Congenital stenosis of the pylorus

The subject of Congenital Stenosis of the Pylorus presents interest alike for the Physician, the Pathologist and the Surgeon. The first recorded ob- servation was made in 1341 by Williamson of Leith. The symptoms described leave no doubt that the patient suffered from Congenital Stenosis of the Pylorus, whic proved fatal when the child was 5 weeks old. The Stomach and Pylorus were removed post mortem and were - exhibited at a meeting of the Edinburgh Anatomical Society, where the condition was considered to be Con - enital Scirrhus of the Pyloric extremity of the Stom- ach. In 1842 Dawoskk reported a case with similar !!symptoms, which proved fatal at the age of 10 weeks. At the post mortem examination a hard Pyloric tumour as found, the lumen of which would hardly admit a robe. Dawosky looked upon the condition as one of h ypertrophy with induration of the submucous tissue. Landerer, in 1879, and Maier, in 1335, again called attention to the subject of Congenital Pyloric Sten- osis by the publication of some observations they had ade, both clinical and anatomical. But their cases were all observed in adults, the two youngest patients being respectively 16 and 12 years of age, and they re now not generally regarded as true cases of Con - genital Stenosis of the Pylorus. In 1888 Hirschsprung recorded two cases of his. Both patients suffered from symptoms similar to those which will be described belo las typical of the condition and both died. From the post mortem examinations Hirschsprung was the first to ' recognise that the hypertrophy of the Pylorus was chie- ly of the muscular tissue. In 1889Peden showed a,spec - imen at a meeting of the Glasgow Pathological and Clines ical Society taken from the body of a child who had died from malnutrition, the result of Congenital Sten- osis of the Pylorus. At a meeting of the Pathological Society of London in 1891 Newton Pitt showed another specimen taken from an infant 7 weeks old at death, 1 and he drew attention to the hypertrophy of the musculi ar coat of the Stomach as well as the Pylorus. In 1891 Henschel published notes of four cases which poss4 iibly were cases of Congenital Stenosis of the Pylorus.; One of them recovered without operation and the others¡ died between the ages of 7 months and 2- years. At the post mortem examinations of the three fatal cases none of them revealed the marked muscular hypertrophy which is usually met with at the Pylorus. Thomson in 1896 published notes of two fatal cases (see below)¡ E nd of another the following year with full descrip- ions of the morbid anatomy. About the same time as homson published his first two cases, Gran recorded otes of three cases. Soon afterwards Finkelstein ublished.a paper on Congenital Stenosis of the Pylorue nd gave notes of a case of his own and three cases from Heubner's private practice. In 1896 De Bruyn op and Schwyzer each reported a case and the following ear Ashby published a paper on the subject with notes of two cases. In his book on "Disorders of Digestion in Infancy and Childhood" in 1897 W.S.Fenwick gave Totes of two cases of Congenital Stenosis of the Pylor- us, which he had treated. In 1898 cases were recorded Meltzer, by EAVElfEreN Batten and Rolleston, and in that year Stern had a case on which he operated. The following year, Still recorded three cases he had had under his charge, and Abel also operated on a case of Kehr's about the same time. Since then the literature on the subject of Congenital Stenosis of the Pylorus has been rapidly increasing, and a considerable number of cases have been recorded. The following have either written on the subject, or recorded cases - Blackadder Cantley and Dent, Dival, Fletcher, Greeff, Kehr, Lark- ins, Lobker, fonnier; Xicoll, Pritchard, Rolleston and Crofton- Atkins, Saunders, Schmidt, Simonson and South - worth. A complete bibliography will be found below.Owing to the kindness of Mr. H. J. Stiles and Dr. John Thomson I am enabled to give notes of their cases. The first three cases recorded have been published by Dr. Thomson and they are copied from the punished notes. Three of the cases were treated at the 'Min- burgh Children's Hospital by Dr. Thomson when I held the position of House Surgeon to the Hospital and I had ample opportunity of seeing the cases. Mr. Stiles operated upon two of these three cases and'i'assisted him at the operations

