Esophageal and small bowel obstruction by occupational bezoar: report of a case

BACKGROUND: Phytobezoar may be a cause of bowel obstruction in patients with previous gastric surgery. Most bezoars are concretions of poorly digested food, which are usually formed initially in the stomach. Intestinal obstruction (esophageal and small bowel) caused by an occupational bezoar has not been reported. CASE PRESENTATION: A 70-year old male is presented suffering from esophageal and small bowel obstruction, caused by an occupational bezoar. The patient has worked as a carpenter for 35 years. He had undergone a vagotomy and pyloroplasty 10 years earlier. The part of the bezoar, which caused the esophageal obstruction was removed during endoscopy, while the part of the small bowel was treated surgically. The patient recovered well and was discharged on the 8(th )postoperative day. CONCLUSIONS: Since occupational bezoars may be a cause of intestinal obstruction (esophageal and/or small bowel), patients who have undergone a previous gastric surgery should avoid occupational exposures similar to the presented case

The contribution of leptin in neoangiogenesis in experimental study

Leptin, the product of the ob gene, is a non-glucosylated, 146 amino acid residue polypeptide that is produced and secreted by the adipocytes. Leptin plays a pivotal role in the regulation of body weight by controlling food intake, energy expenditure and sympathetic nervous system activity. Overwhelming evidence suggested a role for leptin as a multipotent cytokine implicated in the physiology of the digestive tract, reproductive function, haemopoesis, systemic neuroendocrine response and angiogenesis. Aim: The aim of this study was to investigate the angiogenic effect of leptin in vivo. Materials and methods: The disc angiogenesis system (DAS) was constructed as described previously and the disks were implanted subcutaneously in the back of 130 adult Wistar rats, in groups of 5 animals each. In the study group the disks contained as an angiogenic factor recombinant human leptin in concentrations of 25, 50, 100 and 250 ng/ml, respectively. In the negative control group leptin was replaced by normal saline. In order to study the specificity of the angiogenic effect of leptin, a specific anti-leptin antibody was used to inhibit the function of leptin with the implanted disks containing human recombinant leptin in concentrations of 25, 50, 100 and 250 ng/ml combined with 37.5, 75, 150 and 375 ng/ml of anti-leptin antibody, respectively. The discs were removed at 7 and 14 days after implantation, fixed in 10% formalin, embedded in paraffin and 5 μm thick planar sections were cut for immunohistochemistry and histological evaluation. Qualitative assessment of angiogenesis was performed on haematoxylin-eosin stained slides whereas quantitative assessment of angiogenesis was performed after immunohistochemical staining with an anti-CD34 antibody. Results: The number of new blood vessels in discs containing different leptin concentrations was significantly higher compared with control discs and increased proportionally with increasing concentrations of leptin and peaked at 100 ng/ml. This finding was observed at both time points (7 and 14 days after disc implantation). There was no significant difference between the leptin-induced number of blood vessels at 7 and 14 days for any