Factors affecting outcome following proximal and distal intestinal resection in the dog: an examination of the relative roles of mucosal adaptation, motility, luminal factors, and enteric peptides

In the clinical setting, resection of the ileum results in an inferior functional outcome compared to jejunal resection. This may be related to a greater adaptive capacity of the ileum, intrinsic structural and functional differences, or regional differences in motor and hormonal function. Our aim was to evaluate the relative contributions of these factors to functional outcome after resection of the proximal or distal intestine. Twenty-four dogs underwent either intestinal transection or 50% resection of the proximal or distal intestine. Studies (nutritional status, absorption, adaptation, motility, peptide levels) were performed every four weeks until the animals were killed at 12 weeks. Caloric intake was similar in all four groups. Weight loss was greater and more sustained after distal resection (DR). Serum cholesterol levels decreased significantly only in the DR group. While stool weight and moisture were similar, the DR animals had persistent, significant steatorrhea. Intraluminal anaerobic bacteria and SCFA concentrations were significantly greater in the ileum but were not influenced by resection. Intestinal remnant length increased to a greater extent after proximal resection (PR), but circumference increased to a similar extent after both resections. Villus height and crypt depth increased significantly only after PR. MMC frequency was similar in all four groups. In the DR animals 26% of migrating motor complexes (MMCs) originated within the remnant. The jejunal remnant of these animals had a dominance of cluster activity similar to the intact distal ileum. Following PR, the postprandial motilin response was decreased. After DR, there were transient increases in neurotensin and PYY. Of the various factors evaluated, mucosal adaptation and the intestinal motor response appear most likely to explain the inferior nutritional and absorptive outcome associated with resection of the distal small intestine.

Electron microscope studies of the structure of the microvilli on principal epithelial cells of rat jejunum after treatment in hypo- and hypertonic saline

Immersion of the intestinal tissue, from rat jejunum, in hypertonic saline produced very rapid changes in all regions of the epithelial cells, but the apical region was apparently unaffected by hypotonic solutions for at least ½ hour. In both cases, blistering of the microvilli was taken as the first sign of degenerative changes which finally resulted in a breakdown to large vesicular particles. Consideration of both normal and modified tissue indicates that the core of the microvillus contains either paired strands or tubular structures. Lateral cross-fibres extended from the core to the microvillus membrane and may be an essential part of the supporting structure of the microvillus. Densitometer traces across the microvillus membrane at various stages of modification indicated that this membrane might include a 75 A unit membrane structure with additional components associated at either surface. Interruptions in the membrane were apparently expanded by the hypotonic solutions and these might possibly be distinguished from preparative artefacts.

Sucrase-isomaltase ontogeny: synergism between glucocorticoids and thyroxine reflects increased mRNA and no change in cell migration

During postnatal maturation of the rat small intestine, glucocorticoid hormones (GC) and thyroxine (T4) act synergistically to elicit a precocious increase of sucrase activity. The current work shows that the synergistic effect on sucrase activity is paralleled by increased steady-state levels of sucrase-isomaltase mRNA. The enhancing effects of T4 on dexamethasone (DEX)-induced sucrase activity was seen even after prolonged treatment (9 days). Moreover, when the location of sucrase-bearing cells was examined after 2 days of hormone treatment, there was distinctly stronger immunostaining of sucrase in the presence of T4, and the sucrase-bearing cells were located on the lower quarter of the intestinal villi regardless of whether the animals received DEX or T4 plus DEX. Thus, despite predictions from the literature, there was no evidence for increased migration in the presence of T4. Instead, we conclude that the synergism between the two hormones is due to greater accumulation of sucrase-isomaltase per epithelial cell.

What surface of the intestinal epithelium is effectively available to permeating drugs?

