Morphological evaluation of bulb and distal duodenal biopsies in pediatric celiac disease with clinical and serological correlation.

BACKGROUND AND AIMS: An early correct diagnosis of celiac disease (CD) is fundamental to reversal of symptoms and prevention of complications in pediatric patients. Our aim was to evaluate the role of duodenal bulb biopsy by studying the degree of mucosal damage in the duodenal bulb (D1) and second part of the duodenum (D2) and correlating the findings with serum IgA anti-tTG levels. SETTINGS AND DESIGN: Pediatric patients (age <18 years) with clinical suspicion of CD and positive IgA anti-tTG titers were consecutively enrolled over a period of one year. Demographic variables, anthropometry, clinical history, laboratory values and endoscopic findings were studied. Endoscopic biopsies obtained from D1 and D2 were evaluated and assigned histopathologic grades that were correlated with serology. STATISTICAL ANALYSIS USED: Descriptive statistics were employed. RESULTS: A total of 37 clinically suspected cases of pediatric CD were studied. The mean age was 6.7 years and the M:F ratio was 1:1.3. Thirty-two (32) children had varying degrees of growth impairment. Eight (8) children had only extra-intestinal symptoms. Thirty (30) children were anemic, hypoalbuminemia was seen in five (5) children while transaminitis was seen in two (2) children. IgA anti-tTG >300 U/ml was associated with Marsh-Oberhuber Grade 3 morphology at atleast one site. CONCLUSIONS: Low positive serology values should be confirmed by histopathology. Biopsies should be taken even in the absence of endoscopic abnormality. Additional D1 biopsies placed in a separate container can increase the diagnostic yield.

Morphological speculation of the MHPD and related clinical projections.

OBJECTIVE: The concept of mesopancreas has been brought into focus nowadays. Studies on membrane morphology of pancreas are clinically significant in determining an ideal surgical route for a "holy plane". In this paper, we aimed to observe the structure of the peripancreatic membranes and its interactions with adjacent tissues; tentatively put forward the proposition of mesohepatopancreaticoduodenum (MHPD) and explore in depth in surgical local resection. METHODS: 33 cadavers were examined in the experiment, including 30 for gross anatomy and 3 for histological observation after transection. The histological characteristics of the membrane covering the pancreas were proved by Masson and Bielschowsky silver staining and further explored in clinical application and testified in a surgical scenario. All above were carried out through traditional procedures. RESULTS: The anterior surface membrane of the pancreas was intact and the posterior portion expanding to the pancreaticoduodenum enclosed the surface of the duodenum and the pancreatic head, which could be easily isolated from the posterior abdominal wall. The posterior surface membrane around the body and tail wrapped the pancreatic parenchyma, which created a soft-tissue window for the posterior abdominal wall. Then, dense connective tissue adhesions were detected between the celiac artery and the superior mesenteric artery. CONCLUSIONS: The embryonic origin of the mesopancreas and the surgical procedures were reviewed and inspected based on the proposition of MHPD and above results. We hope that this study could stir up our interest in the advancement of imaging diagnoses and minimally invasive surgical treatment of pancreas.

Incubation variables, performance, and morphometry of the duodenal mucosa of Japanese quails (Coturnix coturnix japonica) submitted to different incubation temperatures and thermally challenged after hatching / [Variáveis de incubação, desempenho e morfometria da mucosa duodenal de codornas japonesas (Coturnix coturnix japonica) submetidas a diferentes temperaturas de incubação e desafiadas termicamente após eclosão]

