Effects of octreotide acetate and Saccharomyces boulardii on bacterial translocation in an experimental intestinal loop obstruction model of rats

Destructive colon injuries requiring resection: Is colostomy ever indicated?

BACKGROUND

The management of destructive colon injuries requiring resection has shifted from mandatory diverting stoma to liberal use of primary anastomosis. Various risk criteria have been suggested for the selection of patients for primary anastomosis or ostomy. At our center, we have been practicing a policy of liberal primary anastomosis irrespective of risk factors. The purpose of this study was to evaluate the colon-related outcomes in patients managed with this policy.

METHODS

This retrospective study included all colon injuries requiring resection. Data collected included patient demographics, injury characteristics, blood transfusions, operative findings, operations performed, complications, and mortality.

RESULTS

A total of 287 colon injuries were identified, 101 of whom required resection, forming the study population. The majority (63.4%) were penetrating injuries. Furthermore, 16.8% were hypotensive on admission, 40.6% had moderate or severe fecal spillage, 35.6% received blood transfusion of >4 U, and 41.6% had Injury Severity Score of >15. At index operation, 88% were managed with primary anastomosis and 12% with colon discontinuity, and one patient had stoma. Damage-control laparotomy (DCL) with temporary abdominal closure was performed in 39.6% of patients. Of these patients with DCL, 67.5% underwent primary anastomosis, 30.0% were left with colon discontinuity, and 2.5% had stoma. Overall, after the definitive management of the colon, including those patients who were initially left in colon discontinuity, only six patients (5.9%) had a stoma. The incidence of anastomotic leaks in patients with primary anastomosis at the index operation was 8.0%, and there was no colon-related mortality. The incidence of colon anastomotic leaks in the 27 patients with DCL and primary anastomosis was 11.1%, and there was no colon-related mortality. Multivariate analysis evaluating possible risk factors identified discontinuity of the colon as independent risk factor for mortality.

CONCLUSION

Liberal primary anastomosis should be considered in almost all patients with destructive colon injuries requiring resection, irrespective of risk factors.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.

Effect of probiotic Saccharomyces boulardii in experimental giardiasis

The aim of the study was to assess the efficacy of Saccharomyces boulardii in experimental treatment of giardiasis and its impact on intestinal integrity and some functions of gerbils infected with Giardia lamblia. 28 gerbils (Meriones unguiculatus), aged 4-6 weeks, were divided into four groups: untreated and uninfected control (CT); infected with G. lamblia (IGL); treated with S. boulardii (SB); and infected with G. lamblia and treated with S. boulardii (ITSB). The SB and ITSB groups received S. boulardii 15 days prior to being infected with G. lamblia. The treatment continued until completion of the experiment (22nd day). The IGL and ITSB groups were gavage-inoculated with G. lamblia ensuring one-week infection. 4 h before euthanasia, all animals were gavaged with a solution containing diethylenetriamine-pentaacetic acid (DTPA) marked with technetium-99mTc DTPA to determine intestinal permeability. The small intestine was removed for histopathological, morphometric analysis and count of trophozoites adhered to the mucosa. The selected probiotic caused an approximate reduction of 70% of parasite load, which was determined by attached trophozoites (P<0.01) and immune-marked trophozoites (P<0.05). Treatment with S. boulardii (SB and ITSB groups) also increased the height of the intestinal villi and crypt depth compared to the CT and IGL groups (P<0.05). The area of mucus production and the number of goblet cells of the SB and ITSB groups were higher compared to the CT and IGL groups (P<0.01). The animals treated with S. boulardii also exhibited a significant increase of intraepithelial lymphocytes counts (P<0.01). There was no difference in the intestinal permeability between the groups studied. The efficacy of S. boulardii in reducing damages caused by Giardia was demonstrated, with an approximate reduction of 70% of the parasite load, suggesting its use as a coadjuvant in giardiasis treatment.

Discontinuity of the Bowel Following Damage Control Operation Revisited: A Multi-institutional Study

BACKGROUND

Discontinuity of the bowel following intestinal injury and resection is a common practice in damage control procedures for severe abdominal trauma. However, there are concerns that complete occlusion of the bowel, especially in the presence of hypotension or edema that may result in ischemic bowel changes or increase bacterial or toxin translocation.

