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PubMedDate not supplied

[X-ray diagnostic features of giant bleeding ulcers in stomach and duodenum].

The study was based on the analysis of clinical, X-ray, and morphological examinations made in 64 patients with giant gastric and duodenal ulcers. All the patients were admitted for gastroduodenal hemorrhage. Among the examinees, there were 28 patients with giant ulcer of the stomach and 26 with that of the duodenum. The authors present the methods of X-ray examinations and the X-ray symptomatology of giant ulcers of the stomach and duodenum. Gastroscopic and X-ray examinations were comparatively analyzed. The paper gives evidence that the X-ray examination has many advantages in estimating the size and ratio of ulcers to the adjacent organs and tissues. The paper outlines giant duodenal ulcers. The authors identify two groups of patients with giant ulcers of the duodenal bulb, which differ in its size and the extent of deformity. One of valid signs of the penetration of giant ulcers is not only their size, but their depth and fixation to the adjacent organs and tissues.

Duodenal Ulcer↗

PubMedDate not supplied

Nontraumatic intramural hematoma of the duodenum complicating warfarin therapy.

A 74-year-old man receiving chronic anticoagulant therapy presented with symptoms of acute small bowel obstruction. He was subsequently found to have an intramural hematoma of the duodenum. Early noninvasive diagnosis was possible using computed tomography. Conservative therapy proved successful in allowing resolution of obstructive symptoms. This case illustrates the effectiveness of a conservative approach to intramural hematoma of the duodenum, even in patients requiring anticoagulation.

Aged↗

PubMedDate not supplied

[Schwannoma of duodenum: a case report].

We report a case of malignant schwannoma of the duodenum, a neural tumor, which rarely occurs in the gastroduodenal tract. The diagnosis was done after an hemorragic episode of the upper gastrointestinal tract and the treatment done was a local resection. Two years later the patient had no symptoms, but the control endoscopy showed a recurrence of the tumor in the second portion of the duodenum and the patient was submitted to a gastroduodenopancreatectomy. The authors reported the case and make a revision on intestinal schwannomas.

Duodenal Neoplasms↗

PubMed1997

[Duodenojejunostomy in the symptomatic treatment of neoplastic obstruction of the duodenum--clinical observations].

The aim of the study was to evaluate the value of duodenojejunostomy and gastrojejunostomy in the treatment of neoplastic obstruction in the distal part of the duodenum. From 1992-1996, 37 patients (15 women, 22 men, aged 31-76 years) underwent a palliative operation for pancreatic cancer infiltrating the distal part of duodenum. Roux-en-Y procedure was used to create anastomoses between the duodenal bulb and jejunal loop. In 13 patients only alimentary by-pass was made whereas in the remaining 24 biliary decompression was also performed. The results were compared with the outcome in 26 patients in whom gastrojejunal side-to-side anastomosis been made. The advantage of Roux-en-Y duodenojejunostomy is that it does not interfere with gastric emptying and thus prevents jejuno biliary reflux and the consequent complications. Improvement of nutrition and quality of life in patients with inoperable pancreatic cancer, were noticed with this method.

Adult↗

PubMed1996

[Modified duodenum-preserving resection of the head of the pancreas].

A modified procedure of duodenum-preserving resection of the head of the pancreas was used in treating three patients with benign lesions in the head of the pancreas. Compared with Beger's procedure, the modified procedure was simpler, and pancreaticojejunostomy on duodenal side was not necessary because of less remaining pancreas attached to the conjunction of the pancreatobiliary duct. The patients, recovered and ate food from 4 to 6 days after operation without symptoms of duodenal obstruction. The patient's digestive function was normal, and the pre- and postoperative pancreatic endocrine function was almost identical. This procedure can be used as the first-choice surgical procedure for benign lesions in the head of the pancreas. Problems in how to protect blood supply of the duodenum were also discussed.

Adult↗

PubMed1998

[Gangliocytic paraganglioma of the duodenum].

Gangliocytic Paraganglioma of the duodenum is rare neuroendocrine tumor. This type of the tumor can cause bleeding into the gastrointestinal tract and epigastric pain in this region. It can be difficult to differentiate this tumor from the primary tumor of the head of the pancreas growing secondary to the duodenum. The authors describe one such misdiagnosed case treated finally successfully by hemipancreatodecodenectomy.

