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1.
World J Gastroenterol ; 27(35): 5958-5966, 2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34629812

RESUMO

BACKGROUND: Endoscopic resection of duodenal subepithelial lesions (SELs) is a difficult procedure with a high risk of perforation. At present, dealing with perforation after endoscopic resection of duodenal SELs is still considered a great challenge. AIM: To evaluate the effectiveness and safety of an over-the-scope clip (OTSC) in the treatment of perforation post-endoscopic resection of duodenal SELs. METHODS: From May 2015 to November 2019, 18 patients with perforation following endoscopic resection of duodenal SELs were treated with OTSCs. Data comprising the rate of complete resection, closure of intraprocedural perforation, delayed bleeding, delayed perforation, and postoperative infection were extracted. RESULTS: The rate of complete removal of duodenal SELs and successful closure of the perforation was 100%. The median perforation size was 1 cm in diameter. Seventeen patients had minor intraoperative bleeding, while the remaining 1 patient had considerable amount of bleeding during the procedure. Seven patients had postoperative abdominal infections, of which 1 patient developed an abscess in the right iliac fossa and another patient developed septic shock. All 18 patients recovered and were discharged. No delayed bleeding or perforation was reported. The mean time taken to resume normal diet after the procedure was 6.5 d. The mean postoperative hospital stay was 9.5 d. No residual or recurrent lesions were detected during the follow-up period (15-66 mo). CONCLUSION: Closing a perforation after endoscopic resection of duodenal SELs with OTSCs seems to be an effective and reasonably safe therapeutic method.


Assuntos
Duodeno , Complicações Pós-Operatórias , Duodeno/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
2.
Saudi Med J ; 42(10): 1145-1148, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34611011

RESUMO

OBJECTIVES: To determine the prevalence of superior mesenteric artery (SMA) syndrome in patients presenting with abdominal pains, and to evaluate computed tomographic (CT) findings needed for its diagnosis. METHODS: This retrospective record-based study was carried out at the radiology department, from January 2016 to January 2021. All young patients (aged under 25) who underwent CT scans for abdominal pains were reviewed. Post-surgery, tumor, and trauma cases were excluded. Imaging findings for SMA syndrome were recorded as 'suggestive' (reduced aortomesenteric angle and distance with proximal duodenal dilatation), 'possible' (reduced angle and distance without proximal duodenal dilatation) and 'probable' (reduction of either angle or distance). Two radiologists interpreted the findings and consensus reporting was made. Diagnoses were confirmed on clinical grounds (symptomatic improvement by specific treatment and exclusion of other diagnoses), or barium studies. Imaging findings were compared to final diagnoses. McNemar's Chi-square test was used to determine association. RESULTS: Out of 141 patients (mean age=10.8, standard deviation=4), 7 (4.9%) patients mostly females were having SMA syndromes based on 'suggestive' imaging criteria (p=0.0005), and one patient underwent surgery. CONCLUSION: Superior mesenteric artery syndrome is not an uncommon condition and should be considered in differential diagnosis of acute abdomen in young patients after excluding other diagnoses.


Assuntos
Síndrome da Artéria Mesentérica Superior , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Idoso , Criança , Duodeno , Feminino , Humanos , Masculino , Estudos Retrospectivos , Síndrome da Artéria Mesentérica Superior/complicações , Síndrome da Artéria Mesentérica Superior/diagnóstico por imagem , Tomografia Computadorizada por Raios X
3.
J Vis Exp ; (175)2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34661584

RESUMO

The pancreas is a bifunctional organ with both endocrine and exocrine components. A number of pathologies can afflict the pancreas, including diabetes, pancreatitis, and pancreatic cancer. All three of these diseases mark active areas of study, not only to develop immediate therapy, but also to better understand their pathophysiology. There are few tools to further these areas of study. Pancreatic duct infusion is an important technique that can allow for lineage tracing, gene introduction, and cell line-specific targeting. The technique requires the intricate dissection of the second portion of the duodenum and ampulla, followed by the occlusion of the bile duct and the cannulation of the pancreatic duct. Although the technique is technically challenging at first, the applications are myriad. Ambiguity in the specifics of the procedure between groups highlighted the need for a standard protocol. This work describes the expression of a green fluorescent protein (GFP) within the pancreas after the pancreatic duct infusion of a viral vector expressing GFP versus a sham surgery. The infusion and therefore expression is specific to the pancreas, without expression present in any other tissue type.


