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At least 1,621 records · Page 90Linked to original sources
PubMed2003

18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) does not visualize follicular lymphoma of the duodenum.

18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has been used as a potential tool for imaging nodal follicular lymphoma (FL) and extranodal spread. As primary intestinal FL is increasingly being recognized, we have performed a study to investigate the usefulness of 18F-FDG-PET for staging of extranodal FL within the gastrointestinal tract. In eight patients with a diagnosis of FL localized in the duodenum (six cases in stage I and one each in stages II and IV, respectively) whole body 18F-FDG-PET scans were performed. Seven patients with duodenal FL were rated WHO grade 1 and one had FL grade 3, while both patients with secondary spread had FL WHO grade 1. All patients were imaged before initiation of therapy. None of the patients with primary duodenal FL showed pathologically elevated 18F-FDG uptake. 18F-FDG-PET findings were not influenced by histological grade or proliferative activity of FL. These findings suggest that 18F-FDG-PET is not useful for clinical assessment of primary duodenal FL.

Adult↗
PubMed1999

'Pyloric gland-type adenoma' arising in heterotopic gastric mucosa of the duodenum, with dysplastic progression of the gastric type.

'Pyloric gland-type adenoma' is a recently described and very rare entity. We report a case of a pedunculated polyp of the duodenal bulb showing the features of pyloric gland-type adenoma. Heterotopic gastric mucosa was found adjacent to the tumour. Immunohistochemically, the tumour cells at the surface of the polyp showed foveolar-type mucin (M1) while most other tumour cells showed deep gastric mucin (M2), displaying a pattern of differentiation similar to the normal gastric mucosa. The polyp also showed villous or papillary structures with disorganization of gastric differentiation and marked increase of proliferating in foci cells. This is the first case of pyloric gland-type adenoma found to arise in heterotopic gastric mucosa of the duodenum, showing dysplastic progression of the gastric type.

Adenoma↗
PubMed1997

A 7-year-old child with primary tumour localisation in the distal duodenum--new imaging procedures for an improved diagnosis.

UNLABELLED: Duodenal gastrinomas in childhood are extremely rare and often missed at first medical consultation. We report on a 7-year-old child with sporadic gastrinoma of primary localisation in the distal duodenum. Small metastases in the liver and regional nodes were detected pre-operatively by somatostatin receptor scintigraphy (SRS) but not by other conventional imaging procedures. Diagnostic procedures include pre-operative SRS, endoscopic ultrasound and intra-operative endoscopic transillumination. CONCLUSION: Gastrinomas are rare abdominal tumours in childhood. Pre-operative tumour-specific diagnosis is possible by 111indium pentreotide SRS.

Biomarkers, Tumor↗
PubMed2005

Consecutive instances of gallstone ileus due to obstruction first at the ileum and then at the duodenum complicating a gallbladder carcinoma: a case report.

Ectopic gallstone obstruction, gallstone ileus, due to cholecystoenteric fistula is an infrequent condition. Its occurrence as a complication of a gallbladder (GB) carcinoma is even more rare. We describe an unusual case of a GB carcinoma complicated by a cholecystoduodenal fistula leading to first gallstone obstruction in the ileum and then, later, in the duodenum, in which an accurate preoperative diagnosis was based on pathognomonic computerized tomography (CT) features. A correct diagnosis of this may be crucial and requires prompt surgical intervention; radiologists should be familiar with their classic CT appearance.

Aged↗
PubMed1988

Congenital atresia and stenosis of the duodenum: the impact of a prenatal diagnosis.

This review was undertaken to determine the effects of prenatal diagnosis, on the basis of ultrasonographic evidence, of a duodenal obstruction on the care and morbidity of the newborn infant. The records of 46 cases of either atresia or stenosis of the small bowel in infants treated during the last six years in a tertiary perinatal center were reviewed retrospectively. A prenatal fetal diagnosis of obstruction was made in 13 patients (12 obstructions located in the duodenum and one in the jejunum). The mean gestational age at prenatal diagnosis was 33.7 weeks (range 27 to 37 weeks). The course of those infants with the prenatal diagnosis made by ultrasound was compared with that of those infants in whom the diagnosis was established after the onset of symptoms of obstruction appeared. Such a prenatal diagnosis resulted in earlier surgical intervention (1.8 versus 3.9 days). Metabolic complications secondary to repeated vomiting were found to be less frequent. The expectant mother in whom such a fetal prenatal diagnosis has been made can be transported to a tertiary level perinatal center where neonatal and specialized surgical expertise are available. After birth, the infant can undergo immediate operation without being separated from its mother.

