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At least 217 records · Page 12Linked to original sources
PubMed1993

Diagnostic and therapeutic management of esophageal and gastric caustic burns in childhood.

Early esophago-gastroscopy is the most effective investigation for the classification of caustic burns. Evaluation includes graduation of the pathological lesion. Assessment of extension of spread and of control of motility of esophagus and stomach. The aim of all therapeutic procedures is to preserve the patients' own esophagus. All endoscopies were done under general anesthesia. From September 1988 to April 1992, 102 endoscopies were carried out on 39 patients. Gastric lesions with clinical relevance were found in 10 patients (26%). First degree of corrosion was found in 21 patients (54%): they were discharged without any therapy within 48 hours. Maximal second degree was seen in 14 patients (36%), who were successfully treated with diet, antacids and H2-blockers: they were discharged after control-endoscopy after one week. Four patients (10%) suffered from third-grade lesions: a gastrostomy was performed as well as treatment with cortisone, antibiotics and H2-blockers. Bouginage was started between the 5th and 7th day after ingestion and was necessary for 8, 11 and 16 weeks in three patients and more than 2 years in one patient. Even in this last case we could preserve the esophagus, although a gastric or colon interposition was discussed.

Antacids↗
PubMed1990

Caustic intoxication.

After a retrospective study of 17 cases of caustic intoxication in the intensive care unit, the epidemiologic, pathophysiologic, clinic and therapeutic aspects are reviewed. The following procedure is suggested: early endoscopies, abstention of any gastric lavage, corticosteroids and empiric antibiotic therapy and the most early possible introduction of a parenteral nutrition.

Adolescent↗
PubMed1981

Caustic burns and carcinoma of the esophagus.

A history of caustic injury was obtained in 12 of 846 patients with squamous cell carcinoma of the esophagus. The average age was 52.8 years; the interval from injury to development of carcinoma was 45.8 years. Nine of the 12 carcinomas were in the midthoracic segment. Resection was possible in nine patients, with two surviving over ten years. A survey of reported series with this association confirms the increased resection rate and probability of long survival compared with the usual carcinoma of the esophagus.

Adolescent↗
PubMed1995

Prediction of complications following unintentional caustic ingestion in children. Is endoscopy always necessary?

The records of 115 children hospitalized following caustic ingestion over an 18.5-year period from 1976 to 1994 were reviewed. The relationship between types of product ingested, signs and symptoms, degree of esophageal injury and complications was analyzed. All complications were the result of strong alkali ingestion (sensitivity = 1.0). Among the 102 incident patients, 36.8% of lye ingestions resulted in complications, whereas only 2.7% (one) of automatic dishwasher detergent (ADD) ingestions caused any complications (p < 0.01). Endoscopy 6 h to 4 days after injury was accurate in predicting or identifying complications in all types of strong alkali ingestions. In lye ingestions, endoscopy was not superior to the test, "one or more signs or symptoms" in predicting complications (predictivity = 1.0). Endoscopy is recommended to establish or confirm a prognosis, or to identify acute respiratory complications, in symptomatic ingestions of lye or ammonia water, in children with respiratory symptoms, and in rare cases of severe symptoms following ADD or strong acid ingestion. It is suggested that children who are non-symptomatic following unintentional ingestions are not at risk of complications and do not need endoscopic examination.

Adolescent↗
PubMedDate not supplied

Comparative caustic and biological activity of trichloroacetic and glycolic acids on keratinocytes and fibroblasts in vitro.

OBJECTIVES: Beside their causticity, the biological mechanism by which trichloroacetic acid (TCA) and glycolic acid (GA), two agents extensively used for chemical peeling, might act remains unknown. The purpose of this study was to examine in vitro the effect of TCA and GA on human keratinocytes and the influence of the released epithelial mediators on collagen and matrix metalloproteinases (MMPs) production by human dermal fibroblasts. METHOD: Cultured keratinocytes were treated by TCA and GA at 10 mg/ml brought to pH 3, 5 and 7, and the conditioned media neutralized to pH 7 were added to human normal skin fibroblasts. RESULTS: TCA was cytotoxic for keratinocytes at each tested pH. The conditioned medium depressed protein and collagen synthesis and the expression of MMPs when added to fibroblasts as did also TCA when added directly to fibroblasts. GA was not cytotoxic for keratinocytes at neutral pH and the conditioned medium obtained at each pH applied to fibroblasts did not alter protein, collagen nor MMPs production while causing an elevated secretion of IL-6. CONCLUSION: TCA exerts a toxic effect on keratinocytes and fibroblasts while GA does not alter the metabolism of fibroblasts but induces the secretion of IL-6.

Caustics↗
PubMed2006

Caustic gastroesophageal lesions in childhood: an analysis of 473 cases.

