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Some cases of pyloric stenosis cured without surgical intervention by Dr. Donato Perez Garcia A paper presented at the Ninth
National Assembly of Surgeons, Translated to English from Spanish by
Maria Anabel Cañon Reference was made to Aime Ricci's English translation of Dr. Perez Garcia's 1953 book, Cellular Therapy, chapter 3, where updated versions of some cases, and x-ray images can be found.
Now that surgery has reached its greatest splendor, I would like to present this paper about the medical treatment of pyloric stenosis, which has always been treated surgically due to its mechanical nature. It seems absurd even to think it might be treated otherwise. But the facts I am going to show demonstrate that the medical treatment I call Cellular Therapy offers more advantages because: there are neither risks of surgical shock nor post-surgery complications, and it is not necessary to prescribe any life-long diet or special care, as is usual with such patients. My observations from more than five years of treating the most serious patients make me think that it should be true with the majority of cases treated with this system. Stenosis occurs due to an obstruction in the lumen of the pylorus, either in its walls or their contour, caused by a strange body, a pediculated vegetation or lesions in the walls, usually of cancerous origin, though the most frequent are those caused by duodenal, prepyloric, juxtapyloric, and duodenal pyloric ulcers. We shall not mention stenosis caused by external factors. Pyloric stenosis, due almost always to an ulcerous or neoplastic process of the duodenum, is the most frequent, and we shall talk about it. The canal lumen can be obstructed for 1-10 cm. It is almost always eccentric and allows the passage of a certain amount of liquid. When obstruction begins, the gastric muscle exaggerates its peristalsis, then is exhausted and, at last, atony appears and chyle is accumulated in the gastric bottom, thus extending the walls of the stomach, which may reach enormous dimensions. Radiologically, gastric ptosis is differentiated from the dilation produced by stenosis because with ptosis the stomach adopts an almost spherical figure, and its vertical diameter is larger than the transverse one. On the other hand, the form adopted in stenosis is that of a crescent moon; the transverse diameter is larger than the vertical diameter. Peristaltic movements are almost nonexistent, and gradually disappear as stenosis advances. Let us mention first the x-ray study that always makes or clarifies the diagnosis. The symptom that generally opens the scene is the sensation of gastric pressure that the patient experiences. This increases for up to two or three hours after taking any food. It quickly turns into a painful cramp that is almost always mitigated by the ingestion of some food or antacid. The nausea continues, and finally there is vomiting: first of sour liquid and then of food, between 4 and 7 hours after being ingested. Vomiting produces a great relief to the patient. As a consequence, severe constipation alternating with false diarrhea is common. When this local condition is reached, the general condition of health has been greatly affected: general asthenia, deep paleness, and emaciation. Having just summarized pyloric stenosis clinically and radiologically, I am now going to present some cases treated with Cellular Therapy. All the patients treated are ambulatory, so follow up has been very difficult. For this reason I am going to present a few cases that have been perfectly studied.
Mr. CM. 66 years old, 56 kilograms, and 90 mg/dL average fasting glycemia. Occupation: peasant. May, 1944. Neither personal nor pathological antecedents of importance. He has been suffering from indefinite digestive disorders for the past 30 years. During the last 20 years he has visited many doctors. But in spite of the medication prescribed for his disease, the following main symptoms have been established in the last 5 years: intense pain in the pit of the stomach, accompanied for the last year by vomits that occurred one hour after eating. At first they were sour liquids, now he vomits all meals. Sometimes they occur at night and are preceded by pain that disappears with the vomiting of the food he has eaten during the day. They are sometimes fetid in odor and taste. Pain has become more intense lately and the patient has had sensations of stretching, cramps, or laceration. Again, he feels better after vomiting the gastric contents. Vomits are incoercible and medication cannot stop them. The continuous pain has hardly allowed him to sleep one hour in the past seven months. He has not evacuated his bowels for periods of up to 15 days; usually he is able to do so with an enema every 8 days. Loss of weight is clear: he has lost 20 kg in the last 7 months. He also suffers from deep asthenia and his general aspect is that of a seriously ill patient. The belly presents a very irregular shape: above the navel it appears expanded, with convex shape; below the navel it looks more like a trough. Palpation in the upper part produces pain and muscular defense. The colonic flexure is perfectly palpated in both sides; there is pronounced meteorism in the upper part of the abdomen and faint in the lower part: with exploration maneuvers the eyes become more receded, the outlines of the face more drawn, the nose sharper; in short, the facie is clearly peritoneal. Breathing is superficial and accelerated: 25 respirations and 106 pulsations per minute; blood pressure: 125/70. The radiological study says: “... strong gastric dilation, especially at the level of the antrum, with pronounced enlargement of the stomach; transverse diameter is larger than vertical diameter. Abundant liquid