[Endorectal echography. Its usefulness in the study of neoplasms of the rectum]

OBJECTIVE

To analyze prospectively the results of the first endorectal ultrasonographies performed at the Coloproctology Unit of the Hospital Mutua de Terrassa in patients with rectal tumors.

METHODS

During the period between September 94 to June 95, 27 endorectal ultrasonographies were performed to patients with rectal tumors. The echographies were performed with a 360 degrees transducer. The ultrasound findings were compared to the histological results.

RESULTS

Three patients were not treated surgically, and were excluded from the analysis. In addition, three patients with perianastomotic recurrence were excluded. Of the remaining 21 patients the level of penetration in the rectal wall was correctly identified in 17 (81%). The presence of metastatic nodes was correctly assessed in 19 of the 24 patients explored (78%).

CONCLUSION

For the preoperative assessment of rectal tumors, endorectal ultrasonography offers a good accuracy even during the learning curve.

Evidence of differential effects produced by ethanol on specific phospholipid biosynthetic pathways in rat hepatocytes

1. The aim of the present study was to investigate the effects of ethanol in vitro on the phospholipid biosynthetic pathways in hepatocytes isolated from the rat. We have used [methyl-14C]-choline, [1-3H]-ethanolamine and L-[3-3H]-serine as exogenous precursors of the corresponding phospholipids, phosphatidylcholine (PC), phosphatidylethanolamine (PE) and phosphatidylserine (PS). 2. Incubation of hepatocytes in the presence of ethanol significantly alters the incorporation of radiolabel from [14C]-choline and [3H]-ethanolamine into the metabolic intermediates and the final products of the CDP-choline and CDP-ethanolamine pathways. Radioactivity in the metabolic intermediates of both pathways was significantly decreased and the amount of label in PE was reduced whilst that of PC was not modified. 3. In the presence of 4-methylpyrazole, an inhibitor of alcohol dehydrogenase (ADH) activity, ethanol produces a reduction in the label of choline phosphate, ethanolamine phosphate and a significant decrease in the amount of PC and PE radiolabel. 4. On the other hand, ethanol increases the incorporation of serine into phosphatidylserine, phosphatidylethanolamine and phosphatidylcholine, although this effect is observed only in the absence of 4-methylpyrazole, indicating that this alteration is produced by some metabolite generated as a consequence of hepatic alcohol metabolism. 5. Ethanol also interferes with the methylation of phosphatidylethanolamine produced via the CDP-ethanolamine pathway but it does not alter phosphatidylethanolamine methylation when this phospholipid is produced by mitochondrial phosphatidylserine decarboxylation, suggesting the existence of different intramembrane pools of phosphatidylethanolamine, which may exhibit different sensitivity to alcohol. 6. Our results indicate that ethanol exerts two different effects on phospholipid metabolism in hepatocytes: a stimulatory effect on the incorporation of exogenous substrates into different phospholipids probably related to an alteration in the availability of lipogenic substrates as a consequence of ethanol metabolism, and another inhibitory effect produced by ethanol per se, which can be observed only when ethanol metabolism is inhibited by the presence of a specific inhibitor of alcohol dehydrogenase activity.

Studies on phospholipid biosynthesis in hepatocytes from alcoholic rats by using radiolabeled exogenous precursors

We have studied the synthesis of phospholipids in hepatocytes isolated from chronically ethanol-treated rats by using isotopically labelled serine, ethanolamine, and choline as exogenous precursors. Our results demonstrate that ethanol induces specific effects on the biosynthesis of phosphatidylethanolamine and phosphatidylcholine via CDP-derivatives and also on the synthesis of phosphatidylserine via the Ca(++)-dependent base-exchange reaction. Thus, the synthesis of phosphatidylethanolamine from [3-H]ethanolamine and the incorporation of [3H]serine into phosphatidylserine were clearly higher in hepatocytes from ethanol-treated rats compared to controls. The synthesis of phosphatidylcholine from [methyl-14C]choline, on the other hand, decreased markedly, suggesting a specific inhibition of cholinephosphotransferase activity. We have also demonstrated that the phosphatidylcholine levels are markedly decreased in hepatocytes isolated from chronically ethanol-treated rats as a consequence of the lower phosphatidylcholine biosynthesis. The decrease in the incorporation of radioactivity from choline to betaine, which we also found, is interpreted as being the result of a higher use of betaine as methyl donor instead of methionine to maintain the hepatic S-adenosylmethionine levels in chronic alcoholism.

