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PubMed1982

Lye ingestion. Clinical patterns and therapeutic implications.

Conventional treatment of caustic esophagitis consists of early endoscopy to the first site of injury followed by antibiotic and steroid therapy, with early mechanical dilatation to prevent stricture formation. The failure of this approach in two recent patients led us to review our overall experience with the management of patients who had ingested lye or other caustic substances. Of 42 patients treated at the Santa Clara Valley Medical Center between 1970 and 1980, seven sustained severe esophageal burns. All had intractable strictures despite steroids, antibiotics, and, in three cases, attempts at dilatation. We conclude that patient survival should not be jeopardized by overly aggressive attempts to salvage an extensively damaged esophagus. Such attempts will probably prove both futile and dangerous, and effective re-establishment of oral-intestinal continuity is now possible by a variety of techniques.

Adolescent↗
PubMed1978

Corrosive injury of the esophagus. Result of ingesting some denture cleanser tablets and powder.

Denture cleansers are ubiquitous compounds frequently found in the household. Experimental studies were carried out to investigate the caustic, chemical, and histopathological properties of Polident and Efferdent tablets and Ansodent powder. All products were found to have caused severe focal to diffuse caustic burns of the esophagus due to the concentration of hydrogen peroxide that was liberated by these compounds.

Animals↗
PubMed2000

Workplace toxic exposures involving adolescents aged 14 to 19 years: one poison center's experience.

BACKGROUND: While many previous reports describe injuries to adolescents in the workplace, few focus on toxic substance exposures among such injuries. Yet low-skill, entry-level jobs pose a particular hazard of toxic exposure owing to the frequent use of cleaning agents, solvents, and/or other chemicals in carrying out assigned tasks. OBJECTIVE: To analyze the types and severity of adolescent occupational toxic exposures. DESIGN: Secondary analysis of calls to a single regional poison control center (PCC). SETTING: Massachusetts PCC poisoning consultations between 1991 and 1996. SUBJECTS: Children aged 19 years or younger reporting toxic exposures occurring in the workplace. RESULTS: Of 7024 occupational toxic exposures recorded by the PCC in the 6 years of study, 269 incidents (3.8%) involved adolescents aged 14 to 19 years (median age, 18 years; 124 aged 14-17 years and 145 aged 18-19 years; 65% were male). The most frequently involved agents were cleaning compounds (27.8%); paints, solvents, and glues (9.0%); caustics (8.7%); hydrocarbons (8.7%); and bleaches (7.3%). Of 88 cases (32.7%) in which a worksite was identified, food services (30.7%), automotive services (14.8%), and general retail stores (12.5%) were the most common locations. One hundred fifty-six patients (58.0%) were triaged to an emergency department; 7 were hospitalized. Forty-three subjects (16.0%), 18 who were between the ages of 14 and 17 years and 25 who were aged 18 or 19 years, were judged to have moderate to severe injuries. There were no deaths. CONCLUSIONS: This study confirmed the usefulness of PCC surveillance as a source of information about adolescent toxic exposures occurring in the workplace. The occupational toxic exposures reported here most commonly involved cleaning agents, solvents, paints, caustics, and bleach used in those entry-level jobs most frequently filled by adolescents. We conclude that occupational toxic exposures are an underrecognized adolescent injury, and that PCC experience can be used to fill a gap in the surveillance of such workplace-associated events.

Adolescent↗
PubMed1990

Sclerosing cholangitis induced by formaldehyde solution injected into the biliary tree of rats.

Sclerosing cholangitis has been reported after surgical treatment of hydatid disease of the liver and has been hypothetically attributed to the caustic effect of the parasiticide solution injected into the cyst and diffusing into the biliary tree through a cystic-biliary fistula. In this experimental study, we showed that, in rats, injection into the biliary tract of 20% hypertonic saline solution or 2% formaldehyde solution, the most commonly used scolicidal solutions, was followed by lesions of the biliary epithelium. As compared with 20% hypertonic saline solution, the 2% formaldehyde solution caused more severe lesions of the biliary epithelium and, in addition, induced the development of sclerosis. This experimental study confirms the deleterious effect of scolicidal solutions to the biliary epithelium, shows that their effect is mainly related to the causticity of the scolicidal solution, and indicates that intracystic injection of 2% formaldehyde solution should be abandoned.

