Double pylorus--an unusual complication of peptic ulcer disease.
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Three patients are presented with double pylori due to antrobulbary fistulas after penetration of ulcers through the prepyloric mucosa or the pyloric ring. Two cases were diagnosed radiographically; in one of them the diagnosis was confirmed by gastroscopy and verified by subsequent operation. The third case was revealed at autopsy. The etiology and pathogenesis of fistulas within the gastrointestinal tract are discussed with regard to the current literature.
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OBJECTIVE: To determine if ultrasonography is necessary for the diagnosis of pyloric hypertrophy in children and if in (clinical) doubt the ultrasonographic diagnosis of 'pylori hypertrophy' may constitute the indication for operation. SETTING: Leiden University Hospital and Amsterdam Centre for Paediatric Surgery. DESIGN: Retrospective study. METHOD: In the period 1985-1990, 83 children younger than 4 months were operated on for pyloric hypertrophy (group I; 73 of them had been examined by ultrasonography), while 15 underwent sonography because of suspicion of pyloric hypertrophy (group II), without operation. An attempt was made to find clinical and laboratory data that might be an indication of pyloric hypertrophy, and render supplementary ultrasonography unnecessary. RESULTS: In group I, the combination of projectile vomiting, discernible gastric peristalsis after test meal and metabolic alkalosis was present in 34%, while a tumour in the upper abdomen was palpated in 25%; neither finding was present in group II. The sensitivity of one-time ultrasonography was 74%, that including follow-up examination in case of doubt, 82%. The predictive value of an ultrasonographic result positive for 'pyloric hypertrophy' was 98%, that of a negative finding 52%, the accuracy was 84%. CONCLUSION: In children younger than 4 months with the combination of projectile vomiting, gastric peristalsis after test meal and metabolic alkalosis, or with a palpable swelling in the upper abdomen, no ultrasonography is necessary to make the diagnosis of 'pyloric hypertrophy'. In case of clinical doubt, the indication for operation may be based on the result of ultrasonography.
The clinical records of 18 children were studied, between 15 and 60 days old. They were hospitalized due to vomiting and diagnosis of suspected pyloric hypertrophic stenosis (PHS). The sonography confirmed the diagnosis in 8 children, by the thickening of the muscular layer and enlargement of the pyloric canal. The surgery (pyloromyotomy) ratified the diagnosis in all 8 children. They all were in good health after being operated.
The clinical records of 18 children were studied, between 15 and 60 days old. They were hospitalized due to vomiting and diagnosis of suspected pyloric hypertrophic stenosis (PHS). The sonography confirmed the diagnosis in 8 children, by the thickening of the muscular layer and enlargement of the pyloric canal. The surgery (pyloromyotomy) ratified the diagnosis in all 8 children. They all were in good health after being operated.
Within the recent 7 years in the clinic 400 operations of trunk vagotomy with drainage of the stomach were performed for complicated ulcers of the duodenum, 110 of them - in perforating ulcer. The postoperative mortality was 1.8%. The immediate and late results were studied within the terms from 6 months to 6 years. Good results were obtained in 79.9%, satisfactory - in 17.6%. Poor issues were noted in 1 patient, who was reoperated upon gastric resection being performed.
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A comparative study of gastric secretion in rats with pyloric ligature according to either Shays' or Dais' methods was carried on, studying in both groups gastic acid and peptic secretions, mucous pepsinogen, and Na+, K+, and Cl-. The acid-peptic output as well as gastric Pu/g were greater in Dais' method. There were no changes regarding mucous pepsinogen when comparing both methods. Cl- and Na+ determinations showed minimal changes, whereas K+ showed no difference in both methods. We explain these modifications based on the difference in the secreted volume, since the acid concentration and Pu/ml are practically the same when comparing both methods.
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