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Paediatric Anaesthesia Jul 2020Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed... (Review)
Review
BACKGROUND
Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed that metabolic derangements should be corrected prior to surgery to prevent apnea, the exact incidence of perioperative apneas in infants with IHPS and the association with metabolic alkalosis are unknown. We performed this systematic review to assess the incidence of apnea in infants with IHPS and to verify the possible association between apnea and metabolic alkalosis.
METHODS
We searched MEDLINE, Embase, and Cochrane library to identify studies regarding infants with metabolic alkalosis, respiratory problems, and hypertrophic pyloric stenosis. We conducted a descriptive synthesis of the findings of the included studies.
RESULTS
Thirteen studies were included for analysis. Six studies described preoperative apnea, three studies described postoperative apnea, and four studies described both. All studies were of low quality or had other research questions. We found an incidence of 27% of preoperative and 0.2%-16% of postoperative apnea, respectively. None of the studies examined the association between apnea and metabolic alkalosis in infants with IHPS.
CONCLUSIONS
Infants with IHPS may have a risk to develop perioperative apnea. However, the incidence rates should be interpreted with caution because of the low quality and quantity of the studies. Therefore, further studies are required to determine the incidence of perioperative apnea in infants with IHPS. The precise underlying mechanism of apnea in these infants is still unknown, and the role of metabolic alkalosis should be further evaluated.
Topics: Apnea; Humans; Incidence; Infant; Pyloric Stenosis, Hypertrophic
PubMed: 32298502
DOI: 10.1111/pan.13879 -
The Pan African Medical Journal 2016
Topics: Abdominal Pain; Adult; Constipation; Humans; Male; Pyloric Stenosis; Vomiting
PubMed: 28154715
DOI: 10.11604/pamj.2016.25.23.10707 -
Birth Defects Research Feb 2019Antecedents for infantile hypertrophic pyloric stenosis (IHPS) vary across studies; therefore, we conducted a multistate, population-based retrospective study of the...
BACKGROUND
Antecedents for infantile hypertrophic pyloric stenosis (IHPS) vary across studies; therefore, we conducted a multistate, population-based retrospective study of the prevalence and descriptive epidemiology of IHPS in the United States (US).
METHODS
Data for IHPS cases (n = 29,554) delivered from 1999-2010 and enumerated from 11 US population-based birth defect surveillance programs, along with data for live births (n = 14,707,418) delivered within the same birth period and jurisdictions, were analyzed using Poisson regression to estimate IHPS prevalence per 10,000 live births. Additional data on deliveries from 1999-2005 from seven of these programs were analyzed using multivariable logistic regression to estimate adjusted prevalence ratios (aPR)s and 95% confidence intervals (CI)s for selected infant and parental characteristics.
RESULTS
Overall, IHPS prevalence from 1999-2010 was 20.09 (95% CI = 19.87, 20.32) per 10,000 live births, with statistically significant increases from 2003-2006 and decreases from 2007-2010. Compared to their respective referents, aPRs were higher in magnitude for males, preterm births, and multiple births, but lower for birth weights <2,500 g. The aPRs for all cases increased with decreasing parental age, maternal education, and maternal parity, but decreased for parental race/ethnicity other than non-Hispanic White. Estimates restricted to isolated cases or stratified by infant sex were similar to those for all cases.
CONCLUSIONS
This study covers one of the largest samples and longest temporal period examined for IHPS in the US. Similar to findings reported in Europe, estimates suggest that IHPS prevalence has decreased recently in the US. Additional analyses supported associations with several infant and parental characteristics.
