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At least 199 records · Page 11Linked to original sources
PubMed2003

Evaluation of a new curved linear array echoendoscopy system for EUS.

BACKGROUND: EUS-FNA can be used to accurately diagnose and stage GI and pulmonary neoplasms. This study evaluated the performance characteristics of a new compact linear EUS system during EUS-FNA. METHODS: A total of 37 patients enrolled in this prospective pilot study underwent clinically indicated EUS-FNA and/or celiac plexus neurolysis with the compact EUS system. RESULTS: The mean time to perform a radial and linear array EUS with FNA and/or celiac plexus neurolysis was 24 minutes shorter with the compact EUS system compared with that for an historical control procedure in which a conventional linear EUS unit was used (p = 0.0007). The EUS images and visualization of the needle during EUS-FNA were rated good to excellent in greater than 95% of the patients. With respect to ease of esophageal intubation, duodenal intubation, and general maneuverability, the performance of the new linear echoendoscope, compared with a radial scanning videoechoendoscope, was the same or better in, respectively, 85%, 87%, and 100% of procedures. The video image quality of the new linear array echoendoscope was superior to that of the radial scanning videoechoendoscope in all patients. No complications were encountered. CONCLUSIONS: EUS-FNA and celiac plexus neurolysis can be performed safely with the new compact EUS system. The efficiency of this procedure is enhanced compared with historical experience with other instruments. Although image quality is sufficient for EUS-FNA and celiac plexus neurolysis, the compact unit cannot be used as a "stand-alone" system for routine diagnostic EUS, and its use must be complemented by standard radial imaging.

Biopsy, Needle↗
PubMed1991

Evaluation of atropine, glucagon, and metoclopramide for facilitation of endoscopic intubation of the duodenum in dogs.

Modification of gastroduodenal motility has been proposed to aid endoscopic examination of the duodenum in dogs. The objective of this study was to evaluate the use of the following pharmacologic agents for facilitation of endoscopic intubation of the duodenum in 6 clinically normal dogs: metoclopramide HCl (0.2 mg/kg of body weight), atropine sulfate (0.045 mg/kg), glucagon (0.06 mg/kg), and isotonic saline solution. In a randomized, blinded, crossover design, the ease of endoscopic duodenal intubation was qualitatively scored by 3 endoscopists (in random order), using the following scale: 1 - immediate entry; 2 - rapid entry--moderate manipulation; 3 - difficult entry--multiple attempts; and 4 - no entry after 2 minutes [corrected]. Anesthesia was induced with thiopental and maintained with halothane. The 4 agents were diluted to a fixed volume and randomly administered. Duodenal intubation was attempted 2 minutes after IV injection of 1 of the agents. Four endoscopic procedures (1 for each agent) were performed on each dog with a minimum of 5 days between each procedure. In this study, no agent facilitated endoscopic duodenal intubation at the dose used. Instead, atropine and metoclopramide made duodenal intubation significantly more difficult, compared with use of saline solution. Difference between intubation after administration of glucagon and saline solution was not seen. On the basis of our findings, the use of these agents for facilitating endoscopic duodenal intubation is not recommended. In addition, in this study, we found that experience in endoscopic intubation is an important factor in determining the ease of duodenal intubation.

Animals↗
PubMed2001

Impaired hepatocyte glucose transport protein (GLUT2) internalization in chronic pancreatitis.

Chronic pancreatitis (CP) is associated with impaired glucose tolerance and with reduced hepatic sensitivity to insulin. We have previously shown that in normal and sham-operated rats, insulin suppresses hepatic glucose production, and this suppression is associated with a decrease in the hepatocyte plasma membrane-bound quantity of the facilitative glucose transport protein GLUT2. The insulin-mediated reduction in membrane-bound GLUT2 is impaired in CP, and may play a role in the glucose intolerance associated with CP. To determine whether GLUT2 is actively internalized and whether this mechanism is disordered in CP, livers from fed and fasting rats in whom CP had been induced 2-3 months earlier by pancreatic duct oleic acid infusion, and in sham-operated (sham) rats, were fractionated to yield endosome (E)- and plasma membrane (PM)-enriched fractions. Forty-five minutes after duodenal intubation alone (fasting) or intubation plus duodenal feeding, livers were removed, homogenized and ultracentrifuged, and microsomal pellets were separated by sucrose density gradient ultracentrifugation. GLUT2 content of fractions was determined by Western blotting and scanning densitometry. The E:PM ratio of GLUT2 increased from 0.68 +/- 0.11 (mean +/- SEM) in fasting sham livers (n = 8) to 1.04 +/- 0.09 in fed sham livers (n = 8; p < 0.05). However, there was no change in the E:PM ratio of GLUT2 in CP livers after duodenal feeding (0.90 +/- 0.12 vs. 0.86 +/- 0.10; n = 8,8; p = NS). To test our findings using confocal laser scanning microscopy, liver specimens from fed and fasting CP and sham rats were minced, fixed in 4% paraformaldehyde, sectioned, and stained with rabbit antirat GLUT2 antibody followed by rhodamine-labeled secondary antibody. GLUT2 was quantified by mean pixel intensity in an 8 x 16-pixel area of PM and a 16 x 16-pixel area of cytosol (CYT) in each of 30 random cells/field (400x) in each of three rats per group. As in the fractionation study, duodenal feeding increased the CYT:PM ratio of GLUT2 from 0.75 +/- 0.01 in fasting sham liver to 0.86 +/- 0.01 in fed sham liver (p < 0.0001), while the CYT:PM ratio in CP remained unchanged. We conclude that feeding induces a shift in GLUT2 from the plasma membrane to the endosomal pool. The feeding-induced internalization of GLUT2 is absent in livers from rats with CP and may play a role in the glucose intolerance associated with CP.

