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PubMed1996

[Skin burns, necrosis and ulcers caused by wet cement, ready-mixed concrete and lime. 8 cases].

INTRODUCTION: Skin burns and caustic ulcers caused by wet cement, due to calcium hydroxyde, are rarely reported in the literature. They occur mostly among amateur cement users. OBSERVATIONS: We report seven cases of skin burns, necrosis and ulcerations after use of wet cement and ready-mixed concrete, and one case of caustic ulcers induced by wet lime. CONCLUSION: Even short skin contacts to wet cement or concrete may induce extensive lesions in some cases. However, we were not able to incriminate with certainty any special concrete additives which could increase skin penetration of calcium hydroxyde. Warning notices about the danger of skin contact should be prominent on sacked cement. When ready-mixed concrete is delivered, the purchaser should be handed a note explaining the risk of kneeling in wet concrete and the importance of protective measures. This may probably contribute to reduce the frequency of those accidents.

Accidents, Home↗
PubMed1997

[Application of phytotherapy in odontology: the case of Euphorbia balsamifera. Endodontic clinical trial].

Phytotherapy is a medicinal and ancestral practice in Africa. It deals with all the fields of human pathology. We wanted to ascertain the efficacy of some plants used in odontology as Euphorbia balsamifera traditionally used as antalgic treatment of acute dental pulpitis. The latex of the plant was caught and treated as to get enough stable paste. We used that paste in the same conditions we use arsenical nerve caustics, a pulpal devitalizer widely used in dental offices. The study carried out on 37 teeth has shown that latex of Euphorbia balsamifera is an effective pulpal devitalizing in contact with the pulp. Its lifetime action was comparable to that of the pulpal nerve caustics. The active principles are not known, however the product seems attractive as a pulpal devitalizing agent.

Adult↗
PubMed1981

Inhibition of experimental esophageal lye strictures by penicillamine.

We describe a new experimental model for the study of caustic stenosis of the esophagus in the rat. Sixty-five Wistar rats were given a standard esophageal lye burn. Animals were divided into two groups: (1) a control group and (2) a treatment group that received penicillamine from the day after the esophageal lye burn. Stenosis developed in only two of the 23 treated rats. Our conclusion is that penicillamine-induced lathyrism inhibits the onset of stenosis in the rat. Double-blind controlled studies of the effect of penicillamine in the prevention of corrosive strictures of the esophagus in man seem warranted.

Animals↗
PubMed1991

Cerebral abscess complicating dilatation of a corrosive esophageal stricture.

A case is presented in which a metastatic cerebral abscess developed in a 62-year-old female who required repeated dilatation for an esophageal stricture following accidental ingestion of liquid caustic soda. The literature is reviewed and management suggested for the avoidance of this uncommon complication.

Brain Abscess↗
PubMed1992

Steroids for the treatment of corrosive esophageal injury: a statistical analysis of past studies.

Caustic esophageal injury causes substantial morbidity and mortality. However, the use of corticosteroids to treat this problem has been evaluated in a limited number of studies because adequate sample size is difficult to obtain. We analyzed 361 subjects with corrosive esophageal injury derived from 10 retrospective and three prospective publications. We divided cases into those treated with corticosteroids and antibiotics (T) and those that received neither modality (NT) based on inclusion and exclusion criteria. Forty-one percent of NT cases developed esophageal stricture and 19% of T cases developed this complication (P less than .01). There were no reported strictures among 72 first-degree esophageal burns (combined T and NT cases). The T group contained 54 strictures among 228 patients (24%) with either second- or third-degree burns. The NT group of 25 patients with the same burn severity suffered 13 strictures (52%) (P less than .01). Reports of death and gastrointestinal hemorrhage did not increase among steroid-treated patients. We do not recommend corticosteroid therapy for first-degree esophageal injuries. However, this therapy may be useful in preventing strictures among patients with second- or third-degree corrosive esophageal burns.

Adult↗
PubMed2006

Removal of metallic stent by using polyflex stent in esophago-colic anastomotic stricture.

Benign strictures or anastomoses of the esophagus can be treated by stents. However, short-term and long-term complications, including migration and hyperplastic tissue reaction can occur. Bowel reconstruction by interposition has been performed after esophagectomy. Stricture of cervical anastomosis is an important late complication. Self-expandable metallic stents have been used to improve this problem. To remove the obstructed metallic stent, self-expandable covered plastic stents can be used. Herein we present the removal technique of tissue-embedded self-expandable metallic stents by using self-expandable covered plastic stents after colon interposition in a case of benign cervical anastomosis of the esophagus due to caustic stricture.

Adult↗
PubMed2006

Dysphagia [corrected] due to solitary jejunal diverticulum after free jejunal transfer for reconstruction of the cervical oesophagus.

