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Results for “PYLORIC STENOSIS”

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At least 127 records · Page 7Linked to original sources

PubMed1975

Plasma gastrin in congenitial hypertrophic pyloric stenosis. A hypothesis disproved.

Fasting plasma gastrin levels were measured in babies with pyloric stenosis and in normal babies of similar age. There was no difference in gastrin levels either before or after operation between the babies with pyloric stenosis and normal babies. Similarly, neither the fasting blood glucose nor the fasting gastric pH of the babies with pyloric stenosis differed significantly from the values obtained in normal babies. Our findings do not support the hypothesis that gastrin in the fasting baby has an aetiological role in the development of hypertrophic pyloric stenosis of infancy. An alternative hypothesis is suggested.

Animals↗

PubMed1979

MITRAL VALVE PROLAPSE AND CONGENITAL PYLORIC STENOSIS IN IDENTICAL TWINS.

Both congenital pyloric stenosis and the mitral valve prolapse syndrome are reported to have a familial incidence. Although mitral valve prolapse has been documented in twins, only one case has received echocardiographic confirmation. The present account describes typical symptomatic mitral valve prolapse in identical twins, both of whom had undergone surgery during infancy to correct congenital pyloric stenosis.

Journal Article↗

PubMed2000

Infantile hypertrophic pyloric stenosis. Decreasing incidence.

INTRODUCTION: The study aimed to prove or disprove a clinical suspicion of a decreasing frequency of pyloric stenosis. METHOD: Retrospective review of hospital records of all children operated for pyloric stenosis in the hospitals of the County of Viborg from 1 January 1973 to 31 December 1997. This regional review was supplemented by a nationwide study, in which the National Registry of Patients was searched for the diagnosis number and the operation code of pyloric stenosis during the period 1 January 1977 to 31 December 1997. RESULTS: One hundred and forty-seven children were operated for infantile hypertrophic pyloric stenosis in Viborg County during the period in question. When calculated in five-year periods, the respective numbers per 1000 liveborn children were: 1.6, 2.4, 2.0, 2.8, and 0.9. Only one child was operated per year during 1996 and 1997, compared with an average of seven children annually during the preceding 20 years. The same tendency was found in the nationwide study. Until 1993 an average of 160 children were operated per year, i.e. 2.2 to 3.2 per 1000 liveborn children. From 1993-1997 inclusive the number decreased to 1.4. In 1996 and 1997, respectively, 75 and 76 children were operated, i.e. 1.1 per 1000 liveborn children. CONCLUSION: There has been a significant decrease in the incidence of children with infantile hypertrophic pyloric stenosis, both in the County of Viborg and in the whole of Denmark. The decrease, which started in 1993, has for unknown reasons continued to accelerate ever since. The decrease coincides with changing recommendations concerning the positioning of infants during sleep, but a causal connection is uncertain.

Denmark↗

PubMedDate not supplied

[Endoscopic management of pyloric stenosis in patients with high surgical risk].

Pyloric stenosis is a serious complication of acid peptic disease of the stomach. The treatment with balloon dilation by endoscopy has been reported successfully and with few complications. We use a therapeutic endoscope and different diameter dilators during various sessions. We report our experience in 18 patients with high surgical risk and peptic pyloric stenosis during four years (january 1988 to december 1991). Our results were satisfactory and we believe this technique could be used as a valid alternative to surgical procedures in high risk patients.

Catheterization↗

PubMed1999

[Primary hypertrophic pyloric stenosis. A are form and stomach outlet stenosis in the adult].

A 38-year-old white female with primary hypertrophic pyloric stenosis is presented. The patient was admitted to our service with a history of upper digestive tract pain and postprandial vomiting since her 17th year of life. Diagnosis of benign pyloric stenosis was made preoperatively and the patient was successfully treated by Finney pyloroplasty. Primary hypertrophic pyloric stenosis in adults is a rare condition of unknown etiology. Only about 200 cases of primary hypertrophic pyloric stenosis in adults have been reported in the literature.

Adult↗

PubMed2005

Population demographic indicators associated with incidence of pyloric stenosis.