Assuntos
Neoplasias Pancreáticas , Preparações Farmacêuticas , Duodeno , Humanos , Pâncreas/cirurgia , Ductos Pancreáticos
4.
Cir Cir ; 89(5): 638-645, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34665179

RESUMO

BACKGROUND: Cholecystectomy is one of the most performed abdominal surgical procedures, with approximately 1.5 million procedures performed annually in the United States of america. Most of the biliary duct injuries during laparoscopic cholecystectomy are due to a wrong perception of the anatomy. Two thirds of postsurgical stenosis develop within two and three years after repairing and the other third in the following ten years. OBJECTIVE: To show the adequacy for postoperative endoscopic access in Roux-in-Y biliodigestive diversions. METHOD: The best technique to repair biliary duct injuries is the Roux-in-Y hepaticojejunostomy or choledochojejunostomy, from this procedure we propose a surgical technique that consists to perform a perpendicular anastomosis between the defunctionalized jejunum loop and the duodenum for later endoscopic access of the Roux-en-Y biliodigestive diversion. RESULTS: The duodenal-jejunal perpendicular anastomosis procedure was performed in four patients with Roux-Y biliodigestive diversion. CONCLUSIONS: With the technique that is proposed, we have that advantage of keeping the anastomosis permanently open due to its rhomboidal design and because of the pylorus is kept intact alkaline reflux would not be a problem.


Assuntos
Jejuno , Laparoscopia , Anastomose em-Y de Roux , Anastomose Cirúrgica , Duodeno/cirurgia , Humanos , Jejuno/cirurgia
6.
J Int Med Res ; 49(9): 3000605211010091, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34590919

RESUMO

Duodenal cavernous haemangiomas are rare, benign disorders, and massive gastrointestinal (GI) bleeding is a rare clinical condition. The present case report describes a 50-year-old male patient who presented with severe, ongoing haematochezia. A peripheral blood smear at the time of admission showed significant anaemia, and haemoglobin level was 52 g/l (normal range, 120-175 g/l). Albumin level was also low at 28 g/l (normal range, 40-55 g/l). Standard computed tomography (CT) showed mural thickening and relative lumen stenosis in the ascending (fourth) portion of the duodenum. Contrast-enhanced CT using hypotonic solution revealed the lesions to be hypervascular haemangiomas. Laparotomy and segmental duodenum resection were performed, and the first jejunal limb was anastomosed using a side-to-end technique. Histopathological examination confirmed the diagnosis of cavernous haemangioma. The patient showed marked improvement during follow-up. The present case findings emphasize that duodenal haemangioma is possible without a history of chronic anaemia, and should remain a consideration in differential diagnosis for patients presenting with massive GI bleeding. CT is useful for preoperative diagnosis of massive bleeding, and surgery with segmental resection is usually curative.


Assuntos
Anemia , Hemangioma Cavernoso , Diagnóstico Diferencial , Duodeno , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Hemangioma Cavernoso/complicações , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
7.
Arab J Gastroenterol ; 22(3): 203-208, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34538761

RESUMO

BACKGROUND AND STUDY AIMS: No standard ultrasonography (US) method exists for visualizing the distal common bile duct (CBD). The supine HD view is usually adopted for CBD evaluation, but duodenal or colonic gas shadowing can affect this view. PATIENTS AND METHODS: We developed and evaluated an easy-to-perform technique, the supine distal CBD view, applying the US protocol for the distal CBD evaluation. Five reviewers checked the visibility of the distal CBD and cystic duct, as well as each view's image quality and influencing factors. RESULTS: The visibility of the distal CBD was enhanced on the supine distal CBD view (86.0%-94.6%) versus the supine hepatoduodenal view (40.8%-82.1%), with less variability among the reviewers. The image quality of the supine distal CBD view was superior to that of the supine HD view (2.52 ± 0.67 vs. 1.93 ± 0.86, respectively; p < 0.01). The depth of the distal CBD from the surface was significantly larger in the patients with nonvisible distal CBDs. CONCLUSION: We present a user-friendly, easy-to-perform US view for locating and visualizing the distal CBD. With this technique, the distal CBD can be evaluated without changing a patient's position or increasing the duration of the procedure.