A mathematical model is presented which examines the extent to which the intestinal epithelium is accessed by drug molecules. Morphological information from the literature for the jejunum, ileum, and colon of the rat and for human jejunum was incorporated. Perturbation theory was used to derive the limiting cases for total access to the entire epithelial surface, for transport by diffusion and by diffusion with convection, respectively. A parameter gamma = square root of (Ph2)/(Db) was identified to provide a measure of the ability of drug molecules to access the entire epithelial surface down to the crypt wells, where P is the cell permeability, D the aqueous diffusion coefficient, h the channel depth between the villi, and b is half the width of the idealized intervillous channel. When gamma << 1, diffusion is not a limitation and the entire surface is fully utilized for absorption of drug. This condition arises with drugs of low permeability and is more likely to be met with colonic than small intestinal epithelium. When gamma >/= 1, diffusion becomes a limitation and then not all of the epithelial surface is functionally accessible to drug molecules, a condition most likely to prevail with drugs of high permeability traversing the jejunum. Furthermore, water flux per se is predicted to have relatively little influence on enhancing surface accessibility. This simple, but quantitative approach showed that the ranking order of permeability jejunum >ileum> colon for low permeable drugs can at least in part be explained by the differences in surface amplification between these different epithelial regions. The analysis also indicates that for highly permeable drugs extreme caution should be exercised in extrapolating permeability measurements in vitro across various preparations and to events in vivo.

Neither intact nor hydrolyzed soy proteins elicit intestinal inflammation in neonatal piglets

BACKGROUND

Efficacy of feeding hydrolyzed soy proteins to infants intolerant to cow milk proteins has not been determined fully. This study compared growth and intestinal responses of neonatal piglets fed formulas with hydrolyzed soy protein to piglets fed formulas with intact soy or cow milk (casein-whey) proteins.

METHODS

Piglets (n = 40, day 2 postpartum) were fed commercial milk replacer until day 7 postpartum (designated day 0) and then were assigned randomly to casein-whey (CW) or soy (intact, SI; hydrolyzed SH) formulas to evaluate intestinal responses on days 0, 2, 5, and 10.

RESULTS

Average daily gain was higher for CW (121 g/d; p < .05) compared with SI piglets 85 g/d); SH pig weight gain was intermediate (109 g/d). Villus height-to-crypt depth ratio in proximal jejunum was lower (p < .05) on day 2 than day 0 in soy-fed pigs and lower (p < .05) on day 5 than day 0 in CW pigs. Mucosal mast cells were generally higher in CW pigs compared with soy-fed pigs. Villus goblet cell numbers in the midjejunum of SH-fed piglets were lower (p < .05) on day 5 compared with day 0. On day 5, crypt goblet cell numbers were higher (p < .05) in the midjejunum of CW-fed piglets compared with SH-fed piglets with numbers intermediate for SI-fed piglets. Intestinal differences were not detected among dietary treatments for major histocompatibility complex class I and II gene expression, tissue concentrations of prostaglandin E2, or CD8+ T-cell numbers.

CONCLUSIONS

Hydrolyzed soy proteins do not elicit intestinal inflammatory responses in piglets and may be viable alternatives to milk and intact soy proteins for feeding infants.

Intestinal adaptation after massive proximal small-bowel resection in the pig

BACKGROUND

Small-intestinal adaptation to resection has been extensively studied in rats. The present study investigates morphology, crypt cell proliferation, and disaccharidase activities of the remaining small intestine and colon after 75% proximal resection of porcine small intestine.

METHODS

Specimens were obtained from the proximal jejunum, middle and distal ileum, and proximal colon preoperatively (n = 5) and 14 weeks after small-bowel transection (n = 5) or resection (n = 5). Proliferation was analyzed immunohistochemically with the Ki-67 antigen MIB-1. Disaccharidase activities were determined in accordance with the method of Dahlqvist.

RESULTS

In addition to macroscopic enlargement, resection markedly increased the villi and crypts of the remaining small bowel. Crypt cell proliferation decreased with advancing age after transection but remained at the preoperative level after resection. Specific, but not total, activities of maltase and sucrase in the mid-ileum decreased after resection.

CONCLUSION

Small-intestinal adaptation in the pig involves macroscopic enlargement and a prompt increase in villus size, which is associated with high crypt cell proliferation.