METHODS

This was a retrospective study from three Level-1 trauma centers. Included were trauma patients who required bowel resection and damage control. The study population was stratified into two groups based on the management for bowel injury: bowel discontinuity versus primary anastomosis. Outcomes included anastomotic leak, organ space infection, bowel ischemia, and mortality.

RESULTS

A total of 167 cases were included. In 84 cases, continuity of the bowel was established, and in 83, the bowel was left in discontinuity. The epidemiological, admission, and intraoperative physiological characteristics, the abdominal Abbreviated Injury Scale, type of intra-abdominal injury, and transfusion requirements were similar in the two study groups. The mortality was 8.3 % in the continuity group and 16.9 % for the discontinuity group (p = 0.096). On the crude bivariate and adjusted regression analyses, there was a higher rate of bowel ischemia at the take-back operation in the discontinuity group (p = 0.003 for the crude and p = 0.034 for the adjusted). The organ space infection and anastomotic leak rate were not significantly different between the study groups.

CONCLUSIONS

Discontinuity of the bowel following damage control operation is associated with a higher risk of bowel ischemia than in patients with anastomosis. Further prospective observational and randomized studies are warranted.

LEVEL OF EVIDENCE

III.

Intraintestinal drainage as a damage control surgery adjunct in a hypothermic traumatic shock swine model with multiple bowel perforations

BACKGROUND

Temporary bowel ligation (TL) has been proposed to prevent contamination as a damage control procedure in multiple bowel perforations. However, bacteria translocation and intestinal ischemia may develop in a prolonged duration. We here hypothesized that intraintestinal drainage combined with temporary ligation (D-TL) would decrease intestinal injury and improve survivals in a gunshot multiple bowel perforation swine model in the setting of a damage control surgery.

MATERIALS AND METHODS

The abdomen was shot one time with an experimental modified gun whereas pigs were hemorrhaged to a mean arterial pressure of 40 mm Hg and maintained in shock for 40 min. Cold lactated Ringer solution was gradually infused to induce hypothermia. Animals were randomized to primary anastomosis, TL and intraintestinal D-TL groups (n = 8). Animals were resuscitated for 12 h with the shed blood and lactated Ringer solution. Delayed anastomosis was performed in TL and D-TL animals after resuscitation. Surviving animals were humanely killed 24 h after operation. Systemic hemodynamic parameters were recorded and blood samples were obtained for biochemical assays. Intra-abdominal pressure, portal vein and peripheral vein bacterial cultures, small intestine hematoxylin-eosin staining, and transmission electron microscopy examination were performed at 0, 2, 6, 12, and 24 h after the surgery.

RESULTS

All animals suffered extreme physiologic conditions as follows: hypothermia, severe acidosis, hypotension, and depressed cardiac output. Compared with the primary anastomosis and TL group, D-TL animals required less resuscitation fluid, suffered a lower intra-abdominal hypertension and bacterial translocation, normalized lactate levels faster, had lower serum creatine kinase, aspartate aminotransferase levels and tissue TNF-α level, and nuclear factor-kB activations and thus had greater early survival.

CONCLUSIONS

Compared with primary intestinal anastomosis and TL, rapid bowel ligation combined with intraintestinal drainage as a damage control adjunct improved survivals in a multiple bowel perforation swine model in the setting of damage control surgery.

The Effects of Erythropoietin on Bacterial Translocation and Inflammatory Response in an Experimental Intestinal Obstruction Model in Rats / Uticaj Eritropoetina Na Bakterijsku Translokaciju I Inflamatorni Odgovor U Eksperimentalnom Modelu Intestinalne Opstrukcije Kod Pacova

Background:Intestinal obstruction results in distortion of balance of antiinflammatory cytokines and release of oxidants, and also leads to bacterial translocation, sepsis and multiple organ failure. Asymmetric dimethylarginine is related to multiple organ failure as a new prognostic marker. Erythropoietin reduces the inflammatory response by decreasing the levels of proinflammatory cytokines and cytokine-induced apoptosis. In this study, we aimed to investigate the effectiveness of erythropoietin in reducing the severity of bacterial translocation and inflammatory response after intestinal obstruction and the relation between asymmetric dimethylarginine and inflammatory markers.

