservoir pressure. Regularly occurring pressure waves with amplitudes of 30-65 cm H2O were recorded in the reservoirs, sometimes reflected as transient increases in radioisotope activity in the renograms. In some patients the two kidneys differed considerably in their response to a full urinary bladder or reservoir. The cause may have been difference in the dynamics of the two ureterovesical junctions or of the ureterointestinal anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Physiologic basis of blood loss during Eimeria tenella infection

Eimeria tenella-induced hemorrhage resulted in total blood losses of up to 10% of the body weight. Although packed cell volume was reduced 50%, neither plasma volume nor blood volume was significantly decreased, except briefly. The retention of lost blood in the ceca varied with the strain of E. tenella. Chicks infected with laboratory strain (L.S.) 24 passed most of the blood into the feces, whereas those infected with L.S. 49 retained most of the blood within the ceca.

Crohn's disease and the enterohepatic circulation

Crohn's disease is a chronic inflammatory process which may affect any part of the alimentary tract. This cause is unknown. Overall the distribution of the lesions coincides with that of the enterohepatic circulation. A possible causative agent is a metabolic or ingested substance excreted into the bile in the form of a polar and inactive conjugates. The agent would have to have a prolonged half life in the enterohepatic circulation. In the ileocaecal region and elsewhere when bacterial colonisation occurs the inactive conjugates may be hydrolysed to release the active substance. This would act locally on the intestinal tissues either as a result of altering the physicochemistry of mucus or during passage through the gut wall.

Coccidial infection with Eimeria tenella and caecal defaecation in chicks

1. The periodicity of caecal defaecation was investigated in chicks infected with Eimeria tenella. The birds were illuminated for 12 h/d (07.00-19.00) and faeces were collected at 3-h intervals for up to 21 d. 2. In uninfected birds caecal faeces were never collected during the dark period. During the periods 07.00-10.00 h, 10.00-13.00 h, 13.00-16.00 h and 16.00-19.00 h, caecal defaecation occurred on approximately 44, 19, 55 and 91% of the total number of days respectively. 3. In infected birds production of haemorrhagic caecal faeces began from between 90 and 156 h after infection and continued during both light and dark periods for between 12 and 48 h. After this period, no caecal faeces were observed for between 39 and 120 h. Normal caecal defaecation resumed from between 198 and 264 h.

Ileocolic intussusception in an adult caused by a granuloma of the appendiceal stump: report of a case

Images