Topics: Adult; Birth Weight; Female; Humans; Incidence; Infant; Infant, Newborn; Logistic Models; Male; Parity; Population Surveillance; Pregnancy; Prevalence; Pyloric Stenosis, Hypertrophic; Retrospective Studies; Risk Factors; United States
PubMed: 30549250
DOI: 10.1002/bdr2.1439 -
British Medical Journal Apr 1959
Topics: Constriction, Pathologic; Pyloric Stenosis; Pylorus
PubMed: 13629154
DOI: 10.1136/bmj.1.5126.890 -
Antimicrobial Agents and Chemotherapy Jul 2013Macrolide antibiotics are largely used in pregnancy for different bacterial infections. Their fetal safety has been studied by several groups, yielding opposing results....
Macrolide antibiotics are largely used in pregnancy for different bacterial infections. Their fetal safety has been studied by several groups, yielding opposing results. In particular, there have been studies claiming an association between macrolides and cardiovascular malformations. Exposure in early infancy has been associated with pyloric stenosis and intussusception. This has led to an avoidance in prescribing macrolides to pregnant women in several Scandinavian countries. The Objectives of the present study was to investigate the fetal safety of this class of drug by linking a large administrative database of drug dispensing and pregnancy outcome in Southern Israel. A computerized database of medications dispensed from 1999 to 2009 to all women registered in the Clalit health maintenance organization in southern Israel was linked with two computerized databases containing maternal and infant hospitalization records. Also, medical pregnancy termination data were analyzed. The following confounders were controlled for: maternal age, ethnicity, maternal pregestational diabetes, parity, and the year the mother gave birth or went through medical pregnancy termination. First- and third-trimester exposures to macrolide antibiotics as a group and to individual drugs were analyzed. During the study period there were 105,492 pregnancies among Clalit women that met the inclusion criteria. Of these, 104,380 ended in live births or dead fetuses and 1,112 in abortion due to medical reasons. In the first trimester of pregnancy, 1,033 women were exposed to macrolides. There was no association between macrolides and either major malformations [odds ratio (OR), 1.08; 95% confidence interval (CI), 0.84 to 1.38)] or specific malformations, after accounting for maternal age, parity, ethnicity, prepregnancy diabetes, and year of exposure. During the third trimester of pregnancy, 959 women were exposed to macrolides. There was no association between such exposure and perinatal mortality, low birth weight, low Apgar score, or preterm delivery. Similarly, no associations were demonstrated with pyloric stenosis or intussusception. Use of macrolides in the first trimester of pregnancy is not associated with an increased risk of major malformations. Exposure in the third trimester is not likely to increase neonatal risks for pyloric stenosis or intussusception in a clinically meaningful manner.
Topics: Abnormalities, Drug-Induced; Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Cardiovascular Abnormalities; Cohort Studies; Female; Humans; Infant, Newborn; Intussusception; Israel; Macrolides; Middle Aged; Perinatal Mortality; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimester, First; Pyloric Stenosis; Registries; Retrospective Studies; Young Adult
PubMed: 23650169
DOI: 10.1128/AAC.01691-12 -
Insights Into Imaging Jun 2012We describe a systematic approach to the ultrasound (US) examination of the antropyloric region in children. US is the modality of choice for the diagnosis of...
We describe a systematic approach to the ultrasound (US) examination of the antropyloric region in children. US is the modality of choice for the diagnosis of hypertrophic pyloric stenosis (HPS). The imaging features of the normal pylorus and the diagnostic findings in HPS are reviewed and illustrated in this pictorial essay. Common difficulties in performing the examination and tips to help overcome them will also be discussed. Main Messages • Hypertrophic Pyloric Stenosis is defined by thickening of the muscular layer and failure in relaxation of the pyloric canal. • The main diagnostic criterion is a measurement of more than 3mm in thickness of the muscular layer. • Abnormal elongation of the canal is characterised as greater than 12 mm in length.
PubMed: 22696086
DOI: 10.1007/s13244-012-0168-x -
Surgical Case Reports Jan 2021The indication of surgical resection for liver metastasis from gastric cancer (GC) is still limited and controversial because of its more aggressive oncological...