Abnormalities, Multiple↗
PubMed2005

[Intraductal papillary mucinous tumor of the pancreas degenerated and fistulisated in the stomach, the duodenum and colon].

We report a case of intraductal papillary mucinous tumor of the pancreas (IPMT) degenerated and fistulized into the stomach, the duodenum and the colon. Diagnoses of malignancy and fistulization were proven preoperatively. Pancreaticoduodenectomy extended to the body was performed. Pathological examination revealed a malignant IPMT with an invasive component. Of the 3 fistulizations tracts, both gastric and duodenal ones were malignant. To our knowledge, this is the first reported case of IPMT with colonic fistulization. Twelve months later, the patient is alive without signs of recurrence.

Aged↗
PubMedDate not supplied

Retroperitoneal perforation of the duodenum from biliary stent erosion.

Endoscopically placed biliary stents have supplanted surgical decompression as the preferred treatment option for patients with obstructive jaundice from advanced pancreatic cancer. An unusual complication of indewelling biliary stents is duodenal perforation into the retroperitoneum. We describe the case of a patient with end-stage pancreatic cancer who presented with an acute abdomen from erosion of a previously placed bile duct stent through the wall of the second portion of the duodenum. Although our patient presented with advanced symptoms, clinical presentations can vary from mild abdominal discomfort and general malaise to overt septic shock. Definitive diagnosis is best made with computed tomography (CT) imaging, which can detect traces of retroperitoneal air and fluid. Treatment options vary from nonoperative management with antibiotics, bowel rest, and parenteral alimentation in the most stable patients to definitive surgery with complete diversion of gastric contents and biliary flow from the affected area in patients with clinical symptoms or radiologic evidence suggesting extensive contamination. Complications of management can include duodenal fistulization, residual retroperitoneal or intrabdominal abscess, and ongoing sepsis. This report highlights the salient issues in the presentation, diagnosis, and modern management of patients with this rare complication of indwelling biliary stents.

Abdominal Pain↗
PubMedDate not supplied

Surgical treatment of pancreas divisum causing chronic pancreatitis: the outcome benefits of duodenum-preserving pancreatic head resection.

Pancreas divisum (PD) represents a duct anomaly in the pancreatic head ducts, leading frequently leading to recurrent acute pancreatitis (rAP) or chronic pancreatitis (CP). Based on endoscopic retrograde cholangiopancreatography, pancreas divisum can be found in 1% to 6% of patients with pancreatitis. The correlation of this abnormality with pancreatic disease is an issue of continuing controversy. Because of the underlying duct anomalies and major pathomorphological changes in the pancreatic head, duodenum-preserving pancreatic head resection (DPPHR) offers an option for causal treatment. Thirty-six patients with pancreatitis caused by PD were treated surgically. Thirty patients suffered from CP, 6 from rAP. The mean duration of the disease was 47.5 and 49.8 months, respectively. The age at the time of surgery was 39.2 years in the CP group, and 27.6 years in the rAP group. Median hospitalization since diagnosis was 18.8 weeks for CP patients and 24.6 weeks for rAP patients. Previous procedures performed in these patients included endoscopic papillotomy (30%), duct stenting (14%), and surgical treatment (17%). The median preoperative pain score was 8 on a visual analog scale. According to the classification of pancreas divisum, 10 patients demonstrated a complete PD, 25 had a functionally incomplete PD, and 1 had a dorsal duct type. The pain status as well as the endocrine (oral glucose tolerance test) and exocrine (pancreolauryl test) function were evaluated preoperatively and early and late postoperatively with a median follow-up time of 39.3 months. There was no operative-related mortality. The follow-up was 100%; 4 patients died (1 from suicide, 1 from cardiac arrest, and 2 from cancer of the esophagus). Fifty percent of the patients were completely pain-free, 31% had a significant reduction of pain with a median pain score of 2 (P < 0.001). Six patients (5 CP, 1 rAP) had further attacks of acute pancreatitis with a need for hospitalization. DPPHR reduced pain and preserved the endocrine function in the majority of patients with pancreas divisum. Therefore, DPPHR is an alternative to other resective or drainage procedures after failure of interventional treatment.

