兔急性胰腺炎并发十二指肠粘膜损伤与一氧化氮合酶改变的关系

目的:探讨急性胰腺炎并发十二指肠粘膜损伤与一氧化氮合酶(nitric oxide synthase,NOS)改变的关系。方法:用胰管结扎及加压注射法建立大白兔急性胰腺炎模型,采用黄递酶组织化学染色法观察与比较两组动物胰腺及十二指肠组中NOS的变化。结果:经Winslow法测定血清淀粉酶分析及组织学检查,急性胰腺炎模型建立;经NADPH-d染色表明:实验组NOS染色强度明显高于对照组。结论:一氧化氮(nitric cxide,NO)在急性胰腺炎并发十二指肠粘膜损伤的病变过程中起重要的介导作用。     

Investigating Population Risk Factors of Pancreatic Cancer by Evaluation of Optical Markers in the Duodenal Mucosa

Pancreatic cancer screening has been hampered by the high rate of complications associated with interrogating the pancreas. The closest non-invasively accessible mucosa available for pancreatic cancer screening is the periampullary duodenal tissue. Our earlier report has shown the potential of using optical markers to interrogate this tissue for the presence of pancreatic cancer. In this study, we report a larger data set of low-coherence enhanced backscattering (LEBS) and elastic light scattering fingerprinting (ELF) optical markers from the periampullary duodenal mucosa. Optical measurements from biopsy samples were acquired from a total of 203 patients with varying clinical classification including healthy controls, a family history of pancreatic cancer, pancreatitis, mucinous cystic precursor lesions, pancreatic cancer, and other pancreatic malignancies. Evaluation of the performance of an independent testing set for discriminating healthy control patients from pancreatic cancer patients showed a 95% sensitivity, 71% specificity, and 85% area under the receiver operator characteristic (AUROC) curve. Importantly, this performance was uncompromised for detecting potentially curable stages of the disease. Additionally, optical markers in higher risk populations such as family history and pancreatitis had values between those of healthy control and pancreatic cancer patients, thus allowing for future investigations of screening from these high risk groups.     

Acid-induced increase in duodenal mucosal alkaline secretion in the rat involves the L-arginine/NO pathway

Duodenal mucosal alkaline secretion increases in response to hydrochloric acid exposure. The tentative role of nitric oxide (NO) in the mediation of this response was investigated. The mucosal alkaline output by a duodenal segment was recorded by in situ titration in chloralose-anaesthetized rats. In some experiments the duodenal blood flow was estimated by laser-Doppler flowmetry. Exposure of the duodenum to acid (0.01 M HCl, 5 min) increased the alkaline secretion by ≈85%. The NO synthase inhibitor N^G-nitro-L -arginine methyl ester (L -NAME, 10 mg kg^?1 intravenously or 0.3 mM intraluminally) blocked the secretory increment after mucosal acid exposure. Mean arterial pressure and basal alkaline secretion were markedly raised, whereas duodenal blood flow was decreased, when L -NAME was given intravenously (i.v.). Intraluminal (i.l.) administration left mean arterial pressure as well as duodenal blood flow unaltered, and the duodenal mucosal alkaline secretion was only slightly elevated. The stereoisomer N^G-nitro-D -arginine methyl ester (D -NAME) had no effect on either basal or acid-induced duodenal alkaline output. In animals receiving L -arginine (10 mg kg^?1 min^?1 i.v., or 3 mM i.l.) and L -NAME, the acid exposure elicited an increase in duodenal mucosal alkaline secretion, similar to that observed in controls. The results suggest that the acid-induced increase in duodenal mucosal alkaline secretion involves NO synthesis, which takes place close to the lumen, probably within the mucosa.     

脂糖舒对大鼠离体小肠运动的影响

观察纯中药复方脂糖舒对小肠运动的影响。方法：大鼠随机分组,采用离休肠平滑肌实验装置,应用三种不同浓度脂糖舒（０．２０％、０．６０％、１．２０％）,观察其对离体十二指肠和回肠自发运动的作用及高浓度脂糖舒（１．２０％）对乙酰胆碱、氯化钡、肾上腺素的拮抗作用。结果：各浓度脂糖舒对十二指肠自发运动均有抑制作用,且随剂量增大而增强;高浓度脂糖舒对乙酰胆碱、氯化钡、紧不素有拮抗作用,对乙酰胆碱的拮抗作用最明显     

Vascular anatomy of the pancreaticoduodenal region: A review

Vascular anatomy of the pancreaticoduodenal region has been the subject of numerous studies. However, several essential areas of confusion remain in interpretation of the vascular configuration. We note and discuss three key points in relation to this confusion: (1) a missing vascular arcade, (2) a rearrangement of the arcade by collateral and/or transverse vessels, and (3) a solitary vessel without an accompanying comites vein or artery. In addition, we consider that different interpretations as well as varying reported incidences depend on different "thresholds" when observations are made. Consideration of new aspects of vascular anatomy of the pancreaticoduodenal region is required for further improvement of surgical procedures. In terms of the selection of lymph node resection procedure, we discuss mainly the inferior arterial origin. Special attention should be paid to the ligation of inferior arteries because of the high incidence of the common trunk formation of the upper jejunal and inferior pancreaticoduodenal arteries. With regard to duodenum-preserving pancreatic head resection for benign tumors, our observations are introduced in view of either arterial or venous configuration. First, a communicating artery between the anterior and posterior arterial arcades is noted because of its possible critical role in blood supply to the papilla of Vater. Second, a venous drainage route from the duodenum to the retroperitoneal space in "normal" specimens is described. Received for publication on June 17, 1998; accepted on July 27, 1998     