during fasting. In the x-rays taken in standing position, non-persistent minor curvature deformations can be seen. By the eighth hour, a small quantity of the barium has gone into the intestine, while the rest is still in the stomach. .... Radiological evaluation: advanced pyloric stenosis. The cause of this stenosis is not perceived radiologically; its origin could be ulcerous, neoplastic, etc… Dr. José Ramírez Ulloa.” The strong gastric dilation, with predominance of the transverse diameter over the vertical one, the permanence of barium for more than eight hours, and the small quantity of this element gone into the intestine, are conclusive radiological facts for diagnosing advanced pyloric stenosis, corroborating the clinical diagnosis. Applications of the healing medical system I call Cellular Therapy were made every five days. From the third one on, there was an evident improvement. With the fourth treatment, vomiting disappeared, pain decreased, and the patient began evacuating his intestines. This improvement allowed us to apply the treatment every eight days. In all, the patient received seven treatments. All his digestive functions had been regulated, he was feeling healthy, and he had gained 10 kilos in two months when the treatment was brought to an end. Without being discharged and, therefore, without previous examination, he stopped his treatment. Four and half years later, the patient reappeared. To corroborate his evident health state he was radiologically examined, with the following result: “Mr. C.M.... The strong gastric dilation has disappeared, especially at the level of the antrum… The air chamber is now normal… very little liquid during fasting… Deformations in the minor curvature have disappeared… A persistent duodenal diverticulum can be seen in all x-rays... Some gastric spasms near the duodenal bulb... Barium goes through the duodenum, and that has made it possible to observe the diverticulum… Dr. Jose Ramirez Ulloa.” The patient had been diagnosed, both clinically and radiologically, with advanced pyloric stenosis due to duodenal ulcer. Four years after receiving an incomplete Cellular Therapy course of treatment, it was verified, both clinically and radiologically, that the advanced pyloric stenosis had disappeared.
“Mr. A.V., 35 years old, 62 kg, 78 mg/dL blood glucose; employed. He was examined on June 4, 1946. For two months he had suffered from tertiary malaria, gonorrhea, and syphilitic chancre. Syphilis reactions in blood have always been positive, even though he has been methodically treated for his intense infection during the past five years. In March of this year, Kahn’s reaction in cerebrospinal fluid was positive, with a slight increase of albumin. More than five years ago, that is, before positive reactions in blood,
the ingestion of certain foods caused him intense stomach ache that would
disappear with antacids. That has changed in the last months. The pain is
more intense before meals, and food makes it disappear, which has motivated
him to eat food at any time to mitigate the pain. But now the pain has
become constant. The abdomen looks swollen due to gas; there is extended pain; palpation produces muscular defense. Palpation of the liver edges is painful; the splenic area is large. Blood pressure is 110/65. The radiological study says: “... in the pyloric area there is a very notable deformation caused by a repletion defect that includes also the duodenal bulb and the first portion of the duodenum. The radiological image of the bulb is limited by a slim flexure corresponding to the small curvature of the organ, while the rest of the image has disappeared. The flexure presents a recessed shape in its inferior edge, giving it a paracyclical aspect. The first portion of the duodenum presents an irregular form with festooned or toothed edges. Manual pressure produces localized pain in the area. Stenosed duodenal ulcer with carcinomatous process in the stomach pyloric area, duodenal bulb, and first portion of the duodenum… Dr. Manuel Herrera Sobreyra." The progressive and rapid clinical development and the radiological data confirm the diagnosis of pyloric stenosis due to a syphilitic carcinomatous process of the duodenum. Following the standard procedure for this therapy, the patient was administered 30 units of insulin intravenously. 35 minutes later, hypoglycemic symptoms appeared, but they stopped some minutes later. After one hour he was administered 25 more units, without obtaining the desired symptoms. 45 minutes later the dosage was again increased by 20 units, and 20 minutes after this third injection he began showing all the typical symptoms of the change of blood properties. 28 minutes after reaching its maximum (the sought after therapeutic moment), he was administered intravenously:
He received this treatment every five days; but since he began feeling
much better after the first three treatments, they were then administered
every eight days. The irregular effect observed after the first treatment
normalized by the sixth treatment. In the three last treatments he was
administered 90 units of insulin intravenously. The average time for the
first presentation of symptoms was 40 minutes, and at 73 minutes they
reached their peak. In all he received 10 treatments and finally felt
completely healthy; he could eat all kinds of food without discomfort. He
stopped the treatment without radiological and clinical examination. The complete suppression of all digestive disorders, the notable increase of weight, and the return to normal activity of the subject after more than two and a half years, lead us to think that the pyloric communication was restored and that the patient, without undergoing the standard surgical intervention for this condition, can be considered healthy again.
