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PubMed2004

Effect of pulping variables on the characteristics of oil-palm frond-fiber.

Caustic pulping of oil-palm frond-fiber strands was conducted following a central composite design using a two-level factorial plan involving three pulping variables (temperature: 160-180 degrees C, time: 1-2 h, alkali charge: 20-30% NaOH). Responses of pulp properties to the process variables were analyzed using a statistical software (DESIGN-EXPERT). The results indicated that frond-fiber strands could be pulped with ease to about 35-45% yield. Statistically, the reaction time was not a significant factor while the influences of the treatment temperature and caustic charge were in general significantly relative to the properties of the resultant pulps.

Arecaceae↗

PubMed2006

Corrosive injury of oral cavity--a rare presentation.

Corrosive injury of the upper gastrointestinal tract has been frequently reported in medical literature. The ingestion of acid or alkali may be accidental or intentional. The spectrum of injury varies from involving the oesophagus, stomach, and duodenum either individually or together. The oral cavity is rarely involved. The sequelae of oral cavity caustic injury that have been reported include microstomia, shallow vestibule, ankyloglossia, speech impairment, loss of teeth and impairment of facial expression. We report a case of corrosive injury of the oral cavity following accidental ingestion of caustic alkali, who presented to us with bilateral submandibular gland enlargement following the development of corrosive stricture of the submandibular ducts. The scar tissue in the anterior floor mouth was excised with the submandibular salivary glands. Concomitant release of the contracture in the gingivo-buccal sulcus was also done and the defect was covered with a radial forearm free flap. The presentation of corrosive oral injury as salivary duct obstruction and enlarged salivary glands has not been reported. Free tissue transfer for corrosive scarring in the oral cavity helps to restore pliable tissue.

Adult↗

PubMed2006

Prevention of stricture with intraluminal stenting through laparotomy after corrosive esophageal burns.

OBJECTIVE: We sought to present our experience in preventing esophageal stricture formation using modified intraluminal stenting in patients with caustic burns. METHODS: Between April 1976 and June 2005, 33 of 162 patients with corrosive esophageal burns were included in this study. Endoscopy was performed to define the degree of injury in all the patients but one. Among the 33 patients, 31 underwent modified esophageal intraluminal stenting through laparotomy 2-3 weeks after ingestion of corrosive agent and the remaining 2 patients underwent immediately after experiencing esophageal perforation. RESULTS: There was no death in this series. A 1-year-old child had aspiratory pneumonia because of poor compliance. The stent was removed without requiring anesthesia after it had been in situ for 4-6 months in the 33 patients. All the patients had a normal intake of food after removal of the stents, and stricture was not found on barium swallow. However, five patients had esophageal stenosis from 2 to 3 months during follow-up. One of them responded to esophageal bougienage, the remaining four patients required esophageal reconstruction and had a normal diet postoperatively. Twenty-four-hour pH monitoring in five patients showed that there was no gastroesophageal reflux. CONCLUSION: The modified esophageal intraluminal stent is able to prevent the formation of caustic esophageal stricture.

Adolescent↗

PubMed2005

Trimetazidine reduces the degree of fibrosis in alkali burns of the esophagus.

PURPOSE: The aim of this study was to investigate the efficacy of trimetazidine (TMZ), an antioxidant agent, on the prevention of stricture development after esophageal caustic injuries in rat. METHODS: Thirty rats were divided into 3 equal groups. A standard esophageal caustic burn was produced by application of 37.5% NaOH for a period of 90 seconds followed by water rinse. Group A (sham) animals were uninjured. Group B rats were injured but untreated. Group C rats were injured and received TMZ (5 mg/kg/d) via intraperitoneal route. Efficacy of the treatment was assessed in 28 days by measuring stenosis index and histopathologic damage score and by determining tissue hydroxyproline content. RESULTS: The stenosis index in the TMZ-treated group was significantly lower than the untreated group, similarly in the sham laparotomy group (stenosis index: 0.34 +/- 0.10, 0.94 +/- 0.21, 0.38 +/- 0.05, respectively; P < .05). The hydroxyproline level (microgram per milligram of wet tissue) was significantly lower in the TMZ-treated group compared with untreated group, similarly in the sham laparotomy group (1.06 +/- 0.14, 1.33 +/- 0.08, 0.68 +/- 0.15 microg/mg wet tissue, respectively; P < .05). In the untreated group, histopathologic damage score was significantly higher than TMZ-treated group (P < .05). CONCLUSIONS: Trimetazidine reduces the degree of fibrosis and ameliorates histopathologic damage in experimental model of corrosive esophagitis in rats.