Methods:Forty Wistar albino rats (200-250 g) were divided into 4 groups as follows: Group 1 (Sham), only ileocaecal junction dissection; Group 2 (Erythropoietin), ileocaecal junction dissection and 3000 lU/kg erythropoietin subcutaneously; Group 3 (Intestinal Obstruction), complete ileal ligation; Group 4 (Intestinal Obstruction + Erythropoietin), complete ileal ligation and 3000 IU/kg erythropoietin subcutaneously. After 24 hours, the rats were sacrificed by taking blood from the heart for biochemical analyses. Peritoneal swab culture, liver, mesenteric lymph nodes, spleen and ileum were collected for microbiological and histopathological examinations.

Results:Erythropoietin reduced the secretion of inflammatory cytokines, oxidative damage and bacterial translocation, prevented the formation of inflammatory changes in the intestine, liver, spleen and mesenteric lymph nodes,and also significantly prevented the formation of intestinal damage after intestinal obstruction (p<0.05). Conclusions: Asymmetric dimethylarginine levels did not differ between the groups. Erythropoietin may be useful to preserve from intestinal injury and related sepsis in patients with intestinal obstruction. Asymmetric dimethylarginine is not a suitable prognostic marker.

Protection against increased intestinal permeability and bacterial translocation induced by intestinal obstruction in mice treated with viable and heat-killed Saccharomyces boulardii

BACKGROUND

There are substantial evidences suggesting that probiotics can protect the gastrointestinal tract against inflammatory or infectious episodes. The effects of oral treatment with viable or heat-killed cells of Saccharomyces boulardii (Sb) on bacterial translocation, intestinal permeability, histological aspect of the ileum, and some immunological parameters were evaluated in a murine intestinal obstruction (IO) model.

RESULTS

Bacterial translocation and intestinal permeability in the IO group were significantly higher when compared to a Sham group (p < 0.05). Pretreatment with both viable and heat-killed S. boulardii prevented these increases, and the data obtained for IO + Sb and IO + heat-killed Sb groups were similar to those observed in the Sham group (p > 0.05). Histological analysis showed preservation of the ileum mucosa in mice that received both forms of the yeast when compared to the lesions observed in the IO group. The levels of serum interleukin (IL)-10 and intestinal secretory immunoglobulin A (sIgA) were higher in the animals that received both yeast treatments when compared to those from IO and Sham groups.

CONCLUSION

Oral treatment with viable or heat-killed cells of S. boulardii maintained intestinal integrity and modulated the immune system in a murine IO model, preventing bacterial translocation and intestinal lesions.

Saccharomyces cerevisiae strain UFMG 905 protects against bacterial translocation, preserves gut barrier integrity and stimulates the immune system in a murine intestinal obstruction model

Probiotic is a preparation containing microorganisms that confers beneficial effect to the host. This work assessed whether oral treatment with viable or heat-killed yeast Saccharomyces cerevisiae strain UFMG 905 prevents bacterial translocation (BT), intestinal barrier integrity, and stimulates the immunity, in a murine intestinal obstruction (IO) model. Four groups of mice were used: mice undergoing only laparotomy (CTL), undergoing intestinal obstruction (IO) and undergoing intestinal obstruction after previous treatment with viable or heat-killed yeast. BT, determined as uptake of (99m)Tc-E. coli in blood, mesenteric lymph nodes, liver, spleen and lungs, was significantly higher in IO group than in CTL group. Treatments with both yeasts reduced BT in blood and all organs investigated. The treatment with both yeasts also reduced intestinal permeability as determined by blood uptake of (99m)Tc-DTPA. Immunological data demonstrated that both treatments were able to significantly increase IL-10 levels, but only viable yeast had the same effect on sIgA levels. Intestinal lesions were more severe in IO group when compared to CTL and yeasts groups. Concluding, both viable and heat-killed cells of yeast prevent BT, probably by immunomodulation and by maintaining gut barrier integrity. Only the stimulation of IgA production seems to depend on the yeast viability.