concentration. Specific blocking of leptin abolished completely its angiogenic effect. The number of new blood vessels in discs containing different VEGF165 concentrations was significantly higher compared with control discs and increased proportionally with increasing concentrations of VEGF165 with a peak at 100 ng/ml. This finding was observed at both time points (7 and 14 days after disc implantation). The number of VEGF165-induced blood vessels at 14 days was significantly higher compared with the number of blood vessels at 7 days for all concentrations used. The leptin-induced number of new blood vessels at 7 days was significantly higher compared with the VEGF165-induced number of new blood vessels and was observed at all concentrations used. In contrast, there was no significant difference between leptin- and VEGF165-induced numbers of new blood vessels at the 14-day time point. Conclusions: It is concluded that leptin has an angiogenic effect in vivo. This effect is specific, dose- and time- dependent, and comparable with the angiogenic effect of VEGF165 but is evident earlier compared with the angiogenic effect of VEGF165.Το παράγωγο του γονιδίου ob, η λεπτίνη, αποτελεί ένα μη γλυκοζυλιωμένο πολυπετίδιο 146 αμινοξέων που παράγεται και εκκρίνεται από το λιπώδη ιστό και διαδραματίζει κυρίαρχο ρόλο στη ρύθμιση του σωματικού βάρους ελέγχοντας την πρόσληψη τροφής, την ομοιόσταση του ενεργειακού ισοζυγίου και τη δραστηριότητα του συμπαθητικού συστήματος. Νεότερες μελέτες έδειξαν ότι η λεπτίνη διαδραματίζει επίσης ρόλο στη φυσιολογία του πεπτικού, του αιμοποιητικού και του αναπαραγωγικού συστήματος, στην νευροενδοκρινική απάντηση του οργανισμού και στην αγγειογένεση. Έτσι, σήμερα η λεπτίνη θεωρείται σαν μία πολυδύναμη κυττοκίνη με πολλαπλές δράσεις και λειτουργίες στον ανθρώπινο οργανισμό. Σκοπός: Σκοπός αυτής της πειραματικής μελέτης ήταν η διερεύνηση της αγγειογενετικής δράσης της λεπτίνης in vivo. Υλικό και μέθοδοι: Το σύστημα μελέτης της αγγειογένεσης σε δίσκο (Disc Angiogenesis System, DAS) εμφυτεύθηκε στο υποδόριο της ραχιαίας επιφάνειες 130 επίμυων Wistar σε ομάδες των 5 πειραματοζώων η καθεμία. Στις ομάδες μελέτης, οι δίσκοι περιείχαν ανασυνδυασμένη ανθρώπεια λεπτίνη σε συγκεντρώσεις 25, 50, 100 και 250 ng/ml, αντίστοιχα, ενώ στις ομάδες αρνητικού ελέγχου η λεπτίνη αντικαταστάθηκε από φυσιολογικό ορό. Για τον έλεγχο της ειδικότητας της αγγειογενετικής δράσης της λεπτίνης, οι εμφυτευθέντες δίσκοι περιείχαν λεπτίνη και ειδικό αντίσωμα έναντι αυτής με συγκεντρώσεις λεπτίνης 25, 50, 100 και 250 ng/ml, και συγκεντρώσεις αντισώματος 37,5, 75, 150 και 375 ng/ml, αντίστοιχα. Στις ομάδες θετικού ελέγχου εμφυτεύθηκαν δίσκοι που περιείχαν ανασυνδυασμένο ανθρώπειο αυξητικό παράγοντα του αγγειακού ενδοθηλίου (VEGF165) σε συγκεντρώσεις 25, 50, 100 και 250 ng/ml. Τα πειραματόζωα θανατώθηκαν 7 και 14 ημέρες μετά την εμφύτευση των δίσκων, οι δίσκοι αφαιρέθηκαν, μονιμοποιήθηκαν σε διάλυμα φορμαλδεΰδης 10%, σκηνώθηκαν σε παραφίνη και ελήφθησαν τομές για μικροσκοπική μορφολογική μελέτη σε χρώσεις αιματοξυλίνης-ηωσίνης και ποσοτικό προσδιορισμό των νεοσχηματισθέντων αγγείων σε ανοσοϊστοχημικές χρώσεις του αντιγόνου CD34 των ενδοθηλιακών κυττάρω

Burn wound angiogenesis is increased by exogenously administered recombinant leptin in rats A administração exógena de leptina recombinante induz à angiogênese em queimaduras cutâneas provocadas em ratos