[Correlation between membrane and soluble forms of intestinal enzymes in rat ontogenesis]

With ageing the membrane/soluble form ratio of membrane-boundenzymes increases especially in the ileum and that of peptidases changes rather insignificantly in both portions of the rat small intestine. The soluble forms are supposed to take part in assimilation of food substrates penetrating enterocytes in an unsplit form due to an enhanced permeability of the membranes, particularly those of the ileum.

Organization of the lamina propria mucosae of rat intestinal mucosa, with special reference to the subepithelial connective tissue

Light microscopy, scanning electron microscopy and transmission electron microscopy have been used to delineate the structure and function of the lamina propria mucosae in the rat jejunum. In silver-impregnated sections, the adepithelial surface of the lamina propria mucosae was framed by a sheet of reticular fibers (reticular sheet). Short-term (3-hour) immersion of jejunal tissues in 2 N NaOH solution enabled us to simultaneously view networks of reticular fibrils and fibroblasts residing in the subepithelial connective tissue under a scanning electron microscope. The reticular fibrils, which measured about 40 nm in diameter and were interwoven in dense networks, formed a sheet 2-3 microns thick. In the villi, this sheet contained numerous foramina ranging from 3 to 7 microns in diameter, through which lymphocytes, macrophages, basal extensions of epithelial cells and fat particles traversed. The reticular sheet in the domes of isolated lymphoid nodules was markedly porous, and many lymphocytes migrated into or out of the epithelium through the foramina. The formaina of the reticular sheet may participate in the communication between the intestinal epithelium and the lamina propria mucosae. It was noted that the foramina of the reticular sheet in the villi were surrounded by end feet of the cytoplasmic processes of fibroblasts. In addition, these fibroblasts were combined with lymphocytes or dendritic cells in the lamina propria mucosae.

Glutamine protects function and improves preservation of small bowel segments

BACKGROUND

Improved organ preservation is essential for the success of small bowel transplantation. Small bowel is usually preserved in UW (University of Wisconsin) solution which does not contain glutamine (Gln), the principal fuel for the enterocyte. We hypothesized that Gln-supplemented UW would improve mucosal function and structure of cold preserved small intestine.

MATERIALS AND METHODS

Jejunum (40 cm) was harvested from Lewis rats and preserved for 18 hr at 4 degrees C in saline; UW solution only; UW with 1, 2, or 4% Gln; and UW containing 1, 2, or 4% isonitrogenous balanced nonessential amino acids (NEAA). 14C glucose transport, mucosal protein, mucosal maltase and alkaline phosphatase, jejunal villous height, and histologic damage were measured.

RESULTS

UW with 2% Gln significantly increased glucose transport and mucosal protein when compared to the 2% NEAA and UW-only groups. Two percent Gln significantly decreased histologic damage of jejunum following cold preservation. Increasing Gln to 4% did not significantly increase its efficacy when compared to the UW with 2% Gln group. There were no significant differences in the activities of mucosal maltase and alkaline phosphatase among the various treatment groups.

CONCLUSIONS

The addition of Gln, optimally provided at a concentration of 2%, to UW solution may protect the preserved small bowel segments from cold ischemic injury and improve mucosal function.

Modification of the Merendino procedure

The jejunal interposition operation after resection of distal esophagus and cardia, designed by Merendino and Dilard, has not been widely employed until now. The complexity of the procedure, demanding high performance, and still unacceptable postoperative mortality, were limiting factors and a challenge for many surgeons. The aim of this paper is to present three modifications of the original technique, without changing the basic concept of the Merendino procedure. These modifications differ from the original technique in three main ways: the longer isoperistaltic jejunal segment, the terminolateral mechanical esophagojejuno anastomosis, and the placement of the lower jejunogastric anastomosis on the posterior wall of the stomach. This report comprises an experience in 29 patients operated on in period 1972 through 1995. There were two postoperative deaths and long-term results were excellent in all except one patient who had an ischemic stenosis of the transplanted jejunal segment. Despite this, the Merendino procedure, simplified by these modifications, deserves to be more frequently used in the treatment of undilatable or recurrent strictures and other benign lesions which require resection of the distal esophagus and cardia.

