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PubMed1991

Serotonin-containing epithelial cells in rat duodenum. I. Quantitative morphometric study of the distribution density.

Serotonin (5HT)-containing epithelial cells in rat duodenum were studied quantitatively by three-dimensional morphometric analysis. Longitudinal sections covering the whole length of rat duodenum were stained by either 5HT immunohistochemistry or by glyoxylic acid fluorescent histochemistry. Three-dimensional values for positive cell density, namely the number of 5HT cells per unit volume of the epithelium, were obtained by stereological morphometry with the aid of a computer-assisted image analyzer. This analytical method provides an absolute value for the distribution density of 5HT-containing cells regardless of thickness of sections, or which of the two histochemical procedures is used. The mean number of such cells per unit volume was higher in the crypts than in the villi but varied little along the duodenum. The density of 5HT cells in a given duodenal region, however, varied greatly among individual animals. The villi of the 10 to 16-mm segment from the pylorus were identified as having the smallest individual variation and therefore as being the most suitable for statistical evaluation in future pharmacohistochemical investigations.

Animals↗
PubMed1993

Esophago-jejuno-duodenal anastomoses with an ultra-short duodenum.

Reconstruction following total gastrectomy usually requires one of the various methods of esophagojejunal anastomosis. We present herein the case of a 78-year-old woman with gastric carcinoma involving the adjacent organs for which resection of the whole stomach, distal pancreas, transverse colon, and distal duodenum was performed. Reconstruction was carried out with an esophagojejunostomy, followed by a side-to-side anastomosis between the raised jejunal limb and the residual short duodenum. Her postoperative course was uneventful and she was able to lead a relatively comfortable life at home until she died after tumor recurrence caused GI bleeding 1 year postoperatively. This new modified Roux-en-Y with an ultra-short duodenum can be applied for such contiguously invasive gastric carcinoma to achieve a better quality of life, when conventional reconstruction techniques after total gastrectomy are not indicated.

Adenocarcinoma↗
PubMed1981

Vascular compression of the duodenum (cast syndrome) associated with the treatment of spinal deformities. A report of six cases.

Vascular compression of the duodenum, the so-called cast syndrome, which is due to the mechanical compression of the third part of the duodenum from the superior mesenteric artery, was developed postoperatively in six patients treated for their spine deformities. The early recognition of the clinical signs of the obstructive ileus and the proper conservative treatment proved efficient for five of the patients, and only in one laparotomy and duodeno-jejunostomy were inevitable due to the severity and persistency of the symptoms. The purpose of this report is to record these cases describing the clinical manifestations, the treatment, and the pathogenesis of the vascular compression of the duodenum which may occur during the treatment of the spine deformities.

Adolescent↗
PubMed1988

Histochemical, ultrastructural and X-ray microprobe analytical studies of localization of calcium in the mucous lining of the rat duodenum.

Localization of calcium in a rapid frozen and freeze substituted duodenum of normal, starved or calcium-repleted rat was examined using either of the glyoxal bis(2-hydroxyanil) (GBHA) staining method, a sensitive histochemical calcium stain or electron microscopy. In normally-fed rats, a majority of absorptive cells of the duodenum showed numerous discrete red granular GBHA reactions, approximately 1 micron or less in diameter, located primarily along their lateral plasma membranes and within intercellular spaces. Electron microscopy also revealed electron-dense granules, 30-100 nm in diameter, showing a similar distribution as the GBHA granules in the respective absorptive cells, and confirmed their absence in mitochondria and other intracellular compartments. Some of the absorptive cells located exclusively at the tip of each villus contained highly GBHA-reactive tubulo-vesicular structures extending throughout the cytoplasm. However, they displayed virtually no granular GBHA reaction. In these cells, electron microscopy revealed numerous electron-dense granules in the nucleus, mitochondria and in other unidentified organelles. X-ray microprobe analyses of ultrathin sections confirmed the presence of calcium within electron-dense granules associated with both types of absorptive cells. The number and intensity of all GBHA reactions fluctuated according to luminal calcium concentration. In calcium-repleted rats, strong GBHA reactions appeared in a narrow zone of lamina propria at the tip of the villus, overlaid, predominantly, with absorptive cells showing tubulo-vesicular GBHA reactions. These results suggest the existence of distinct types of absorptive epithelial cells in the rat duodenum, with respect to patterns of calcium localization which they display.