The therapeutic strategy for advanced gastric cancer with pyloric stenosis and liver metastasis; successfully treated by gastro-jejunal bypass and chemotherapy first, followed by curative R0 resection.
BACKGROUND
The indication of surgical resection for liver metastasis from gastric cancer (GC) is still limited and controversial because of its more aggressive oncological characteristics than liver metastasis from colorectal cancer. Pyloric stenosis causes an inadequate oral intake and malnutrition in GC patients. We herein report a case of GC with these two factors that was successfully treated by the combination of gastro-jejunal bypass and chemotherapy, followed by curative R0 resection.
CASE PRESENTATION
A 60-year-old man was diagnosed with type 2 GC with liver metastasis and pyloric stenosis, which was confirmed as the HER2-positive type. He underwent gastrojejunostomy and received capecitabine and cisplatin (XP) + trastuzumab chemotherapy. After three courses of the XP + trastuzumab regimen, shrinkage of the primary lesion and liver metastasis was confirmed and his nutritional parameters markedly improved with a stable oral intake after bypass surgery. He underwent curative R0 resection by distal gastrectomy with D2 lymphadenectomy and partial hepatectomy. Histologically, viable tumor cells were observed in less than one-third of the primary lesion, and only scar tissue without viable cancer cells was noted in the resected liver specimen. His postoperative course was uneventful, and recurrence has not been detected in the 30 months after surgery without adjuvant chemotherapy.
CONCLUSION
The present case report describes a successful strategy for advanced GC with pyloric stenosis and liver metastasis.
PubMed: 33409765
DOI: 10.1186/s40792-020-00979-7 -
Pediatrics and Neonatology Jun 2009Sonography is used to diagnose infantile hypertrophic pyloric stenosis, but Little information is available about the appearance of postoperative sonographs. The purpose...
BACKGROUND
Sonography is used to diagnose infantile hypertrophic pyloric stenosis, but Little information is available about the appearance of postoperative sonographs. The purpose of this study was to evaluate the morphology of the pylorus in association with an obstruction before and after pyloromyotomy.
METHODS
Pyloric length, diameter, muscle thickness and intermuscular space were measured sonographically at diagnosis and daily after pyloromyotomy until discharge in 12 infants with infantile hypertrophic pyloric stenosis. The ratios of pyloric wall thickness and intermuscular space to the entire pyloric diameter were measured.
RESULTS
The pylorus still appeared hypertrophied after pyloromyotomy on the sonograms. The traditional measurement of linear dimensions of the pylorus was not significantly changed from the preoperative values by the time of discharge, except for muscle thickness. The intermuscular space increased from 4.8+/-0.8 mm preoperatively to 7.3+/-2.1 mm by postoperative day 3 (p=0.10). Lowe's pyloric ratio at diagnosis was a mean of 0.32, decreasing to 0.29 on postoperative day 3 and 0.29 on the day of discharge (p=0.82). The alternative pyloric ratio increased significantly by postoperative day 2 (0.24+/-0.09 on day 2 vs. 0.11+/-0.07 preoperatively, p=0.02).
CONCLUSION
The pyloric ratio appears to be a reliable parameter in evaluating the regression of pyloric stenosis after pyloromyotomy, and also aids in the diagnosis of pyloric stenosis.
Topics: Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Pyloric Stenosis, Hypertrophic; Pylorus; Treatment Outcome; Ultrasonography
PubMed: 19579758
DOI: 10.1016/S1875-9572(09)60046-2 -
The Ulster Medical Journal Sep 2011In infants with pyloric stenosis we explored (a) if males develop symptoms and present to hospital earlier than females and (b) does any delay in presentation influence...
AIMS
In infants with pyloric stenosis we explored (a) if males develop symptoms and present to hospital earlier than females and (b) does any delay in presentation influence the severity of metabolic derangement.