This study aimed to evaluate the effects of different temperatures on incubation variables, performance, and morphometry of the duodenal mucosa of Japanese quails (Coturnix coturnix japonica) submitted to chronic heat stress after hatching. We distributed 540 eggs in three incubators with a temperature of 37.8°C and 60% of humidity. From the 6th day of incubation until hatching, the temperatures were adjusted to (37.8°C, 38.5°C and 39.5°C). After hatching, quails were evaluated for the quality score, weighed, and distributed in a completely randomized design with three incubation temperatures (37.8, 38.5, and 39.5°C) and two ambient temperatures (stress and thermoneutral). At 10, 20, 30, and 40 days they were weighed to determine the live weight (g) and weight gain(g). To collect the duodenum and determine morphometric parameters, we euthanized four quails of each treatment. The data were analyzed, and the differences between the means determined by the Tukey test at 5%. The incubation temperature of 39.5°C provided lower hatching rate and the live weight at birth; however, from the 10th day of age, increased live weight, weight gain, and positively influenced the morphological parameters of the duodenal mucosa in situations of chronic stress.(AU)

Objetivou-se avaliar os efeitos de diferentes temperaturas de incubação sobre as variáveis de incubação, desempenho e morfometria da mucosa duodenal de codornas japonesas (Coturnix coturnix japonica) submetidas ao estresse térmico crônico por calor após eclosão. Foram distribuídos 540 ovos em três incubadoras, com temperatura de 37,8°C e umidade 60%. A partir do sexto dia de incubação até a eclosão, as temperaturas foram ajustadas para 37,8°C, 38,5°C e 39,5°C. Após a eclosão, as codornas foram avaliadas quanto ao escore de qualidade, pesadas e distribuídas em um delineamento inteiramente ao acaso, com três temperaturas de incubação (37,8ºC, 38,5ºC e 39,5°C) e duas temperaturas ambientes (estresse e termoneutro). Aos 10, 20, 30 e 40 dias, foram pesadas para determinar o peso vivo (g) e o ganho de peso(g). Quatro codornas de cada tratamento foram eutanasiadas para coleta do duodeno, para determinar os parâmetros morfométricos. Os dados foram analisados e as diferenças entre as médias foram determinadas pelo teste de Tukey a 5%. A temperatura de incubação de 39,5°C proporcionou menor taxa de eclosão e menor peso vivo ao nascer, entretanto, a partir do 10° dia de idade, essa temperatura aumentou o peso vivo, o ganho de peso e influenciou positivamente os parâmetros morfológicos da mucosa duodenal em situações de estresse crônico.(AU)

Mesentery - a 'New' organ.

The mesentery is the organ in which all abdominal digestive organs develop, and which maintains these in systemic continuity in adulthood. Interest in the mesentery was rekindled by advancements of Heald and Hohenberger in colorectal surgery. Conventional descriptions hold there are multiple mesenteries centrally connected to the posterior midline. Recent advances first demonstrated that, distal to the duodenojejunal flexure, the mesentery is a continuous collection of tissues. This observation explained how the small and large intestines are centrally connected, and the anatomy of the associated peritoneal landscape. In turn it prompted recategorisation of the mesentery as an organ. Subsequent work demonstrated the mesentery remains continuous throughout development, and that abdominal digestive organs (i.e. liver, spleen, intestine and pancreas) develop either on, or in it. This relationship is retained into adulthood when abdominal digestive organs are directly connected to the mesentery (i.e. they are 'mesenteric' in embryological origin and anatomical position). Recognition of mesenteric continuity identified the mesenteric model of abdominal anatomy according to which all abdominal abdomino-pelvic organs are organised into either a mesenteric or a non-mesenteric domain. This model explains the positional anatomy of all abdominal digestive organs, and associated vasculature. Moreover, it explains the peritoneal landscape and enables differentiation of peritoneum from the mesentery. Increased scientific focus on the mesentery has identified multiple vital or specialised functions. These vary across time and in anatomical location. The following review demonstrates how recent advances related to the mesentery are re-orientating the study of human biology in general and, by extension, clinical practice.

Clinical anatomy of the anterior and posterior hepatic plexuses, including relations with the pancreatic plexus: A cadaver study.

