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PubMed2002

Pedunculated early carcinoma of supra-ampullary duodenum presenting as acute pancreatitis.

Background. A 43-yr-old man was admitted to our hospital after sudden onset of epigastric pain. He was diagnosed with acute pancreatitis by clinical, laboratory, and radiographic signs. Examinations for the etiology of acute pancreatitis revealed a duodenal tumor arising at the proximal portion of the descending limb, extending by a long stalk, and coming into contact with Vater's papilla. The tumor was snare-resected endoscopically. Histological examination showed an early carcinoma. Extra-ampullary carcinoma of the duodenum should be considered an unusual cause of acute pancreatitis secondary to obstruction of the major duodenal papilla. Endoscopic polypectomy is effective because of the difficulty in making a precise diagnosis by endoscopic biopsy.

Acute Disease↗
PubMed1981

Quantitative studies of vasoactive intestinal peptide (VIP) binding sites and VIP-induced adenosine 3':5'-monophosphate production in epithelial cells from duodenum, jejunum, ileum, cecum, colon and rectum in the rat.

The binding of vasoactive intestinal peptide (VIP) and its effect on adenosine 3':5'-monophosphate (cyclic AMP) production were measured in isolated rat intestinal epithelial cells from duodenum, jejunum ileum, cecum, colon and rectum. In every segment tested, VIP binding and VIP-induced cyclic AMP production exhibited a similar pattern with two populations of VIP binding sites and similar magnitude of cyclic AMP production. Continuous displacement of the binding of 125I-labelled VIP and stimulation of cyclic AMP production were observed in the range of 10(-10)--10(-7) M VIP concentrations. Fifty per cent inhibition of the initial binding of tracer was obtained with 2.2 to 3.2 nM VIP. The Km of stimulation of cyclic AMP production was 1.2 to 2.6 nM VIP. Chicken VIP and porcine secretin showed a 4-fold higher and a 100-fold lower affinity than porcine VIP for binding sites, respectively. The same was true for the stimulation of cyclic AMP production. The existence of receptors highly sensitive to VIP in the separate segments of the bowel corresponds to the presence of high concentration of VIP at the vicinity of epithelial cells and strongly suggests that VIP is active in regulating different intestinal functions.

Animals↗
PubMed2002

Pancreas duodenum homeobox-1 regulates pancreas development during embryogenesis and islet cell function in adulthood.

Pancreas duodenum homeobox-1 (PDX-1) (also known as insulin promoter factor-1, islet/duodenum homeobox-1, somatostatin transactivating factor-1, insulin upstream factor-1 and glucose-sensitive factor) is a transcription factor encoded by a Hox-like homeodomain gene. In humans and other animal species, the embryonic development of the pancreas requires PDX-1, as demonstrated by the identification of an individual with pancreatic agenesis resulting from a mutation that impaired the transcription of a functionally active PDX-1 protein. In adult subjects, PDX-1 is essential for normal pancreatic islet function as suggested by its regulatory action on the expression of a number of pancreatic genes, including insulin, somatostatin, islet amyloid polypeptide, the glucose transporter type 2 and glucokinase. Furthermore, heterozygous mutations of PDX-1 have been linked to a type of autosomal dominant form of diabetes mellitus known as maturity onset diabetes of the young type 4. The dual action of PDX-1, as a differentiation factor during embryogenesis and as a regulator of islet cell physiology in mature islet cells, underscores the unique role of PDX-1 in health and disease of the human endocrine pancreas.

Amino Acid Sequence↗
PubMed2003

A rare case of idiopathic retroperitoneal fibrosis involving obstruction of the mesenteric arteries, duodenum, common bile duct, and inferior vena cava.

Idiopathic retroperitoneal fibrosis (IRF), usually affects the ureter, although the biliary tree, duodenum and vasculature may also be susceptible. This case report describes a 64-year-old man with IRF, who presented painless watery diarrhea, radiological features of obstructive jaundice and duodenal obstruction, and ultimately an obstruction of the inferior vena cava. We employed tamoxifen for his treatment, but the disease progressed and the patient died of multiple organ failure two years after the onset. While the cause of IRF in this patient was obscure, we suspected his painless watery diarrhea indicated chronic ischemia of the small bowel, and the findings of an abdominal CT scan were extremely valuable in indicating IRF.

