Duodenal Contents Research Articles

Effects of 25-hydroxyvitamin D3 on localisation and extent of gastrointestinal calcium absorption in dairy cattle

The combination of 25-hydroxyvitamin D3 (25-OHD3) and a diet negative in dietary cation anion difference (DCAD) has recently been shown to have beneficial effects on peripartal calcium (Ca) homeostasis in dairy cows. To further elucidate the underlying mechanisms, it was the aim of the experiments to investigate the effects of 25-OHD3 in combination with DCAD values about –70 meq/kg DM on pre-duodenal and overall gastrointestinal Ca absorption. A group of six ruminally fistulated lactating cows equipped with a cannula in the proximal duodenum were assigned to three dietary treatments (Control diet, anionic salts, anionic salts +25-OHD3) of 5 weeks each. Urine and faeces were collected quantitatively and flow of duodenal contents was calculated by applying chromium oxide. Blood samples were taken at regular intervals. Treatment with anionic salts and 25-OHD3 resulted in an increased Ca net absorption from the total gastrointestinal tract, which was mainly due to respective increases in intestinal Ca absorption. Furthermore, anionic salts and 25-OHD3-treated animals had significantly higher plasma phosphate concentrations and lower plasma levels of CrossLaps and the overall net absorption of phosphorus was significantly higher in these animals. From these data, it can be concluded that anionic salts in combination with 25-OHD3 positively influence the overall net Ca and phosphorus absorption, which is obviously associated with a reduced mobilisation of bone minerals as indicated by decreases in plasma CrossLaps concentrations.

Acute Pancreatitis Secondary to Sorafenib Use

Introduction: Sorafenib is indicated for the treatment of advanced renal cell carcinoma and unresectable hepatocellular carcinoma. Case Report: A 68-year-old male with metastatic renal cell carcinoma was started on sorafenib 200 mg orally bid. He presented to the ER 11 days afterward with severe epigastric pain radiating to the back. Serum amylase and lipase on admission were 148 U/L and 805 U/L, respectively. Abdominal CT revealed microlithiasis without evidence of cholecystitis, this was unchanged from imaging done a couple of months ago; there was no abnormality of the biliary and pancreatic ductal system. He had no history of alcohol abuse; serum triglyceride, calcium, and liver function tests were within normal limits. Sorafenib was discontinued upon admission, he was made NPO, IV fluids were started, and narcotics were administered as needed; there was complete symptom resolution within 48 hours. Sorafenib was re-started 7 days after admission at the same dose. During outpatient follow-up 3 weeks later, serum amylase and lipase were 50 and 99, respectively, and there was no recurrence of symptoms. He took sorafenib for a total of 10 weeks before voluntarily discontinuing it; he opted for hospice care. Discussion: Sorafenib is a small-molecule inhibitor that binds to serine/threonine Raf-1 kinase and multiple classes of receptor tyrosine kinases (RTKs), including vascular endothelial growth factor receptor (VEGFR)-2, VEGFR-3, platelet-derived growth factor receptor (PDGFR), Fms-like tyrosine kinase-3 (FLT-3), and c-kit. The VEGFR-2/PDGFR signaling cascade is involved in vasculogenesis, angiogenesis, tumor cell motility, and metastasis. The development of acute pancreatitis in patients on sorafenib may lie in the role of VEGF in the maintenance of adult pancreatic fenestrated capillaries and regulation of the cell cycle of the acinar cells; therefore, VEGF inhibition would lead to ischemia, acinar cell apoptosis, and release of autodigestive enzymes. In addition, sorafenib decreases GI motility, which in turn may cause reflux of duodenal contents into the pancreatic duct and induce the premature activation of zymogens within the pancreatic acinar cell, resulting in the release of active enzymes within pancreatic tissue, leading to autodigestion. Sorafenib may cause pancreatitis; patients initiating this medication should be made aware of this potential complication and monitored for it. Sorafenib should be interrupted in patients who develop pancreatitis, but may be re-started after carefully assessing the risks and benefits of treatment. If there's a recurrence of pancreatitis we recommend discontinuing the medication permanently.

