Background: Among various feed additives currently used in poultry nutrition, an important role is played by bioactive substances, including prebiotics. The beneficial effect of these bioactive substances on the gastr...Background: Among various feed additives currently used in poultry nutrition, an important role is played by bioactive substances, including prebiotics. The beneficial effect of these bioactive substances on the gastrointestinal tract and immune system give rise to improvements in broiler health and performance nutrition, thus increasing the productivity of these birds. An innovative method for introducing bioactive substances into chickens is the in ovo injection into eggs intended for hatching. The aim of the study was to evaluate the development of histomorphological parameters of the duodenum and productivity in chickens injected in ovo with the prebiotic DiNovo~?(extract of Laminaria species of seaweed, BioA tlantis Ltd., Ireland) on d 12 of incubation, under large-scale, high density poultry production conditions.Results: There was no significant impact of the injection of DiNovo~? prebiotic on the production parameters of broiler chickens(body weight, FCR, EBI and mortality) obtained on d 42 of rearing. No significant impact of the DiNovo~? injection on the duodenum weight and length was observed, as wel as on the CSA, diameter and muscular layer thickness of the duodenum. The in ovo injection of DiNovo~? significantly increased the width of the duodenal vil i(P < 0.05) and crypt depth(P < 0.01) of chickens on d 21 of rearing. Other histomorphological parameters of duodenal vil i at d 42 of chickens rearing such as: the height, width, and cross section area of vil i were significantly greater in chickens from the control group compared to those from the DiNovo~? group(P < 0.05 and P < 0.01).Conclusions: In conclusion, this study demonstrates that injection of DiNovo~? prebiotic into the air chamber of egg significantly influences the histomorphological parameters on d 21 of rearing without negatively affecting productivity in chickens at the end of rearing.展开更多
BACKGROUND An inflammatory fibrotic polyp(IFP)of the gastrointestinal tract is generally considered benign and noninvasive.An IFP in the duodenum is very rare.Here we report the case of an aggressive and infiltrative ...BACKGROUND An inflammatory fibrotic polyp(IFP)of the gastrointestinal tract is generally considered benign and noninvasive.An IFP in the duodenum is very rare.Here we report the case of an aggressive and infiltrative duodenal IFP resembling a malignancy and the patient subsequently underwent surgery.To the best of our knowledge,this is the first case of duodenal IFP invading the subserosa.CASE SUMMARY A 50-year-old female patient presented with recurrent epigastric pain for more than 1 month.Gastroscopy revealed a mass in the duodenal bulb involving the pylorus.Endoscopic ultrasound suggested that the lesion was a hypoechoic mass involving the muscularis propria,and duodenal bulb stromal tumor was considered based on abdominal computed tomography and gastric magnetic resonance imaging findings.A distal gastrectomy was subsequently performed.Based on the histopathology and immunohistochemical results,the lesion was finally diagnosed as duodenal IFP.The patient recovered well after surgery and had no recurrence at the 27-month follow-up.CONCLUSION This duodenal IFP invading subserosa indicates that IFP has specific invasion characteristics,and accurate diagnosis is critical to avoid inadequate treatment.展开更多
A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incisio...A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).展开更多
BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal neoplasms primarily originating in the stomach or small intestine.Duodenal GISTs are particularly uncommon,accounting for only a small fraction of ...BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal neoplasms primarily originating in the stomach or small intestine.Duodenal GISTs are particularly uncommon,accounting for only a small fraction of GIST cases.These tumors often present with nonspecific symptoms,making early detection challenging.This case discusses a duodenal GIST misdiagnosed as pancreatic cancer due to obstructive jaundice.CASE SUMMARY A 40-year-old male with jaundice and abdominal symptoms underwent imaging,which suggested a malignant periampullary tumor.Preoperative misdiagnosis of pancreatic cancer was made,and surgery was performed.Postoperative histopathology confirmed a duodenal GIST.The role of artificial intelligence in the diagnostic pathway is explored,emphasizing its potential to differentiate between duodenal GISTs and other similar conditions using advanced imaging analysis.CONCLUSION Artificial intelligence in radiomic imaging holds significant promise in enhancing the diagnostic process for rare cancers like duodenal GISTs,ensuring timely and accurate treatment.展开更多
