The significance of hematemesis in congenital hypertrophic pyloric stenosis.
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Ultrasonographic follow-up of infantile hypertrophic pyloric stenosis after pyloromyotomy: a controlled prospective study.
Although the ultrasonographic assessment of hypertrophic pyloric stenosis (IHPS) has become the main radiological method for this disease, our knowledge about postoperative ultrasonographic follow-up is very limited. To evaluate the ultrasonographic outcome of the pylorus, we performed ultrasonographic measurements of the pylorus in 22 children with IHPS, before and after the operation in a prospective trial. The sonograms following surgery were undertaken at the end of the 1st postoperative week and of the 1st, 3rd and 6th month postoperatively. Three main ultrasonographic parameters were used: pyloric muscle thickness (MT), pyloric diameter (PD) and pyloric length (PL). The values of the pylorus, especially the "MT" measurements, began to decrease almost by the end of the first postoperative week, and were normal by the 3rd month in the majority of cases. However, the averages of the PL and PD values never returned to normal throughout the 6 months follow-up. There was a highly significant difference between the average values of pyloric muscle thickness at admission and at the 6th month after surgery (p < 0.001). Within one month after surgery, the ultrasonographic parameters returned to the levels of those in control infants. However, except for MT, they did not return to their normal ranges. Therefore, MT is the most useful parameter for ultrasonographic postoperative evaluation if the normal ultrasonographic values, as given in the literature, are used.
Female↗
[Hypertrophic pyloric stenosis of the infant. Apropos of 8 cases].
Eight cases of Infantile Hypertrophic Pyloric Stenosis collected in 10 years (1980-1989) in the Pediatric Surgery Unit of the Surgical Clinic of Dakar are reported. The rarity of this pathology among Blacks and a male predominance are noted. The clinical onset occurred after an average period of 3,25 weeks marked by food vomiting. At the start of the surgical management the age of patients was 6 weeks. X-ray examination following a barium meal showed no passage of contrast in 3 cases. However a narrowed and elongated pyloric canal was noted in 5 cases. Abdominal sonography was used in 3 cases and showed gastric stasis with a hypertrophy of pyloric muscle. A rammstedt pyloromyotomy was performed after a period of few hours to 13 days of resuscitation. A duodenal perforation complicated the operation twice and was subsequently repaired. In the post operative period, two patients died within 2-3 days. One of them had duodenal perforation. Six patients made a good recovery.
Female↗
The epidemiology of infantile hypertrophic pyloric stenosis in Greater Glasgow area, 1980-96.
The annual incidence of infantile hypertrophic pyloric stenosis (IHPS) in Greater Glasgow area from 1980 to 1996 was calculated. An increasing incidence was observed between 1980 and 1988 but not thereafter. There is a suggestion that environmental factors may play a role in the aetiology of this condition.
Chi-Square Distribution↗
Infantile hypertrophic pyloric stenosis in Greater Manchester.
An "unprecedented" rise in the incidence of infantile hypertrophic pyloric stenosis (IHPS) was reported from the Central Region of Scotland in 1979. Examination of statistics from Greater Manchester showed a similar trend in some district health authorities but not others. Possible explanations are examined but future research is required. Hospital Activity Analysis can provide a useful tool for such research.
England↗
A novel point mutation of the androgen receptor (F804L) in an Egyptian newborn with complete androgen insensitivity associated with congenital glaucoma and hypertrophic pyloric stenosis.
Androgen-insensitivity syndrome (AIS) is a major cause of male pseudohermaphroditism (MPH). Although AIS is usually reported as a monogenic disease resulting from androgen receptor (AR) mutations, on rare occasions it has been observed as part of a multiple congenital anomaly syndrome. We report here a patient who was the first newborn girl of an unrelated couple. Shortly after birth, the diagnoses of congenital glaucoma and pyloric stenosis were made. A detailed history of the father's family revealed that nine members presented glaucoma before 40 years of age. Clinical and ultrasound evaluation showed two inguinal testes, with female external genitalia and no Mullerian derivatives. The patient had a 46,XY karyotype, good testicular response to gonadotrophin stimulation and a remarkably high T : dihydrotestosterone ratio. Sequencing of the five exons of the 5alpha-reductase type 2 gene (SRD5A2) was normal. Conversely, a de novo point mutation was found in exon 6 of the AR gene, resulting in an F804L substitution, which has never been described previously. To our knowledge, the association of complete AIS, congenital glaucoma and pyloric stenosis has also never been reported previously.
Androgen-Insensitivity Syndrome↗
Haematemesis in infantile hypertrophic pyloric stenosis: the source of the bleeding.
Thirteen infants with haematemesis associated with hypertrophic pyloric stenosis were investigated in order to elucidate the source of bleeding. All 13 patients showed endoscopic evidence of oesophagitis, moderate in 4 and severe in 9. No significant gastric mucosal lesion was found. It was concluded that the site of the haemorrhage was the oesophageal mucosa in all 13 infants. Eleven of the patients experienced troublesome postoperative vomiting.
Esophagitis↗
Hypertrophic pyloric stenosis in twins: same genes or same environments?
