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PubMedDate not supplied

[Nutritional treatment in the therapeutic strategy in benign esophageal stenosis].

Oesophageal strictures prevent a normal alimentation, and in chronic and more prolonged cases are the cause of severe denutrition. Many organs then undergo changes reflected on ultrastructural morphology, that in most severe and lasting cases can demonstrate irreversible. The functional aspect of such changes correspond to a hindered performance of the damaged organs with possible sudden cardiovascular accidents, which are particularly meaningful in the surgical steps of reconstruction, that is heavy for the patient not only in the perioperative period but also during the recovery when higher are the caloric energetic requirements. For the positive outcome of the surgical therapy of these strictures it is therefore necessary to preventively restore an acceptable nutritional status of the patient by the use of one or more of the nowadays available techniques of artificial nutrition. A particular topic of the need of a efficacious nutritional treatment can be pointed in the cases of oesophageal caustic burns, where the caloric requirements is high since the beginning to meet the catabolic effects of the traumatic condition, while malnutrition represents one of the negative factors in prolonging connettival and fibroblastic proliferation, cause of most severe strictures and recurrences. After a general survey of the whole problem, the characteristics of the various artificial nutrition techniques are discussed, with the identification of an optimal scheme of global and nutritional treatment in oesophageal caustic burns.

Burns, Chemical↗
PubMed1992

[Sclerosing cholangitis in the evolution of a surgical hepatic hydatid cyst].

The retrospective analysis of 3 clinical observations points out the etiopathogenetic, clinical and therapeutical aspects of the diffuse stenotic cholangitis, which can occur after the surgical treatment of the hepatic hydatid cyst. Although rare (2.9% of hydatid cysts, 13% of those which communicate with the bile ducts), the diffuse stenotic posthydatid cholangitis represents a severe postoperative complication in cases of median cysts, exerting a compression upon the convergence of hepatic ducts and communicating with the biliary tract. Its presence should be clinically suspected if a mechanical icterus with septic angiocholitis, sometimes associated with an external biliary fistula (from the residual cavity), occurs in the postoperative course of these patients, especially if the primary operation has excluded the remanance of an obstacle at the level of the main bile duct. The lesional substrate is comparable with that of the primitive sclerosing cholangitis, from which it differs through its clear relation with the primary treatment of the hepatic hydatid cyst, through the rapid course of stenotic lesions which, although diffuse, may become more marked in certain segments, as well as through the constant suprastenotic dilatation of the bile ducts. In the pathogenesis are involved the caustic action of some scolicide solutions (2 per cent formaldehyde solution, hypertonic salt solution) on the wall of the bile duct and the cystobiliary communication which predisposes to the peroperative occurrence o-a migration syndrome and of angiocholitis. It requires an early surgical reintervention in order to solve the cholestasis and angiocholitis: according to the morphological situation, we have the choice between disobstruction and trans-stenotic calibration drainage, on the one hand, and biliodigestive derivations in the hilum, which are more efficient, on the other. The prognosis is burdened with the vital risk of septic angiocholitis and with the early occurrence of a secondary biliary cirrhosis or of stenotic recurrences. Prophylaxis consists in the performance of a primary surgical treatment, adequate in median and communicating hydatid cysts, avoiding the "blind" intracystic administration of scolicide solutions, which exert a caustic action on the bile ducts.

Adult↗
PubMed2003

Carbon dioxide scrubbing capabilities of two new nonpowered technologies.

Current guidance for survivors aboard a disabled submarine (DISSUB) recommends the use of the "stir-and-fan" method of carbon dioxide (CO2) scrubbing in which the contents of canisters of lithium hydroxide (LiOH) are dispersed onto horizontal surfaces. This technique is objectionable because it releases large quantities of fine, caustic LiOH dust and it utilizes LiOH inefficiently. This report presents the results of laboratory studies of the CO2 scrubbing capabilities of two new products that might improve on "stir-and-fan": the Battelle Curtain (BC) and the Micropore Reactive Plastic Curtain (RPC). Experiments took place within a sealed hyperbaric chamber. CO2 was added to the chamber at a known mass flow that reproduced what might be encountered in a "worst-case" DISSUB scenario. Natural convection alone circulated gas within the chamber. The mass of BCs or RPCs necessary to limit CO2 to 3% for about 2 days was determined. The total scrubbing capacity (mass of CO2 scrubbed per unit mass of agent) of the BC was 0.756 +/- 0.012 (mean +/- SD), and the comparable value for the RPC was 0.808 +/- 0.007. Both products provided a scrubbing capacity that is close to the stoichiometric limit of the reaction (0.919). Neither product released sufficient caustic dust to prevent handling by a trained individual wearing no personal protective equipment.

