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pyloric stenosis [keywords]
- Oral prednisolone and triamcinolone injection for gastric stricture after endoscopic submucosal dissection. [Journal Article]
- Ann Transl Med 2014 Mar; 2(3):22.
The expansion of the indications for endoscopic submucosal dissection (ESD) to include early gastric cancers has enabled extensive resection. However, post-ESD stenosis after large resections applied to the gastric cardia or pylorus is often difficult to manage. The aim of this study was to evaluate the benefit of oral prednisolone and triamcinolone injection for stenosis after gastric ESD.Eight patients who underwent ESD for large neoplastic lesions that extended more than three-fourths of the luminal circumference were enrolled in this study. Four patients underwent ESD for gastric cardia cancer, and four patients were treated for pyloric lesions. To prevent post-ESD stricture, oral prednisolone was started at 30 mg daily on the second day after ESD and then tapered gradually in two cases, while topical injection of 80 mg triamcinolone was performed once immediately after ESD in six cases. Endoscopic balloon dilatation (EBD) was used for stricture-related symptoms or signs including nausea, vomiting, or food residuals observed on endoscopy. EBD was also applied if a 10-mm-diameter endoscope was not able to pass through the lumen. The incidence of stenosis, the frequency and period required for EBD, the duration required for ulcer healing after ESD, and the incidences of post-procedural bleeding and perforation were assessed.One of the eight patients had post-ESD stenosis requiring EBD. The median ulcer healing period after ESD was 87.5 (range, 56-133) days. No patients experienced post-procedural bleeding or perforation. There were no adverse events due to steroid therapy.The results of the present study showed the safety and usefulness of steroid therapy for management of stenosis after large ESD in the gastric cardia or pylorus.
- Hypertrophic pyloric stenosis in infants: is it a congenital or acquired disorder? Reflections on 2 cases. [Journal Article]
- Springerplus 2014.:555.
Based on evidence from two collected and treated clinical observations of hypertrophic pyloric stenosis in children of 5 and 12 months of age, the authors give their point of view on the unresolved issue of the etiology of hypertrophic pyloric stenosis. They emphasize that there are more and more factors to prove this is an acquired condition.
- [Single laparoscopic approach in newborns and infants.] [JOURNAL ARTICLE]
- Khirurgiia (Mosk) 2014; (9):55-60.
The aim of this investigation is evidence of opportunity of single laparoscopic approach using during operations in newborns and infants. The authors have an experience of 274 single-port operations performed from January 2009 to December 2013. Success of single laparoscopic approach has been demonstrated in patients with inguinal hernia, congenital hypertrophic pyloric stenosis, feeding violations, ovarian cyst and multi-cystic kidney dysplasia.
- Duodenal obstruction due to a preduodenal portal vein. [Journal Article]
- Afr J Paediatr Surg 2014 Oct-Dec; 11(4):359-61.
An infant presented with clinical signs and symptoms suggestive of a pyloric stenosis. On abdominal ultrasound, pyloric stenosis was excluded, and other causes for proximal duodenal obstruction, such as a duodenal web or annular pancreas, were suspected. At surgery, the cause was found to be due to an anterior portal vein or preduodenal portal vein, compressing the duodenum. There were no associated findings such as midgut malrotation, duodenal web and congenital anomalies. The treatment was a diamond-shaped duodeno-duodenostomy anterior to the portal vein. The patient improved after surgery.
- The scars of time: the disappearance of peptic ulcer-related pyloric stenosis through the 20th century. [Journal Article]
- J R Coll Physicians Edinb 2014 Sep; 44(3):201-8.
The changing pattern of haemorrhage and perforation from peptic ulcer disease is well documented but little is known about pyloric stenosis, the third complication of the disease.We reviewed records relating to definitive operations (with intent to cure) for peptic ulcer disease carried out in York, UK from 1929-1997. We categorised the patients as pyloric stenosis and no pyloric stenosis based on findings at operation and examined the change in total number of cases with pyloric stenosis and proportion of cases with pyloric stenosis, by year of operation and by decade of birth. To place our results in perspective, we reviewed world literature to examine rates of pyloric stenosis as a percentage of operative cases reported in other case series in the 20th century.4178 patients were included in the analysis; 3697 without pyloric stenosis and 481 with pyloric stenosis (11.5%). Analysis by birth cohort showed that the proportion found to have pyloric stenosis at surgery fell from 17% in the first cohort (birth 1880-89) to only 2.9% in the last cohort (birth 1950-59; p<0.001). Mean age at operation fell more steeply for those with pyloric stenosis: 74 to 30 years vs. 65 to 28 years (p <0.001). The trend of final decline started before the introduction of modern medical treatment. Review of similar case series from across the world shows a similar decline in the proportion of peptic ulcer cases showing pyloric stenosis at operation.The reduction in pyloric stenosis over the last several decades is disproportionately greater than the change seen in peptic ulcer disease requiring surgery. Our findings suggest that this reduction in pyloric stenosis is largely the result of the changing natural history of the disease rather than due to the introduction of acid-suppressing medication.