Enzyme-histochemical demonstration of the intramural lymphatic network in the monkey jejunum

The structural organization of the intramural lymphatic networks in the jejunum of the Japanese monkey (Macaca fuscata) was studied by an enzyme-histochemical method using whole-mount preparations of tissue layers. A distinction between the lymphatics and the blood vessels was made by light microscopy using 5'-nucleotidase (5'-Nase)-alkaline phosphatase (ALPase) double staining. In each tissue specimen, the reaction product for 5'-Nase activity was localized in the lymphatic vessels, whereas that for ALPase activity was restricted to blood vessels. The mucosal layer exhibited an irregular network of tubular lymphatics connecting to the central lymphatics in the villi. The submucosal layer revealed a horizontal mesh-like network consisting of tubulo-saccular lymphatics. A dense maze-like network of lymphatics was distributed throughout the myenteric layer. The lymphatic networks were independent of the blood vessels. The present results indicate the usefulness of the enzyme-histochemistry of whole-mount preparations of the laminar layers for demonstration of the structure and distribution of the lymphatic system in the intestinal wall.

Quantification of immunohistochemical staining by color translation and automated thresholding

OBJECTIVE

To develop a method of quantitating immunohistochemical staining using diaminobenzidine (DAB) and hematoxylin by means of color image analysis.

STUDY DESIGN

Red-green-blue (RGB)-filtered grayscale values from images from microscopic slides of mouse jejunum, stained with DAB, hematoxylin or both were analyzed using the public domain program NIH Image. Based on the correlations between the R-G- and B-filtered grayscale values, a simple translation algorithm using the RGB information was developed, providing the option for separation of DAB only- and double-stained areas from hematoxylin only-stained areas by means of automated thresholding. The method was tested by staining mouse jejunum for the growth factors EGF, TGF-alpha and TGF-beta 1-3 using immunohistochemical techniques.

RESULTS

A good separation of DAB- and double-stained pixels from hematoxylin-stained pixels was achieved, with misclassification of only 2.4% of the pixels as compared to 34% misclassification using automated thresholding of the blue component of the RGB image, the untransformed grayscale images with the most contrast for DAB- and non-DAB-stained areas. Significant differences in relative areas stained and mean specific optical density for the growth factors in mouse jejunal crypts and villi were observed.

CONCLUSION

The image analysis method described offers the possibility of objective determination of stained area in histologic slides with the commonly used DAB and hematoxylin chromophores. It shows that reproducible and objective measurements can be made based on RGB true color images acquired using a simple microscope and video camera setup and the public domain program NIH Image.

Effects of exogenous neurotensin on intestinal postresectional growth in the suckling rat

BACKGROUND

In the suckling rat, massive bowel resection provokes intestinal malabsorption that leads to diminished growth. The object of this report was to test whether neurotensin, intestinal trophic peptide, enhances postresection intestinal adaptation, improving absorption and reducing the adverse effects of resection on growth.

METHODS

Fifty-seven 15-day-old suckling. Wistar rats were divided into four groups: 41 rats were subjected to resection of 90% of their small bowel, while the rest (n = 16) underwent laparotomy. Half of the animals, resected and laparotomized, were treated with neurotensin for 30 days. The body weight was monitored, and samples of bone and intestinal mucosa were obtained at the end of the study period for analysis. Blood was tested to determine iron, ferritin, folic acid, and vitamin B12 levels.

RESULTS

The resected animals lost body weight regardless of neurotensin administration. In the resected animals, femur weight increased significantly when they received neurotensin. Bowel resection provokes significant increases in the intestinal mucosa (crypts and villi), but after neurotensin administration, significant increases were detected only in the jejunum of the resected animals but not in the ileum of laparotomized rats. In the resected animals, significant decreases in iron, ferritin, folic acid, and vitamin B12 levels were observed. The postresection administration of neurotensin only produced a significant rise in the ferritin concentration.