BACKGROUND: Leptin is a potent direct angiogenic factor that stimulates endothelial cell migration and activation in vitro and angiogenesis in vivo. In addition, leptin has been discussed to play an important role in angiogenesis, as it promotes the formation of new blood vessels. PURPOSE: The effect of exogenously administered leptin on the healing process of a full tissue burn wound model. METHODS: Sixty-three Sprague-Dawley male rats were used. Full tissue burn wound was created by electrocautery. The width of the pin was 0.3 cm; its length was 2 cm and was used at the "cut" modulation. Rats were divided into seven groups of nine animals each. Burn wounds were injected with murine recombinant leptin and the rats were sacrificed 3, 7 and 9 days after surgery. Every group had obtained three animals for the three different days of sacrifice. Three different leptin doses of 250 pg/ml, 500 pg/ml and 1000 pg/ml were used in different animal groups (A, B and C). For every one of the three leptin doses used, another animal group was evaluated by using the combined injection of leptin and antileptin (A1, B1, and C1), in order to study the inhibitory effect to the leptin factor. Nine rats were served as controls. These were injected with 0.3 ml water for injection solution and sacrificed at the same time intervals. After sacrifice of the animals, the skin was grossly determined by its appearance, colour and texture. Full thickness burn wounds were dissected for histological examination. A qualitative analysis of angiogenesis in the burn wound was conducted following a standard hematoxylin and eosin stain. The wound tissue samples from each experimental group underwent immunohistochemical evaluation of microvessel density by endothelial cell staining with mouse anti-rat CD 34 monoclonal antibody. RESULTS: The most impressive growth of new blood vessels appeared seven and nine days after treatment with the highest leptin doses. There were no significant differences in microvessel density between the seventh and the ninth postoperative day among different groups treated with leptin. All wounds from the control group, as well as those from animal groups treated with the combined injection of leptin and antileptin did not develop any new vessels. CONCLUSION: Exogenous administration of recombinant leptin increases early tissue angiogenesis in the burn wound level of an experimental animal model.<br>INTRODUÇÃO: A leptina é um potente fator angiogênico que estimula a migração e a ativação de células endoteliais in vitro e a angiogênese in vivo. Além disso, a leptina tem sido considerada importante na angiogênese pois ela promove a formação de novos vasos sanguíneos. OBJETIVO: Investigar o efeito da leptina administrada por via exógena no processo de cicatrização em um modelo experimental de queimadura. MÉTODOS: Foram utilizados sessenta e três ratos Sprague-Dawley, machos. A lesão de espessura total da queimadura foi realizada por eletrocautério. O dano tecidual foi de 0.3 cm numa extensão de 2 cm tendo sido empregada o módulo de "corte"do eletrocautéio. Os ratos foram distribuídos em sete grupos de nove animais. As lesões por queimadura receberam leptina recombinante. Os animais foram sacrificados 3, 7 e 9 dias após o ato operatório. Obteve-se três animais de cada grupo nos três períodos estipulados. Três diferentes dosagens de leptina: 250 pg/ml, 500 pg/ml e 1000 pg/ml foram aplicados nos três diferentes grupos (A, B e C). Para cada uma das três dosagens de leptina, outro grupo de animais foi avaliado pelo uso de injeção combinada de leptina e antileptina (A1, B1 e C1) no sentido de investigar o efeito inibitório do fator leptina. Nove ratos serviram de controles. Estes foram submetidos à injeção de 0.3 ml de água e sacrificados nos mesmos intervalos de tempo. Após o sacrifício dos animais, o tegumento foi avaliado por sua aparência, cor e textura. Fragmentos das feridas queimadas foram ressecadas para exame histológico. A análise qualitativa de angiogênese, na ferida queimada, seguia o padrão da coloração de hematoxilina e eosina. Cada fragmento de tecido, de cada grupo experimental, foi submetido à avaliação imunohistoquímica da densidade dos microvasos pela coloração da célula endotelial por anti-rato CD 34 anticorpo monoclonal. RESULTADOS: O desenvolvimento de novos vasos sanguíneos foi mais significativo após sete e nove dias do tratamento com as altas doses de leptin. Não houve diferenças significativas de densidade de microvasos entre o sétimo e o nono dia pós-operatório entre os diferentes grupos tratados com leptina. Todas as feridas do grupo controle assim como dos outros grupos de animais, com a injeção combinada de leptina e antileptina, não desenvolveram novos vasos. CONCLUSÃO: A administração exógena de leptina recombinante aumenta a angiogênese tecidual em queimaduras em modelo experimental