Aminophenols↗
PubMed1984

Selective inhibition by amiflamine of monoamine oxidase type A in rat brain, liver and duodenum.

Amiflamine (FLA 336(+)), N-desmethylamiflamine (FLA 788(+)) and N,N-didesmethylamiflamine (FLA 668(+)) were examined for their monoamine oxidase (MAO) inhibitory effects in rat brain, liver and duodenum and were compared with the irreversible inhibitors clorgyline and (-)-deprenyl. The potency of each FLA compound was the same in each tissue both in vitro and after oral administration with either serotonin or tyramine as substrate. The in vitro effect of FLA 788(+) was 2-6 times stronger than that of amiflamine although the compounds were equipotent after oral administration. FLA 668(+) was 2-3 times less potent than amiflamine in vitro and had very poor activity after oral administration. The deamination of phenethylamine was weakly affected by the three FLA compounds. Clorgyline inhibited strongly the deamination of serotonin and tyramine in the duodenum after oral administration, being 1,000 times more potent than in the brain and the liver. Similar results were obtained for (-)-deprenyl which, however, was more potent in inhibiting the deamination of phenethylamine than that of serotonin and tyramine. Amiflamine was a reversible MAO inhibitor with no MAO inhibitory capacity 24 h after a single oral dose. On the other hand the irreversible inhibitor clorgyline had a maximal effect on brain MAO 48 h after a single dose while the inhibitory effect in the duodenum had almost disappeared. The influence of amiflamine on the excretion of acid and basic metabolites of orally administered 14C-tyramine (58 mumol/kg) in rat was examined.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Thermal injury of the posterior duodenum during laparoscopic cholecystectomy.

While complications of laparoscopic cholecystectomy occur in 3-7% of cases, bowel injuries are uncommonly reported. Bowel injuries appear to be of two types: penetrating bowel injury from either the Veress needle or trocar, and thermal bowel injury from either contact or conductive burn. The duodenum is usually spared from Veress needle or trocar injury because of its posterior location. However, during dissection in the triangle of Calot, the duodenum is at risk for direct contact burn or energy conduction burn. In this report we describe a presumed conductive burn injury of the posterior second portion of the duodenum which followed laparoscopic cholecystectomy. This unrecognized injury resulted in full-thickness necrosis of the duodenal wall with delayed perforation. This injury was successfully managed with pyloric exclusion. The diagnosis and management of this previously unreported injury are described.

Aged↗
PubMed1992

Biliary pressure variation in coordination with migrating motor complex of duodenum in patients with cholecystectomy and effects of morphine and cerulein.

Pressures in the common bile duct and duodenum were continuously measured with two pressure microtransducers placed by endoscopy in 10 postcholecystectomy patients. A complete cycle of the migrating motor complex of the duodenum was obtained in seven patients, its length ranging from 62 to 174 min with a mean of 114 min. The biliary pressure showed a transient elevation of 5.0 +/- 0.6 (mean +/- SEM) mm Hg (P < 0.001) in concert with phase III of the duodenal cycle in all 10 patients, whereas it remained stable during other phases. Intramuscular morphine (0.2 mg/kg) given to induce spasm of the sphincter of Oddi 20 min after the passage of phase III invariably produced an activity front in the duodenum and a sustained increase in the biliary pressure, the magnitude of which was 8.3 +/- 0.9 mm Hg. The biliary pressure raised by morphine dropped after an intravenous injection of cerulein (0.1 microgram/kg) as a sphincter relaxant. These findings indicate that the biliary pressure rises transiently at phase III of the duodenal cycle in patients after cholecystectomy, probably due to contractions of the sphincter of Oddi.

Adult↗
PubMed1987

[Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis].

In patients with chronic pancreatitis the duodenum-preserving resection of the head of the pancreas aims at the removal of the inflammatorily enlarged head of the pancreas with preservation of stomach, duodenum, and bile duct. In 105 patients with chronic pancreatitis the hospital mortality after duodenum-preserving resection of the head of the pancreas was 0.95% and the late mortality over a period of 14 years amounted to 5.8%. This surgical procedure leads to lasting freedom of pain in more than 80% of the patients and decompresses the pancreas and its neighbouring organs without major impairment of other organs.

Chronic Disease↗
PubMed1979

Impaired acid neutralization in the duodenum in pancreatic insufficiency.

