Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CAUSTICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed2003

[Extensive digestive caustic burns: what are the limits for resection? A series of 12 patients].

AIM OF THE STUDY: To report the results of oesogastric resections extended to surrounding organs following caustic ingestion, and to precise indications for resection and results of reconstruction. PATIENTS AND METHODS: From 1988 to 2001, 12 patients underwent oesophago-gastrectomy, extended to duodenum and pancreatic head (n = 6), jejunum (n = 4), colon (n = 2), spleen (n = 2) or pancreatic body (n = 1). Early morbidity and mortality, specificities of reconstruction, and quality of oral feeding were assessed retrospectively. RESULTS: Mean intensive care unit stay was 50 days (range: 16-152 days). All patients developed complications. Six patients were reoperated for secondary extension of caustic burns, mainly to colon (n = 4), small bowel (n = 2) and pancreas (n = 2). Three patients died on postoperative days 17, 20, and 130. Secondarily, eight patients (75%) underwent a substernal right ileocoloplasty. Six patients (50%) survived initial resection, and esophageal reconstruction. After a mean follow-up of 35 months (range: 7-87 months), four patients (33%) eat normally. CONCLUSIONS: After caustic burn, oesogastric resections extended to surrounding organs are associated with high morbidity and mortality. However, return of normal oral feeding can be expected in 33% of cases. Secondary extension of caustic burns to adjacent organs is a common eventuality, and may lead to prompt reintervention. Massive injury to small bowel or colon may compromise digestive function or secondary esophageal reconstruction, and thus may be the reasonable limit for resection.

Adult↗
PubMed1992

Conservative treatment of caustic esophageal strictures in children.

The most common cause of esophageal stricture in children is the accidental ingestion of strong corrosive agents. During a 13-year period between 1976 and 1989, 202 patients were diagnosed as having caustic esophageal strictures at the Hacettepe University Children's Hospital Department of Pediatric Surgery. A retrospective clinical study was performed to find out the place and predictors of a successful outcome for conservative treatment in children who have caustic esophageal strictures. Two hundred two children, of whom 145 were male (71.7%) and 57 female (28.3%) with 168 (83.2%) being younger than 6 years of age, were evaluated retrospectively. Whereas only 49.3% of patients could be treated within a 12-month period, 50.7% needed more than 1 year, 32.9% needed more than 2 years, 26.7% needed more than 3 years, and 15.4% needed more than 4 years of periodic dilations in order to become swallowers through native esophaguses. The success of conservative treatment has been higher in patients younger than 8 years of age, and in strictures due to caustics other than lye involving upper third portion and less than five cm of an esophageal segment. Most caustic esophageal strictures could have been treated by conservative measures in children.

Burns, Chemical↗
PubMed2001

Treatment of olefin plant spent caustic by combination of neutralization and Fenton reaction.

Spent caustic from olefin plants contains much H2S and some mercaptans, phenols and oil. A new treatment process of spent caustic by neutralization followed by oxidation with Fenton's reagent (Fe2+/H2O2) was successfully developed. Over 90% of dissolved H2S were converted to gas phase by neutralization at pH = 5 and T = 70 degrees, and the vent gas stream could be introduced to sulfur recovery plant. The neutralized liquid was oxidized with OH. free radical, which was provided by a Fenton's reagent. The residual sulfides in the neutralized spent caustic were oxidized to less than 0.1 mg/L. The total COD removal of spent caustic is over 99.5% and the final COD value of the effluent can be lower than 100 mg/L under the following oxidation conditions: reaction time = 50 min, T = 90 degrees, Fe2+ = 100 mg/L, and a stoichiometric H2O2/COD = 1.1. The value is better than the 800 mg/L value obtained by common WAO process. The optimum pH of the Fenton reaction is around 2 for this process, and the oxidation step can maintain a pH value in the range of 1.8-2.4. Moreover, the iron catalyst can be recycled without affecting process effectiveness thus preventing secondary pollution.

Alkenes↗
PubMed2001

Detection of caustic oesophageal injury with technetium 99m-labelled sucralfate.

