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PubMed1999

Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience.

OBJECTIVE: To present preoperative and early postoperative data for 504 patients who underwent duodenum-preserving pancreatic head resection (DPPHR) for severe chronic pancreatitis (CP). BACKGROUND: The pancreatic head is considered to be the pacemaker of the disease in alcohol-induced CP. Indications for surgery in CP are intractable pain and local complications. DPPHR offers the advantage of treating the complications related to the inflammatory process in the head, relieving the pain syndrome, and preserving the bilioduodenal anatomy, and it may have the potential to change the natural course of chronic pancreatitis. METHODS: Between November 1972 and December 1998, 504 patients with chronic pancreatitis and an inflammatory mass in the pancreatic head were treated surgically after medical pain treatment for a median of 3.6 years. The procedure resulted in a hospital mortality rate of 0.8%. A continuous follow-up investigation lasting up to 26 years was conducted, during which the patients were reevaluated four times (1983, 1987, 1994, 1996). Between November 1982 and October 1996, 388 patients treated surgically were reinvestigated to evaluate the late outcome; the follow-up rate was 94% (25 patients were lost to follow-up). The reinvestigation evaluation included glucose tolerance test, exocrine pancreatic function test, pain status, physical status, professional and social rehabilitation, and quality of life. RESULTS: After an observation period of up to 14 years, 78.8% of the patients were completely pain-free and 12.5% had (yearly) pain. 91.3% were considered as pain-free; 8.7% had continuing abdominal pain; 12% had abdominal complaints. During the 14 years of follow-up, only 9% were admitted to the hospital for acute episodes of chronic pancreatitis. Endocrine function was improved in 11%; in 21%, diabetes developed de novo. The rate of hospital admission for acute episodes decreased from 69% before surgery to 9% after surgery. In the clinical management period of 9 years (median), the frequency of hospital admission dropped from 5.4 per patient before surgery to 2.7 after surgery. Fourteen years after surgery, 69% of the patients were professionally rehabilitated; in 72%, the quality of life index (Karnofsky criteria) was 90 to 100 and in 18%, it was <80. CONCLUSION: In patients with alcoholic chronic pancreatitis in whom an inflammatory mass has developed in the pancreatic head, DPPHR results in a change in the natural course of the disease in terms of pain status, frequency of acute episodes, need for further hospital admission, late death, and quality of life.

Adult↗
PubMed1983

Leiomyosarcoma of the duodenum recognized preoperatively.

We report the preoperative histologic diagnosis of leiomyosarcoma of the duodenum and review the clinical aspects and treatment of this tumor. The endoscopic techniques were critical in obtaining the diagnosis and deciding the treatment plan.

Aged↗
PubMed1988

Pseudomelanosis of the duodenum. Endoscopic, histologic, and ultrastructural study of a case.

We present the endoscopic, microscopic, and histochemical studies of a patient with pseudomelanosis of the duodenum. The pigment was located mainly in the lysosomes of macrophages in the lamina propria and was heterogeneous, showing features of melanin, pseudomelanin, and hemosiderin. The origin of this pigment remains unknown, but antihypertensive medication may have played a role.

Aged↗
PubMed1998

Pathologic changes in the glandular stomach and duodenum in an H. pylori-infected Mongolian gerbil model.

We have established a Helicobacter pylori-infected Mongolian gerbil model following Hirayama's method to investigate gastric diseases associated with H. pylori infection. We orally administered the culture broth of H. pylori ATCC 43504 to 8-week-old male Mongolian gerbils. After this, the gerbils were fed in a vinyl isolator. Subsequently, over the course of 48 weeks some of them were sacrificed for histopathologic examination and H. pylori culture. H. pylori colonization in the glandular stomach was seen in all the infected gerbils but only a few H. pylori were detected histologically. Acute inflammation, immature epithelium, and erosion were observed 2 weeks after H. pylori infection. Chronic inflammation was noted from 4 weeks after H. pylori infection. In addition, we found intestinal metaplasia and gastric ulcers from 12 and 24 weeks, respectively. There was mild to moderate inflammation in the duodenum but no ulcerative lesions or gastric metaplasia were observed. Some histologic findings were similar to those in humans, but inflammation occurred mainly in the deep mucosa and submucosa. This is a good animal model for H. pylori-associated gastric diseases but not for duodenal ulcers or gastric metaplasia. It might be useful for investigating the pathogenesis of H. pylori infection in the stomach.