CONCLUSIONS

In the suckling rat, neurotensin enhances the intestinal proliferative phenomenon but does not improve the course of medium-term postresection growth.

Bedside placement of pH-guided transpyloric small bowel feeding tubes in critically ill infants and small children

BACKGROUND AND METHODS

The small bowel of critically ill infants and small children was cannulated using a soft feeding tube with a pH sensor at the distal tip. By monitoring pH, the tubes were guided through the stomach into the small bowel.

RESULTS

Successful placements were performed in 36 of 37 (97%) attempts in 29 critically ill patients whose age was 7.9 +/- 6.3 months and weight was 5.9 +/- 2.6 kg. Continuous jejunal feedings were administered for 3.7 +/- 3.1 weeks without difficulties or complications in all but one patient.

CONCLUSION

pH-guided jejunal tube placement provides a safe, easy bedside alternative to fluoroscopic, endoscopic or surgical placement in critically ill infants and small children.

Congenital intractable diarrhea of infancy in Iraqi Jews

We report on five patients who presented with intractable diarrhea starting during the first days of life. The patients belonged to four families of Iraqi Jewish origin. Autosomal recessive inheritance is suggested by parental consanguinity in three families and recurrence in another sib in one family. The patients were all born after uneventful pregnancy and labor, with birth weight in the normal range. There were no dysmorphic features. Three patients were breast fed. Diarrhea started between the first and eighth day of life. Diarrhea was of the secretory type. No pathogen was cultured from the stool. Jejunal biopsies performed on all patients ranged from normal to severe partial villous atrophy. The patients received different drug regimens with no beneficial effect and all are dependent on TPN. These findings and the common ethnic origin of the patients suggest that these patients have the same syndrome of congenital intractable diarrhea. No similar cases are known in other ethnic groups in Israel, suggesting a possibility of high gene frequency among the Jews of Iraqi origin.

Effects of alanyl-glutamine on gut barrier function

Traditional parenteral nutrition (PN) and chemotherapy may lead to changes of mucosal morphology and gut barrier function. This study investigated the effect of alanyl-glutamine (Ala-Gln) on intestinal morphology and gut barrier function in PN-fed rats challenged with 5-fluorouracil (5-FU). Male Wistar rats were centrally catheterized and then randomized to receive PN devoid of glutamine (control group; n = 10) or 3% Ala-Gln-supplemented PN (study group; n = 10) for 7 d. Intestinal permeability to lactulose and mannitol was measured before and 72 h post 5-FU administration on day 4. Serum glutamine concentration and jejunal mucosal structure were maintained in the study group compared with the control group (P < 0.05). The bacterial translocation rates of mesenteric lymph nodes in the study group were significantly lower than the control (30% versus 90%; P < 0.05). No significant differences was found between the control and study groups with respect to ratio of lactulose and mannitol excreted in urine (L/M) (0.026 +/- 0.005575 versus 0.022 +/- 0.03079; P > 0.05) on day 3. On day 7, L/M was unaltered in the study group, whereas it increased in the control (0.042 +/- 0.004634 versus 0.029 +/- 0.002020; P < 0.05). We concluded that glutamine dipeptide maintained intestinal mucosal morphology and barrier function in PN-fed rats challenged with 5-FU.

Smooth muscle adaptation after intestinal transection and resection

Changes in motor function occur in the intestinal remnant after intestinal resection. Smooth muscle adaptation also occurs, particularly after extensive resection. The time course of these changes and their interrelationship are unclear. Our aim was to evaluate changes in canine smooth muscle structure and function during intestinal adaptation after transection and resection. Twenty-five dogs underwent either transection (N = 10), 50% distal resection (N = 10), or 50% proximal resection (N = 5). Thickness and length of the circular (CM) and longitudinal (LM) muscle layers were measured four and 12 weeks after resection. In vitro length-tension properties and response to a cholinergic agonist were studied in mid-jejunum and mid-ileum. Transection alone caused increased CM length in the jejunum proximal to the transection but did not affect LM length or muscle thickness. A 50% resection resulted in increased length of CM throughout the intestine and thickening of CM and LM near the anastomosis. Active tension of jejunal CM increased transiently four weeks after resection. Active tension in jejunal LM was decreased 12 weeks after transection and resection. Sensitivity of CM to carbachol was similar after transection and resection. It is concluded that: (1) Structural adaptation of both circular and longitudinal muscle occurs after intestinal resection. (2) This process is influenced by the site of the intestinal remnant. (3) Only minor and transient changes occur in smooth muscle function after resection. (4) Factors other than muscle adaptation are likely involved in the changes in motor function seen following massive bowel resection.

