1
|
Muse AI, Hussein BO, Adem BM, Osman MO, Abdulahi ZB, Ibrahim MA. Treatment outcome and associated factors of infantile hypertrophic pyloric stenosis at eastern Ethiopia public hospitals. BMC Surg 2024; 24:262. [PMID: 39272073 DOI: 10.1186/s12893-024-02567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 09/09/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is a condition whose etiology is not clear, but it is characterized by progressive hypertrophy of the circular muscles of the pylorus with consequent obstruction of the gastric outflow, mostly in neonates and infants under the age of one year. OBJECTIVES To assess the treatment outcome and associated factors of infantile pyloric sphincter stenosis among paediatric patients admitted to HFCSUH and JUSHYRH. METHODOLOGY A retrospective patient record review with 78 participants was studied consecutively using a structured questionnaire. The data was processed and analyzed using Epi Info 7 and SPSS version 24. Descriptive analysis was done, and then associated factors to the outcome were assessed using logistic regression analysis. The association's significance was determined using an odds ratio with a 95% confidence interval and a P-value less than 0.05. The study period was from November 1st to 30th, 2022. RESULTS The magnitude of unfavorable IHPS was 17.1% with a 95% confidence interval of 16.7-23.9%. Hypokalemia (AOR = 2.3, CI = 3.015-19.54), severe dehydration (AOR = 30.9, CI = 2.89-31.75), and delayed presentation (AOR = 7.37, CI = 2.761-12.08) were independent predictors. CONCLUSIONS The study found a highly unfavorable treatment outcome with delayed presentation; dehydration and electrolyte disturbance were the main predictors of poor outcome. It is recommended to increase community awareness about non-bilious vomiting in infants and ensure high suspicion among healthcare providers. Moreover, following guidelines to correct fluid and electrolyte disturbances and managing these patients in the pediatric ICU postoperatively.
Collapse
Affiliation(s)
- Abdilahi Ibrahim Muse
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, P.O.BOX: 1020, Jigjiga, Ethiopia.
| | - Badri Omar Hussein
- Department of Medicine, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Burka Mohammedsani Adem
- Department of Medicine, College of Medicine and Health Science, Haramaya University, Harar, Ethiopia
| | - Mohamed Omar Osman
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, P.O.BOX: 1020, Jigjiga, Ethiopia
| | - Zinedin Beker Abdulahi
- Department of Medicine, College of Medicine and Health Science, Haramaya University, Harar, Ethiopia
| | - Musse Ahmed Ibrahim
- Department of Medicine, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| |
Collapse
|
2
|
Khandelia H, Krishnan N, Kainth D, Verma A, Anand S, Agarwala S. Comparison between umbilical and right upper transverse abdominal incisions for pyloromyotomy: a systematic review and meta-analysis. Pediatr Surg Int 2024; 40:163. [PMID: 38935193 DOI: 10.1007/s00383-024-05747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
The aim of this study was to compare the operative parameters and complication rates between the umbilical (UMB) and right upper quadrant (RUQ) skin incisions for Ramstedt's pyloromyotomy for the treatment of infantile hypertrophic pyloric stenosis (IHPS). PubMed, EMBASE, Web of Science and Scopus databases were systematically searched. The studies where any one of the main outcomes of interest, i.e., operative time, wound infection rate, mucosal perforation rate were reported were eligible for inclusion. The statistical analysis was performed using a random-effects model. The methodological quality of the studies was assessed utilizing the Newcastle-Ottawa Scale. Fifteen studies comprising 2964 infants were included. As compared to the UMB group, the RUQ group showed a significantly lower mean operative time (p = 0.0004), wound infection rate (p < 0.0001) and mucosal perforation rate (p = 0.02). Although UMB incision produces an almost undetectable scar, this approach results in significantly more complications. Therefore, the risks and benefits must be weighed and discussed with the caregivers in deciding the surgical approach in patients with IHPS. However, due to a poor methodological quality of nine out of fifteen studies, further studies need to be conducted for an optimal comparison between the two groups.
Collapse
Affiliation(s)
| | - Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| | - Deepika Kainth
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Verma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| | - Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India.
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| |
Collapse
|
3
|
Leonhardt J, Muensterer O, Alsweed A, Schmedding A. Nationwide trends of laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis in Germany: A slow path forward. Front Pediatr 2023; 11:1149355. [PMID: 37090925 PMCID: PMC10117636 DOI: 10.3389/fped.2023.1149355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023] Open
Abstract
Since its introduction, laparoscopic pyloromyotomy (LP), has become increasingly popular in many countries. We have noticed an attenuated trend in Germany. The aim of this study was to analyse the distribution of open and LP in Germany. The national database of administrative claims data of the Institute for the Remuneration System in Hospitals (InEK) was analysed regarding numbers of patients with pyloromyotomy in the years 2019-2021. The German quality reports of the hospitals of 2019 and 2020 were analyzed regarding the number of procedures performed per hospital and pediatric surgical department. A total of 2050 patients underwent pyloromyotomy. The incidence of hypertrophic pylorus stenosis (HPS) was 699 and 657 patients in 2019 and 2021, respectively. Regarding age, 31.1% were admitted before 28 days of age. LP gradually increased from 216 patients (30.9%) in 2019 to 239 patients (36.4%) in 2021. Thirty-three laparoscopic operations (4.8%) were converted to an open approach. In 24 of all patients, there was an injury to the stomach, in 20 patients to the duodenum, needing repair with sutures. Analysis of the quality reports indicated that 44% of pediatric surgical departments performed LP. Although LP has became more prevalent in Germany recently, about two thirds of patients still undergo an open procedure.