Animals↗
PubMed2003

Balloon dilatation in children for oesophageal strictures other than those due to primary repair of oesophageal atresia, interposition or restrictive fundoplication.

BACKGROUND: Balloon dilatation of the oesophagus in children has been performed predominantly for treating strictures, which are the result of primary repair of oesophageal atresia, interposition surgery or restrictive Nissen's fundoplication. Reports of the use of this technique for alternative causes of stricture are few. OBJECTIVE: To report our experience and success with balloon dilatation of strictures due to caustic ingestion, achalasia, oesophagitis, congenital stenosis, and epidermolysis bullosa (EB) and to make comparisons with our treatment of patients with primary repair of oesophageal atresia (OA), as well as with reports in the English language literature. MATERIALS AND METHODS: Retrospective review of fluoroscopically guided balloon oesophageal dilatation procedures in 19 patients over a 5-year period, and comparison of those performed for OA repair complications with those due to other diseases. The average radiation dose, per procedure, was calculated by a medical physicist. RESULTS: Ten patients had strictures as a result of primary repair of OA. Three patients had stricture as a result of EB, two from achalasia, two from caustic injury, one due to an oesophageal web and one from reflux oesophagitis. Our results show that the technique can also be curative for the last group and that it may be used intermittently to alleviate symptoms in ongoing diseases. We have not experienced any complications and have also calculated that, even with prolonged use of multiple procedures, the radiation exposure is comparable to other radiological techniques. CONCLUSIONS: Patients with alternative causes for oesophageal stricture may be treated to resolution within 2 years using balloon dilatation. Ongoing diseases such as EB require ongoing dilatation, but balloon dilatation of strictures has been successful in alleviating swallowing difficulty. Patients with stricture from OA repair sometimes need ongoing dilatation. Radiation exposure for multiple procedures, over an extended period, is comparable to that from a single abdominal CT, and can be considered acceptable when repeat complex surgery is the alternative treatment option, or when ongoing incurable disease is the cause of the stricture.

Adolescent↗
PubMed2004

Ketotifen ameliorates development of fibrosis in alkali burns of the esophagus.

An experimental study was performed to investigate the efficacy of ketotifen, which is a mast cell stabilizer and histamine H(1)-receptor antagonist, on the prevention of stricture development after esophageal caustic injuries in the rat. Caustic esophageal burn was created by applying 37.5% NaOH to the distal esophagus. Forty rats were divided into four equal groups. Group A (sham) animals were uninjured. Group B rats were injured but untreated. Group C rats were injured and received ketotifen (1 mg/kg/day) via the oral route. Group D rats were injured and received ketotifen (1 mg/kg/day) via the intraperitoneal route. Efficacy of the treatment was assessed on day 28 by measuring the stenosis index and histopathologic damage score and biochemically by determining tissue hydroxyproline content. The stenosis index in group B (0.93+/-0.22) was significantly increased compared with group A (0.39+/-0.06, p <0.05), group C (0.42+/-0.09, p <0.05), and group D (0.35+/-0.07, p <0.05). The hydroxyproline level ( micro g/mg wet tissue) was significantly increased in group B (1.31+/-0.08, p <0.05) compared with group A (0.69+/-0.16, p <0.05), group C (1.06+/-0.16, p <0.05), and group D (0.95+/-0.12, p <0.05). In group B the histopathologic damage score was significantly higher than in groups C ( p<0.05) and D ( p<0.05). There was no significant difference between group C and group D in terms of all parameters evaluated. Treatment with ketotifen decreased tissue hydroxyproline levels, histological damage, and the stenosis index. We conclude that ketotifen has a preventive effect in the development of fibrosis in an experimental model of corrosive esophagitis in rats.

