The logical complication violations motor-evacuation activity of the duodenum is its progressive ectasia and development of structural changes in its wall.This applies particularly to the mucosa of the duodenum.We investigated the status of the mucosa in 39 patients with different variants of duodenal stasis.Study duodenal mucosa performed either by needle biopsy or in the process of operation - excising the colonic wall.
for aspiration biopsy, we used a special probe, constructed Ts Masevich.This probe consists of two parts.The proximal end thereof is a spiral enclosed in vinyl chloride pipe.The helix in the distal portion connected to the other coil, which is made of a very thin wire and enclosed in a vinyl chloride pipe the same as the first spiral.Cable biopsionnogo the distal part of the probe is made of a very thin wire and soldered with a rope in its proximal part.At the distal portion of the probe is fixed biopsionnaya capsule having an outer diameter which is equal to 6 mm.The capsule made a la
teral opening 2.5 mm in diameter for aspiration of the mucosa.Probe length 140 cm. All metal parts are made of acid-proof its alloy steel.The distal part of the probe on its flexibility does not differ from the normal duodenal probe.
Technique of insertion of the probe and sampling of material for the next study.In the morning the patient is enema.Fasting is introduced probe biopsionnym open a hole in the capsule to mark 60 cm from the edge of the teeth.The patient then is placed with a heater on the right side (as in the procedure of duodenal intubation) and slowly (about 30 min turning) to a label probe ingests 80 cm. Location of the probe is controlled radiographically.Under the control of the X-ray tube screen can be set in a desired part of the duodenum.
biopsy of the mucous membrane of the duodenum produced in lying or sitting position of the patient.The probe is connected to a mercury manometer and the probe lumen Janet syringe within 2 seconds at a negative pressure of 300-360 mm Hg.Art.Pulling up the rope cut off the mucosa.The probe is removed, and the knife is in cylindrical piece of mucosa immersed in 10-12% neutral formalin solution.Further excised piece embedded in paraffin and subjected to special processing for histological preparations.
method aspiration biopsy is a safe and technically difficult to carry out.We did not have any complications associated with biopsy of the mucosa of the duodenum.
These histological examination duodenal mucosa indicate that in patients with duodenal stasis, on the part of the mucous membrane develop in varying degrees of severity (than normal) changes.
Normally, the lining of the crypts and villi of the duodenum mucosa is represented mainly prismatic and rare among these goblet cells.Cores oval prismatic cells located in the basal section.Apical departments villi are lined with high prismatic cells with very long narrow core.The secret is they do not.In these cells compared with conventional - prismatic more clearly revealed PAS-positive cytoplasmic process, soldered to the basement membrane, which is painted leykofuksinom.In these cells subnuclear zone drops visible fat, protein, a small amount of acidic and neutral polysaccharides (not glycogen).Yate Such substances are found in the cytoplasm and processes of the connective own mucosal cell layer.The goblet cells of the crypts and villi can be distinguished in the secretory phase of the cycle 2: accumulation and mucus.After separation of the secretions (usually part of it) goblet cells normally become clear already, and in the accumulation phase of the cell increases in transverse dimension.
Depending on the data about the state of the mucosa of the duodenum 39 distributed we studied patients with duodenal stasis, into 3 groups.The first group consisted of 8 patients who have had a moderately severe atrophy of the villi and crypts, as well as a marked increase in the number of goblet cells in the upper regions of the crypts and villi nadkriptovoy zone compared with the norm.Goblet cells are large-sized spherical.The impression that these cells rapidly setserniruyut mucus.In rare villi high prismatic cells lining both the apical and middle sections.Some of these cells lost their connection to the basement membrane and were rejected.Occasionally there are more pronounced infiltration of villi plasma and lymphoid cells, as well as multiple sclerosis submucosa.These changes were focal in nature and have been observed in patients with a long history of dyspeptic disorders, but in mild degree.
In the second group of patients (9 men) were more pronounced inflammation of the mucous membrane by the presence among the infiltration of leukocytes and segmented cells.mucosa structure in some places changed (bizarre contours of the villi, their fusion with each other, and so on. d.).
It is most often concerned duodenostasis patients who have dominated the painful effects and symptoms reminiscent of gastric ulcer or duodenal ulcer.
patients of the third group (22 patients) compared with the previous patient marks a significant atrophy of the villi and from the crypt.The latter were a narrow lumen;epithelium shortened, often sealed therein.The villi often had a corrugated appearance.Highly prismatic cells lining the villi, almost all over were at different levels in relation to each other.
some cells losing their connection to the basement membrane and were rejected.In some parts of the prismatic cells supranuclear zone contain PAS-positive grains, which extended to the brush border.