A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duoden...A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duodenal carcinoma and performed pancreas-preserving segmental duodenectomy. Adenocarcinoma arising from a heterotopic pancreas at the third portion of the duodenum was finally diagnosed by immunohistochemical staining. Malignant transformation in the duodenum arising from a heterotopic pancreas is extremely rare; to our knowledge, only 13 cases have been reported worldwide, including the present case. The most common location of malignancy is the proximal duodenum at the first and descending portion. Herein, we describe the first case of adenocarcinoma arising from a heterotopic pancreas, which was located in the third portion of the duodenum, with a review of the literature.展开更多
AIM:To provide long-term survival results of operable duodenal gastrointestinal stromal tumors(DGISTs)in a tertiary center in China.METHODS:In this retrospective study,the pathological data of 28 patients with DGISTs ...AIM:To provide long-term survival results of operable duodenal gastrointestinal stromal tumors(DGISTs)in a tertiary center in China.METHODS:In this retrospective study,the pathological data of 28 patients with DGISTs who had been treated surgically at the Second Department of General Surgery,Sir Run Run Shaw Hospital(SRRSH)from June1998 to December 2006 were reviewed.All pathological slides were examined by a single pathologist to confirm the diagnosis.In patients whose diagnosis was not confirmed by immunohistochemistry at the time of resection,representative paraffin blocks were reassembled,and sections were studied using antibodies against CD117(c-kit),CD34,smooth muscle actin(SMA),vimentin,S-100,actin(HHF35),and desmin.Operative procedures were classified as wedge resection(WR,local resection with pure closure,without duodenal transection or anastomosis),segmental resection[SR,duodenal transection with Roux-Y or BillrothⅡgastrojejunostomy(G-J),end-to-end duodenoduodenostomy(D-D),end-to-end or end-to-side duodenojejunostomy(D-J)],and pancreaticoduodenectomy(PD,Whipple operation with pancreatojejunostomy).R0 resection was pursued in all cases,and at least R1 resection was achieved.Regional lymphadenectomy was not performed.Clinical manifestations,surgery,medical treatment and follow-up data were retrospectively analyzed.Related studies in the literature were reviewed.RESULTS:There were 12 males and 16 females patients,with a median age of 53 years(20-76 years).Their major complaints were"gastrointestinal bleeding"(57.2%)and"nonspecific discomfort"(32.1%).About14.3%,60.7%,17.9%,and 7.1%of the tumors originated in the first to fourth portion,respectively,with a median size of 5.8 cm(1.6-20 cm).Treatment was by WR in 5 cases(17.9%),SR in 13 cases(46.4%),and by PD in 10 cases(35.7%).The morbidity and mortality rates were 35.7%and 3.6%,respectively.The median post-operative stay was 14.5 d(5-47 d).During a follow-up of 61(23-164)mo,the 2-year and 5-year relapse-free survival was 83.3%and 50%,respectively.Eighty-four related articles were reviewed.CONCLUSION:Surgeons can choose to perform limited resection or PD for operable DGISTs if clear surgical margins are achieved.Comprehensive treatment is necessary.展开更多
We report a case of intravenous(IV) amiodarone drug induced liver injury(DILI).The patient received IV N-acetylcysteine(NAC) which resulted in a rapid improvement in liver enzymes.While the specific mechanisms for the...We report a case of intravenous(IV) amiodarone drug induced liver injury(DILI).The patient received IV N-acetylcysteine(NAC) which resulted in a rapid improvement in liver enzymes.While the specific mechanisms for the pathogenesis of IV amiodaroneDILI and the therapeutic action of IV NAC are both unknown, this case strongly implies at least some commonality.Because IV amiodarone is indicated for the treatment of serious cardiac arrhythmias in an intensive care unit setting, some degree of ischemic hepatitis is likely a cofactor in most cases.展开更多
AIM To study the antagonism of cholecystokinin octapeptide (CCK 8) against effect of morphine and its mechanism. METHODS The electrical and mechanical activities of rat duodenum in vitro were recorded simultan...AIM To study the antagonism of cholecystokinin octapeptide (CCK 8) against effect of morphine and its mechanism. METHODS The electrical and mechanical activities of rat duodenum in vitro were recorded simultaneously. RESULTS Acetylcholine (ACh) could increase the amplitude and the number of the spike potential (SPA and SPN) of rat duodenum in vitro , followed by the increase of the duodenal contraction amplitudes (CA), showing a positive correlation. Morphine, on the contrary, inhibited the potentiation of ACh, showing a negative correlation. CCK 8 could antagonize the effects of morphine, i.e. SPA and SPN were increased again, followed by the increase of CA. CCK A receptor antagonist Devazepide could reverse the antagonism of CCK 8 to the effect of morphine. CONCLUSION CCK 8 could antagonize the effect of morphine which inhibited the potentiation of ACh on the duodenal activities in vitro . The antagonistic effect of CCK 8 on morphine was mainly mediated by CCK A receptor.展开更多