“Mr. F.P.G., 56 years old, 55 kg, average fasting glycemia 70 mg/dL, army man, December 1944. His father died due to an intestinal ailment; his mother due to a non-defined gastric ailment; his wife had two abortions and they have two healthy sons. For many years he drank great quantities of alcohol; he suffered from syphilis and was intensively treated until reactions to it were negative and all symptoms disappeared. In February, 1942 he had peritonitis caused by an acute appendicitis that was treated and cured with Cellular Therapy. He also recovered 12 kilos he had lost. To verify his state of health state after the treatment, a laparotomy was performed: it showed a floating appendix without any microscopic lesions. In December, 1944, he suddenly felt an intense pain in the epigastrium, accompanied by nausea and general discomfort that medication could not relieve. As his condition worsened, he went to the Military Central Hospital. Dr. Mario Quiñonez performed the clinical examination and Dr. C. Gomez del Campo the radiological study. Diagnoses from both physicians were: “Stenosed duodenal ulcer; needs immediate surgical intervention…” Apparently without dyspeptic antecedents, he began suffering from epigastric pain with nausea. This was followed by vomiting for a month, sour at first, watery and burning later. He finally began vomiting food with a strong odor. For almost two months he was put on painkillers that did not relieve his pain. Loss of strength and emaciation were the results of the acute state of those two months. Examination showed peritoneal facie, and an emaciated and palid subject who displays much pain. Abdomen distended with gas, muscular defense or simply abdominal pressure. Palpation produces peristaltic movements that bring on pain, followed by expulsion of gases that relieve the patient. During exploration maneuvers the patient had vomiting with butyric odor. On March 11 of the same year, he underwent the first application of Cellular Therapy, with the following medications:
At the second presentation of the symptoms of change of the blood properties, aluminum and bismuth salts with 250 mg. of nicotinic acid in sweetened water were administered. After the first treatment, all symptoms began to clearly disappear, so that he could leave the therapy after only two treatments, without any medication. After that, they were reinitiated until he completed ten treatments. On August 18 of the same year, Dr. J. Ramirez Ulloa said in his radiological study: ".... Stomach is filled like those of orthotonic type. Normal air chamber. No liquid is observed during fasting. Normal shape, volume, and situation, without deformations in the contour, nor accidents in the curvatures. No dilation in the pyloric antrum indicating stenosing process. Duodenum… no shades of ulcerous niches are observed... August 18, 1945. Dr. J. Ramírez Ulloa.” To this date, the patient effectively carries out all his activities, and does not follow any special diet; he is in perfect health.