BACKGROUND/PURPOSE: Radiolabelled sucralfate has been used to show the extent and severity of reflux oesophagitis, peptic ulceration, and inflammatory bowel disease. Endoscopy under general anaesthetic has been the preferred method to assess the injury after caustic ingestion. The aim of this study was to assess whether sucralfate has an affinity for the chemically injured oesophageal mucosa and, if so, to assess the accuracy of radiolabeled sucralfate as an indicator of presence and extent of oesophageal injury. METHODS: A prospective study was conducted of 22 patients with mean age of 30 months (range, 13 to 90) admitted consecutively with a history of caustic ingestion between January 1998 and January 2000. A sucralfate-labelled scan followed by endoscopic assessment of upper gastrointestinal tract with documentation of extent and grade of injury was performed in all patients within 24 hours of admission except the first 6 who underwent scan after the endoscopy. The sucralfate was labelled by the direct stannous reduction method. Oesophageal transit was studied by recording 120 images (64 x 64 matrix size) at 1 image per second while the child swallowed 5 mL of labelled sucralfate containing 2 to 3 MBq Technetium 99m. Retention of radiolabelled oesophageal activity was considered abnormal. RESULTS: The caustic substances ingested were household cleaners in 18, potassium permanganate in 3, and pool chlorine in 1. There were 11 scans that showed residual activity in the oesophagus, which correlated exactly with endoscopic findings. The other 11 patients had normal oesophageal mucosa, but 2 were found to be falsely positive on scanning. In 2 cases repeat sucralfate scan results correlated well with the healing process assessed endoscopically. CONCLUSIONS: The results indicate that technetium 99m sucralfate swallow is an accurate technique for assessing oesophageal injury after ingestion of caustic substances. In addition, it may be used to document healing.

Burns, Chemical↗
PubMed2002

What is the utility of selected clinical and endoscopic parameters in predicting the risk of death after caustic ingestion?

BACKGROUND AND STUDY AIMS: Despite the increasing use of early esophagogastroduodenoscopy, the prognostic evaluation and triage of patients who have ingested caustic material is challenging. We evaluated the usefulness of selected clinical and endoscopic parameters in predicting the risk of death after ingestion of caustic substances. PATIENTS AND METHODS: Clinical and endoscopic parameters were obtained from the records of all the patients admitted to our endoscopy unit because of ingestion of caustic material between 1 March 1982 and 30 June 1999. Parameters significantly associated with the risk of death by univariate analysis were entered into a multivariate logistic model. The independent predictors of death by multivariate analysis were used to build a risk score system. RESULTS: Out of 210 patients, 13 underwent emergency surgery (6.2 %) and 25 died (11.9 %). Multivariate analysis identified the following as independent predictors of death: age (10-year intervals; odds ratio [OR] 2.4; 95 % confidence interval 1.4 - 4.1), ingestion of strong acids (OR 7.9; 1.8 - 35.3), white blood cell count at admission > or = 20 000 units/mm3 (OR 6.0; 1.3-28), deep gastric ulcers (OR 9.7; 1.4 - 66.8), and gastric necrosis (OR 20.9; 4.7 - 91.8). The values of the risk score system devised from the results of the multivariate analysis ranged from 1 to 16. No patient scoring < 10 points died and just one of the patients scoring > 14 points survived. CONCLUSION: Age, ingestion of a strong acid, leucocytosis, deep gastric ulcers, and gastric necrosis are predictive of death after caustic ingestion. A risk score system including these predictors may be useful in prognostic evaluation.

Adolescent↗
PubMed2000

Extensive abdominal surgery after caustic ingestion.

OBJECTIVE: To report the authors' experience in extensive abdominal surgery after caustic ingestion, and to clarify its indications. SUMMARY BACKGROUND DATA: After caustic ingestion, extension of corrosive injuries beyond the esophagus and stomach to the duodenum, jejunum, or adjacent abdominal organs is an uncommon but severe complication. The limit to which resection of the damaged organs can be reasonably performed is not clearly defined. METHODS: From 1988 to 1997, nine patients underwent esophagogastrectomy extended to the colon (n = 2), the small bowel (n = 2), the duodenopancreas (n = 4), the tail of the pancreas (n = 1), or the spleen (n = 1). Outcome was evaluated in terms of complications, death, and function after esophageal reconstruction. RESULTS: Five patients required reintervention in the postoperative period for extension of the caustic lesions. There were two postoperative deaths. Seven patients had secondary esophageal reconstruction 4 to 8 months (median 6 months) after initial resection. Three additional patients died 8, 24, and 32 months after the initial resection. Three survivors eat normally, and one has unexplained dysphagia. CONCLUSIONS: An aggressive surgical approach allows successful initial treatment of extended caustic injuries. Early surgical treatment is essential to improve the prognosis in these patients.

Adult↗
PubMed2001

Accidental caustic ingestion in children: is endoscopy always mandatory?