- Transient hypertrophic pyloric stenosis due to prostoglandin infusion. [Journal Article]
- J Perinatol 2014 Oct; 34(10):800-1.
Prostaglandin E1 (PGE1) is widely used in ductus-dependant congenital heart disease to maintain the patency of ductus. Hypertrophic pyloric stenosis (HPS) due to gastric mucosal proliferation is a rare complication of prolonged PGE infusion. A male newborn who developed HPS during PGE1 infusion is presented to discuss the clinical features and treatment modalities of PGE-related transient HPS. The boy was 2500 g and born at 35 weeks of gestation from a 23-year-old mother. He was admitted to neonatal intensive care with breathing difficulty and cyanosis. His echocardiography revealed pulmonary atresia, ventricular septal defect and major aorta-pulmonary collateral (MAPCA). PGE infusion with a dose of 0.05 mcg kg(-1) was initiated. At the 8th day of infusion, he developed non-billous vomiting. Ultrasonographic evaluation revealed 1.9 cm length of pyloric channel and 0.5 cm of wall thickness on 11th day and diagnosed as HPS. On 42th postnatal day, he underwent MAPCA closure, right modified Blalock-Taussi shunt and repair of pulmonary artery bifurcation with bovine patch. PGE infusion was stopped and enteral nutrition was started on 8th postoperative day. Control ultrasonography on 12th postoperative day revealed normal pyloric channel length (0.9 cm) and wall thickness (0.3 cm). Prolonged use of PGE infusion in neonates with congenital heart disease may cause transient HPS. The clinical and radiological features of HPS relieves after stopping PGE infusion. It should be kept in mind that HPS due to PGE infusion can be transient and pyloromyotomy should be kept for patients with persistent findings.
- Eosinophilic gastritis with gastric outlet obstruction mimicking infantile hypertrophic pyloric stenosis. [Journal Article]
- J Pediatr Gastroenterol Nutr 2014 Jul; 59(1):e9-e11.
- Cornelia de Lange Syndrome. [JOURNAL ARTICLE]
- Clin Genet 2014 Sep 11.
Cornelia de Lange Syndrome (CdLS; MIM #122470, 300590, 610759, 614701, 300882) is a rare and clinically variable disorder that affects multiple organs. It is characterized by intellectual disability (mild to severe), distinctive facial features, pre- and postnatal growth retardation, and hirsutism. Congenital anomalies include malformations of the upper limbs, gastrointestinal malformation/rotation, pyloric stenosis, diaphragmatic hernia, heart defects and genitourinary malformations. Gastroesophageal reflux disease is present in almost all patients. In addition to classic forms, milder phenotypes have been reported. To date five genes (NIPBL, SMC1A, SMC3, RAD21 and HDAC8) have been associated with CdLS and mutations of these genes comprise the underlying defect in 70% of the patients. Here, we will provide a brief review of the clinical features of Cornelia de Lange syndrome, summarize the known underlying genetic defects, pre- and postnatal diagnosis possibilities, and genetic counseling.
- Infantile hypertrophic pyloric stenosis in an extremely preterm male twin; a case report and review. [Journal Article]
- J Indian Assoc Pediatr Surg 2014 Jul; 19(3):184-5.
- Pyloric stenosis of infancy and primary hyperacidity the missing link. [JOURNAL ARTICLE]
- Acta Paediatr 2014 Sep 2.
Miller in an analysis of 50 neonates in 1941 demonstrated that there was a wave of hyperacidity which started a few hours after birth and lasted around 2 days. Thereafter acidity was low until it began to rise again at around 10 days. He speculated that a maternal hormone- a gastric secretagogue- was responsible. Gastrin had not yet been defined (1). This article is protected by copyright. All rights reserved.