Animals↗

PubMed2004

Self-expanding plastic stents for benign esophageal lesions.

BACKGROUND: A benign condition is a relative contraindication to the use of self-expanding metallic stents, because these devices usually are not retrievable. The self-expanding plastic stent is removable and induces less tissue hyperplasia. This study prospectively evaluated the use of a self-expanding plastic stent to treat benign esophageal conditions. METHODS: Over 4 years, 21 patients underwent self-expanding plastic stent placement for various benign esophageal disorders, including refractory peptic (n = 2), caustic (n = 3), post-radiotherapy (n = 3), and anastomotic (n = 4) stenoses; hyperplastic (n = 5) stenosis within a previously implanted metallic stent; and anastomotic leak (n = 4) after esophagectomy. The self-expanding plastic stent was removed from all patients. Patients were followed for at least 8 months after stent removal. RESULTS: Implantation was successful in all cases. Temporary self-expanding plastic stent placement was curative in 17/21 patients, especially those with caustic and hyperplastic strictures and anastomotic fistula, all of which were treated successfully without re-intervention. Median follow-up was 21 months (range 8-39 months) after stent removal. Moreover, by inducing tissue ischemia, self-expanding plastic stent allowed delayed removal of metallic stents. Only one severe complication (tracheal compression) was encountered, and this resolved after stent removal. CONCLUSIONS: A range of benign stenosing disorders of the esophagus can be treated safely with a self-expanding plastic stent. Because the long-term results were highly favorable, self-expanding plastic stent placement could be used as the initial treatment for various conditions. Self-expanding plastic stent insertion within an esophageal self-expanding metallic stent allowed removal of the latter, theoretically unretrievable, stent.

Adult↗

PubMed2001

Corrosive esophagitis in children: a 30-year review.

Caustic ingestion with resultant corrosive esophagitis in the pediatric population comprises a heterogeneous group in terms of offending agent, location of burn and the degree of damage. Consequently, the treatment of these injuries has also varied over the years and the optimal management remains controversial. Another area of concern that is seldom reported in the otolaryngology literature is the socioeconomic impact of such injuries both on the child and on the family. We report a 30-year retrospective review of aerodigestive tract caustic injuries at The Hospital for Sick Children. Eighty patients were identified with an age range from 1 month to 16 years. Early and late complications are reviewed including 23 patients (29%) that developed medical complications and 16 patients (20%) that developed severe esophageal strictures. Five of these children required repeat prograde dilatation, while 11 children required gastrostomy and stringing with subsequent retrograde dilatation. All the 11 children required esophageal replacement surgery. The economic and social consequences to the child and family were also noted with particular attention to hospital costs, parental absenteeism from work, and the need for job relocation. A partial cost analysis using a child with a severe injury is presented as an example. Psychological aspects such as attempted murder, jail terms and attempted suicides are also documented. We also present an analysis of those children requiring esophageal replacement surgery, and examine the possible role of esophageal stents in recalcitrant strictures.

Adolescent↗

PubMed2004

[Reactive airway dysfunction syndrome: more flexible application of diagnostic criteria are important for occupational accident victims].

Reactive airway dysfunction syndrome (RADS), or Brooks syndrome, is a complication observed after inhalation of caustic or highly irritating substances. The diagnosis is based on a group of criteria which include the absence of prior respiratory disease. Strict application of these criteria could have a prejudicial effect for certain victims. Three serious cases of RADS were observed in workers who were exposed to massive inhalation of caustic substances. The products implicated (phosphoric oxychloride, titanium tetrachloride, and trichloroacetyl chloride) hydrolyze to hydrochloric acid when they come in contact with the airway mucosa. After an initial period of acute respiratory distress, the patients encountered serious difficulties in achieving an appropriate diagnosis, and in having their sequellae recognized as resulting from an occupational accident. The problem was that these patients had a history of cured allergic asthma or smoking-related COPD. The presence of prior respiratory disorders must not exclude the diagnosis of RADS. A prior respiratory disorder cannot be used as an argument to exclude such victims from indemnities for occupational accident sequelae.