A flow visualization model of duodenogastric reflux after esophagectomy with gastric interposition

BackgroundOur goal was to verify surgical factors that affect duodenogastric reflux (DGR) after esophagectomy through the use of a flow visualization model that would mimic an intrathoracic gastric tube.MethodsTransparent gastric tube models for different routes (retrosternal space [RS] and posterior mediastinum [PM]) were fabricated. Various distal pressures were applied to the experimental model filled with water, and the flow was recorded with a high-speed camera. The volume and maximum height of the refluxate through the pylori of two different sizes (7.5 mm, 15 mm) in two different postures (upright, semi-Fowler) was measured by analyzing the video clips.ResultsFor the large pylorus setting, when the pressures of 20, 30, and 40 mmHg were applied in the upright position, the volumes of the refluxate in the RS/PM tubes were 87.7 ± 1.1/96.4 ± 1.7 mL, 150.8 ± 1.1/158.0 ± 3.2 mL, and 156.8 ± 3.3/198.0 ± 4.7 mL (p < 0.05), and the maximum heights were 101.6 ± 4.8/113.4 ± 2.9 mm, 151.4 ± 2.2/165.4 ± 1.5 mm, and 166.1 ± 1.7/193.7 ± 6.6 mm (p < 0.05). The data for the small pylorus setting or in the semi-Fowler position showed similar tendencies. For any given route, posture or pressure setting, DGR in the large pylorus model was definitively higher than that for small one.ConclusionsThis fluid mechanics study demonstrates posterior mediastinal gastric interposition or pyloric drainage procedure, or both, is associated with high reflux of duodenal contents.

Bacteria Isolated From Patients With Cholelithiasis and Their Antibacterial Susceptibility Pattern

Bacteria Isolated From Patients With Cholelithiasis and Their Antibacterial Susceptibility Pattern

Optimization of lambliasis microscopic diagnostics by the method of polarized fluorescence for patients with rosacea and urticaria

Introduction: There is little information about diagnosis of concurrent lambliasis in patients with rosacea and urticaria. We used method of polarized fluorescence to diagnose liambliasis, taking into account belonging of macromolecular structures of unicellular parasites Giardia lamblia to the optically active substances with the properties of liquid crystals. Material and Methods: Lambliasis was diagnosed on the basis of feces parasitological research and duodenal contents by methods of light and optic microscopy and polarized fluorescence in 105 patients with rosacea and urticaria. Research results were processed by the method of variation statistics in the Statgraf program by using Student’s criterion. Results: Search results of lamblia in patients with rosacea and urticaria depended on the conditions of its holding, patients’ preparation and from the previously received basic therapy if it consisted absorbents. Due to the fact that the fluorescence polarization as a physical method does not require the use of any generally toxic, dye- fluorochromes, qualitative cyto fluorescent analysis of lamblia in greeting microdrugs enables to distinguish vegetative forms of cysts. Conclussions: Polarized fluorescence method allows optimize the microscopic diagnosis of lambliasis, increasing its sensitivity. Previous preparation for the laboratory examination of Giardia lamblia is needed for the best exposure of vermin for patients with rosacea and urticaria.

Standards of the Polish Ultrasound Society - update. Pancreas examination.