Adult↗
PubMed2005

The coactivator Bridge-1 increases transcriptional activation by pancreas duodenum homeobox-1 (PDX-1).

Well-orchestrated transcriptional regulation of pancreatic beta cells is essential for insulin production and glucose homeostasis. Pancreas duodenum homeobox-1 (PDX-1) is a key regulator of glucose-dependent insulin production and glucose metabolism. We find that PDX-1 interacts with the PDZ-domain coactivator Bridge-1 in yeast interaction trap assays. Rat Bridge-1 and PDX-1 interact directly in GST pull-down assays via Bridge-1 interactions with the amino-terminal transactivation domain of PDX-1. Bridge-1 also interacts with wild-type and mutant human PDX-1 (IPF-1) proteins and strongly interacts with the amino-terminal PDX-1 P63fsdelC (MODY4) mutant protein. Transcriptional activation by PDX-1 is increased by addition of Bridge-1 in multiple contexts, including synergistic activation of a Gal4 reporter by Gal4-Bridge-1 and Gal4-PDX-1 fusion proteins, activation of the somatostatin promoter TAAT1 enhancer, and synergistic activation of the rat insulin I promoter FarFlat enhancer by PDX-1, E12, and E47. We propose that the coactivator Bridge-1 modulates PDX-1 functions in the regulation of its target genes.

Animals↗
PubMed1997

Gastric emptying following pylorus-preserving Whipple and duodenum-preserving pancreatic head resection in patients with chronic pancreatitis.

BACKGROUND: After pylorus-preserving Whipple (PPW), delayed gastric emptying (DGE) is reported in up to 50% of these patients. We analyzed gastric emptying and hormonal adaptation of cholecystokinin (CCK), pancreatic polypeptide (PP), and gastrin following two surgical procedures for chronic pancreatitis (CP): the PPW and the duodenum-preserving pancreatic head resection (DPPHR). METHODS: Ten patients underwent DPPHR and 10 underwent PPW for CP. Preoperatively and 10 days and 6 months postoperatively, gastric emptying (paracetamol absorption test) and CCK, gastrin, and PP were measured using a test meal stimulation. RESULTS: The area under the serum paracetamol time curve for 0 to 120 minutes (AUC) showed no preoperative difference. Ten days postoperatively, the AUC was significantly reduced (P <0.05) after PPW but not after DPPHR. Six months postoperatively, AUC was comparable with the preoperative findings in DPPHR and PPW. The integrated 180-minute PP release was significantly reduced 10 days and 6 months postoperatively in both groups. The integrated 180-minute CCK release was decreased 10 days after PPW, but failed to be significant (P = 0.053). Gastrin levels were postoperatively unchanged. CONCLUSION: Following DPPHR we found no delay in gastric emptying. In contrast, DGE occurs early after PPW. Our data may help explain the slower recovery in PPW patients with regard to weight gain and relief from pain, which may be due to the functional alteration of gastric emptying and motility after this type of surgery.

Acetaminophen↗
PubMed1997

Total resection of the head of the pancreas preserving the duodenum, bile duct, and papilla with end-to-end anastomosis of the pancreatic duct.

Many surgeons have recently attempted operative procedures for limited resection of the head of the pancreas. This site-specific approach has emerged as a result of precise diagnostic radiologic studies that have become available. The author performed a new operative procedure in 2 patients with mucin-producing pancreatic cysts that included total resection of the head of the pancreas with careful regard to its vasculature. The procedure provided a way of resecting the head of the pancreas while preserving the duodenum, bile duct, and papilla. The pancreatic duct was cut 5 mm before the point of confluence with the bile duct, and an end-to-end anastomosis was performed on the pancreatic duct. Both patients were discharged within 1 to 1.5 months after surgery, without complication. The operative procedure requires no processing of the jejunum, only a simple anastomosis of the pancreatic duct.