We report a case of phlegmonitis of the esophagus, stomach, and duodenum in patient in an immunocompromised state. Culture of gastric juice and blood yielded Bacillus thuringiensis. This case showed that even low-viru...We report a case of phlegmonitis of the esophagus, stomach, and duodenum in patient in an immunocompromised state. Culture of gastric juice and blood yielded Bacillus thuringiensis. This case showed that even low-virulence bacilli can cause lethal gastrointestinalphlegmonous gastritis in conditions of immunodeficiency.展开更多
Primary adenocarcinoma of the small intestine occurs in over 50% of cases in the duodenum. However,its location in the third and fourth duodenal portions occurs rarely and is a diagnostic challenge. The aim of this wo...Primary adenocarcinoma of the small intestine occurs in over 50% of cases in the duodenum. However,its location in the third and fourth duodenal portions occurs rarely and is a diagnostic challenge. The aim of this work is to report an adenocarcinoma of the third and fourth duodenal portions,emphasizing its diagnostic difficulty and the value of video capsule endoscopy. A man,40 years old,with no medical history,with abdominal discomfort and progressive fatigue,presented four months ago with one episode o f m o d e ra t e m e l e n a. T h e p hy s i c a l e x a m i n a t i o n was normal,except for mucosal pallor. Blood tests were consistent with microcytic,hypochromic iron deficiency anemia with 7.8 g/d L hemoglobin. The upper and lower endoscopy were normal. Additional work-up with video capsule endoscopy showed a polypoid lesion involving the third and fourth portions o f t h e d u o d e n u m. B i o p s y s h o w e d a m o d e ra t e l y differentiated adenocarcinoma. Abdominal computed tomography showed a wall thickening from the third duodenal portion to the proximal jejunum,without distant metastasis. The patient underwent segmental resection(distal duodenum and proximal jejunum) with duodenojejunostomy. The surgical specimen histology confirmed the biopsy diagnosis,with transmural infiltration,without nodal involvement. Conclusion: Adenocarcinoma of the third and fourth portions of the duodenum is difficult to diagnose and capsule endoscopy is of great value.展开更多
Gangliocytic paragangliomas are rare tumors that almost exclusively occur within the second portion of the duodenum. Although these tumors generally have a benign clinical course, they have the potential to recur or m...Gangliocytic paragangliomas are rare tumors that almost exclusively occur within the second portion of the duodenum. Although these tumors generally have a benign clinical course, they have the potential to recur or metastasize to regional lymph nodes. The case report presented here describes a 57-year-old female patient with melena, progressive asthenia, anemia, and a mass in the second-third portion of the duodenum that was treated by local excision. The patient was diagnosed with a friable bleeding tumor. The histologic analysis showed that the tumor was a 4 cm gangliocytic paraganglioma without a malignant cell pattern. In the absence of local invasion or distant metastasis, endoscopic resection represents a feasible, curative therapy. Although endoscopic polypectomy is currently considered the treatment of choice, it is not recommended if the size of the tumor is > 3 cm and/or there is active or recent bleeding. Patients diagnosed with a gangliocytic paraganglioma should be closely followed-up for possible local recurrence.展开更多
Benign duodenal tumors are rare and less commonthan malignant tumors.Furthermore,vascular lesionsof the duodenum,including hemangiomas,are rarecauses of gastrointestinal bleeding.This report describes a case with blee...Benign duodenal tumors are rare and less commonthan malignant tumors.Furthermore,vascular lesionsof the duodenum,including hemangiomas,are rarecauses of gastrointestinal bleeding.This report describes a case with bleeding hemangiomas in the thirdportion of the duodenum and jejunum and their successful treatment using a laparoscopic approach.Thereis no report of totally laparoscopic resection for tumorin the third portion of duodenum.After performinga laparoscopic Kocher maneuver,the location of theduodenal hemangioma was confirmed by endoscopicand laparoscopic observation.The lesion was excisedusing ultrasonic coagulating shears and the defect inthe duodenal wall was sutured laparoscopically.Thehemangioma of the jejunum was treated extracorporeally through a 3.0 cm umbilical incision.The operatingtime was 241 min and blood loss was negligible.Thepostoperative course was uneventful.For benign duodenal tumors in the third portion,if endoscopic resection is not adapted,this less invasive technique may be a standard treatment.展开更多