The poor prognosis after surgery for pancreatic cancer or extrahepatic bile duct cancer has mainly been attributed to early lymph node metastasis, as well as a high frequency of perineural invasion along the peripancreatic neural plexuses or extrahepatic bile duct plexus. However, there has been no detailed morphological description of the anterior and posterior hepatic plexuses (AHP and PHP). In addition, the concepts of the pancreatic plexus and PHP are confused by surgeons. To assess the relations of the pancreatic plexus and hepatic plexuses from the morphological, developmental, and clinical perspectives, these plexuses were dissected in 24 cadavers. The PHP was found to be completely independent of the AHP. The PHP ran behind the portal vein, with most nerve fibers ascending along the bile duct to the gallbladder and the liver or descending to the distal common bile duct and duodenal papilla. Some branches of the PHP contributed to the pancreatic plexus, corresponding to pancreatic head plexus I as defined by the Japan Pancreas Society. The differences between the PHP and pancreatic head plexus I should be understood, even though liver function is not obviously affected after PHP excision for pancreatic head cancer. Further study is needed to determine whether there are functional differences between the AHP and PHP. Clin. Anat., 33:630-636, 2020. © 2019 Wiley Periodicals, Inc.

Traumatic bruising of the hepatoduodenal ligament can conceal a catastrophic injury to the hepatic artery.

We present the case of a 22-year-old man transferred to the regional major trauma centre following a fall of ~15 m. He remained consistently haemodynamically stable for over 10 hours of observation until he deteriorated suddenly with major haemorrhagic shock requiring immediate trauma laparotomy. At laparotomy, 2 L of blood was drained from the abdomen but no source of active bleeding identified. 30 minutes after closure of the abdomen, 500 mL of fresh blood was noted in the drain so he was returned to the theatre where the bleeding source was found to be-after manual compression of a mildly bruised hepatoduodenal ligament-the proper hepatic artery (PHA). This case describes an unusual finding at relaparotomy and shows that even when there is no active bleeding from abdominal organs or classified vessels, it is possible to have isolated injury to PHA.

The hepatoduodenal ligament revisited: cross-sectional imaging spectrum of non-neoplastic conditions.

INTRODUCTION: The hepatoduodenal ligament is frequently involved by conditions affecting the portal triad and surrounding structures, including a vast array of non-neoplastic conditions. Due its unique location between the retroperitoneum and the peritoneal space, the hepatoduodenal ligament is also targeted by inflammatory conditions involving the retroperitoneum and the liver. Finally, the presence of lymphatics and of the biliary tracts makes the hepatoduodenal ligament a route of spread for a variety of infections. The purpose of this pictorial essay is twofold: to review the cross-sectional radiological anatomy and variants of the structures within the hepatoduodenal ligament, and to illustrate the non-neoplastic conditions that may arise within the hepatoduodenal ligament. CONCLUSION: Familiarity with these specific entities and their cross-sectional imaging findings is fundamental for a more accurate diagnosis.

Mass-forming lesions of the duodenum: A pictorial review.

Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.

Oral administration of Saccharomyces boulardii alters duodenal morphology, enzymatic activity and cytokine production response in broiler chickens.

The present study evaluated the effects of Saccharomyces boulardii on duodenal digestive enzymes, morphology and cytokine induction response in broiler chicken. A total of 200 birds were allotted into two groups (n = 100) and each group divided into five replications (n = 20). The control group was fed basal diet in addition to antibiotic (virginiamycin 20 mg/kg), and treatment group received (1 × 108  colony-forming units/kg feed) S. boulardii in addition to basal diet lasting for 72 days. The results compared to control group revealed that adenosine triphosphatase, gamma glutamyl transpeptidase, lipase and trypsin activities were higher, while, no significant improvement was observed in amylase activities in the duodenum of the treatment group. Moreover, morphological findings showed that villus height, width and number of goblet cells markedly increased. Additionally, transmission electron microscopy visualized that villus height, width and structural condensation significantly increased in the treatment group. The immunohistological observations showed increased numbers of immunoglobulin A (IgA)-positive cells in the duodenum of the treatment group. Meanwhile, cytokine production levels of tumor necrosis factor-α, interleukin (IL)-10, transforming growth factor-ß and secretory IgA markedly increased, and IL-6 statistically remained unchanged as compared to the control group. These findings illustrated that initial contact of S. boulardii to the duodenum has significant impact in improving enzymatic activity, intestinal morphology and cytokine response in broiler chicken.

