Treatment of multiple liver metastasis from gastric carcinoma

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The effects of long-term total parenteral nutrition on gut mucosal immunity in children with short bowel syndrome: a systematic review

BACKGROUND: Short bowel syndrome (SBS) is defined as the malabsorptive state that often follows massive resection of the small intestine. Most cases originate in the newborn period and result from congenital anomalies. It is associated with a high morbidity, is potentially lethal and often requires months, sometimes years, in the hospital and home on total parenteral nutrition (TPN). Long-term survival without parenteral nutrition depends upon establishing enteral nutrition and the process of intestinal adaptation through which the remaining small bowel gradually increases its absorptive capacity. The purpose of this article is to perform a descriptive systematic review of the published articles on the effects of TPN on the intestinal immune system investigating whether long-term TPN induces bacterial translocation, decreases secretory immunoglobulin A (S-IgA), impairs intestinal immunity, and changes mucosal architecture in children with SBS. METHODS: The databases of OVID, such as MEDLINE and CINAHL, Cochran Library, and Evidence-Based Medicine were searched for articles published from 1990 to 2001. Search terms were total parenteral nutrition, children, bacterial translocation, small bowel syndrome, short gut syndrome, intestinal immunity, gut permeability, sepsis, hyperglycemia, immunonutrition, glutamine, enteral tube feeding, and systematic reviews. The goal was to include all clinical studies conducted in children directly addressing the effects of TPN on gut immunity. RESULTS: A total of 13 studies were identified. These 13 studies included a total of 414 infants and children between the ages approximately 4 months to 17 years old, and 16 healthy adults as controls; and they varied in design and were conducted in several disciplines. The results were integrated into common themes. Five themes were identified: 1) sepsis, 2) impaired immune functions: In vitro studies, 3) mortality, 4) villous atrophy, 5) duration of dependency on TPN after bowel resection. CONCLUSION: Based on this exhaustive literature review, there is no direct evidence suggesting that TPN promotes bacterial overgrowth, impairs neutrophil functions, inhibits blood's bactericidal effect, causes villous atrophy, or causes to death in human model. The hypothesis relating negative effects of TPN on gut immunity remains attractive, but unproven. Enteral nutrition is cheaper, but no safer than TPN. Based on the current evidence, TPN seems to be safe and a life saving solution

Differentiation between malignant melanomas and benign melanocytic nevi by computerized DNA cytometry of imprint specimens

Recently image analysis (IA) and DNA-cytophotometry (CP) have proved to be useful for the differentiation between benign and malignant melanocytic lesions on paraffin sections. Since, on sections, these procedures are very time-consuming, we tested in the present study whether IA of imprint specimens, which can be evaluated in less than 30 minutes, might also be sufficient. In 39 malignant melanomas (MM), 18 melanocytic nevi (MN), and 6 dysplastic nevi (DN), 12 different morphometric and DNA cytometric features were determined in 100 randomly selected nuclei. In univariate analysis, 5 features were found to be significantly different between the benign and malignant groups (p < 0.0001): mean value (MAREA) and standard deviation (SAREA) of nuclear area and the 80th, 90th, and 95th percentiles of DNA distribution. Using SAREA, the best univariate feature, 82.5% of the cases could be correctly separated. In multivariate analysis with a combination of three features--standard deviation of nuclear area (SAREA), mean DNA value (MDNA), and 95th percentile of DNA distribution (PERC95)--a correct diagnosis was achieved in 89.5% of the cases. Results obtained in the cases of DN indicated an increased proliferation, but did not allow the separation of DN from MM and MN. Since our technique allows a rapid analysis without loss of tissue, which might be important for histological analysis, and the classification rates are equal or still higher than reported in studies on sections, imprints of melanocytic lesions seem to be most appropriate for the calculation of DNA cytometric features as helpful diagnostic criteria in equivocal melanocytic lesions