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At least 217 records · Page 12Linked to original sources
PubMed1984

Evaluation of serum pancreatic polypeptide estimations following hormonal stimulation for the diagnosis of exocrine pancreatic insufficiency.

Pancreatic polypeptide (PP) was measured in 74 patients with normal and in 42 patients with abnormal pancreatic function under fasting conditions (before and after duodenal intubation) and following secretin and cholecystokinin (CCK) stimulation. Fasting PP values of patients with severe but not with moderate exocrine pancreatic insufficiency were significantly lower than those of controls. Duodenal intubation led to a significant increase in fasting PP values. Both CCK and, to a lesser extent, secretin led to an increase in PP values. PP increase was significantly lower in patients with severe and not with moderate exocrine pancreatic insufficiency compared to controls following stimulation. Therefore, while fasting serum levels of PP and those following low stimulation indicate severe exocrine pancreatic insufficiency in the absence of previous vagotomy, PP estimations do not enable diagnosis of moderate functional impairment of the pancreas.

Adult↗
PubMedDate not supplied

Ultrasound examination of the small bowel: comparison with enteroclysis in patients with Crohn disease.

BACKGROUND: Screening for inflammatory small bowel disease has hereto relied on barium examination, usually performed after duodenal intubation. A noninvasive technique for imaging of the small bowel in such patients would be preferable. METHODS: A total of 59 patients were included in the study. A small bowel barium examination (SBE) was performed after duodenal intubation using a barium and air double-contrast technique. Ultrasound (US) of the right lower quadrant was performed with a 3.5- or 5-MHz transducer. The patients fasted overnight. RESULTS: In 37 of 39 patients with a normal SBE, US was also normal. In 20 patients, SBE showed lesions compatible with Crohn disease and in 18 of these the US study showed thickening of the bowel wall. One of these patients later tested positive for Yersinia enterocolitica. There were two false-positive and two false-negative US examinations. For detection of inflammatory disease of the small bowel, US was calculated to have a sensitivity of 0.95, specificity of 0.93, accuracy of 0.93, predictive value of a positive test was 0.90, and a predictive value of a negative test was 0.95. CONCLUSIONS: US, therefore, seems to be a reliable method in the workup of patients suspected of having inflammatory small bowel disease. Thereby, US probably can select patients for SBF.

Adolescent↗
PubMed1982

Effects of nutrients on acid secretion by innervated total gastric pouch in conscious rats.

In conscious rats with innervated total gastric pouches, intravenous infusion or duodenal intubation with fat and glucose decreased gastric acid secretion while amino acids produced the opposite effect. Intravenous infusion of amino acids strongly increased plasma gastrin, but fat and glucose had no effect. Plasma gastrin increased after duodenal intubation with all three nutrients, amino acids being the most effective. Mechanisms of action of gastrin release and acid secretion are discussed concerning the route of nutrients administration which could play a role in the liberation of known or unknown stimulatory or inhibitory factors from intestinal cells.

Amino Acids↗
PubMed1977

[Double-contrast radiography of the small intestine].

On the basis of 170 double-contrast radiographic examinations of the small intestine, a description is given, in the first part of this paper, of the technique employed. Emphasis is laid, on the one hand, on duodenal intubation, which is easily effected with a Dotter-Bilbao tube and, on the other, on a study obtained by filling with a continuous barium column, the double-contrast being merely an adjunct. In the second part of the paper the results are analysed from a photographic and diagnostic standpoint: Photographically, duodenal intubation affords a clearer visualization of the jejunum but the chief merit of double-contrast radiography lies in the visualization of the ileum and the study it makes possible of the last ileal fold. With regard to diagnosis, from personal series, 20 % of organic lesions have been observed, although it must be admitted that this figure is certainly boosted by the selectivity of a specialized gastroenterologic unit. The interest of this technique rests also on the fact that the examination is very well tolerated by the patient and does not last more than two hours on an average.

Contrast Media↗
PubMed1981

Preliminary evaluation of a single-day tubeless test of pancreatic function.

