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Since controlled clinical studies on the value of steroid therapy do not exist, the discussion on its effect is still controversial. Several well documented studies on animals have been done since 1952. Based on these findings we can expect an inhibition of stricture formation in cases of moderate acid burns where the muscular layer is not or only slightly damaged.
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The management of long segment esophageal stenosis following chemical burns in children remains a difficult problem although various kinds of treatment have been proposed. The surgical treatment, consisting in replacing the injured segment, is mutilating and always performed at some risks. On the other hand dilatations must be carried on over several years in order to produce results and are not compatible with normal life. Furthermore, they are often followed by complications. The authors have been led to develop a method which would both allow the conservation of the esophagus and avoid long term dilations. This procedure mainly consists in a lengthwise myotomy of the residual structure after 12 or 18 months retrograde dilatations so as to peel off the wall fibrosis. The technique is presented and discussed about 2 successfully treated cases with a 9 to 12 months follow up.
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The authors report four cases of carcinoma of the oesophagus developing at the site of old burns. They review the classical features of this type of lesion, found in their own cases: the role of trauma from dilatations and the very long time elapsing before malignant change occurs (29 to 57 years, according to the individual cases). They discuss the prophylactic value of oesophagectomy with oesophagoplasty following severe burns with stenotic scarring. Finally, they note that whilst the treatment of these forms of carcinoma of the oesophagus is in general palliative, curative surgery may nevertheless be envisaged.
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A retrosternal esophageal by-pass, mainly using isoperistaltic transverse colon, was performed in ten patients. In three of them, a gastrectomy for antral stenosis was associated. All the patients are alive and normally eating. A resection of the burned segment does not appear as mandatory. That surgery is essentially functionnal, and the indication must make much account of the patient's will.
We report the case of an antral stricture following lye ingestion. The patient was treated by 3 dilations using a through-the-scope balloon dilator, initially with good results. One year later, the recurrence of the symptoms led to 2 other sessions of dilation without success and a partial gastrectomy was performed. The intensity of the gastric wall fibrosis on the surgical specimen, probably responsible for major motor impairment, accounts for the discordance between the good endoscopic result and the clinical failure. Endoscopic dilation of lye-induced gastric strictures could be a temporary alternative to surgical resection because the gastric wall fibrosis blemishes the long-term functional result.
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The spores of Bacillus cereus were treated with 5% NaOH at 50 degrees C and 0.25% NaOCl. As a result, 99% of the spores had lost their viability by the 11th and 19.5th minutes, respectively. Kinetics of the process has shown that the rates of elimination of calcium and dipicolinic acid from the spores are different, and intensive loss of RNA and DNA was registered. Progressive degradation of spore envelopes and inner structures has been revealed by electron microscopy. Lethal effect of the studied chemical substances is presumed to be related to changes in the spore envelopes, thus interfering with normal barriers of permeability.
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Ingestion of a corrosive agent results in a life-threatening clinical condition that requires emergency intensive care and often surgical intervention. Treatment is multifactorial and varies with the extent and depth of the injury. We report a case of a young 24-year-old man with accidental ingestion of sulphonic acid. After 1 month he developed a progressive dysphagia. Early endoscopic examination showed grade III injury to both the esophagus and stomach with severe and undilatable stricture of the antrum. Therapy included total parenteral nutrition and antibiotics. Repeat endoscopic examinations on days 30 and 40 showed progressive healing of the esophageal injuries, but confirmed a complete antral stenosis. After two months a large antecolic jejuno-gastroplasty was performed on the anterior wall of the stomach. The postoperative course was regular, and endoscopic examination showed complete healing of the injuries.
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