Mr. J.P.P., 47 years old, 59 kg, 80 mg/dL average fasting glycemia. September 29, 1950. He had amebic dysentery, Malta fever, and digestive disorders all his life. He has been deaf in the right ear since childhood. During the last year and a half, digestive disorders increased. The most constant and annoying symptom has been the sensation of inflation in the abdomen that becomes stronger after meals. He has a burning sensation in the esophagus and has had vomiting for the last two months. In the last fifteen days he vomits everything, and food does not stay in his stomach. For this reason he has lost 14 kilos in this short period of time. Distressed facies, enlarged liver palpable in its borders, painful right colic flexure. Blood pressure: 110/85. Radiological study carried out by Dr. Emma Rosa Corominos Galvez says: ".... Very large stomach, hypotonic, with a very low bottom in bucket shape. There is pain from pressure in the duodenal bulb, which is only filled by manual pressure. Peristalsis is clearly diminished but it exists, and it passes a little through the pylorus… In the other x-rays it was not possible to find an even slightly impregnated duodenal bulb... Radiologically: Gastric atony. Pyloric stenosis due to possible duodenal ulcer. Dr. Emma Rosa Coromina Galvez. September 12, 1950.” Clinical data are not enough to diagnose pyloric stenosis, but those given by the radiological study are clear enough, as can be seen in the attached x-rays. On September 29 he received the first treatment. Two days later he began taking liquid food that he no longer vomited. By the third day, he stopped vomiting solid food as well. Seven days later he received the second treatment, and one week later he got the third one. The therapy was interrupted before the fourth treatment because the patient believed he was cured. But he ate to excess in quantity and quality and he vomited three times in 15 days. This alarm made him resume treatment on November 3. He has received two more treatments, and his improvement is even more remarkable. Once a series of 10 treatments without interruptions is finished, I expect x-rays to be taken to either discharge him or continue his therapy.
E.D.M., female, 38 years old, 60 kg, 80 mg/dL average fasting glycemia; rural teacher. She was examined on October 4 this year. [1950] One brother died of duodenal ulcer. In 1941, without any apparent reason, she suddenly felt an intense stomachache that lasted two days. With some injections the pain disappeared and everything went back to normal. In August 1945 at midnight, and again without apparent cause, she had vomits and epigastric pain. She took a laxative of castor oil at daybreak and remained a few months without discomfort. In 1948 a very intense pain below the ribs, near the hepatic area, accompanied vomits; the clinical diagnosis was Cholelithiasis. She was prescribed milk, eggs, and medication for ulcer, but would vomit everything with intense pain. During the last days of such a diet she was being administered daily six ampoules of Sedol. Her nutritional diet was changed to cornmeal drinks without milk and gelatin, and that brought about improvement. X-rays showed that there was no ulcer. In June, 1948, she underwent surgery that revealed a gall bladder in perfect state; but there was a cyst that obstructed the lumen of the biliary duct. She went back to eggs and milk, doing fine for almost a year. But by the end of 1949, vomits and pain started again without apparent reason. X-rays were taken of the stomach and duodenum, and the latter was found
to be healed. In spite of this, her condition kept worsening, and by the end
of September and the beginning of October the pain was the same day and
night. She vomited everything she ate some fifteen minutes after ingesting
it, whether liquid or solid. In fact, she could not eat at all for a month.
Constipation increased. During that period of time she lost 20 kilos. The x-ray study says: "Dr. Jorge Segura Millan.... Small air chamber. Small quantity of stasis liquid during fasting, normal esophageal transit, normal filling, normal mucous creases, stomach very incurvated on itself and with prepyloric portion dilated. Picture in persistent screen can be observed in the small curvature during the initial phase of gastric contractility; when contractions reach their greatest intensity, they disappear from the previous picture. Normal mobility, without pain. Contractions of normal initiation and shape, with very increased frequency and intensity. Their intensity produces gastric segmentation but evacuation is not in relation because of pyloric obstacle. Posterior small bulb, badly inflated with undefined edges, painful. With compression there is no perceptible suspended image. Evacuation is delayed, and in the final stages, the intensity of the contractility decreases and there is a slight expansion, mainly antral... Duodenal bulbar uncus in front with micro bulb by retraction and periduodenitis. The preceding suggests incomplete pyloric stenosis with initial hyper peristalsis and antral dilatation with following hypotonia, relaxation, and gastric stasis. Dr. Jorge Segura Millan.” On October 4, I administered the first Cellular Therapy treatment to her, thus obtaining the almost complete disappearance of pain, and resumption of daily intestinal evacuation. By the fifth treatment, vomits stopped and she began taking meat, milk, juices, vegetables, and sweets. I expect to discharge her as soon as she has received 15 treatments.
I. As shown in this paper, there is a non-invasive procedure, other than surgery, to treat pyloric stenosis. It should be tried by all physicians expert in this disease, so that they can make their own observations.
II. — Since the true cause of pyloric stenosis is outside the affected mucosa, and because it is a general disease with local effects, all the treatments in vogue, medical or surgical, are only temporarily palliative. III. — For the present we can say that, since this treatment has
worked in the majority of cases, it must be considered as truly addressing
the cause, and therefore it is the most rational treatment for pyloric
stenosis. |
