[Comments on the technic of duodenal intubation and determination of lipase activity in infants].
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The use of secretin to facilitate the demonstration of Giardia lamblia in duodenal juice was studied in children under investigation for chronic diarrhoea. 30 children aged 3 months to 13 years, whose stools were negative for G. lamblia, were studied. G. lamblia was demonstrable in a sample of duodenal juice in 1 of the 30 children before an intravenous injection of secretin (1 or 2 mg/kg), but in 9 of the 30 children after secretin. It is concluded that examination of duodenal juice after secretin stimulus is an effective method of showing giardial infestation.
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A prospective study involving 27 infants with cholestatic jaundice was carried out to evaluate the diagnostic utility of the 24-h duodenal drainage test. Extrahepatic cholestasis was confirmed by either exploratory laparotomy or autopsy in 12 of 13 cases without bile drainage, with only one false-positive result. The sensitivity of this test for extrahepatic cholestasis was 100% while the accuracy and specificity were 96.3 and 93.3%, respectively. The corresponding sensitivity, accuracy, and specificity for liver biopsy in patients with extrahepatic cholestasis were 83.3, 92.6, and 100%, respectively. It is concluded that the duodenal drainage test is a simple, rapid, and inexpensive procedure with high sensitivity and specificity in the diagnosis of infantile cholestasis.
Overall twelve essentially healthy subjects were evaluated for the tone and contractile function of the gallbladder according to phases of interdigestive motility of duodenum as were for effects on these functions of phase-by-phase administration of 30 ml of 33% solution of magnesium sulphate. The gallbladder in healthy individuals was found out to function according to phases of duodenal interdigestive motility and be ready to evacuate bile during phase II. Prior diagnostic techniques did not take advantage of interdigestive phase of duodenal and gallbladder motility during which phase a standard stimulating agent was routinely employed. This can lead to wrong diagnosis of the functional state of the biliary tract, gallbladder and their sphincters in the interdigestive period: incomplete gallbladder emptying from bile in case the stimulating agent is being introduced during phase I or III; hyperdiagnosis of cholecystitis; heterodirectivity of the same patient's notion about type of dyskinesias of the gallbladder and biliary tract.
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