HYPERTROPHIC PYLORIC STENOSIS

Hypertrophic pyloric stenosis, a relatively common condition, is caused by hyperplasia of the musculature of the pylorus. The diagnosis is made by a history of projectile vomiting and failure to gain weight, the observation of gastric peristaltic waves, and the palpation of a pyloric “tumor.” A method of palpating this tumor is described in detail. Roentgenological studies are rarely indicated.Pylorotomy for treatment of hypertrophic pyloric stenosis was not successful until the development of necessary supporting measures.Preparation for operation consists of intravenous administration of fluids and electrolytes and sometimes serum or whole blood. The position of the tumor governs the choice between two different incisions. The operative procedure herein described is essentially that devised by Ramstedt many years ago, with modifications to facilitate the procedure.     

Clinical diagnosis of pyloric stenosis: a declining art.

OBJECTIVE--To assess whether diagnostic imaging of pyloric stenosis has made a difference in rapidity of diagnosis, duration of pre-operative hydration, and length of stay in hospital. DESIGN--Chart review of infants with confirmed diagnosis of pyloric stenosis. SETTING--Paediatric teaching hospital. SUBJECTS--215 infants with a confirmed diagnosis of pyloric stenosis seen during 1974-7 and 187 infants with pyloric stenosis seen during 1988-91. MAIN OUTCOME MEASURES--State of hydration on admission, time between presentation to hospital and a definite diagnosis, techniques used to make the diagnosis, whether a pyloric mass was felt before or after an imaging procedure, time between presentation and surgery, and length of stay in hospital. RESULTS--The average age at presentation was 40 days in both groups. A pyloric mass was palpated either without or before an imaging study in 87% (187/215) of cases during 1974-7 but in only 49% (91/187) during 1988-91. The use of barium meal examination and ultrasonography increased from 20% (42/215) of cases during 1974-7 to 61% (114/187) during 1988-91. There were no significant differences between the two groups in the time taken to establish a diagnosis, the mean duration of preoperative treatment, or the length of stay in hospital (after allowance for the decline in average length of stay of all hospital patients between the two periods). CONCLUSIONS--An increased use of diagnostic imaging for pyloric stenosis did not lead to earlier diagnosis or better management. While imaging is important in identifying pyloric stenosis in difficult cases, increasing reliance on imaging has reduced doctors'' skills in diagnosing pyloric stenosis clinically.     

The association of sex ratio anomalies with pyloric stenosis

Published family data were examined for evidence of aberrant sex ratios in relatives of pyloric stenosis index cases. An excess of males over females was found among unaffected members of sibships in which there occurred more than one case of pyloric stenosis. The male excess among affected members of these sibships did not differ from that among index cases without affected sibs. An unusual frequency of spontaneous abortions in these subships, which might account for the observed excess of males, was not observed. No evidence was found of sex ratio anomalies in other classes of relative of pyloric stenosis index cases, whether or not the index cases had affected sibs.     

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.     

Neuroendocrine tumors of gastrointestinal tract in own material

Neuroendocrine tumors are rare gastrointestinal tract disorders, in which diagnosis and treatment are often difficult. The aim of the paper is to present two cases of patients with neuroendocrine tumor of gastrointestinal tract, who underwent surgical procedure in II Department of General and Gastroenterological Surgery of Medical University of Bia?ystok in 2005. A 63-year-old female patient with primary diagnosis of neuroendicrine tumor metastases in liver was not successfully investigated for primary tumor in the preoperative period. The laparotomy procedure indicated the malignant neuroendocrine tumor in the terminal ileum and metastases to the liver and to the greater omentum. The right hemicolectomy and liver metastatic segment VII and VIII resection were performed. The neurological disturbances of obscure origin were observed in the postoperative period and the patient suddenly died on the 15(th) day after surgery. A 57-years-old male patient was operated on for lymph node recurrence of gastric tumor. Pathologic examination of tissue sample revealed the diagnosis of carcinoid. The patient underwent subtotal gastric resection for a pyloric ulcer, diagnosed as Adenocarcinoma G2 pT2N0M0 6 years before. Liver and abdominal node metastases, confirmed by octreoscan, were observed after lymphadenectomy, The treatment of somatostatin analogues (LAR octreotide) was used. In spite of therapy the patient died. The authors present their own experiences and show the preoperative diagnostic difficulties in patients with neuroendocrine gastrointestinal tumors. Unexpected neurological complications in the treatment course were described.     