METHOD
A retrospective casenote review of 99 infants who underwent pyloromyotomy (with confirmation of pyloric stenosis) over a two year period (Jan 2006-Dec 2007) in our hospital. The data collected included: sex, age at onset of symptoms, age at presentation to hospital and initial blood results.
RESULTS
The group comprised 84 males and 15 females. Symptoms developed at 26 (0-70) days in males and 35 (0-77) in females. (Mann-Whitney U=428, p=0.04 two tailed). Males presented to hospital at 34 (13-91) days, females at 45 (13-98) days (Mann-Whitney U=391, p=0.01 two tailed). The differences between males and females for (1) age at onset of symptoms and (2) age at presentation to hospital became more significant when weighted averages were calculated using SPSS (Statistical Package for Social Sciences). The lower weighted averages for male infants can be seen in the final table. Increasing duration of symptoms showed a positive correlation with fall in Chloride level. (Spearman's rho: rs= -0.2, p=0.049 two tailed). There was a positive correlation between duration of symptoms and bicarbonate level but this was not significant. (rs=0.06, p>0.05 two tailed). There was a positive correlation between duration of symptoms and pH, but this was not significant (rs=0.12, p>0.05 two tailed).
CONCLUSION
In our hospital, females with pyloric stenosis develop symptoms and present significantly later than males. This should be considered when assessing a female with vomiting outside the usual 20-40 day range.
Topics: Chlorides; Female; Humans; Infant; Infant, Newborn; Male; Pyloric Stenosis; Retrospective Studies; Sex Factors; Time Factors
PubMed: 23526330
DOI: No ID Found -
Children (Basel, Switzerland) Aug 2021The standard of treatment for infants with hypertrophic pyloric stenosis is still pyloromyotomy. Recently, in most of the pediatric surgery centers laparoscopic...
BACKGROUND
The standard of treatment for infants with hypertrophic pyloric stenosis is still pyloromyotomy. Recently, in most of the pediatric surgery centers laparoscopic pyloromyotomy has become popular. The aim of the present study is to compare the outcomes of treatment in infants with hypertrophic pyloric stenosis between traditional open approach and laparoscopic pyloromyotomy using 3-mm electrocautery hook.
METHODS
A total of 125 infants, 104 (83.2%) males, with median age 33 (interquartile range, IQR 24, 40) days, who underwent pyloromyotomy because of hypertrophic pyloric stenosis, between 2005 and 2021, were included in the retrospective study. Of that number 61 (48.8%) infants were allocated to the open group and 64 (51.2%) to the laparoscopic group. The groups were compared in regards to time to oral intake, duration of surgery, the type and rate of complications, rate of reoperations, frequency of vomiting after surgery, and the length of hospital stay.
RESULTS
No differences were found with regards to baseline characteristics between two investigated groups. Laparoscopic approach was associated with significantly better outcomes compared to open approach: shorter duration of surgery (35 min (IQR 30, 45) vs. 45 min (40, 57.5); = 0.00008), shorter time to oral intake (6 h (IQR 4, 8) vs. 22 h (13.5, 24); < 0.00001), lower frequency of postoperative vomiting ( = 10 (15.6%) vs. = 19 (31.1%)), and shorter length of postoperative hospital stay (3 days (IQR 2, 3) vs. 6 days (4.5, 8); < 0.00001). In regards to complications and reoperation rates, both were lower in the laparoscopic pyloromyotomy group but the differences were not statistically significant ( = 0.157 and = 0.113, respectively). The most common complication in both groups was mucosal perforation (open group, = 3 (4.9%); laparoscopic group, = 2 (3.1%)) followed by wound infection in open group, = 3 (4.9%). No cases of wound infection were recorded in the laparoscopic group.
CONCLUSION
Open and laparoscopic pyloromyotomy are equally safe and effective in treatment of hypertrophic pyloric stenosis. Laparoscopic technique is associated with faster recovery, shorter duration of surgery and shorter duration of hospital stay.
PubMed: 34438592
DOI: 10.3390/children8080701