Collapse
Affiliation(s)
- Johannes Leonhardt
- Department of Pediatric Surgery and Pediatric Urology, Klinikum Braunschweig gGmbH, Braunschweig, Germany
| | - Oliver Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU Klinikum, Munich, Germany
- Correspondence: Oliver Muensterer
| | - Ahmad Alsweed
- Department of Pediatric Surgery and Pediatric Urology, Klinikum Braunschweig gGmbH, Braunschweig, Germany
| | - Andrea Schmedding
- Department of Pediatric Surgery and PediatricUrology, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt, Germany
| |
Collapse
|
4
|
Factors associated with pyloric hypertrophy severity and post-operative feeding and nutritional recovery in infantile hypertrophic pyloric stenosis. Biomed J 2022; 45:948-956. [PMID: 34995820 PMCID: PMC9795358 DOI: 10.1016/j.bj.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To examine factors that affect the severity of pyloric hypertrophy, post-operative feeding and nutritional recovery in infantile hypertrophic pyloric stenosis (IHPS). METHODS Medical records of infants diagnosed with IHPS at a single tertiary center between 2009 and 2018 were retrospectively reviewed. Clinical characteristics, biochemistry data and outcome were assessed for their association with the severity of pyloric hypertrophy and post-operative recovery. Nutritional recovery was assessed using weight-for-age status improvement after surgery. RESULTS Eighty-five patients were recruited in this study. The mean pre-operative weight-for-age percentile was 18.2. Elevated bicarbonate was positively correlated with symptom duration (p = 0.007). Pyloric muscle thickness was significantly correlated with age, weight, and symptom duration (p = 0.004, 0.003, 0.008, respectively). The mean weight-for-age percentile increased to 41.6 by post-operative weeks 6-8. Pyloric muscle thickness was negatively correlated with nutritional recovery by post-operative weeks 6-8 (p = 0.003). In multivariable analysis, pyloric length related to nutritional recovery at week 1-2 postoperatively (OR = 1.42, p = 0.030, 95% CI = 0.03-1.94), and pyloric muscle thickness related to nutritional recovery at week 6-8 postoperatively (OR = 4.08, p = 0.032, 95% CI = 1.13-14.7). CONCLUSION Our study indicated that favorable nutritional outcome and successful weight gain was observed 6-8 weeks after surgery in children with IHPS. Pyloric muscle thickness positively correlated with age, weight, symptom duration, and favorable nutritional recovery. Serum bicarbonate showed a positive correlation with symptom duration.
Collapse
|
5
|
van den Bunder FAIM, Allema JH, Benninga MA, de Blaauw I, van de Brug T, den Dulk M, Hulscher JBF, Keyzer-Dekker CMG, Witvliet MJ, van Heurn ELW, Derikx JPM. The Dutch Incidence of Infantile Hypertrophic Pyloric Stenosis and the Influence of Seasons. Eur J Pediatr Surg 2021; 31:525-529. [PMID: 33171518 DOI: 10.1055/s-0040-1721055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Studies report contradicting results on the incidence of infantile hypertrophic pyloric stenosis (IHPS) and its association with seasons. We aim to assess the IHPS incidence in the Netherlands and to determine whether seasonal variation is present in a nationwide cohort. MATERIALS AND METHODS All infants with IHPS hospitalized in the Netherlands between 2007 and 2017 were included in this retrospective cohort study. Incidence rates per 1,000 livebirths (LB) were calculated using total number of LB during the matched month, season, or year, respectively. Seasonal variation based on month of birth and month of surgery was analyzed using linear mixed model and one-way ANOVA, respectively. RESULTS A total of 2,479 infants were included, of which the majority was male (75.9%). Median (interquartile range) age at surgery was 34 (18) days. The average IHPS incidence rate was 1.28 per 1,000 LB (variation: 1.09-1.47 per 1,000 LB). We did not find a conclusive trend over time in IHPS incidence. Differences in incidence between season of birth and season of surgery were not significant (p = 0.677 and p = 0.206, respectively). CONCLUSION We found an average IHPS incidence of 1.28 per 1,000 LB in the Netherlands. Our results showed no changing trend in incidence and no seasonal variation.
Collapse
Affiliation(s)
- Fenne A I M van den Bunder
- Department of Pediatric Surgery, University of Amsterdam and Vrije Universiteit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jan Hein Allema
- Department of Pediatric Surgery, Juliana Children's Hospital, HAGA Hospital, The Hague, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, University of Amsterdam and Vrije Universiteit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud University, Amalia Children's Hospital, Radboud UMC, Nijmegen, The Netherlands
| | - Tim van de Brug
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, The Netherlands
| | - Marcel den Dulk
- Department of Surgery, MUMC, Maastricht University, Maastricht, The Netherlands
| | - Jan B F Hulscher
- Department of Pediatric Surgery, University of Groningen, Beatrix Children's Hospital, UMC Groningen, Groningen, The Netherlands
| | - Claudia M G Keyzer-Dekker
- Department of Pediatric Surgery, Erasmus Medical Center, Erasmus University, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marieke J Witvliet
- Department of Pediatric Surgery, University of Utrecht, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Ernest L W van Heurn
- Department of Pediatric Surgery, University of Amsterdam and Vrije Universiteit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, University of Amsterdam and Vrije Universiteit, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Infantile hypertrophic pyloric stenosis in Bosnia and Herzegovina: A retrospective cohort study from the largest tertiary care facility. Asian J Surg 2021; 45:1694-1697. [PMID: 34801371 DOI: 10.1016/j.asjsur.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/07/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is the most common condition requiring surgery in infancy, but the etiology of IHPS is still unclear. The study aimed to analyze the epidemiological and clinical features of the infants with IHPS in our setting and determine the yearly trends in IHPS incidence in the Sarajevo Canton between 2007 and 2016. METHODS We retrospectively analyzed epidemiologic, clinical, and operative data of all infants undergoing pyloromyotomy for IHPS over ten years in the largest tertiary care facility in Bosnia and Herzegovina. RESULTS Fifty-three IHPS patients were diagnosed, yielding an overall incidence of 1.17 per 1000 live births (1.25 and 1.09 cases in 2007-2011 and 2012-2016, respectively). IHPS was more prevalent among male infants (ratio 6.6:1, p < 0.001). The mean age at onset of symptoms was 39.6 days (range, 17-107 days). The estimated median time from symptoms onset to hospitalization was 11 days (range, 1-17 days). The mean age at diagnosis was significantly longer in premature infants compared with term infants (p = 0.003). Both first-born rank and bottle-feeding were significantly associated with IHPS (p = 0.001 and p = 0.04, respectively). No seasonal variation associated with IHPS was detected (p = 0.25). No evidence was found of differences in the incidence of IHPS related to maternal age (p = 0.24) and smoking (p = 0.59). CONCLUSION Our data indicate a declining trend and provide insights into the clinical characteristics of IHPS in Bosnia and Herzegovina. Most of the obtained results are in line with the published data and could improve the quality of local pediatric services.