Ingested corrosive agents produce oropharyngeal and gastroesophageal injuries ranging from minor burns to severe necrosis, depending on the agent amount, concentration, and duration of exposure. The aim of this study was to present our patients with corrosive ingestion retrospectively. Four hundred seventy-three children younger than 16 years of age (mean age, 3.7+/-0.1 years) who were admitted to our hospital for suspected corrosive ingestion between the years 1995 and 2003 were studied. Two hundred eighty-six (60.5%) of 473 patients were males. Household bleaches (36.6%) and oven cleaners (23%) were the most frequently encountered corrosive agents. During endoscopy, lesions in the esophagus were recorded in 379 children. Eighty-one of the cases had gastric lesions. During the follow-up, esophageal stricture, esophageal perforation, and gastric outlet obstruction (GOO) developed in 11 cases, 1 case, and 2 cases, respectively. Caustic ingestion of alkali substances such as oven cleaner seem to cause more severe injuries. Early admission to the hospital with clinical and endoscopic evaluation and early surgery when required may reduce morbidity and mortality.

Accidents, Home↗
PubMed1986

Caustic ingestions. Pathophysiology, diagnosis, and treatment.

More than 5,000 caustic ingestions are estimated to occur each year. Liquid lye is associated with the greatest morbidity. Endoscopy is the only method for evaluating the extent of the injury; clinical signs and symptoms (e.g., vomiting, dysphagia, abdominal pain, oral burns, leukocytosis) are not reliable. In less severe burns (involving only mucosal irritation or ulceration), current therapy with antibiotics and steroids results in a very favorable prognosis. Circumferential or very deep burns have a much poorer outcome, with a greatly increased risk of stricture formation and/or perforation. The risk of developing esophageal carcinoma may be 1,000 times greater for individuals who have had a lye burn than in the general population. It cannot be overemphasized that prevention is still the key to decreasing this morbidity.

Ampicillin↗
PubMed1993

Ingestion of caustic cosmetic products.

Twelve children over a 6-year period (1985 to 1991) underwent aerodigestive tract endoscopy after ingestion of lye-containing cosmetic products. All children were less than 2 years of age and had facial and/or oral cavity burns. Eleven of these patients ingested alkaline hair products such as "activators" or "relaxers." Endoscopy revealed pharyngeal burns in five patients but no laryngeal or esophageal burns in any patient. Erythema of the esophageal mucosa was seen in one patient. One patient ingested a solution used in fingernail decorating. This patient sustained extensive superficial burns of the pharynx, larynx, and esophagus and required intubation and admission to the intensive care unit. No long-term sequelae developed. Cosmetic products containing caustic chemicals represent a significant health risk to small children, especially because child-proof packaging is not standard for these products.

Burns, Chemical↗
PubMed1976

[Acute esophagitis and gastritis caused by caustic acids].

9 cases of caustic ingestion are reported and the diagnostic and therapeutic problems of the consequent gastritis and oesophagitis conditions discussed. In the case of small quantities of acids at low concentrations, the immediate steps are largely medical and conservative, their purpose being to monitor complications. In cases of massive ingestion, surgery should be as early as possible to avoid secondary lesions to the surrounding viscera and serious electrolytic imbalances; the limit for action with a relatively favourable prognosis is within 5 hours and removal of the damaged segments must be radical and extensive.

Adolescent↗
PubMed2000

[Pharyngo-esophagoplasty by right coloplasty for the treatment of post-caustic pharyngo-laryngeal-esophageal burns: a report of 13 cases].

We report a new technique of pharyngoesophagoplasty by right coloplasty, indicated in postcaustic severe pharyngeal stenosis, analyzing the anatomical and functional results in terms of respiratory tract and phonation as well as digestive tract outcome. We compared our results with those obtained with other procedures. Between March 1995 and September 1998, pharyngoesophagoplasty by right coloplasty was performed in 13 patients. All had severe hypopharyngeal stricture with total obliteration of the two piriform sinuses and the upper esophageal sphincter. Nine patients underwent emergency esophagectomy or esogastrectomy by stripping and four had a cicatricial esophagus. Eight patients underwent tracheotomy before the pharyngoplasty due to burns of the laryngeal margin or airway infections. There was no perioperative mortality. The retrospective analysis in February 1998 with a follow-up of 22 months disclosed two deaths, one from septic shock following pneumnia and one suicide. For the 11 other patients, respiratory function had been restored successfully as the tracheostomy tube had been removed. Eight of the patients were on regular oral diet and the jejunostomy tube had been removed. Three had mild dysphagia and the oral diet was supplemented by jejunostomy tube feedings. These results were most successful compared with those obtained with 29 other patients. Pharyngo-esophagoplasty by right colonic transposition appears to be the method of choice for the reconstruction of post-caustic pharyngeal and esophageal stenosis.

Adult↗
PubMed2001

The role of upper gastrointestinal endoscopy in the diagnosis and treatment of caustic ingestion, esophageal strictures, and achalasia in children.

The practice of upper gastrointestinal endoscopy in children continues to evolve. Therapeutic endoscopic procedures are now routinely performed in children. Patient preparation, sedation, and instrumentation have improved, allowing therapeutic endoscopy to be performed for a wide variety of conditions. This article focuses on the role of endoscopy in the diagnosis and care of caustic ingestion, balloon dilation of esophageal strictures, and new developments in the treatment of achalasia in children.

