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Pyloric Stenosis [keywords]
- Olive without a cause: the story of infantile hypertrophic pyloric stenosis. [JOURNAL ARTICLE]
- Pediatr Radiol 2013 Nov 27.
For many diseases and medical conditions the clinical recognition and the development of accurate diagnostic methods and the etiological cause precede effective treatment. In the case of infantile hypertrophic pyloric stenosis (HPS), this sequence of events did not happen. Clinical recognition of the entity proceeded directly to the development of curative treatment. Reliable diagnostic imaging methods followed, but a definitive etiology has not been elucidated. This paper reviews the historical aspects of hypertrophic pyloric stenosis, discusses how and why it took so long for this not uncommon disease to be recognized, and highlights the physicians who changed an often fatal disease into an easily diagnosed and treated minor affliction.
- Hypertrophic pyloric stenosis in an older child: a rare presentation with successful standard surgical management. [Journal Article]
- BMJ Case Rep 2013.
Infantile hypertrophic pyloric stenosis is a disease of neonatal period usually manifest between the third and fourth weeks of life. Metabolic alkalosis and paradoxical aciduria are two common sequel of this entity. We report an unusual case of an 8-year-old boy who presented with recurrent, long-standing episodes of non-bilious vomiting and poor weight gain without any other metabolic derangement.
- Trocarless laparoscopic pyloromyotomy with conventional instruments: Our experience. [Journal Article]
- J Minim Access Surg 2013 Oct; 9(4):159-62.
The incidence of hypertrophic pyloric stenosis is approximately 1-3 per 1,000 live births. Hypertrophic pyloric stenosis is seen more often in males, with a male-to female ratio of 4:1. Laparoscopic pyloromyotomy is becoming increasingly popular as the standard treatment for hypertrophic pyloric stenosis.We describe our initial experience with laparoscopic pyloromyotomy in 16 infants using conventional laparoscopic instruments. Laparoscopic pyloromyotomy was performed through 5-mm umbilical port with 5mm 30 endoscope. Two 3-mm working instruments were inserted directly into the abdomen via separate lateral incisions.All patients were prospectively evaluated. The procedure was performed in 16 infants with a mean age of 36 days and mean weight of 3.1 kg. All procedures, except two, were completed laparoscopically with standard instruments. Average operating time was 28 mins, and average postoperative length of stay was 2.8 days. There were no major intraoperative and postoperative complications.Laparoscopic pyloromyotomy can be safely performed by using standard conventional laparoscopic trocarless instruments.
- From the Journal archives: Epidural anesthesia in young children: What have we learned in the past 60 years? [JOURNAL ARTICLE]
- Can J Anaesth 2013 Nov 19.
Francis G. Ruston MD CITATION: Ruston FG. Epidural anaesthesia in infants and children. Can Anaesth Soc J 1954: 1: 37-44.The author describes the use of single-shot epidural anesthesia in a series of 44 infants and children. The patients were anesthetized in hospitals in Hamilton, Ontario from 1949 until the time of publication in 1954. The study aimed to describe the indications and efficacy of this technique as well as any apparent complications. A detailed description of the management of these patients was given, including many tips and suggestions that are still applicable in 2013.Seventy-seven infants and children received epidural anesthesia for a variety of procedures, particularly for pyloric stenosis. Forty-four of the procedures were carried out by the author. All patients survived, apart from one child who died of recurrent intestinal obstruction unrelated to the anesthetic. It was found, after some experience, that the sitting position was preferable for epidural needle insertion. Use of the hanging drop technique for identification of the epidural space proved to be simple and reliable. Surgical conditions were found to be excellent and relaxation was profound; however, some sedation was often required to obtain optimal conditions for surgery. The surgeons became sold on the technique and began to request an epidural on a regular basis.Epidural anesthesia in infants and young children is effective for a variety of procedures below the diaphragm, even in moribund patients.
- Genetic contribution to motility disorders of the upper gastrointestinal tract. [Journal Article]
- World J Gastrointest Pathophysiol 2013 Nov 15; 4(4):65-73.
