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At least 325 records · Page 18Linked to original sources
PubMed1993

[Value of duodenal drainage in the etiologic diagnosis of acute pancreatitis].

The most common etiology of acute pancreatitis (PA) in western Countries is gallstone disease. From recent data it has become clear that up to 30% of the so-called idiopathic AP are due to microlithiasis. Overlooking this diagnosis precludes to carry out a correct treatment and leads to relapses. In this prospective study bile for microscopic examination has been collected by duodenal intubation from 50 patients admitted because of AP of unknown etiology (history, laboratory data, ultrasound). In 21 patients the bile contained crystals, but only in 15 were considered as significant. Seven of these 15 patients underwent surgery which confirmed microlithiasis in all but one who had cholesterolosis. After cholecystectomy only one patient presented with a new episode of AP. In conclusion, microscopic examination of the bile may establish reliably a biliary origin in cases of AP of unknown etiology, allowing an adequate treatment of these patients and decreasing their risk of recurrences.

Acute Disease↗
PubMed1993

The failure of conventional methods to promote spontaneous transpyloric feeding tube passage and the safety of intragastric feeding in the critically ill ventilated patient.

Nasoenteral tube feedings are often recommended in critically ill patients when gastrointestinal tract function is intact. Conventional methods of placement include turning the patient on the right side and the use of drugs that stimulate peristalsis to promote transpyloric passage. A prospective study was initially performed to assess the success of conventional methods used to promote transpyloric feeding tube placement in patients requiring assisted ventilation admitted to the Surgical Intensive Care Unit (SICU) (Part I of the study). In 68 critically ill ventilated patients, placement of nasoduodenal feeding tubes was attempted. Successful transpyloric placement was achieved in only ten patients. There was no correlation between age, gender, admitting diagnosis, time of tube placement and successful placement. The second part of the study was initiated to assess the safety of nasogastric feeding in critically ill ventilated patients. Forty-two patients admitted to the SICU were considered candidates for gastrointestinal tract feeding and were fed through the gastric route. Twenty-five patients reached enteral feeding goal rate within 72 hours, while 34 patients achieved goal rate by five days. Eight patients required total parenteral nutrition to meet nutritional needs because of an inability to achieve adequate nutritional support enterally. There were 11 complications noted in ten patients, including one episode of aspiration pneumonia. The presence of complications was not related to age, gender, admitting diagnosis, infusion method or type of formula used. Duodenal intubation using conventional methods in critically ill ventilated patients is unsuccessful in most patients. Nasogastric feeding in this group of patients can be safely administered in selected instances.

Critical Illness↗
PubMedDate not supplied

Non-radiological investigation of pancreatic disease.

Pancreatic exocrine insufficiency is investigated by long established techniques: either by duodenal intubation studies, or by indirect functional methods. Serum markers and specific gastrointestinal hormones are available for the diagnosis of pancreatic inflammation, carcinoma, and rare pancreatic endocrine tumours. The clinical utility of these diagnostic tests is discussed in this article.

Amylases↗
PubMed1996

Endoscopically-assisted duodenal feeding tube placement using a nasogastric tube: preliminary two-year experience.

Our initial 2-year experience using a new technique of nasoduodenal feeding tube placement with a soft nasogastric tube is presented. This technique was used for patients with major burns to initiate early, safe enteral feeding. With the use of double loops in the tube and endoscopic assistance, the placement of the nasogastric tube beyond the second portion of the duodenum was accomplished in approximately 20 minutes. A method of transpyloric duodenal intubation using a soft, unstented nasogastric tube that allowed rapid bedside nasoduodenal intubation, with the patient in the supine position, was used. The tube placement technique minimizes the suffering of critically ill patients and the labor of clinicians performing the tube placement.

Burns↗
PubMed1977

Prospective evaluation of the pancreatic secretion of immunoreactive carcinoembryonic antigen, enzyme, and bicarbonate in patients suspected of having pancreatic cancer.

We undertook to test the recent suggestion that measurement of immunoreactive carcinoembryonic antigen (CEA) in pancreatic secretion may be useful in diagnosis of pancreatic cancer. Using duodenal intubation and a perfusion method in 57 cases, we measured the rate of pancreatic CEA secretion into the duodenum under basal saline perfusion, alone and with continuous intravenous infusion of secretin (2 clinical units per kg per hr) and of cholecystokinin-pancreozymin (CCK, 15 Crick-Harper-Raper units per kg per hr); and we compared the CEA output with secretion of trypsin, lipase, and bicarbonate under the same conditions. Subsequent laparotomy revealed pancreatic carcinoma in 25 patients, pancreatitis in 7, other intraabdominal malignancies in 6, and benign nonpancreatic disorders in 19. CEA output rates did not differentiate all pancreatic-cancer patients from other patients in any test condition. However, pancreatic enzyme outputs were abnormal with almost 90% of cancers of the pancreatic head and with 75% of cancers of the pancreatic body and tail. For detection of pancreatic cancer, enzyme and bicarbonate outputs in response to CCK are more accurate than pancreatic CEA or bicarbonate outputs in response to secretin. Since CCK-stimulated enzyme outputs can be related accurately to malabsorption (not reported here), we prefer them to bicarbonate output for assessment of pancreatic function.

Adult↗
PubMed1998

[The bile acid and bile lipid spectrum of the migrant population of the Asian North with biliary tract diseases].