Collapse
|
7
|
Oetzmann von Sochaczewski C, Muensterer OJ. The incidence of infantile hypertrophic pyloric stenosis nearly halved from 2005 to 2017: analysis of German administrative data. Pediatr Surg Int 2021; 37:579-585. [PMID: 33469698 PMCID: PMC8026414 DOI: 10.1007/s00383-020-04810-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Some paediatric surgical diseases showed a declining incidence in recent years, among which hypertrophic pyloric stenosis has been particularly striking shortly in the years after the millennium. We aimed to assess whether this development continued over the following decade, as it might offer the chance to better understand the underlying reasons. METHODS We analysed data files obtained from the German federal statistics office for principal diagnosis of hypertrophic pyloric stenosis and pyloromyotomies from 2005 to 2017. Changes over time were assessed via linear regression for incidences per 1000 live births. RESULTS In the respective time interval, there were a mean of 1009 pyloromyotomies (95% CI 906-1112) per year, of which a mean of 835 (95% CI 752-917) were performed in boys. The incidence of hypertrophic pyloric stenosis per 1000 live births almost halved between 2005 and 2017: it decreased by 0.12 pylorotomies annually (95% CI 0.09-0.14; P < 0.0001) in boys-from a maximum of 2.96 to a minimum of 1.63-and 0.03 pyloromyotomies annually (95% CI 0.02-0.04; P < 0.0001) in girls-from a maximum of 0.64 to a minimum of 0.28. There was considerable regional variation in incidences between the German länder. CONCLUSION The decreasing incidence of hypertrophic pyloric stenosis noted around the millenium continued into the following decades. The underlying reasons are unclear, which should prompt further research on the subject matter.
Collapse
Affiliation(s)
- Christina Oetzmann von Sochaczewski
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany ,Sektion Kinderchirurgie der Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Oliver J. Muensterer
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany ,Kinderchirurgische Klinik und Poliklinik, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität, München, Germany
| |
Collapse
|
8
|
Gilani SA, Bacha R, Manzoor I. Sonography and Test-Feeding in the Diagnosis of Infantile Hypertrophic Pyloric Stenosis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320961075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the use of sonography and test-feeding in the diagnosis of infantile hypertrophic pyloric stenosis (IHPS). Methodology: A total of 79 infants from 2 weeks up to 12 weeks presenting with clinical signs (projectile vomiting) of IHPS were included in the study while sent to sonography. The study duration was February 2014 to December 2019. Results: The mean age of patients was 5.18 ± 2.69 weeks ranging from 1 to 12 weeks. Male gender was predominant with 62 (78.5%) cases. Of the total 79 cases, 36 (54.6%) were suggested as positive cases of IHPS and 43 (54.4%) were as normal with sonography. Most of the cases of IHPS (23; 29.1%) were observed in firstborn babies. Mean pyloric length in normal and IHPS was 12.69 ± 0.87 and 20.78 ± 2.28 mm, respectively, and mean pyloric muscle thickness in the normal and IHPS was 2.24 ± 0.36 and 5.27 ± 0.82 mm, respectively, while mean pyloric diameter in normal and IHPS was 12.69 ±0.87 and 15.01± 2.52 mm, respectively. Conclusion: The reliability of sonographic findings was better than test-feeding in the diagnosis of IHPS. Male infants, in this cohort, were five times more susceptible to develop IHPS, compared with females.
Collapse
Affiliation(s)
- Syed Amir Gilani
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Raham Bacha
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
- Gilani Ultrasound Center, Lahore, Pakistan
| | | |
Collapse
|
9
|
Yau A, Cha R, Jayaratnam S, Wilson T, Kukkady A, Evans SM, Wells JM. Declining incidence of pyloric stenosis in New Zealand. ANZ J Surg 2019; 89:1242-1245. [PMID: 31450263 DOI: 10.1111/ans.15377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/04/2019] [Accepted: 06/22/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pyloric stenosis is a relatively common paediatric surgical condition, but a worldwide decline in its incidence has been observed in recent decades. The objective of this study was to identify if the incidence of pyloric stenosis in New Zealand has been declining. METHODS A retrospective review of the four New Zealand paediatric surgical centres' theatre databases from 2007 to 2017. Demographic data were recorded for all infants who had a pyloromyotomy and annual incidences of pyloric stenosis calculated. RESULTS A total of 393 infants underwent a pyloromyotomy for pyloric stenosis during the study period. Most infants (81%) were of European ethnicity. There was a significant decline (P = 0.0001) in the national incidence of pyloric stenosis from 0.73/1000 live births (LB) in 2007 to 0.39/1000 LB in 2017. From 2007 to 2017, the incidence of male infants with pyloric stenosis declined from 1.27/1000 LB to 0.62/1000 LB. The current annual incidence of pyloric stenosis in New Zealand is 0.39/1000 LB. CONCLUSIONS The incidence of pyloric stenosis in New Zealand has significantly declined in the last decade and is currently the lowest reported incidence in the world involving a predominantly European cohort. A decline in male infants developing pyloric stenosis was also observed. Further study is required to investigate causes for this low incidence and declining trend.
Collapse
Affiliation(s)
- Annie Yau
- Department of Pediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Ryan Cha
- Department of Pediatric Surgery, Starship Children's Health, Auckland, New Zealand
| | | | - Toni Wilson
- Department of Pediatric Surgery, Wellington Regional Hospital, Wellington, New Zealand
| | - Askar Kukkady
- Department of Pediatric Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Stephen M Evans
- Department of Pediatric Surgery, Starship Children's Health, Auckland, New Zealand
| | - Jonathan M Wells
- Department of Pediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
| |
Collapse
|
10
|
Abstract
Infantile hypertrophic pyloric stenosis (IHPS) is the most common gastrointestinal disease among infants. IHPS occurs as an isolated condition or together with other congenital anomalies. Association with genetic and environmental factors, bottle feeding, younger maternal age, maternal smoking, and erythromycin administration in the first two weeks of life has been shown. Familial aggregation has been described and a family history is seen in 47.9 percent of siblings. Infants typically present with projectile vomiting associated with symptoms of failure to thrive. An olive-like mass palpable in the right upper abdominal quadrant is being reported less frequently because of earlier diagnosis by ultrasound. IHPS is generally corrected through laparoscopic pyloromyotomy. Endoscopic pyloric balloon dilation is a novel alternative. Further studies on different populations, the general population, and familial segregation to determine the prevalence, influence, and mode of familial aggregation and correlation with environmental factors are needed to determine the etiology of IHPS.
