fluids was begun six hours postoperatively and continued at two hour intervals, always preceded by administration of pro¬ caine amide, 15 mg. in aqueous solution. No vomiting was present in the postoperative period, and procaine amide therapy was discontinued on the sixth postoperative day.Comment.-It is not unusual for an infant to vomit for a short time after pyloromyotomy because of the dis¬ turbed physiology in the operative area. The fact that all feedings were retained after the first dose of procaine amide strongly suggests that there was an element of residual spasm in the pyloric region and that it was re¬ lieved by therapy with the drug. The use of procaine amide solution in the postoperative management of in¬ fants undergoing pyloromyotomy is suggested by case 5. Cases 5 and 6 both illustrate that procaine amide therapy given in the presence of a pyloric tumor mass has no significant effect in the relief of vomiting. The immediate cessation of vomiting after pyloromyotomy and the ad¬ ministration of procaine amide indicated a complemen¬ tary effect of this antispasmodic.
SUMMARYThe use of procaine amide (Pronestyl) in pylorospasm has not been previously reported. Its mode of action in the alleviation of spasm of the upper gastrointestinal tract is unknown. On the basis of our knowledge of the phar¬ macology of this drug, we postulate that its mode of action is due to anesthetization of the gastric mucosa that causes a diminution in local irritability and an elevation of thresholds to all gastrointestinal stimuli, a relaxation of the pyloric sphincter, and a quiescence of all gastro¬ intestinal motility. Investigations to test this hypothesis are in progress.The findings in these cases and the course of the infants described here suggests that procaine amide can play an important role in the alleviation of spasm in the upper gastrointestinal tract of infants. Four cases of pyloro¬ spasm in which marked improvement followed its use are presented. It did not appear to be of benefit in two cases of congenital hypertrophie pyloric stenosis in alleviating vomiting before pyloromyotomy. It seemed to be helpful in the postoperative management of these patients. It may prove to be an aid as a therapeutic test in pylorospasm. Further trial of procaine amide administered orally in pylorospasm in infants is suggested. It must be pointed out, however, that any child receiving procaine amide should be checked carefully for the various side-actions of this drug. Although these effects have not been ob¬ served, we have watched carefully for evidence of cardiac changes, central nervous system stimulation or depres¬ sion, and blood constituent changes. In another study on this drug,3 we saw minimal side-actions. In several pa¬ tients who have used procaine amide for periods over a year for arthritic pain, we have not seen changes. How¬ ever, too few cases have been reported for definite con¬ clusion to be reached. In an adult study to be reported at a later date, we found that gastric retention of various types have on ...
four hours after onset of symptoms. The mortality rate in this group was 3 per cent, and, if the 2 patients who died following cholecystectomy through an incision originally intended for an appendectomy are excluded, the mortality rate was zero. Of the patients coming to the hospital one to three days after onset the mortality rate was 6 per cent, and of those coming more than three days, who formed more than half the series, the From the
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