Ultrasound examination of the pancreas constitutes an integral part of the abdominal ultrasound. It is mostly indicated to diagnose pain in the epigastrium, discomfort and jaundice as well as to monitor the patients with acute pancreatitis. The assessment of this organ in an ultrasound examination may be problematic due to its anatomical location and the fact that it might be covered by gastric and duodenal contents as well as due to a number of possible pathological changes, including inflammation and benign or malignant neoplasms, which require differentiation. The basis for establishing a correct diagnosis is the knowledge of the examination technique, correct pancreas structure and images of individual pathologies. This paper presents the standards of ultrasound examination published in 2011 and updated with the current knowledge. The following are discussed: preparation of the patient for the examination, abnormal lesions in the pancreas, acute pancreatitis, chronic pancreatitis, cystic lesions (benign and malignant cysts) and solid focal lesions. Ultrasound is also used to guide the drainage of fluid cisterns, abscesses and cysts. The prime role in the diagnosis and treatment of selected diseases of the upper gastrointestinal tract and parenchymal organs of the abdomen belongs to endosonography of the upper gastrointestinal tract, with the possibility to conduct a fine needle aspiration biopsy, and intraoperative or laparoscopic ultrasound.

Side-to-end duodenojejunostomy (Grégoire's technique modified by Stoppa)

Originally described by Raymond Gregoire in the May 1922 issue of the Journal de Chirurgie [1], this technique of side-to-end duodenojejunostomy was designed to ‘‘drain the duodenal contents into the small intestines whenever some obstacle hindered the evacuation’’ [of the duodenal contents]. In reality, there are several indications for side-to-end duodenojejunal derivation, which makes this technique of interest to surgeons. This derivation can be indicated in elective surgery for malignancy (caricinomatosis involving the duodenojejunal flexure, proximal jejunal metastases, or tumor invading the third or fourth portions of the duodenum) or benign disease (aorto-mesenteric compression syndrome [also called the superior mesenteric artery syndrome] or diverticulum of the third portion of the duodenum resulting in obstruction). In the emergency setting, this operation may be indicated for infectious jejunitis with perforation [2] or for loss of substance of the duodenum. The described simple technique has been modified. The original technique was a side-to-side dudenojejunostomy with an omega loop; the side-to-end modification has two advantages: • avoidance of the circulus vitiosus (enteric recycling); • the dependent location which enhances duodenal emptying.

Effect of pelleting temperature and probiotic supplementation on growth performance and immune function of broilers fed maize/soy-based diets

The aim of the present experiment was to examine the effect of pelleting temperature and a probiotic supplementation based on three Bacillus subtilis strains on growth performance and the immune function of broilers fed maize/soy-based diets. The experimental design was a 2×3 factorial arrangement of treatments evaluating two levels of probiotic supplementation (without or with 1.5×105cfu/g feed) and three pelleting temperatures (75, 85 and 90°C). Each treatment was fed ad libitum to 8 pens of 22 male broilers, in both the starter (1–21 day) and the grower (22–42 day) phases. On day 21 and 42, 6 birds per treatment were randomly selected to measure blood immunoglobulin M (IgM) and immunoglobulin A (IgA), production of reactive oxygen intermediates (ROI) and duodenal secretory IgA. Data were analysed by two-way analysis of variance (ANOVA) using the general linear model (GLM) procedure of statistical analysis software (SAS). During the starter phase (1–21 day), pelleting temperature had no effect (P>0.05) on broiler performance. However, probiotic supplementation tended to reduce feed intake (P=0.055) compared to unsupplemented diets with no effect (P>0.05) on weight gain or feed conversion. During the finisher phase (22–42 day) and over the entire period (1–42 day) pelleting temperature at 85°C reduced (P<0.05) weight gain compared to those fed diet pelleted at 75 or 90°C. Probiotic supplementation reduced (P<0.05) feed intake and improved (P<0.05) feed conversion. No interactions (P>0.05) were observed for any of the measured performance parameters during the overall period. There was no effect (P>0.05) of dietary treatments on the measured blood IgM, IgA and ROI. Probiotic supplementation and pelleting temperatures (85 and 90°C) increased (P<0.05) the concentration of secretory IgA in the duodenum on day 21. On day 42 an interaction (P<0.01) between probiotic and pelleting temperature was observed for the duodenal concentration of secretory IgA. In probiotic supplemented diets, pelleting temperature at 90°C reduced the concentration of secretory IgA compared to diets pelleted at 75 or 85°C. In conclusion, the results of this study suggest that increased pelleting temperature and probiotic supplementation stimulate duodenal secretory IgA production during the starter phase (1–21 day). Furthermore, over the entire period (1–42 day), probiotic supplementation based on three Bacillus subtilis strains improved feed conversion ratio in broilers fed maize/soy diets, regardless of the pelleting temperature used.