Assuntos
Colo , Duodeno , Ducto Colédoco/diagnóstico por imagem , Duodeno/diagnóstico por imagem , Humanos , Ultrassonografia
8.
BMC Gastroenterol ; 21(1): 349, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544364

RESUMO

BACKGROUND: IgG4-related disease involvement of the digestive tract is very rare. In few reported cases of isolated gastric/duodenal IgG4-related disease, none of which resulted in luminal obstruction. CASE PRESENTATION: A 59 years old female presented with longstanding gastrointestinal symptoms. CT showed mural thickening of the proximal duodenum. Gastroscopy showed antral ulcer extending into the duodenum with outlet obstruction and biopsy showed acute on chronic duodenitis. Whipple's procedure was performed and IgG4-related disease was diagnosed on final pathology. Symptoms were revolved on mycophenolate mofetil and prednisone with no recurrence. CONCLUSIONS: Our case is the only reported case with gastric outlet obstruction secondary to gastroduodenal IgG4-related disease. The diagnosis should be considered in the differential diagnosis of unexplained duodenal stricture, gastric outlet obstruction or gastrointestinal ulceration. IgG4-related disease usually responds to steroids but long-term response rates to steroid-sparing agents, especially in the subset of patients with luminal IgG4-related disease remains to be determined.


Assuntos
Obstrução da Saída Gástrica , Doença Relacionada a Imunoglobulina G4 , Duodeno , Feminino , Obstrução da Saída Gástrica/etiologia , Gastroscopia , Humanos , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Pessoa de Meia-Idade , Recidiva Local de Neoplasia
9.
Ann Ital Chir ; 92: 377-383, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34524120

RESUMO

BACKGROUND: Because of the lack of specific signs and symptoms, benign and malignant small bowel disease (SB) diagnoses and their treatments are very difficult. The aim of this study was to determine the challenges of diagnostic and surgical treatment of SB diseases. MATERIAL AND METHODS: Of 51 patients, 29 (56.9%) had undergone surgery for non-malignant small bowel (NMSB) diseases, whereas 22 (43.1%) had malignant small bowel (MSB) diseases. All data were collected and compared between the two groups. RESULTS: Patients with MSB had statistically higher levels of disease in the jejunum (50% versus 10.3%; p=0.004), while patients with NMSB had statistically higher disease levels in the ileum (89.7% versus 50%; p=0.002). Twelve (54.5 %) patients in MSB and 18 (62%) patients in NMSB had emergent laparotomy (P=0.76). There were not significant diferrences in postoperative complications (8 [36.4%] in MSB versus 4 [13.8%] in NMSB; p=0.10 and 5 [22.7%] versus 3 [10.3%]; p=0.374). Patients in the MSB group had a statistically signficant lower 5-year survival rate (p=0.038). CONCLUSION: Overall this study showed that preoperative evaluation may not always be capable of differentiating MSB from NMSB disease. Therefore, most patients present with advanced disease stages. KEY WORDS: Adenocarcinoma, Ileum, Small bowel, Jejenum.


Assuntos
Adenocarcinoma , Duodeno , Humanos , Íleo , Intestino Delgado/cirurgia , Jejuno
10.
BMC Pediatr ; 21(1): 392, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496824

RESUMO

BACKGROUND: Diagnostic delay of superior mesenteric artery syndrome (SMAS) is common due to its rarity and lack of index of clinical suspicion. Early diagnosis under suspicion is pivotal for adequate treatment. Present study aims to explore the endoscopic features for early decision to evaluate SMAS in children. METHODS: In case controlled observation study, the recruitment was limited to patients who had endoscopic finding I or finding 1 plus more as follows: a pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 s (finding I), a marked dilation of the duodenal first and second part during air insufflation at the third part of the duodenum (finding II), a bile mixed fluid collection (bile lake) in the stomach (finding III). SMAS was confirmed with UGI series or hypotonic duodenography in enrolled patients. We analyzed positive endoscopic findings related with SMAS. RESULTS: The enrolled 29 patients consisted of 18 (62.1%) with SMAS and 11 (37.9%) without SMAS. The three most common presenting symptoms were abdominal pain, postprandial discomfort, and early satiety. The clinical impressions based on history and physical examination before endoscopy were functional dyspepsia (34.6%), gastritis or gastric ulcer (31.0%), and SMAS (17.3%). The constellation of three endoscopic findings (finding I + II + III, feature D) observed in 13 (72.2%) patients of SMAS group and 3 (27.3%) patients of non SMAS group (P = 0.027). Of 16 patients with features D, SMAS was diagnosed in 13 patients (81.2%) and not detected in 3 patients (18.8%) on UGI series or hypotonic duodenography. CONCLUSIONS: Endoscopic examination to the third part of the duodenum can provide a clue making a decision to evaluate SMAS, which consists of features of three endoscopic findings as follows: a pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 s, a marked dilation of the first and second part of the duodenum, and a bile lake in the stomach.