Adult↗

PubMed2001

Is it necessary to resect the diseased esophagus in performing reconstruction for corrosive esophageal stricture?

OBJECTIVE: The incidence of carcinoma of the esophagus among patients with chronic esophageal stricture caused by ingestion of corrosive agents is reported to be significantly higher than that of the general population. The question of whether or not a resection of the diseased esophagus should be included in the surgical reconstruction procedure of the undilatable esophageal stricture continues to be a controversial. METHODS: During the 12 year period from 1988 to 1999, a total of 54 consecutive patients with caustic stricture of the esophagus were treated in our department. We retrospectively reviewed these cases and analyzed the incidence of cicatrical carcinoma among the patients and the risk of esophagectomy according to the procedures performed. RESULTS: We found seven cases of esophageal cancer among these patients. There was no significant increase in mortality or morbidity related to esophagectomy. CONCLUSIONS: Considering the high incidence of cicatrical carcinoma from the stricture sites as well as the possible chance of hidden malignancy, we concluded that the simultaneous resection of the esophagus with reconstruction for patients with chronic intractable caustic stricture would give the patients a better probability of being completely cured of the disease.

Adult↗

PubMedDate not supplied

Successful management of an acquired gastric outlet obstruction with endoscopy guided balloon dilatation.

Antral-pyloric strictures and gastric outlet obstruction are known complications of caustic ingestions. These lesions can develop even in the absence of overt signs of potentially serious upper gastrointestinal tract pathology such as oropharyngeal burns, dysphagia, vomiting, or abdominal pain at the time of ingestion. The development of radial balloon catheters, which can be endoscopically guided into narrow strictures and inflated, offers an alternative therapy to surgical resection of obstructing lesions. We report the successful management of a pyloric stricture secondary to a caustic ingestion by sequential endoscopically guided balloon dilatations and offer guidelines for the use of this procedure.

Catheterization↗

PubMed2000

[Poisoning by household products].

Caustic products are responsible for the most serious cases of poisoning, which are always emergency cases. Application of current intervention procedures has decreased both morbidity and mortality. Water-diluted bleach, the ingestion of which remains extremely frequent, is a moderate irritant rather than a caustic product. Emission of gas produced when mixing bleach with other agents can be responsible for choking gas poisoning. Anionic and nonionic detergents are mostly dangerous because of their foam-producing properties. Mercury vapours and methanol are other potentially hazardous products.

Acute Disease↗

PubMed2002

Development of a standardized animal model for the study of alkali ingestion.

The purpose of this study was to develop an animal model that would grade in-vivo therapeutic modality testing for caustic ingestion. Caustic substances are found in many household items (eg detergents, bleaches, pipe cleaners) and pose a serious threat to health if ingested accidentally or intentionally with resulting injuries including immediate death or chronic debilitating morbidity. This study used 5, 3.8 or 1.8% sodium hydroxide (NaOH) to determine macro/microscopic injury at 10, 30, or 60 minutes. Macroscopic grading was based on gross evaluation of denudation of mucosa, edema, hyperemia, hemorrhage, ulcerations and necrosis. Microscopic grading was based on epithelial viability, cornified epithelial cell differentiation, granular cell differentiation, epithelial cell nuclei, muscle cell viability and muscle cell nuclei. Product concentration was shown a more significant predictor of injury than time of exposure. The grading system presented should provide a reliable method of producing and grading alkaline ingestions for future treatment hypothesis testing.

Administration, Oral↗

PubMed2002

Desiccant-induced gastrointestinal burns in a child.

Desiccants are commonly composed of non-toxic chemicals such as silica gel. A 2-y-old male unintentionally ingested the contents of a desiccant packet found in a container of imported Chinese cookies. He presented with vomiting, drooling and inability to drink. A caustic injury to his tongue and phaynx was noted. He improved over the next 12 h and was discharged a day later. The packet was found to contain caustic lime Although patients who ingest desiccant packets generally develop no clinical effects, ingestion of packets containing strong alkali may prove consequential. Providers should be aware of the potential for this toxicity before dismissing desiccant exposures as benign.

Burns, Chemical↗

PubMed1992

[Emergency treatment of corrosive gastrointestinal injuries].