The foregut-ossicle system of Dromia wilsoni, Dromia personata and Lauridromia intermedia (Decapoda, Brachyura, Dromiidae), studied with a new staining method

The ossicles of the cardiac and pyloric foregut of three species of decapods: Dromia wilsoni [Fulton and Grant, 1902], Dromia personata [Linnè, 1758] and Lauridromia intermedia [Lauri, 1906] are described and illustrated in detail. Five new ossicles are recognized based on a specific staining-method with Alizarin-Red. The ossicle terminology of the brachyuran foregut is revised now to include 37 ossicles. All described ossicles are documented by drawings and photographs. The two new cardiac ossicles, the prepterocardiac and the postpterocardiac ossicles are narrow ossicles associated with the pterocardiac ossicles at the antero-dorsal margin of the cardiac foregut. The pyloric foregut includes the newly described lateral mesopyloric- and the posterior uropyloric ossicles. These pyloric ossicles are clearly recognizable only in the stained condition. Based on our data we provide new additional evidence for brachyuran monophyly and the paraphyletic status of the podotrematan crabs.     

An uncommon association of vacterl complex with hypertrophic pyloric stenosis and horseshoe lung

We report a case of VACTERL complex which had concomitant horseshoe lung, laryngeal cleft, and hypertrophic pyloric stenosis, which has not been previously reported.     

Comparison of pyloric ligation and pyloric cuff techniques for collecting gastric secretion in the rat.

A comparison was made between two methods for collecting gastric secretion in the rat. The two included a pyloric ligation technique and a snare-type pyloric cuff which was surgically implanted 2 weeks before the collection was initiated. It was hypothesized that the surgical trauma associated with pyloric ligation would inhibit gastric secretion and thus yield smaller gastric samples with this procedure as compared to the cuff technique. No differences in volume of gastric secretion or total acid output were observed between the two methods.     

Selective Vagotomy without Drainage. An Interim Report

The results of surgical treatment for duodenal ulcer were compared in two groups of patients—51 who had undergone selective vagotomy without drainage and 17 who had had selective vagotomy and pyloroplasty. It is suggested that in the absence of organic pyloric or duodenal stenosis the former method seems both preferable and desirable, since postoperativley dumping does not occur and there is a steady improvement in gastric emptying.     

A quantitative study of the effects of anaesthesia and stress of operation on gastric secretion in rats

Ether anaesthesia, present from 5 min before to 5 min after pyloric occlusion, significantly reduced gastric secretion in rats observed over a period of 2 hr. The reduction in gastric secretion was similar to that caused by surgical trauma resulting from acute pyloric ligation. The inhibitory effects induced by ether anaesthesia were found to wear off after 2 hr while those caused by surgical trauma persisted for 5 hr. These findings show conclusively that both surgical trauma and ether anaesthesia will depress gastric secretion in rats which are operated upon immediately before use in gastric secretory studies. Such effects are not present with the technique for pyloric occlusion described by the present authors.     

Genetic evidence for the neuronal nitric oxide synthase gene (NOS1) as a susceptibility locus for infantile pyloric stenosis.

The etiological role of the gene for neuronal nitric oxide synthase (NOS1) in infantile pyloric stenosis (PS) was investigated by analysis of two intragenic polymorphisms (NOS1a and NOS1b) in 27 families. There was significant overall transmission disequilibrium between PS and NOS1a (P = .006). Consideration of each allele independently revealed a highly significant tendency for allele 7 (210 bp) to be preferentially transmitted to the affected offspring (P = .0006). These observations suggest that NOS1 is a susceptibility locus for PS.     

Naturally occurring hypertrophic pyloric stenosis in the domestic rabbit.

Hypertrophic pyloric stenosis was observed to occur naturally in laboratory rabbits. Three cases in juvenile and adult rabbits and their antemortem histories were examined. The gross and microscopic pathology were studied. It was shown that not only the pylorus, but the stomach as a whole was increased in size both relatively and absolutely. The thickness of the pylorus was doubled, but its circumference was not increased, in hypertrophic stenosis. The chief histologic finding was hypertrophy of circular and longitudinal smooth muscles and their enveloping fascia. The myenteric plexi were essentially normal in appearance. The literature on a similar condition in man, dog, and cat was reviewed.     

A simple method of continuous passage of human tumors in immunocompetent mice]

A simple procedure is described for the continuous passage of a human tumor in immunocompetent mice. The BRO human melanoma was transplanted consecutively 25 times by implanting tumor tissue under the sub--renal capsule of mice which had been immunosuppressed by a single dose of whole--body irradiation or by cytosine arabinoside followed by irradiation. The tumor grew continuously for 14 days, and cytological examination showed that the growth consisted almost entirely of tumor cells.     

