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Background. Our previous study using genetically labeled Escherichia coli strain JNW14 revealed that obstructive jaundice promotes bacterial translocation in rats and that the absence of bile in the intestinal tract is considered to be a factor inducing bacterial translocation. The aim of this study was to investigate the role of bile and bile acids in intestinal barrier function against bacterial translocation.Materials and methods. Eight-week-old male specific-pathogen-free Wistar rats were subjected to ligation of their common bile ducts (CBDL). The CBDL rats were treated with bacitracin, neomycin sulfate, and streptomycin sulfate, and the intestinal tract was colonized with E. coli strain JNW14, which was genetically labeled with resistant markers against the above three antibiotics, to monitor the bacterial translocation. The rats were then administered saline, cholic acid (20 mg/100 g BW), taurocholic acid (TCA: 5–50 mg/100 BW), or bile (1.5–6 mL/day) via a duodenal catheter. The degree of bacterial translocation of E. coli strain JNW14 to the mesenteric lymph nodes was compared. Histopathological examination of the terminal ileum and intestinal permeability test using phenolsulfonphthalein was also performed.Results. Both cholic acid and TCA showed no inhibitory effect on bacterial translocation at any of the doses tested in CBDL rats, although TCA significantly decreased the numbers of E. coli strain JNW14 in the cecum. However, bile administration reduced the numbers of E. coli strain JNW14 in the cecum and mesenteric lymph nodes in CBDL rats although the inhibitory effect was weak. The integrity and permeability of the intestinal mucosa were kept at normal levels by bile administration in CBDL rats whereas the morphological changes, such as villous atrophy, villous edema, and lacteal canal dilatation, were observed in other CBDL rats.Conclusion. Bile plays an important role in maintaining the intestinal barrier function to prevent the invasion of enteric bacteria to the underlying tissues, suggesting that the intestinal administration of bile to patients with obstructive jaundice is a useful way to reduce infectious complications by inhibiting bacterial translocation from the intestine to other organs. [Copyright &y& Elsevier]

A case of generalized peritonitis, secondary to a perforation of the rectosigmoid colon during barium-enema roentgenography, is presented. The patient required immediate surgical intervention with the prime importance of the treatment being removal of as much of the contaminating materials as possible. This was done successfully with irrigation and wiping, using urokinase solution. Peritoneal lavage with urokinase solution was also carried out in the early postoperative period. Fluid replacement with careful monitoring of fluid and electrolyte balance is essential before, during, and after the surgical procedure. Adequate antibiotic therapy and careful respiratory and nutritional support are also important. [ABSTRACT FROM AUTHOR]

Aim: Adipocyte derived leptin is an obese gene product. A possible role of leptin in feedback mechanism that regulates food intake, energy expenditure and fat mass. The purpose of this study was to investigate the leptin matabolism under surgical stress and the effect of nutritional support on leptin levels in gastric cancer patients. Methods: 1) The nutritional status and serum levers of leptin were measured perioperatively in patients with gastric cancer. 2) The influence of TPN on serum leptin levels were measured in pyloric strenosis (Group I) and cancerous cachexia (Group II) groups. Result: Serum leptin levels in 50% of gastric cancer patients were below the normal range at admission. Serum leptin levels were decreased in malnourished cases with advanced stage. Serum leptin levels in the group with high concentration of total body fat were higher than in low group. Serum leptin levels were significantly incensed after gastroctomy in comparison with the preoperative value (Pre. Op.: 4.2±1.1 vs 1POD: 9.8±5.3ng/ml, p<0.01). Serum leptin levels on the 1POD were significantly higher in the group with high (≥2.5ng/ml) levels of serum leptin, compared to the group with low (<2.5ng/ml) preoperative levels (p<0.01). The body fat weights were higher in Group I than Group II. After 2 weeks of TPN siginificant increase of serum leptin levels was observed in Group I (p<0.05) whereas not increased in Group II. Conclusions: Surgical stress is associated to an increase of serum leptin levels in patients with gastric cancer. The body fat accumulation quantity greatly affected the serum leptin levels after gastrectomy and in short period of parenteral nutritinal support. [ABSTRACT FROM AUTHOR]