Laparoscopic Nissen fundoplication in the treatment of Barrett's esophagus - 10 years of experience.

IntroductionBarrett's esophagus (BE) is a state in which the distal portion of esophageal mucosa becomes lined with cylindrical epithelium as a result of adaptive remodeling. It is widely accepted that the metaplastic lesions result from chronic irritation with gastric and/or duodenal contents in the course of reflux disease. For many years, research centered on the risk factors of BE and resulting adenocarcinoma. Anti-reflux operations are the only procedures which offer the possibility of treating the cause by restoring the anatomic barrier responsible for guarding against irritating effects of gastroduodenal content on the distal esophagus. Total (i.e. 360°) laparoscopic Nissen fundoplication (LNF) is considered the most effective amongst these procedures. Still, controversies related to the indications for anti-reflux surgery are frequently encountered.AimRetrospective analysis of long-term treatment outcomes in patients with BE subjected to laparoscopic Nissen fundoplication.Material and methodsThe group included 42 BE patients, amongst them 30 men and 12 women. Initially, all the patients were treated conservatively for at least 1 year. The subgroup with dysplasia was subjected to preoperative argon plasma coagulation (APC). From 1 year after surgery (laparoscopic Nissen fundoplication), control biopsy specimens were obtained from the gastroesophageal junction of all the patients.ResultsNone of the patients showed the development of esophageal adenocarcinoma during the follow-up period. Furthermore, no cases of dysplasia progression or de novo development of dysplasia were observed in the analyzed group. In the initial 12-24 months after surgery, complete regression of metaplasia was documented in 7 (31.8%) patients from group A, and a reduction in the area of Barrett's metaplasia was observed in another 7 patients (31.8%). Throughout the period of this study, persistent planoepithelial re-epithelialization was observed in 14 (70%) group B patients, i.e. in individuals with baseline dysplasia subjected to preoperative argon plasma ablation. In the remaining patients of this group, the developed changes of BE character were less advanced than at baseline.ConclusionsOur opinion is that laparoscopic Nissen fundoplication, as a result of high effectiveness, represents the method of choice in the treatment of BE in the case of patients who were qualified for surgery.

Effect of the Enrichment Medium on the Detection and Diversity ofSalmonellafrom Porcine Duodenal Content

This study assesses the effect of the enrichment medium used on the isolation of Salmonella from the duodenal content of naturally infected slaughter pigs. At six slaughterhouses, the duodenum was collected from 458 randomly chosen pigs and examined in the laboratory. Three semi-solid enrichment media (modified semi-solid Rappaport-Vassiliadis medium [MSRV], diagnostic semi-solid Salmonella medium [DIASALM], and Simple Method Salmonella [SMS] agar) and three enrichment broths (Rappaport-Vassiliadis, Rappaport Vassiliadis broth with Soya [RVS], and Muller Kauffmann Tetrathionate novobiocin broth [MKTTn]) were evaluated. If a migration zone was present on the semi-solid media, a loopful was taken both near the inoculation drop and at the edge of the migration zone and streaked on a Xylose Lysine Desoxycholate (XLD) agar plate. Each enrichment broth was streaked on XLD, and three presumptive colonies were further examined. Detection rate was calculated, and isolates were, after serotyping, genotyped by performing pulsed-field gel electrophoresis (PFGE). The overall frequency of Salmonella isolated in at least one of the six different media was 15.5% (71/458). No significant differences in relative sensitivity were obtained within semi-solid media and within liquid media. Semi-solid media showed a significant higher relative sensitivity than the one obtained with liquid media. A relative sensitivity higher than 83.1%, namely of 94.4%, could only be obtained by combining three different enrichment media (MSRV or DIASALM+RVS+MKTTn). In 13.4% of the positive pigs, more than one serotype was found within the duodenum of one pig. In 12.9% of the duodenal contents, different genotypes were found within the same serotype. Differences in serotypes and genotypes were found predominantly within the same enrichment medium. In conclusion, to obtain the highest Salmonella detection rate in naturally contaminated pig samples, MSRV should be used as enrichment medium. However, to obtain a realistic picture of the sero- and genotypes present, different samples per enrichment medium and different enrichment media should be tested.

