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Query: UMLS:C0031154 (peritonitis)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The adaptive response of the gastrointestinal tract to gastric stapling was studied in a Zucker (fafa) genetically obese rat model. The effects of gastric stapling in rats with a Roux-en-Y gastrojejunostomy were compared to Roux-en-Y and intact controls. Rats (225 to 275 g) were divided into three groups: group I (GI), Roux-en-Y, stapled, ad libitum fed; group II, Roux-en-Y, unstapled; and group III, intact (laparotomy only). Groups II and III were further subdivided into group IIA (GIIA) and group IIIA (GIIIA), pair-fed to GI; and group IIB (GIIB) and Group IIIB (GIIIB), fed ad libitum. All rats were fed a diet of liquid rat formula and rat food (50:50 cal ratio). After 2 wk rats were killed and the liver, pancreas, and stomach removed, weighed, and tissue taken for histology. The intestine was divided into three segments corresponding to the excluded segment (1, duodenum), transposed segment (2, jejunum), and ileal segment (3), with tissue taken for histology. Liver lipid, pancreatic amylase, serum amylase and gastrin, and intestinal mucosal protein and DNA were measured. Weight gain, g/14 days, was: GI, 24.1 +/- 7.8; GIIA, 17.0 +/- 2.0; GIIB, 42.6 +/- 4.8; GIIIA, 17.6 +/- 4.7; GIIIB, 54.6 +/- 8.9. All rats were in positive N balance. Liver weight and lipid were similar in all groups. Pancreatic mass was significantly increased in all Roux-en-Y animals, while amylase activity per g tissue was significantly less than in intact animals. Stapled rats had atrophy of the glandular portion of the stomach, decreased stomach mucosal weight, and lower serum gastrin concentration compared with all other rats (p less than 0.01). In stapled rats, segment weight and mucosal weight were lower in the excluded segment, and higher in the transposed segment, compared to all other rats. Tissue pathology was found only in stapled rats: gastric atrophy, focal fibrosis of gastric wall, peritonitis, minimal to mild multifocal hepatitis, and mild periductal fibrosis of the pancreas. There are significant early adaptive and pathological changes after gastric stapling in the rat.
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PMID:Gastric stapling for morbid obesity: gastrointestinal response in a rat model. 620 81

Cushing's ulcers of the duodenum are well known complications of neurosurgery, head trauma, and other causes of increased intracranial pressure. Perforation of Cushing's ulcer of the duodenum is infrequently described. That the use of high-dose corticosteroids for cerebrovascular infarct in an aphasic patient may obscure the symptomatology and physical findings of a perforated Cushing's ulcer has not been described to our knowledge. We report a patient with a large left hemispherical infarct and resultant aphasia who developed a perforated duodenal ulcer and extensive chemical peritonitis while receiving high dose corticosteroids for increased intracranial pressure. She was unable to register any complaints and the typical physical findings of perforated duodenal ulcer with chemical peritonitis were virtually absent. A high index of suspicion must be maintained for a perforated Cushing's duodenal ulcer in the patient receiving high dose dexamethasone despite the presence of nonspecific symptomatology and abdominal findings. Elevated serum gastrin levels, as in this patient, may also indicate the patients with increased intracranial pressure who are at greater risk for developing Cushing's ulcer.
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PMID:Occult duodenal perforation complicating cerebral infarction: new problems in diagnosis of Cushing's ulcer. 711 24

Two personal cases of Zollinger-Ellison syndrome (ZES) are described. Total gastrectomy (TG) was performed in the first case as an emergency measure, following acute peritonitis caused by a recurrence of ulcer, with perforation 27 days after the first gastric resection. The patients is in good health, though with persistently high blood gastrin levels. The second case was marked by a long history of recurrent ulcer, with two earlier gastric resections. Here, success was obtained by simply enucleating a small gastrinoma from the head of the pancreas in view of the arteriographic evidence. The patient is in excellent health 2 1/2 yr after surgery with stable, normal blood gastrin. The recent literature and these cases suggest that surgery is the method of choice for ZES, its primary aim being the removal of gastrinomas, since these prove malignant in 60-100% of cases, and TG does not in any way inhibit their growth, as was once supposed. Blood gastrin values permit early diagnosis and postoperative monitoring, while arteriography and transhepatic portal catheterisation constitute a useful guide to the location of the tumour. Hyperchlorhydria can be effectively controlled with H2 receptor inhibitors, both in the preoperative diagnostic stage, and after surgery in the event of failure. TG offers the best results in over 60% of cases, when the tumours is multifocal, widely metastasised, or undiscoverable.
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PMID:[Surgery of Zollinger-Ellison syndrome]. 730 Nov 47