OBJECTIVES: To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. METHODS: Pyloromyotomy rates were calculated from hospital discharge data from 1993 through 2000. Four-year data (1993-1996 and 1997-2000) were combined to ensure the stability of the rates. Small-area variations in pyloromyotomy rates and correlations between sociodemographic indicators were studied. RESULTS: Approximately 84.0% of the patients were male infants (younger than 1 year). The sex-adjusted pyloromyotomy rates were 1.57 and 1.86 per 1000 with a 3.4-fold and 3.0-fold regional variation in 1993-1996 and 1997-2000, respectively. Urban areas consistently had the lowest pyloromyotomy rate (1.04 and 1.11 per 1000 in Metropolitan Toronto), but the highest rates were from more rural areas (3.30 and 3.38 per 1000 in Quinte, Kingston, Rideau). After adjusting for socioeconomic status and availability of surgeons in the region, living in a rural area remained a significant factor associated with a higher incidence of pyloromyotomy. The risk of pyloromyotomy for an infant who lives in a region with more than two thirds of its area classified as rural was 1.79 (95% confidence interval, 1.23-2.61; P<.005). CONCLUSIONS: The observed changes in incidence and a higher rate among male infants are consistent with results from previous comparative studies conducted in North America and Sweden. The rural/urban differences suggest that environmental influences related to living in these areas may have a role in the etiology of pyloric stenosis. Further research is needed to evaluate these differences.

Demography↗

PubMed1982

Infantile hypertrophic pyloric stenosis: a review.

Infantile hypertrophic pyloric stenosis is a relatively common condition and there is some recent evidence that the incidence is increasing in this country. Gastric outlet obstruction is caused by hypertrophy of the pyloric smooth muscle and the clinical presentation is with non-bilious vomiting starting at the age of 3-4 weeks. The diagnosis can usually be made by palpation of the hypertrophied pylorus. Operation has now superseded medical treatment as the treatment of choice but meticulous assessment and correction of fluid and electrolyte imbalance is essential preoperatively. The operation of pyloromyotomy as described by Ramstedt in 1912 is simple and effective, but attention to detail is necessary if minimal morbidity and zero mortality are to be achieved. Untreated, the mortality is high but, after successful treatment, these babies are healthy and normal, so that treatment is both worth while and gratifying. The aetiology is obscure; a polygenic pattern of inheritance has been shown to be a predisposing factor, but the postnatal precipitating factors are less defined. Early hopes that the hormone gastrin might prove to be the key have not been sustained by more recent research, but the role of other gastrointestinal hormones awaits clarification.

Female↗

PubMed2002

Erythromycin use during pregnancy in relation to pyloric stenosis.

OBJECTIVE: Newborn infants treated with erythromycin may be at risk for developing pyloric stenosis. Because erythromycin is known to cross the placenta and is a recommended treatment for chlamydia and other infections in pregnancy, we explored whether erythromycin taken during pregnancy might similarly lead to an increase in risk of pyloric stenosis. STUDY DESIGN: We used data collected between 1976 and 1998 as part of an ongoing case-control surveillance program. Cases were 1044 infants with a diagnosis of pyloric stenosis. Two control groups were used: 1704 nonmalformed infants and 15,356 infants with a wide range of other malformations. Odds ratios and 95% CIs were calculated by using data from each control group. RESULTS: All odds ratio estimates are close to 1.0, all CIs include 1, and all upper 95% confidence bounds are less than 2.0. CONCLUSION: We found no evidence of an increased risk of pyloric stenosis among infants born to mothers exposed to erythromycin during pregnancy.

Adult↗

PubMedDate not supplied

[Diagnostic imaging in hypertrophic pyloric stenosis].

This report discusses hypertrophic pyloric stenosis (HPS) and the current approach to diagnostic imaging in the vomiting infant. Signs and symptoms include dehydration and vigorous gastric peristalsis with vomitus. Palpation of an olive-shaped firm muscular tumor is pathognomonic of this condition. The radiographic signs of HPS are well known. Previously published criteria for the sonographic diagnosis of HPS are discussed, these include: measurements of pyloric length, diameter and muscle thickness. The thickened muscle is the most discriminated and accurate one. It was concluded that real-time ultrasound is a simple, and reliable method for the diagnosis of HPS and should be the initial imaging procedure.

Diagnosis, Differential↗

PubMedDate not supplied

Histamine and mast cell study in the gastric tissue of south Indian patients suffering from duodenal ulcer with pyloric stenosis.