REVIEW ARTICLE; DUODENO-GASTRO-ESOPHAGEAL REFLUX COMBINED AND ISOLATED

Barrett’s esophagus is the chief risk factor for esophageal adenocarcinoma. Reflux of gastric acid has long been related to the development of esophagitis and Barrett’s esophagus, but the role of duodenal contents is controversial. We review the literature on the role of duodenal contents in the development of esophagitis, Barrett’s esophagus and adenocarcinoma in addition to the role of acid suppressant therapy in the development or prevention of these changes. A computer-based search of the literature using the terms "Bilirubin, Barrett, Bile Reflux, duodeno-gastric reflux and oesophagus/esophagus" was performed. The role of bile and other constituents of duodenal refluxate were examined. Techniques for identifying non-acid reflux were also reviewed, as were the role of pH, medication and surgery in modulating disease severity. Complicated Barrett’s esophagus is associated with increased exposure to gastric and duodenal refluxate. Biological effect of bile acids depends on the conjugation status, the pH of the milieu and the pKa of bile acids. While Proton Pump Inhibitors reduce the levels of DGER, they also produce changes in gastric and lower esophageal pH that activate different bile acids at different pH levels resulting in unexpected injury. Conjugated bile acids are harmful in acidic environment while unconjugated bile acids are harmful at neutral pH environment. An overlap of toxicity among conjugated and unconjugated bile acids occurs between strongly acidic and neutral pH levels. Normalisation of gastric and duodenal refluxate should ideally be the goal of treatment.

The severity of duodeno‐esophageal reflux influences the development of different histological types of esophageal cancer in a rat model

The mechanism through which each histological type of carcinoma arises from the esophageal mucosa remains unknown. This study was designed to investigate whether there is an association between the severity of duodeno-esophageal reflux and the histological type of esophageal cancer. A series of 120 male Fischer rats, weighing ∼180 g, were randomized to receive one of the following procedures: duodeno-forestomach reflux (DFR) with reduced exposure to duodenal contents, duodeno-esophageal reflux (DER) with increased exposure to duodenal contents and three control operations (DFR, DER control and sham). The reflux of bile was estimated with (99m)Tc-PMT scintigraphy. All animals were fed a standard diet without carcinogen. The esophageal mucosa was assessed 50 weeks after surgery for carcinoma. The median scanned fraction rate of duodeno-esophageal reflux was significantly lower for the rodents in the DFR group than those in the DER group. Five of 28 rodents in the DFR group and 17 of the 22 rodents in the DER group developed esophageal carcinoma. None of the controls developed carcinoma. The five rodents in the DFR group developed SCC. Of 22 esophageal carcinomas for the DER group, nine were SCC, 12 ADC and one was adenosquamous carcinoma. The fraction of esophageal SCC for the DFR group was significantly higher than that for the DER group, while the fraction of esophageal ADC for the DFR group was significantly lower than that for the DER group. These observations suggest that the severity of duodeno-esophageal reflux in rodents is related to the development of different histological types of esophageal carcinoma.