AIM:To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis(S.stercoralis)hyperinfection. METHODS:Over a period of 23 years(1984-2006),we investigated 25 pat...AIM:To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis(S.stercoralis)hyperinfection. METHODS:Over a period of 23 years(1984-2006),we investigated 25 patients withS.stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis.The clinical and endoscopic findings were analyzed retrospectively. RESULTS:Twenty-four(96%)of the patients investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1(HTLV-1)infection.The abnormal endoscopic findings,mainly edematous mucosa,white villi and erythematous mucosa,were observed in 23(92%) patients.The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy.The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative(Endoscopic severity score:4.86±2.47vs 2.71 ±1.38,P<0.05). CONCLUSION:Our study clearly demonstrates that,in addition to stool analysis,endoscopic observation and biopsies are very important.We also emphasize that S.stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.展开更多
Here we report the case of a 34-year-old man who underwent endoscopic removal of a tablespoon from the stomach that was lodged within the duodenum.Removal required the use of a two-channel upper endoscope and polypect...Here we report the case of a 34-year-old man who underwent endoscopic removal of a tablespoon from the stomach that was lodged within the duodenum.Removal required the use of a two-channel upper endoscope and polypectomy snares.Using the doublesnare technique, the spoon was grasped at the proximal and distal parts of the handle.The doublesnare was first pulled unsuccessfully and then pulled with simultaneous manual abdominal compression of the bulbus from the body surface.Compression was gently applied towards the stomach.As a result, the head of the spoon prolapsed from the bulbus, and was easily retracted from the stomach without any complications.In cases of foreign body lodging within the duodenum, the manual abdominal compression technique may help clinicians pull out the object and avoid surgery.The usefulness of manual compression is dependent on the foreign body's sharpness and the location.展开更多
We report a rare case of duodenal perforation caused by an ingested 12-cm long toothbrush handle. A 22-year-old female presented with intermittent epigas- tric pain for 6 d after swallowing a broken toothbrush. The sw...We report a rare case of duodenal perforation caused by an ingested 12-cm long toothbrush handle. A 22-year-old female presented with intermittent epigas- tric pain for 6 d after swallowing a broken toothbrush. The swallowed toothbrush could not be removed from the second portion of the duodenum by endoscopy. Laparotomy revealed a perforation in the anterior wall of the duodenal bulb. The toothbrush was removed via the perforation which was debrided and closed. There were no postoperative complications.展开更多
基金funded from the European Union’s Seventh Framework Programme managed by REA Research Executive Agency http://ec.europa.eu/research/rea(FP7/2007-2013)under grant agreement number:315198
文摘Background: Among various feed additives currently used in poultry nutrition, an important role is played by bioactive substances, including prebiotics. The beneficial effect of these bioactive substances on the gastrointestinal tract and immune system give rise to improvements in broiler health and performance nutrition, thus increasing the productivity of these birds. An innovative method for introducing bioactive substances into chickens is the in ovo injection into eggs intended for hatching. The aim of the study was to evaluate the development of histomorphological parameters of the duodenum and productivity in chickens injected in ovo with the prebiotic DiNovo~?(extract of Laminaria species of seaweed, BioA tlantis Ltd., Ireland) on d 12 of incubation, under large-scale, high density poultry production conditions.Results: There was no significant impact of the injection of DiNovo~? prebiotic on the production parameters of broiler chickens(body weight, FCR, EBI and mortality) obtained on d 42 of rearing. No significant impact of the DiNovo~? injection on the duodenum weight and length was observed, as wel as on the CSA, diameter and muscular layer thickness of the duodenum. The in ovo injection of DiNovo~? significantly increased the width of the duodenal vil i(P < 0.05) and crypt depth(P < 0.01) of chickens on d 21 of rearing. Other histomorphological parameters of duodenal vil i at d 42 of chickens rearing such as: the height, width, and cross section area of vil i were significantly greater in chickens from the control group compared to those from the DiNovo~? group(P < 0.05 and P < 0.01).Conclusions: In conclusion, this study demonstrates that injection of DiNovo~? prebiotic into the air chamber of egg significantly influences the histomorphological parameters on d 21 of rearing without negatively affecting productivity in chickens at the end of rearing.
