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PubMed1977

[The effect of caerulein on intraluminal pressures of the common bile duct and duodenum in man (author's transl)].

Caerulein is a dekapeptide related to gastrin and cholecystokinin with profound effects on gastrointestinal motility. In the present study we examined the effect of intravenously administered caerulein (0.1 microgram/kg body weight) on the intraluminal pressure of common bile duct and duodenum in 12 patients. The pressure recordings were obtained by endoscopic perfusion manometry. The tip of the perfused catheter was positioned under radiological control and the measurements were carried out under standardized conditions. Following the injection of caerulein there was a rise in pressure in the common bile duct and the mid portion of the duodenum. The pressure increase in the common duct appears to be predominantly due to contraction of the gallbladder as it is considerably less pronounced in patients with cholecystectomy. The problems inherent to endoscopic pressure recordings under pharmacological stimulation are discussed.

Adult↗
PubMedDate not supplied

Duodenum-sparing resection of the pancreatic head combined with pancreatogastroanastomosis in the treatment of chronic pancreatitis--surgical technique.

Chronic pancreatitis is defined as progressively developing disease which reduces exocrine parenchyma and decreasing exocrine capacity of the pancreas. The disease is commonly manifested by recurrent attacks of severe and often incapacitating upper abdominal and back pain. The goal of surgical therapy is pain relief and unblocking of the stenosis of the common bile duct and duodenum. Our method of solving this problem is a duodenum sparing resection of the pancreatic head followed by simple reconstruction of the gastrointestinal tract using pancreatogastroanastomosis. All unnecessary anastomoses are thus reduced and the risk of anastomotic leak is minimized. The substantial advantage of this operation is the removal of the pancreatic head where the source of symptoms related to chronic pancreatitis is localized.

Abdominal Pain↗
PubMed1997

[Hyperplastic polyps arising in islands of gastric mucosa in the duodenum].

Hyperplastic polyps originating from islands of gastric mucosa can be observed in the duodenum. We report 3 cases of duodenal hyperplastic polyps on antral or fully developed fundic mucosa. They macroscopically presented as small confluent polyps or as large villous polyps. Their microscopic features were the same as those observed in hyperplastic gastric polyps. This type of polyp must be added to the list of tumor like lesions of the duodenum that may endoscopically present as polyps.

Adult↗
PubMed1997

Technique and results of duodenum-preserving resection of the head of the pancreas in the treatment of chronic pancreatitis.

Surgical treatment of chronic pancreatitis is either by ductal decompression or resection of the pancreas. Among various resection operations the duodenum preserving resection of the head of the pancreas is the newest surgical technique. At the 2nd Dept. of Surgery of Debrecen Medical University duodenum preserving resection of the head of the pancreas with simple modified reconstruction was performed in 22 patients with chronic pancreatitis. The authors evaluate the early and late results: there was no mortality. The rate of complication was 27.2%. Considering late results complete relief of pain was found in about 80% of patients. The authors suggest that this type of resection can be well applied in the treatment of chronic pancreatitis with low risk and relatively good late results.

Abdominal Pain↗
PubMedDate not supplied

Morphological and quantitative study of the myenteric plexus of the duodenum of streptozotocin-induced diabetic rats.

The purpose of this work was to study the morphological and quantitative alterations of the myenteric plexus neurons of the duodenum of rats with acute and chronic streptozotocin-induced diabetes and establish a comparison with non-diabetic animals. Samples of duodenum were destined to histological sections stained by Hematoxilin-Eosin and to membrane preparings stained by the Giemsa and NADH-diaphorasis methods. Small, medium and large neurons were found, with a predominance of medium ones on chronic and acute diabetic animals. It was verified that most of the neurons of diabetic and non-diabetic animals have an eccentrical nucleus and thus this characteristic is not an indicative of degenerative process. It was observed that in diabetes there is a decrease in the number of myenteric neurons. It is argued that this initial decrease is due to the toxic effects of the drug and not to the physiopathology of diabetes itself, and also that the expressive smaller proportion of neurons on the chronically diabetic animals is due to the immediate loss related to streptozotocin and the further consequences of aging during nine weeks of diabetes.

Animals↗
PubMed1997

[Duodenum preserving resection of the head of the pancreas: a new standard operation in chronic pancreatitis].

Between 1972 and 1993, 298 patients with chronic pancreatitis underwent a duodenum-preserving pancreatic head resection (DPPHR). The early and late outcomes were prospectively analyzed. An operative mortality rate of 1%, a postoperative morbidity rate of 28.5% and a relaparotomy rate of 5.7% for the DPPHR were competitive with the rates for Whipple resection. After a median late follow-up of 6 years (range: 1 to 22 years), late mortality was 9%; 88% of the patients had no or infrequent episodes of pain and 63% were completely rehabilitated professionally. Only 6 patients developed diabetes mellitus early postoperatively. Our study proves that the duodenum-preserving pancreatic head resection provides better results than the Whipple resection. Therefore, this operation should be adopted as a new standard operation in patients with chronic pancreatitis.