Animals↗
PubMed1988

Calcium and sodium transport in the duodenum of the Dahl salt sensitive and salt resistant rat.

We measured food intake, body growth and transport of calcium and sodium by duodenum of female Dahl salt sensitive (DS) and salt resistant (DR) rat strains. Food intake and body growth were similar for DS and DR rats taking both 0.4 and 8% sodium chloride diets. Food intake increased with age up to 5 weeks and then remained constant despite continuing body growth. Comparing DS and DR rats fed the 0.4% sodium chloride diet at 6 and 11 weeks or the 8% sodium chloride diet at 6 weeks, transport of calcium and sodium were the same in both the DS and DR groups. Transport of calcium, but not sodium, was lower at 11 than at 6 weeks. Comparing simultaneous feeding of either 0.4 or 8% sodium chloride diets to 6-week old DS and DR rat strains, transport of calcium tended to be lower in animals fed the 8% as compared to the 0.4% sodium chloride diet, and the difference was significant for net 40Ca transport for DR rats. The DS rat fed on 8% sodium chloride had higher systolic blood pressure (SBP) than the DR rat. We conclude that growing DS and DR rats, ingesting equal amounts of food, do not differ in duodenal calcium and sodium transport measured by the everted sac technique. The response to feeding sodium chloride differs between strains: the high salt diet decreases net 40Ca transport in the DR but not the DS strain.

Animals↗
PubMed1976

Roll seat belt induced injury of the duodenum.

A case of duodenal rupture with a roll three-point seatbelt is described. It is apparently the seventh reported case of duodenal rupture in safety belt users. A female driver fell asleep, and her car went off the road, rolling forward in a ditch, slowing slightly, and then came to a sudden stop. The rupture was unusual: on the first part of duodenum, intraperitoneal, and longitudinal. The rupture mechanism is discussed, and the deficiencies of the roll seatbelt pointed out in accidents like the one described.

Adult↗
PubMed1987

Transvaginal injury of the duodenum, diaphragm, and lung.

An unusual case of transvaginal impalement is presented. At initial exploration the broad ligament and vagina were repaired. When bile drained from suction catheters reexploration revealed an injury to the duodenum and diaphragm. Wounds that penetrate the vagina may injure nonpelvic viscera. Vaginal penetrating wounds should be managed like other abdominal penetrating injuries.

Abdominal Injuries↗
PubMed1976

Intramural hematoma of the duodenum.

A case concerning a patient with an intramural hematoma involving the first and second portions of the duodenum was presented with a brief review of etiology, pathogenesis, clinical features, and management. An intramural hematoma usually occurs after blunt trauma, manifesting clinically as a high small bowel obstruction with a palpable mass. Roentgenograms usually confirm the diagnosis and treatment in simple evacuation of the hematoma.

Adult↗
PubMed1983

The endoscopically abnormal duodenum in patients with dyspepsia: biopsy findings in 60 cases.

Biopsies from 60 patients with dyspepsia and endoscopically abnormal first part of duodenum were examined. The main endoscopic findings were duodenitis (35 cases), chronic ulceration (eight) and abnormal mucosal patterns (17). The latter included mucosal atrophy, thickening, irregularity, nodularity and polypoid formation. The main histological findings were duodenitis (40), gastric metaplasia (42) and gastric heterotopia (seven). The first two were commonly seen together. Heterotopia was not associated with inflammation. Good correlation existed between endoscopic and histological findings.

Adult↗
PubMed1991

Effect of chewing Qat on mucosal histology and prevalence of Helicobacter pylori in the oesophagus, stomach and duodenum of Yemeni patients.