BACKGROUND: Patients who have experienced severe caustic injury to the gastrointestinal tract are at high risk of esophageal strictures. Early endoscopy is usually recommended systematically in children after caustic ingestion to assess the severity of the initial digestive lesions. The aim of this study was to determine the predictive value of clinical symptoms and ingested-substance types as markers of severe esophagogastric lesions and to define indications for endoscopy. METHODS: Ingested-product types, clinical symptoms, endoscopic data and outcome were prospectively recorded in 85 children admitted after accidental caustic ingestion. RESULTS: Forty-eight children (57%) had no symptoms; the others presented with vomiting, hematemesis, drooling, respiratory distress, and/or oropharyngeal lesions. Endoscopy showed no or minimal lesions in 63 cases (74%). None of the children developed digestive sequelae. Severe esophagogastric lesions were present in 22 cases (26%), mostly caused by lye ingestion (14 of 22) but also by strong acids (4 of 22); 9 of the 22 children (41%) developed esophageal stenosis. Vomiting, drooling, and oropharyngeal lesions did not predict severe endoscopic lesions. Hematemesis, respiratory distress, or presence of at least three of the symptoms was associated with severe lesions (positive predictive value = 1). The absence of symptoms was always associated with no or minimal lesions (negative predictive value = 1). CONCLUSIONS: In conclusion, endoscopy is not recommended for children living in developed countries who are asymptomatic after accidental caustic ingestion.

Accidents, Home↗
PubMed1985

Caustic ingestion in adult patients.

Sixteen adult patients who ingested caustic substances were seen from 1977 through 1984. All patients underwent endoscopy to determine the site and severity of burns; mild hyperemia to severe, penetrating necrosis was detected in each patient. Ten ingestions were intentional, 4 accidental, and 2 questionably accidental. Morbidity and mortality were high, especially in patients who ingested caustic materials intentionally. A protocol for treatment with steroids and antibiotics was followed in half the patients studied. Those patients who completed this regime tended to have moderately severe burns. Caustic ingestion in adults must be viewed as a problem different from that of accidental ingestion in children. Since most adult caustic ingestions are intentional, the injuries are worse, more deaths result, and more severe scars causing permanent disability are a frequent outcome.

Adolescent↗
PubMed1994

Caustic ingestion in adults--epidemiology and prevention.

A 16 year retrospective review identified 179 patients hospitalized for ingestion of caustic products in Aarhus County, Denmark. Seventy-five were adults over 15 years of age and residents of Aarhus County. The average annual incidence rate of hospitalization for caustic injury in adults was 1/100,000 with an incidence of esophageal burns of 0.8/100,000/y. Of the adults 61% attempted suicide: of these 61% were women. The annual incidence rate for adult women attempting suicide had an increasing trend (p = 0.048). Changes of the incidence rate for unintentional ingestions and for male suicide attempts were not significant. More than half of the suicide attempts were by patients with a history of a psychiatric illness. Of the caustics ingested by adults 94% were liquids. Acids accounted for 55% of the ingested products. Suicidal ingestion of hydrochloric acid was fatal in 6 of 12 adults. The inavailability of liquid caustics in the homes of patients at suicidal risk might prevent impulsive ingestion.

Adolescent↗
PubMed1998

[Emergency surgical management of lesions from ingestion of caustics. Role of primary endoscopic classification].

Management of caustic ingestion in adults improved in the last decade due to the new diagnostic developments, the better predictability of injuries from signs and symptoms, the intensive care improvements and the more aggressive surgical approach for the most severe lesions. In fact, the early surgical treatment of severe lesions for ingestion of caustic and corrosive substances may reduce mortality, morbidity and hospitalization. The role of early endoscopic examination is today worldwide accepted: is herein proposed a new endoscopic classification of caustic lesions adjusted after a retrospective analysis of a twenty years experience in this field, and applied in twelve patients affected by severe esophageal and gastric injuries then submitted to emergency surgical treatment and survived. It showed a great usefulness in selection of patients to submit immediately to surgery and may play a fundamental role in indications and timing of surgical management of severe injuries by caustic ingestion.

Adult↗
PubMedDate not supplied

[Tailored surgical treatment for post-caustics stenosis of the upper digestive tract with complicated lesions. Clinical experience at our department in the last ten years].