Adult↗
PubMedDate not supplied

Simple reconstructive method in cases of duodenum-preserving subtotal resection of the head of pancreas.

BACKGROUND/AIMS: Surgical treatment of chronic pancreatitis is either by ductal decompression, or resection of the pancreas. Among various resection operations the duodenum preserving resection of the head of pancreas is the newest surgical technique. This paper describes substances of our modified reconstructive method following resection of the pancreatic head, and the results of this procedure. METHODOLOGY: Duodenum preserving resection of the head of pancreas with a simple modified reconstruction was performed in 21 patients with chronic pancreatitis. Early and late results are herein evaluated. RESULTS: There was no mortality. The rate of complication was 28.5%. Considering late results, complete pain relief was achieved in 80% of patients. Body weight was unchanged in 50%, decreased in 15% and gained in 35% of patients. Progression of endocrine dysfunction (rate of diabetes mellitus and glucose tolerance impairment) was observed to a small degree two years (average follow-up) after the operation. CONCLUSION: Our procedure can be applied in the treatment of chronic pancreatitis, with low risk and relatively good late results.

Adult↗
PubMed1998

[Myoelectric activity of the rabbit stomach and duodenum following neurogenic and humoral effects].

Electrical activity of the duodenum increased after the immobilisation or haemorrhage stress to a greater extent than the stomach and pylorus myoelectrical activity. Pentagastrin or serotonine increased the electrical activity of the duodenum and decreased the stomach and pylorus myoelectrical activity. Chronophysiological mechanism of the gastro-duodenal discoordination is analysed.

Action Potentials↗
PubMed1977

Brunner gland adenoma of the duodenum: resection through the fiberoptic endoscope.

We present a case of polypoid adenoma of the Brunner glands of the duodenum. The patient had upper gastrointestinal bleeding. Correct diagnosis of a polypoid mass in the first portion of the duodenum as the cause of bleeding was made, and the lesion was resected endoscopically via an endoscope, using a cautery snare. To our knowledge this is the first reported case of resection of a Brunner gland adenoma with endoscopy, and we hope to encourage the use of this technique for removal of polypoid lesions of the upper gastrointestinal tract.

Brunner Glands↗
PubMed1980

Management of Crohn's disease involving the duodenum, including duodenal cutaneous fistula.

Crohn's disease involving the duodenum is rare and is usually associated with Crohn's disease elsewhere in the alimentary tract. Seven patients were treated at the Los Angeles County-University of Southern California Medical Center with complications of Crohn's disease involving the duodenum. These included two patients with abscess and duodenoileocolocutaneous fistulas, two with gastrointestinal tract bleeding, one with gastric outlet obstruction, and two with symptoms of small-bowel disease only. Four of the seven were successfully treated nonoperatively with a variety of modalities, including ulcer regimen, sulfasolazine, adrenocortical steroids, enteric rest, and total parenteral nutrition. Three patients required surgery, one for intractable bleeding and two for enterocutaneous fistulas. The majority of patients with duodenal Crohn's disease can be treated nonoperatively, with resolution of symptoms and roentgenographic healing of lesions. Surgical intervention is only advocated for those patients with complications that do not resolve with nonoperative therapy.

Adult↗
PubMed1999

Depressed adenoma of the duodenum in patients with familial adenomatous polyposis: endoscopic and immunohistochemical features.

BACKGROUND: Depressed neoplastic lesions of the colorectum have been specified in patients with familial adenomatous polyposis (FAP). The aim of this study was to characterize endoscopic, histologic, and immunohistochemical features of depressed adenoma of the duodenum in patients with FAP. METHODS: Duodenoscopy was performed on 25 patients with FAP, and the neoplastic nonampullary lesions were classified as polypoid or depressed adenomas. The grade of dysplasia, the proliferative activity determined by Ki-67 labeling index (LI), and the grade of p53 expression were compared between polypoid and depressed neoplasia. RESULTS: Ten subjects had depressed nonampullary adenoma, whereas polypoid adenoma was found in the remaining 15 subjects. Moderate dysplasia was more frequent in depressed adenoma than in polypoid adenoma (70% vs. 27%, P = 0.04). Whereas p53 expression was not different between the two adenoma groups, the LI was significantly higher in depressed adenoma than in polypoid adenoma (59.7 +/- 9.5 vs. 47.5 +/- 10.7, P < 0.01). CONCLUSIONS: Depressed adenoma of the duodenum is a distinctive phenotype of duodenal neoplasm in patients with FAP. The high proliferative activity of depressed adenoma suggests that there may be a need to survey FAP patients with such lesions intensively.

Adenoma↗
PubMed1979

Somatostatinoma of the duodenum.