Similar changes have occurred in patients with reduced power expressed dyspeptic disorders, chronic duodenostasis as an independent disease, and in combination with duodenostasis gastric ulcer or duodenal ulcer or gastric cancer lesions.When
histochemical study duodenal mucosa in patients with a prismatic duodenostasis villus cells were detected in the supranuclear area of the smallest drop of secretion that is normally not formed.Secret contained a small amount of neutral polysaccharides.Subnuclear zone comprises the same substance (fat droplets, proteins, polysaccharides), and in that the highly villous prismatic cells apical sections.
more accelerated differentiation of normal cells in the narrow prismatic cells, increased amounts of the latter in the villi causes apparently higher voltage regenerator zone near the bottom of the crypts.This circumstance, apparently, explains the intensity of the reactions on the nucleic acids in the crypt epithelium and nadkriptovoy zone.
detects intensity difference reactions for nucleic acids (DNA nucleus, cytoplasmic RNA) and protein in the cytoplasm of epithelial cells of various portions nadkriptovoy zone villi same crypt.
should be noted that the mucus of goblet cells of the mucosa of patients with duodenal stasis and control biopsies was sharply PAS-positive, intensively stained with colloidal iron, weak alcian blue and toluidine blue (metachromasia).According to Maury and Winkler is a PAS-positive, but much weaker with alcian blue at Ritter and Oleson almost with the same intensity was painted as a leykofuksinom and colloidal iron, and mucus cells are stained with iron were evenly distributed among the surrounding PAS-positive mucus.Incubation of slices with sialidase resulted in a weakening of Alcian blue staining mucus compared with control slices;testicular hyaluronidase did not allow differences in the color of both Alcian blue, and with toluidine blue.
However, in patients with duodenal stasis as an independent disease as well as concomitant diseases mucous secretion cells characterized by large deviations in the intensity of the histochemical reaction polysaccharides compared to the control reactions mucosa biopsies.
secret of goblet cells containing polysaccharides;neutral (no glycogen), acid - sulfated (a small amount), non-sulfated (sialic acid), a small amount of protein, does not contain chondroitin sulfate A, C
When comparing changes in the mucous layer of the duodenum wall with clinical symptoms and severity from duodenostasispatients with chronic violation of the motor-evacuation activity of the duodenum can set a certain relationship.In the presence of pain and dyspeptic disorders in the foreground inflammatory changes in the mucous membrane of the duodenum.At the same time, the study of the mucosa in remission of duodenal stasis often detected in varying degrees of severity atrophic changes.
any correlation between the duration of violation motor-evacuation activity of the duodenum and depth of lesion mucosa we have not identified.Even with long-term history of duodenal stasis, but weak clinical manifestations of the disease were detected slight atrophic and sclerotic changes in the mucous membrane of the duodenum.At the same time, with marked clinical manifestations of dysmotility of the duodenum sometimes with a short history, there were considerable changes in the mucosa of the duodenum.
comparison of developing changes in the duodenal mucosa in connection with duodenal stasis and without it, we have studied a condition duodenal mucosa in 42 patients with various digestive diseases (duodenal ulcer, stomach cancer, cholecystitis, pancreatitis, gastritis),who had no signs of dysmotility of the duodenum.The data indicate that only mild symptoms of inflammatory and degenerative changes of the endometrium was observed when the normal functional activity of the duodenum.At the same time, duodenal stasis degenerative changes were more pronounced and profound.
When comparing changes in the duodenum to the changes of its intramural nervous apparatus mucosa in patients with a form of self-flow of duodenal stasis and when dysmotility of the duodenum is a companion condition of other diseases, we can note a certain parallelism.
Morphological changes in the duodenal mucosa were greater pronounced in those patients who were observed deeper reactive and degenerative changes in the intramural nervous apparatus duodenum.
should be noted that in violation of patency of the duodenum is suffering not only the intestinal mucosa, but the rest of its layers.In particular, the submucosal layer is observed sclerosis, and muscular changes can be of two kinds.In some cases, revealed hypertrophy of the muscle layer, and in others - atrophy.Hypertrophy of the muscles is observed in acquired forms of duodenal stasis, while their atrophy - congenital forms of the disease.
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