Diagnosis, Differential↗

PubMedDate not supplied

Duodenum-preserving resection of the pancreatic head for mucinous ductal ectasia without overt carcinoma.

BACKGROUND/AIMS: The clinical characteristics of mucinous ductal ectasia (MDE) of the pancreas without overt carcinoma have not been clarified. To clarify MDE and assess the optimal treatment procedure, including the technique of duodenum-preserving resection of the pancreatic head (DpRPH), we studied four patients. METHODOLOGY: Our patients consisted of three men and one woman, with a mean age of 71 years. The patients underwent DpRPH (n=3) or the pylorus-preserving Whipple procedure (PpW) (n=1). Clinicopathological features, postoperative pancreatic function, and technique to preserve duodenal blood flow were studied. RESULTS: All patients had intraductal mucin-hypersecretion and multilocular cysts lined by hyperplastic epithelium. The lesions were located in the uncinate process (n=3) or head-body (n=1) of the pancreas. DpRPH totally removed the lesions in the uncinate process. Of the three patients receiving DpRPH, dusky duodenum and a postoperative duodenal ulcer developed in two whose gastroduodenal arteries (GDA) were divided, but did not develop in one with undivided GDA. Postoperative glucose tolerance test and peptide para-aminobenzoic acid test after DpRPH showed better values than those after PpW. All patients are alive and well 22 to 40 months after surgery. CONCLUSIONS: DpRPH is a new standard for MDE. During DpRPH, preservation of the GDA and the superior portion of the pancreatic head is recommended to maintain an adequate duodenal blood flow.

Aged↗

PubMed1963

DEMONSTRATION OF ACID PHOSPHATASE-CONTAINING GRANULES AND CYTOPLASMIC BODIES IN THE EPITHELIUM OF FOETAL RAT DUODENUM DURING CERTAIN STAGES OF DIFFERENTIATION.

Dense cytoplasmic bodies surrounded by one or two unit membranes and containing mitochondria, vesicles, ribosomes, rough and smooth surfaced endoplasmic reticulum, and lamellated membranes (myelin figures) have been observed in the differentiating mucosa of the duodenum of rat foetuses by electron microscopy. Generally, the cytoplasmic components in the bodies seem to be in varying stages of disintegration. The bodies are found in greatest number on the 17th and 18th day of gestation, i.e. at the onset of differentiation. At this period of development the epithelium is stratified, and the villus formation is initiated by invagination of the epithelium by buds of mesenchyme followed by a splitting of the epithelium along the sides of the invaginations. When the villi have formed, the stratified epithelium has changed to the simple columnar type and the dense bodies have largely disappeared. Simultaneously, the lumen has widened considerably. In a parallel study with the light microscope, frozen sections incubated for the demonstration of acid phosphatase activity revealed the reaction product to be localized in bodies of the same size and distribution as the dense bodies found by electron microscopy. Hence, it seems that the bodies are altered and enlarged lysosomes (cytolysomes) active during the intensive differentiative events in the small intestine during the last part of intra-uterine life.

Acid Phosphatase↗

PubMed1999

Blood supply to the pancreatic head, bile duct, and duodenum: evaluation by computed tomography during arteriography.

HYPOTHESIS: Blood supply to the peripancreatic region is derived from the celiac and superior mesenteric arteries, complementary to each other. DESIGN: Cohort analytic study. SETTING: Tertiary care public hospital. PATIENTS AND METHODS: Computed tomography (CT) during superior mesenteric artery arteriography (SMAA-CT) and during celiac artery arteriography (CEAA-CT), in which a catheter tip was inserted into the common hepatic or gastroduodenal artery, was performed in 25 patients. MAIN OUTCOME MEASURE: Distribution and correlation of these areas of marked enhancement on SMAA-CT and CEAA-CT were analyzed. RESULTS: The right cephalic part of the pancreatic head that is derived from the dorsal bud was enhanced on CEAA-CT, and the left caudal part of the pancreatic head that is derived from the ventral bud was enhanced on SMAA-CT. Blood supply to the intrapancreatic bile duct, including the ampulla of Vater, is derived from the CEA. The boundary between the areas of the duodenum supplied from the CEA and SMA was in the second or third portion. CONCLUSION: The pancreatic head can be separated into 2 segments by the arterial supply, and each segment may be removed separately.