Collapse
|
11
|
Ndongo R, Tolefac PN, Tambo FFM, Abanda MH, Ngowe MN, Fola O, Dzekem B, Weledji PE, Sosso MA, Minkande JZ. Infantile hypertrophic pyloric stenosis: a 4-year experience from two tertiary care centres in Cameroon. BMC Res Notes 2018; 11:33. [PMID: 29338765 PMCID: PMC5771033 DOI: 10.1186/s13104-018-3131-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/06/2018] [Indexed: 01/25/2023] Open
Abstract
Objective This study aimed to describe the clinical characteristics of patients with infantile hypertrophic stenosis, management and its outcome in two tertiary care centres in Cameroon. Results A total of 21 patients were included from the two centres. The mean age at presentation was 5.2 ± 1.2 weeks, predominantly male with a male-to-female ratio of 4.25:1. The triad of vomiting, visible peristalsis and palpable mass was present in only 7 (33.3%) of the participants. The diagnosis was confirmed with ultrasounds in all participants. Ramstedt pyloromyotomy was done in all participants and in 9.5% of the participants it was complicated by intra-operative duodenal perforation whereas in the postoperative period the most common complications were vomiting (6, 28.6%), sepsis (2, 9.5%), and paralytic ileus (2, 9.5%). The mortality rate from the series is 9.5%. According to univariate logistic regression: severe dehydration [OR = 5.41, 95% CI = (3.11–6.97), p = 0.002], hypokalaemia [OR = 2.63, 95% CI = (1.02–5.91), p = 0.042] and surgical site infection [OR = 3.12, 95% CI (1.22–5.64), p = 0.023] were the main predictors of mortality whereas postoperative hospital length of stay > 5 days was significantly associated with surgical site infection [OR = 2.44, 95% CI = (1.12–6.44), p = 0.002] and postoperative nausea and vomiting [OR = 3.64, 95% CI = (1.18–6.64), p = 0.022].
Collapse
Affiliation(s)
| | - Paul Nkemtendong Tolefac
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon. .,Douala General Hospital, Douala, Cameroon.
| | | | | | | | - Olivier Fola
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | | | | |
Collapse
|
12
|
Ezomike UO, Ekenze SO, Amah CC, Nwankwo EP, Obianyo NE. Infantile hypertrophic pyloric stenosis - Our experience and challenges in a developing country. Afr J Paediatr Surg 2018; 15:26-30. [PMID: 30829305 PMCID: PMC6419543 DOI: 10.4103/ajps.ajps_51_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study aims to evaluate the experience and challenges in managing patients with infantile hypertrophic pyloric stenosis (IHPS). PATIENTS AND METHODS From January 2007 to December 2015, data from patients with IHPS were retrospectively acquired and analyzed using SPSS version 15. Pearson correlation used to assess linear relationships and Student t-test to compare means. P < 0.05 was taken as statistically significant. Results were expressed as percentages, means ± standard deviation and illustrated in tables and graphs. RESULTS Twenty-six cases were managed with the mean age at diagnosis of 49.16 ± 21.4 days. Mean birth weight was 3.7 kg and mean weight at presentation was 3.3 kg. Firstborn was affected in 29%; 91% were term deliveries; 9% were post-term; none was preterm; and 36% were exclusively breastfed. Mean duration of symptoms was 25.6 ± 18.9 days. Hyponatraemia was seen in 36%, hypokalaemia 37.5%, alkalosis 35% and hypochloraemia 62%. Mean pyloric tumour length was 22.85 ± 6.56 mm and pyloric wall thickness 5.51 ± 1.36 mm. There was a significant correlation between duration of symptoms and serum potassium level (R = -0.6326, P = 0.002). Mean symptom duration in patients with hypokalaemia was 39.88 ± 23.41 days and without hypokalaemia 17.15 ± 9.78 days (P = 0.006). Mean hospital stay was 9.45 ± 3.27 days. Four patients developed four complications and three patients died (11.5%). Mean age at presentation for pre-operative mortalities was 84 ± 39 days and 46 ± 17.98 days for others (P = 0.015). CONCLUSIONS IHPS presents late in our environment and occurs mainly in term males. There is a significant positive relationship between duration of symptoms and serum potassium level and the mean duration of symptoms was significantly longer in those with hypokalaemia. Pre-operative mortality was significantly associated with longer duration of symptoms.
Collapse
Affiliation(s)
| | | | - Christopher Chim Amah
- Sub-Department of Pediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Nene Elsie Obianyo
- Sub-Department of Pediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| |
Collapse
|
13
|
Marks IH, Chang DC, Masiakos PT, Kelleher CM. Is all-cause readmission an appropriate performance measure for pediatric surgeons? A case study in pyloromyotomy. J Pediatr Surg 2017; 52:1426-1429. [PMID: 28038764 DOI: 10.1016/j.jpedsurg.2016.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION All cause readmissions are used as a surrogate metric for quality of care for both hospitals and physicians, and are considered in pay for performance initiatives. However, the integrity of using all cause readmissions as a benchmark for surgical outcomes has received little attention. Pyloromyotomy for hypertrophic pyloric stenosis is considered a safe pediatric surgical procedure with few complications or readmissions. The incidence of in hospital complications has been reported, however the rate of readmissions and specifically the proportion of readmissions related to surgical complications have not been previously reported. METHODS Data were abstracted from the longitudinally linked Office of Statewide Health Planning and Development data from the State of California from 1995 to 2009, allowing patient tracking across all hospitals and years within California. Inclusion criteria were primary procedure code of pyloromyotomy, a diagnosis code of hypertrophic pyloric stenosis, and no prior record of any in-hospital admission. RESULTS A total of 1900 patients were identified: 16.8% girls, 31.7% whites, 5.1% blacks, and 58.2% Hispanics. The median length of stay was 2days (IQR 2-3days). The in-hospital complication rate was 5.16% and overall complication rate was 6.84%; there were no deaths. The rate of 30-day all-cause readmission was 4.01%, with a median of 0% across hospitals (IQR 0%-1.1%); and 13.2% of readmissions occurred at a different hospital. Surgically-related readmission rate was 2.16%. Surgically-related readmission comprised 36% readmissions at 30days, but only 13% readmissions overall. The top three primary diagnoses on readmission were respiratory infections (43%), nonrespiratory infections (14%) and other nonsurgical GI indications (14%). All-cause readmissions at 60days, 90days, 180days, and 1year were 5.8%, 7.3%, 10.4%, and 13.7%, respectively. CONCLUSION Thirty-day readmission for a surgical complication occurs in 1 of 50 patients undergoing a pyloromyotomy for hypertrophic pyloric stenosis but for all causes is twice as likely, 1 in 25 patients. All-cause readmission is an inadequate measure for the quality of surgical care and the performance of pediatric surgeons. This is a Prognostic Study with Level II Evidence.
