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Turk Patoloji Dergisi 2020Endoscopic resections are increasingly being used for superficial gastrointestinal lesions. However, application of these techniques in the duodenum remains challenging,...
OBJECTIVE
Endoscopic resections are increasingly being used for superficial gastrointestinal lesions. However, application of these techniques in the duodenum remains challenging, due to the technical difficulties and high complication rates. This study projects a western tertiary center's experience in the endoscopic treatment and diagnostic workup of 19 cases of non-ampullary duodenal lesions.
MATERIAL AND METHOD
Specimens (12 endoscopic mucosal resections, 6 endoscopic submucosal dissections, and one endoscopic full-thickness resection) were processed following a strict protocol (photographed, mapped digitally and submitted totally) for histopathologic examination. Clinicopathologic characteristics, margin status and follow-up information were analyzed.
RESULTS
The mean age of the 16 patients was 52 years (range: 22-81). Mean lesion size was 1.4 cm (range: 0.3-3.6 cm) for all cases, 2 cm for endoscopic submucosal dissections and 1.1 cm for endoscopic mucosal resections. Mean number of blocks submitted was 4/case. Seven neuroendocrine tumors, 3 tubulovillous adenomas were diagnosed along with nine benign lesions. For endoscopic submucosal dissections, en-bloc and R0 resection rates were 100% (n=6/6) and 83% (n=5/6); for endoscopic mucosal resections, they were 92% (n=11/12) and 83% (n=10/12), respectively. Only one patient had procedure-related late perforation that was managed endoscopically. No mortality was encountered.
CONCLUSION
Duodenal endoscopic resections proved successful, safe and feasible methods in a tertiary center. The pathologist's role is to designate the accurate diagnosis, related histopathologic parameters and margin status. The gross protocol was found to be essential in evaluating specimen margins and orientation, as well as in size measurement. We recommend following a standardized approach including gross photography and digital mapping when handling these specimens, for both diagnostic and data collection purposes.
Topics: Adult; Aged; Aged, 80 and over; Duodenum; Endoscopic Mucosal Resection; Female; Humans; Intestinal Polyps; Male; Middle Aged; Young Adult
PubMed: 31825518
DOI: 10.5146/tjpath.2019.01474 -
Journal of the National Medical... May 1979Duodenum inversum is usually associated with chronic abdominal pain which is of unknown etiology. Incomplete rotation of the bowel may be associated with this anomaly....
Duodenum inversum is usually associated with chronic abdominal pain which is of unknown etiology. Incomplete rotation of the bowel may be associated with this anomaly. An unusually high incidence of pancreatitis, elevated bilirubin, and hypoalbuminemia was noted in this series of nine patients.
Topics: Abdomen; Adult; Duodenum; Female; Humans; Laparotomy; Pain; Radiography
PubMed: 448763
DOI: No ID Found -
Poultry Science Oct 2019The objective of this study was to evaluate the effects of rapeseed expeller cake (REC) derived from Brassica napus rapeseed with different concentrations of...
The objective of this study was to evaluate the effects of rapeseed expeller cake (REC) derived from Brassica napus rapeseed with different concentrations of glucosinolate (Gls) and erucic acid (EA) on the egg-production performance, egg quality, apparent nutrient digestibility, and intestinal morphology in laying hens. At 33 wk of age, a total of 1,080 laying hens were randomly divided into 9 treatment groups in a completely randomized design involving a control treatment without REC (a corn-soybean diet) and a 2 × 4 factorial arrangement with 2 concentrations of REC (at 7 and 14%) from 4varieties of rapeseed varying in Gls and EA concentrations [DY6 REC: 22.67 μmol/g (Gls, relative to rapeseed meal), 0.7% (EA, relative to total fatty acids); MB1 REC: 43.23 μmol/g, 3.5%; DY5 REC: 74.66 μmol/g, 16.20%; XH3 REC: 132.83 μmol/g, 44.60%]. The trial lasted for 8 wk. Compared with the control group, REC addition decreased the ADFI, egg production, egg weight, and egg mass of laying hens during wk1 to wk4, wk5 to wk8, and wk1 to wk8 (P < 0.05), and REC did not affect FCR, mortality during wk1 to wk4, wk5 to wk8, and wk1 to wk8 (P > 0.05). The XH3 REC group had a trend to lower egg weight when compared with the DY6 REC group during wk1 to wk8 (P = 0.07).REC decreased AME and DM digestibility at wk8 (P < 0.01), and REC addition in diet did not affect apparent nitrogen digestibility (P = 0.6). REC decreased villi height (P < 0.01) and increased crypt depth (P < 0.01). The XH3 REC group had a lower crude fat digestibility than the DY6 REC group, and the crude fat digestibility of the DY5 and MB1 REC groups was lower than the XH3 REC group (P < 0.01). The DY6 REC group had a higher villi height than the DY5, MB1, and XH3 REC groups (P < 0.01). The XH3 REC group had a higher crypt depth than the DY6, DY5, and MB1 REC groups (P < 0.01). The DY6 REC group had a higher value of the ratio of villi height to crypt depth than the DY5 and MB1 REC groups, and the DY5 and MB1 REC groups had a higher value of the ratio of villi height to crypt depth than the XH3 REC group (P < 0.01).REC decreased albumen height and Haugh unit during wk1 to wk8 (P < 0.01 and P = 0.004), and increased yolk color during wk1 to wk8 (P < 0.01).The XH3, MB1, and DY5 REC groups had a lower albumen height than the DY6 REC group during wk1 to wk8 (P < 0.01), and the XH3 and DY5 REC groups had a lower Haugh unit than the DY6 REC group during wk1 to wk8 (P < 0.01). The DY6 REC group had the highest value of yolk color than other three varieties of REC (DY5, MB1, XH3) at wk6 and wk8 (P < 0.01 and P < 0.01). It can be concluded that the exposure of laying hens to REC with higher Gls and EA (DY5, MB1, XH3) led to a lower egg weight, nutrient digestibility, intestinal absorptive area, and egg internal quality than those with lower Gls and EA (DY6).