Effects of the probiotic agent Saccharomyces Boulardii on the DNA damage in acute necrotizing pancreatitis induced rats

Pancreatitis is a mild and self-limiting disease. Although severe forms such as acute necrotizing pancreatitis (ANP) are rare it is associated with significant mortality rate reported to be 30-70%. Probiotics are viable microbial dietary supplements when introduced in sufficient quantities can have beneficial effects. The physiological effects of probiotics include suppression of bacterial infections, production of some digestive enzymes and vitamins and reconstruction of normal intestinal microflora. In the present study, the aim was to investigate the role of probiotics on the DNA damage in the peripheral lymphocytes, in the exfoliated epithelial cells and lymphocytes of the peritoneal fluids and in the pancreatic acinar cells of ANP induced rats. DNA damage was determined by COMET assay. ANP was induced by intravenous infusion of cerulein and superimposed infusion glycodeoxycholic acid into biliopancreatic duct. Saccharomyces Boulardii was used as the probiotic agent. DNA damage in pancreatic acinar cells and exfoliated epithelial cells and the lymphocytes of the peritoneal fluids was significantly higher in pancreatitis group compared to the controls and probiotic treated groups (P<0.001). No significant difference was observed in the DNA damage between the groups in the peripheral lymphocytes. In conclusion; our results support that probiotic agent Saccharomyces Boulardii can diminish bacterial infections and offer health benefits in the therapy of pancreatitis.

The effects of Saccharomyces boulardii on bacterial translocation in rats with obstructive jaundice

INTRODUCTION

The aim of this study was to investigate the effect of Saccharomyces boulardii treatment on preventing bacterial translocation in an obstructive jaundice animal model.

MATERIALS AND METHODS

Sixty adult rats were divided into five groups: group 1 - the sham-operated group; group 2 - the common bile duct ligation group; group 3 - the S. boulardii group; group 4 - the ampicillin-sulbaktam group; and group 5 - the S. boulardii plus ampicillin-sulbaktam group. The saline, antibiotics and S. boulardii were given, respectively, for a 7-day period as a single dose per day via temporary orogastric intubation. Seven days following the obstructive jaundice, the animal had laparatomy under sterile conditions. Segments of ileum were removed for histopathological examination. Blood, liver, spleen and mesenteric lymph nodes were taken for microbiological culture.

RESULTS

Bacterial translocation rates were 0% in the sham-operated group, 83% in group 2, 42% in group 3, 42% in group 4 and 33% in group 5. Bacterial translocation significantly increased in group 2 compared to groups 3, 4 and 5 (P = 0.001). The bacterial counts (CFU/g) of group 2 were significantly higher than those of groups 3, 4 and 5 (P = 0.001). Histopathological examination of ileum specimens revealed a significant decrease in the heights of villi in groups 2-5 compared to the sham-operated group (P = 0.001). The mean villus height in groups 3 and 5 was significantly higher than that of group 4 (P = 0.001).

CONCLUSIONS

S. boulardii was found to be effective in the successful control of translocation and improvement of intestinal barrier function.

Comparison between cultured small-intestinal and fecal microbiotas in beagle dogs

The microbiota of the small intestine is poorly known because of difficulties in sampling. In this study, we examined whether the organisms cultured from the jejunum and feces resemble each other. Small-intestinal fluid samples were collected from 22 beagle dogs with a permanent jejunal fistula in parallel with fecal samples. In addition, corresponding samples from seven of the dogs were collected during a 4-week period (days 4, 10, 14, and 28) to examine the stability of the microbiota. In the jejunal samples, aerobic/facultative and anaerobic bacteria were equally represented, whereas anaerobes dominated in the fecal samples. Despite lower numbers of bacteria in the jejunum (range, 10(2) to 10(6) CFU/g) than in feces (range, 10(8) to 10(11) CFU/g), some microbial groups were more prevalent in the small intestine: staphylococci, 64% versus 36%; nonfermentative gram-negative rods, 27% versus 9%; and yeasts, 27% versus 5%, respectively. In contrast, part of the fecal dominant microbiota (bile-resistant Bacteroides spp., Clostridium hiranonis-like organisms, and lactobacilli) was practically absent in the jejunum. Many species were seldom isolated simultaneously from both sample types, regardless of their overall prevalence. In conclusion, the small intestine contains a few bacterial species at a time with vastly fluctuating counts, opposite to the results obtained for the colon, where the major bacterial groups remain relatively constant over time. Qualitative and quantitative differences between the corresponding jejunal and fecal samples indicate the inability of fecal samples to represent the microbiotas present in the upper gut.

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