Assuntos
Síndrome da Artéria Mesentérica Superior , Dor Abdominal , Estudos de Casos e Controles , Criança , Diagnóstico Tardio , Duodeno , Endoscopia , Humanos , Síndrome da Artéria Mesentérica Superior/diagnóstico por imagem
11.
Khirurgiia (Mosk) ; (9): 103-106, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480463

RESUMO

The manuscript is devoted to the outstanding Russian surgeon Zakharov E.I.. He first performed gastrojejunoduodenoplasty in 1938 (distal stomach repair with small bowel substitute). Zakharov E.I. developed the method of post-resection stomach repair with jejunum segment interposed between the esophagus and duodenum (esophagojejunoduodenoplasty). Further studies confirmed functional advantage of gastroplasty procedures with preserved duodenal passage.


Assuntos
Gastrectomia , Jejuno , Duodeno , Humanos , Intestino Delgado/cirurgia , Masculino , Estômago/cirurgia
12.
Khirurgiia (Mosk) ; (8): 116-124, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34363454

RESUMO

AIM: Compare the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of the surgery of chronic pancreatitis. MATERIALS AND METHODS: There has been the analysis of the immediate and long-term results of various types of duodenum-saving operations in 48 patients with chronic pancreatitis since 2011 to 2020. The patients were divided into two groups: the control group (n=26) where typical duodenum-saving operations were performed, and the study group (n=22) - the original resection-draining method of surgery. RESULTS: The groups had no difference in gender, age, clinical manifestations. After typical duodenum-saving operations, the number of postoperative complications was higher than after original resection-draining method (31 [14; 52]% and 23 [8; 45]% respectively). In the control group the incidence of pancreatic fistula 19% [7; 39], hemorrhagic complications 12% [2; 30] was higher. In both groups, one patient died in the early postoperative period. However, these differences were statistically insignificant. 12 (52% [31; 73]; p<0.001) patients have died in the control group for the 9-year observation period, mainly (7 cases) as a result of the progression of chronic pancreatitis against the background of alcoholism. The groups had no difference in the level of pain reduction, development of dyspeptic syndrome and diabetes mellitus. CONCLUSIONS: The proposed original technique of subtotal resection of the head, ventral part of the body and tail of the pancreas with longitudinal pancreatojejunoanastomosis made it possible to improve the short-term results and reduce the incidence of pancreatic fistula formation. Taking into account the level of compliance the selection of patients permitted to achieve a better quality of life according to the results of the SF - 36 questionnaire and to reduce the lethality to 5 [0; 25]% (p<0.001) in the long-term period. Statistically significant difference was obtained for three of the five criteria, the total value of the physical (PCS, p=0.033) and mental (MCS, p=0.032) health components.


Assuntos
Pancreatite Crônica , Qualidade de Vida , Doença Crônica , Duodeno/cirurgia , Humanos , Pâncreas/cirurgia , Pancreatectomia/efeitos adversos , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/cirurgia
13.
Khirurgiia (Mosk) ; (8): 125-130, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34363455

RESUMO

Gastrointestinal stromal duodenal tumors are rare diseases of small intestine. Duodenal GISTs may be giant; these neoplasms can also simulate malignancies of other organs. These features result diagnostic and treatment mistakes. Neoadjuvant therapy with imatinib results tumor shrinkage and ensures organ-sparing surgery. We report duodenal GISTs in patients with primary diagnosis «retroperitoneal tumor¼, «pancreatic cyst¼ and «retroperitoneal abscess¼, who were treated at the Blokhin National Cancer Research Centre in 2019-2020.