The test for pancreatic exocrine function using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BTP test) does not require duodenal intubation, but misleadingly abnormal results often occur in patients with liver or bowel disease because the p-aminobenzoic acid (PABA) released by chymotrypsin hydrolysis of the peptide either is not conjugated or is malabsorbed. This study evaluated a modified BTP test, using a tracer dose of 14C-PABA to eliminate misleading results, to assess exocrine function from a single six-hour collection of urine. The test clearly distinguished all patients with pancreatic steatorrhoea from normal subjects and identified patients with less severe pancreatitis as often as did the Lundh test. Furthermore, in patients with bowel or liver disease the misleadingly abnormal results of the unmodified BTP test were eliminated by the modified test in all but one case. These findings suggest that the modified BTP test provides a practical alternative to conventional tests of pancreatic function that entail duodenal intubation.

4-Aminobenzoic Acid↗
PubMed1993

[A prospective randomized study of the usefulness of weighted versus unweighted feeding tubes. A comparison of the transpyloric passage capacity, duration time and the signs of intolerance for enteral nutrition].

Weighted feeding tubes for parenteral nutrition were designed to facilitate duodenal intubation and to reduce the risk of aspiration into the bronchi. The goal of the study was to compare the effectiveness of two types of tubes, weighted and unweighted, with regard to their ability to pass the pylorus in 24 hours' time, the time they remained, their involuntary detubation percentages, and the appearance of signs of digestive intolerance during enteral nutrition. Only patients who preserved some level of consciousness were included. Thirty-eight were fitted with weighted tubes, and 32 with unweighted tubes. Twenty-four feeding tubes reached the duodenum during the first day. The average time the tubes remained after insertion was 10.2 +/- 1.1 (range of 1-51) days. In 20 patients, the tube left the body unnoticed, and 15 displayed signs of intolerance to enteral nutrition, though it had to be suspended in the case of only 5. Weighted feeding tubes showed greater effectiveness in their duodenal intubation rate (47% versus 19%, p = 0.0058), the time they remained in the body (12.2 +/- 1.7 versus 7.9 +/- 1.1 days; p = 0.037) and their percentage of involuntary detubation (6 weighted tubes and 14 unweighted tubes, p = 0.009). There were no differences between the two tube types with regard to the appearance of signs of digestive intolerance. The weighted tubes that reached the duodenum (n = 18) were those which remained for the longest periods; 73% of them remained for over 8 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMedDate not supplied

The usefulness of microscopic bile examination in patients with suspected microlithiasis: a prospective evaluation.

Gallbladder bile collected by duodenal intubation or during surgery was examined microscopically in patients who were free of stones and in patients with proven stones. None of the 16 patients free of stones had cholesterol monohydrate crystals or calcium bilirubinate granules in bile. Among the 17 patients with proven cholelithiasis, 13 with cholesterol stones had cholesterol monohydrate crystals in their bile, but only 2 of the 4 patients with pigment stones had calcium bilirubinate granules. These data confirm that cholesterol monohydrate crystals are sensitive and specific for cholesterol stones, whereas calcium bilirubinate granules lack sensitivity for the diagnosis of pigment stones. From these results, the diagnostic usefulness of microscopic examination of bile collected from the duodenum was studied prospectively in 46 patients with symptoms suggestive of cholelithiasis but in whom stones had not been visualized at cholecystography and ultrasonography. In 15 of them, bile was found to be abnormal: cholesterol monohydrate crystals were seen in 11, cholesterol crystals + calcium bilirubinate granules in 2 and calcium bilirubinate granules in 2. To date, nine of these patients have been operated on: 6 (all with cholesterol monohydrate crystals) had small cholesterol gallstones and 3 (2 with cholesterol monohydrate crystals and 1 with calcium bilirubinate granules) had signs strongly suggestive of the recent migration of gallstones. One patient refused operation, but minute pigment stones were found to be associated with calcium bilirubinate granules at duodenal intubation. In the other 31 patients, bile contained neither cholesterol monohydrate crystals nor calcium bilirubinate granules. They were not operated on and were followed up with repeated investigations for 12 to 24 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1980

Duodeno-jejunal intubation in examination of the small intestine.

The small intestine was examined with the duodenal intubation method in 113 patients. Patients admitted with acute abdominal disease were not included. The frequency of positive findings was 22%, which exceeds that of previous years before the method was introduced. Eight per cent were found to have Crohn's disease. Thirteen patients were admitted for gastrointestinal bleeding, and in two of them the cause was found. All patients with uncharacteristic abdominal symptoms, were normal. The results and advantages of the method are discussed.