Adolescent↗
PubMedDate not supplied

Distraction of oral scars contractures following caustic ingestion. A form of conservative treatment.

The chemical burns in the oral mucosa as consequence of accident of suicide attempt are relatively frequent. The evolution of the repairing process is conditioned by the quality and concentration of the caustic as by the location and time exposure of the affected region. At this report, we document a form of conservative treatment for the limitation of mouth opening, which the patient presented after swallowing a detergent acid. In order to obtain a minimal oral opening, a screwed cone, whose action mechanism was acting as a cradle between both jaws, was used. Once achieved a 10 mm opening, it was possible to use an external distractor to accomplish a continuous traction.

Adult↗
PubMedDate not supplied

[Post-caustic gastric stenosis].

Two cases of postcaustic antropyloric stenosis are reported. The lesions developed 3 and respectively 5 weeks after ingestion of the caustic substance and surgery for complete stenosis was performed 35 and 56 days after the initial accident. In both cases antropylorectomy with gastroduodenoanastomosis of the Péan-Billroth type I, in two layers, was performed. Integrity of the esophagus and good function of the anastomotic mouth, appraised by the clinical symptomatology and evolution of the radiologic aspect, showed that at least in some cases it is possible to apply the curative intervention 5-6 weeks after the accident, without a previous shunt being necessary.

Adult↗
PubMedDate not supplied

[Surgical management of post-caustic prepyloric stenosis. The Y-V intravascular segmental antrectomy (considerations on 71 cases)].

The author presents 71 cases of gastric stenoses following caustic lesions, of which 20 were located in the stomach and 51 also involved the oesophagus (oesophagian stenosis). In cases with limited antrum stenoses the author performed antrectomy and gastro-duodenal anastomosis. In the pre-pylorus stenoses, when these were located at 3--5 cm from the pylorus the author recommends the conservation of the denevated pylorus by double pylorotomy and anastomosis with the entire gastric section. He describes a personal procedure which he calls: The Y--V intravascular segmental antrectomy". In cases with extensive gastric stenoses (over 75% of the area), as well as in evolutive corrosion lesions the author recommends Y-jejunostomy, of the Maydl type.

Burns, Chemical↗
PubMed1992

[Management of caustic burns of the esophagus in children].

The authors describe their therapeutic approach to caustic burns of the esophagus in pediatric patients. Initially, early endoscopic evaluation is carried out under general anesthesia using a stiff tube then a fiberoptic endoscope. During this procedure, severity of esophageal damage is determined: stage I: mild burn requiring no treatment; stages II and III: severe burn with a risk of subsequent esophageal stricture requiring insertion of a nasogastric stent. A repeat endoscopy is performed after approximately 25 days to evaluate healing. If healing has occurred, the nasogastric tube is removed and dynamic esophagography is performed 2 to 7 days later. Patients with strictures should be treated with repeated endoscopic dilatation at gradually increasing intervals. Surgery is indicated only in patients with complications or multiple strictures after failure of dilatation; trans-mediastinal colon esophagoplasty with removal of the burned esophagus is the method of choice.

Burns, Chemical↗
PubMed1992

[Current status of poisoning by ingestion of caustics: apropos of a series of 49 cases].

The authors report the history of 49 patients, admitted to an intensive care unit after a caustic or corrosive ingestion. This series follows a similar one, related in 1979. An update is made for early evaluation and management, based on patients classification in three groups: severe cases, moderate cases, mild cases. Clinical and biological data, treatment and outcome for the three groups are related. The frequency and gravity of these poisonings appear to be the same as in the first series, with poor prognosis for extreme emergencies and high risk of oesophageal or gastric stricture for important forms. In this population, 20% of extreme emergencies have favorable outcome with early major surgical procedure.

Adolescent↗
PubMed2004

UV-catalytic treatment of spent caustic from ethene plant with hydrogen peroxide and ozone oxidation.

The performance of UV/H2O2, UV/O3 and UV/H2O2/O3 oxidation systems for treating spent caustic from an ethylene plant was investigated. In UV/H2O2 system, with the increase of H2O2 dosage, removal efficiencies of COD and the ratio of biochemical oxygen demand (BOD) to chemical oxygen demand (COD) of the effluent were increased and a better performance was obtained than the H2O2 system alone. In UV/H2O2 system, removal efficiency of COD reach 68% under the optimum condition, and BOD/COD ratio was significantly increased from 0.22 to 0.52. In UV/O3 system, with the increase of O3 dosage, removal efficiency of COD and BOD/COD ratio were increased, and a better performance was obtained than the O3 system alone. Under the optimum condition, removal efficiency of COD was 54%, and BOD/COD ratio was significantly increased from 0.22 to 0.48. In UV/H2O2/O3 system, COD removal efficiency was found to be 22.0% higher than UV/O3 system.

Caustics↗