Multimodal distribution and discontinuous variation in period of interacting oscillators in the crustacean stomatogastric nervous system

Summary In the stomatogastric ganglion (STG) of Homarus gammarus, pacemaker neurons of the pyloric central pattern generator are entrained by a network oscillator (CPO) contained in the commissural ganglion. A consequence of CPO's influence is that the spontaneous pyloric period can take one of several absolute values, most commonly displaying a bimodal distribution. These discrete values correspond to different coordination modes with the CPO rhythm. Moreover, the oscillation period of pyloric pacemaker neurons varies discontinuously with their membrane potential. This behavior persists when the mean pyloric period is modified by different perfusion salines but disappears when the STG is disconnected from the anterior ganglia. Under these conditions, pyloric pacemaker neurons are deprived of CPO inputs and behave like independent oscillators whose period varies continuously as a function of the membrane potential. The modulatory pyloric suppressor neurons (PS), which are known to decrease the oscillatory capabilities of the pyloric pacemakers, can change the coordination mode between these neurons and the CPO. PS can provoke discontinuous variations in the pyloric period as a function of their firing frequency. Finally, the nonlinear behavior of the pyloric pattern generator described in Homarus also occurs in Jasus lalandii, in which the existence of a CPO has not yet been demonstrated.Abbreviations AB anterior burster neuron - ASW artificial seawater - COG commissural ganglion - CP commissural pyloric neuron - CPG central pattern generator - CPO commissural pyloric oscillator - IC inferior cardiac neuron - ivn inferior ventricular nerve - LP lateral pyloric neuron - OG esophageal ganglion - PD pyloric dilator neuron - PDn pyloric dilator nerve - PS pyloric suppressor neuron - son superior esophageal nerve - PY pylonic neuron - STG stomatogastric ganglion - stn stomatogastric nerve - vlvn ventral branch of the lateral ventricular nerve Maître de conférence à l'U.E.R. de Médecine et de Pharmacie, 2 rue Dr Marcland, 87025 Limoges Cedex, France.     

The reproductive cycle of the asteroid Coscinasterias muricata in Port Phillip Bay, Victoria, Australia

The reproductive cycles of two populations of Coscinasterias muricata from Port Phillip Bay, Victoria, Australia are described in terms of organ indices, oocyte development and progesterone levels. Both Governor's Reef and South Channel Fort populations exhibited clearly defined reproductive cycles with two spawning periods, during summer and during spring. In both populations, the pyloric caecal index and gonadal index showed inverse cycles suggesting nutrient translocation from the pyloric caeca to the gonads for gametogenesis. Physiological changes, such as decreases in pyloric caecal index, and increases in gonadal index and oocyte diameter were observed following the months of increased progesterone concentrations in the female pyloric caeca. These results indicate a role for this steroid in the reproductive cycle. The results from the Governor's Reef population suggest that the influence of progesterone on the reproductive cycle of female C. muricata is regulated by photoperiod. Results also provide evidence of a role for seawater temperature in the reproductive process of this species.     

Vagotomy effect on the content and synthesis of acetylcholine in autonomic ganglia in dog stomach

The effect of total, selective and highly selective vagotomy was studied on the content and synthesis of acetylcholine in the tissues of the gastric fundus and pyloric part of the stomach in mongrel dogs of either sex aged 3 to 6 years. Total vagotomy produced after 3 weeks a non-significant rise in the amount and a highly significant increase of the synthesis of ACh in the fundus, and a significant increase in the amount and synthesis of ACh in the pyloric part. Six weeks after the procedure the Ch content of the fundus and pyloric part decreased statistically significantly, while the synthesis rate was not different from the initial one. Three weeks after selective vagotomy the ACh content of the fundus and pyloric part was significantly increased. The rate of ACh synthesis was normal. Six weeks after vagotomy the content of ACh and its synthesis in the fundus were similar to those before vagotomy. In the same time the ACh synthesis rate was significantly decreased in the pyloric part, while the ACh content there was similar to the control value. Highly selective vagotomy with denervation of the fundus and corpus of the stomach but with maintenance of the innervation of the pyloric part caused after 3 weeks a rise of the ACh content of the fundus tissues. The ACh synthesis rate was not different from the normal one. In the pyloric part the ACh content was significantly decreased and the synthesis of ACh was somewhat inhibited.(ABSTRACT TRUNCATED AT 250 WORDS)     

Isolation of mitochondria from ascites tumor cells permeabilized with digitonin

A new, improved procedure for isolating mitochondria from ascites tumor cells is described. The unique feature of this technique is the use of digitonin to make the cells susceptible to disruption by Teflon pestle/glass vessel homogenization. The yield and respiratory control ratios of mitochondria isolated by this method from murine Ehrlich ascites tumor cells and rat AS30-D ascites hepatoma cells are significantly better than those obtained for mitochondria isolated by the commonly employed Nagarse method, which involves the use of proteolytic enzymes. Moreover, mitochondria isolated by this new procedure from three different lines of tumors exhibit respiratory control ratios with both adenosine diphosphate and a respiratory uncoupler comparable to those obtained with mitochondria present in situ within digitonin-permeabilized tumor cells.     

Glycogen and degeneration in the pyloric gland of Dendrodoa grossularia (Ascidiacea,Tunicata)

Summary Degeneration is observed in cells of the pyloric gland of Dendrodoa grossularia in which glycogen storage occurs. The ultrastructure of four phases of the degeneration cycle is described. Natural senescence seems to be the cause of the degeneration. Glycogen storage might be the result of metabolic disturbance, but its presence reveals the importance of glycogen in the function of the organ. The role of the pyloric gland is discussed.