Animals↗
PubMed1998

Effective endless-loop bougienage through the oral cavity and esophagus to the gastrostomy in corrosive esophageal strictures in children.

The authors present a safe, conservative method of endless-loop bougienage (ELB) through the oral cavity and esophagus to a gastrostomy without general anesthesia in three children with corrosive esophageal burns treated since 1966. Esophagogastroscopy was performed to evaluate for esophagitis at an early phase after ingestion of the caustic substance. When esophageal stricture formation was recognized after subsequent conservative treatment, a feeding gastrostomy was made. A continuous string loop with plummets of progressively larger size was positioned to pass through the patient's oral cavity and esophagus to the gastrostomy. Strictures were found in the upper esophagus in two patients and in the middle and lower esophagus in one. The gastrostomy was performed 15 months, 20 days, and 2 months after the injury, respectively, and the periods of ELB were 3, 5, and 2(1/2) years, respectively. The patients were able to start eating at 26, 42, and 29 months after injury, respectively. They are now 30, 18, and 17 years old, and slight dysphagia remains in patients 1 and 2. No patient developed esophageal carcinoma at the site of the corrosive stricture. Our method of ELB through the patient's oral cavity and esophagus to the gastrostomy appears to be safe, reliable, and useful. We believe that most caustic esophageal strictures in children can be treated by this conservative measure.

Burns, Chemical↗
PubMed2002

Effect of antioxidant therapy on collagen synthesis in corrosive esophageal burns.

To investigate the efficacy of antioxidant therapy on collagen synthesis in corrosive esophageal burns, 110 Sprague-Dawley rats were divided into five groups of 22 animals each. A standard esophageal caustic burn was produced by 1 ml of 10% sodium hydroxide solution for the rats in groups B to E; group A was instilled only with 0.9% saline after preparation of the distal esophageal segment. Group A animals (controls) were uninjured and untreated. Group B had untreated esophageal burns. Esophageal burns were treated in group C with vitamin E (10 mg/kg IM), in group D with vitamin C (10 mg/kg IP), and in group E with methylprednisolone (30 mg/kg IM) on each of 5 days. Eight rats from each group were killed 4 days after initiation of the study and the abdominal esophagus was studied for tissue malondialdehyde (MDA; micromol/g protein) levels. The other rats were killed 28 days after initiation of the study and determination of hydroxyproline (HP) (microg/g tissue) levels in esophageal tissue was performed for 8 rats in each group. Histopathologic evaluation was also performed in the other 6 rats from each group. MDA levels in esophageal tissue were significantly lower in groups C (9.24 +/- 2.62, P < 0.01) and group E (6.26 +/- 2.22, P < 0.001) than in group B (12.35 +/- 1.80). HP levels were significantly lower in groups A (0.75 +/- 0.21, P < 0.001), C (1.11 +/- 0.15, P < 0.01), and E (0.96 +/- 0.15, P < 0.001) than in group B (1.40 +/- 0.20). Histopathologically, collagen deposition in the submucosa and tunica muscularis was lower in groups C and E than in group B (P < 0.05, and 0.01, respectively). Our results demonstrate that treatment with antioxidant drugs such as vitamin E and methylprednisolone decreased tissue HP levels, and thus inhibited new collagen synthesis and stricture formation in rats with alkali-induced caustic esophageal burns.

Analysis of Variance↗
PubMed2005

Relationship of eye burns with calcifications of the cornea?