Collapse
Affiliation(s)
- Isobel H Marks
- Department of Surgery, Massachusetts General Hospital; Barts and the London School of Medicine and Dentistry, University of London
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital; Harvard Medical School
| | - Peter T Masiakos
- Harvard Medical School; Department of Pediatric Surgery, MassGeneral Hospital for Children
| | - Cassandra M Kelleher
- Harvard Medical School; Department of Pediatric Surgery, MassGeneral Hospital for Children.
| |
Collapse
|
14
|
Li J, Gao W, Zhu JM, Zuo W, Liu X. Epidemiological and clinical characteristics of 304 patients with infantile hypertrophic pyloric stenosis in Anhui Province of East China, 2012-2015. J Matern Fetal Neonatal Med 2017; 31:2742-2747. [PMID: 28701060 DOI: 10.1080/14767058.2017.1355361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the clinical and epidemiological features of patients with infantile hypertrophic pyloric stenosis (IHPS) so as to provide scientific evidence for diagnosis and prevention of IHPS. METHODS We performed a retrospective study of infants with IHPS diagnosed from 2012 to 2015 at Anhui Provincial Children's Hospital. Demographic characteristics and clinical data were collected. RESULTS Three hundred four patients (264 males and 40 females) were studied, of which 94.7% were full term and 75.7% were bottle fed or mixed fed; 16.8% of the patients had other congenital malformations in combination with IHPS. The proportion of IHPS cases with hyponatremia, hypokalemia, and hypochloremia was 18.4%, 12.5%, and 53.9%. A negative correlation was found between duration of disease and serum electrolytes. The mean pyloric muscle thickness, pyloric length, and diameter were 4.8 ± 0.7 mm, 19.4 ± 2.5 mm, and 13.3 ± 1.8 mm, respectively. There were significant differences in muscle thickness, pyloric length, and diameter between short (≤14 d) and long (>14 d) durations of disease. All patients underwent pyloromyotomy, and postoperative recovery was good. CONCLUSIONS IHPS occurs mainly in male, full-term, bottle-fed or mixed-fed infants. Patients with long duration of disease were more likely to develop electrolyte disorder and thicker muscle layer. More attention should be paid to early discovery and diagnosis, which will help to improve the curative effect and prognosis of IHPS.
Collapse
Affiliation(s)
- Jing Li
- a Department of Public Health and General Medicine , Anhui University of Chinese Medicine , Hefei , Anhui , China
| | - Wei Gao
- b Department of Pediatric Surgery , Anhui Provincial Children's Hospital , Hefei , Anhui , China
| | - Ji-Min Zhu
- a Department of Public Health and General Medicine , Anhui University of Chinese Medicine , Hefei , Anhui , China
| | - Wei Zuo
- b Department of Pediatric Surgery , Anhui Provincial Children's Hospital , Hefei , Anhui , China
| | - Xiang Liu
- b Department of Pediatric Surgery , Anhui Provincial Children's Hospital , Hefei , Anhui , China
| |
Collapse
|
15
|
Wu SF, Lin HY, Huang FK, Chen AC, Su BH, Li CI, Lin HC. Efficacy of Medical Treatment for Infantile Hypertrophic Pyloric Stenosis: A Meta-analysis. Pediatr Neonatol 2016; 57:515-521. [PMID: 27215474 DOI: 10.1016/j.pedneo.2016.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/21/2016] [Accepted: 02/21/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is a common disease in infancy. Pyloromyotomy is universally considered the treatment for IHPS; however, oral or intravenous atropine has been reappraised for the treatment of IHPS in the past 20 years. We investigated the efficacy of atropine in the medical management of IHPS by using meta-analysis and investigated the sonographic changes of the pyloric canal, as well as the efficacy and adverse effects of atropine. METHODS Information was retrieved from PubMed, Ovid, and MEDLINE. The efficacy and adverse effects of atropine treatment for IHPS were reviewed using the standard process of meta-analysis. RESULTS Eleven articles were obtained. Five reports showed that 77 of 110 (70%) infants who were administered oral atropine benefitted by the induced remission of IHPS. Six reports showed that 288 of 345 (83.5%) patients who were treated initially with intravenous atropine then changed to oral atropine showed beneficial effects and had no serious side effects. Time to pyloric muscle normalization ranged from 5 weeks to 15 months. CONCLUSION The study results indicate that atropine is a possible alternative treatment for IHPS, particularly in infants with major concurrent disease, and is safe without obvious side effects.
Collapse
Affiliation(s)
- Shu-Fen Wu
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiang-Yu Lin
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Fu-Kuei Huang
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan
| | - An-Chyi Chen
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Bai-Horng Su
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Chih Lin
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
16
|
Chia ST, Chen SCC, Lu CL, Sheu SM, Kuo HC. Epidemiology of Hirschsprung's Disease in Taiwanese Children: A 13-year Nationwide Population-based Study. Pediatr Neonatol 2016; 57:201-6. [PMID: 26541757 DOI: 10.1016/j.pedneo.2015.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/13/2015] [Accepted: 04/27/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Hirschsprung's disease (HD) is an important colon disease in children. The aim of this study is to describe the epidemiological features of HD in Taiwanese children. METHODS We conducted a study from the Taiwan National Health Insurance Research Database and analyzed cases who received surgical intervention between 1998 and 2010 due to HD (International Classification of Diseases, 9(th) Revision, Clinical Modification 751.3) or megacolon (International Classification of Diseases, 9(th) Revision, Clinical Modification 564.7). The incidence, sex ratio, age at the surgical intervention, associated complication, and medical expenditures were analyzed. RESULTS There were a total of 629 HD cases, including 458 boys and 171 girls, with an overall incidence of 2.2 per 10,000 live births. The male-to-female incidence ratio was 2.38. There was no secular trend of incidence across the years. Seventy-two percent of cases received surgical treatment before the age of 1 year. The younger cases had higher operation-related medical expenditures. Those patients with preoperative enterocolitis (EC) had a higher possibility of postoperative EC than those patients without preoperative EC (34.6% vs. 24.3%, p = 0.013). There were 169 (26.9%) HD cases with additional anomalies, the most common being gastrointestinal and circulatory system anomalies. Of these, 12 (1.9%) cases were Down syndrome. CONCLUSION The incidence of HD in Taiwanese children, a majority Chinese population, was one per 4545 live births with a male predominance. Preoperative EC was a significant factor that was associated with postoperative EC. The percentage associated with Down syndrome was relatively low, probably due to a prenatal screening program.