Topics: Animal Feed; Animal Nutritional Physiological Phenomena; Animals; Brassica napus; Chickens; Diet; Dietary Supplements; Digestion; Dose-Response Relationship, Drug; Duodenum; Female; Nutrients; Ovum
PubMed: 31134274
DOI: 10.3382/ps/pez254 -
JOP : Journal of the Pancreas May 2011Groove pancreatitis is a rare condition characterized by fibrotic inflammation affecting the groove anatomical area between the head of the pancreas, the duodenum and... (Review)
Review
CONTEXT
Groove pancreatitis is a rare condition characterized by fibrotic inflammation affecting the groove anatomical area between the head of the pancreas, the duodenum and the common bile duct.
OBJECTIVES
We report a miniseries of five cases treated surgically in our centre over a period of four years. A review of the literature is also discussed.
METHODS
Patients undergoing pancreaticoduodenectomy over a four-year period were retrospectively reviewed. Patients with a confirmed histological diagnosis of groove pancreatitis were assessed under the headings; patient demographics, presenting symptoms, radiological and histological findings.
RESULTS
One-hundred and 60 pancreaticoduodenectomies were performed. Thirty-nine cases demonstrated benign disease and within this, five cases (3.1% of total series; 12.8% of benign cases) were groove pancreatitis. All patients presented with abdominal pain and weight loss, and the majority consumed excess alcohol and were smokers. Radiological findings (CT/MRCP/EUS) revealed duodenal wall thickening in all cases, abnormalities at the head of pancreas and bile duct dilation in four, and cystic changes in the duodenal wall and pancreatic duct dilation in three cases. Groove fibrosis, Brunner's gland hyperplasia and cystic changes in duodenal wall were present in all cases on histological review. All patients reported significant improvement in quality of life at 12 months after surgery.
CONCLUSION
Groove pancreatitis can present in a similar fashion to head of pancreas cancer and chronic pancreatitis. For this reason it is paramount for clinicians to be aware of groove pancreatitis, as this can lead to the correct diagnosis and management of this unique disease.
Topics: Adult; Aged; Common Bile Duct; Duodenum; Female; Humans; Male; Middle Aged; Pancreas; Pancreatitis; Retrospective Studies
PubMed: 21546697
DOI: No ID Found -
Medicine Feb 2017Inflammatory fibroid polyp (IFP) is a very rare benign condition in children that can occur throughout the gastrointestinal tract. It is characterized as a polypoid... (Review)
Review
BACKGROUND
Inflammatory fibroid polyp (IFP) is a very rare benign condition in children that can occur throughout the gastrointestinal tract. It is characterized as a polypoid lesion originating in the submucosa, composed of connective tissue and eosinophilic infiltrate. It is most common in the stomach and in adults between the fifth and seventh decades of life. Its occurrence is unusual in the duodenum.
CASE SUMMARY
One case of duodenal IFP was described and the literature is reviewed with emphasis on the clinical and pathological features of IFP in children. A case of an IFP in the duodenum of a 13-year-old girl, who presented with abdominal pain, weight loss, vomiting, and constipation. The patient underwent exploratory laparotomy; a stenosing tumor of the third duodenal portion was found. The affected segment was resected and an end-to-end anastomosis between the duodenum and jejunum segment was performed. Immunohistochemically, actin and CD34 were positive, Ki67 was positive in <1% of cells, and the proteins CD117 and S100 were negative.
