Classification of natural gums. VII. Relationships between the series Vulgares (Acacia senegal) and Gummiferae (Acacia seyal)

Real-Time Intraoperative Assessment of Microcirculation in Living-Donor Small Bowel Transplant: A Case Report

Living-donor small bowel transplant has emerged as a modality to transplant patients with short bowel syndrome without prolonged wait time, albeit at the cost of technical challenges associated with vascular anastomosis due to the small size of vessels. Suboptimal perfusion in a transplanted bowel can lead to a devastating outcome, and clinical judgment alone is not completely reliable for assessment of bowel microcirculation. Here, we report a 55-year-old female patient who underwent flow cytometric cross-match-positive living-donor bowel transplant from her daughter. Initial suboptimal perfusion prompted a revision of the arterial anastomoses. Despite normal Doppler signals over the mesenteric vessels, the bowel had a variegated appearance. The microcirculation of the bowel wall was subsequently assessed in a real-time fashion by indocyanine green fluorescence angiography, which showed improved perfusion indices with time. Hence, this simple test helped us to avoid another unnecessary exploration and revision of the anastomoses. At present, the patient is thriving on an enteral diet. This case underpins the importance of real-time intraoperative assessment of bowel per-fusion and microcirculation in difficult cases. These assessments are needed to help surgeons identify tissues at risk for ischemia and necrosis, thereby allowing for maneuvers to improve intestinal viability.

Acacia gum (Gum Arabic): a nutritional fibre; metabolism and calorific value

Gum Arabic (Acacia gum, INS 414: E414) is extensively used as a food additive, but there is no regulatory or scientific consensus about its calorific value. It is a complex polysaccharide, primarily indigestible to both humans and animals, not degraded in the intestine, but fermented in the colon under the influence of microorganisms. Despite a range of animal studies, there are no usable data for humans which can quantify the utilizable energy of Gum Arabic. Estimates in the literature from animal experiments vary from 0 to 4 kcal/g. After certain allowances are made for the energy losses from volatile and gaseous fermentation products, an upper level of 2 kcal/g for rats has been set. The situation in man is demonstrably different, with greatly reduced amounts of such products, and the need to adapt for varying periods before Gum Arabic is attacked by colonic bacteria. In the absence of an agreed scientific assignment, the FDA in the USA insist upon 4 kcal/g in nutritional labelling, whereas in Europe, no value has been assigned to soluble dietary fibre, such as Gum Arabic. This review argues that based on present scientific knowledge only an arbitrary value can be used for regulatory purposes.