Experimental studies on the effect of some chemical caustics on the ohmic resistance of corneal epithelium.
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Twenty-two cases of corrosive oesophageal strictures were reviewed and divided into annular, short segment and long segment lesions. The lower third of the oeseophagus was involved in all the long segment strictures, but with sparing of the extreme distal portion in most. Irregularity of the stricture walls with an appearance similar to reported cases of intramural diverticulosis is a common finding but smooth strictures can also occur.
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Treatment of lye ingestions by antidotes recommended on product labels includes the use of acid neutralizers. The possibility that heat produced by this exothermic reaction increased tissue damage was examined in vitro. Although Drano produced heat with all diluents including water and milk, acid antidotes prolonged the duration of high temperature. Clinitest tablets neutralized with milk produced no temperatures above 40 degrees C. The ready availability of milk or water, their acceptance by the child, and lack of toxic side effects make them diluents of choice for alkaline corrosive agents.
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Esophageal stenosis is a frequent consequence of lye ingestion, and their treatment is of longstanding and complex matter. The search of new solutions for this problem is challenging and always attractive if its associated with less aggressiveness to the patient. The use of intraesophageal stents is not new in the treatment of stenosis, but it was anecdotal, until histocompatible material came out in the market. The stent is designed in the OR, having the same length as the stenosis, previously observed by endoscopy, its made out of a silicone tube 30 or 36 French, mounted over an ng tube 16, all this is fixed in the ends of the silicone tube, that way won't slip over the ng tube. It is placed with a laryngoscope assistant, the proximal end of the ng tube comes out the nasal nares. Once the location of the tube is checked, the stent is left in place for six weeks. Our experience, with seven patients, has shown excellent tolerance to the stent; at the third post procedure day the patients were eating soft diet by mouth, we believe that the esophageal spasm had resolved by this day. Once the stent was withdraw, five cases were free of esophageal lesions, in the other two small areas of bleeding were visualized. In the follow-up the five cases that were free of lesions, had a normal esophageal diameter, in the other two, one had a moderate restenosis and the other case was severe.
The chemical etching of enamel required for adhesion of sealant layers on the dental surfaces means that the enamel structure is weakened, especially due to the fact that after application of the sealant the cauterized layers are no longer in a remineralization equilibrium with the dental environment. The reactions on which cauterization is based are critically discussed. Newly developed synthetics are mentioned whose application as a sealant renders previous cauterization of the enamel by acids superfluous.