Collapse
Affiliation(s)
- Shu-Ti Chia
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; The Institute of Clinical Medicine of National Cheng Kung University, Tainan City, Taiwan
| | - Solomon Chih-Cheng Chen
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; Department of Pediatrics, School of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chin-Li Lu
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Shew-Meei Sheu
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Hsing-Ching Kuo
- Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
| |
Collapse
|
17
|
Badebarin D, Aslanabadi S, Yazdanpanah F, Zarrintan S. Is there any correlation between radiologic findings and eradication of symptoms after pyloromyotomy in hypertrophic pyloric stenosis? Afr J Paediatr Surg 2016; 13:73-5. [PMID: 27251656 PMCID: PMC4955443 DOI: 10.4103/0189-6725.182560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hypertrophic pyloric stenosis (HPS) is one of the most common gastrointestinal disorders during early infancy, with an incidence of 1-2:1000 live births in the world. In this study, we aimed to investigate the correlation between radiologic findings and eradication of symptoms after pyloromyotomy in HPS. MATERIALS AND METHODS One hundred and twenty-five (102 boys and 23 girls) patients with suspected infantile HPS were treated surgically by Ramstedt pyloromyotomy between March 21, 2004 and March 20, 2014 at paediatric surgery ward of Tabriz Children's Hospital, Iran. The demographic features, clinical findings, diagnostic work-up, operation type and postoperative specifications of the patients were studied retrospectively. RESULTS Male to female ratio was 4:1. The patients were 16-90 days of old and the mean age was 39 ± 1.42 days. The range of pyloric canal length was 7.60-29.00 mm and the mean length was 19.54 ± 3.42 mm. Pyloric muscle diameter was 2.70-9.00 mm, and the mean diameter was 4.86 ± 1.14 mm. Seventy-two percent of patients had episodes of vomiting after operation. Mean time of persistence of vomiting after pyloromyotomy was 15.73 ± 0.15 h. Mean discharge time was 55.22 ± 0.08 h. Radiologic findings did not show any significant correlation with persistence of vomiting or discharge time. CONCLUSION The present study revealed that radiographic findings could not predict postoperative symptom eradication after pyloromyotomy in HPS.
Collapse
Affiliation(s)
- Davoud Badebarin
- Division of Pediatric Surgery, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeid Aslanabadi
- Division of Pediatric Surgery, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fereshteh Yazdanpanah
- Department of Surgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Zarrintan
- Division of Pediatric Surgery, Children's Hospital; Department of General and Vascular Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
18
|
Chalya PL, Manyama M, Kayange NM, Mabula JB, Massenga A. Infantile hypertrophic pyloric stenosis at a tertiary care hospital in Tanzania: a surgical experience with 102 patients over a 5-year period. BMC Res Notes 2015; 8:690. [PMID: 26581339 PMCID: PMC4652415 DOI: 10.1186/s13104-015-1660-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/02/2015] [Indexed: 11/22/2022] Open
Abstract
Background Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants. There is paucity of published data regarding this condition in our setting. This study describes the clinical presentation, mode of treatment and outcome of treatment of this disease and identifies factors responsible for poor outcome of these patients. Methods This was a descriptive retrospective study of infants with HPS admitted to Bugando Medical Centre and subsequently underwent surgery between February 2009 and January 2014. Results A total of 102 patients (M:F = 4.7:1) were studied. The median age at presentation was 5 weeks. The median duration of illness was 4 weeks. Fifty-four (52.9 %) patients occur in first-born children. Associated anomalies were reported in 7 (6.9 %) patients. Non-bilious vomiting was the most frequent symptom and it was described in all (100 %) patients. A palpable mass was found in 23.5 % of infants. The diagnosis of IHPS was made clinically in 86 (84.3 %) and by ultrasound in 16 (15.7 %) patients. The treatment was Ramstedt’s pyloromyotomy in all cases. There were 6 (5.9 %) intra-operative mucosal perforations which were repaired successively. Postoperative complication was 11.8 %. The median length of hospital stay was 12 days and it was significantly associated with prolonged pre-operative hospitalization (p = 0.001). The mortality rate was 4.9 %. Age below 2 weeks, late presentation (≥14 days), severe dehydration on admission, hypokalaemia on admission and surgical site infection were the main predictors of mortality (p < 0.001). Conclusion This study has shown that IHPS is a common condition in our setting. Age <2 weeks, delayed presentation, prolonged preoperative hospital stay, surgical site infection and high proportion of dehydration and electrolyte disturbance were the main predictors of poor outcome. A high index of suspicion is needed in infants with non-bilious vomiting to avoid delay in diagnosis.
Collapse
Affiliation(s)
| | - Mange Manyama
- Department of Anatomy, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Neema M Kayange
- Department of Pediatrics, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Joseph B Mabula
- Department of Surgery, Bugando Medical Centre, Mwanza, Tanzania. .,Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| | - Alicia Massenga
- Department of Surgery, Bugando Medical Centre, Mwanza, Tanzania. .,Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
| |
Collapse
|
19
|
Li SY, Chen SCC, Tsai CF, Sheu SM, Yeh JJ, Tsai CB. Incidence and survival of retinoblastoma in Taiwan: a nationwide population-based study 1998-2011. Br J Ophthalmol 2015; 100:839-42. [PMID: 26370121 PMCID: PMC4893080 DOI: 10.1136/bjophthalmol-2015-307211] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/23/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the epidemiology of retinoblastoma in Taiwan from 1998 to 2011. DESIGN This was a retrospective population-based cohort study using the Taiwan National Health Insurance Research Database. RESULTS The present study included 154 patients (92 males, 62 females) with retinoblastoma and the documented overall retinoblastoma incidence was 1 in 17 373 live births without a notable trend over the study period. The incidence per million live births examined by gender was 65.8 for males and 48.5 for females. The age-specific sex ratio increased from 1.4 at age younger than 1 year to 3.0 above age 4 years. Enucleation was performed in 109 (70.8%) children with retinoblastoma, and it was more prevalent in males than in females (77.2% vs 61.3%, p=0.0335). Multivariate Cox regression analyses with adjustment for diagnostic age, sex, and birth year elucidated that enucleation was a significant factor associated with survival (OR 0.27, 95% CI 0.10 to 0.61). CONCLUSIONS The incidence of retinoblastoma in Taiwan exhibited no marked trend over time. There were more cases of males than females and the male-to-female rate ratio increased with age. Survival outcome was significantly associated with the intervention of enucleation.
