Feasibility of self-expandable metallic stent plus chemotherapy for metastatic gastric cancer with pyloric stenosis.

BACKGROUND AND AIM: Self-expandable metallic stent placement is accepted as palliative therapy for advanced gastric cancer with gastric outlet obstruction, but data are lacking for chemotherapy after self-expandable metallic stent insertion. This study retrospectively compared results between surgery plus chemotherapy and stenting plus chemotherapy for metastatic gastric cancer with pyloric stenosis. METHODS: Subjects comprised 26 patients who received chemotherapy after surgery or endoscopic stenting for metastatic gastric cancer with pyloric stenosis between April 2000 and December 2007 in four Japanese hospitals. Patients were categorized into two groups: 15 patients who received chemotherapy after surgery for pyloric stenosis (Surgery group); and 11 patients who received chemotherapy after self-expandable metallic stent placement for pyloric stenosis (Stent group). RESULTS: Median survival time and median time to treatment failure were 284 days and 226 days in the Surgery group and 337 days and 247 days in the Stent group, respectively. No significant differences were noted between survival and time to treatment failure. No significant differences were found in median oral intake rate (Surgery, 93.1%; Stent, 93.2%) or median hospital stay rate (Surgery, 24.6%; Stent, 23.7%) during survival. Response rate was 45.5% in the Surgery group and 50% in the Stent group, with no significant difference. Likewise, no significant differences were noted between groups for frequencies of toxicity or complications. CONCLUSIONS: The present results suggest that chemotherapy after stenting is as effective and safe as chemotherapy after surgery. Stents may replace surgery in combination therapy with chemotherapy for metastatic gastric cancer with gastric outlet obstruction.

Early death in two sisters with Hennekam syndrome.

We report on two sisters with facial anomalies, protein-losing enteropathy, and intestinal lymphangiectasia consistent with the diagnosis of Hennekam syndrome. Both patients had a number of other anomalies not previously described in this autosomal recessive disorder, i.e., primary hypothyroidism, hypertrophic pyloric stenosis, and an early fatal outcome. These cases support the autosomal recessive transmission and the expansion of the phenotype of the Hennekam syndrome.

Long-term investigations after pyloromyotomy for infantile pyloric stenosis.

Between 1919 and 1941, 71 infants suffering from pyloric hypertrophy were operated on by Ramstedt performing an extramucosal pyloromyotomy. Of these patients, we could identify and investigate 41. Four out of 31 long-term surviving patients have been Billroth II-resected (BII). One of these needed re-resection because of an anastomotic ulcer. None of all the long-term survivors developed a carcinoma. Two patients were treated conservatively because of gastritis and one because of esophagitis. All patients, except the one requiring re-resection and one suffering from maldigestion, were absolutely free of complaints. The average time between operation and re-checking was 57 years. The oldest patient was examined 72 years after the operation.

Infantile hypertrophic pyloric stenosis.

A brief review of the development of the surgical management of infantile hypertrophic pyloric stenosis is made. The incidence, investigation, management and complications of cases treated at the Royal Hospital for Sick Children, Glasgow over a period of six decades is reported. The mortality fell from 59 per cent in 1925 to 0 per cent in 1975. Pyloromyotomy in infants with hypertrophic pyloric stenosis is shown to be a very effective treatment for this potentially lethal condition and must rank as one of the most cost-effective forms of treatment in medical practice.

Hospitalization of rural and urban infants during the first year of life.

OBJECTIVES: To examine hospitalizations and length of stay (LOS) for infants aged <1 year in rural and urban counties, hypothesizing that infants living in rural counties experience significantly different hospital use compared with urban infants. METHODS: Birth certificates for infants born in California hospitals between 1993 and 2005 and surviving to discharge were linked to hospital discharge records and death certificates during the first year of life, resulting in a study population of >6.4 million. Hospitalizations, cumulative LOS, readmission rates, and mortality were compared by using univariate and multivariable analysis for infants living in small rural, large rural, small urban, and large urban counties. Odds of hospitalization and cumulative LOS were also examined for common infant diagnoses. RESULTS: Infants living in increasingly rural counties experienced decreasing rates of hospitalization and decreasing number of hospitalized days during the first year of life. Infants living in small rural counties experienced 370 hospital days per 1000 infants compared with 474 hospital days per 1000 infants living in large urban counties. In multivariable analysis, infants in large urban counties experienced increased odds of hospitalization (odds ratio: 1.20 [95% confidence interval: 1.06-1.36]) and increased hospitalized days (incidence risk ratio: 1.17 [95% confidence interval: 1.06-1.29]) compared with infants in small rural counties. For most common diagnoses, urban residence was associated with either increased odds of hospitalization or increased cumulative LOS. CONCLUSIONS: Infants living in rural California counties experienced decreased hospital utilization, including decreased hospitalization and decreased LOS, compared with infants living in urban counties.

Determinants of good outcome in pyloric stenosis.

Good outcome following pyloromyotomy for pyloric stenosis is dependent on the training of the surgeon, availability of a specialist paediatric anaesthetist, and the quality of preoperative correction of fluid and electrolyte abnormalities. Complications (including death, inadvertent duodenal perforation, incomplete pyloromyotomy, wound dehiscence and infection), higher hospital costs and increased length of hospital stay are all more likely to occur when the pyloromyotomy is performed by a surgeon who has had no speciailist paediatric surgical training.

[Pyloromyotomy, 720 cases (1953-1982). Retrospective study]. / Pyloromyotomie, 720 Fälle (1953-1982). Eine retrospektive Analyse.

From 1953 to 1982 720 babies underwent pyloromyotomy for infantile hypertrophic pyloric stenosis. In this retrospective report the results obtained are compared to the data published in the literature.