Duodenal Mucous Membrane Research Articles

CYSTS OF THE DUODENUM

CYSTS of the duodenum are rarely reported in the literature. Twelve cases of enterogenous cysts of the duodenum have been described since the initial case of Sanger and Klopp,1in 1880. A cyst of the ampulla of Vater, described by Brooks and Weinstein,2appears to be one of the mucosa covering the ampulla of Vater, and yet it was both lined and covered with normal duodenal mucous membrane so that, as the authors described, this cyst was a congenital anomaly of the duodenal wall. Microscopic study of this cyst was not reported. These authors were unable to find a similar condition in the literature except the anomalous duodenal pouch presented by Grant,3a pouch of mucosa which hung within the lumen of the gut like a hollow polypus whose mouth was directed towards the pylorus. This pouch showed a reduplication of the entire mucous membrane of the

1. Peptic ulcer disappearance after feedings of normal human gastric juice

1. The gastric juice of normal volunteer subjects was fed to a series of patients with uncomplicated peptic ulcer. The normal gastric juice was neutralized, filtered and preserved with tricresol. 2. The relief of peptic ulcer symptoms and prompt roentgen disappearance of peptic ulcer is herein recorded following the feeding of gastric juice from normal human subjects. 3. Evidence is presented which tends to indicate that a “protective principle” is elaborated within the gastric and duodenal mucous membranes and secreted into the gastric juice. This protective principle may be lacking or be impaired in patients with peptic ulcer. 4. It appears that the protective principle in normal gastric juice can be fed to uncomplicated peptic ulcer patients causing the ulcers and symptoms in these patients to disappear.

Early Carcinoma of the Ampulla of Vater

Primary carcinoma of the ampulla of Vater is an extremely rare condition. According to Lieber,1 only one proved case of this condition has been reported, for while many cases are described in the literature, careful scrutiny of the reports reveals that a possible origin from other nearby and closely related structures has not been excluded. There are four possible sources of origin of a tumor in this region: (1) the duodenal mucous membrane covering the papilla of Vater, (2) the terminal common bile-duct, (3) the proximal main pancreatic duct, and (4) the ampulla of Vater. The lesion is seldom considered in arriving at a clinical diagnosis, and by the time the patient comes to autopsy the tumor has attained such a size as to involve two or more of the structures alluded to above. A decision as to its exact source is then obviously impossible. The case here reported is of particular interest since the patient was seen early, and the primary lesion observed at autopsy was small and self-limited so that a definite opinion could be formed as to its origin. A. P., a white man aged fifty-six years, was admitted to the Nanticoke State Hospital on Jan. 10, 1938, complaining of jaundice, epigastric pain, gaseous eructations, light stools, and dark brown urine. He had been in apparently good health until a week before admission to the hospital, when jaundice appeared insidiously and increased progressively. Two days later he experienced gradually increasing pain in the epigastric region, associated with gaseous eructations but without nausea or vomiting. His appetite was good, but, in spite of this, there had been a loss of weight of ten pounds in the last six weeks. Chills and fever were absent, and constipation was not a feature.

"TRAUMATIC ULCER OF THE DUODENUM AND STOMACH"

To Editor: —InThe Journal, May 27, Drs. Crohn and Gerendasy report a case and discuss subject of traumatic of duodenum and stomach. The conclusion that the evidence seems convincing that trauma caused ulcer might be misleading. The reference to students of gastro-enterology refusing to accept concept of traumatic gastric ulcer calls for elucidation as to just what this concept is. The four postulates of Liniger and Molineus satisfactorily exclude cases of pseudo-ulcer but fail to explain why gastro-duodenal trauma should be followed by development of in certain cases and not in others. The evidence in reported case is certainly convincing, that trauma caused injury to duodenal mucous membrane. Of this sequence there can be no reasonable doubt. Because intestinal mucosa, like skin, has an inherent tendency toward repair, something more than injury is