Congenital hypertrophic pyloric stenosis: a historical, anatomical, pathological and clinical study

PATHOLOGY: We feel we have shown, by histological sections of the normal pylorus and of the pylorus affected by congenital hypertrophy, that the pyloric sphincter itself is not directly affected by the hypertrophy.The prepyloric portion of the pyloric canal undergoes marked hypertrophy of its circular muscle, and we believe an outgrowth of this circular muscle, forcing its way into the duodenum, compresses the pyloric sphincter, which is only slightly enlarged and is seen to be at the apex of the fornix of the portio vaginalis. The points which occur to us are such questions as, whether the pyloric sphincter and the prepyloric portion of the pylorus have a separate nerve supply.Is this under the control of the sympathetic parasympathetic nervous system? We know in Hirschsprung's Disease division of the sympathetic fibres leads to remarkable recoveries.More recent work on cardiospasm shows very encouraging results by removing the sympathetic fibres round the left gastric artery and its oesophageal branch.In no other condition, however, is there such marked hypertrophy of muscle at the sight of obstruction, and it seems doubtful even if the course of the sympathetic fibres to the pylorus was definitely established, that attempts would be made to divide these nerves in the hope of a satisfactory result. The treatment, by division of this hypertrophied muscle, is so satisfactory in this condition, that little in the way of methods of treatment is being sought after, but more in the nature of methods of prevention. The causation, however, still remains definitely obscure.CLINICAL: This thesis is based on fourteen cases operated on over a period of nine years. Two of the cases were delivered into this world by the author and these were the only cases operated on at an early date. The average age of these infants when submitted to surgical treatment was 6 weeks and the average weight was 7 lbs. 8 ozs. In all cases a Fredet-Rammstedt operation was performed.The majority of these infants were discharged from hospital within seven to nine days.Two of these babies died, one from broncho pneumonia 14 days after the operation, and the other immediately after operation owing to the parents refusing operation when the child was four weeks old, and returning two months later with the marasmic, dying infant, pleading for something to be done. The prognosis in this case was extremely bad as the child was practically moribund and at that time our knowledge of pre-operative treatment was very much less than it is now.The work of Maizels & McArthur, who stress the value of pre -operative treatment and the recognition of alkalosis so common in neglected pyloric stenosis cases has, we feel, done much to make the course of these little patients much easier after operation and has resulted in a greatly lowered mortality.Another important factor is the advantages of the private room in hospital and the private nurse. Most of these cases were operated on in the Transvaal Memorial Hospital for Children.All were in private rooms and many had their own private experienced children's nurses.Congenital pyloric stenosis has always been looked upon., and we believe rightly, as a medical disease.The operation is only an incident, albeit an important one, in the malady.The gradual onset, the change from occasional regurgitation to the characteristic vomiting, the presence of gastric peristalsis and the routine palpation of the abdomen for a tumour must be the duty of the physician.Similarly, after the operation, the details of feeding are of great importance to secure a successful_ result and entirely beyond the province of the surgeon.The surgeon may study his operation figures and decide that his failures occur in wasted infants who have been weaned from one patent food to another. That his successes occur in the breast fed children of nearly normal weight and in his private cases which are nearly always diagnosed and operated on at an early age. It is reasonable for him to ask that his aid should be invoked before the patient is in extremis.We agree most heartily with Wallace & Wevill who show, in a report of 145 pyloric stenosis cases operated on in the Royal Hospital for Children, Edinburgh, that if the mortality rate which in this series was in the region of 20% is to be reduced to a reasonable figure,it is essential that the diagnosis should be made at a much earlier date.There appears in nearly all cases to be a period of three to four weeks after the commencement of symptoms, during which time these cases are treatrl as digestive disorders and the feeding is changed every few days in the vain hope that the vomiting will cease. Eventually, when the child is more or less in extremis, it is sent to hospital in a state of health which makes any form of treatment a dangerous procedure.Pyloric $tenosis should be considered as a possibility in every case of forceful vomiting in infancy and it should be recognised that the longer the delay in sending the cap i ld for treatment the less are its chances of survival.It should be cons idered an abdominal emergency of infants and one feels confident, if the condition . were diagnosed within one week after the commencement of symptoms and sent for operation without delay, the mortality rate would be greatly reduced,How can this be attained? We feel it is only from the family doctor, more keenly alive to this somewhat rare disease and more aware of the possibili ties of surgery, that further improvement must come