An adenocarcinoma of the second portion of the duodenum in a 26-year-old male is presented. The patient was suffering from pain in the epigastrium. Immunofluorescent studies revealed that it consisted almost exclusively of cells with a distincly positive somatostatin-like immunoreactivity. Ultrastructurally, the cytoplasm of the tumor cells had numerous large round granules (about 400 micrometers) with variable electron density. Most of these cells closely resembled the D cells normally seen in the duodenum and the islets of the pancreas, although a few argyrophil cells could be demonstrated by light microscopy. Radioimmunoassay of extracts of the tumor revealed a large amount of somatostatin (2260 pg/mg); substance P and VIP were detected also. Somatostatinoma has been known to occur in the pancreas, but this seems to be the first somatostatinoma found in the intestine.

Adenocarcinoma↗
PubMed1975

Carcinoma of the duodenum: its preoperative diagnosis.

Carcinoma of the duodenum, although uncommon, can be diagnosed by direct visualization, photography of the tumour and biopsy by the fibre-duodenoscope. The duodenoscopic examination may not only distinguish carcinoma of the duodenum from pancreatic carcinoma, ampullary carcinoma and secondary tumour from an adjacent organ but will also enable a correct diagnosis to be made early in the course of the disease. It is therefore suggested that duodenoscopy and biopsy will increase the resectability and 5-year survival rate.

Adenocarcinoma↗
PubMed1994

Adenocarcinoma of the duodenum: factors influencing survival. French Association for Surgical Research.

The records of 66 patients with histologically proven adenocarcinoma of the duodenum were reviewed retrospectively to determine factors influencing survival. The parameters studied were age, sex, weight loss, jaundice, anaemia, duodenal stenosis, type of surgical procedure, tumour size and location, depth of parietal invasion, presence and location of lymph node metastases, and pancreatic invasion. These factors were assessed in a group of 46 patients who underwent curative resection of the tumour; 20 patients who received palliative procedures were excluded from statistical analysis. Survival curves were established by the Kaplan-Meier method and compared by the Mantel-Haentszel test. The actuarial 3- and 5-year survival rates of patients undergoing curative resection were 59 and 45 per cent respectively. None of the prognostic factors studied influenced survival. These results indicate that resection of adenocarcinoma of the duodenum should be performed whenever possible, even in the presence of lymph node metastasis and pancreatic spread.

Adenocarcinoma↗
PubMed1986

Villous tumors of the duodenum and ampulla of Vater.

Polypoid epithelial tumors of the duodenum and ampulla of Vater are rarely diagnosed preoperatively without wide application of fiberoptic endoscopy. The symptoms are nonspecific. Only a high index of suspicion will lead to early diagnosis. Life-threatening complications and increased incidence of malignant transformations are associated with delayed diagnosis. This paper reviews 11 patients (nine previously unreported) with villous tumor of the ampulla of Vater and two with this neoplasm in the duodenum. It also reviews the important principles of management illustrated by the behavior of the tumors of these 11 patients compared to those of previous reports. For favorable results, all lesions must be excised in toto and evidence of invasive malignancy must lead to aggressive treatment whenever feasible.

Adenoma↗
PubMed1978

Polypoid nonchromaffin paraganglioma of the duodenum.

A polypoid tumor was surgically removed from the second part of the duodenum of a 56-year-old male. The main body consisted of large epithelioid cells arranged in an adenoma like pattern of strands and nests. These cells were argyrophil and had marked nonspecific esterase activity. Unmyelinated nerves with proliferated Schwann cells accompanied these epithelioid cells together with scattered gangliocyte like elements. Ultramicroscopically, the epithelioid cells were seen to contain round electron dense granules, 150 nm in diameter on average. The tumor is considered to be a nonchromaffin paraganglioma, as it probable developed from paraganglion cells associated with small arteries or branches of the vagus nerve, or from the undifferentiated pluripotent APUD cells of the duodenum.

APUD Cells↗
PubMed1975

Rhabdomyosarcoma of the duodenum with sinus tract formation into the gastric wall, visualized by gastroduodenoscopy.

Fiberoptic instruments have improved the accuracy of diagnosis of lesions of the upper digestive tract, particularly since the capability to perform biopsy under direct vision has been developed. Primary rhabdomyosarcoma of the upper gastrointestinal tract is an extremely rare entity. A literature search has revealed only 10 instances of rhabdomyosarcoma involving the esophagus, stomach, or duodenum (1-5). In this report, we describe the use of fiberoptic diagnosis and gastroduodenoscopic biopsy in a patient with rhabdomyosarcoma of the stomach and duodenum.

Aged↗
PubMed1991

Ectopic thyroid follicles in the submucosa of the duodenum.

Ectopic microscopic thyroid follicles were encountered fortuitously in the submucosa of the duodenum in a 63-year-old man undergoing pancreaticoduodenectomy for pancreatic carcinoma. The follicles, filled with a colloid-like substance, were intermingled with Brunner's glands of the duodenum. There were no signs or symptoms of a thyroid tumour. The epithelial cells and colloid-like substance were both immunoreactive for thyroglobulin but no cells stained for calcitonin. The possibility of a metastatic origin for the follicles from an occult thyroid carcinoma was excluded by the clinical and histopathological findings. These ectopic thyroid follicles cannot be explained by developmental inclusions or metastasis and may be metaplastic in nature.

Calcitonin↗