INTRODUCTION: The clinical pattern of corneal calcification has been considered to be a part of chronic eye diseases, such as uveitis, severe glaucoma, keratitis and eye burns. Since, in some cases of eye burns, we have found corneal calcifications to be related to the initial calciferous caustic agents and to the use of phosphate-buffer-containing fluids, we have reviewed our files of clinical eye burns for the incidence and appearance of corneal calcification. METHODS: A total of 176 burnt eyes of 98 patients suffering from severe eye burns were retrospectively reviewed. The following data set was acquired: the type of caustic agent, the time of the burns, the delay and type of immediate treatment and the time and type of first aid, the subsequent medication, the clinical grading and the later results. RESULTS: Calciferous burning agents and corneal calcification are correlated (P<0.01). Initial single rinsing with phosphate does not produce corneal calcification (P=0.134). There is evidence that corneal calcifications are correlated with chronically administered phosphate-buffered eye drops (P<0.005). DISCUSSION: Eye burns followed by calcifications follow two different major patterns: the corrosive substance contained calcium or the continued therapy was applied with phosphate-buffered eye drops. We present case reports of three different types of eye burns and later therapy resulting in corneal calcification. Corneal calcifications are presumably related to longer-lasting phosphate application. One suspicious mechanism is the low content of calcium ion stabilizing proteins such as hyaluronate or fetuin in treatments for severe eye burns. The exceeding of the solubility product of Ca(2+) and PO(4) (-) results in the precipitation of calcium phosphates. In cases of chronic corneal disturbance, we recommend the elimination of phosphate-buffered medications to prevent corneal calcification.

Adolescent↗
PubMed1994

Prevention and management of strictures after hypopharyngocolostomy or esophagocolostomy.

The records of 14 patients who underwent surgical revision for anastomotic strictures after hypopharyngocolostomy or esophagocolostomy were reviewed. The esophageal reconstruction was originally performed for esophageal strictures or resections after corrosive injury in 13 patients and for achalasia in 1. The esophageal substitutes used consisted of right ileocolon in 12 patients and left colon in 2. Routes of colon positioning were substernal in 13 patients and subcutaneous in 1. One-half of all strictures were located at the hypopharynx and the other half at the cervical esophagus. Causes of the strictures were anastomotic leakage in 5 patients, progressive caustic scarring in 4, graft ischemia in 3, combined caustic and tuberculous scar in 1, and technical error in 1. The interval from esophageal reconstruction to the revision was 1 month to 15 years with a median of 7 months. Surgical approaches included cervical incision only in 9 patients, cervical incision plus sternotomy in 3, and cervical incision plus partial resection of sternal manubrium in 2. Revisional procedures consisted of excision of scar with reanastomosis in 12 patients, skin graft in 1, and free jejunal graft in 1. After revision, all but 1 patient had excellent results. On the basis of these experiences we conclude that most strictures after pharyngocolostomy or esophagocolostomy can be surgically corrected after excision of the scar and mobilization of the esophageal substitute through a cervical incision only or a cervical incision plus sternotomy.

Adult↗
PubMed2004

[Black oesophagus, a rare event in intensive care unit].

We report a new case of acute necrotizing oesophagitis, diagnosing on a patient hospitalised in intensive care unit. This pathology is still a rare event; the definition excludes patients with a history of recent caustic ingestion. Oesophageal necrosis can be diagnosed at endoscopy by the presence of black necroting appearing oesophagus. Contrary to the caustic oesophagitis whose treatment is often surgical, treatment of the acute necrotizing oesophagitis is primarily medical. The prognosis for patients who develop acute necrotizing oesophagitis is generally poor, even if one can hope for the cure without after-effect of it.

Abdominal Neoplasms↗
PubMed2006

Perforated diverticulum: rare complication of interposed substernal colon.

Substernal colon interposition is a good reconstruction option after salvage surgery for caustic ingestion injury. Although redundancy and reflux sometimes complicate these cases, there have been no reports in the English literature of perforated diverticula in interposed colon segments. We report a 23-year-old man who underwent substernal colon flap reconstruction after caustic ingestion injury. He had perforated colon diverticulitis develop, which led to a lung abscess 7 years later, followed by resection of the necrotic lung parenchyma and colon repair. This rare case illuminates the importance of including perforated diverticula in interposed colon in the differential diagnosis for such patients.

Adult↗
PubMed2006

A new pulping process for wheat straw to reduce problems with the discharge of black liquor.