文摘BACKGROUND An inflammatory fibrotic polyp(IFP)of the gastrointestinal tract is generally considered benign and noninvasive.An IFP in the duodenum is very rare.Here we report the case of an aggressive and infiltrative duodenal IFP resembling a malignancy and the patient subsequently underwent surgery.To the best of our knowledge,this is the first case of duodenal IFP invading the subserosa.CASE SUMMARY A 50-year-old female patient presented with recurrent epigastric pain for more than 1 month.Gastroscopy revealed a mass in the duodenal bulb involving the pylorus.Endoscopic ultrasound suggested that the lesion was a hypoechoic mass involving the muscularis propria,and duodenal bulb stromal tumor was considered based on abdominal computed tomography and gastric magnetic resonance imaging findings.A distal gastrectomy was subsequently performed.Based on the histopathology and immunohistochemical results,the lesion was finally diagnosed as duodenal IFP.The patient recovered well after surgery and had no recurrence at the 27-month follow-up.CONCLUSION This duodenal IFP invading subserosa indicates that IFP has specific invasion characteristics,and accurate diagnosis is critical to avoid inadequate treatment.
基金supported by grants from the National Natu-ral Science Foundation of China(81302161 and 82003103)the Science and Technology Department of Sichuan Province(2021YFS0375 and 2020YJ0450).
文摘A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal neoplasms primarily originating in the stomach or small intestine.Duodenal GISTs are particularly uncommon,accounting for only a small fraction of GIST cases.These tumors often present with nonspecific symptoms,making early detection challenging.This case discusses a duodenal GIST misdiagnosed as pancreatic cancer due to obstructive jaundice.CASE SUMMARY A 40-year-old male with jaundice and abdominal symptoms underwent imaging,which suggested a malignant periampullary tumor.Preoperative misdiagnosis of pancreatic cancer was made,and surgery was performed.Postoperative histopathology confirmed a duodenal GIST.The role of artificial intelligence in the diagnostic pathway is explored,emphasizing its potential to differentiate between duodenal GISTs and other similar conditions using advanced imaging analysis.CONCLUSION Artificial intelligence in radiomic imaging holds significant promise in enhancing the diagnostic process for rare cancers like duodenal GISTs,ensuring timely and accurate treatment.
文摘A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duodenal carcinoma and performed pancreas-preserving segmental duodenectomy. Adenocarcinoma arising from a heterotopic pancreas at the third portion of the duodenum was finally diagnosed by immunohistochemical staining. Malignant transformation in the duodenum arising from a heterotopic pancreas is extremely rare; to our knowledge, only 13 cases have been reported worldwide, including the present case. The most common location of malignancy is the proximal duodenum at the first and descending portion. Herein, we describe the first case of adenocarcinoma arising from a heterotopic pancreas, which was located in the third portion of the duodenum, with a review of the literature.