Collapse
Affiliation(s)
- Su-Yin Li
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan Chia Nan University of Pharmacy and Science, Taiwan
| | - Solomon Chih-Cheng Chen
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan Department of Pediatrics, School of Medicine, Medical College, Taipei Medical University, Taipei City, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Shew-Meei Sheu
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Jun-Jun Yeh
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan Chia Nan University of Pharmacy and Science, Taiwan Meiho University, Pingtung, Taiwan
| | - Chong-Bin Tsai
- Department of Ophthalmology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| |
Collapse
|
20
|
Markel TA, Proctor C, Ying J, Winchester PD. Environmental pesticides increase the risk of developing hypertrophic pyloric stenosis. J Pediatr Surg 2015; 50:1283-8. [PMID: 25783294 DOI: 10.1016/j.jpedsurg.2014.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/08/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hypertrophic pyloric stenosis (HPS) is a condition noted within the first several weeks of life that results in hypertrophy of the pyloric muscle between the stomach and duodenum. The etiology has not been elucidated but genetic and environmental influences are suspected. We hypothesized that agricultural pesticides would be associated with an increased incidence of pyloric stenosis. STUDY DESIGN Data from infants with HPS were obtained from the Indiana Birth Defects Registry (IBDR) for all counties in Indiana from 2005 to 2009. Data from all live births were obtained from the Indiana State Health Department (ISHD). Maternal demographics and clinical characteristics of infants were abstracted. The US Geological Survey (USGS) provided estimated use of agricultural pesticides (EPEST), and these values were correlated with HPS incidence. Univariate and multivariate logistical regression models were used to assess the association between HPS risk and pesticide use. RESULTS A total of 442,329 newborns were studied with 1313 HPS cases recorded. The incidence of HPS was 30/10,000 live births. HPS incidence was correlated with total county pesticide use, as well as subcategories of pesticides (fungicides, fumigants, insecticides, herbicides). Indiana counties were then divided into low, moderate and high pesticide use (mean±standard deviation: 127,722±73,374, 308,401±36,915, and 482,008±97,260pounds of pesticides). Incidence of HPS was 26, 29, and 36 cases per 10,000 in low, moderate and high pesticide-use counties respectively. Subset analysis showed that the positive association between HPS and county pesticide use was more likely for male infants from mothers who were white, aged 20-35 years, had education at high school or lower, and smoked (p<0.05). CONCLUSION Pesticide use correlated significantly with incidence of HPS. Positive correlations between HPS risk and pesticide use were found for most risk factors. Further studies will be needed to verify our findings and further delineate the nature of this correlation.
Collapse
Affiliation(s)
- Troy A Markel
- Pediatric Surgery, Indiana University School of Medicine/Riley Hospital, Indianapolis, IN, United States.
| | - Cathy Proctor
- Neonatology, Indiana University School of Medicine/Riley Hospital, Indianapolis, IN, United States
| | - Jun Ying
- Department of Environmental Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Paul D Winchester
- Neonatology, Indiana University School of Medicine/Riley Hospital, Indianapolis, IN, United States
| |
Collapse
|
21
|
Ong CT, Sheu SM, Tsai CF, Wong YS, Chen SCC. Age-dependent sex difference of the incidence and mortality of status epilepticus: a twelve year nationwide population-based cohort study in Taiwan. PLoS One 2015; 10:e0122350. [PMID: 25826701 PMCID: PMC4380468 DOI: 10.1371/journal.pone.0122350] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/15/2015] [Indexed: 11/19/2022] Open
Abstract
Status epilepticus (SE) is a serious neurologic emergency associated with a significant mortality. The objective of this study is to investigate its epidemiology in terms of age- and sex-specific incidences and mortality. By using the Taiwan National Health Insurance Research Database during 2000 to 2011, we identified hospitalized patients with a discharged diagnosis of SE and calculated the incidence and in-hospital mortality of SE with respect to age and sex. The overall incidence of SE was 4.61 per 100,000 person-years, which displayed a "J-shaped" distribution by age with a little higher under the age of 5 and highest over 60 years. The male-to-female rate ratio was 1.57 and it demonstrated a "mountain-shape" across ages with the peak at 45 to 49 years old. The in-hospital mortality was significantly lower in males (7.38%) than in females (11.12%) with an odds ratio of 0.64 (95% CI 0.56-0.72). Notably, the in-hospital mortality for females increased rapidly after the age of 40 to 45 years. The multivariate analysis found males had a significantly lower risk of mortality than females after, but not before, 45 years of age with an odds ratio of 0.56 (95% CI 0.49-0.65). Sex and age are crucial factors associated with the incidence and in-hospital mortality of SE. The females over 45 years of age have a higher risk of occurrence and mortality from SE. The underlying mechanism deserves further study.
Collapse
Affiliation(s)
- Cheung-Ter Ong
- Department of Neurology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi city, Taiwan
- Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chia-Yi, Taiwan
| | - Shew-Meei Sheu
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi city, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi city, Taiwan
| | - Yi-Sin Wong
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi city, Taiwan
| | - Solomon Chih-Cheng Chen
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi city, Taiwan
- Department of Pediatrics, School of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail: (SCC)
| |
Collapse
|
22
|
Feng Z, Liang P, Li Q, Nie Y, Zhang Y. Association between NKX2-5 rs29784 and infantile hypertrophic pyloric stenosis in Chinese Han population. Int J Clin Exp Med 2015; 8:2905-2910. [PMID: 25932253 PMCID: PMC4402900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/28/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the association of three single nucleotide polymorphisms (SNPs, rs11712066 and rs573872 near MBNL1, rs29784 near NKX2-5) with infantile hypertrophic pyloric stenosis (IHPS) in Chinese Han population. METHODS A total of 47 family trios consisting of infants with IHPS and their healthy biological parents were recruited for this study. Genotypes were determined using direct sequencing. Transmission disequilibrium test (TDT) was performed for family-based association analysis. RESULTS Genotypic distributions of three SNPs in both groups (patients and proband's parents) were in conformity with Hardy-Weinberg equilibrium (P > 0.05). There were significant preferential transmission of A allele of rs29784 from the parents to affected offspring (TDT: x(2) = 5.444, P = 0.0196). However, other two polymorphism loci (rs11712066 and rs573872) were not significant susceptibility loci for IHPS in Chinese Han population. CONCLUSIONS We found that there was a significant association between rs29784 and IHPS.