CONSIDERATIONS ON ANATOMY AND PHYSIOLOGY OF LYMPH VESSELS OF UPPER AERO DIGESTIVE ORGANS AND CERVICAL SATELLITE LYMPH NODE GROUP.

The almost constant local regional development of the cancers of upper aero digestive organs requires the same special attention to cervical lymph node metastases, as well as to the primary neoplastic burning point. The surgical therapy alone or associated has a mutilating, damaging character, resulting in loss of an organ and function, most of the times with social implications, involving physical distortions with aesthetic consequences, which make the reintegration of the individual into society questionable. The problem of cervical lymph node metastases is vast and complex, reason why we approached several anatomical and physiological aspects of lymph vessels of the aero digestive organs. Among the available elements during treatment, the headquarters of the tumour, its histologic degree, and its infiltrative nature, each of them significantly influences the possibility of developing metastases.

Morfologia do estômago e do duodeno da paca (Cuniculus paca Linnaeus, 1766) / Morphology of the stomach and duodenum of paca (Cuniculus paca Linnaeus, 1766)

Considerando a importância da paca (Cuniculus paca, Linnaeus, 1766), tanto como fonte proteica alternativa para a população quanto pela possibilidade de vir a se tornar um animal de experimentação e pela falta de informações sobre a sua anatomia, objetivou-se descrever a morfologia macroscópica e histológica do estômago e do duodeno desse roedor, reconhecendo as relações, forma e posição que esses órgãos estabelecem entre si e com outros órgãos. O estômago da paca é unicavitário, está no plano médio mais voltado para o antímero esquerdo, transversalmente, na região hipocôndrica em posição ventrocaudal, interposto entre o esôfago e o duodeno. O duodeno da paca se inicia em sequência ao estômago, segue caudalmente até o nível da quinta ou sexta vértebra lombar, na altura das quais se curva e toma direção cranial, dirigindo-se até o nível da transição entre a última vértebra torácica e a primeira vértebra lombar, onde se continua como jejuno. Histologicamente, o estômago e o duodeno da paca possuem o padrão característico da arquitetura dos órgãos ocos, apresentando as seguintes túnicas: mucosa, submucosa, muscular e serosa. Da forma que se conduziu este estudo, conclui-se que o estômago e duodeno da paca, de forma geral, possuem características morfológicas macroscópicas e histológicas semelhantes às dos animais domésticos e de outros roedores selvagens.

Considering the importance of paca (Cuniculus paca, Linnaeus, 1766) as an alternative protein source for the population as well as the possibility to become an experimental model and the lack of information regarding to the anatomy of this species, the present study aims to describe the gross anatomy and the histology of the stomach and duodenum of this rodent, recognizing the relations, shape and position that these organs establish between themselves and among other organs. The paca stomach is monocavitary; it is located at the median plane, more toward the left antimere, transversally, at the hypochondriac region in a ventrocaudal position, interposed between the esophagus and duodenum. The duodenum of paca begins in sequence of the stomach, following caudally until the fifth or sixth lumbar vertebra, at this level it curves and takes the cranial direction, going until the transition level between the last thoracic vertebra and the first lumbar vertebra where it continues as jejune. Histologically, the stomach and duodenum of paca have the characteristic pattern of the hollow organs architecture, presenting the following layers: mucosa, submucosa, muscular and serous. As this study was conducted, it is possible to conclude that the stomach and duodenum of paca, in general, present gross anatomical and histological characteristics similar to the domestic animals and to the other wild rodents.

MRI Findings of Intrinsic and Extrinsic Duodenal Abnormalities and Variations.

This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.

Mesenteric-Based Surgery Exploits Gastrointestinal, Peritoneal, Mesenteric and Fascial Continuity from Duodenojejunal Flexure to the Anorectal Junction--A Review.