Assuntos
Neoplasias Duodenais , Tumores do Estroma Gastrointestinal , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Duodeno , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Mesilato de Imatinib , Terapia Neoadjuvante
14.
World J Gastroenterol ; 27(28): 4738-4745, 2021 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-34366633

RESUMO

BACKGROUND: Adenocarcinoma originating from heterotopic pancreas tissue is a rare disease. Furthermore, to our knowledge, no HER2-positive cases in the duodenum have been reported in the scientific literature nor has the efficacy of trastuzumab treatment for the disease been reported. CASE SUMMARY: A 65-year-old woman whose clinical diagnosis was unresectable advanced duodenal cancer with HER2 overexpression responded well to trastuzumab chemotherapy. The main tumor in the duodenum reduced drastically. The patient underwent pancreaticoduodenectomy and lymph node dissection. A small number of cancer cells remained in the submucosal layer of the duodenum and pancreas head. After histological and immunohistochemical examination, the patient was diagnosed with duodenal adenocarcinoma originating from heterotopic pancreas tissue. CONCLUSION: Trastuzumab treatment is effective in HER2-positive adenocarcinoma originating from heterotopic pancreas tissue in the duodenum.


Assuntos
Adenocarcinoma , Coristoma , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/cirurgia , Idoso , Coristoma/cirurgia , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Feminino , Humanos , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Pancreaticoduodenectomia
15.
Cancer Radiother ; 25(6-7): 723-728, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34391649

RESUMO

The aim of this article is to review unrecognized toxicities resulting from radiation therapy of digestive neoplasms. Due to their precocious occurrence, acute toxicities are well-known by radiation oncologist, and their treatment well-established. Thus, acute toxicities will not be described in this review. We will focus on incidence, diagnosis, and management of late and uncommon toxicities occurring in the digestive tract and digestive organs. Prevention, by respecting healthy tissues constraints, is the main tool to reduce incidence of those rare complications. Nonetheless, once installed, late toxicities remain a major burden in terms of quality of life and can even be life threatening. Hence, information and education about their diagnosis and management is important.


Assuntos
Neoplasias do Sistema Digestório/radioterapia , Lesões por Radiação/complicações , Canal Anal/efeitos da radiação , Duodeno/efeitos da radiação , Esôfago/efeitos da radiação , Humanos , Incidência , Pâncreas/efeitos da radiação , Lesões por Radiação/epidemiologia , Reto/efeitos da radiação , Estômago/efeitos da radiação
16.
Nutrients ; 13(8)2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34444676

RESUMO

Iron deficiency with or without anemia, needing continuous iron supplementation, is very common in obese patients, particularly those requiring bariatric surgery. The aim of this study was to address the impact of weight loss on the rescue of iron balance in patients who underwent sleeve gastrectomy (SG), a procedure that preserves the duodenum, the main site of iron absorption. The cohort included 88 obese women; sampling of blood and duodenal biopsies of 35 patients were performed before and one year after SG. An analysis of the 35 patients consisted in evaluating iron homeostasis including hepcidin, markers of erythroid iron deficiency (soluble transferrin receptor (sTfR) and erythrocyte protoporphyrin (PPIX)), expression of duodenal iron transporters (DMT1 and ferroportin) and inflammatory markers. After surgery, sTfR and PPIX were decreased. Serum hepcidin levels were increased despite the significant reduction in inflammation. DMT1 abundance was negatively correlated with higher level of serum hepcidin. Ferroportin abundance was not modified. This study shed a new light in effective iron recovery pathways after SG involving suppression of inflammation, improvement of iron absorption, iron supply and efficiency of erythropoiesis, and finally beneficial control of iron homeostasis by hepcidin. Thus, recommendations for iron supplementation of patients after SG should take into account these new parameters of iron status assessment.


Assuntos
Gastrectomia/efeitos adversos , Hepcidinas/sangue , Ferro/deficiência , Adulto , Proteínas de Transporte de Cátions/análise , Estudos de Coortes , Suplementos Nutricionais , Duodeno/química , Duodeno/metabolismo , Eritrócitos/química , Feminino , Humanos , Absorção Intestinal/fisiologia , Ferro/administração & dosagem , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/complicações , Obesidade/cirurgia , Estudos Prospectivos , Protoporfirinas/sangue , Receptores da Transferrina/sangue , Fatores de Transcrição/análise
17.
Am J Physiol Endocrinol Metab ; 321(3): E392-E409, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34370593