Given an indication for surgery in patients with chronic pancreatitis, such as distal common bile duct obstruction, duodenal stenosis, or dilated pancreatic duct with stones and congestion, the surgeon must decide the type of operation to perform. A duodenopancreatectomy, the Whipple procedure, is widely considered to be the gold standard. It is highly effective in relieving pain and eliminating the structural abnormalities noted above. Duodenum-preserving resection of the head of the pancreas (DPRHP) seems to be an attractive alternative to pancreaticoduodenectomy (PD) in the treatment of chronic pancreatitis. In a clinical prospective randomized trial the efficiency of both operative methods was investigated. Between 7/1987 and 12/1993 43 patients were randomly assigned to undergo either a Whipple procedure (n = 21) or DPRHP (n = 22). Data on postoperative course, mortality, and postoperative morbidity were compiled. As concerns long-term results, postoperative hormonal status (insulin, neurotensin, cholecystokinin, gastrin) was checked, basal and stimulated with a standardized meal, using standard hormonal assay kits. All patients with PD survived, whereas one with DPRHP died from peritonitis. Patients with DPRHP had a significant more rapid convalescence (16.5 vs. 21.7 days). The range for postoperative follow-up is from 36 months to 5.5 years. In the DPRHP group 18 patients are in good condition. Two had diabetes and one developed carcinoma. In the PD group one died from hepatic coma, 14 are in good condition and 6 developed diabetes. All gained body weight with an average of 6.4 vs. 4.9 kg, DPRHP vs. PD. A difference between DPRHP and PD was obvious for the postoperative hormonal status. Results are satisfactory in both groups. For patients with DPRHP however, we see a quicker convalescence and a significant benefit as concerns postoperative hormonal status.
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PMID:[Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple's operation]. 763 46

A psammomatous endocrine tumor of the duodenum associated with a perforated duodenal ulcer, acute diffuse peritonitis and multiple organ failure is described. Histologic evaluation of the tumor shows a mixed pattern, with solid and glandular structures. Immunohistochemical stains further show cytoplasmic storage of gastrin and somatostatin. Apical CEA staining is also demonstrated in glandular areas of the tumor.
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PMID:[Duodenal endocrine tumor associated with ulcerous perforation]. 818 13

Achievements in the experimental inducement of canine gastric cancer in Japan are reviewed. Canine gastric cancer was initially induced experimentally by the administration of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) in drinking water. However, intestinal sarcoma caused death before the gastric cancer was detected. By giving an N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG)-soaked diet to dogs, we specifically induced gastric cancer and followed the process of carcinogenesis by X-ray, endoscopy, and biopsy. The initial macroscopic findings were areas of discoloration, with erosion or mucosal unevenness which became visible from approximately the 9th to 10th experimental months in mongrel dogs and around the 13th to 17th months in beagle dogs. The protruded type of cancer occurred in mongrel dogs early in the experimental period, while the less protruded but more ulcerated gastric cancer occurred in beagle dogs later. Histological examination of the autopsied stomachs 277, 395, 546 and 813 day in mongreal dogs and 804, 946, and 1591 day in beagle dogs revealed well differentiated, poorly differentiated, and undifferentiated adenocarcinoma. In animals with a lengthy survival (more than 600 days from the start of the experiment), metastases to lymph nodes, and, rarely, to liver, lung, bones, and other organs, were observed, as well as peritonitis carcinomatosa. Heterotransplantation of gastric cancer to nude mice succeeded to the fifth passage. Development of scirrhous cancer was induced in dogs by the combined use of ENNG and subcutaneous injection of gastrin, indicating that the experimentally induced canine gastric cancer resembled human gastric cancer. Although the induction of canine gastric cancer takes 2-3 years and the macroscopic type and time period differs among individual dogs, our results in the experimental induction of canine gastric cancer should be useful in various areas of research that require an animal model, such as genetic alteration during carcinogenesis, modulation of carcinogenesis, and prevention of gastric cancer.
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PMID:Inducement of canine gastric cancer by N-ethyl-N'-nitro-N-nitrosoguanidine (ENNG). 1195 52

We present a rare case of renal gastrinoma. To the best of our knowledge, only one case of renal gastrinoma has been reported in the literature so far. An African American male was diagnosed with Zollinger Ellison syndrome at the age of 15 years, when he underwent surgery for peritonitis secondary to duodenal ulcer perforation. Further evaluation was deferred and proton pump inhibitors were prescribed. Later evaluation showed a left renal mass. Serum gastrin levels were 4,307 pg/ml. A CAT scan of the abdomen showed 4- x 4-cm heterogeneous solid mass in the interpolar region of the left kidney with central hypodensity. Somatostatin scintigraphy confirmed a receptor-positive mass in the same location. Nephrectomy was done and the tumor was diagnosed on histopathological examination as a gastrinoma. At 6-month follow-up, gastrin levels were 72 pg/ml. After a follow-up of 6 years, the patient has no recurrent symptoms.
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PMID:A rare case of renal gastrinoma. 1957 6