Vitamin A-deficient rats have only mild changes in jejunal structure and function

This study investigated the effect of clinical and subclinical vitamin A deficiency on intestinal structure and function in rats. Weanling male rats fed a vitamin A-deficient diet (VA-) for 40-42 or 60-63 d were compared with rats either pair-fed (PF) or with free access to the same diet supplemented with vitamin A (VA+). A reference (REF) group was fed a standard rat diet. Weight began to plateau in VA- rats after 42 d, becoming significantly different from PF rats at 60-63 d (P < 0.02). Diarrhea did not develop in any study group. VA- rats had clinical signs of vitamin A deficiency in the 60-63 d study, but not in the 40-42 d study. However, serum and liver retinol concentrations were negligible in all VA- rats. VA- rats in the 60-63 d study had significantly reduced villus height (P < 0.02), and sucrase and maltase activities (P < 0.02) compared with PF rats. There were no differences between VA- and PF rats in mucosal wet weights, protein and DNA concentrations, thymidine kinase activity and glucose transport. No differences were detected in the 40-42 d study for any variable measured. Because clinical vitamin A deficiency in rats causes only mild changes in intestinal structure and function, it is unlikely that these alterations alone are responsible for the interactions observed in epidemiological studies between vitamin A deficiency and diarrheal disease.

Laparoscopic anatomy of the abdomen in dorsally recumbent horses

OBJECTIVES

To provide an accurate and detailed description of the laparoscopic anatomy of the abdomen of horses positioned in dorsal recumbency and to compare those observations with laparoscopic anatomy of standing horses. The effects of laparoscopy and positional changes on arterial blood pressure and blood gas values also were investigated.

DESIGN

Descriptive anatomic study.

SAMPLE POPULATION

Laparoscopy was performed on 6 horses (2 mares, 2 geldings, and 2 stallions) to record the normal laparoscopic anatomy of the abdomen in dorsal recumbency.

PROCEDURE

Feed was withheld from all horses for 36 hours. Horses, under general anesthesia, were examined in horizontal and inclined positions (head-up and head-down). Intermittent positive-pressure ventilation was used, arterial blood pressure was continuously monitored, and samples for arterial blood gas measurements were taken at intervals.

RESULTS

The main structures of diagnostic relevance observed in the caudal region of the abdomen were the urinary bladder, mesorchium and ductus deferens (left and right), left and right vaginal rings, insertion of the pre-pubic tendon, random segments of jejunum and descending colon, pelvic flexure of the ascending colon, body of the cecum, and cecocolic fold. The main structures observed in the cranial region of the abdomen were ventral surface of the diaphragm, falciform ligament and round ligaments of the liver, ventral portion of the left lateral, left medial, quadrate, and right lateral lobes of the liver, spleen, right and left ventral colons, sternal flexure of the ascending colon, apex of the cecum, and stomach.

CONCLUSIONS

Alterations in cardiovascular and respiratory function in response to pneumoperitoneum and various positional changes indicated the need for continuous and thorough anesthetic monitoring and support. Comparison of anatomic observations made in dorsally recumbent, inclined horses with those reported for standing horses should enable practitioners to make patient positioning decisions that best suit access to specific visceral structures. Development of special instrumentation for manipulation of the viscera in horses, particularly the intestinal tract, would increase the diagnostic and therapeutic capabilities of laparoscopy during dorsal recumbency.