Angiography↗
PubMed2006

Heterotopic pancreas in the stomach which caused obstructive stenosis in the duodenum.

The patient, a 43-year-old Japanese man suffering from duodenal ulcer and reflux esophagitis, was admitted to our hospital because of submucosal tumor in the antrum and obstructive stenosis of duodenum. Several imaging tests could not rule out the possibility of malignant disease. Therefore, the patient was surgically treated. Pathohistological examination of resected tissue demonstrated Heinrich type I heterotopic pancreas in the gastric lesion and submucosal abscess in the duodenal lesion with stenosis. In this case, it was considered that the heterotopic pancreas caused chronic inflammation to form the gastric tumor, and submucosal abscess leading to the severe duodenal stenosis.

Abscess↗
PubMed1979

Pancreatic pseudocysts of the duodenum.

A pancreatic pseudocyst within the wall of the duodenum is presented. Its radiographic features were analyzed and comprehensively compared with 10 proved cases. These pseudocysts can be intramural or extrinsic severely compressive lesions. The occurrence of these pseudocysts at multiple sites throughout the gastrointestinal tract emphasizes the need to consider them in the differential diagnosis of severe extrinsic compressive or intramural lesions.

Duodenal Diseases↗
PubMedDate not supplied

[Two cases of pancreatic head polypeptide tumors, one with a central cavity which fistulized into the duodenum].

PP omas are rare, usually malignant tumours of the PP cells of the Langerhan's islets which secrete pancreatic polypeptide. The authors present two women operated for PP-omas of the pancreas. The first was 55 year-old woman in whom we did a cephalic duodenopancreatectomy (Whipple's procedure) for the tumor of the head of the pancreas with central cavity containing gas due to communication with the duodenum. Immunohistochemistry showed a PP oma with strong generalised immunoreactivity with antibodies against Chromogramin A, neuron specific enolasa and PP with more the 95% of tumor cells and coexpression of somatostatine in 35% and VIP in less then 5% of tumor cells. Following uneventful recovery the patient stayed symptom free so far and put 20 kilograms in weight. The second patient was 19 year-old girl with a multinodal tumor of almost the entire pancreas in whom a local excision of the nodal mass of the head of the pancreas had been carried out in the other hospital, three years ago and relaparotomy and tumor biopsy a month before admission to our institution. In her we did a total duodenopancreatectomy and standard lymphadenectomy for a multinodal mass occupying almost the entire pancreas. Immunohistochemistry showed a strong generalised immunoreactivity with antibodies against Chromographin A, Neuron specific enolasa and PP for more then 95% of tumors, cells. Glucagon was expressed in few focuses (in less then 1% of cells), somatostatin was expressed very rarely in single cells while the rest of tumor markers did not show a visible immunologic reactions in the majority of tumors, cells. Three years after surgery she died due to multiple liver secondaries.

Adult↗
PubMed2004

Does the aspartic acid to asparagine substitution at position 76 in the pancreas duodenum homeobox gene (PDX1) cause late-onset type 2 diabetes?

OBJECTIVE: Considerable data support an inherited defect in insulin secretion as one component of type 2 diabetes. Coding variants of the pancreas duodenum homeobox gene (PDX1) were proposed to predispose late-onset type 2 diabetes and to decrease transactivation in vitro. We tested the hypothesis that the Asp76Asn (D76N) variant that was identified in several populations predisposed type 2 diabetes and reduced insulin secretion. RESEARCH DESIGN AND METHODS: We performed a case-control study in 191 control subjects and 190 individuals with type 2 diabetes, all of European descent, then characterized the D76N variant in 704 members of 68 families. We compared the phenotypic characteristics of those with and without the variant by diagnostic status and determined the insulin secretory response to intravenous glucose and tolbutamide among nondiabetic family members. RESULTS: D76N was not associated with type 2 diabetes, either in our population or when all reported studies in Caucasians were combined. D76N did not segregate with diabetes among the families examined. Among D76N carriers, nondiabetic individuals had a lower waist-to-hip ratio and a trend to lower BMI than their diabetic counterparts. Diabetic carriers of D76N were significantly leaner by BMI (P = 0.012) and tended to be younger than diabetic individuals with the D/D genotype. However, insulin secretion in response to oral and intravenous glucose challenge and to intravenous tolbutamide was not reduced in D76N carriers. CONCLUSIONS: The D76N variant of PDX1 does not significantly alter insulin secretion or act as a high-risk susceptibility allele for late-onset type 2 diabetes as proposed previously, although we cannot exclude a minor role in increasing risk of diabetes.