CONCLUSION
To our best of our knowledge, this is the fourth report of IFP in adolescents, the first in a female's duodenum.
Topics: Adolescent; Diagnosis, Differential; Duodenal Diseases; Duodenum; Female; Humans; Intestinal Polyps
PubMed: 28225494
DOI: 10.1097/MD.0000000000006131 -
Laboratory Investigation; a Journal of... Mar 2020Intestinal Na-nutrient cotransport depends on claudin-2 and claudin-15 mediated Na recycling. Expression of these proteins is coordinately regulated during postnatal...
Intestinal Na-nutrient cotransport depends on claudin-2 and claudin-15 mediated Na recycling. Expression of these proteins is coordinately regulated during postnatal development. While expression of claudin-2 and claudin-15 has been studied in inflammatory bowel disease (IBD) and celiac disease (CD), it has not been assessed in other malabsorptive diseases, and no reports have compared expression in children and adults. We used quantitative immunofluorescence microscopy to assess claudin-2 and claudin-15 expression in duodenal biopsies from children and adults with malabsorptive disease and healthy controls. Consistent with previous work in rodents, claudin-2 expression in healthy children was markedly greater, and claudin-15 expression was less, than that in adults. Claudin-2 expression was increased in adults with CD and downregulated in children with graft-versus-host disease (GVHD). In contrast, claudin-15 expression was reduced in adults with GVHD and common variable immunodeficiency (CVID). These data show that one of the two Na/water pore-forming claudins is upregulated in CD and downregulated in GVHD and CVID. The specific claudin whose expression changes, however, reflects the age of the patient (child or adult). We conclude that contributions of claudin-2 and claudin-15 to pathophysiology of and responses to diarrhea in children and adults with GVHD and CVID differ from those in CD and IBD.
Topics: Adult; Aged; Aged, 80 and over; Child, Preschool; Claudin-2; Claudins; Duodenum; Female; Humans; Infant; Malabsorption Syndromes; Male; Middle Aged
PubMed: 31605016
DOI: 10.1038/s41374-019-0324-8 -
BMJ Case Reports Apr 2017Isolated duodenal rupture is a rare injury encountered among children following blunt abdominal trauma. Early diagnosis and treatment are essential to decrease the... (Review)
Review
Isolated duodenal rupture is a rare injury encountered among children following blunt abdominal trauma. Early diagnosis and treatment are essential to decrease the associated morbidity and mortality. The debate is about the optimum operative management. We report a 6-year-old child who presented with acute abdominal pain due to isolated duodenal injury following blunt abdominal trauma. Emergency laparotomy revealed duodenal rupture at the junction of the first and second part of duodenum and absence of any other visceral injuries. The duodenal injury was defined as grade III, that is, involving 75% of the circumference. We opted to perform primary repair of the injured duodenum in two layers alone without diversion. The abdominal cavity was drained using an open system drain next to the repair. Nasogastric and jejunostomy tubes were used postoperatively for gastric decompression and enteral feeding, respectively. The child had an uneventful recovery, was discharged well on the 10th postoperative day and no stenosis was found on long-term follow-up. The debate was whether to repair the defect primarily or to combine the repair with diversion. Early diagnosis, the isolated nature of the duodenal injury and the possibility of minimal contamination favoured primary repair of the defect without diversion. The good outcome attributed to these factors were in agreement with most of the literature.
Topics: Child; Duodenum; Humans; Intubation, Gastrointestinal; Jejunostomy; Laparotomy; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 28433976
DOI: 10.1136/bcr-2016-215251 -
PloS One 2022This study examined the correlation between pancreatic microbiome and patients characteristics. Furthermore, we compared different duodenal materials to examine their...
BACKGROUND/OBJECTIVES
This study examined the correlation between pancreatic microbiome and patients characteristics. Furthermore, we compared different duodenal materials to examine their reflection of the pancreatic microbiome.
METHODS
Patients undergoing pancreatic surgery were included in the study. Characteristics of those patients were prospectively registered and sterile pancreatic biopsies were collected during surgery. After completion of the resection, duodenal fluid, -tissue and -swab were collected. Bacterial DNA was extracted and analyzed with IS-pro assay.
RESULTS
Paired samples of 51 patients were available for evaluation, including pancreatic biopsies from all patients, 22 duodenal fluids, 21 duodenal swabs and 11 duodenal tissues. The pancreatic microbiome consisted mostly of Proteobacteria followed by Firmicutes, Actinobacteria, Fusobacteria and Verrucomicrobia (FAFV) and Bacteroidetes. On species level, Enterococcus faecalis, Escherichia coli, and Enterobacter-Klebsiella were most abundant. In pancreatic biopsies, the total bacterial load and Proteobacteria load were significantly higher in patients with biliary drainage (54618.0 vs 5623.5; 9119.0 vs 2067.1). Patients who used proton pump inhibitors had a significantly higher total bacterial load (115964.7 vs 8495.8), more FAFV (66862.9 vs 1890.1), more Proteobacteria (24245.9 vs 2951.4) and more Bacteroidetes (542.5 vs 25.8). The head of the pancreas contained significantly more bacteria (21193.4 vs 2096.8) and more FAFV (5225.7 vs 19.0) compared to the tail, regardless of biliary drainage. Furthermore, the microbiome of all duodenal materials showed a weak correlation with the pancreatic microbiome.