This investigation was aimed at assessing whether the Yemeni habit of chewing Qat on a regular basis had a significant effect on the upper alimentary tract. Seventy patients with dyspepsia attending Al-Thawra Hospital in Taiz, Yemen Republic were examined by endoscopy. Biopsies were taken from the oesophagus, stomach and duodenum. The patients included 28 who gave a history of daily Qat intake, 21 with less frequent intake and 21 who took none. The only statistically significant finding associated with daily Qat intake was a higher prevalence of duodenal ulcer, particularly in females. However, a strong association was also found between heavy smoking and ulcer, with most ulcer patients who chewed Qat daily being heavy smokers. Chewing Qat was not associated with a higher prevalence of oesophageal dysplasia, making it unlikely to be the cause of the perceived high incidence of oesophageal carcinoma in Yemen. There was a high prevalence of gastric H. pylori colonization (93%) and columnar-lined lower end of oesophagus (18%), as well as low prevalence of intestinal metaplasia of stomach (4%); this was not, however, related to chewing Qat. Further epidemiological and histological studies are needed to assess the significance of these findings in relation to the incidence of oesophageal and gastric carcinoma in Yemen.

Colony Count, Microbial↗
PubMed1993

Clear cell sarcoma of tendons and aponeuroses (malignant melanoma of soft parts) in the duodenum: the first visceral case.

An ulcerated tumour was removed by a Whipple's operation from the descending part of the duodenum of a 38-year-old male. The tumour cells were mainly spindle-shaped, arranged in nests and had very prominent nucleoli. A few cells contained melanin and melanosomes. Immunoreactivity for S-100 protein and focally for HMB-45 was observed. These features are diagnostic for clear cell sarcoma of tendons and aponeuroses. Because no other primary tumour could be found and the search for similar cases from the literature was unsuccessful, we believe that this tumour is the first reported clear cell sarcoma in a visceral location.

Adult↗
PubMed1982

An improved method for combined autoradiography and histochemistry: the simultaneous detection of 6-3H thymidine and acid phosphatase activity in cryostat sections of mouse thymus and duodenum.

A new method is described that enables the simultaneous detection of 6-3H thymidine incorporation and acid phosphatase activity in the same tissue section. Histochemically, naphthol AS B1 released by tissue based acid phosphatase activity from the substrate naphthyl AS B1 phosphoric acid is coupled with a range of diazonium salts to produce insoluble azo dyes. The azo dye tests result in a particulate localization of lysosomal acid phosphatase and also label diffuse sources associated with cell death. The tests selected permit the application of photographic emulsion without the necessity of an inert barrier layer to separate the emulsion from the histochemically treated cryosections. The localization of 6-3H thymidine incorporation and cell death in mouse thymus and duodenum is demonstrated and comparative counts estimating the distribution of 6-3H thymidine incorporation and hydrolase labelled cell death in the thymus are presented. Young mouse thymus (5 weeks) was found to contain 1.36 +/- 0.12% dying cells and 6.78 +/- 0.03% thymidine incorporating cells, whilst old mouse thymus (53 weeks) was found to contain 2.34 +/- 0.6% dying cells and 5.29 +/- 0.37% thymidine incorporating cells.

Acid Phosphatase↗
PubMed2004

Spatial determination of successive spikes in the isolated cat duodenum.

In seven isolated segments of the feline duodenum, the timings of all spikes and the locations of all spike patches that occurred after 12-16 successive slow waves were analysed. Simultaneous recordings were performed during 1-min periods using 240 extracellular electrodes (24 x 10 array; interelectrode distance 2 mm) positioned onto the serosal surface. In all seven preparations, spikes always occurred during the first half of the slow wave cycle. From preparation to preparation, and within 1-min periods in each preparation, there was limited variation in the spike-spike intervals, in the times between the spikes and the preceding slow wave and in the number of spikes at each electrode site. In contrast, the number of electrode sites that recorded spikes and the number of spike patches both showed great variability between preparations and sometimes within a single preparation. In addition, the location of spikes and spike patches was not random but was significantly concentrated in certain areas, often located along the anti-mesenteric border, while other sites showed little or no spike activity. In conclusion, spikes and spike patches tend to occur significantly in some areas and not in others. This spatial heterogeneity will play a role in intestinal motility.

Action Potentials↗
PubMed1989

Purification and characterization of spermidine N1-acetyltransferase from chick duodenum.