Gastrinoma, an infrequent diagnosis in middle-aged dogs, occurs with nonspecific gastrointestinal morbidity. Laboratory tests can yield a presumptive diagnosis, but definitive diagnosis depends on histopathology and immunohistochemistry. We describe a malignant pancreatic gastrinoma with lymph node metastases and corresponding Zollinger-Ellison syndrome in a Mexican gray wolf ( Canis lupus baileyi) and review this endocrine neoplasm in domestic dogs. A 12-y-old, captive, male Mexican gray wolf developed inappetence and weight loss. Abdominal ultrasonography revealed a thickened duodenum and peritoneal effusion. Two duodenal perforations were noted on exploratory celiotomy and were repaired. Persisting clinical signs led to a second celiotomy that revealed a mesenteric mass, which was diagnosed histologically as a neuroendocrine carcinoma. During the following 16 mo, the wolf received a combination of H2-receptor antagonists, proton-pump inhibitors, gastroprotectants, and anti-emetics, but had recurrent episodes of anorexia, nausea, acid reflux, and remained underweight. Worsening clinical signs and weakness prompted euthanasia. The antemortem serum gastrin concentration of 414 ng/L (reference interval: 10-40 ng/L) corroborated hypergastrinemia. Autopsy revealed a mass expanding the right pancreatic limb; 3 parapancreatic mesenteric masses; duodenal ulcers; focal duodenal perforation with septic fibrinosuppurative peritonitis; chronic-active ulcerative esophagitis; and poor body condition. The pancreatic mass was diagnosed histologically as a neuroendocrine carcinoma and the parapancreatic masses as lymph node metastases. Immunohistochemistry of the pancreatic mass was positive for gastrin and negative for glucagon, insulin, pancreatic polypeptide, serotonin, somatostatin, and vasoactive intestinal peptide.
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PMID:Gastrinoma and Zollinger-Ellison syndrome in canids: a literature review and a case in a Mexican gray wolf. 2986 Sep 31

Pancreatic neuroendocrine tumors (PNETs) are rare and characterized by widely variable clinical presentation and often challenging surgical management. Methods: Retrospective study conducted during the last 15 years at the First Surgical Clinic of the Iasi St Spiridon University Hospital, and which included all the patients diagnosed with pancreatic endocrine tumors by immunohistochemistry. Results: There were 26 cases diagnosed with PNET. The male/female ratios was 7/19 and mean age 41.93 +- 2.48 years (range 20-79 years). Of the PNET cases 13 were insulinomas, 5 gastrinomas, 2 gastrinomas associated with other endocrine neoplasms (Wermer syndrome), 5 non-functional endocrine pancreatic tumors and 1 ACTHoma. Clinical manifestations depended on tumor type: hypoglycemia and Whipple triad for insulinoma, Zollinger Ellison syndrome and complicated peptic ulcer (hemorrhage, perforation) for gastrinoma, Cushing syndrome for ACTHoma. Biological diagnosis included biological markers (e.g. insulin, gastrin and cortisol). Tumor site and size at diagnosis were determined by ultrasound, CT-scan, angiography, PETscan, octreoscan and intraoperative ultrasound. Surgical procedures for PNET insulinomas were: tumor resection - 6 cases; left splenopancreatectomy - 3 cases; left spleen-preserving pancreatectomy - 2 cases; pancreaticoduodenectomy - 2 cases. We also present 4 cases of gastrinoma with multiple ulcers and multiple surgical interventions for hemorrhage and perforation with peritonitis. The two patients with Wermer syndrome also had ulcers complicated with hemorrhage and peritonitis and parathyroid adenoma. Nonfunctional pancreatic endocrine tumors were diagnosed in 5 women of which in 3 the tumors were located in the pancreatic tail (in which splenopancreatectomy and left pancreatectomy with spleen preservation were performed) and in 2 in the pancreatic head (in which pancreaticoduodenectomy and Beger type operation were performed). Conclusions: Knowledge of clinical signs of secreting tumors and exploring the patients are of crucial importance for management of PNETs. Immunohistochemistry is mandatory for confirming the diagnosis and assessing the proliferation and biological behavior of the tumor, thus facilitating the administration of specific therapy. Aggressive surgical treatment is indicated, even in advanced stages.
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PMID:The Pancreatic Endocrine Tumors - Experience of First Surgical Clinic Iasi. 3167 Jun 40