Nocturnal rise of leptin in lean, obese, and non-insulin-dependent diabetes mellitus subjects

We studied 24-h profiles of circulating leptin levels using a sensitive and specific RIA in lean controls and obese subjects with or without non-insulin-dependent diabetes mellitus (NIDDM) during normal routine activity. Serum leptin levels were significantly higher in obese (41.7 +/- 9.0 ng/ml; n = 11) and obese NIDDM (30.8 +/- 6.7; n = 9) subjects compared with those in lean controls (12.0 +/- 4.4, n = 6). In all the three groups, serum leptin levels were highest between midnight and early morning hours and lowest around noon to midafternoon. The nocturnal rise in leptin levels was significant when data were analyzed by ANOVA (lean: F = 3.17, P < 0.0001, n = 4; obese: F = 2.02, P < 0.005, n = 11; and obese NIDDM: F = 4.9, P < 0.0001, n = 5). The average circadian amplitude between acrophase and nadir was 75.6% in lean, 51.7%, in obese and 60.7% in obese NIDDM groups, respectively. No significant correlations (P > 0.05) were observed between circulating levels of leptin and either insulin or glucose levels in any of the 20 subjects studied for 24-h profiles. The nocturnal rise in leptin observed in the present study resembles those reported for prolactin, thyroid-stimulating hormone, and free fatty acids. We speculate that the nocturnal rise in leptin could have an effect in suppressing appetite during the night while sleeping.

Persistence of the effects of ethanol in vitro on the lipid order and enzyme activities of chick-liver membranes

Results demonstrate for the first time that ethanol exerts two different effects on the lipid order of chick-liver mitochondria and microsomes: a fluidizing effect both in the core and at the surface of the membrane, which depends on its physical presence, and a rigidization of the surface of these membranes which occurs after its removal. In addition, and directly related to the reduction in fluidity produced in the membrane surface after ethanol removal, we have detected a persistent alteration in different enzyme activities involved in the hepatic mitochondrial and microsomal electron-transport systems. The persistence of the alterations in the lipid order and enzyme activities may result from a structural rearrangement of the lipid and protein components produced in the lipid bilayer surface when ethanol is no longer present in the membrane.

[The endoscopic treatment of postcholecystectomy biliary leakage]

Although there is a decrease in the total number of complications observed on performance of laparoscopy cholecystectomy (LC) there does appear to be an increase in biliary tract lesions. Seven cases of postcholecystectomy biliary leakage treated with endoscopic methods are presented. These cases include 4 patients with leakage from the cystic canal stump and 3 with leakage from the common bile duct. In 5 cases the biliary tract lesion occurred following LC, 1 after conventional cholecystectomy and in 1 reconverted LP. CPRE identified the site of the leakage in the 7 patients and in 2 residual choledocholithiasis. In 5 cases treatment consisted in endoscopic papillotomy and placement of biliary endoprosthesis while only papillotomy was performed in 2 patients. In one of these cases CPRE was repeated and the sphincterotomy widened due to persistence of the leakage at 5 days, with the same finally closing at 15 days of the second CPRE. Closure of the biliary leakage was obtained in the other 6 cases in less than 72 hours post-CPRE. No complications secondary to the technique were observed. It was concluded that CPRE together with endoscopic papillotomy and placement of biliary prostheses is an effective and safe treatment for postcholecystectomy biliary leakages of the common bile duct or cystic duct.

Hydatid disease of the soft tissues of the lower limb: findings in three cases

Three cases of hydatid disease are reported, all presenting as soft tissue lesions in the lower extremities. All three cases were studied with ultrasound (US), two with computed tomography (CT), and two with magnetic resonance (MR) imaging techniques. Two patients presented with multivesicular lesions which were considered diagnostic of hydatid disease. The third patient showed a lesion with a predominantly solid pattern, closely mimicking a soft-tissue neoplasm. US was not diagnostic, but MR outlined vesicular structures and a fibrous pericyst. Hydatid disease presenting in the soft tissues can therefore be diagnosed with confidence when it shows multivesicular lesions but MR may be the most useful imaging technique when a complex or solid pattern is present.

Cholesterol synthesis and esterification in isolated enterocytes: regulation by cholesterol and cholestyramine feeding

The purpose of the present study was to investigate the physiological control of the main regulatory enzymes of cholesterol metabolism in isolated enterocytes obtained from chick duodenum, jejunum and ileum. Cholesterol feeding resulted in an inhibition of 3-hydroxy-3-methyl-glutaryl-CoA reductase and mevalonate 5-pyrophosphate decarboxylase, while cholestyramine feeding increased reductase activity in all the regions studied and decarboxylase activity only in duodenum. Cholesterol feeding markedly increased acyl-CoA:cholesterol acyltransferase, but the effects of cholestyramine were less clear. The effects on transferase activity cannot be due to differences in the availability of acyl-CoA as exogenous substrate as no significant differences were found in acyl-CoA hydrolase activity after any of the dietary treatments. The effects of cholesterol feeding were related to changes in the cholesterol content of epithelial cells, whereas in the case of cholestyramine this relationship was less apparent.