Patterns of gene expression along the crypt-villus axis in mouse jejunal epithelium

BACKGROUND

There is considerable interest in gene expression along the crypt-villus axis of the small intestinal epithelium, particularly in the identification of genes expressed in intestinal crypts.

METHODS

In an attempt to identify crypt-expressed genes, single-stranded cDNA made from normal mouse jejunal epithelium was used in subtractive hybridization against single-stranded cDNA from epithelium from which crypt cells were depleted by 2,000 rads of gamma irradiation. Partial DNA sequence and in situ hybridization of 72 resulting clones were determined.

RESULTS

The sequence of 45 clones matched previously published genes. Gene expression patterns fell into three categories: expression throughout the crypt-villus axis, expression restricted to the villus, and expression restricted to the crypt. Clones in the first two categories could be further divided into three subgroups: those with uniform expression, those with an increasing gradient of expression, and those with a decreasing gradient of expression along the crypt-villus axis. Twenty two clones showed a stronger expression in crypt and lower villus cells, four of these were differentially localized to the crypt. Two of the crypt localized clones were uniformly expressed throughout the crypt, expression of one was stronger in the lower crypt, and expression of the remaining clone was enhanced Paneth cells. We report the full-length cDNA sequence of the Paneth-cell-enhanced clone.

CONCLUSIONS

The screen isolated crypt-expressed genes that may prove useful tools in the study of crypt biology. In a companion report, we characterize one of the crypt clones.

Treitz redux: the ligament of Treitz revisited

In the medical literature, the ligament of Treitz is frequently used as a term to designate the duodenojejunal flexure, but the attributes of the structure itself are not generally known. Indeed, anatomists describe it as the suspensory muscle of the duodenum, arising from the connective tissue around the stems of the celiac and superior mesenteric arteries and inserting as nonstriated muscle commonly into the third and fourth portions of the duodenum and frequently into the duodenojejunal flexure as well. Misconceptions regarding its configuration and anatomic relationships continue to be widely illustrated. The fibromuscular structure plays an important role in the embryologic rotation of the bowel and in facilitating normal progression of contents from the extraperitoneal duodenum to the mesenteric small bowel and contributes to the effects of the superior mesenteric artery syndrome. Whereas virtually all other ligaments and mesenteries in the abdomen have been imaged, features of the ligament of Treitz render its visualization by CT or MRI challenging.

CT of the duodenojejunal junction

To determine the location of the duodenojejunal junction (DJJ) at computed tomography (CT), we retrospectively reviewed 309 consecutive CT examinations. These included 162 men and 127 women (mean age = 57 years old, range = 11-85 years old). Some people received more than one examination. The clinical indications included various kinds of neoplasms, inflammations, congenital lesions, trauma, and other conditions. The DJJ was defined as the first sectioned ascending duodenum whose major part lies to the right side of the crossing part of the inferior mesenteric vein over the immediate beginning of the jejunum. Forty-nine examinations were excluded due to distortion of the DJJ by contiguous pathologic processes or nonadministration of intravenous contrast medium. In 36 examinations, the junctions were not identified. In the successfully identified 224 examinations, the DJJ was located to the left in 75 (33.5%), in the left half in 87 (38.8%), and in the right half or to the right of the vertebral body in 4 (1.8%) examinations. The midline of the DJJ was along the left margin and in the midline of the vertebral body in 53 (23.7%) and 5 (2.2%) examinations. In the anteroposterior direction, it was totally in front of the aorta in 189 (84.4%) and within the projected contour of the aorta in 11 (4.9%) examinations. The midline of the DJJ was along the anterior margin of the aorta in 24 (10.7%) examinations. Its cephalocaudal position was at the upper L1 in 36 (16.1%), lower L1 in 70 (31.3%), upper L2 in 75 (33.5%), and lower L2 in 21 (9.4%) examinations even though it ranged from upper T12 to upper L3.(ABSTRACT TRUNCATED AT 250 WORDS)