Air Conditioning↗
PubMedDate not supplied

[Transhiatal esophagectomy].

Between 1991-2001, 40 patients underwent esophagectomy without thoracotomy for: caustic esophageal stenosis (26 cases), cervical esophageal cancer (1), lower esophageal cancer (7), and acute post-caustic oesophagitis (2). Thirty-four patients underwent transhiatal esophagectomy, 3 patients had an esophagectomy by "stripping" and in 3 other patients a combination of stripping and transhiatal esophagectomy. Postoperative complications included: injuries of the laryngeal recurrent nerve (2), pulmonary complications (13), anastomotic leakage (5). Two patients died in the postoperative period one from a myocardial infarction and the other from an acute myocardial dilatation. Trans-hiatal esophagectomy can be considered as a viable alternative to transthoracic esophagectomy in the management of the benign and malignant diseases of the esophagus. Transhiatal esophagectomy is a safe method of resection because of its reported lower morbidity and mortality and similar survival rates compared to transthoracic esophagectomy.

Adult↗
PubMed1991

Four-year experience in the treatment of upper gastrointestinal strictures with balloon dilatation.

One hundred and sixty-four cases of upper gastrointestinal tract stricture were treated by balloon dilatation in 4 years. A total of 682 procedures were performed. One hundred and forty cases (anastomosis stenosis 95, caustic stenosis 33 and other stenoses of the esophagus 12) were followed up with an effective rate of 90% (126/140) and a long-term effective rate of 71.4% (100/140). Fourteen cases (10%) failed, and 11 of them were due to tumor recurrence. The concept about the short-term and long-term effects, the criteria for evaluation of the results, the factors influencing the effectiveness, and the time suitable for dilatation are described. For the dilatation, indications are anastomosis stricture of the upper gastrointestinal tract, esophageal web and caustic stenosis of the esophagus. This method is also indicated for cicatricial stricture of the upper gastrointestinal tract of various causes.

Adolescent↗
PubMed1990

[Use of the colon for esophageal substitution. Mortality and morbidity. Report of 105 cases].

One hundred and five colonic interpositions were performed in 102 patients. The indications for operation were caustic stenosis in 57 cases (Group A) and esophageal cancer in 45 patients (Group B). The right colon was used in 97 cases and isoperistaltic transverse colon in 8 cases. Eighty-nine transplants were anastomosed to the cervical esophagus and 16 to the pharynx. The distal anastomosis was to the antrum in 67 cases, to the second duodenum in 37 cases, and to the jejunum in 1 case. The overall mortality rate was 8.6 percent (9 cases), 5.3 percent (3 cases) in group A and 13.6 percent (6 cases) in group B (p less than 0.05). The morbidity rate was significantly higher in group B than in group A (77.3 percent vs 53.7 percent, p less than 0.05). Ischemic necrosis (3 cases) and chronic ischemia of the transplant (7 cases) were the major complications. Strictures occurred at the proximal anastomosis significantly more often in group B (63 percent) than in group A (40 percent) (p less than 0.05). Seven failures occurred in 93 survivors, i.e. oral feeding was impossible. In conclusion, mortality and morbidity rates of coloplasty are high. The use of colon as an esophageal substitute is justified only in case of caustic stenosis with unavailable stomach.

Adolescent↗
PubMed1989

[Treatment of esophageal stenosis in children].