Patients undergoing surgery for pyloric stenosis secondary to duodenal ulcer were the subjects for the study. Two pieces of full thickness gastric wall (all coats) were obtained at laparotomy. The pieces were immediately split into two halves. One of these was used for histamine assay where as the other was used to study the mast cell population. Histamine content and mast cell population was found to be less in gastric mucosa of our patients as compared to values from normal human gastric mucosa. There was lack of correlation between mast cell population and histamine content which suggests that there could be some other storage sites for histamine.

Adult↗

PubMed1996

Ultrasound compared with clinical examination in infantile hypertrophic pyloric stenosis.

OBJECTIVES: To assess the accuracy of clinical examination as compared with ultrasound imaging in the diagnosis of infantile hypertrophic pyloric stenosis. Duration of hospital stay, time between admission and surgery, and financial implications were also considered. DESIGN: A prospective study of patients referred to the surgical team with a possible diagnosis of pyloric stenosis from May 1993 to January 1995. SETTING: Neonatal and paediatric surgical wards and imaging department of a paediatric teaching hospital. SUBJECTS: 116 patients referred to the surgical team with a possible diagnosis of pyloric stenosis. RESULTS: 75 patients in this study had pyloric stenosis (64.6%). Clinical examination had a sensitivity of 72%, specificity of 97%, with a positive and negative predictive value of 98% and 61% respectively. There were 16 diagnostic errors (one false positive and 15 false negative). Ultrasound imaging had a sensitivity of 97%, specificity of 100%, with a positive and negative predictive value of 100% and 98% respectively. There was one diagnostic error (one false negative). Eight patients required repeat scans for confirmation of the diagnosis. On review of the initial scans in these patients, seven were noted to have inaccurate measurements due to poor technique. The average time between repeated scans was 28.2 hours. Ultrasound imaging cost 13.90 pounds per scan and initiated a change in management only in the clinically false negative group at a cost of 52 pounds per patient. The average duration of hospital stay was 3.1 days and the mean time between admission and surgery was 19.2 hours. The total cost for treatment of a patient with pyloric stenosis was 1602 pounds. CONCLUSION: Ultrasound imaging should be reserved for those cases where clinical examination is negative and should be carried out by sonographers who see enough cases to maintain their expertise.

Costs and Cost Analysis↗

PubMed1982

[Sonography in the diagnosis of hypertrophic pyloric stenosis].

Abdominal ultrasonic examination was performed in 8 infants with hypertrophic pyloric stenosis, and in 23 control patients of the same age. The average anteroposterior diameter of the pylorus in children with hypertrophic pyloric stenosis measured 17 mm (range 15-20 mm), and 9.6 mm (range 6-12 mm) in the control group. The statistical difference was highly significant (p less than 0.001). In addition, delayed gastric emptying and retroperistalsis of the stomach were demonstrated. The sonographic findings of hypertrophied pylorus correlated well with roentgenologic results and were confirmed during following operation. Abdominal sonography is a rapid, safe and non-invasive method for the identification of hypertrophic pyloric stenosis.

Cardia↗

PubMed1981

Pyloric stenosis--a report of triplet females and notes on its inheritance.

Pyloric stenosis has been reported in multiple sibs and multiple births, A case of the disease affecting triplets is reported, the second in the literature. The expression of pyloric stenosis is dependent upon the genetic influence of ancestors affected with the disease, as well as unknown environmental influences in the postnatal period. Descendants of affected females are the most likely to develop pyloric stenosis.

Female↗

PubMed1992

The olive on end: a useful variant of the "shoulder" sign in the barium X-ray diagnosis of idiopathic hypertrophic pyloric stenosis.

We describe a radiographic sign of infantile hypertrophic pyloric stenosis. This sign, elicited during firm compression of the barium-coated pyloric region, is a round or avoid filling defect caused by the hypertrophied pyloric muscle protruding en face into the gastric lumen. This filling defect typically reveals a barium-containing central depression or stellate indentation, representing the proximal end of the obstructed pyloric channel. This sign, like the closely related "shoulder sign", appears to establish the diagnosis of hypertrophic pyloric stenosis without need for filling of the pyloric channel or for additional radiographic maneuvers.

Barium Sulfate↗

PubMed2001

Combined use of electrosurgical incisions and balloon dilatation for the treatment of refractory postoperative pyloric stenosis.