Anastomosis, Surgical↗
PubMed2001

[Endocrine tumors of the duodenum and pancreas: "prerequisites", imaging, and intraoperative detection].

Non-secreting pancreatic neuroendocrine tumors and diarrheogenic tumors are usually bulky and easy to recognize thanks to somatostatin-receptor scintigraphy and hormonal dosages. The real difficulty concerns insulinomas and particularly gastrinomas, which are found at the level of the duodenum and can be very small. Diagnosis is based on biological examinations, and the search for MEN I must be done systematically. Their localization is based on two essential and noninvasive exams: echoendoscopy and somatostatin-receptor imaging, though the surgeon's skill in the operative field, aided by an intraoperioperative echography, is indispensable. Surgical treatment of insulinomas gives excellent results. However, for sporadic gastrinomas, there was only a 34% recovery rate, and still less for MEN I gastrinomas.

Diagnosis, Differential↗
PubMed1987

Do juxtapapillary diverticula of the duodenum interfere with cannulation at endoscopic retrograde cholangiopancreatography? A prospective study.

Previous observations indicate that juxtapapillary diverticula (JD) of the duodenum have made cannulation of the papilla of Vater difficult in endoscopic retrograde cholangiopancreatography. This prospective study of 1,243 cases that underwent ERCP shows that 153 patients with JD had the same failure rate as the 1,090 patients without JD (8.49% vs. 8.99%). The incidence of JD increases with age, but the incidence of biliary calculi or cholangitis is not different between the JD group and the nondiverticulum group.

Adult↗
PubMedDate not supplied

Local staging and assessment of resectability in carcinoma of the esophagus, stomach, and duodenum by endoscopic ultrasonography.

Eighty-eight patients with carcinoma of the esophagus (N = 44), stomach (N = 41), and duodenum (N = 3) who underwent surgery were pre-operatively examined by endoscopic ultrasonography (EUS). The ability of EUS to accurately predict the T stage and the N stage was 82% and 70% for esophageal carcinoma, 71% and 75% for gastric cancer, and 100% and 66% for duodenal malignancy. In esophageal carcinoma, the accuracy of T staging was only slightly lower in cases with non-traversable tumor stenoses (77%) compared with traversable carcinomas (84%). This was probably due to the fact that all non-traversable tumors were either in stage T3 or T4. The accuracy of EUS in predicting the stages T1 to T3, which correspond to R0 resectability (no macroscopic or microscopic tumor remains), was 92% for adenocarcinoma of the distal esophagus and 85% for gastric cancer. However, in squamous cell carcinoma of the esophagus, R0 resection was possible in only 66% of all cases, whereas EUS predicted an 84% R0 resection rate. In adenocarcinoma of the distal esophagus and stomach, EUS prediction of stages T1 to T3 correlated well with the actual rate of R0 resection. These results show that EUS is a reliable diagnostic method for the local staging of upper gastrointestinal cancer. Its impact on treatment and hence on prognosis of patients with these malignancies has yet to be determined.

Adenocarcinoma↗
PubMed1986

Intramural haematoma of the duodenum following blunt abdominal injury--the place for conservative treatment.

Two patients with intramural haematoma of the duodenum following blunt abdominal injury are presented. They responded well to conservative treatment. Complete resolution of the duodenal obstruction was demonstrated by consecutive radiological studies. Because haematomas usually resolve spontaneously, awareness and diagnosis of this rare condition are important in order to prevent unnecessary operation.

Abdominal Injuries↗
PubMed1990

Leiomyosarcoma of the duodenum in two horses.

Two horses affected by chronic, intermittent colic were found, at post-mortem examination, to have localized annular thickening of a segment of the duodenum. Histological examination of the lesion in both cases revealed a tumour composed of bundles of oval or spindle-shaped cells that stained as muscle with van Gieson stain. The histological diagnosis was leiomyosarcoma. The tumour had caused partial bowel obstruction in both horses.

Animals↗