Adolescent↗
PubMed1986

Value of fluoroscopic assistance during transpyloric intubation.

Blind insertion of a weighted nasoenteric tube (NET) has a low chance of immediate duodenal intubation and may cause serious complications. This study used fluoroscopic assistance to facilitate the passage of an NET to the duodenum. The success rate and complications were compared to those for NET insertion without fluoroscopy. Blind passage of a weighted feeding tube was associated with a 15% success rate in 13 patients; by contrast, fluoroscopic assistance allowed 95% of 20 patients to be intubated successfully in an average of 14 +/- 12 min. Although blind insertion caused intrabronchial intubation in two patients, there were no complications associated with fluoroscopy.

Adolescent↗
PubMed1981

A new method for the measurement of bile acid turnover and pool size by a double label, single intubation technique.

A new method is described for measuring the cholic acid turnover and pool size by a single duodenal intubation technique. The method is based on determination in a single bile sample of the ratio of the specific activities of [14C]cholic acid and [3H]cholic acid administered intravenously with an interval of 24 hr. With this ratio the fractional turnover rate (k) of cholic acid can easily be calculated as well as the half-life and pool size. Studies in ten normal subjects indicate that the cholic acid half life and pool size, determined by this single intubation technique, correlate very well (r greater than or equal to 0.98) with the results obtained by Lindstedt's method. Unlike the other methods using a single intubation, this method allows a good estimate of the bile acid turnover as well as the bile acid pool size.

Adult↗
PubMed1986

Is biliary excretion of paracetamol significant in man?

The extent of biliary excretion of paracetamol and its principal metabolites was studied in 10 healthy adults. Duodenal intubation was performed approximately 12 h after an oral dose of 1 g paracetamol. Duodenal fluid was aspirated following intravenous cholecystokinin, and urine was collected for 12 h after dosing. The mean concentration of the cysteine and glucuronide conjugates in the bile was 253.7 +/- 39.0 micrograms ml-1 (s.e. mean) and 69.3 +/- 15.3 micrograms ml-1, respectively. The mean recoveries of the cysteine and glucuronide conjugates in the bile were 6.0 +/- 1.5 mg and 1.2 +/- 0.41 mg, respectively. The bile is an important route of elimination for the cysteine conjugate and accounts for 19.4 +/- 4.4% of the total excretion of the metabolite. The fate of the biliary excreted conjugates is not known, and needs further investigation.

Acetaminophen↗
PubMed1979

Rapid duodenal and jejunal intubation.

A size 12 French radiopaque catheter, 135 cm long, suitable for rapid duodenal and jejunal intubation, is described. Its size and flexibility enable it to be passed with ease through the nose, stomach and duodenum. A guide wire is used to act as a stiffener as the catheter is passed through the stomach. The catheter is suitable for infusing barium directly into the small intestine and for performing hypotonic duodenography. The technique for duodenal and jejunal intubation is discussed.

Barium Sulfate↗
PubMed1993

Comparison of three methods to obtain upper small bowel contents for culture.

In this study of 27 patients with dyspepsia, we compared three methods for obtaining upper small bowel contents for culture: 1) the Enterotest or string capsule method, 2) duodenal intubation using a closed polyethylene tube filled with water that had been boiled for sterilization and removal of dissolved oxygen, and 3) brushing of duodenal mucosa with a cytology brush protected by a sheath (the last two done during endoscopy). In 12 of the 27 patients, duplicate intubations and brushings were performed. The samples obtained were cultured aerobically. Parameters used to compare the three methods were: the contribution of each method to the diagnosis of upper small bowel bacterial overgrowth (USBBO), agreement between the methods in diagnosis of USBBO and in detailed microbiological findings, and the reproducibility of diagnosis of USBBO and of microbiological findings in duplicate intubation and brushing. Intubation and brushing were highly reproducible and superior to the Enterotest in all of the tested parameters. Intubation and brushing are equally efficacious, but intubation is preferred because of the slight cost advantage, ease of specimen processing, and the ability to obtain anaerobic specimens.

Adult↗
PubMed1972

Bilirubin conjugates in bile of man and rat in the normal state and in liver disease.