Clinical advantages of a metal stent with an S‐shaped anti‐reflux valve in malignant biliary obstruction

Transpapillary stent insertion is the standard treatment for palliating malignant biliary obstruction. However, luminal occlusion often occurs due to sludge formation, tumor ingrowth, or tumor overgrowth. Currently, influx of duodenal contents by duodenobiliary reflux is considered a mechanism of stent obstruction. The aim of the present study was to evaluate the efficacy and safety of a metal stent with an anti-reflux valve in distal malignant biliary obstruction. Thirty-two patients diagnosed with unresectable malignant biliary obstruction were enrolled. This trial was conducted at two tertiary hospitals in Korea from June 2009 to June 2011. An uncovered metal stent (M.I.Tech) with an S-type anti-reflux valve was placed. A total of 32 patients were enrolled. The technical success rate of stent insertion was 100%. The median duration of stent patency was 14.4 months. Stent occlusion occurred in 11 cases, which was caused by sludge formation in six cases, tumor ingrowth in four cases, and migration of the stent membrane in one case. During the follow-up period, there were no episodes of ascending cholangitis, acute pancreatitis, or bleeding. The new metal stent with an S-shaped anti-reflux valve demonstrated a relatively long duration of stent patency. This was attributable to reductions in duodenobiliary reflux by the anti-reflux valve. Also, the stent with an S-shaped anti-reflux valve is technically feasible and very safe. However, further prospective, randomized comparison studies of stents with anti-reflux valves and conventional stents are needed to evaluate the duration of stent patency.

Comparable reduction in cholesterol absorption after two different ways of phytosterol administration in humans

Consumption of phytosterols is a nutritional strategy to reduce cholesterol absorption, but the efficacy of various phytosterol intake modalities remains uncertain. The main objective was to investigate the effects of phytosterol esters (PE) provided either as a spread (dispersed in fat) during a mixed meal or as a minidrink (micro-dispersed in liquid form) after a meal. In a randomized, single-blinded crossover design, 12 healthy intubated volunteers tested three different liquid meal sequences with and without PE. The liquid meal (500 mL, Fortisip) contained an oral dose (80 mg) of deuterium-enriched cholesterol (D7C). The intubation was stopped at 240 min, and the fate of sterols was determined in the different phases of duodenal content samples as function of time. A second solid fat-containing meal without sterols was consumed at 270 min. D7C was quantified in chylomicrons and plasma for 8 h. The conditions tested were as follows: (1) no PE added (control), (2) PE in a spread added into a liquid meal (PE-spread meal) and (3) PE given 30 min after a liquid meal as 100-g yoghurt drink (PE-minidrink meal). Addition of PE decreased the incorporation of cholesterol into the duodenum aqueous phase including micelles. PE added as a spread or as a minidrink significantly and comparably lowered meal cholesterol occurrence in chylomicrons (-40 % for PE-spread and -54 % for PE-minidrink, p < 0.0001) compared with the control meal. PE either dispersed in fat during a meal or micro-dispersed in a liquid form after a meal resulted in a markedly reduced occurrence of meal-derived cholesterol in the circulation at a comparable extent.

Effect of fat additions to diets of dairy cattle on milk production and components: A meta-analysis and meta-regression