The aetiology of infantile hypertrophic pyloric stenosis (IHPS) remains obscure. Cases in twins, usually monozygotic, have been sporadically reported as evidence for the genetic origin of the disease. We present a case of IHPS in a pair of dizygotic male twins together with a review of the literature, focusing on the question of whether the twin cases actually support a genetic or an acquired nature of IHPS.
Genetic Predisposition to Disease↗
Pyloromyotomy versus atropine sulfate for infantile hypertrophic pyloric stenosis.
PURPOSE: Atropine sulfate (atropine) and pyloromyotomy were compared for managing infantile hypertrophic pyloric stenosis (IHPS). METHODS: From 1996 to 1998, cases of IHPS treated surgically (pyloromyotomy; n = 20) or medically (atropine; n = 14) at separate institutions were compared retrospectively with regard to status on presentation, physical symptoms and signs, progress, and costs. Atropine was given orally, then intravenously if ineffective. Refractory cases were referred for pyloromyotomy. RESULTS: All subjects were matched for clinical and physiological status on admission. Oral atropine alone was effective in 11 cases, was converted to intravenous atropine in 2 cases, and was terminated in 1 case because of hematemesis. Two cases were referred for pyloromyotomy. All pyloromyotomies were successful. Atropine took on average, 2.6 days to take effect. The difference in time taken for normalization of pyloric muscle thickness between the 2 groups was not significant. Average time to return to full feeding was longer in the atropine group (P<.01). Costs were lower in the atropine group (P<.01). There were 2 wound infections in the pyloromyotomy group, but no adverse effects of atropine. There were no recurrences in either group. CONCLUSION: This study provides reasonable evidence to support a trial of atropine in IHPS.
Adult↗
Infantile hypertrophic pyloric stenosis: a review of 222 cases.
The results of 222 cases of hypertrophic pyloric stenosis operated on at the Princess Margaret Hospital for Children in Perth, from 1979 to 1984, have been reviewed. There were no deaths, but there was a 7% incidence of wound infection and a 72% incidence of postoperative vomiting. Staphylococcus Aureus was cultured from 62% of the infected wounds. Prophylaxis against Staphylococcus Aureus infection and delayed introduction of feeding are suggested.
Bicarbonates↗
Infantile hypertrophic pyloric stenosis--unusual familial incidence.
A man, who had been treated for infantile hypertrophic pyloric stenosis (PS), was found to have 3 sons with the same condition. A genealogical table of his family showed that both his parents had relatives with PS. So far as it was known, none of his wife's relatives had the condition. It is suggested that the man's parents carried genes predisposing to PS and transmitted these to him in such quantity that he and all his children acquired the condition.
Humans↗
Incidence of infantile hypertrophic pyloric stenosis in Saskatchewan, 1970-85.
We reviewed the incidence rates of infantile hypertrophic pyloric stenosis (IHPS) and pylorospasm in Saskatchewan from 1970 to 1985 and found a marked decrease in the rates after 1976. As expected, there was a preponderance of males among those with IHPS and among those with pylorospasm discharged from hospital between 1 and 3 months of age. No seasonal pattern was observed. We believe that the decrease in incidence rates was related to environmental influences, such as changes in the methods of feeding observed since 1977.
Female↗
Infantile hypertrophic pyloric stenosis in Ghana.
In a retrospective study of 84 Ghanaian infants with hypertrophic pyloric stenosis seen over a 15-year period between 1974 and 1988, the male/female incidence ratio was 9:1. First-born infants constituted 23.8% of the patient population. The incidence of associated congenital anomalies and jaundice were 10.7% and 3.6% respectively. About 33.3% of the infants started vomiting within the first week of life. The peak-age of presentation and diagnosis was between the second and sixth weeks of life. The operative mortality was 3.6%.
Birth Order↗
Blood serum immunoreactive gastrin level in infants with hypertrophic pyloric stenosis.
Blood serum immunoreactive gastrin level (IRG) was measured in infants with hypertrophic pyloric stenosis before and after corrective surgery and in a control group children of corresponding age. No significant difference in IRG level was found between the stenotic infants and the control group. In the stenotic infants IRG values were higher at the seventh day after than before the operation and significantly higher in those infants in whom gain of body weight was noted during that time as compared with the infants without gain of weight. These observations remain in agreement with the view that the main role of gastrin in infants is trophic action on the mucosa of the upper gastrointestinal tract.
Body Weight↗
Successful endoscopic balloon dilatation for hypertrophic pyloric stenosis.
The authors successfully applied endoscopic balloon dilatation for the treatment of hypertrophic pyloric stenosis (HPS). The patient was an infant girl who had undergone repair of a giant omphalocele. Endoscopic balloon dilatation was performed using a 9-mm endoscope and an 8-mm polyethylene terephthalate (PET) balloon dilator. Dilatation was performed three times for 10 minutes. Vomiting continued after the dilatation. At the second session, dilatation was performed using a 12-mm PET balloon dilator. The 9-mm endoscope then passed through the pylorus. The patient has had no episodes of vomiting since the second treatment. This procedure is an important therapeutic option for selected patients with HPS.
Catheterization↗
The inheritance of congenital pyloric stenosis.
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Humans↗
[A peculiar cause of pyloric stenosis].
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Humans↗