Aqueous ammonia mixed with caustic potash as wheat straw pulping liquor was investigated. The caustic potash did not only reduce the NH3 usage and cooking time, but also provided a potassium source as a fertilizer in the black liquor. Excess NH3 in the black liquor was recovered and reused by batch distillation with a 98% recovery rate of free NH3. The black liquor was further treated for reuse by coagulation under alkaline conditions. The effects of different flocculation conditions, such as the dosage of 10% aluminium polychloride, the dosage of 0.1% polyacrylamide, the reaction temperature and the pH of the black liquor on the flocculating process were studied. The supernatant was recycled as cooking liquor by adding extra NH4OH and KOH. The amount of delignification and the pulp yield for the process remained steady at 82-85% and 48-50%, respectively, when reusing the supernatant four times. The coagulated residues could be further processed as solid fertilizers. This study provided a new pulping process for wheat straw to reduce problems of discharge black liquor.

Chemical Precipitation↗
PubMed2006

Performance of sulphonic cation exchangers in the recovery of ammonium from basic and slight acidic solutions.

Two sulphonated polystyrene-divinylbenzene cation exchangers (gel type Purolite SGC 100 x 10 MBH and macroporous Purolite C160 MBH) have been investigated for NH(4)(+) ions uptake from the ammonium-rich simulated solutions, corresponding to the caustic condensate of the nitrogen fertilizers production. One component (NH(3) or NH(4)NO(3)) solutions and the mixtures with varying molar ratio of these compounds have been used at the total concentration 0.214 mol/L. Batch and column experiments have been conducted to establish the influence of the matrix structure on the performance of the cation exchangers investigated during the sorption and the desorption. Batch sorption isotherms and breakthrough curves have shown the similar behaviour of the cation exchangers in the removal of NH(4)(+) and NH(3). On decreasing the influent pH from 11.4 to 5.74 a decrease in breakthrough capacity (BC) from 2.57 to 1.93 mol/L was observed. The distribution coefficients (K(d)), calculated from the batch sorption isotherms, are higher for the basic feed solution than for slightly acidic one. Both the degree of the cation exchanger regeneration (N/N(0)) and the efficiency of the NH(4)(+) ions recovery (N(R)), obtained using 0.7 bed volume (BV) of eluent (20% nitric acid) are lower for Purolite C 160 MBH than those for Purolite SGC 100 x 10 MBH. Using 5 BV of eluent the efficiency of the ammonium recovery amounted to 100% for both cation exchangers investigated. With respect to the efficiency of NH(4)(+) ions sorption and regeneration cation exchangers investigated are applicable for the recovery of ammonium ions from caustic condensate in the nitrogen fertilizers production.

Adsorption↗
PubMed2004

Gastric transposition in children--a 21-year experience.

PURPOSE: The purpose of this study was to analyze the outcome in 173 children (104 M, 69 F) undergoing transposition since 1981. METHODS: The most common indications for esophageal replacement included failed repair of different varieties of esophageal atresia (127), caustic injury (23), and peptic strictures (8). A total of 81% of the patients were referred from other hospitals (50% from other countries). Age at operation ranged from 7 days to 17 years. The gastric transposition was performed using blunt mediastinal dissection only in 90 patients with an additional 81 patients undergoing lateral thoracotomy. The retrosternal position was used in 2 patients. RESULTS: There were no graft failures including those who had previously failed gastric tube or Scharlilike operations. Anastomotic leakage occurred in 12% (all but 1 resolved spontaneously). Anastomotic stricture requiring dilatation occurred in 19.6%. Half of these patients had previous caustic esophageal injury. There were 9 deaths in the group (5.2%). One death occurred intraoperatively, 5 in the early postoperative period, and there were 3 late deaths. In more than 90% of our patients, the outcome was considered good to excellent in terms of absence of swallowing difficulties or other gastrointestinal symptoms. Many, however, preferred to eat small frequent meals. Poor outcome was particularly associated with multiple previous attempts at esophageal salvage. There was no deterioration in the function of the gastric transposition in those patients followed up for more than 10 years. CONCLUSIONS: Gastric transposition for esophageal substitution is an acceptable procedure. It is attended by 5% mortality and a 12% leak rate. A total of 19.6% of the patients needed anastomotic dilatation for stricture. In the long term, good function has been maintained. Gastric transposition compares favorably with alternative methods of esophageal replacement.