Authors discuss their experience of management for caustic gastrointestinal injury. Importance of urgent endoscopy in establishing the extend of injury is emphasized. In eight out of 12 surgical intervention an esophagogastrectomy were performed. According to their experience in case of serious caustic burn the only hope to save the patients life is the early radical operation.

Adult↗

PubMed2005

A particular case of a "captive forceps" in the esophagus.

We present a particular case of a "captive" forceps in the esophagus in an attempt to remove a foreign body in a patient with previous esophageal post-caustic stenosis. The mechanism of incarceration and the surgical therapeutic option consisting of open thoracic surgery are detailed and argumented. Postoperative course was favorable, though the patient developed a small esophageal fistula visible at radiology without any clinical expression. This case emphasizes the difficulties that may occur but in the management of esophageal foreign bodies in patients with esophageal post-caustic stenosis, which may lead finally to open surgery.

Aged↗

PubMed2005

Mortality rate in acute poisoning in a pediatric toxicology department.

INTRODUCTION: Acute poisoning, an important health issue in children can result in some cases in severe evolution and even death. OBJECTIVE: The aim of the study is to analyze cases of death caused by acute poisoning which occurred in a ten-year-period in a Pediatric Toxicology Department in Bucharest. METHODS: For the purpose of the study all medical records of the deceased patients with acute poisoning between 1995-2004 were analyzed with particular focus on the following criteria: etiology, age, social environment, type of intoxication (unintentional or intentional). RESULTS: Between 1995-2004, 46 fatal cases were recorded out of a total 8802 cases of acute poisoning (0.52%). The main two causes of death by acute poisoning were: caustics (16 cases--34.78%) and mushrooms (12 cases--26.08%), followed by carbon monoxide (7 cases 15.11%), pharmaceuticals (5 cases--10.86%), ethanol (2 cases--4.34%), pesticides (2 cases--4.34%), nitrites (1 case--2.17%) and lead tetraethyl (1 case--2.17%). CONCLUSIONS: Although morbidity in acute poisoning is still high, mortality is low, the registered average being 0.52%. The main agents causing death are caustics and mushrooms, and the most affected age group is that between 1 and 5 years of age.

Acute Disease↗

PubMed1987

[Esogastric lesions caused by ingestion of liquid chlorine bleach in adults].

A retrospective study of 193 adult patients who ingested liquid chlorine bleach is reported. This figure represents 37 p. 100 of caustic product ingestions treated in the authors' hospital unit, these being attempted suicides in 85 p. 100 of the cases. All patients had oesophagogastric fibroscopy on the day of the ingestion: serious, grade 2 or 3 lesions were present in 38 p. 100 of the cases. Emergency surgery was necessary in 10 patients for a complication that occurred within the first 3 weeks, and after 2 months in 6 patients to treat a digestive tract stenosis. Compared with the other caustic products, liquid chlorine bleach predominantly creates gastric lesions and may produce digestive tract perforations by secondary necrosis which occurs after a free interval ranging from 2 to 26 days.

Adolescent↗

PubMedDate not supplied

[Jejunal invagination after antrectomy and gastrostomy in postcaustic esophagogastric stenoses].

The author presents 3 cases of jejunal invagination in a lot of 120 cases of post-caustic oeso-gastric stenoses that were operated. In two of the patients the invagination developed following antrectomy and in one case it occurred after gastrostomy with jejunal intubation. Invagination developed one month after surgery, and between 47 and 60 days from the ingestion of the caustic substance. In all the cases de-invagination was performed, followed by partial pleating of the mesenterium (Ghilda-Phillips). Oesophagitis, erosive gastritis, gastrostomy and prolonged jejunal intubation may explain the increased frequency of this complication (2.4% against 1.6% in patients with resections for ulcers).

Adult↗

PubMed1984

Corrosive substance ingestion: a review.

Patients who ingest caustic substances continue to pose difficult problems in diagnosis and management. Flexible endoscopy and radiological studies have helped to delineate the extent of damage caused by corrosives. Management techniques have been directed toward avoiding the development of esophageal strictures. Although a number of nonsurgical techniques are available, i.e., stenting, anticollagen agents, antibiotics, and corticosteroids none has been evaluated in well-controlled studies. In the future efforts should be made to evaluate adequately these management techniques. Public health efforts should be made to educate the public about the dangers of caustic substances so that their threat may be diminished.

Adult↗