Audit of results of operations for infantile pyloric stenosis in a district general hospital

Article Abstract:

Hypertrophic pyloric stenosis is an abnormal thickening of the muscular valve which controls flow of digested food from the stomach into the small intestine. This is a fairly common congenital defect in infants, and surgery is used to release the muscle and open the passageway. It has been suggested that only surgeons who specialize in pediatric surgery should perform such operations, due to a high complication rate. The outcomes of surgical procedures done by general surgeons on 46 infants with hypertrophic pyloric stenosis were evaluated from medical records. Thirty-six infants recovered uneventfully, and 44 stopped vomiting within three days after surgery. Neither repeat surgeries nor deaths occurred. The intestinal mucosal lining was inadvertently cut in 11 infants, six of whom had complications such as mild vomiting or wound infections. Nine of these infants had received preventive antibiotics, and the average hospitalization was significantly longer, by two days. Mild wound infections occurred in seven infants. Two children had vomiting for four days or more. No long-term feeding problems resulted. The findings indicate that good results for surgical repair of hypertrophic pyloric stenosis can be achieved by general surgeons. Attention to meticulous surgical technique, preoperative antibiotics, and slowly graduated introduction of oral feeding should lead to even fewer complications. However, an accompanying commentary suggests that more than surgical technique should be considered, as a high rate of infection is noted in this study. Ultimately, the best treatment for infants with pyloric stenosis would indeed be in the hands of a physician who specializes in children's surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Birth defects, Pediatric surgery

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Mineral balance in infantile cortical hyperostosis: effects of corticosteroids

Article Abstract:

In infantile cortical hyperostosis, there is bone overgrowth, especially in the jaw and collar bone, accompanied by fever and other symptoms. The disorder is frequently treated with steroids. Few studies of calcium balance and metabolism of other minerals in hyperostosis have been performed. Mineral metabolism was studied five times during early childhood in one infant treated with steroids, while mineral balance in three other children, not treated with steroids, was studied once. Blood levels of calcium, magnesium, and phosphorus were normal in all four children, and none had kidney or liver dysfunction. Calcium balance (intake minus excretion) was positive in children not treated with steroids, indicating retention of calcium in the body, and this was greater in children with more widespread disease. Phosphate balance was also positive, but not to as great a degree as calcium balance. In the one treated infant, calcium excreted in the feces increased greatly during the steroid treatment, leading to a negative calcium balance which continued for three months after halting steroid therapy. During this time period, growth also slowed, but after calcium balance became positive, catch-up growth occurred. Magnesium balance also became negative, while changes in phosphorus were less consistent. The study indicates the deleterious effects of steroid therapy on mineral balance and growth in infants. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Physiological aspects, Drug therapy, Corticosteroids, Adrenocortical hormones, Growth, Calcium metabolism disorders, Exostosis, Hyperostosis

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Increasing incidence of hypertrophic pyloric stenosis

Article Abstract:

Hypertrophic pyloric stenosis is the narrowing of the pylorus (opening) between the stomach and duodenum (the upper part of the small intestine) due to hypertrophy, or enlargement, of the muscle of the pylorus. Although the incidence of infantile hypertrophic pyloric stenosis increased during the 1970s, it is not known if this trend continued during the 1980s. Pyloric stenosis can now be easily diagnosed by ultrasound (the use of sound waves to visualize internal structures), which became a reliable diagnostic tool during the 1980s. The incidence of hypertrophic pyloric stenosis was assessed by studying two groups of patients who were diagnosed with pyloric stenosis 10 years apart. The results reveal that the incidence of hypertrophic pyloric stenosis in a specific region of England increased from 1.54 cases per 1,000 births (1976 to 1978) to 2.22 cases per 1,000 births (1986 to 1988). The use of ultrasound was associated with more reliable diagnosis of this disorder and demonstrated the development of lesions in six patients. However, the interval between the onset of symptoms and diagnosis was not shortened by the use of ultrasound. These findings suggest that infantile hypertrophic pyloric stenosis can be identified by clinical examination and ultrasound examination. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Ultrasound imaging, Diagnosis

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