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pyloric stenosis [keywords]
- [Bart´s syndrome associated with epidermolysis bullosa junctionalis and with pyloric atresia. An autopsy case report]. [English Abstract, Journal Article]
- Cesk Patol 2014; 50(4):155-8.
Barts syndrome, in literature also known under the name CLAS (Congenital Localised Absence of Skin), first described by Bart in 1966 as congenital localized absence of skin, epidermolysis bullosa congenita and nail abnormalities. The authors present a macroscopic and histological findings of a newborn with Barts syndrome, with epidermolysis bullosa junctionalis and atresia pylori, who died 17 days after birth and 13 days after surgery for pyloric stenosis.Key words: Bart´s syndrome - atresia pylori - epidermolysis bullosa junctionalis - CLAS.
- Infantile hypertrophic pyloric stenosis (IHPS): A study of its pathophysiology utilizing the newborn hph-1 mouse model of the disease. [JOURNAL ARTICLE]
- Am J Physiol Gastrointest Liver Physiol 2014 Oct 30.:ajpgi.00221.2014.
Infantile hypertrophic pyloric stenosis (IHPS) is a common disease of unknown etiology. The tetrahydrobiopterin (BH4) - deficient hph-1 newborn mouse has a similar phenotype to the human condition. hph-1 and wild-type control animals' pyloric tissue agonist-induced contractile properties, reactive oxygen species (ROS) generation, cGMP, neuronal nitric oxide synthase (nNOS) content, as well as, ROCK-2 expression and activity were evaluated. Primary pyloric smooth muscle cells from wild-type newborn animals were utilized to evaluate the effect of tetrahydrobiopterin (BH4) deficiency. One-week old hph-1 mice exhibited a 4-fold increase (P<0.01) in the pyloric sphincter muscle contraction magnitude, but similar relaxation values, when compared with wild-type animals. The pyloric tissue nNOS expression and cGMP content were decreased, while the rate of nNOS uncoupling increased (p<0.01) in one-week old hph-1 mice, when compared with wild-type animals. These changes were associated with increased pyloric tissue ROS generation and elevated ROCK-2 expression/activity (p<0.05). At 1-3 days of age and during adulthood, the hph-1 mice's gastric emptying rate was not altered and there were no genotype differences in pyloric tissue ROS generation, nNOS expression or ROCK-2 activity. BH4 inhibition in pyloric smooth muscle cells, resulted in increased ROS generation (p<0.01) and ROCK-2 activity (p<0.05). Oxidative stress upregulated ROCK-2 activity in pyloric, but no changes were observed in newborn fundal tissue in vitro. We conclude that ROS-induced upregulation of ROCK-2 expression accounts for the increased pyloric sphincter tone and nNOS downregulation in the newborn hph-1 mice. The role of ROCK-2 activation in the pathogenesis of IHPS warrants further study.
- How should the pyloric submucosal mass coexisting with hypertrophic pyloric stenosis be treated?: a case of pyloric ectopic pancreas with hypertrophic pyloric stenosis. [Journal Article]
- Pediatr Gastroenterol Hepatol Nutr 2014 Sep; 17(3):196-200.
Co-existing pyloric submucosal masses with hypertrophic pyloric stenosis (HPS) are very rare and treating these lesions is always a problem. A 20-day-old boy presented with recurrent episodes of projectile non-bilious vomiting lasting for 5 days. HPS was suspected due to the presenting age and the symptoms. The sonography demonstrated not only circumferential wall thickening of the pylorus, but also a pyloric submucosal mass. At laparotomy, a 0.8 cm sized pyloric submucosal mass was identified along with a hypertrophied pylorus. Pyloric excision was performed due to the possibility of sustaining the symptoms and malignancy. The pathological report of the submucosal mass was ectopic pancreas. Coexisting pyloric lesions can be diagnosed along with HPS, and surgical excision, not just pyloromyotomy, should be considered in these circumstances. To the best of our knowledge, this is the first case report of pyloric ectopic pancreas and HPS to be diagnosed concurrently.
- Laparoscopic pyloromyotomy: Lessons learnt in our first 101 cases. [Journal Article]
- J Indian Assoc Pediatr Surg 2014 Oct; 19(4):213-7.
To analyze our experience with laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis for the lessons that we learnt and to study the effect of learning curve.This is a retrospective analysis of case records of 101 infants who underwent laparoscopic pyloromyotomy over 6 years. The demographic characteristics, conversion rate, operative time, complications, time to first feed and post-operative hospital stay were noted. The above parameters were compared between our early cases (2007-2009) (n = 43) and the later cases (2010-2013) (n = 58).89 male and 12 female babies ranging in age from 12 days to 4 months (mean: 43.4 days) were operated upon during this period. The babies ranged in weight from 1.8 to 4.7 kg (mean: 3.1 kg). Four cases were converted to open (3.9%): three due to mucosal perforations and one due to technical problem. The mean operative time was 45.7 minutes (49.7 minutes in the first 3 years and 43.0 minutes in the next 3 years). There were 10 complications-4 mucosal perforations, 5 inadequate pyloromyotomies and 1 omental prolapse through a port site. All the complications were effectively handled with minimum morbidity. In the first 3 years of our experience the conversion rate was 9.3%, mucosal perforations were 6.9% and re-do rate was 2.3% as compared to 0%, 1.7% and 6.9%, respectively, in the next 3 years. Mean time for starting feeds was 21.4 hours and mean post-operative hospital stay was 2.4 days.Laparoscopic pyloromyotomy is a safe procedure with minimal morbidity and reasonable operative times. Conversion rates and operative times decrease as experience increases. Our rate of inadequate pyloromyotomy was rather high which we hope to decrease with further experience.
- [A Case of Unresectable Stage IV HER2-Positive Advanced Gastric Cancer Treated by Using Trastuzumab Combined with Chemotherapy]. [English Abstract, Journal Article]
- Gan To Kagaku Ryoho 2014 Oct; 41(10):1316-8.
We observed a case of unresectable Stage IV human epidermal growth factor receptor 2(HER2)-positive advanced gastric cancer treated by using trastuzumab combined with chemotherapy. A 55-year-old man was admitted to our hospital because of dysphagia for 4 months. He was diagnosed with advanced gastric cancer with pyloric stenosis, multiple lung metastases, multiple liver metastases, peritoneal dissemination, and rectal muscle invasion. First, we initiated weekly chemotherapy with paclitaxel. Because the biopsy tissue was HER2-positive, we added trastuzumab to the weekly paclitaxel regimen. After 2 courses, dietary intake became possible, and he was then discharged from our hospital. However, after 3 courses of chemotherapy, disease progression was observed. He was admitted to the hospital again. We inserted a duodenal stent and changed the chemotherapy regimen to fluorouracil plus cisplatin(CDDP)plus trastuzumab. He did not experience any major adverse events during treatment. However, after 2 courses of chemotherapy, he died owing to cancerous peritonitis and intestinal obstruction.
- 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.