RESUMO

The improvement of cognitive function following bariatric surgery has been highlighted, yet its underlying mechanisms remain elusive. Finding the improved brain glucose uptake of patients after Roux-en-Y gastric bypass (RYGB), duodenum-jejunum bypass (DJB), and sham surgery (Sham) were performed on obese and diabetic Wistar rats, and intracerebroventricular (ICV) injection of glucagon-like peptide-1 (GLP-1) analog liraglutide (Lira), antagonist exendin-(9-39) (Exe-9), and the viral-mediated GLP-1 receptor (Glp-1r) knockdown (KD) were applied on both groups to elucidate the role of GLP-1 in mediating cognitive function and brain glucose uptake assessed with the Morris water maze (MWM) and positron emission tomography (PET). Insulin and GLP-1 in serum and cerebral spinal fluid (CSF) were measured, and the expression of glucose uptake-related proteins including glucose transporter 1 (GLUT-1), GLUT-4, phospho-Akt substrate of 160kDa (pAS160), AS160, Rab10, Myosin-Va as well as the c-fos marker in the brain were examined. Along with augmented glucose homeostasis following DJB, central GLP-1 was correlated with the improved cognitive function and ameliorated brain glucose uptake, which was further confirmed by the enhancive role of Lira on both groups whereas the Exe-9 and Glp-1r KD were opposite. Known to activate insulin-signaling pathways, central GLP-1 contributes to improved cognitive function and brain glucose uptake after DJB.NEW & NOTEWORTHY The improvement of cognitive function following bariatric surgery has been highlighted while its mechanisms remain elusive. The brain glucose uptake of patients was improved after RYGB, and the DJB and sham surgery performed on obese and diabetic Wistar rats revealed that the elevated central GLP-1 contributes to the dramatic improvement of cognitive function, brain glucose uptake, transport, glucose sensing, and neuronal activation.


Assuntos
Cognição , Diabetes Mellitus Experimental/metabolismo , Derivação Gástrica , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Obesidade/metabolismo , Animais , Encéfalo/metabolismo , Duodeno/cirurgia , Glucose , Jejuno/cirurgia , Obesidade/cirurgia , Ratos Wistar
18.
J Vet Intern Med ; 35(5): 2167-2176, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34432324

RESUMO

BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is used to evaluate vascularity of the gastrointestinal wall in neoplastic and inflammatory diseases. OBJECTIVE: To assess the feasibility of CEUS for the evaluation of duodenal perfusion in dogs with inflammatory bowel disease (IBD). ANIMALS: Forty-two dogs with IBD and 20 clinically healthy dogs. METHODS: All CEUS studies of the duodenum were analyzed to obtain time-intensity curves and perfusion parameters. The procedure was repeated in 12 IBD dogs 2 months after a standardized treatment. RESULTS: On CEUS, the duodenal wall showed a typical perfusion pattern characterized by a radial and simultaneous enhancement of the wall in all dogs. On qualitative assessment, no differences were observed in contrast medium distribution between healthy and affected dogs, or between dogs with IBD before and after treatment. Peak intensity (PI) and area under the curve (AUC) significantly differed between healthy (PI = 3.58 arbitrary units [au; 1.86-4.93 au] and AUC = 47.63 au seconds [aus, 22.68-62.15]) and affected dogs (PI = 5.10 au [0.63-15.16 au] and AUC = 63.62 aus [5.31-212.20 aus]; P = .03 and .03, respectively). No significant differences were found for the perfusion parameters before and after treatment. CONCLUSIONS AND CLINICAL IMPORTANCE: We showed that CEUS allows discrimination between IBD affected dogs and healthy dogs by evaluation of time-intensity curves, but did not provide useful information for monitoring therapeutic response. The qualitative assessment identified no significant differences between healthy and affected dogs, or between dogs before and after treatment.


