Context:Gangliocytic paragangliomas are unusual and often misunderstood tumors that occur almost exclusively in the second portion of the duodenum, although they have been described in other sites such as the urinary bladder, spermatic cord, prostate, urethra, uterus and scalp. We describe our experience with the surgical management of an endoscopically unresectable gangliocytic paraganglioma located in the third part of the duodenum causing a partial upper gastrointestinal obstruction.Case Report:A fifty-two-year-old male presented to the Geisinger clinic with a four-year history of postprandial projectile vomiting associated with epigastric discomfort. Computed tomography scan revealed an oval-shaped filling defect in the third part of the duodenum. Endoscopic ultrasonography showed a 22 × 16 × 35 mm submucosal mass that was not amenable to an endoscopic resection. Exploratory laparotomy revealed an absence of extraduodenal involvement. A long-stalked tumor was successfully excised and extruded through a longitudinal duodenotomy. The pathology report showed a gangliocytic paraganglioma with negative lymph nodes.Conclusions:In patients presenting with prolonged recurrent attacks of vomiting, diagnostic workup to exclude anatomic causes is mandatory. Gangliocytic paraganglioma must be considered in the differential diagnosis of an intraduodenal tumor.

This paper outlines the use of an IBM Series/1 small computer for instrument automation and data reduction for X-ray polycrystalline diffractometry and wavelength dispersive X-ray fluorescence spectrometry. The profile fitting method is used to determine 2θ, d and relative peak and integrated intensities in diffraction, and the fundamental parameters method (LAMA program) is used for quantitative analysis of bulk and thin film samples. The methods are precise and rapid.

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The profile-fitting method was used to analyze data, collected at speeds up to 1 ° (20) per second with a computer-controlled diffractometer, which gave precise values of intensities and angles of reflections above a selected intensity threshold level. Powder diffraction data with 52 reflections in a 40 ° range were collected and analyzed in a few minutes. This technique has also been applied to X-ray fluorescence spectroscopy, and is applicable to single-crystal diffractometry and wavelength-dispersive electron microprobe analysis. 229

The operation of a new polycrystalline phase identification method using the IBM Series/1 minicomputer is described. Data of the unknown can be entered by automatic transfer of previous runs, stored data sets and manually. Full screen menu selections are provided to facilitate operations and correct entries. Typical S/M time for a multi-phase inorganic mixture containing 43 reflections using a 0.3° window averaged 11 sec per 100 standards and with simple chemical prescreening less than 4 sec including program initialization and calculations of comprehensive figures of merit. Interactive options provide graphics terminal comparison of the unknown pattern with selected standards which appear as diffractometer patterns, subtraction of identified standards from the unknown and others. Utility programs permit storing data sets for later analysis, user created files and a program to display any file standard as a diffractometer pattern.