Splanchnology Cardiovascular and Immune Systems

Посібник рекомендований для студентів вищих медичних навчальних закладів IV рівня акредитації, які вивчають анатомію людини англійською мовою.This manual is intended for the students of medical higher educational institutions of IV accreditation level who study Human Anatomy in the English language

Notes of Cases of Remittent Fever which occurred in the Baltimore Almshouse Infirmary:

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INFANT FEEDING AND DISORDERS OF THE DIGESTIVE SYSTEM: RÉSUMÉ OF THE LITERATURE OF THE PAST SIX MONTHS

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Journal of the Allentown Hospital

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The radiological examination of the oesophagus

The aim of this Thesis has been to present a review of the scope , and of the limitations, of the radiological examination in the diagnosis of oesophageai lesions.After a general description of the special Anatomy and Physiology of the region, and of the technique used in its radiological investigation, the various pathological conditions found are.briefly described, with special reference to any X -Ray appearances which may be typical of the lesion.Wherever possible, prints from radiograms showing the the typical appearances upon which the radio -' logical diagnosis has been made are included.In conclusion, the following points are put forward:(I). A full radiological examination by a duly experienced radiologist should be made in the case of 1 . every patient presenting himself with symptoms refer - able to the oesophagus. This X -Ray examination should precede direct examination; in a large proport ion of cases it will enable a definite diagnosis to be made.(2). The danger of an incomplete examination is ;emphasised - for instance, if the oesophagus alone is examined, and that only in the erect position, (carcinomata of the fundus of the stomach will almost certainly be missed, though the condition may be the cause of the dysphagia which led to the examination and may give rise to no other symptoms.(3). It is of great importance that the fluoroscopic examination should be supplemented by the taking of radiograms, especially in the case of suspected radio- opaque foreign bodies of small size.(4). There is a well defined group of conditions, embracing most benign tumours of the gullet, superficial ulcerations without cicatricial stenosis, and most transradiant foreign bodies, in which the radiological findings are either very inconclusive or even entirely negative.In all these cases, the oesophagoscope is the only certain means of diagnosisAgain, in cases in which the radiological examination shows a state of spasm in some part of the oesophagus, it may not be possible to determine whether this is the result of the irritation of some organic intra- oesophageal lesion, such as a peptic ulcer, syphilitic or tubercular ulceration, early carcinoma or some such condition which does not give any direct radiological evidence of its presence, or is of reflex or even purely functional origin.Here also, direct examination is required in order to determine the exact state of the oesophageal lumen.(5). Para -Oesophageal, or Hiatus Hernia of the cardiac end of the stomach is not so rare a lesion as has been supposed.It is almost invariably diagnosed as a result of radiological examination, undertaken on account of a complaint of dysphagia, or of obscure and indefinite gastric symptoms.Para- Oesophageal Hernia can not be diagnosed except by X -ray examination, or surgical exploration.(6). The use of any blind method of examination of the oesophagus is quite unjustifiable

Volume 17, issue

The mission of CJS is to contribute to the effective continuing medical education of Canadian surgical specialists, using innovative techniques when feasible, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research. Visit the journal website at http://canjsurg.ca/ for more.https://ir.lib.uwo.ca/cjs/1130/thumbnail.jp