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PubMed1984

The reliable sonographic diagnosis of hypertrophic pyloric stenosis.

Fifty-five infants who presented to the Oklahoma Children's Memorial Hospital with vomiting and the clinical suspicion of hypertrophic pyloric stenosis (HPS) were evaluated using real-time ultrasound. Previously published criteria for the sonographic diagnosis of HPS were evaluated in these patients. The anterposterior diameter measurement of 1.5 cm or greater proposed by Strauss et al. had an accuracy of 36/50 (72%). The 4-mm or greater wall thickness measurement of Blumhagen et al. was correct in 46/50 (92%) of cases. A proposed criterion, the true pyloric muscle (TPM) length of 2.0 cm or greater was accurate in 33/33 cases. Application of the TPM length criterion should improve the reliability of sonographic diagnosis of HPS and decrease the need for radiographic studies.

Humans↗
PubMedDate not supplied

[Personal experience with ultrasonic diagnosis of hypertrophic pyloric stenosis in infants].

Until wide use of ultrasound in diagnostic procedures took its part, the only relevant procedures to diagnose Infantile Hypertrophic Pyloric Stenosis (IHPS) were clinical examination and X-ray of gastroduodenal tract. Use of diagnostic ultrasound avoids harmful effects of X-rays on immature children's tissues. Reliability of the procedure is very high. In the period between July 1993 and January 1999 we diagnosed 12 cases of IHPS in our Hospital by ultrasound examinations. Eleven patients were males between five and eight weeks of age, and one female was six weeks old. In six of them the finding was confirmed by radiological examination (on surgeon's request), in one neither radiological examination not surgery was performed, and five were operated on the basis of only ultrasound finding. In eleven operated patients ultrasound finding is proven by surgery.

Female↗
PubMed1986

Unconjugated hyperbilirubinaemia in hypertrophic pyloric stenosis, an enigma.

In a search of features that might be relevant to the understanding of the hyperbilirubinaemia of infants with hypertrophic pyloric stenosis (HPS), we examined the duodenal fluid in 11 infants with this condition. Four (36%) had an unconjugated bilirubin level above 2.5 mg/dl in the serum. Levels of electrolytes, bicarbonate, liver function tests and cholesterol were similar in the jaundiced and the non-icteric infants. Examination of duodenal fluid for pH, concentration of bilirubin, bile salts, electrolytes and beta-glucuronidase levels also did not disclose any significant differences between the HPS patients and the controls. Bacterial culture of the fluid yielded similar results in both groups. We may conclude that the unconjugated hyperbilirubinaemia observed in some patients with HPS is not associated with overgrowth of bacteria, changes in glucuronidase levels, pH, electrolytes or biliary obstruction.

Bilirubin↗
PubMed1993

Esophagitis in infants with hypertrophic pyloric stenosis: a source of hematemesis.

This study was undertaken to clarify the source of blood in the vomitus of patients with hypertrophic pyloric stenosis (HPS). Twenty-one infants with HPS were examined. Hematemesis was noted in 14 infants. Esophagogastric endoscopy showed a 100% incidence of esophagitis and in one patient gastric erosion was also observed. Histological study of the esophageal mucosa showed evidence of esophagitis in 18 patients (85.7%). Preoperative pH monitoring showed gastroesophageal reflux (GER) in all infants. Excessive acid exposure (> or = 7%) was significantly correlated with the grade of esophagitis and the incidence of hematemesis, whereas acid exposure time was shorter in the cases without histological esophagitis. These results suggested that the source of bleeding in HPS is the esophageal mucosa affected by esophagitis secondary to excessive acid reflux. Although there is obvious massive gastroesophageal reflux in HPS, it is too difficult to evaluate the lower esophageal sphincter function in HPS.

Esophagitis, Peptic↗
PubMed1985

Observations and perspectives of the pathology and possible aetiology of infantile hypertrophic pyloric stenosis--a histological, biochemical, histochemical and immunocytochemical study.

This study was aimed at providing new knowledge on the pathology of Infantile Hypertrophic Pyloric Stenosis (IHPS) with some recently developed techniques and hence contributing to the understanding of its unsolved aetiology. Biopsy specimens of the pylorus were obtained from 15 children with IHPS at operation and 6 normal children at autopsy and compared as follows: (a) the presence or absence of muscle hyperplasia in IHPS was studied with special chromatin stain. No mitotic figures were observed in 10,000 cells screened; (b) Using the Schneider procedure, specimens from IHPS showed 1.47 +/- 0.09 mg DNA/g wet tissue (mean +/- SEM) compared with 2.38 +/- 0.18 mg DNA/g wet tissue in normal, defining the magnitude of muscular hypertrophy objectively to be in the region of 1.62 times normal; (c) Cholinesterase staining revealed adequate density of ganglia with no gross distortion of morphology in IHPS; (d) Immunocytochemical study with the marker neurone-specific-enolase confirmed that ganglia in IHPS were mature; (e) Immunocytochemical study with substance P revealed rich peptidergic innervation of the normal pylorus and a relative paucity in IHPS. This was interpreted as a phenomenon of exhaustion of substance P-neurones in IHPS. In conclusion, IHPS is a true muscle hypertrophy with little or no hyperplasia. The cholinergic ganglia are adequate and neural elements in general are sufficiently mature. The novel idea of possible disturbances of peptidergic innervation contributing to its aetiology has received some support.

