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PubMed2006

Methane production and solids destruction in an anaerobic solid waste reactor due to post-reactor caustic and heat treatment.

This study was undertaken to determine the feasibility of caustic and heat treatment of sludge from a dry anaerobic reactor (DAR) with respect to increased methane production and solids destruction. The DAR was operated semi-continuously at 55 degrees C on sized-reduced municipal solid waste at a solids retention time of 15 days. A respirometer was employed to monitor the extent and rate of methane production from anaerobic biodegradation of DAR sludge that was treated with caustic and heat. Results indicate that caustic and heat treatment at 50 degrees C and 175 degrees C increased methane production by 22% and 52%, respectively. Also, volatile solids destruction increased from 46% to 58% and 83%, respectively. Based on these results, economic analysis for a full-scale 10(5) kg/d facility suggests that annual project revenue for 50 degrees C and 175 degrees C treatment is estimated at $21,000 and $445,000, respectively.

Anaerobiosis↗
PubMed1989

Comparison of titratable acid/alkaline reserve and pH in potentially caustic household products.

Exposure to caustic agents is a common problem, affecting thousands of individuals annually. Despite this incidence, the factors responsible for the production of injury remain poorly defined. Although extremes of pH seem to correlate well with the production of esophageal lesions, pH alone fails to explain the damage resulting from exposure to agents with near neutral pH, such as soldering flux containing zinc chloride. We determined titratable acid/alkaline reserve (TAR) in 38 potentially caustic household agents. A subset of these products was evaluated in an in-vitro canine esophageal model to determine whether TAR correlated with esophageal injury. The results indicate that for the products evaluated TAR correlated better than pH with the production of caustic esophageal injury.

Animals↗
PubMed1999

[Caustic burns of the esophagus in children: experience at the National Hospital and University Center of Cotonou].

Fifty-two children (mean age = 4.1 years) were admitted from 1992 to 1997 for an caustic burn of the oesophagus. Caustic ingestions were accidental in children less than 10 years old and mainly suicidal in older children. Burns were due to alkaline (82%), acids (14%), ou insecticide (4%). The ingested product was decanted from its original packing in 88% of cases. Thirty-six patients had an exclusive medical treatment, including a naso-gastric tube in 3. Endoscopic treatment included naso-gastric tube (n = 4) and bouginage (n = 5). An oesophagoplasty using a colonic transplant was performed in 8 children (15%), always after a previous feeding gastrostomy to improve the nutritional status. There was no operative mortality. These results conform with the main points of the literature. They underline the difficulties in the management of patients with caustic burns of the oesophagus and allow to determine preventive measures of this disease in children of Benin.

Adolescent↗
PubMed2002

[Treatment of severe caustic injuries of the anterior segment of the eye with limbal stem cell transplantation, penetrating keratoplasty and amnionic membrane transplantation].

The concept of limbal stem cells (LSC) opened new possibilities for the treatment of severe caustic damage of the anterior segment. These possibilities include transplantation of LSC, perforating keratoplasty, possibly transplantation of the amniotic membrane. In three patients with severe caustic damage of the anterior segment of the eye the authors implemented transplantation of LSC, perforating keratoplasty and in one patient also transplantation of the amniotic membrane. Where only one eye was damaged LSC for transplantation were obtained from the sound eye (autotransplantation, in case of damage of both eyes LSC were obtained in one case from a close relative in the second case from a cadaverous eye from a corneal bank (Allotransplantation). In the patient with autotransplantation of LSC, perforating keratoplasty and transplantation of the amniotic membrane the result was very good. The corneal disc remained clear 1.5 years after operation, the conjunctival sac was free from synbleropharons and vision improved from movement of the hand to 0.5. In the two patients with allotransplantation of LCS and perforating keratoplasty, LCS did not become incorporated despite immunosuppressive treatment and the corneal disc became turbid. Restored activity of LCS in severe caustic damage of the anterior segment opened new therapeutic opportunities.

Amnion↗
PubMedDate not supplied

[Esophago-gastric lesions caused by caustics].