Animals↗
PubMedDate not supplied

When does metoclopramide facilitate transpyloric intubation?

Postpyloric feeding probably reduces the incidence of tracheobronchial aspiration and improves feeding tolerance. However, duodenal intubation is often unsuccessful in critically ill patients due to gastric atony. Metoclopramide improves gastric emptying. In a pilot study, 12 adult patients were administered 10 to 20 mg of intravenous metoclopramide after weighted nasal feeding tubes had failed to spontaneously pass distal to the pylorus. In no patient did metoclopramide induce transpyloric passage of the tube. A randomized prospective study involving 10 adult patients was conducted to examine the effect of preinsertion intravenous metoclopramide on transpyloric intubation. All patients had failed to achieve spontaneous duodenal intubation. Five patients received 20 mg of metoclopramide 10 min prior to nasal insertion of a weighed feeding tube. Five control patients received no premedication. Four metoclopramide patients achieved duodenal intubation immediately. In none of the control patients did transpyloric intubation occur (p = 0.048). Metoclopramide, administered after nasogastric intubation, is ineffective in promoting transpyloric advancement of feeding tubes. There is a significant increase in transpyloric intubation when metoclopramide is administered prior to tube insertion.

Adult↗
PubMed1991

Comparative effects of duodenal and ileal intubation on gastric emptying and postprandial antral, pyloric, and duodenal motility.

The influence of gastric and small-intestinal intubation on fed patterns of antropyloroduodenal motility and gastric emptying of a solid meal has been investigated in normal volunteers. In 10 subjects a manometric assembly was passed as far as the fourth part of the duodenum; in 8 other subjects the terminal ileum was intubated; and a further 8 subjects were not intubated. The manometric assemblies were similar, apart from their length, and both incorporated a sleeve/side hole assembly located across the pylorus. All subjects ingested a meal of 100 g 99mTc-labelled liver/ground beef. There was no significant difference in either the lag phase or the linear emptying phase of gastric emptying between the control and duodenal intubation groups. The emptying phase of the test meal, but not the lag phase, was slower (p less than 0.01) in the ileal intubation group than in the non-intubated and duodenal intubation groups. There were fewer (p less than 0.01) antral pressure waves in the ileal than in the duodenal intubation group. We conclude that ileal but not duodenal intubation has an important inhibitory influence on gastric emptying and antral motility.

Adult↗
PubMed2004

Exocrine pancreatic function after alcoholic or biliary acute pancreatitis.

OBJECTIVES: There have been various studies of exocrine pancreatic function after acute pancreatitis, but few have examined the relationship between this function and the etiology of the pancreatitis. The aim of this work was to study pancreatic function in patients who had had acute alcoholic or acute biliary pancreatitis. METHODS: Seventy-five patients who had had a single attack of acute pancreatitis were studied. The etiology was alcohol in 36 and cholelithiasis in 39. Pancreatic function was studied between 4 and 18 months after pancreatitis by duodenal intubation in 18 patients (8 alcohol, 10 lithiasis) and by the amino acid consumption test (AACT) in the remaining 57 (28 alcohol, 29 lithiasis). For those who underwent AACT, the test was repeated 1 year after the first examination. RESULTS: Among the 36 patients with alcoholic pancreatitis, most had impaired pancreatic function at both duodenal intubation (8/8, 100%) and at AACT (22/28, 78.6%); at the second test, the AACT remained pathological (18/23, 82.1%). Of the 39 patients with biliary pancreatitis, only 4 of the 10 (40%) who underwent duodenal intubation and only 5 of the 29 (17.2%) who performed AACT had pancreatic insufficiency; at the second test, only 4 of the 26 (15.4%) who repeated the AACT were pathological. The differences in the frequency and degree of pancreatic insufficiency between patients with alcoholic and those with biliary pancreatitis were statistically significant. CONCLUSIONS: The results show that after alcoholic acute pancreatitis, the pancreatic insufficiency was significantly more frequent and more severe than after biliary pancreatitis. These findings together with the fact that the insufficiency was also more persistent suggest that acute alcoholic pancreatitis may occur in a pancreas that already has chronic lesions.

Acute Disease↗
PubMedDate not supplied

[Changes of pH and kinematic viscosity of the contents of gall-bladder at the pre-gallstone stage of cholelithiasis].