Age of Onset↗
PubMed2006

Effect of short-term sequential administration of nonsteroidal anti-inflammatory drugs on the stomach and proximal portion of the duodenum in healthy dogs.

OBJECTIVE: To evaluate effects of injection with a nonsteroidal anti-inflammatory drug (NSAID) followed by oral administration of an NSAID on the gastrointestinal tract (GIT) of healthy dogs. ANIMALS: 6 healthy Walker Hounds. PROCEDURES: In a randomized, crossover design, dogs were administered 4 treatments consisting of an SC injection of an NSAID or control solution (day 0), followed by oral administration of an NSAID or inert substance for 4 days (days 1 through 4). Treatment regimens included carprofen (4 mg/kg) followed by inert substance; saline (0.9% NaCl) solution followed by deracoxib (4 mg/kg); carprofen (4 mg/kg) followed by carprofen (4 mg/kg); and carprofen (4 mg/kg) followed by deracoxib (4 mg/kg). Hematologic, serum biochemical, and fecal evaluations were conducted weekly, and clinical scores were obtained daily. Endoscopy of the GIT was performed before and on days 1, 2, and 5 for each treatment. Lesions were scored by use of a 6-point scale. RESULTS: No significant differences existed for clinical data, clinicopathologic data, or lesion scores in the esophagus, cardia, or duodenum. For the gastric fundus, antrum, and lesser curvature, an effect of time was observed for all treatments, with lesions worsening from before to day 2 of treatments but improving by day 5. CONCLUSIONS AND CLINICAL RELEVANCE: Sequential administration of NSAIDs in this experiment did not result in clinically important gastroduodenal ulcers. A larger study to investigate the effect of sequential administration of NSAIDs for longer durations and in dogs with signs of acute and chronic pain is essential to substantiate these findings.

Administration, Oral↗
PubMed1980

Crohn's disease of the duodenum.

Seven cases of Crohn's disease of the duodenum are presented. They made up 2% of 350 cases of Crohn's disease seen over a period of 15 years. Mean age at onset of Crohn's disease was 22 years (range, 13--47). All patients had other, and most patients severe, lesions elsewhere in the alimentary tract. In three patients the duodenal lesion appeared simultaneously with or within a year of lesions elsewhere, in four cases not until 4 to 15 years later. The period of observation after detection of regional duodenitis was 2 to 14 years; mean, 8 years. The commonest complaint due to duodenitis was epigastric pain. It was present in everyone. Gastrointestinal bleeding rarely occurred. Complicating pancreatitis was not seen. Pathophysiologic abnormalities (decreased vitamin B12 and iron absorption, abnormal protein loss) depended more on the extraduodenal extension of Crohn's disease than on the duodenal lesion. In three patients duodenal obstruction required a bypass operation (gastrojejunostomy or duodenojejunostomy). The same three patients and three other of the series were subjected to other surgical treatment, including ileal resection and, in four cases, subtotal colectomy. Two patients died, one of pneumonia in his home and one in her home town of, probably, acute gastroenteritis complicating a severe short-bowel syndrome. The prognosis in this series seemed to be worse than in Crohn's disease in general, not because of the duodenal lesion but because of its association with severe lesions elsewhere in the gastrointestinal tract.

Adolescent↗
PubMed1994

A case of echinostomiasis with ulcerative lesions in the duodenum.

Echinostomiasis is an endemic intestinal trematodiasis of humans in Korea. We observed a human case of Echinostoma hortense infection who had ulcerations on the duodenal mucosa. A 55-year old man living in Hamyang-gun, Kyongnam, complained of epigastric pain with hematemesis in April 1994. Endoscopy revealed lesions of early gastric cancer and duodenal ulcerations. A penetrating parasite into the duodenal mucosa was picked out, and identified as E. hortense. As the patient was treated with praziquantel 10 mg/kg single dose, 3 more E. hortense and 7 Metagonimus worms were recovered. This case demonstrates that echinostomiasis causes gross ulcerations in the duodenum.