Esophageal stenoses, both congenital and acquired, represent a serious problem in childhood due to the deleterious effects, of these anomalies in the patients nutritional state and lifestyle. Choosing the best way to the solution of such problems is of primary importance, paying special attention to the techniques that may not compromise irreversibly the continuity of the alimentary tract. The authors experience on the treatment of 77 esophageal stenoses, 8 of which were congenital and 69 acquire, is reported. Of this group, 24 are sequelae of esophageal atresias, 33 are of caustic origin and 12 of peptic nature. In 3 congenital stenoses with a cartilaginous matrix, surgical repair was undertaken. In the remaining cases forward and retrograde dilatation guided by a thread, through the gastrostomy orifice were performed, in accordance to the length and severity of the stenoses. Duration of the treatment varied broadly, ranging from 3-5 anterograde sessions, in the cases of esophageal atresia sequelae, to several years with an average monthly periodicity of one session in cases of total pharyngoesophageal caustic burn. As for complications, there were three cases of mediastinitis and two of subcutaneous infiltrations at the cervical level that were solved with antibiotics. The authors believe, on the basis of their experience, the absence of mortality and the scarce morbidity that, in the pediatric patients the treatment of choice of esophageal stenoses consists of dilatations on their different modalities. A yearly follow-up must be strictly maintained until the patients have completed their growth. We reject esophageal coloplasties in the pediatric age because of their complications rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1989

[Esophagectomy without thoracotomy using a stripping method: technic, results, indications in benign and malignant diseases of the esophagus].

A technique of esophagectomy without thoracotomy using a stripper with limited dissection of the mediastinum has been applied to 48 patients: neoplasia in 41 (squamous-cell carcinoma of the esophagus: 34, carcinoma of the gastric cardia: 5, pharyngeal carcinoma: 2) and non-malignant pathology in 7 (2 caustic necroses, 2 ruptured esophagus, 2 anastomotic leakages after gastro-esophageal resection, 1 caustic stenosis). There were 3 post-operative deaths. The best indications of this procedure are extended tumors of the lower esophagus in poor-risk patients, and perhaps superficial carcinomas of the esophagus whatever the site. The usefulness of this technique in such situations as perforations and mediastinitis is emphasized.

Adult↗
PubMed1986

[Structural changes demonstrable by optic and electron microscopy in cellular and support components of nevi in the phase of neoplastic transformation and their therapeutic treatment].

The mole can transform itself in melanoma. The transformation is caused in some's opinion by congenital cells, in some's opinion by external elements (metabolic, physical, caustic, etc.). The authors lean to external causes metabolic, physical caustic) and they consider useful the chirurgical and radiant treatment.

Cell Transformation, Neoplastic↗
PubMed1985

[Esophageal plasty in children. Retrospective study of 22 colonic transplants. Current orientation].

Esophageal replacement using transverse colon with left colic pedicle is reviewed. 18 were done for caustic stenosis with one death, 4 for atresia without mortality. For caustic stenosis the authors advocate early transplant since the third month if dilatations failed. Improvement of technique using staplers prevented any complication in the last 8 patients. These good results allowed the authors to switch to isoperistaltic gastric tube. In esophageal atresias, the authors did not find any indication of replacement in the 12 last years.

Burns, Chemical↗
PubMed1985

Transhiatal esophagectomy for benign disease.

Transhiatal esophagectomy without thoracotomy has been performed in 65 adult patients with dysphagia from benign esophageal disease: strictures (30), neuromotor dysfunction (24), acute iatrogenic perforation (five), acute caustic injury (four), and recurrent gastroesophageal reflux (two). Nearly 70% (45) had undergone at least one prior esophageal operation, and 26% (17) had a history of between two and four esophageal operations. The esophagus was replaced with stomach in 53 patients (82%), colon being used only when there was a history of either prior gastric resection or caustic injury to the stomach (10 patients). Intraoperative blood loss averaged 1,050 ml. Intraoperative complications included pneumothorax in 38 patients (58%) and a tracheal laceration in one patient. Postoperative complications included transient recurrent laryngeal nerve paresis (11 patients, 17%), chylothorax (four patients, 6%), anastomotic leak (four patients, 6%), and small bowel obstruction (two patients). There were five hospital deaths (8% mortality), none related to the technique of esophagectomy. Follow-up ranges from 1 to 84 months (average 28 months). Of 46 patients with a cervical esophagogastric anastomosis in the original esophageal bed, 42 have had an excellent functional result although 17 have required at least one postoperative esophageal dilation. Two have developed true anastomotic strictures. Clinically significant gastroesophageal reflux has not occurred. Transhiatal esophagectomy for benign disease is feasible and safe, even after multiple previous esophageal operations. The stomach appears to be a better visceral esophageal substitute than colon, because it allows an initially easier technical operation and superior long-term functional results.