A wide range of lesions may occurs after accidental or voluntary ingestion of caustic substances including mild epithelial injury to whole thickness necrosis of the involved organs. The type of management varies according to the severity of the damage, medical therapy being indicated in the less severe cases while surgery is required in life threatering lesins or alternatively as elective treatment of trighly desabling sequelae last complications such as. From 1981 to 1989 we observed 20 patients with acute hastro-oesophageal lesions due to ingestion caustic substances 19 of then were successfully treated with medical therapy. Only 1 patient underwent surgery and died of oesophagus cardiac fistula with right atrium perforation (24 days following total gastrectomy). Based on either our own experience and the data reported in the literature we believe that the most adequate management of patients with lesions of the E.G. due to caustic agents tract must include: vital functions control maintenance intensive care treatment of shock endoscopic monitoring of E.G. lesions emergency surgical treatment where needed.

Adolescent↗
PubMed1992

[Caustic esophagitis in children].

Treatment of caustic ingestion in children is a difficult and controversial problem which has not yet to be resolved. Here we report the evolution of fourteen children with esophageal injury after caustic ingestion that were treated with steroids at high-doses, nasogastric intubation and antibiotics. An early esophagoscopy was performed in all patients. Four patients developed esophageal strictures, three of which were mild and subsequent dilatation was successful. Only one patient was referred to surgery. We think that although it cannot be established, the use of high-dose of steroids and nasogastric intubation may be helpful for children with caustic esophagitis. We conclude that early endoscopy is useful to evaluate the severity of the lesions and to establish the necessity for treatment.

Anti-Bacterial Agents↗
PubMed1990

[Accidental ingestion of caustics in Tunisian children. Report of 125 cases].

The authors reviewed 125 cases of accidental ingestion of caustic substances admitted to a general pediatrics department over the last four years. L'eau de Javel (bleaching agent with sodium hypochloride) was the most frequently encountered caustic substance (89%). Esophagogastric fibroscopy was performed in 100 cases and esophageal lesions were classified according to tree grades of severity. In 46 cases, fibroscopy was normal, while severe esophagogastric lesions (grades 2 and 3) were found in 26 cases. On follow-up, six patients developed esophageal stricture, three of them after concentrated, eau de Javel ingestion. Stricture was severe in four cases, and required colonoplasty of the esophagus; it was limited in two cases and required endoscopic dilatation only. The authors emphasize the frequency and the severity of lesions caused by chloride bleach (eau de Javel) and recommend that fibroscopy be carried out in all children following ingestion of any caustic substance, even in the absence of oropharyngeal burns.

Burns, Chemical↗
PubMed1990

[Caustic burns of the stomach secondary to ingestion of acid in infants: importance of fibro-endoscopy].

Two cases of corrosive burns of the stomach after the ingestion of acid by children are presented. Both patients were the same sex and of a similar age (19 and 20 months). The chemical nature of the caustic substance ingested (hydrochloric acid) and the lack of initial symptoms were also similar. The clinical diagnosis however, was completely different due to the endoscopic finding of serious gastric lesions in one of the patients which were then treated accordingly. In children, the accidental ingestion of caustic acids is often accompanied by few clinical symptoms initially. This can lead to failure to diagnose correctly when symptoms are correlated with the existence and severity of digestive lesions. When a caustic substance has been ingested, in addition to symptoms, consideration of the acidity or alkalinity of the ingested product is also an important parametre in evaluating endoscopic findings.

Burns, Chemical↗
PubMed1989

[Immediate oesojejunal anastomosis after total gastrectomy in caustic necrosis].

Eight patients underwent total gastrectomy for caustic ingestion. Oesophago-jejunostomy was performed in the same surgical session. One patient died from hemorrhage. Only one of the 7 survivors had a benign anastomotic fistula. Five healed without any sequelae, 2 underwent colonoplasty 3 months later, because of a secondary oesophageal stenosis. We conclude that it is feasible, in certain unusual cases, to restore gastrointestinal continuity after total gastrectomy for caustic necrosis: moderate oesophageal lesions (stage I or II) and ingestion of a caustic product that cause few oesophageal damage (acids, liquid chlorine bleach, ...).

Adolescent↗
PubMed1989

[Does the ingestion of caustics produce irreversible motor changes in the esophagus? Manometric study of 17 cases].

During the acute period of caustic esophagitis, important alterations in esophageal motor function appear. However, it is not known if these alterations persist later. To determine whether motor disorders persist (after the aggression) in the esophagus that has suffered caustic aggression, a manometric study was made in two groups of patients classified as mild (9 cases) or severe esophagitis (8 cases), and results were compared with those of a control group. Patients who had developed stenosis or suffered the caustic aggression less than a year earlier were excluded. The probable existence of motor anomalies could determine the appearance of dysphagia or reduce the effectiveness of motor clearance of the esophageal body, thus conditioning a situation of esophageal defenselessness against physiological or eventual abnormal episodes of gastroesophageal reflux (RGE). Our results indicate that in a variable percentage of cases some peristaltic dysfunctions can persist in the esophageal body in relation to the severity of the initial lesion.