Duodenal Ulcer↗
PubMed2006

Interdigitating dendritic cell sarcoma of the duodenum with rapidly fatal course: a case report and review of the literature.

Interdigitating dendritic cell sarcoma is an extremely rare malignancy derived from antigen-presenting cells. Dendritic cells constitute a heterogeneous group of cells, which includes Langerhans cells, dermal dendrocytes, follicular dendritic cells, and interdigitating dendritic cells present in lymphoid and nonlymphoid organs. We report the case of a 36-year-old woman who presented with epigastric pain, projectile vomiting, and significant weight loss. Upper gastrointestinal endoscopy showed a duodenal lesion; a biopsy of the lesion was taken and was diagnosed as sarcoma. She underwent a Whipple procedure. A final diagnosis of interdigitating dendritic cell sarcoma was made, with liver and peripancreatic lymph node involvement. The patient deteriorated rapidly and died 4 months later. Although interdigitating dendritic cell sarcoma of the duodenum is extremely rare, we think it should be included in the differential diagnosis of unusual spindle cell tumors with a rich lymphocytic infiltrate.

Adult↗
PubMed1976

Villous tumour of the duodenum.

The occurrence of a villous tumour of the duodenum in an 18-year-old female patient is reported. This is the youngest patient who has been recorded as having this type of tumour. Fibre-optic endoscopy with biopsy of the tumour permitted a pre-operative diagnosis to be made.

Adolescent↗
PubMed1998

Leiomyosarcomatosis involving the duodenum and the subcutaneous tissue.

Soft tissue sarcomas include only 0.7% of all malignancies and leiomyosarcomas constitute about 10% of all sarcomas. Very rarely leiomyosarcoma may present as multifocal primaries. We report a 65-year-old patient with multiple subcutaneous nodules. During the investigation period the patient had hematemesis and melena. Upper gastro-intestinal endoscopy was performed and multiple polipoid lesions were discovered in the duodenum. The rest of gastrointestinal system was normal with barium graphies. Biopsies from the subcutaneous nodules and duodenal lesions showed leiomyosarcoma. Although we cannot rule out the possibility of metastases, we strongly consider a multicentric origin since no other metastasis is present and duodenal lesions are also multiple.

Aged↗
PubMed1998

[Giant diverticulum of the duodenum. Case report].

The authors describe the case of a 49-year-old man with a giant diverticulum of the duodenum, with apparently scarce symptoms, pointed out by gastroscopy and X-ray of the upper gastrointestinal duct with barium meal. The removal of the lesion, obtained after surgical operation, showed a diverticulum with a 6 cm diameter, with signs of diverticulitis; the histological test did not point out is degenerative lesions. A survey of the recent literature on the matter is presented.

Diverticulum↗
PubMed1976

[Primary malignant neoplasms of the duodenum. Considerations on 4 cases].

Starting from four primitive malignant neoplasias of the duodenum observed during the course of the last two years, the Authors briefly outline the clinical aetiopathological and especially the radiological characteristics of duodenal primitive malignant neoplasias. They stress the importance of the radiological investigation for early diagnosis of such disturbances, as can clearly by deduced from illustration of the radiological pictures concerning the four cases, all male patients aged from 55 to 68 years. A localisation in the duodenal bulb, with ulceration, is to be considered very rare; the other localisations were two at the 2nd and one at the 1st duodenal portion.

Adenocarcinoma↗
PubMed1999

[The bleeding ulcer of the duodenum: the procedure in unreliable hemostasis].

The treatment of patients with bleeding duodenal ulcers is still one of the most complicated and discussable problems in surgery. The aim of this study was an attempt to predict the relapse of bleeding from ulcer of the duodenum on the basis of the experience in the treatment of 539 patients with this disease, 101 of whom underwent surgery. Diagnostic criteria for prognosis of repeated bleeding have been developed and the role of each of them in reliability of hemostasis in ecores was determined. It was established that indication for urgent operations for unreliable hemostasis is determined by the sum of 11 scores and more, as probability of bleeding recurrence in this situation in 90.2%.

Adult↗