Collapse
Affiliation(s)
- Zhiqiang Feng
- Department of Gastroenterology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou Digestive Disease CenterGuangzhou, China
- Guangzhou Key Laboratory of Digestive Disease, Guangzhou First People’s Hospital, Guangzhou Medical UniversityGuangzhou, China
| | - Peizhi Liang
- Department of Gastroenterology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou Digestive Disease CenterGuangzhou, China
- Guangzhou Key Laboratory of Digestive Disease, Guangzhou First People’s Hospital, Guangzhou Medical UniversityGuangzhou, China
| | - Qingning Li
- Department of Gastroenterology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou Digestive Disease CenterGuangzhou, China
- Guangzhou Key Laboratory of Digestive Disease, Guangzhou First People’s Hospital, Guangzhou Medical UniversityGuangzhou, China
| | - Yuqiang Nie
- Department of Gastroenterology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou Digestive Disease CenterGuangzhou, China
- Guangzhou Key Laboratory of Digestive Disease, Guangzhou First People’s Hospital, Guangzhou Medical UniversityGuangzhou, China
| | - Youxiang Zhang
- Department of Pediatrics, Guangzhou First People’s Hospital, Guangzhou Medical UniversityGuangzhou, China
| |
Collapse
|
23
|
Question of an infectious etiology or contribution to the pathogenesis of infantile hypertrophic pyloric stenosis. J Pediatr Gastroenterol Nutr 2014; 58:546-8. [PMID: 24345839 DOI: 10.1097/mpg.0000000000000261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Infantile hypertrophic pyloric stenosis is a concerning cause of nonbilious vomiting in the neonatal population. Although a number of etiological theories exist, its exact cause remains nebulous. The question of an infectious etiology (or contribution) has been previously examined in case reports and case series, with recent support through suggestions of seasonality and familial aggregation with unclear inheritance patterns. The present review discusses the published literature regarding infectious etiologies of infantile hypertrophic pyloric stenosis. Furthermore, it attempts to demonstrate that newer research regarding an NOS1 genetic etiology does not exclude, but rather can be consistent with, an infectious etiology.
Collapse
|
24
|
The clinical features of infantile hypertrophic pyloric stenosis in Chinese Han population: analysis from 1998 to 2010. PLoS One 2014; 9:e88925. [PMID: 24586444 PMCID: PMC3929628 DOI: 10.1371/journal.pone.0088925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 01/14/2014] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate clinical features of infantile hypertrophic pyloric stenosis (IHPS) in Chinese Han population. Methods Three hundred and sixteen hospitalized patients with IHPS from January 1998 to February 2010 were retrospectively reviewed, and data including patient's sex, onset age, other coexisting congenital defects, pyloric circular muscle thickness evaluated by ultrasonograph, serum electrolytes concentration, and results of arterial blood gas analysis on admission were collected. The patients were divided into two groups: the duration between first onset and admission less than or equal to 10 days (early onset group), and more than 10 days (late onset group). The results of arterial blood gas and serum electrolyte concentration were compared between the two groups. Results There were 271 males and 45 females in 316 patients; the onset age ranged between 1 and 351 (26.5±26.6) days. The birth weight ranged between 1.6 and 4.5 (3.23±0.44) kilograms; coexisting congenital defects were found in 65 cases (20.6%). Pyloric circular muscle thickness was 4–8 (5.4±1.0) millimetres (mm). For the early onset group, the rates of hypokalemia, hypochloraemia and hypercapnia were significantly lower than those in the late onset group (18.67% VS 50%, P<0.0001; 46.03% VS 71.01%, P = 0.003; 56.58% VS 83.44%, P = 2.17×10−5; respectively). Conclusions The symptom duration in Chinese Han population was longer than that in other populations. And as the prolongation of symptom duration, the incidence of acid-base imbalance increased significantly. Infants with persistent vomiting at the age of 3∼5 weeks after birth should be considered IHPS, and go to hospital as soon as possible in order to reduce the incidence of hypokalemia, hypochloraemia and hypercapnia, and avoid deterioration.
Collapse
|
25
|
de Laffolie J, Turial S, Heckmann M, Zimmer KP, Schier F. Decline in infantile hypertrophic pyloric stenosis in Germany in 2000-2008. Pediatrics 2012; 129:e901-6. [PMID: 22430445 DOI: 10.1542/peds.2011-2845] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The incidence of infantile hypertrophic pyloric stenosis (IHPS) is highly variable over time and geographic regions. A decline in IHPS incidence was recently reported in Sweden, the United States, Denmark, and Scotland. In Sweden, the IHPS decline seemed to be concurrent with a declining incidence in sudden infant death syndrome (SIDS), which suggested a common cause; the latter was attributed to campaigns against the prone sleeping position. We investigated the time course of the IHPS incidence in all German federal states (N = 16) between 2000 and 2008. We examined correlations between the IHPS incidence and the SIDS incidence. METHODS Data were extracted from the public report of health (Gesundheitsberichterstattung des Bundes). We collected the numbers of IHPS (International Classification of Diseases, 10th Revision [ICD-10], code 40.0), SIDS (ICD-10, R95), and live births (LB; male/female) in each federal state for 2000-2008. RESULTS The IHPS incidence declined in Germany from 2000 (3.2086/1000 LB [range: 1.67-5.33]) to 2008 (2.0175/1000 LB [1.74-3.72]; P = .005). The recorded incidence was highly variable in different federal states and over time. The SIDS incidence also declined during the same time period (2000, median: 0.759/1000 LB [interquartile range: 0.54-1.029]; 2008, median: 0.416/1000 LB [interquartile range: 0.285-0.6485]; P = .0255). However, the SIDS regional distribution was different from that of IHPS. CONCLUSIONS The IHPS incidence declined by ∼38% nationwide. A parallel decline in SIDS displayed a different pattern in regional distribution; thus, a common cause was unlikely. The regional differences indicated that etiologic factors remained unresolved.
Collapse
Affiliation(s)
- Jan de Laffolie
- Children's Hospital, Department of General Pediatrics and Neonatology, University of Giessen, Giessen, Germany.
| | | | | | | | | |
Collapse
|