The ingestion of caustic substances generates severe lesions of superior digestive tract, leading to stenosis in 50% of patients, of which almost 50% will require surgical treatment. A number of 29 patients with caustic lesions were treated in the IIIrd Surgical Unit from 1993 to 2004. The most frequent corrosive agent was a strong alkaline solution. The location of the post caustics strictures was esophageal in 18 cases, esophagogastric in 7 cases and laryngo-pharyngo-esophageal in 4 cases. Surgical procedures consisted of 8 esophagoplasties with ascending colon and ileum, 12 with left colon, 3 with transverse colon and splenic flexure, and in 5 cases transhiatal resection with cervical esophago-gastric anastomosis. 5 patients required gastric resections of variable extent, in addition to the esophageal reconstruction: antrectomy with trunk vagotomy--1 case, subtotal gastrectomy--3 cases and total gastrectomy--1 case. In the group with pharyngeal lesions, esophageal reconstruction followed pharyngoplasty with cutaneous tube performed in the ENT department. Hospital mortality rate was 3,4 % (1 case). Postoperative morbidity of 20,6 % consisted of cervical anastomosis leakages in 2 cases and pleural effusions in 4 cases. Surgical treatment of the post caustics strictures of the upper digestive tract must be adapted to the location and severity of the lesions, requiring adequate operative experience and special pre- and postoperative care.

Anastomosis, Surgical↗
PubMed1990

Caustic strictures of the oesophagus.

Ingestion of caustic material is a major management problem which occurs most commonly in children. Twenty-five patients with caustic ingestion seen over a ten-year period are reported. Twelve patients had severe burns, resulting in oesophageal strictures. Of these, ten were children below six years of age (median age, 3 years). Dysphagia and vomiting were the main presenting features. Oropharyngeal burn was present in 83% of patients with oesophageal burns. The strictures involved the entire oesophagus in two patients, the upper third in four, the mid oesophagus in two and the lower third in four. Periodic dilatations were successful in restoring an adequate lumen in 7 patients with short strictures. Five patients required surgery. There was one death. Caustic damage to the oesophagus is preventable. Education of the public and simple measures by manufacturers of caustics are urgently needed.

Accidents, Home↗
PubMedDate not supplied

[The problem of caustic poisoning in children].

The exposure to caustic substances in childhood, being accidental in most cases, can cause doubts in the initial diagnostic therapeutic approach; the risk of missing lesions following caustic ingestion when symptoms are scarce or lacking is high. The paper provides an overview of the physiopathology and clinical presentation of caustic injuries and stress the possibility of burns of esophagus and/or stomach even without oropharyngeal symptoms and/or signs. The esophagogastroduodenoscopy has now an essential role in the evaluation of gastrointestinal tract injury, as a guide to the therapy and as a prognostic criterion. So it is possible to reduce the risk of poor outcomes by the appropriate treatment. Anyway the primary prevention against the exposition to caustic substances at home is fundamental and must be effected both through active and passive measures.

Adolescent↗
PubMed1987

Caustic alkali ingestions by farm children.

Liquid lye drain cleaners responsible for a childhood epidemic of household ingestions in the early 1970s are now marketed in drastically reduced alkali concentrations and packaged in child-resistant containers. However, farm and industrial caustic agents continue to be sold without poison prevention safeguards, as exemplified by dairy pipeline cleaners (liquid NaOH/KOH concentrations 8% to 25%) used routinely on dairy farms. In this study, the ingestion epidemiology of farm/industrial v household caustic alkali products was compared in a population that included farm children. Forty-three children were admitted from 1973 to 1983 to four rural hospitals for nonintentional caustic alkali ingestion. Farm products constituted 23% of all products and 43% of all drain/pipe cleaners ingested. Dairy pipeline cleaners were the single most common causative substance, injuring ten toddlers (mean age 1.6 years), perforating the esophagus in two. Liquid dairy pipeline cleaners were usually ingested in tiny amounts from nonchild-resistant containers or drinking glasses at evening milking time. In contrast, household drain cleaners were associated with fewer ingestions, with all serious complications related to highly concentrated products not available on the consumer market after 1975. Poison prevention strategies successfully applied in the 1970s to household drain cleaners should be redirected and modified for farm-related caustic alkali agents. Preventive measures are suggested by the highly specific pattern of injury and the small, defined population at risk.

Burns, Chemical↗
PubMed1993

[Ingestion of caustic agents. Epidemiology, pathogenesis, course, complications and prognosis].

The incidence of caustic ingestion varies with the availability of caustic products and preventive measures. A transient increase was seen in the US round 1970, in Denmark in the late seventies. Diagnosis and treatment of caustic ingestion injuries remains controversial, and must to a high degree be based on retrospective studies and animal studies, especially concerning the pathology and clinical course of the disease. These subjects are reviewed together with complications and prognosis. It is stressed, that ingestion of alkalies and acids result in a variety of lesions, depending on a number of factors listed. Ingestion of alkalies occurs in approximately 85% of all cases, with oesophageal stricture as the most frequent complication, and tracheal necrosis as the most frequent cause of death. Ingestion of acid in large amounts may lead to early gastric perforation, massive metabolic acidosis, and eventual death. Pyloric stenosis is the most common complication of acid ingestion. Approximately 33% of all patients admitted with (suspected) caustic injury reveal oesophageal damage. This leads to subsequent oesophageal stricture in 10-15%. Mortality is less than 10% in unselected groups.