The influence of severe exocrine pancreatic disease on the acid-neutralizing capacity of the duodenum was studied in five patients with pancreatic insufficiency (PI) and six control subjects using duodenal perfusion-marker technique. Hydrochloric acid (0.1 N containing 1% PEG) was infused at constant rates (1.2, 4.5 and 7.0 ml/min) into the duodenum just distal to the duodenal bulb. Samples were aspirated from the tip of the duodenal perfusion tube located at the ligament of Treitz. All samples were analyzed for volume, pH, titrable acidity, PEG and [14C]PEG (gastric marker) determination. Patients with PI demonstrated significantly diminished ability to neutralize various acid loads as compared to controls who virtually completely neutralized acid loads in the range of maximal gastric acid secretion. Exogenous secretin did not significantly improve percent acid neutralized in PI. These data clearly indicate that patients with PI have significantly impaired ability to neutralize even small loads of acid in the duodenum.

Bicarbonates↗
PubMed1988

Cysteamine-induced inhibition of mucosal and pancreatic alkaline secretion in rat duodenum.

To determine the effect of cysteamine on the alkaline secretion by the duodenal epithelium, pancreas, and Brunner's glands in relation to the pathogenesis of duodenal ulceration, the alkaline secretion by various types of duodenal loops was comparatively studied. The results obtained were as follows: (1) Cysteamine significantly reduced both mucosal and pancreatobiliary alkaline secretion in the proximal duodenum of rats. (2) The ratio of contribution of pancreatobiliary alkaline secretion to total neutralization of acid in the proximal duodenum was 55.9% under continuous perfusion. (3) There was no significant difference between the amounts of alkali per unit volume of the proximal and distal duodenal loops. (4) The alkaline substance secreted by the proximal duodenal mucosa was confirmed to be the bicarbonate. From these findings, it has been concluded that the impairment of bicarbonate secretion by the mucosal epithelium of proximal duodenum, not by Brunner's glands, plays a causative role in cysteamine-induced duodenal ulceration.

Animals↗
PubMed1992

Influence of vagotomy on bicarbonate secretion in the rat proximal duodenum.

The influence of vagotomy on bicarbonate secretion in the proximal duodenum was assessed in rats receiving truncal, hepatoduodenal and gastric vagotomy. Two weeks after vagotomy, animals fasted for 24 hr were subjected to laparotomy under urethane anesthesia. A proximal duodenal loop excluding the outlet of the common bile duct was prepared as part of an airtight extracorporeal perfusion circuit. The circuit was filled with a bathing solution at pH 4.5 and which was perfused at a rate of 10 ml/min at a constant temperature of 37 degrees C. The pH and CO2 tension of the bathing solution were determined using microelectrodes, and bicarbonate secretion was calculated from the pH and CO2 tension data by the Henderson-Hasselbalch equation. The bicarbonate secretion at the first portion of the duodenum over a 60-min period was significantly higher in the truncal and hepatoduodenal vagotomy groups than in the control group. However, there was no significant difference between the gastric vagotomy and control groups. Furthermore, no significant difference was noted between the truncal and hepatoduodenal vagotomy groups. Since bicarbonate secretion was increased by hepatoduodenal vagotomy, the hepatoduodenal branch of the vagus nerve appeared to inhibit bicarbonate secretion at the first portion of the duodenum.

Animals↗
PubMed1993

Peroxisomes in liver, kidney and duodenum of nude mice bearing xenografts of human pancreatic adenocarcinomas.

In the liver, kidney and duodenum of nude mice with xenografts of two human pancreatic adenocarcinomas differing in growth rate, catalase activity was assayed and peroxisomes were studied using catalase cytochemistry and light and electron microscopy. Hepatic and duodenal catalase activity were significantly decreased in tumour-bearing mice. Renal catalase activity was unchanged. At light microscopic level, a decrease in peroxisomal staining was evident in all duodenums and most livers of tumour-bearing mice. Only minor changes were observed in the kidneys. Ultrastructural morphometry of the hepatocellular peroxisomes revealed a decrease in size, volume density and surface density only in mice with fast-growing xenografts. These observations indicate that the two pancreatic adenocarcinomas exerted a different effect on the hepatic peroxisomes, and that catalase activity and peroxisomes in liver and duodenum are more affected than in kidney.

Adenocarcinoma↗
PubMed2001

Neuroendocrine tumours of the duodenum. Clinical aspects, pathomorphology and therapy.