We have reported that spermidine N1-acetyltransferase has a larger role than ornithine decarboxylase in putrescine synthesis in chick duodenum induced by 1 alpha,25-dihydroxycholecalciferol (calcitriol) [Shinki, T., Kadofuku, T., Sato, T. and Suda, T. (1986) J. Biol. Chem. 261, 11712-11716]. In the present study, spermidine N1-acetyltransferase was purified from the duodenal cytosol of calcitriol-treated chicks to homogeneity judged by SDS/polyacrylamide gel electrophoresis. The purified enzyme converted spermidine only to N1-acetyl-spermidine. The apparent molecular mass of the purified spermidine N1-acetyltransferase was found to be 36 kDa by gel filtration on Sephacryl S-200 and 18 kDa by SDS/polyacrylamide gel electrophoresis. When duodenal crude 105,000 x g extracts were directly applied to a Sephacryl S-200 column without prior purification, three peaks with spermidine N1-acetyltransferase activity appeared. The first peak was in the void volume, the second peak was in the fraction corresponding to an apparent molecular mass of 70 kDa, and the third peak was in the fraction corresponding to 36 kDa. These results suggest that spermidine N1-acetyltransferase exists as a dimer of the 18 kDa subunits and is stabilized in (a) form(s) bound to other components or proteins in intact cells.

Acetyltransferases↗
PubMed1991

Development of the bovine duodenum with reference to enterochromaffin cells.

The present light microscopic study describes the morphological changes which occur in the duodenal mucosa of the bovine fetus from the third month of gestation until birth with regard to the sequence of appearance and morphology of enterochromaffin cells. The mucosa of the duodenum is prepared for digestive activity during the first months of development. This becomes obvious in the early differentiation of the fetal intestinal mucosa. The enterocytes in villus epithelium contain glycogen in the early months. These glycogen pools seem to shrink during the following months. They may provide a metabolic reserve for the fetus, which derives all of its nutrition from carbohydrates. Enterochromaffin cells appear in the three month old bovine fetus with two cell-types situated in the epithelial lining of crypts and villi. The density of enterochromaffin cells increases during gestation. There were no findings to indicate that the fetal enterochromaffin cells did not originate from endoderm. The early appearance from enterochromaffin cells (which are the producers of serotonin, 5-hydroxytryptamine) correlates with first gastrointestinal movements, which are known to commence in the first third of gestation, leading us to believe that 5-HT represents the chemical inducer of muscular motility in the developing intestine.

Animals↗
PubMed1998

Immunohistochemical colocalization of serotonin, substance P and Met-enkephalin-Arg6-Gly7-Leu8 in the endocrine cells of the ruminant duodenum.

The duodenum of various ruminants was examined by immunohistochemical staining for serotonin, substance P and Metenkephalin-Arg6-Gly7-Leu8 (MENK8). Serotonin- and substance P-immunoreactive endocrine cells were detected in samples from cow, calf, sheep, goat, and barbary sheep, MENK8-immunoreactive endocrine cells were detected exclusively in samples from cow and calf. Substance P and MENK8 immunoreactivity was found in serotonin-immunoreactive endocrine cells of cattle. Substance P- and MENK8-immunoreactive nervous elements were detected in all ruminants examined. The present results suggest that the expression and/or the mechanism that controls the expression of each peptide might differ between endocrine cells and nerve cells and might also depend on animal species.

Aging↗
PubMed2004

Postbiopsy intramural hematoma of the duodenum in an adult with Noonan's syndrome.

Intramural duodenal hematoma is a rare complication of endoscopic biopsy. It is usually seen in children with growth failure and in patients with bleeding disorders or who are anticoagulated. It is frequently associated with acute pancreatitis. We present a case of an adult patient with Noonan's syndrome who developed postbiopsy intraduodenal hematoma. Abdominal ultrasound and computed tomography scan established the diagnosis. Conservative treatment was successful. According to a brief review of the literature, patients with Noonan's syndrome may develop hematoma after sampling of the duodenum because they present all the main predisposing factors. Additionally, pulmonic valve stenosis may be another predisposing factor, but this may warrant further investigation.

Adult↗
PubMed1976

Traumatic retroperitoneal rupture of the duodenum.

A report of six cases of retroperitoneal rupture of the duodenum is presented. A high index of suspicion is necessary to enable early diagnosis to be made and appropriate treatment carried out. Early treatment will prevent the extremely rare, but at present uniformly fatal complication of gas gangrene. Plain X-ray and Gastrografin studies may help to elucidate the situation in particular cases, but are no substitute for repeated careful abdominal examination. It is suggested that large doses of penicillin be employed where possible in the management of these cases, in addition to such antibiotic therapy as may be expected to be effective against the usual Gram-negative bowel flora.

Adult↗