INTRODUCTION: It is now well established that mesenteric-based colorectal surgery is associated with superior outcomes. Recent anatomic observations have demonstrated that the mesenteric organ is contiguous from the duodenojejunal to the anorectal junction. This led to similar observations in relation to associated peritoneum and fascia. The aim of this review was to demonstrate the relevance of the contiguity principle to resectional colorectal surgery. METHODS: All literature in relation to mesenteric anatomy was reviewed from 1873 to the present, without language restriction. RESULTS: Mesenteric-based surgery (i.e. complete mesocolic excision, total mesocolic and mesorectal excision) requires division of the peritoneal reflection (i.e. peritonotomy), and mesenteric mobilisation in the mesofascial plane. These are the fundamental technical elements of mesenterectomy. Mesenteric, peritoneal and fascial contiguity mean that in resectional surgery, these technical elements can be reproducibly applied at all levels from the origin at the superior mesenteric root, to the anorectal junction. CONCLUSIONS: The goals of complete mesocolic, total mesocolic and mesorectal excision can be universally achieved at any level from duodenojejunal flexure to anorectal junction, by adopting technical elements based on mesenteric, peritoneal and fascial contiguity.

Extrahepatic biliary tract in chinchilla (Chinchilla laniger, Molina).

The aim of the study was the macromorphological analysis of extrahepatic biliary tract in chinchilla (Chinchilla laniger Molina). Bile ducts, the gall bladder and portal vein were injected with coloured latex. Using the technique of dissection, bile ducts were isolated from the liver lobes. It was found that the cystic duct in this species is rarely single. Hepatic ducts form a system of multiple anastomosing structures running in the hepatoduodenal ligament. Many bile duct openings were observed in the duodenal papilla. The results confirm wide variations of the biliary tract in mammals and may be important for comparative analysis of the morphological differentiation of these structures in small mammals.

Effect of feed grade L-methionine on growth performance and gut health in nursery pigs compared with conventional DL-methionine.

Two experiments were conducted to test if supplementation of LMET has beneficial effects on growth performance and gut health in nursery pigs compared with DL-Met. In Exp. 1, 168 pigs in 56 pens were randomly allotted to 7 dietary treatments for 20 d, including a basal diet (BD; 55% of the NRC requirement for Met), the BD+0.048% L-Met or DL-Met (70% of the NRC requirement), the BD+0.096% L-Met or DL-Met (85% of the NRC requirement), and the BD+0.144% L-Met or DL-Met (100% of the NRC requirement). Body weight and feed disappearance were recorded every 5 d for computation of growth performance. In Exp. 2, 20 individually housed nursery pigs were randomly allotted to 2 dietary treatments for 20 d: DML (0.16% Met from the BD+0.145% supplemental DL-Met) or LMET (0.16% Met from the BD+0.145% supplemental L-Met). Both diets had Met meeting 95% of the NRC requirement. Duodenum samples from all pigs were collected at the end of the trial to evaluate morphology and redox status. In Exp. 1, during the entire 20 d, pigs fed diets supplemented with L-Met tended to have greater (P=0.087) ADG and reduced (P<0.01) plasma urea nitrogen (PUN) than pigs fed diets supplemented with DL-Met. The relative bioavailability (RBA) of L-Met to DL-Met for ADG and G:F was 143.8 and 122.7%, respectively. In Exp. 2, pigs fed a diet supplemented with L-Met had duodenum tissue with greater (P<0.05) concentrations of glutathione (GSH) and greater villus height and width as well as lower (P<0.05) concentrations of protein carbonyl compared with pigs fed DL-Met. Overall, compared with DL-Met, the use of L-Met as a source of supplemental Met in nursery pig diets enhanced duodenum villus development in association with reduced oxidative stress and improved GSH. The beneficial effects of supplementing L-Met compared to DL-Met in gut of nursery pigs resulted in a potential enhancement of ADG and reduction of PUN.

Variability of target and normal structure delineation using multimodality imaging for radiation therapy of pancreatic cancer.