BACKGROUND AND AIMS: Neuroendocrine tumours (NTs) of the duodenum are uncommon neoplasms. They represent a heterogeneous spectrum of subtypes and may be associated with von Recklinghausen's disease type I (VRD) and multiple endocrine neoplasia type I. There are few studies concerning the biological characteristics and adequate therapy of these tumours. PATIENTS AND METHODS: We report on a retrospective analysis of 12 patients with NTs of the duodenum: six non-ampullary (naNTs) and six ampullary tumours (aNTs). These patients were treated between January 1992 and January 2001. Clinical and histopathological features, therapy and follow-up were evaluated retrospectively and compared with the literature. RESULTS: All tumours were located in the first and second portions of the duodenum. Three of six aNTs presented with jaundice, and four of six naNTs were incidental findings. Two patients with naNTs showed Zollinger-Ellison syndrome and two with aNTs VRD. Of the six patients with naNTs, four were treated by local excision (two endoscopically, two surgical resection), one by Kausch-Whipple operation and in one patient the tumour was an incidental finding in the Billroth II specimen. Four of the six patients with aNTs underwent Kausch-Whipple procedure, one patient ampullectomy (gangliocytic paraganglioma) and one patient palliative chemotherapy. The size of the naNTs were less than 0.6 cm, whereas the size of the aNTs ranged from 1.5 cm to 4 cm. Tumour size of aNTs had no correlation with depth of invasion and metastases. Metastases were found in two aNTs and none of the naNTs. Immunohistochemically tumour cells expressed somatostatin in 5 of 6 aNTs and gastrin in 1 of 6 aNTs and in two gastrinomas. There was no hospital mortality. Two patients died for reasons not related to the tumour. Tumour excision of both patients with gastrinomas was not curative. Three patients with naNTs and four with aNTs are alive without disease. One patient with palliative treatment of a metastasising aNT is alive 66 months after diagnosis. CONCLUSION: Non-ampullary duodenal NTs differ clinically, histologically and immunohistochemically as well as with respect to the extent of resection from NTs of the ampulla of Vater.

Adult↗
PubMed1998

Nitric oxide synthase expression in enteric neurons during development in the pig duodenum.

The expression of the constitutive neural isoform of nitric oxide synthase (bNOS) is dynamic and thus forms an ideal parameter to evaluate whether development and region affect the enteric nervous system. By applying NADPH-diaphorase histochemistry on whole-mount preparations of the myenteric and submucosal plexuses and by using the 'unbiased counting frame', a qualitative and quantitative description of bNOS-expression in enteric neurons in the pig duodenum in various developmental stage and region was obtained. Examinations were carried out on the oral and aboral duodenum of fetal pigs from the second half of gestation, of 1-2-day-old pigs and of 6-8-week-old pigs. In the pig duodenum, three enteric plexuses were readily distinguished: the inner submucous, the outer submucous and the myenteric plexuses. All three plexuses already harboured, to different degrees, bNOS-expressing neurons at midgestation. Although the enteric nervous system was present at midgestation, the enteric neurons had not yet reached their adult phenotype and morphology. During gestation, the number of inner submucous bNOS-expressing neurons increased approximately 50-fold, whereas after birth that number fell to about 10% of the prenatal value. During further postnatal development it returned to prenatal values. In addition, the number of bNOS-expressing myenteric neurons doubled postnatally. These changes favour a role for NO in mediating the development of enteric neurons and point to a greater necessity for inhibitory innervation in the adult pig as compared with the fetal pig. Furthermore, the number of bNOS-expressing outer submucosal and myenteric neurons was significantly higher in the oral duodenal segment compared with the aboral duodenal segment. This regional difference suggests that the oral duodenal segment is more prominently involved in the regulation of NO-mediated gastrointestinal processes than the aboral one. The developmentally and regionally dependent bNOS-expression can be explained by shifts and differences in the balanced system of hormones, presynaptic input and target-derived signals that affects neurotransmitter expression.

Age Factors↗
PubMed2004

Tryptophan administration increase contractility and change the ultrastructure of mice duodenum.