Societies and Academies

LONDON Royal Society, Nov. 3.—J. Mellanby: Secretin. Secretin may be prepared from the duodenal mucous membrane by (a) extraction with absolute alcohol, (6) precipitation by dilute acid, and (c) resolution of the precipitate in acid alcohol and precipitation by acetone. The product has the percentage composition of a sulphur-containing protein. It is soluble in water but insoluble in dilute acid. The physiological actions of secretin are: (a) the production of a copious secretion of pancreatic juice, (6) the contraction of intestinal muscle, and (c) the secretion of a small quantity of bile.—Margaret Hill and A. S. Parkes: Studies on the hypophysectomised ferret (1, 2, 3). Hypophysectomy of the male during the breeding season (June) caused regression to the anoestrous condition in about a month; the regression being characterised by decrease in testis weight and by aspermatogenesis. The experimentally produced degeneration is about three times as rapid as the normal decline into anoestrus. In the female ferret, removal of the pituitary body about two hours after the beginning of copulation did not inhibit ovulatibn, which occurs in the normal animal about 36 hours after mating. It would thus appear that some ovulation-producing substance is secreted by the anterior pituitary body within two hours of the beginning of copulation. The corpus luteum, however, failed to develop, and there were no signs of pregnancy or pseudo-pregnancy.—J. D. Gillett and V. B. Wiggles-worth: The climbing organ of an insect, Rhodnius prolixus (Hemiptera; Reduviidae). It is present in both sexes of the adult, but is absent in the nymphs. It occurs on the distal end of the tibia of the anterior and middle pairs of legs. It enables the insect to climb upwards on clean glass at almost a right angle, but it is of little use in the reverse direction. The organ is a little oval sac of pliant chitin filled with blood. On its lower surface it bears about 5000 tubular hairs, 1 μ. in diameter, which appear to be the outlets of unicellular glands producing an oily secretion. At their free ends the anterior surface of these hairs is cut away obliquely so that only their hind margin comes in contact with the surface the insect climbs. Among these hairs are about 50 delicate tapering hairs arising from large sockets and projecting slightly beyond the others. These appear to be sense organs. They are surmounted by a spindle-shaped mass of cells giving off a nerve fibre.

THE QUESTION OF A GASTRIC HORMONE

1. Edkins’ observations regarding pyloric extracts and their effect in causing gastric secretion is confirmed. Extracts made from the cardiac and duodenal mucous membranes are less active; fundus extracts are comparatively inert, while jejunal and ileal extracts are ineffective.2. Histamine causes gastric secretion when injected intravenously; contrary to the observations of Popielski and others, who only obtained secretion when it was injected subcutaneously or intramuscularly.3. Adrenalin does not inhibit the secretion provoked by the above substances but may delay its outflow from the stomach. Adrenalin excites secretion in some individuals.4. The distribution of the gastric excitant or gastrin in the stomach and duodenum corresponds with the distribution of mucoid glands ; it is suggested that the excitant is extracted from mucoid cells.5. The blood of fed animals has no effect on gastric secretion when transfused directly or indirectly. The blood was taken at various intervals after a meal, and when citrated was injected either intravenously or intra‐arterially into the recipient.Since there is no gastric exciting substance in the blood after meals, it is concluded that the excitant found in pyloric and other extracts is not secreted into the blood stream and the mechanism of secretagogue action is not due to internal secretion.

On the treatment of Diabetus mellitus by acid extract of Duodenal Mucous Membrane

The carrying out in the Bio-Chemical Laboratory of the experiments otn the secretion of organic acids in diabetes described in the previous paper supplied an opportuniity for testing the hypothesis that the internal secretion of the pancreas might be stimulated and initiated (similarly to the externial secretion) by a substance of the nature of a hormone or secretin yielded by the duodenal mucous membrane ; and that in certain cases of diabetes the appearance of sugar in the urine might be due to funictional disturbance occasioned by the absence of such an intestinial excitanit of the initernal secretion. The fact that an internal secretion of the pancreas is niecessary for the regulation of carbohydrate metabolism, and that in the absence of this secretion oxidation of dextrose canniot be carried out, with the result that death occurs from acute diabetes, has been clearly proven by the experimenits of Minkowski and v. Mering,; and others on complete and partial panicreas removal, and the history of the subject is too well-known to require detailed description here. It was suggested by Schafer that the formation of the internal pancreatic secretion might possibly bc due to peculiar nests of cells of different form and staining properties to the other secreting cells of the gland. These cells from their isolated appearanice, and after the name of the observer who first described them, are called the 'islets of Langerhans.'

Further Observations on the Treatment of Diabetes Mellitus by Acid Extract of Duodenal Mucous Membrane

Further Observations on the Treatment of Diabetes Mellitus by Acid Extract of Duodenal Mucous Membrane