PURPOSE: To explore the potential of multimodality imaging (dynamic contrast-enhanced magnetic resonance imaging [DCE-MRI], apparent diffusion-coefficient diffusion-weighted imaging [ADC-DWI], fluorodeoxyglucose positron emission tomography [FDG-PET], and computed tomography) to define the gross tumor volume (GTV) and organs at risk in radiation therapy planning for pancreatic cancer. Delineated volumetric changes of DCE-MRI, ADC-DWI, and FDG-PET were assessed in comparison with the finding on 3-dimensional/4-dimensional CT with and without intravenous contrast, and with pathology specimens for resectable and borderline resectable cases of pancreatic cancer. METHODS AND MATERIALS: We studied a total of 19 representative patients, whose DCE-MRI, ADC-DWI, and FDG-PET data were reviewed. Gross tumor volume and tumor burden/active region inside pancreatic head/neck or body were delineated on MRI (denoted GTVDCE, and GTVADC), a standardized uptake value (SUV) of 2.5, 40%SUVmax, and 50%SUVmax on FDG-PET (GTV2.5, GTV40%, and GTV50%). Volumes of the pancreas, duodenum, stomach, liver, and kidneys were contoured according to CT (VCT), T1-weighted MRI (VT1), and T2-weighted MRI (VT2) for 7 patients. RESULTS: Significant statistical differences were found between the GTVs from DCE-MRI, ADC-DW, and FDG-PET, with a mean and range of 4.73 (1.00-9.79), 14.52 (3.21-25.49), 22.04 (1.00-45.69), 19.10 (4.84-45.59), and 9.80 (0.32-35.21) cm(3) for GTVDCE, GTVADC, GTV2.5, GTV40%, and GTV50%, respectively. The mean difference and range in the measurements of maximum dimension of tumor on DCE-MRI, ADC-DW, SUV2.5, 40%SUVmax, and 50%SUVmax compared with pathologic specimens were -0.84 (-2.24 to 0.9), 0.41 (-0.15 to 2.3), 0.58 (-1.41 to 3.69), 0.66 (-0.67 to 1.32), and 0.15 (-1.53 to 2.38) cm, respectively. The T1- and T2-based volumes for pancreas, duodenum, stomach, and liver were generally smaller compared with those from CT, except for the kidneys. CONCLUSIONS: Differences exists between DCE-, ADC-, and FDG-PET-defined target volumes for RT of pancreatic cancer. Organ at risk volumes based on MRI are generally smaller than those based on CT. Further studies combined with pathologic specimens are required to identify the optimal imaging modality or sequence to define GTV.

Effect of dietary laminarin and fucoidan on selected microbiota, intestinal morphology and immune status of the newly weaned pig.

A 2 × 2 factorial experiment was conducted to investigate the interactions between laminarin (LAM; 0 and 300 parts per million (ppm)) and fucoidan (FUC; 0 and 240 ppm) levels on intestinal morphology, selected microbiota and inflammatory cytokine gene expression in the weaned pig. There was an interaction between LAM and FUC supplementation on the Enterobacteriaceae population (P< 0·05) and the abundance of attaching and effacing Escherichia coli (AEEC) strains (P< 0·05) in the colon. Pigs offered the FUC diet had a reduced Enterobacteriaceae population compared with pigs offered the basal diet. However, the effect of FUC on the Enterobacteriaceae population was not observed when combined with LAM. Pigs offered the LAM diet had reduced abundance of AEEC strains compared with pigs offered the basal diet. However, there was no effect of LAM on the abundance of AEEC strains when combined with FUC. There was an interaction between LAM and FUC supplementation on villous height (P< 0·01) and the villous height:crypt depth ratio (P< 0·01) in the duodenum. Pigs offered the LAM or FUC diet had an increased villous height and villous height:crypt depth ratio compared with pigs offered the basal diet. However, there was no effect of the LAM and FUC combination diet on intestinal morphology. Pigs offered the LAM-supplemented diets had a lower IL-6 (P< 0·05), IL-17A (P< 0·01) and IL-1ß (P< 0·01) mRNA expression in the colon compared with pigs offered the diets without LAM. In conclusion, supplementation with either LAM or FUC alone modified intestinal morphology and selected intestinal microbiota, but these effects were lost when offered in combination.