Large gangliocytic paraganglioma of the duodenum: A rare entity

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.     

完全性胸腹腔内脏反位合并十二指肠壶腹周围癌一例报告与文献复习

目的总结完全性胸腹腔内脏反位合并十二指肠壶腹周围癌的临床诊治方法。方法报道2006年3月收治的1例极为罕见的完全性胸腹腔内脏反位合并十二指肠壶腹周围癌行胰十二指肠切除术的病例,并复习国内外相关文献。结果本例患者病理诊断为十二指肠乳头及壶腹部腺癌Ⅰ-Ⅱ级。术后1周胆红素降至正常;但2周后出现胃-空肠吻合输出袢粘连性不完全性梗阻,经内镜下置管、鼻饲、营养支持、针灸等处理,40d后痊愈出院。经检索,全球自1936-2006年间报道的全胸腹腔内脏反位合并恶性肿瘤的患者仅15例;其中只有5例全胸腹腔内脏反位合并胰头与壶腹周围癌的报道。结论完全性胸腹腔内脏反位合并肿瘤时,若无明显禁忌证,应同样予以积极的外科治疗,术中操作应注意完全相反的解剖学结构。     

Case report: CT of a duodenal paraganglioma

Paraganglioma is a neoplasm of neuroectodermal origin that occurs rarely in the bowel. This case report illustrates the previously undescribed CT appearance of a duodenal paraganglioma. An intensely enhancing mass in the region of the pancreatic head was found. The intense enhancement ruled out adenocarcinoma and focal pancreatitis. An islet cell tumor of the pancreas was the major differential diagnostic consideration.     

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目的 探讨外伤性十二指肠损伤的处理及影响预后的因素。方法 对1992年1月至2002年月1月收治的32例外伤性十二指肠损伤病例的临床资料进行回顾性分析。结果 术前确诊19例(59．4％)，漏诊13例(40．6％)；治愈29例(90．6％)，死亡3例(9．4％)；发生并发症9例(28．1％)。十二指肠瘘是主要的并发症。结论 简单而合理的手术方式是治疗十二指肠损伤的重要措施。早期手术，有效的十二指肠减压和术后肠外营养是影响预后的主要因素。     

十二指肠溃疡生活事件及社会支持的对照研究

目的 探讨十二指肠溃疡与生活事件及社会支持的关系。方法 采用生活事件量表（LES），社会支持评定量表（SSRS）对十二指肠溃疡患者（58例）与健康对照（67例）进行问卷测试与评价分析。结果 十二指肠溃疡患者在生活事件里正性刺激量，负性刺激量和总刺激量都明显高于健康对照组，十二指肠溃疡患者受到的主观支持比一般人群多；而客观支持比一般人群少，但十二指肠溃疡患者受到的总支持量并不比一般人多，而且，十二指肠溃疡患者对支持的利用度也不比一般人高。结论 十二指肠溃疡患者有明显的生活事件和不足的社会支持，对生活事件的刺激尤为敏感。     

Origin of olfacto-gustatory alliesthesia: Intestinal sensitivity to carbohydrate concentration?

Gustatory and olfactory alliesthesia was observed in nine healthy adult humans who received on three different days an intragastric load of 50 g glucose dissolved into various amounts of water in order to make 100, 200 and 400 ml of solution. Maximal alliesthesia to sweet stimuli was observed with the smallest volume, i.e., highest concentration. Comparison of these results with previous results [7], obtained not by varying the volume but by varying the glucose mass, shows identity. Maximal alliesthesia to olfactory anchovy and Viandox^R was also observed after ingestion of the most concentrated gastric load. Maximal negative alliesthesia was observed about 45 min after the gastric load; thereafter alliesthesia tended to decrease. A gastric 200 ml load containing 40 g Mannitol, a nonabsorbed sugar, was followed by a strong negative alliesthesia to alimentary stimuli. Ten g glucose in 20 ml solution produced a more intense and rapid alliesthesia when injected into the duodenum than when injected into the stomach. It may be concluded that postinjective negative alliesthesia for alimentary stimuli can be caused by intraduodenal concentration of nutrients, probably sensed by duodenal nervous chemoreceptors.     

Mechanisms of peptide YY release induced by an intraduodenal meal in rats: neural regulation by proximal gut

 Peptide YY (PYY) release in anaesthetized rats was studied during the 2 h following the intraduodenal administration of a semi-liquid meal of 21 kJ. Surgical and pharmacological manipulations were performed in order to analyse the mechanisms of PYY release. Postprandial PYY release was suppressed or strongly decreased by caecocolonectomy, truncal vagotomy, tetrodotoxin, hexamethonium, sensory denervation by perivagal capsaicin, and by the NO-synthase inhibitor L-N-arginine methyl ester, while atropine, adrenergic blockers, antagonists of type-A or type-B cholecystokinin (CCK) receptors or bombesin receptors had no effect. Comparing the digestive transit of the semi-liquid meal with the amount of PYY contained in the small bowel wall showed that nutrients had not reached the area rich in cells containing PYY by 30 min, the time at which there was a large PYY release in plasma. By 120 min, the meal front had travelled 72% of the small intestine length, just beginning to reach the PYY-rich part of the ileum. We conclude that the main postprandial PYY release studied in this model comes from ileal and colonic L-cells indirectly stimulated through a neural mechanism originating in the proximal gut and involving sensory vagal fibres, nicotinic synapses and NO release, while CCK and bombesin do not seem to be physiologically involved. Received: 17 July 1996 / Received after revision: 11 October 1996 / Accepted: 18 October 1996     

Comparison of gastric, duodenal and jejunal contributions to the inhibition of food intake in the rat

Rats equipped with tubes leading to their stomach, duodenum or jejunum were infused with a liquid diet for 9 hr (4 ml/hr) and were allowed to eat during the last 8 hr of infusion. All rats ate significantly less on diet infusion days than on saline or no infusion days. A second study showed that a taste aversion could not be conditioned to flavored water associated with diet infusion. Apparently, intrajejunal injection of nutrients produces satiety and not discomfort. Infusion of the diet for 5 consecutive days into the stomach, duodenum or jejunum consistently and significantly lowered food intake by reducing meal size, not meal frequency. Results suggest that the small intestine below the infusion site contributes to normal satiety.     

A simple intra-operative maneuver to decrease a duodenal ulcer hemorrhage temporarily: description and anatomical bases

Intraoperative hemostatic suture to treat a bleeding duodenal ulcer is sometimes difficult when there is massive hemorrhage. The aims of this paper are: (1) to describe a practical and easy intraoperative procedure which quickly decreases a massively bleeding duodenal ulcer, allowing the surgeon to identify the bleeding site clearly and obtain definitive hemostasis by suturing the involved vessels with a low risk of common bile duct lesion; and (2) to study in cadavers the anatomical basis of this surgical procedure already successfully performed on patients. Fourteen patients with massive duodenal ulcer bleeding, after unsuccessful endoscopic hemostasis, were operated on and included in this study. After surgical anterior gastroduodenotomy, the surgeon introduced a finger in a downward and forward direction in the bursa omentalis vestibule through the omental foramen. This simple and quick procedure decreased hemorrhage by compressing the gastroduodenal artery against the first part of the posterior surface of the duodenum. Twenty-four fresh blocks of normal tissue were removed from cadavers and were injected with silicone rubber through the common hepatic artery. The distance between the gastroduodenal artery and the omental foramen was measured. With this maneuver the surgeon can clearly see the exact bleeding site and perform an adequate suture with a minor risk of common bile duct lesion.