BACKGROUND: Drug therapy plus balloon dilatation without gastroscopic incision does not always relieve postoperative pyloric stenosis. METHODS: Five patients with postoperative pyloric stenosis whose symptoms did not improve with drug therapy and balloon dilatation underwent a combination of gastroscopic incision and balloon dilatation. Two or 3 small radial incisions were made in the stenotic muscle of the pylorus electrosurgically at gastroscopy. Then the stenotic muscle layer was loosened and split bluntly along the incisions with balloon dilatation for 15 to 20 minutes. One week later, the combination procedure or balloon dilatation alone was repeated to prevent restenosis. RESULTS: In the 5 patients, the stenosis was improved with the combination therapy. No complications were observed. CONCLUSIONS: Combined use of gastroscopic incision and balloon dilatation may be considered for patients with refractory pyloric stenosis caused by surgical truncal vagotomy.

Aged↗

PubMed1994

Hypertrophic pyloric stenosis in the infant without a palpable olive: accuracy of sonographic diagnosis.

PURPOSE: To evaluate the accuracy of sonography for both diagnosis and exclusion of pyloric stenosis in the infant with nonbilious vomiting without a palpable olive and to clarify the relationship between infant age and size and the dimensions of the hypertrophic pylorus. MATERIALS AND METHODS: The sonograms of 152 infants with suspected pyloric stenosis were evaluated. The prospective diagnoses were categorized as pyloric stenosis, normal pylorus, and pylorospasm with potential to progress to pyloric stenosis. Positive findings were confirmed at surgery; negative findings were confirmed by means of chart review. RESULTS: Sensitivity, specificity, and accuracy of sonography in determination of appropriate surgical referral were 100%. A significant (P < .05) correlation was found between the size of the hypertrophied muscle and the age of the patient at initial examination. CONCLUSION: Sonography is highly sensitive and, in this patient population, highly specific, and by virtue of direct visualization of the pyloric muscle, it is the method of choice for both diagnosis and exclusion of pyloric stenosis.

Humans↗

PubMed1997

Tetrahydrobiopterin in the treatment of infantile hypertrophic pyloric stenosis.

Evidence is emerging that reduced nitric oxide production may be involved in the pathogenesis of hypertrophic pyloric stenosis. Nitric oxide synthase (NOS) requires tetrahydrobiopterin (BH4) for activity. Four infants with hypertrophic pyloric stenosis were treated with oral BH4 (10 mg/kg/day) for 2.5 days. Although plasma total biopterin increased significantly at 3, 27, and 51 h after BH4 administration, there was no effect on the production of plasma cGMP, nitrite, nitrate, or citrulline. Ultrasound investigations before and after the ingestion of BH4 revealed no changes in the hypertrophic pyloric stenosis. We conclude that oral BH4, in the dose utilized in our investigations, does not modify the cause of hypertrophic pyloric stenosis, presumably because it did not restore nitric oxide production in the nonadrenergic noncholinergic nerves of the enteric nervous system.

Amino Acids↗

PubMed1979

[Influence of pyloroplasty and pyloric stenosis on motoric and secretory function of the stomach after selective proximal vagotomy--an experimental study (author's transl)].

In conscious fullgrown minipigs simple SPV alone, SPV and pyloric stenosis and SPV and pyloroplasty were performed. After a liquid test meal the motoric and secretory function of the stomach were examined simultaneously by a modified method of intestinal perfusion and aspiration. After simple SPV initially a marked decrease of gastric volume and normal emptying into the duodenum were found. With additional pyloric stenosis no significant change was found. The pyloroplasty lead to an increase of gastric volume and delayed emptying. The acid secretion after feeding reduced by SPV was not changed significantly neither by pyloroplasty nor by pyloric stenosis. The baseline values of serum gastrin were elevated after SPV as well as after SPV in combination with pyloric stenosis or pyloroplasty. After food stimulation there was a delayed increase of gastrin after SPV which differed from that after SPV with pyloric stenosis or pyloroplasty only during the first hour. These results show that after SPV no further improvement of the motoric and secretory function can be achieved by an additional pyloroplasty. Furthermore these findings permit the conclusion that even after SPV with additional artificial pyloric stenosis no delayed gastric emptying occurs and that there is no negative effect postoperatively on the acid secretion and gastrin production.

Animals↗