The objectives of this study were to critically review randomized controlled trials, and quantify, using meta-analysis and meta-regression, the effects of supplementation with fats on milk production and components by dairy cows. We reviewed 59 papers, of which 38 (containing 86 comparisons) met eligibility criteria. Five groups of fats were evaluated: tallows, calcium salts of palm fat (Megalac, Church and Dwight Co. Inc., Princeton, NJ), oilseeds, prilled fat, and other calcium salts. Milk production responses to fats were significant, and the estimated mean difference was 1.05kg/cow per day, but results were heterogeneous. Milk yield increased with increased difference in dry matter intake (DMI) between treatment and control groups, decreased with predicted metabolizable energy (ME) balance between these groups, and decreased with increased difference in soluble protein percentage of the diet between groups. Decreases in DMI were significant for Megalac, oilseeds, and other Ca salts, and approached significance for tallow. Feeding fat for a longer period increased DMI, as did greater differences in the amount of soluble protein percentage of the diet between control and treatment diets. Tallow, oilseeds, and other Ca salts reduced, whereas Megalac increased, milk fat percentage. Milk fat percentage effects were heterogeneous for fat source. Differences between treatment and control groups in duodenal concentrations of C18:2 and C 18:0 fatty acids and Mg percentage reduced the milk fat percentage standardized mean difference. Milk fat yield responses to fat treatments were very variable. The other Ca salts substantially decrease, and the Megalac and oilseeds increased, fat yield. Fat yield increased with increased DMI difference between groups and was lower with an increased estimated ME balance between treatment and control groups, indicating increased partitioning of fat to body tissue reserves. Feeding fats decreased milk protein percentage, but results were heterogeneous. An increased number of milkings increased the milk protein percentage, whereas the difference between the treatment and control groups in duodenal concentrations of 18:2 fatty acids and dietary Mg concentration reduced the milk protein percentage. None of the fat treatments influenced milk protein production. The range of responses to different fats fed approached or exceeded 5 standard deviations from the mean and differed in point direction for all variables studied, indicating the varied and profound biological effects of fats. Responses to fat feeding were highly heterogeneous for all variables studied and heterogeneity was present within responses to individual fat groups. The lower DMI combined with higher milk and milk fat production showed that fats could improve the efficiency of milk production. More studies are required to more completely characterize sources of variation in responses to fats.

Assessing the validity of an ELISA test for the serological diagnosis of human fascioliasis in different epidemiological situations

To improve the diagnosis of human fascioliasis caused by Fasciola hepatica and Fasciola gigantica, we evaluated the diagnostic accuracy of an enzyme-linked immunosorbent assay (ELISA), with Fasciola antigen from the adult liver fluke, for the detection of IgG against fascioliasis in human sera. The sera of 54 fascioliasis cases, originating from three endemic areas, were used in this evaluation: (i) a hyperendemic F. hepatica area where humans usually shed a great number of parasite eggs in faeces (11 sera); (ii) an epidemic F. hepatica area where humans usually shed small amounts of parasite eggs (24 sera) and (iii) an overlap area of both Fasciola species and where human shedding of parasite eggs in faeces is usually scarce or non-existent (19 sera). One hundred and sixty-eight patients with other parasitic infections and 89 healthy controls were also analysed. The respective sensitivity and specificity of this assay were 95.3% (95% confidence intervals, 82.9-99.2%) and 95.7% (95% confidence intervals, 92.3-97.5%). No correlation between egg output and the OD450 values of the F. hepatica IgG ELISA test was observed. This test could be used both as an individual serodiagnostic test for human fascioliasis when backed up by a compatible clinical history together with a second diagnostic technique for other cross-reactive helminth infections, and in large-scale epidemiological studies of human fascioliasis worldwide.

Expression of COX2 and p53 in Rat Esophageal Cancer Induced by Reflux of Duodenal Contents

Aim. Reflux of duodenal contents can induce mucosal injury, stimulate cell proliferation, and promote tumorigenesis. We examined the expression of COX2 and p53 in rat esophageal lesions induced by duodenal content reflux. Methods. Thirty 8-week-old male Wistar rats were exposed to duodenal content esophageal reflux. All animals underwent an esophagoduodenal anastomosis (EDA) with total gastrectomy in order to produce chronic esophagitis. Ten rats were the sham. Control. They were sacrificed at the 40th week. Their esophagi were examined for HE, COX2, p53, and proliferating cell nuclear antigen (PCNA). Results. After 40 weeks of reflux, dysplasia, squamous cell carcinoma (SCC), and adenocarcinoma (ADC) were found. PCNA labeling index was higher in dysplastic and cancer tissue than that in normal. Overexpression of COX2 was shown in ADC and SCC. Wild-type p53 accumulation was found in ADC, and not in SCC. Conclusion. Reflux of duodenal contents into the esophagus led to ADC and SCC in rats. COX2 may play an important role in esophageal cancer by duodenal content reflux. Our present results suggest an association between wild-type p53 accumulation and COX2 expression in ADC, with no such relation seen in SCC.