Adolescent↗
PubMedDate not supplied

[The role of endoscopy in managing esophageal lesions caused by caustic fluids].

In the paper is described the chronological outline adopted from the authors about the endoscopic treatment in case of oesophageal caustications, both in the emergency and, respectively, after one week and after one month. It is emphasized the importance of an endoscopic recognition within 6/12 hours after the caustic ingestion, to prevent the immediate acute complications, the later acute complications and the scarring evolutions of the healing. Important parameter for a clinical evaluation is represented by the volontariety of ingestion to which is connected the quantity of ingested caustic and than the extension of oesophageal lesions.

Accidents, Home↗
PubMed1997

[Caustic ingestion: health impact of a social disease].

PATIENTS AND METHODS: A total of 137 children less than 14 years of age were studied for caustic ingestion in the period 1987-1994. Seventy-five percent of the children affected were less than 3 years old. All ingestions but one, were accidental. The incidence rate of caustic ingestion did not decrease significantly during the period studied. RESULTS: Early esophagogastroscopy was the method of choice for the classification of caustic burns. Esophago-gastric damage occurred in 62 cases (45.3%), and was most frequently related to strong bases included in cleaners used in industry. Ingestion of household cleaners is associated with a good prognosis. The development of esophageal stricture was closely related to the severity of the initial injury. This occurred in 24 patients (17.5%). Prolonged hospital stay was necessary in order to treat adequately these patients. This means an elevated cost, estimated at 1,036,496 pesetas per patient, to the Health Care System. CONCLUSIONS: To minimize the frequency of this kind of childhood accident, an information campaign directed especially to parents is recommended. Furthermore, strict control concerning the commercialization and storage of these products is mandatory.

Adolescent↗
PubMed1997

[Severe caustic esophagitis in childhood].

OBJECTIVE: A retrospective analysis of patients treated for serious caustic esophagitis in our hospital was performed with the aim of defining epidemiological factors, initial treatment and therapeutic criteria for esophageal stricture with long evolution. PATIENTS AND METHODS: Thirty-four cases of serious caustic esophagitis treated since 1982 were analyzed surveying epidemiologic, clinical and endoscopy data, as well as initial medical treatment, dilatation session number, treatment period, complications, surgical treatment indications if necessary and actual situation. RESULTS: Alkaline caustic agents were swallowed in 71% of the cases, with dishwashing detergent being the most frequent (16 patients), Grade II esophagitis was noticed in 13 cases, grade III in 18. Established esophageal stricture was present in 3 patients when admitted. Repeated esophageal dilations were necessary in 13 patients (38%), with between 1 and 21 dilatation sessions needed. Esophageal stricture persistence forced us to perform an esophageal substitution technique by esophagocoloplasty. Resection and enlargement of a short stenotic segment was performed in 1 patient. Long-term evolution in all cases has been satisfactory. CONCLUSIONS: We consider that adequate treatment of these patients includes conservative corticosteroids, sucralfate and anti-H2 combined with a previous endoscopy evaluation. If evolution turns into stricture, dilatations must be done, sometimes throughout years. If this treatment fails and the injury is extensive, esophagocoloplasty is the surgical technique of choice. Nevertheless, as any accident, the best treatment is good prevention.

Adrenal Cortex Hormones↗
PubMed2006

Mitomycin C in the management of pediatric caustic esophageal strictures: a case report.

Although the incidence of caustic ingestion is declining, the management of caustic esophageal strictures remains a challenge. Mitomycin C (MMC) inhibits fibroblast proliferation and is effective in reducing scar in animal experiments. We report the case of a child with a distal esophageal stricture from lye ingestion managed with MMC. Despite repeated dilatations, at 1 year post injury, the stricture was 20% of esophageal diameter. Mitomycin C (4 microg/mL) was applied topically and circumferentially by endoscopy and repeated 4 months later. At 20 months follow-up, the child eats normally, and esophagram showed decreased stenosis (stricture was 50% of esophageal diameter). No complications were observed. Although controlled trials are required to confirm its efficacy, MMC should be considered as an adjunct in the management of caustic esophageal strictures in children.