Angiography↗

PubMed1989

Can the common bile duct drain into the fourth part of the duodenum?

An interesting case masqueraded as a case of the common bile duct entering the fourth part of the duodenum; this is an extremely rare anomaly. A review of the literature was performed. Surgeons should be cautioned about this anomaly with regard to operative procedures for treatment.

Adult↗

PubMed2006

Number of pericryptal fibroblasts correlates with density of distinct mast cell phenotypes in the crypt lamina propria of human duodenum: implications for the homeostasis of villous architecture.

Pericryptal fibroblasts (PFs), a class of myofibroblasts, have strongly been implicated in the regulation of villous structure because of their location close to crypts and their ability to secrete cytokines affecting intestinal epithelial cell proliferation and differentiation. Recently, mast cells (MCs) have also been involved in the homeostasis of villous architecture. As myofibroblasts arise in a wide variety of settings concurrently with a local increase in the number of tissue MCs, we calculated in this study the density of both PF and distinct pericryptal MC phenotypes in the mucosa of human duodenum showing normal, defective, or atrophic villous profiles. In addition, we evaluated the statistical association between PF-MC densities and each pattern of villous architecture. Finally, we correlated the density of PF with the density of pericryptal MC phenotypes. For this purpose, samples taken by endoscopy from 30 patients complaining of inflammatory bowel disorders were studied by immunohistochemistry. The densities of alpha-smooth muscle actin-positive PFs as well as tryptase-, chymase-, and c-kit-positive MCs were determined in the crypt lamina propria. Villous architecture was found to be significantly associated with the number of PFs and tryptase-, chymase-, c-kit-positive MCs in the lamina propria (ANOVA group effect P < 0.001). High density of both PFs and MCs was found in intestinal samples with normal villous morphology while lower densities were associated with defective or atrophic villous profiles (Tukey's test for multiple comparison P < 0.001). In addition, a significant correlation was found between PF density and the density of each pericryptal MC phenotype (vs. tryptase-positive MCs, r = 0.913; vs. chymase-positive MC, r = 0.905; vs. c-kit-positive MC, r = 0.927; P < 0.001 in all cases). This study provides morphological support for an important cooperation between PFs and MCs in maintaining normal villous architecture.

Actins↗

PubMed1980

Intramural haematoma of the duodenum.

Five cases of traumatic intramural haematoma of the duodenum occurring in children are presented. Four of the cases were treated conservatively with nasogastric aspiration and intravenous fluids and it is suggested that this should be the treatment of choice in the majority of cases. Two of the cases were diagnosed initially as having appendicitis and during the exploratory procedure in one of these cases the haematoma was evacuated.

Child↗

PubMed1988

Operative management of tubulovillous neoplasms of the duodenum and ampulla.

Six patients are described to illustrate the operative management of tubulovillous neoplasms of the duodenum. Pancreaticoduodenectomy is appropriate for associated invasive carcinoma. Transduodenal submucosal excision of tubulovillous neoplasms with resection and reconstruction of the distal bile and pancreatic ducts if necessary is a satisfactory alternative when the neoplasm has not penetrated the muscularis mucosae.

Adenoma↗

PubMed2006

Relative bioavailability estimation of carbamazepine crystal forms using an artificial stomach-duodenum model.

The in vitro dissolution of carbamazepine (CBZ) was investigated using an automated artificial stomach-duodenum (ASD) model. Successful simulation of the dog physiology in the fasted state showed that the rank order of the ASD estimated bioavailabilities is as follows: Form III > Form I > dihydrate. This result is in excellent agreement with those found in literature. Additional simulations comparing different gastric transit times during fasted and fed states are also discussed.

Animals↗

PubMed1994

Interactions of cimetidine and ranitidine with aluminum-containing antacids and a clay-containing gastric-protective drug in an "artificial stomach-duodenum" model.