基金Supported by Grants from Science and Technology Departmentof Zhejiang Province,No.2012C13020-2
文摘AIM:To provide long-term survival results of operable duodenal gastrointestinal stromal tumors(DGISTs)in a tertiary center in China.METHODS:In this retrospective study,the pathological data of 28 patients with DGISTs who had been treated surgically at the Second Department of General Surgery,Sir Run Run Shaw Hospital(SRRSH)from June1998 to December 2006 were reviewed.All pathological slides were examined by a single pathologist to confirm the diagnosis.In patients whose diagnosis was not confirmed by immunohistochemistry at the time of resection,representative paraffin blocks were reassembled,and sections were studied using antibodies against CD117(c-kit),CD34,smooth muscle actin(SMA),vimentin,S-100,actin(HHF35),and desmin.Operative procedures were classified as wedge resection(WR,local resection with pure closure,without duodenal transection or anastomosis),segmental resection[SR,duodenal transection with Roux-Y or BillrothⅡgastrojejunostomy(G-J),end-to-end duodenoduodenostomy(D-D),end-to-end or end-to-side duodenojejunostomy(D-J)],and pancreaticoduodenectomy(PD,Whipple operation with pancreatojejunostomy).R0 resection was pursued in all cases,and at least R1 resection was achieved.Regional lymphadenectomy was not performed.Clinical manifestations,surgery,medical treatment and follow-up data were retrospectively analyzed.Related studies in the literature were reviewed.RESULTS:There were 12 males and 16 females patients,with a median age of 53 years(20-76 years).Their major complaints were"gastrointestinal bleeding"(57.2%)and"nonspecific discomfort"(32.1%).About14.3%,60.7%,17.9%,and 7.1%of the tumors originated in the first to fourth portion,respectively,with a median size of 5.8 cm(1.6-20 cm).Treatment was by WR in 5 cases(17.9%),SR in 13 cases(46.4%),and by PD in 10 cases(35.7%).The morbidity and mortality rates were 35.7%and 3.6%,respectively.The median post-operative stay was 14.5 d(5-47 d).During a follow-up of 61(23-164)mo,the 2-year and 5-year relapse-free survival was 83.3%and 50%,respectively.Eighty-four related articles were reviewed.CONCLUSION:Surgeons can choose to perform limited resection or PD for operable DGISTs if clear surgical margins are achieved.Comprehensive treatment is necessary.
文摘We report a case of intravenous(IV) amiodarone drug induced liver injury(DILI).The patient received IV N-acetylcysteine(NAC) which resulted in a rapid improvement in liver enzymes.While the specific mechanisms for the pathogenesis of IV amiodaroneDILI and the therapeutic action of IV NAC are both unknown, this case strongly implies at least some commonality.Because IV amiodarone is indicated for the treatment of serious cardiac arrhythmias in an intensive care unit setting, some degree of ischemic hepatitis is likely a cofactor in most cases.
文摘AIM To study the antagonism of cholecystokinin octapeptide (CCK 8) against effect of morphine and its mechanism. METHODS The electrical and mechanical activities of rat duodenum in vitro were recorded simultaneously. RESULTS Acetylcholine (ACh) could increase the amplitude and the number of the spike potential (SPA and SPN) of rat duodenum in vitro , followed by the increase of the duodenal contraction amplitudes (CA), showing a positive correlation. Morphine, on the contrary, inhibited the potentiation of ACh, showing a negative correlation. CCK 8 could antagonize the effects of morphine, i.e. SPA and SPN were increased again, followed by the increase of CA. CCK A receptor antagonist Devazepide could reverse the antagonism of CCK 8 to the effect of morphine. CONCLUSION CCK 8 could antagonize the effect of morphine which inhibited the potentiation of ACh on the duodenal activities in vitro . The antagonistic effect of CCK 8 on morphine was mainly mediated by CCK A receptor.
文摘We report a case of phlegmonitis of the esophagus, stomach, and duodenum in patient in an immunocompromised state. Culture of gastric juice and blood yielded Bacillus thuringiensis. This case showed that even low-virulence bacilli can cause lethal gastrointestinalphlegmonous gastritis in conditions of immunodeficiency.
文摘Primary adenocarcinoma of the small intestine occurs in over 50% of cases in the duodenum. However,its location in the third and fourth duodenal portions occurs rarely and is a diagnostic challenge. The aim of this work is to report an adenocarcinoma of the third and fourth duodenal portions,emphasizing its diagnostic difficulty and the value of video capsule endoscopy. A man,40 years old,with no medical history,with abdominal discomfort and progressive fatigue,presented four months ago with one episode o f m o d e ra t e m e l e n a. T h e p hy s i c a l e x a m i n a t i o n was normal,except for mucosal pallor. Blood tests were consistent with microcytic,hypochromic iron deficiency anemia with 7.8 g/d L hemoglobin. The upper and lower endoscopy were normal. Additional work-up with video capsule endoscopy showed a polypoid lesion involving the third and fourth portions o f t h e d u o d e n u m. B i o p s y s h o w e d a m o d e ra t e l y differentiated adenocarcinoma. Abdominal computed tomography showed a wall thickening from the third duodenal portion to the proximal jejunum,without distant metastasis. The patient underwent segmental resection(distal duodenum and proximal jejunum) with duodenojejunostomy. The surgical specimen histology confirmed the biopsy diagnosis,with transmural infiltration,without nodal involvement. Conclusion: Adenocarcinoma of the third and fourth portions of the duodenum is difficult to diagnose and capsule endoscopy is of great value.