Accidents↗
PubMed2005

Effect of the prostacyclin derivate iloprost in experimental caustic esophageal burn.

Previous experimental studies have suggested that administration of antithrombotic, antioxidant, and cytoprotective agents have protective effects in caustic injury of the esophagus. Therefore, an experimental study was carried out to investigate the effects of iloprost, a stable analogue of prostacyclin, on the esophagus after caustic burns. Sixty Wistar albino rats were divided into three groups of 20 animals each. In group A, animals were uninjured and untreated. In group B, animals were injured but untreated. In group C, rats were injured and administered intravenous iloprost for 3 days. Caustic esophageal burn was produced by 1 ml of 15% NaOH. Efficacy of the treatment was assessed by measuring the tissue malondialdehyde (MDA), superoxide dismutase, and glutathione levels with biochemical methods on the 3rd postoperative day. Histopathological evaluation was done on the 28th postoperative day. The level of MDA was significantly increased in group B compared with the other groups. In group B, the histopathological damage score was significantly higher than in groups A and C. There was also a significant difference between groups A and C regarding the histopathologic damage. These results indicate that iloprost has a preventive effect in experimental caustic esophageal burn in rats.

Animals↗
PubMed2004

Effects of hyperbaric oxygen therapy on caustic esophageal injury in rats.

BACKGROUND/PURPOSE: Caustic esophageal burn is a serious problem in pediatric surgery. Even though many clinical and experimental studies had been performed, the complication rate could not be reduced to a satisfying level. In this study, the authors evaluated the effects of hyperbaric oxygen (HBO) therapy in caustic esophageal burn in rats. METHODS: Rats were divided into 4 groups, and caustic burn at the distal esophagus was created by applying 50% NaOH for 3 minutes in all groups. The first and third groups did not receive HBO therapy. HBO therapy was applied to the second group for 2 days and to the fourth group for 28 days. To evaluate the effects of short-term HBO therapy, the first 2 groups were compared for ulceration, inflammation, and submucosal vascular thrombosis after 2 days. The third and fourth groups were compared for the long-term effects of HBO therapy. Rats in these groups were killed after 28 days and compared for the collagen content, weight, and mortality rate. RESULTS: In the second group, which received 2 days of HBO therapy, ulcer depth and vascular thrombosis were significantly lower than these in the first group (P =.022 and P =.020, respectively). The fourth group, which received 4 weeks of HBO therapy, had a significantly reduced mortality rate, weight loss, and collagen score and hydroxyproline level if compared with the third group (P =.035; P =.016; P =.028; and P =.033, respectively). CONCLUSIONS: These results indicate that HBO therapy is useful in caustic esophageal burn both in short-term and long-term use.

Animals↗
PubMed2005

Mitomycin C prevents strictures in caustic esophageal burns in rats.

BACKGROUND: Caustic esophageal injuries lead to stricture formation. Although a number of agents have been tried experimentally to prevent strictures, few have gained clinical application. The purpose of this study was to investigate the effectiveness of Mitomycin C (MMC), which inhibits fibroblastic proliferation in preventing caustic esophageal strictures. MATERIAL AND METHODS: Fifty-six rats were allocated into four groups. Caustic esophageal burns were created as described by Gehanno. Group A was instilled only with saline. Group B was injured and untreated. Groups C and D were injured and received topical MMC at 0.02 and 0.04% concentrations, respectively. At 28 days, stenosis index (SI), collagen deposition, and hydroxyproline content (HP) were determined in distal esophageal segments. Statistical analyses were done. RESULTS: Mean SI in Group B was significantly higher than others (P < 0.05). Mean SI was statistically higher in Group C than A and D and similar between groups A and D. The greatest accumulation of collagen was found in Group B, followed by Group C, D, and A, respectively. Collagen deposition in Group D was statistically lower than Group B (P < 0.01) and similar to Group C. Mean HP in Group B was statistically higher than others (P < 0.05), significantly higher in Group C than Group D (P = 0.047), and similar between Groups A and D (P = 0.73). CONCLUSION: MMC was effective in preventing strictures following experimental caustic esophageal injury, in a dose-dependent manner. We consider that it can gain clinical utilization with the establishment of effective mode, dose, and timing of therapy.

Alkalies↗