Serotonin (5-HT) is a metabolite of tryptophan (TRP). 5-HT has been shown to induce contractions in rat duodenum and ileum. We planned to investigate the in vivo effects of TRP administration on duodenal contractility and ultrastructure together. Two equal groups of adult male Swiss-albino mice were used in the experiments. Controls (CONT) and TRP treated (100 mg/kg/24 hr in 0.2 ml. saline solution ip, 7 days). Body weights were recorded at the beginning and at the end of experiments. Duodenum tissues contractility responses to different concentration of KCl and acethycholine (ACh) were recorded on polygraph. The ultrastructural changes in duodenum observed by transmission electron microscopic (TEM) method and 5-HT levels determined by immunohistochemical method. Body weights decreased and duodenal contractile response of ACh increased significantly by TRP treatment. The duodenal ultrastructural changes in TRP group illustrated partially loss of apical surface and fusion in microvilli. Immunohistochemical detection showed that 5-HT increased by TRP treatment. There is a relation between duodenal contractility increased by TRP treatment and changes in the duodenal tissue 5-HT level and ultrastructure.

Acetylcholine↗
PubMed2005

Partial resection of the second portion of the duodenum for gastrointestinal stromal tumor after effective transarterial embolization.

We report herein the case of 64-year-old man with gastrointestinal stromal tumor (GIST), who was treated by partial resection of the duodenum after preoperative transarterial embolization. He presented to our hospital with a history of tarry stools, dizziness, and severe anemia (hemoglobin, 7.5 g/dl). Gastroduodenal endoscopy revealed the presence of a submucosal tumor in the second portion of the duodenum. The presence of the tumor was subsequently confirmed by double-contrast gastrointestinal radiography and abdominal computed tomography. Super-selective angiography showed tumor staining fed from the anterior and posterior superior pancreaticoduodenal arteries, and the inferior pancreaticoduodenal artery. Two weeks after transarterial embolization through these vessels, the tumor size was found to have shrunk to 40% of its original size. Partial resection of the duodenum was performed and absence of tumor cells at the surgical margin was confirmed by intraoperative frozen-section examination. Histopathological examination revealed that the duodenal submucosal tumor consisted of spindle cells, and immunohistochemical analysis revealed positive tumor staining for c-kit protein, CD34 and alpha-smooth muscle actin (SMA), and negative staining for desmin and S-100; the positivity rate for MIB-1 staining was 2.2%. Based on these findings, the tumor was diagnosed as a GIST of low-grade malignancy, classified as the muscular type. It is considered that preoperative treatment of duodenal GISTs, such as transarterial embolization, may be useful for reducing the extent of resection, from pancreaticoduodenenctomy to a partial resection.

Duodenal Neoplasms↗
PubMed2006

Ultrasound-determined geometric and biomechanical properties of the human duodenum.

Methods based on cross-sectional ultrasound imaging may be valuable for assessment of biomechanical parameters in the duodenum in health and disease. In 12 healthy volunteers a specially designed duodenal bag containing a high-frequency ultrasound probe was inflated until the perception of moderate pain. The ultrasound images and bag pressures were recorded before and after administration of butylscopolamine. The duodenum approached a circular shape as the load was increased (P = 0.01). The tension-strain relations were exponential and the curve fitting constant alpha (stiffness) was 1.72+/-0.81 before and 1.13+/-0.22 after administration of butylscopolamine (P=0.5). In three subjects construction of stress-strain diagrams was possible. The wall thickness decreased after administration of butylscopolamine (P < 0.001). The wall thickness was nonhomogeneously distributed along the duodenal circumference, being thickest at high curvatures. In the future this may be useful for assessing the geometry, stiffness, remodeling, and mechanosensory properties in the duodenum and small intestine in health and disease.

Adult↗
PubMed1976

Villous adenoma of the duodenum. A case report and review of the literature.

A case of villous adenoma of the duodenum, with focal in situ carcinomatous changes, has been described with a review of forty-two other case reports from the world literature. Occult bleeding, resulting in anemia, and vague obstructive symptoms appear to be the most common presenting findings. The average age was 56.4 years, which was seven years younger than the average age for villous tumors of the colon. Adequate radiologic studies should establish the diagnosis preoperatively. These tumors obtain relatively large size before causing significant symptoms. Approximately one third showed carcinomatous changes, and approximately one half of these were in situ changes. Local segmental resection for duodenal villous tumors is desirable when possible. However, in areas where this is not feasible, local mucosal excision is acceptable for benign tumors and for those with in situ carcinoma. If invasive carcinoma is found in the excised specimen, pancreatoduodenectomy is recommended. Insufficient evidence is available to adequately evaluate survival for malignant villous tumors of the duodenum, but the available data suggest that the survival after treatment of malignant villous tumors is comparable to other malignant lesions originating in the duodenum.

Adenoma↗