Interactions of cimetidine and ranitidine with aluminum-containing antacids and clay-containing gastric-protective drugs were analyzed in vitro by using an artificial stomach-duodenum model. The model reproduced near-physiologic conditions, taking into account gastric and duodenal flux variations and interactions between gastric mucosa and drugs added to the gastric content. Clay bound cimetidine in acid medium, but the drug was released when the pH increased, resulting in cimetidine amounts in the duodenal site close to those in controls. In contrast, clay bound ranitidine in acid medium and did not release it in the duodenal site. Aluminum-containing antacids did not significantly modify the amount of cimetidine or ranitidine available for absorption. Several factors play a role in the interactions of cimetidine and ranitidine with aluminum-containing antacids and clay-containing gastric-protective drugs: the structure of the antisecretory drugs, gastroduodenal pH, interactions of the antacid and clay with the gastric mucosa, and release of aluminum that could adsorb the drugs or prevent their adsorption by the mucosa. These phenomena are intricate and difficult to analyze without using a physicochemical approach.

Aluminum↗

PubMed2005

Gastrointestinal stromal tumor involving the second and third portion of the duodenum: treatment by partial duodenectomy and Roux-en-Y duodenojejunostomy.

The optimal surgical procedure for duodenal gastrointestinal tumors (GIST) remains undefined because while surgical resection clearly confers survival advantage, there is little submucosal spread in GIST and lymphatic involvement is rare. Various surgical procedures for duodenal GIST, pancreatoduodenectomy, pancreas-sparing duodenectomy, segmental duodenectomy, or local resection, have been described depending on the size and exact site of the lesion. In this report, we describe two cases of GIST involving the second and third portion of the duodenum successfully treated by partial duodenectomy with Roux-en-Y duodenojejunostomy. This surgical technique is ideal when GIST does not involve the ampulla as it avoids a pancreatoduodenectomy and has not been previously described for the management of this malignancy.

Aged↗

PubMed1993

The expression of the trefoil peptides pS2 and human spasmolytic polypeptide (hSP) in 'gastric metaplasia' of the proximal duodenum: implications for the nature of 'gastric metaplasia'.

Expression of pS2 protein (an oestrogen-induced gene discovered in the MCF-7 breast carcinoma cell line) and its homologue human spasmolytic polypeptide (hSP) was analysed, using immunohistochemistry and in situ hybridization to their mRNAs, in the proximal duodenum of 17 partial gastrectomy specimens removed from individuals with chronic peptic ulceration. Eight were found to have gastric-type metaplasia. In gastric metaplasia, mRNAs for pS2 and hSP, and pS2 peptide antibody were co-localized in the cells covering the duodenal villi. pS2 immunostaining was diffusely cytoplasmic in nature. A similar pattern was seen in Brunner's gland ducts. The trefoil peptide localization in gastric metaplasia closely resembles that seen in superficial gastric epithelium and the distal Brunner's gland duct, which in turn shares morphological similarities with gastric epithelium. We therefore conclude that gastric metaplasia may be the result of an expansion of the surface component of the Brunner's gland duct. The function of these trefoil peptides is at present unknown, but their distribution elsewhere suggests an involvement in reparative mechanisms. The similarities between gastric foveolar and Brunner's gland duct epithelium may derive from common restitution-enhancing features pertinent to a locally harsh environment.

Brunner Glands↗

PubMed2001

Cloning of a new aquaporin (AQP10) abundantly expressed in duodenum and jejunum.

A new aquaporin (AQP10) was identified in human small intestine. This gene encoded a 264-amino-acid protein with high sequence identity with AQP3 (53%), 9 (52%), and 7 (43%). These AQPs constitute one subfamily of AQP family that is differentiated from the other subfamily of AQP (AQP0, 1, 2, 4, 5, 6, and 8) by sequence homology. Ribonuclease protection assay and Northern blotting demonstrated almost exclusive expression of AQP10 mRNA in the duodenum and jejunum. In situ hybridization localized it in absorptive jejunal epithelial cells. Xenopus oocytes expressing AQP10 exhibited an increased osmotic water permeability in a mercury-sensitive manner. Although AQP10 belongs to the AQP subfamily, which has been characterized by permeability to water and neutral solutes such as urea and glycerol, it was not permeable to urea nor glycerol. The specific expression of AQP10 suggests its contribution to the water transport in the upper portion of small intestine.

Amino Acid Sequence↗