文摘Gangliocytic paragangliomas are rare tumors that almost exclusively occur within the second portion of the duodenum. Although these tumors generally have a benign clinical course, they have the potential to recur or metastasize to regional lymph nodes. The case report presented here describes a 57-year-old female patient with melena, progressive asthenia, anemia, and a mass in the second-third portion of the duodenum that was treated by local excision. The patient was diagnosed with a friable bleeding tumor. The histologic analysis showed that the tumor was a 4 cm gangliocytic paraganglioma without a malignant cell pattern. In the absence of local invasion or distant metastasis, endoscopic resection represents a feasible, curative therapy. Although endoscopic polypectomy is currently considered the treatment of choice, it is not recommended if the size of the tumor is > 3 cm and/or there is active or recent bleeding. Patients diagnosed with a gangliocytic paraganglioma should be closely followed-up for possible local recurrence.
文摘Benign duodenal tumors are rare and less commonthan malignant tumors.Furthermore,vascular lesionsof the duodenum,including hemangiomas,are rarecauses of gastrointestinal bleeding.This report describes a case with bleeding hemangiomas in the thirdportion of the duodenum and jejunum and their successful treatment using a laparoscopic approach.Thereis no report of totally laparoscopic resection for tumorin the third portion of duodenum.After performinga laparoscopic Kocher maneuver,the location of theduodenal hemangioma was confirmed by endoscopicand laparoscopic observation.The lesion was excisedusing ultrasonic coagulating shears and the defect inthe duodenal wall was sutured laparoscopically.Thehemangioma of the jejunum was treated extracorporeally through a 3.0 cm umbilical incision.The operatingtime was 241 min and blood loss was negligible.Thepostoperative course was uneventful.For benign duodenal tumors in the third portion,if endoscopic resection is not adapted,this less invasive technique may be a standard treatment.
文摘AIM:To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis(S.stercoralis)hyperinfection. METHODS:Over a period of 23 years(1984-2006),we investigated 25 patients withS.stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis.The clinical and endoscopic findings were analyzed retrospectively. RESULTS:Twenty-four(96%)of the patients investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1(HTLV-1)infection.The abnormal endoscopic findings,mainly edematous mucosa,white villi and erythematous mucosa,were observed in 23(92%) patients.The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy.The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative(Endoscopic severity score:4.86±2.47vs 2.71 ±1.38,P<0.05). CONCLUSION:Our study clearly demonstrates that,in addition to stool analysis,endoscopic observation and biopsies are very important.We also emphasize that S.stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.
基金Supported by Department of Gastroenterology and Medicine,Fukuoka University School of Medicine,Fukuoka,Japan
文摘Here we report the case of a 34-year-old man who underwent endoscopic removal of a tablespoon from the stomach that was lodged within the duodenum.Removal required the use of a two-channel upper endoscope and polypectomy snares.Using the doublesnare technique, the spoon was grasped at the proximal and distal parts of the handle.The doublesnare was first pulled unsuccessfully and then pulled with simultaneous manual abdominal compression of the bulbus from the body surface.Compression was gently applied towards the stomach.As a result, the head of the spoon prolapsed from the bulbus, and was easily retracted from the stomach without any complications.In cases of foreign body lodging within the duodenum, the manual abdominal compression technique may help clinicians pull out the object and avoid surgery.The usefulness of manual compression is dependent on the foreign body's sharpness and the location.
文摘We report a rare case of duodenal perforation caused by an ingested 12-cm long toothbrush handle. A 22-year-old female presented with intermittent epigas- tric pain for 6 d after swallowing a broken toothbrush. The swallowed toothbrush could not be removed from the second portion of the duodenum by endoscopy. Laparotomy revealed a perforation in the anterior wall of the duodenal bulb. The toothbrush was removed via the perforation which was debrided and closed. There were no postoperative complications.