Tachykinin receptors mediate atropine-resistant rat duodenal reflex contractions in vivo

The study aimed to establish the possible role of tachykinins as mediators of atropine-resistant reflex contractions evoked by balloon distension in the proximal duodenum of urethane-anesthetized, guanethidine (34 mol/kg s.c.)-pretreated rats. Distension of the balloon with a small amount (0.2–0.3 ml) of saline induced the appearance of phasic rhythmic contractions (about 11 mmHg in amplitude) which were promptly suppressed by either atropine (3 mol/kg i.v.) or hexamethonium (28 mol/kg i.v.). Despite the continuous i.v. infusion of atropine (2 mol/h), low-amplitude rhythmic phasic contractions recovered, which were promptly suppressed by hexamethonium, to indicate the involvement of an atropine-resistant excitatory reflex. The amplitude of these atropine-resistant contractions was increased to about 4–5 mmHg by further distension of the balloon (0.4–0.6 ml) : under these conditions, the atropine-resistant contractions undergo a progressive fading. The fading was prevented by i.v. administration of the nitric oxide (NO) synthase inhibitor, L-nitroarginine methyl ester (L-NAME, 55 mol/h), to provide a suitable baseline (amplitude of contractions was 7–8 mmHg) for studying the effect of tachykinin receptor antagonists.I.v. administration of the selective tachykinin NK₂ receptor antagonists, MEN 10,627 (10–100 nmol/kg) and SR 48968 (100–300 nmol/kg) or of the selective NK₁ antagonist SR 140333 (100 nmol/kg), at doses which do not affect the duodenal contractions induced by acetylcholine (5.5 µmol/kg i.v.), produced a prompt and long lasting suppression of the atropine-resistant reflex duodenal contractions produced by balloon distension in urethane-anesthetized rats, whilst SR 48965 (300 nmol/kg), the enantiomer of SR 48968 devoid of NK₂ receptor blocking activity, was without effect.I.v. administration of the selective NK_i receptor agonists [Sar⁹] substance P sulfone and septide or of the NK₂ receptor selective agonist, Ala⁸] neurokinin A(4–10) produced dose-dependent contractions of the duodenum. SR 140333 (100 nmol/kg i.v.) selectively antagonized the duodenal contractions produced by [Sar⁹] substance P sulfone and septide without affecting those produced by [Ala⁸] neurokinin A(4–10). On the other hand, MEN 10,627 (30–100 nmol/kg i.v.) and SR 48968 (100–300 nmol/kg i.v.) but not SR 48965 (300 nmol/kg i.v.) antagonized, at a comparable extent, duodenal contractions induced by both the selective NK₂ and NK₁ receptor agonists.We conclude that endogenous tachykinins are involved in mediating atropine-resistant reflex contractions evoked by distension of the rat duodenum in vivo: both NK₁ and NK₂ receptors are activated by endogenous ligands to produce NANC contractions of rat duodenum in vivo. However, the contractile response to i.v. administered NK₁ receptor agonists, [Sar⁹] substance P sulfone and septide, may involve the release of mediators producing smooth muscle contraction via NK₂ receptors.     

在体胃十二指肠协调运动实验方法探讨

目的　探讨在体胃、十二指肠协调运动的实验方法学。方法　青紫蓝兔胃、十二指肠水囊植入 ,应用计算机生物信号分析系统 ,记录生理状态、运动低下、运动亢进动物胃、十二指肠运动。结果　 3种不同功能状态下的胃、十二指肠运动协调性实时记录结果与理论预测运动形式相符合 ,无显著性差异 ,P >0 .0 5。结论　水囊植入法适于胃、十二指肠运动协调性的实验研究     

十二指肠血管压迹的影像学观察

目的探讨胃肠钡餐造影检查中十二指肠横部血管压迹的来源.材料和方法对比研究50例钡餐造影所见的十二指肠横部血管压迹与相应CT层面上十二指肠横部、腹主动脉、肠系膜上动、静脉及下腔静脉之间的关系;3例血管造影与钡餐造影联合检查,证实该压迹的来源.结果所有病例十二指肠横部血管压迹均与腹主动脉相吻合;肠系膜上动脉等血管与该压迹的位置及宽度不符;下腔静脉偶可导致另一压迹.结论十二指肠横部血管压迹,为腹主动脉压迫所致,称其为"十二指肠腹主动脉压迹”较为准确.     

Assessment of duodenal circular drainage operations to treat superior mesenteric artery syndrome

To assess the clinical value of duodenal circular drainage operation to treat superior mesenteric artery syndrome(SMAS). Methods Forty two cases of SMAS were treated with duodenal circular drainage operation from 1959 to 2001. Clinical data were analyzed retrospectively. Results In this group,37 cases were treated with duodenal circular drainage operation,and had good effect after follow- up of 1～15 years,the other 5 cases were first treated with anterior repositioning of the duodenum (1 case),gastrojejunostomy (1 case) ,duodeojejunostomy (2 cases) .subtotal gastrectomy and Billroth Ⅱ gastrqjejunostomy( 1 case), but vomiting was not relieved until duodenal circular drainage operation was performed again. Follow-up of 9～10 years revealed good effect. Conclusion In SMAS, if the reversed peristalsis is stronger and continuous,and vomiting appears frequently, the symptom can not be relieved even if the obstruction of duodenum is removed by operation. The key treatment is the relief of reversed peristalsis. Only the duodenal circular drainage operation could resolve the drainage direction of duodenal content and relieve the symptom of vomiting.