Regional variation in canine intestinal muscle mass and function

Our aim was to investigate the contribution of variations in intestinal muscle morphology or function to regional differences in motor properties in vivo. We quantitated intestinal muscle thickness and surface area along the canine gut and compared the in vitro contractile properties of the jejunum and ileum. The thickness and cross-sectional surface area of both circular and longitudinal muscle demonstrated a parabolic distribution along the intestine, with the greatest values occurring in the proximal and distal regions. The terminal ileum had the greatest circular (885 +/- 194 microns) and longitudinal muscle (367 +/- 135 microns) thickness. Circular muscle was 2.5-3 times thicker than longitudinal muscle at all points. Passive tension was similar in muscle strips from the mid-jejunum, mid-ileum, and terminal ileum (2.8 +/- 0.8, 2.5 +/- 0.4, and 2.3 +/- 0.8 vs 2.5 +/- 0.5, 1.9 +/- 0.5, and 2.8 +/- 1.0, longitudinal and circular, respectively). Active and total tension, however, were significantly greater in longitudinal than circular muscle in mid-jejunum (active; 8.5 +/- 1.4 vs 5.6 +/- 1.2, P < 0.05 and total 11.3 +/- 1.7 vs 8.1 +/- 1.2) and in mid-ileum (active 9.5 +/- 1.6 vs 5.8 +/- 1.2 and total 12.0 +/- 1.6 vs 7.7 +/- 1.2). Values for each layer were similar in both sites. In contrast, in the terminal ileum, longitudinal and circular muscle strips demonstrated similar active (10.1 +/- 1.7 vs 9.0 +/- 2.7, NS) and total tension (12.4 +/- 2.0 vs 11.9 +/- 3.4, NS). Dose-response curves to carbachol (10(-8)-10(-2) M) were similar in all these regions. We conclude (1) there are regional variations in muscle mass but contractile properties are similar in jejunum and ileum; and (2) the unique motor properties of the terminal ileum may be related more to differences in muscle morphology and neural input than intrinsic function.

Insulin-like growth factor-I improves mucosal structure and function in transplanted rat small intestine

The transplanted small intestine develops significant mucosal atrophy, impaired nutrient and water absorption, and increased bacterial translocation to mesenteric lymph nodes in rats maintained on elemental diets or total parenteral nutrition. This study determined the effects of administration of an peptide growth factor (insulin-like growth factor-I[IGF-I]) on the mucosal structure and barrier function of rat small bowel isografts. Thirty-six adult Lewis rats underwent either resection of the distal 60% of the small bowel and proximal colon followed by a 40-cm orthotopic jejunal isograft or proximal small bowel transection and distal small bowel resection to leave an analogous length of small intestine in control animals. All rats received an isocaloric, isonitrogenous, polymeric diet (200 kcal/kg/day, 2 gN/kg/day) by gastrostomy and were infused with either IGF-I (2.4 mg/kg/day) or vehicle by osmotic pumps subcutaneously. After 10 days of treatment, jejunal crypt cell production, mucosal morphometric indices, glucose and water absorption, body weight, and bacterial translocation to mesenteric lymph nodes (MLN) were measured. Jejunal mRNA content for IGF-I, IGF-I receptor, and IGF-binding proteins 3 and 4 (IGFBP-3,4) were determined by Northern blotting. Crypt cell production, villus height, crypt depth, and villus surface area were significantly increased in control and transplanted jejunum of rats infused with IGF-I when compared to animals given vehicle alone. Additionally, jejunal glucose absorption and water absorption were significantly improved in both IGF-I groups when compared with their respective vehicle controls. IGF-I infusion increased body weight in transplanted and control animals and markedly reduced bacterial translocation to MLN after small bowel transplantation. Jejunal levels of IGF-I mRNA were significantly increased in transplanted animals when compared to transected controls. IGF-I treatment significantly increased IGFBP-3 tissue mRNA levels in both transected and transplanted animals. These results demonstrate that IGF-I administration, after small bowel transplantation, improves mucosal structure and absorptive function and reduces bacterial translocation to MLN. IGF-I may have important effects in transplanted small bowel both as an endogenous and administered growth factor.