Acetylcholinesterase↗
PubMed2005

Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the "olive"?

BACKGROUND/PURPOSE: Laparoscopic pyloromyotomy has recently gained wide acceptance as the optimum treatment of infantile hypertrophic pyloric stenosis (IHPS). However, medical treatment may be superior to laparoscopic surgery in invasiveness. The efficacy of our regimen of intravenous atropine therapy for IHPS was assessed in comparison with surgical treatment. METHODS: Medical treatment was initially chosen for 52 (61%) of 85 infants with IHPS at our institute between 1996 and 2004. Atropine was given intravenously at 0.01 mg/kg 6 times a day before feeding. When vomiting ceased and the infants were able to ingest 150 mL/kg per day of formula after stepwise increases in the feeding volume, they were given 0.02 mg/kg atropine 6 times a day orally, and the dose was decreased stepwise. RESULTS: Of the 52 patients, 45 (87%) ceased projectile vomiting with treatment using intravenous (median, 7 days) and subsequent oral (median, 44 days) atropine administration. The median hospital stay was 13 days (6-36), and no significant complications were encountered during atropine therapy. The remaining 7 patients required surgery. Of 40 who underwent surgery, 4 had wound infections and 1 with hemophilia had postoperative hemorrhagic shock. The patients who underwent successful atropine therapy had body weights comparable with those who underwent surgery at the age of 1 year. CONCLUSIONS: The high success rate of intravenous atropine therapy for IHPS suggests that this therapy is an effective alternative to pyloromyotomy if the length of the hospital stay and the necessity of continuing oral atropine medication are accepted.

Atropine↗
PubMed2001

Infantile hypertrophic pyloric stenosis and asymptomatic joint hypermobility.

A significant association with asymptomatic joint hypermobility was observed in 37 children with a history of infantile hypertrophic pyloric stenosis (P =.0016) and their parents (mothers, P <.0001; fathers, P <.05). The subjects with articular hypermobility showed an increased frequency of absent mandibular frenulum, thereby suggesting the presence of a previously unrecognized, systemic abnormality of the extracellular matrix.

Extracellular Matrix↗
PubMed1991

[Pyloric stenosis in infants. New surgical approaches].

Pyloromyotomy as described by Fredet and Ramstedt is still widely used for the treatment of infantile hypertrophic pyloric stenosis, with a very low mortality rate. Three hundred case-records of patients treated using this technique were reviewed. Pyloromyotomy can benefit from the use of videosurgical methods. The creation of a pneumoperitoneum requires special precautions in infants. Nineteen infants were treated using laparoscopic Fredet-Ramstedt pyloromyotomy, a technique which can be expected to gain widespread acceptance during the next few years.

Female↗
PubMed1998

Eosinophilic gastroenteritis mimicking idiopathic hypertrophic pyloric stenosis.

We report two infants with eosinophilic gastroenteritis (EG). This rare disease can mimic the clinical symptoms and US appearance of idiopathic hypertrophic pyloric stenosis (IHPS). US examination of the antropyloric region with a high-frequency linear transducer can assist in the differentiation of EG from IHPS, which is important because the therapeutic approaches are completely different. Eosinophilic gastroenteritis should be considered in the differential diagnosis of IHPS, especially when there has been an ineffective pyloromyotomy.

Adrenal Cortex Hormones↗
PubMed1983

Infantile hypertrophic pyloric stenosis in South Glamorgan 1970-9. Effects of changes in feeding practice.

In a retrospective analysis of cases of surgically confirmed infantile hypertrophic pyloric stenosis (IHPS) in South Glamorgan in the decade 1970-9 the incidence rose sharply in 1976 reflecting a general increase reported throughout Wales and from other parts of the United Kingdom. The increase was mainly among boys and although it occurred at a time when breast feeding had become more popular, it affected bottle fed infants more than breast fed infants. The apparent correlation between incidence of IHPS and incidence of breast feeding may coincidental and changes in infant milk formulae that became general in 1976 may be more important. An appreciable excess of first born infants with IHPS was noted but there was no correlation between birthweight and IHPS. Variations according to month of birth did not coincide with true seasonal variation.

Birth Order↗