Motility disorders of the upper gastrointestinal tract encompass a wide range of different diseases. Esophageal achalasia and functional dyspepsia are representative disorders of impaired motility of the esophagus and stomach, respectively. In spite of their variable prevalence, what both diseases have in common is poor knowledge of their etiology and pathophysiology. There is some evidence showing that there is a genetic predisposition towards these diseases, especially for achalasia. Many authors have investigated the possible genes involved, stressing the autoimmune or the neurological hypothesis, but there is very little data available. Similarly, studies supporting a post-infective etiology, based on an altered immune response in susceptible individuals, need to be validated. Further association studies can help to explain this complex picture and find new therapeutic targets. The aim of this review is to summarize current knowledge of genetics in motility disorders of the upper gastrointestinal tract, addressing how genetics contributes to the development of achalasia and functional dyspepsia respectively.
- [Pyloromyotomy of congenital pyloric stenosis : Modified Tan-Bianchi procedure.] [JOURNAL ARTICLE]
- Chirurg 2013 Nov 16.
The aim was to find a simple and safe surgical technique for pyloromyotomy in infancy. An indication exists in typical clinical symptoms with wave-like vomiting and sonographically confirmed pyloric stenosis. Existing movements in the acid-base-household should be balanced beforehand otherwise there is an increased risk in anesthesia. The operation represents a combination of gasless laparoscopy and open pyloromyotomy according to Tan-Bianchi. Postoperative food intake should be initiated as soon as possible.
- [A case of locally advanced gastric cancer in which the patient underwent curative gastrectomy after treatment with systemic chemotherapy with bi-weekly s-1/docetaxel]. [English Abstract, Journal Article]
- Gan To Kagaku Ryoho 2013 Nov; 40(11):1533-6.
Here, we report the case of a patient with advanced gastric cancer complicated by pyloric stenosis and direct invasion into the pancreas who underwent curative resection after bi-weekly S-1/docetaxel(DS)therapy after gastrojejunostomy. A 73-year-old man consulted a general practitioner because of indigestibility, and upper gastrointestinal endoscopy indicated gastric cancer. He was referred to our hospital. Gastric cancer, whole stomach tumor(LMU), 150×80 mm, Type 3, T4a(SE), N2, M0, stage III B was diagnosed, and surgery was performed. The tumor was seen to directly invade the pancreas and the middle colic artery intraoperatively, so only a gastrojejunostomy was performed. After the operation, the patient was treated with DS therapy for 13 courses, and the response was defined as non-complete response(CR)and non-progressive disease (PD). During the second laparotomy, a curative operation was performed via distal gastrectomy because frozen-section diagnosis revealed that no cancer cells were present at the oral margin. Postoperatively, the tumor was diagnosed as LM, 10× 7 mm, 10×2.5 mm, pType 4, pT2(MP), pN0, pM0, CY0, stage I B. The patient is now receiving S-1 adjuvant chemotherapy and is still alive 2 years and 4 months after the first operation.
- [A case of unresectable gastric cancer with poor ingestion]. [English Abstract, Journal Article]
- Gan To Kagaku Ryoho 2013 Nov; 40(11):1503-6.
We encountered cases of unresectable gastric cancer in which patients had difficulty with ingestion because of pyloric stenosis and diffuse invasion. We examined the improvement in the quality of life(QOL)of patients and the effect and usefulness of S-1 treatment in such cases. The median survival time(MST; 310 days)of patients who received S-1 as primary treatment was significantly longer than that(105 days)of patients who did not receive S-1 treatment(p=0.0001). Of the 25 patients who underwent gastrojejunostomy, S-1 was administered to 10 patients(MST: 384 days). The MST of patients who received drugs other than S-1 was 121 days. Thus, the MST of patients who did receive S-1 was significantly longer than that of patients who did not receive S-1. In univariate analysis, oral ingestion, performance status(PS), best supportive care(BSC), and S-1 administration were prognostic factors. Of these factors, oral ingestion(p=0.0278, hazard ratio[HR]: 2.992)and S- 1 administration(p=0.0002, HR: 14.956)were prognostic factors in multivariate analysis. Gastrojejunostomy is desirable for the treatment of cases of unresectable gastric cancer with poor ingestion. In addition, the use of postoperative chemotherapy with S-1 alone or with S-1 as combination therapy may help improve prognosis.
- Esophageal atresia associated with hypertrophic pyloric stenosis. [Journal Article]
- Tunis Med 2013 Sep; 91(9):551-2.