AIM: The study of biochemical bile composition in Asian North migrants with biliary diseases (BD). MATERIALS AND METHODS: The diagnosis of BD was made upon clinical examination, ultrasound scanning, duodenal intubation in 329 examinees. The bile was examined for total bile acids, total cholesterol, total phospholipids and bile acid spectrum. RESULTS: Cholelithiasis patients were found to have high index of bile cholesterol saturation, high level of deoxycholic acid and low ratio primary/secondary bile acids. CONCLUSION: Changes in bile lipid spectrum are the leading cause of forming bile concrements in migrant population of the high altitudes.

Adult↗
PubMed1988

Duodenal perforation during intubation for small bowel enema study.

Use of the small bowel enema examination (enteroclysis) is increasing, and numerous reports have attested to its value, but virtually no complications have been reported. The author describes a 72-year-old man undergoing enteroclysis for weakness, anemia, and guaiac-positive stools in whom the duodenum was perforated during intubation. Radiologists should be aware of this potential complication, and inexperienced people should be supervised carefully during the procedure.

Aged↗
PubMed1979

Postprandial gastric function in pancreatic insufficiency.

Abnormalities in postprandial gastric function could contribute to the maldigestion of pancreatic insufficiency. To measure simultaneously postprandial gastric secretion and emptying and correlate these measurements with intraluminal duodenal changes, we performed intestinal intubation and duodenal perfusion during feeding of a solid-liquid test meal in 10 healthy controls and 10 patients with documented pancreatic insufficiency before and after replacement therapy. In pancreatic insufficiency, intraduodenal pH was significantly decreased late in the postprandial period while simultaneously measured duodenal acid loads were normal, confirming that reduced bicarbonate output rather than increased acid delivery was responsible for higher duodenal acidity in these patients. Significant (P less than 0.05) reductions in postprandial acid, pepsin, and total secretory outputs were noted in untreated patients only during the first postprandial hour. Absolute gastric emptying rates were lower in patients (P less than 0.05) than in healthy subjects, but fractional rates of emptying were similar. Fasting and postprandial hypergastrinaemia were consistently observed in the patients with pancreatic disease. There are postprandial disturbances of secretory function but no primary gastric motor defect in patients with exocrine pancreatic insufficiency.

Duodenum↗
PubMed1993

Effect of preanesthetic medication on ease of endoscopic intubation of the duodenum in anesthetized dogs.

The effects of preanesthetic medication on ease of duodenal endoscopic intubation in dogs was evaluated. One of 12 combinations of preanesthetic medications (using atropine, glycopyrrolate, morphine, meperidine, acepromazine, and 0.9% NaCl solution) was administered IM to each of 12 dogs in a trial. Twelve endoscopic trials were performed so that each dog received each treatment combination once. Anesthesia was induced with thiamylal administered IV and maintained with halothane vaporized in oxygen. Electrocardiographic recordings, indirect blood pressure measurements, end-tidal carbon dioxide partial pressures, and halothane concentrations were monitored during the anesthetic period. The ease with which the fiberoptic endoscope was passed into the proximal portion of the duodenum was qualitatively score on the basis of time and maneuvering effort. None of the preanesthetic combinations made intubation of the duodenum significantly easier than that with 0.9% NaCl solution (control). Only the combination of morphine and atropine induced gastro-pyloric conditions that resulted in significantly higher (more difficult) endoscopic scores than those after preanesthetic medication with 0.9% NaCl solution.

Animals↗
PubMed1997

[The pathophysiological basis of vagotomy in perforated duodenal ulcers].

Fractional intubation, intragastric pH-metry and other methods were used in complex examination of 107 patients who had perforated duodenal ulcers. The influence of surgical vagotomy upon the state of tissue blood flow was determined by means of polarography with a medicamentous vagotomy test. The medicamentous denervation was found to result in decreased blood supply of the acid-producing area and increased blood filling of the duodenum mucose. A conclusion is made that performing vagotomy is expedient after suturing the ulcer defect in patients having no diffuse purulent peritonitis.

Adult↗
PubMed1982

Effect of liquid meals on duodenogastric reflux in humans.

In humans duodenogastric reflux and gastric emptying were measured simultaneously by a two-marker technique that avoids transpyloric intubation. The duodenal marker consisted of 99mTc-labeled Hepatobida and was infused intravenously at a constant rate. Hepatobida was cleared almost exclusively by the liver and entered the duodenum at a constant rate via the bile. The gastric marker consisted of 51CrCl2 and was used to measure total intragastric volume by the double-sampling technique. Duodenogastric reflux occurred both after meals and under fasting conditions. Reflux rate was on the average 13 times smaller than emptying rate. It was higher with a lipid than with a protein meal and was independent of the rate of gastric emptying. The gastric concentration and total amount of duodenal contents were higher after lipid than protein meals. Since gastric emptying of a protein meal was faster than emptying of a lipid meal, the increased gastric concentration and accumulation of duodenal contents after lipid meals are due to a slowed gastric clearing and increased reflux of duodenal contents. Under fasting conditions, the reflux was lower and the gastric concentration of duodenal contents was higher than with both types of meals. Hence regurgitated duodenal contents may cause more damage to the gastric mucosa under fasting conditions than postprandially.

Adult↗