Burns, Chemical↗
PubMed1996

Gastroesophageal reflux: a determinant in the outcome of caustic esophageal burns.

Deep circumferencial burns of the esophagus always result in stricture formation and obstruction of the lumen. The usual treatment of caustic esophageal strictures is long-term esophageal dilatations. A new method of treatment, long-term stenting of the strictured esophagus gave superior results when compared with the classic dilatation therapy (healing rates, 68% v 33%; P < .01). Although success in the stent group was very satisfactory, the 32% failure rate requires explanation. In the years between 1991 and 1993, 53 stent-treated patients were screened for gastroesophageal reflux (GER). All patients were investigated with 24-hour ambulatory distal esophageal pHmetry. In 18 patients reflux index (RI) was found to be below 4. In 14 patients RI was between 4.1 and 19. In the final group of 21 patients RI was over 20 (minimum, 21.8; maximum, 72.8). When these data were compared with the healing rates of the patients, it was found that none of the 21 patients with RI over 20 responded to the described therapy. We conclude that the esophagus, after a serious caustic insult, not only narrows but also shortens thus altering the lower esophageal sphincter function leading to serious GER. Therefore all caustic esophageal burn patients should be screened for GER periodically during the dilatation or stent therapy programs, and GER should be controlled before RI approaches 20.

Burns, Chemical↗
PubMed1998

[Long-term follow-up of children with esophageal caustic stenosis].

BACKGROUND: Long term follow-up of children with esophageal caustic stenosis is not well known. The aim of the present study was to describe functional, organic and psychological, as well as social consequences. PATIENTS AND METHODS: Thirty-four children with a mean age of 3 years and 7 months +/- 3 years and 2 months (ranges: 1 month-14 years and 3 months) were included in a longitudinal study. Various parameters have been studied: treatment, functional symptoms, nutritional status (weight/height, body composition) and psychological and social consequences. chi 2 and Mann-Whitney tests were used for statistical analysis. RESULTS: Twenty-one patients have been treated by mechanical dilatations whereas surgery was performed in 12 children; the mean number of dilatations per child was higher in patients treated by dilatations (21 +/- 17 vs 14 +/- 16; P < 0.05). The frequency of dysphagia was not different in patients with colon interposition or not (69% vs 53%; P = 0.1). Nutritional status was not affected by the presence of esophageal caustic stenosis. Psychological and social consequences were characterized by scholastic difficulties, anxiety and severe depression. One case of suicide was observed. CONCLUSION: Children with caustic stenosis should be followed for a long period of time. A multidisciplinary approach is necessary, taking into account medical, social and psychological consequences.

Adolescent↗
PubMed2002

Cololaryngostomy procedure in caustic esophageal burns.

The study presented herein was undertaken to report an original case of cololaryngostomy operation in caustic esophageal burns. Cololaryngostomy application to a chronic caustic esophageal burn case is reported with a detailed literature review of the topic. For the first time in the world, the larynx was used for the integrity of the gastrointestinal system by applying a cololaryngostomy procedure as it was found to be the only intact and reliable tissue in the operation. The patient started to gain weight in a 3-month period. Oral nutrition and speech were also achieved. Caustic injury to the upper aerodigestive system with scarring of the pharynx, hypopharynx and esophagus is an important reconstructive problem. In reconstruction, the aim should be the supplementation of both oral nutrition and speech.

Adult↗
PubMed2002

An acute fatality from suicidal caustic soda ingestion complicated by stab wound penetrating the stomach.

Acute death from caustic ingestion is uncommon. We report an autopsy case of acute fatality from suicidal ingestion of a liquid caustic soda solution with peritoneal leakage due to a stab wound to the stomach. The victim was a 58-year-old man, who died about 1 h after being transported to a hospital emergency care unit. There were corrosive erosions around the mouth and a stab wound in the lower chest. The tongue, pharynx, larynx, esophagus, stomach and the proximal portion of the duodenum were all eroded and edematous. The stab wound perforated the diaphragm and stomach, accompanied by liquefactive corrosion in the left-lower thoracic and left-upper peritoneal cavities. There was a marked elevation of the postmortem serum sodium concentration and alkalosis. The observations suggested peritoneal absorption of leaked caustic soda solution, which may have greatly contributed to the acute fatality despite an intensive clinical life support.

Journal Article↗