Duodenoscopic appraisal of duodenal ulcer in dogs

Aim: To assess the usefulness of duodenoscopy in the diagnosis of duodenal ulcers in dogs. Materials and Methods: Sick dogs with chronic gastrointestinal problems were physically examined and samples were collected for haematology, biochemistry and faecal examination. Duodenal biopsies, duodenal contents and brush cytology were obtained via duodenoscopy. Results: Seven duodenal ulcers cases were recorded, higher incidences was recorded in Labrador retriever, 2-4 years of aged male dogs. Significantly decreased Hb (9.10 ± 0.25 g/dl), RBCs (4.39 ± 0.19 mill/cu.mm) and albumin (2.343b ± 0.13 g/dl) level were noticed. Hyperaemia with ulceration of duodenal mucosa was observed. Conclusion: Duodenoscopy is very much useful for detection of duodenal ulceration and provided a sensitive technique for early diagnosis of mucosal lesions and ulceration.

Enfermedad por reflujo gastroesofágico

Gastroesophageal reflux is a highly prevalent clinical entity consisting of the passage of gastric or duodenal contents into the esophagus in the absence of vomiting, belching, or any other situation that induces. It is caused by an imbalance between esophageal defensive factors (antireflux barrier, esophageal clearance and tissue defense) and aggressive factors (the refluxed material, increased intragastric pressure and delayed emptying). Heartburn and regurgitation are the main symptoms but also may be other as dysphagia, chronic cough, chest pain, otolaryngology pathology and asthma. Clinical response to treatment with inhibitors of proton pump is a first step in the diagnostic process and may continue with the implementation of upper endoscopy and pH monitoring in selected cases. The key to treatment are the proton pump inhibitors, having shown that descending patterns (high initial doses) are the most cost-effective. Only a small percentage of patients with gastroesophageal reflux disease need surgery and is usually limited to the occurrence of complications such as Barrett's esophagus, strictures and esophageal adenocarcinoma or failure of medical treatment.

Intra-operative change of gastric pH during laparotomic cholecystectomy under general anaesthesia: A prospective case-control study

Background:Gastric decompression by suctioning often shows greenish/greenish-yellow-coloured gastric aspirates following cholecystectomy under general anaesthesia (GA). Possible intraoperative regurgitation of duodenal contents into stomach because of surgical manipulation may be the reason for such alteration in colour of the gastric secretions.Aim:We conducted this study to determine whether there were any pH changes of gastric secretions during laparotomic cholecystectomy operation to confirm our hypothesis of regurgitation of duodenal contents into the stomach.Settings and Designs:Prospective observational controlled study in the Department of Anaesthesiology and Critical Care in a tertiary care university teaching hospital.Methods:Fifty adult ASA I and II patients scheduled for open cholecystectomy operation under GA were included in the study group and another 50 non-abdominal surgical patients without any gall bladder disease were taken as controls. Three to five milliliters of gastric secretions were aspirated just after intubation and also before reversal of residual neuromuscular blockade for analysis of pH.Statistical Analysis:Analysis of variance test and Chi-square test with Fisher's exact correction were used for statistical analysis. Differences were significant when the P value was <0.05.Results:Post-operative values of pH in the study group were significantly higher than their pre-operative values (2.40±1.10 vs. 4.04±1.6, P≤0.001). Forty-nine patients (98%) in the study group had altered coloured post-operative gastric aspirations, while no patient in the control group had such changes (P<0.001).Conclusions:A significant change in gastric pH takes place during laparotomic cholecystectomy due to reflux of duodenal content into the stomach.