Adolescent↗
PubMed1984

Urine sugar reagent tablet ingestion causing gastric and duodenal ulceration.

The accidental or intentional ingestion of urine sugar reagent (Clinitest) tablets, a potent caustic, has been reported to cause severe esophageal mucosal damage and stricture formation. Gastric mucosal damage was reported once before in a man who intentionally ingested 26 Clinitest tablets. We encountered a case of accidental Clinitest tablet ingestion causing gastric and duodenal ulceration without esophageal damage, a previously undescribed complication of inadvertent Clinitest tablet ingestion. Our case reemphasizes the role of early fiberoptic endoscopy in the evaluation of caustic ingestions.

Accidents↗
PubMed1995

Emergency surgical intervention for severe corrosive injuries of the upper digestive tract.

BACKGROUND: In treating severe corrosive injury of the esophagus and stomach, prompt diagnosis, adequate fluid resuscitation and warranted surgical intervention are the most important factors in rescue of critically ill patients. The purpose of this study was to evaluate the need for, and the advantages of, a surgical approach to treatment of such corrosive injuries to the upper gastrointestinal (UGI) tract, as well as to select the most suitable technique to achieve a good survival rate. METHODS: From January 1983 to December 1991, 220 patients were treated for caustic ingestion injury to the UGI tract. A retrospective review of their records allowed targeting of 27 patients with severe corrosive injury that surgical intervention was required. In this study, peritoneal sign was taken as the key indicator for early emergency operation. The age, sex, elapsed time from injury to operation, the sort and quantity of caustic agent used, injury mechanism, clinical manifestations, alternative surgical treatment methods and causes of death were also reviewed and analyzed in this study. RESULTS: The patients included 13 men and 14 women, of whom the majority were adults (96.3%) who had attempted suicide (85.2%). All of them had taken liquid corrosive agents, usually hydrochloric acid (63%). Eighteen underwent emergency operations; the other nine received only supportive treatment, given their terminal status. The mortality rates for patients with surgery and supportive treatment were 66.7% and 100%, respectively. Four patients died after undergoing esophagectomy with resection of the stomach using the thoracoabdominal method. Only three of the eight patients who received esophageal stripping combined with resection of the stomach through the abdomen died (37.5%). CONCLUSIONS: The time elapsed between injury and development of peritoneal sign is a good indicator of the severity and extent of the injury. When peritoneal sign manifests at a very early stage, it is an indicator that the corrosive injury is very advanced in its progress and that, no matter what procedures were performed, the outcome would be the same. Yet if there were a six-hour gap then aggressive surgical management can rescue some patients. It is recommended based on experience here, that when using the surgical approach, resection of the stomach with stripping of the esophagus is superior to the thoracoabdominal method.

Adolescent↗
PubMed1994

[Isolated burns after white-spirit ingestion in attempted suicide].

INTRODUCTION: We report an unusual complications of prolonged contact with white spirit leading to caustic burns. CASE REPORT: A 20-year-old patient was seen for caustic perianal burns several hours after ingesting one-half liter of white spirit in an attempted suicide. Motor diarrhoea also occurred quickly and a prolonged anal evacuation of white spirit. Complementary examinations did not reveal any lesions of the buccal, oesophageal, gastric or rectosigmoidal mucosa. DISCUSSION: Necrosis of the skin due to prolonged contact with petrol products is well known. Usually due to the delapidating action of dissolved petrol products on the superficial hydrolipid film and subjacent cell membranes. The absence of digestive tract lesions could be explained by the rapid onset of motor diarrhoea which may have limited the time of contact and thus protected the digestive tract mucosa which has a high content of mucopoly-saccharides and a low lipid content.

Adult↗
PubMed1995

[Esophagogastroplasty in childhood: experience in 4 patients].

The most common indications of esophageal replacement in childhood are the esophageal atresia with long gap and caustic strictures. Several techniques has been described, using different components of the digestive tract. Total gastric transposition was performed in 4 children. The indications were esophageal atresia without tracheoesophageal fistula in 3 cases and a caustic stricture in other patient. Follow-up was 12 to 32 months. All patients are normally feed. One patient presented an anastomotic leak that closed spontaneously with total parenteral nutrition but ultimately led to an anastomotic stricture requiring pneumatic dilatation. Other patient presented stricture by sternal compression and required surgical repair. Total gastric transposition is a easy and physiologic technique, with low morbidity and good functional results.