Adolescent↗
PubMed2006

Mercury emissions to the atmosphere from anthropogenic sources in Europe in 2000 and their scenarios until 2020.

The paper reviews the current state of knowledge regarding European emissions of mercury and presents estimates of European emissions of mercury to the atmosphere from anthropogenic sources for the year 2000. This information was then used as a basis for Hg emission scenario development until the year 2020. Combustion of coal in power plants and residential heat furnaces generates about half of the European emissions being 239 tonnes. The coal combustion is followed by the production of caustic soda with the use of the Hg cell process (17%). Major points of mercury emission generation in the mercury cell process include: by-product hydrogen stream, end box ventilation air, and cell room ventilation air. This technology is now being changed to other caustic soda production technologies and further reduction of Hg emissions is expected in this connection. The third category on the list of the largest Hg emitters in Europe is cement production (about 13%). The largest emissions were estimated for Russia (the European part of the country), contributing with about 27% to the European emissions, followed by Poland, Germany, Spain, Ukraine, France, Italy and the United Kingdom. Most of these countries use coal as a major source of energy in order to meet the electricity and heat demands. In general, countries in the Central and Eastern Europe generated the main part of the European emissions in 2000. Emission reductions between 20% and 80% of the 2000 emission amounts can be obtained by the year 2020, as estimated by various scenarios.

Air Pollutants↗
PubMed1980

Bacteremia after esophageal dilation: a clinical and experimental study.

Patients with esophageal stricture caused by caustic ingestion, reflux esophagitis, or esophageal anastomosis often require repeated dilation. These patients frequently have a short febrile course after dilation. After development of brain abscess following esophageal dilation in 1 patient, positive blood cultures were obtained in 4 patients immediately following esophageal dilation. Caustic strictures were produced in cats and esophageal dilations performed. Blood cultures were positive at one minute after dilation in 6 cats and at five minutes in 2 of those cats. The organism responsible in all clinical and three of four experimental examples was Staphylococcus aureus. It is suggested on the basis of this clinical and experimental data that patients undergoing esophageal dilation should have prophylactic coverage if they are immunosuppressed, if endocarditis prophylaxis is necessary, if they are infants, if they are diabetic, or if they had severe bacteremia following dilation.

Animals↗
PubMed2002

Acute esophageal necrosis: a 1-year prospective study.

BACKGROUND: A prospective 1-year study was conducted to assess the frequency, clinical spectrum, histologic description, and follow-up of acute esophageal necrosis unrelated to ingestion of caustic or corrosive agents. METHODS: The diagnosis of acute esophageal necrosis was based on a diffusely black esophagus at endoscopy and typical histologic features of diffuse mucosal and submucosal necrosis. Ingestion of caustic and corrosive agents was excluded in all patients. Medical history, associated diseases, and clinical symptoms were recorded for each patient. Nutritional status was evaluated based on clinical and biochemical parameters. Treatment included short-term parenteral nutrition and intravenous administration of a pump proton inhibitor. A second endoscopy was performed when possible at 2 weeks after presentation to assess regression of acute esophageal necrosis. RESULTS: Among 3900 patients who underwent EGD, 8 (0.2%) with acute esophageal necrosis were identified. Nutritional status was poor for 6 patients. Complete resolution of acute esophageal necrosis without further recurrence was observed in 4. No esophageal strictures appeared during follow-up. Four patients died, but no death was directly related to acute esophageal necrosis. CONCLUSION: Acute esophageal necrosis is not as infrequent an endoscopic finding as has been reported. Acute esophageal necrosis appears to be associated with poor general health status and is not a purely local phenomenon.

Acute Disease↗