CONCLUSION
Biliary drainage, use of proton pump inhibitors, and anatomic location of the pancreatic biopsy influence the pancreatic microbiome. Furthermore, the duodenal microbiome does not suffice as a surrogate for the pancreatic microbiome.
Topics: Humans; Proton Pump Inhibitors; Microbiota; Duodenum; Pancreas; Bacteria; Bacteroidetes; Proteobacteria; Fusobacteria; RNA, Ribosomal, 16S
PubMed: 36525425
DOI: 10.1371/journal.pone.0278377 -
Journal of Medical Case Reports May 2017Visceral artery pseudoaneurysms are relatively rare but have a high mortality rate in case of rupture. Their detection in the last decades is rising due to an increased... (Review)
Review
BACKGROUND
Visceral artery pseudoaneurysms are relatively rare but have a high mortality rate in case of rupture. Their detection in the last decades is rising due to an increased use of computed tomography and angiography. However, due to the nonspecific nature of the clinical symptoms and signs, diagnosis is often delayed or missed. We describe two cases of patients presenting with nonspecific abdominal complaints and anemia leading to a diagnosis of visceral pseudoaneurysm. Both cases are successfully treated with a different endovascular intervention.
CASE PRESENTATION
The first case is a 67-year-old Caucasian man presenting with diffuse abdominal pain, vomiting, diarrhea, and weight loss. Digital angiography showed a complex pseudoaneurysm of the superior mesenteric artery. The patient was treated with stent placement and selective embolization of the afferent branches. The second patient is a 78-year-old Caucasian man with a history of chronic pancreatitis admitted with epigastric pain, rectal bleeding and melena. Angiography showed a pseudoaneurysm of the gastroduodenal artery. The patient was successfully treated with coil embolization.
CONCLUSIONS
We report two cases of visceral pseudoaneurysms and review the literature concerning etiology, presentation, diagnosis, and treatment. Visceral artery pseudoaneurysms should be considered in the differential diagnosis of a patient with nonspecific abdominal symptoms. Diagnosis is often made with computed tomography or computed tomography angiography but digital angiography remains the gold standard. Treatment options include surgical, endovascular or percutaneous interventions. The choice of treatment is case specific.
Topics: Abdominal Pain; Aged; Aneurysm, False; Angiography; Duodenum; Embolization, Therapeutic; Endovascular Procedures; Humans; Male; Mesenteric Artery, Superior; Pancreatitis; Ultrasonography
PubMed: 28472975
DOI: 10.1186/s13256-017-1291-6 -
Journal of Veterinary Science Mar 2018This study aimed to elucidate the effect of tryptophan (Trp) on gut hormone secretion as well as the roles of the calcium-sensing receptor (CaSR) and its downstream...
This study aimed to elucidate the effect of tryptophan (Trp) on gut hormone secretion as well as the roles of the calcium-sensing receptor (CaSR) and its downstream signaling pathway in gut hormone secretion by assessing swine duodenal perfusion . Swine duodenum was perfused with Krebs-Henseleit buffer as a basal solution. Various concentrations (0, 10, and 20 mM) of Trp were applied to investigate its effect on gut hormone secretion. A CaSR antagonist was used to detect the involvement of CaSR and its signal molecules. The 20 mM Trp concentration promoted the secretion of cholecystokinin (CCK) and glucose-dependent insulinotropic peptide (GIP), elevated the mRNA level of , and upregulated the protein levels of CaSR, protein kinase C (PKC), and inositol trisphosphate receptor (IP3R). However, NPS 2143, an inhibitor of CaSR, attenuated the CCK and GIP release, reduced the mRNA level of , and decreased the protein levels of CaSR, PKC, and IP3R with 20 mM Trp perfusion. The results indicate that CCK and GIP secretion can be induced by Trp in swine duodenum , and the effect is mediated by CaSR and its downstream signal molecules PKC and IP3R.
Topics: Animals; Cholecystokinin; Duodenum; Gastric Inhibitory Polypeptide; Immunoblotting; Real-Time Polymerase Chain Reaction; Receptors, Calcium-Sensing; Swine; Tryptophan
PubMed: 29284209
DOI: 10.4142/jvs.2018.19.2.179