Age Factors↗
PubMedDate not supplied

[Treatment of esophageal stenosis with Savary-Gilliard balloons in children].

30 patients (less than 15 years old) were admitted for esophageal strictures, 16 of them secondary to corrosive injury. All the patients were treated with endoscopic dilation with Savary Gilliard bougie. The dilatation were done with general anesthesia using an Olympus GIF-XP10 endoscope and with fluoroscopic control. In the esophageal stenosis secondary to caustic ingestion endoscopic injection with Betamethasone was also used. The most frequent site of the stenosis was the upper third of the esophagus, and the main type of stenosis was tubular in the secondary to caustic burns and annular in the other group. In the posteaustic group 385 dilatations were performed in 115 sessions. Two perforations and one sepsis were reported in patients with corrosive stenosis. There was no mortality. 43.7% of the patients with corrosive stenosis and 85.7% with stenosis secondary to other causes obtained complete healing. Oesophageal dilatation with Savary-Gilliary bougies represents a safe and reliable method for the treatment of esophageal strictures.

Adolescent↗
PubMed1997

[Endoscopic treatment of benign esophageal stenosis].

Benign esophageal stenosis is the most frequent type of stenosis of the digestive tract. Surgical treatment is still affected by a high percentage of morbidity and mortality. This is not acceptable for a condition which is not neoplastic in nature. The introduction of modern endoscopic instruments has significantly simplified the technique also reducing the complications, therefore oesophageal dilatation has a fundamental role. The main indications to endoscopic treatment are represented by postoperative stenosis, and those caused by caustics, peptic acid, actinic lesions and achalasia. During the past 15 years, the Authors performed 205 endoscopic dilatation including 26 cases affected by esophageal achalasia. In the experience of the Authors, olivarian metallic probes were gradually abandoned in favour of Celestin & Savary polimetric dilators while pneumatic dilators were preferred only in achalasic cases. Endoscopic therapy was resolutive in 24 patients affected by achalasia (92.3%). In 158 patients, mechanic dilatation was employed (88.2%) and among them, 4 cases (2.19%) of esophageal perforation were observed. Overall, mortality rate was zero. As far as the average number of dilatation employed, the highest number was registered among caustic lesions (5), followed by peptic (4), and post-operative stenosis (1). The results obtained confirm the validity and efficacy of the endoscopic treatment for benign esophageal stenosis also considering the good compliance of the patients and the fact that no general anaesthesia is required.

Burns, Chemical↗
PubMed1996

[Cutaneous necrosis secondary to topical treatment of wart with 20 p. 100 glutaraldehyde solution].

INTRODUCTION: A commercial 20 p. 100 formulation of glutaraldehyde was recently introduced for the treatment of plantar warts. The rhinopharyngopulmonary toxicity of glutaraldehyde is well known. Allergic skin reactions may also occur. We report a case of necrosis of the pulp of the greater toe during normal use of this product. CASE REPORT: A 7-year-old child consulted for major, dry and painful necrosis of the pulp of the greater right toe. Clinical examination suggested a caustic lesion. The only agent which could be incriminated was a daily application of a 20 p. 100 glutaraldehyde solution every day for 8 weeks. Local application of liquid nitrogen immediately before beginning the glutaraldehyde treatment may have been a favoring factor. After 6 weeks of local antibiotherapy, the lesion had not completely healed. DISCUSSION: In France, warts are not usually treated with 20 p. 100 glutaraldehyde. Used extensively in Great Britain, there have apparently been no major accident at concentrations under 10 p. 100. The recent report by a Japanese group indicating the efficacy and safety of 20 p. 100 glutaraldehyde has led to renewed interest in this treatment: necrosis has never been reported. In our case the necrosis occurred after normal use of the product. The caustic effect appears to dominate (role of concentration, pH?). Incidents due to sensitization have also been reported. Repeated cases of this type have led to the withdrawal of the product from the market in December 1995.

Administration, Topical↗