Conjugates of bilirubin were studied in normal bile of man and rat, and in bile of liver patients. In general human bile was obtained by duodenal intubation. In addition T-tube bile was examined in patients operated on for mechanical obstruction. The bile pigment compositions of duodenal and T-tube bile were similar in two patients where comparison was possible. Obstruction of the bile duct in rats was used as an animal model for obstructive jaundice. Diazotized ethyl anthranilate was used for determination of total conjugated bile pigment and for thin-layer chromatography (t.l.c.) analysis of the derived azopigments. The available t.l.c. procedures are versatile and allow rapid and quantitative analysis. A variety of conjugated azopigments can be distinguished. With chloroform, negligible amounts of unconjugated bilirubin are extracted from bile of man. Therefore, the percentage of monoconjugated bile pigments present in the initial bile sample can be calculated from the percentage of azodipyrrole found after diazotization. Normal bile from man and rat yields similar azopigment patterns. The dominant component is azopigment-delta (azodipyrrole beta-D-monoglucuronoside). Small amounts of azopigments with complex conjugating structures (gamma-azopigments) are present in both cases. Human bile further yields small amounts of azopigments containing xylose or glucose (called azopigments-alpha(2) and -alpha(3), respectively). Monoconjugated bilirubin (estimated from the percentage of azodipyrrole) amounts of 22% of total bile pigments in human bile and to 39% in murine bile. In both, the bulk of bile pigment is bilirubin diglucuronoside. From bile of patients with acquired liver diseases a new azopigment group (beta-azopigment) was derived. The gamma-azopigment group was increased; the delta-azopigment group (containing azodipyrrole beta-D-monoglucuronoside) was decreased. No differentiation was possible between intra- and extrahepatic cholestasis. The percentage of beta-azopigment showed a positive correlation with serum bilirubin concentration (r = 0.6). Recovery of the diseases was accompanied by normalization of the azopigment patterns. In rats, hydrostatic or mechanical obstruction induced increases in beta- and gamma-azopigments and a decrease in delta-azopigment similar to the changes observed in bile of liver patients. Complete normalization was obtained 6 hr after relieving the hydrostatic obstruction (duration 15-21 hr). In contrast, with man after surgery for extrahepatic obstruction, T-tube bile was not normalized when the T-tube was withdrawn (10 days after operation). Hydrostatic obstruction in rats provides an easy model when postobstructive bile pigment composition and parameters have to be investigated. The present investigations stress the importance of the physiopathological state when studying bilirubin conjugation. Hindrance to bile secretion induced heterogeneity of bilirubin conjugates and stimulated the formation of complex structures.

Animals↗
PubMed1985

Upper gastrointestinal endoscopy--how far does the endoscope go?

Two adult-size endoscopes (Olympus GIF-K2 and ACMI TX-8) were compared for extent of duodenal intubation by the endoscopist's estimate of location and x-ray position in 55 patients. The endoscopes were not different in duodenal position when separately analyzed for the endoscopist's estimate or x-ray location. Combining the results for both endoscopes showed the endoscopist's estimate to differ significantly from x-ray location in 47% of patients (p = 0.02). When incorrect, the endoscopist overestimated 62% of the time and underestimated 38% of the time. X-ray evaluation of insertion depth confirmed that the second portion of the duodenum was reached in 96%, third portion in 51%, and fourth portion or beyond in 38% of patients. We conclude that fluoroscopic confirmation may be necessary when endoscopically assessing distal duodenal segments for pathology.

Adult↗
PubMed1972

The composition of hepatic and gallbladder bile in patients with gallstones.

Bile specimens were obtained from 17 patients with gallstones and 21 patients with duodenal ulcer. The specimens were obtained from the former by needle aspiration of the gallbladder and common bile duct at operation and from the latter by duodenal intubation. The concentrations of bile salt, phospholipid, and cholesterol were measured. Gallbladder bile from gallstone patients contained significantly more cholesterol than did ;duodenal' bile from duodenal ulcer patients. Hepatic bile from gallstone patients contained significantly more cholesterol than did gallbladder bile from the same patients. When the data were plotted on triangular coordinates the relative composition lay within the zone of cholesterol solubility in all 21 ulcer patients. The relative composition of hepatic bile lay outside the zone of cholesterol solubility in five gallstone patients, at the limits of cholesterol solubility in a further three, and within the micellar zone in the remaining nine patients. This suggests that supersaturation of hepatic bile with cholesterol is not the sine qua non for the production of cholesterol gallstones.

Adult↗