The aim of the work was to study the indicators of pH and kinematic viscosity of the contents of the gall-bladder at receiving B-portion and their changes after a 7-hour period according to the biliary sediment of patients and to establish their link to the infection. Total 31 patients aged 25-55 with biliary sediment in lumens of their gall-bladders (a general group) and 5 healthy patients (a control group) were studied by us. In all cases the markers of the virus of Hepatitis B in blood serum were determined and ultrasonic examination of gall-bladder was carried out by us prior to the duodenal intubation. B-portion was subjected to bacteriological research for aerobes and anaerobs, and pH and kinematic viscosity (eta=mm(2)/sec) were determined. The patients from the control as well as from the general group after a 7-hour period were redetermined pH and Kinematic viscosity of B-portion. Kinematic viscosity was determined with a capillary viscosimeter, and pH was fixed by a method of potentiometer. Statistical treatment was undertaken by the method of ANOLA p<0,05. During the duodenal intubation the mean value of pH within the control group was fixed at 6.74, and the mean value of the kinematic viscosity was 1.34, and after a 7-hour period the same indicators constituted 6.87 and 1.35 mm(2)/sec, respectively. The same indicators within the general group during duodenal intubation were the following: 7.26 and 1.99 mm(2)/sec, and after a 7-hour period the same indicators were 7.78 and 2.19 mm(2)/sec, respectively. There was a significant statistical difference between the mean values of pH and kinematic viscosity of the contents of gall-bladder of the patients from the control and general groups. During a 7-hour period, there was also a significant statistical difference between the changes of the same indicators. The difference was even greater in case of infection. Following the above-mentioned we can conclude that in case of sediment in the lumen of gall-bladder, inclination of pH to alkalinity and increase in kinematic viscosity of the contents is one of the most important criteria of lithogenicity of gall-bladder contents, and one of the reasons for such changes is chronic infection of a gall-bladder.

Adult↗
PubMed1980

Immunoglobulin concentrations in duodenal fluid of infants and children.

The immunoglobulin content of duodenal fluid in children at different ages has not as yet been determined, while that of serum, feces, and saliva has been well established. In 92 normal infants, children, and young adults on whom duodenal intubation was performed, duodenal fluid IgA, IgM, and IgG levels were measured. From these data, a developmental profile of immunoglobulins in duodenal fluid from 2 weeks of life to 19 years was obtained. Duodenal fluid IgA, IgM, and IgG appeared to maintain rather constant levels. The grand mean IgA level was lower than the mean IgG level (12.7 +/- 0.8 vs 29.1 +/- 2.5 mg/g of protein). Secretory component was detected in all duodenal fluids. IgG concentrations were greater than those of IgM (29.1 +/- 2.5 vs 13.2 +/- 1.4 mg/g of protein) over all age ranges. The developmental patterns of all immunoglobulins appeared to be different from those observed in serum or saliva with the exception of duodenal fluid IgA, which has a pattern similar to that of salivary IgA.

Adolescent↗
PubMed1977

Double contrast examination of the small bowel.

The technique for contrast examination of the small bowel has been considerably elaborated during recent years by the reintroduction of duodenal intubation by Sellink. A double contrast method for the small bowel via duodenal intubation is presented based on a prospective study of 202 patients. When the injected contrast medium had reached the cecum, air was introduced and double contrast views were obtained of the terminal ileum and cecum. It was noted that air passed very rapidly through the bowel but did not seem to influence that transit of the positive contrast medium. The duration of the examination in 75% of the cases was less than 45 min.

Cecum↗
PubMed1996

[The role of different investigations in diagnosis of functional disorders of the biliary system].

The paper presents the results obtained upon examination of inpatients with various types of biliary dyskinesia. The examination included: fraction chromatic duodenal intubation, stepwise manometry, cholecystography, ultrasound investigation of the liver, gall bladder, biochemical tests of the bile. Fraction duodenal intubation discovered gall bladder dysfunction. The manometry was necessary for diagnosis of duodenal hypertension. X-ray revealed primary defects in gall bladder motility. It is concluded that the diagnosis of functional disorders implies combined clinical and instrumental modalities.

Adolescent↗
PubMedDate not supplied

[Functional pancreatic studies in the diagnosis and treatment of chronic pancreatitis].

The diagnosis of chronic pancreatitis is usually established by clinical history and morphological criteria based on radiological and/or endoscopic (ERCP) findings. When these morphological signs are absent or equivocal, pancreatic function testing is necessary. Direct testing by duodenal intubation with hormonal stimulation is still considered as the reference method ("gold standard"). Numerous indirect tests have been introduced to replace the duodenal intubation which is rarely well accepted and difficult to repeat. Moreover this technique is only available in highly specialized centres. Among the tubeless tests, the Paba test and the pancreolauryl test are gaining interest. Several modifications of these tests have improved their sensitivity and specificity. In most instances, these tests are unable to detect mild pancreatic insufficiency. However their reproducibility in individual cases could be useful for the follow-up of patients with proven pancreatic insufficiency, particularly with regard to the efficacy and the compliance of replacement therapy.

Chronic Disease↗