Assuntos
Colite , Doenças do Cão , Doenças Inflamatórias Intestinais , Animais , Colite/veterinária , Meios de Contraste , Doenças do Cão/diagnóstico por imagem , Cães , Duodeno , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Doenças Inflamatórias Intestinais/veterinária , Ultrassonografia/veterinária
19.
Chirurgia (Bucur) ; 116(eCollection): 1-7, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34463243

RESUMO

Background: Small bowel injuries are infrequent after blunt trauma and typically affect fixed segment. Untimely management of such injuries, results in high-output entero-cutaneous fistula which increases morbidity and mortality. Treatment of duodeno-jejunal flexure transection has been traditionally done by pyloric exclusion with gastrojejunostomy, but more recent evidence suggests that end-to-end anastomosis or primary closure may be equally effective in which duodeno-jejunal anastomosis is protected via an external tube duodenostomy. Objective: The objective of the study is to provide a modification to the technique of management of duodeno-jejunal flexure injury, avoiding external tube duodenostomy. Material and Methods: Patients admitted from July 1, 2015 to June 1, 2018 were identified and examined for duodeno-jejunal flexure transection. Non-accidental injury cases were excluded. Results: In the study period, a total of 10 patients were admitted with duodeno-jejunal flexure transection. All cases were admitted 24 hours after the injury and presented with shock. After fluid resuscitation and investigations, they were taken for urgent laparotomy. The whole of duodenum was mobilised, the transected ends were debrided and end-to-end duodenojejunal anastomosis was performed in two-layer fashion. An 18-French Nasojejunal (NJ) tube was placed beyond the anastomosis, and an 18-French nasogastric (NG) tube was placed in the stomach for gastric decompression. A feeding jejunostomy was performed in all cases. Both NG and NJ tubes were removed after bowel movements started and FJ was removed on first follow up. There was no incidence of duodenum related complications, and all were doing well on follow up. Discussion and conclusion: Placing the nasojejunal and nasogastric tube eliminates the need for duodenostomy and gastrostomy, respectively. This method protects the duodeno-jejunal anastomosis and decreases the incidence of duodenum-related complications.


Assuntos
Derivação Gástrica , Ferimentos não Penetrantes , Duodenostomia , Duodeno/lesões , Duodeno/cirurgia , Humanos , Resultado do Tratamento , Ferimentos não Penetrantes/cirurgia
20.
Medicine (Baltimore) ; 100(33): e26944, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414955

RESUMO

BACKGROUND: To explore the diagnostic value of computed tomography (CT) imaging for duodenal lipoma and the potential clinical significance of the findings. METHODS: Clinicopathological and CT data from 57 patients, who were diagnosed with duodenal lipoma at the first affiliated Hospital of Zhengzhou University (Zhengzhou, China) between June 2014 and March 2019, were retrospectively reviewed. Data collected included location and size of the tumor, morphological manifestations (shape, density, boundary), concomitant diseases, pathology and gastroscopy results, and follow-up. Follow-up was performed via telephone, and surgical patients were followed-up for recurrence, metastasis and tumor size, and morphological changes. The follow-up period was up to January 2019. RESULTS: Of the 57 patients with duodenal lipoma, contrast-enhanced scanning was performed in 7 cases. The tumor was located in the descending duodenum in 33 cases, the ascending in 4 cases, the horizontal in 16 cases, and the bulb in 4 cases. Mean tumor size was 13.0 ±â€Š5.8 mm. CT morphological features of the tumor were as follows: tumor shape, round, quasi-round, or oval (n = 42); long strip (n = 3); nodular (n = 2); triangular (n = 1); and irregular lobulated (n = 9). Among the 57 patients, tumor density was homogeneous in 52 cases, inhomogeneous in 4 cases, and nodular with calcification in 1 case. The tumor boundary was classified as clear and with no capsule. Diseases concomitant with the tumor were as follows: gastritis (n = 23), gastric adenocarcinoma (n = 1), and gastric lymphoma (n = 1). Esophageal disease was found in 16 cases, including reflux esophagitis (n = 12) and esophageal cancer (n = 4). There were 13 cases of gallbladder and biliary disease, including cholecystolithiasis and cholecystitis (n = 9), common bile duct disease (n = 2), colorectal cancer (n = 4), lung cancer (n = 2), duodenal carcinoma with obstruction (n = 1), and ureteral space narrowing (n = 1). CONCLUSION: CT was an effective, non-invasive method for diagnosis of duodenal lipoma. CT imaging could clearly discern location, size, shape, and nature of duodenal lipomas. Duodenal lipoma can be associated with digestive tract inflammatory diseases and tumors in different locations, and its diagnosis is potentially valuable for their prevention and treatment.


Assuntos
Neoplasias Duodenais/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/patologia , Duodeno/diagnóstico por imagem , Duodeno/patologia , Feminino , Humanos , Lipoma/diagnóstico , Lipoma/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
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