The free jejunal flap has been widely used in clinical practice for the restoration of the cervical oesophagus, but a variety of complications still pose problems. The purpose of this report is to present a rare complication of the jejunal flap. A diverticulum of the jejunal segment, causing severe dysphagia, occurred 4 years after flap transfer in a 50-year-old man who underwent oesophageal reconstruction due to severe stricture following caustic ingestion. The patient was treated successfully by resection of the diverticulum. When examining a patient with unidentified symptoms in the neck or dysphagia after cervical oesophageal reconstruction with free jejunal transplant the possibility of small bowel diverticula should be borne in mind in order to prevent serious life-threatening complications that may arise from it.

Anastomosis, Surgical↗
PubMed2005

Management of corrosive esophageal burns in 149 cases.

OBJECTIVES: We sought to present our experience in the management of esophageal burns. METHODS: From April 1976 through October 2003, 149 patients with corrosive esophageal burns were included in this study. Treatment modalities consisted of modified intraluminal stenting in 28, colon interposition in 71, gastric transposition in 25, repair of cervical stricture with platysma myocutaneous flap in 17, and miscellaneous operations in 12 patients. Eleven of these patients underwent the above procedures twice at our institute. The remaining 7 patients were treated with conservative therapy. RESULTS: Twenty-three patients recovered from intraluminal stenting, and 5 experienced stricture after stent removal. One of the 5 patients with failed stents responded to bougienage, and the remaining 4 patients required esophageal reconstruction later. Of the 71 colon interpositions, 5 patients died postoperatively, and complications consisted of proximal anastomotic fistula in 17, anastomotic stenosis in 6, and abdominal incision dehiscence in 2 patients. Postoperative complications in the 25 patients with gastric transpositions comprised anastomotic stricture in 2 patients and empyema in 1 patient. There was a cervical leak in 1 of the 17 patients undergoing the repair of cervical esophageal or anastomotic stricture with a platysma myocutaneous flap. One of the patients in the group undergoing 12 miscellaneous procedures died 8 months after surgical intervention. All the survivors currently eat regular diets. CONCLUSIONS: Intraluminal stenting can prevent the formation of caustic esophageal stricture. The location of the cicatricial esophagus dictates whether to perform concomitant esophagectomy during esophageal reconstruction. Platysma myocutaneous flap repair is an excellent method for the treatment of severe cervical esophageal or anastomotic stricture.

Adolescent↗
PubMed2005

Ancient Egyptian doctors and the nature of the biblical plagues.

Paragraph 55 of the London Medical Papyrus describes burns derived from red waters and which later became infected with larvae in the wounds. The prescribed treatment for the burn is unusual as it calls for no rinsing and requires bandaging with alkaline materials only. Refraining from washing in the Nile (the single most readily available source of water in ancient Egypt), and the use of alkali-neutralizing agents indicates that the red caustic waters came from the river, and were acid in nature. A red, acid Nile is consistent with the first biblical plague of Egypt, which killed fish, and kept people from drinking from the river. In turn, the sulfate-laced waters of the medical document also offer a plausible insight into the subsequent biblical plagues. Amphibians would have stayed away from the deadly river, left to die on the banks, just as described in the second biblical plague. Similarly, the larvae in the wounds mentioned by the medical document re-echo the third and fourth biblical plagues: the kînnîm invertebrates and the subsequent 'arob (varied insects) are consistent with larvae and the subsequent adults thereof. In pre-industrial Ancient Egypt, sulfates from a massive volcanic fall out provide the simplest and most exhaustive origin for such waters. A massive precipitation that would account for the waters in the medical document and the biblical texts is known from sediments at the bottom of lakes along the Nile Delta. The site is downwind from the island of Santorini, and the deposit of volcanic ashes took place during the Middle Bronze Age, i.e. at a time consistent with the eruption at the Greek volcanic island.

Animals↗
PubMed2001

Redoing reconstruction of the esophagus using remnants of the ileo-left colon aided by microvascular anastomosis.

Theoretically, the jejunum, fasciocutaneous or myocutaneous flap is recommended as an esophageal substitute in redoing reconstruction of the esophagus after a second incidence of corrosive injury. However, other esophageal substitutes should also be considered. We present a case of a 42-year-old woman who underwent esophageal reconstruction using an ileocolon graft for corrosive esophageal stricture ten years before. The patient ingested caustic drain cleaner again and underwent resection of the ileocolon graft secondary to corrosive necrosis. Two and a half months after the second incidence of corrosive injury, reconstruction of the esophagus was again performed using a graft of remnant ileo-left colon aided by microvascular anastomosis. The patient was able to swallow a regular diet after the procedure. Remnant ileo-left colon is a good alternative esophageal substitute in cases of repeated corrosive injury.

Adult↗
PubMed2004

Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy.

BACKGROUND: Upper endoscopy provides information that can be used to predict complications and to facilitate clinical decisions for patients who have ingested corrosive substances. The role of EUS in corrosive injury has not been investigated. The aim of this study was to determine whether concurrent catheter-probe EUS provides additional information that predicts complications after corrosive injury. METHODS: Eighteen patients were referred (from 1997 to 2003) for EGD and concurrent EUS within 24 hours after ingestion of a caustic agent. Two patients were excluded (1 pneumoperitoneum, 1 markedly swollen cricoarytenoid cartilage/epiglottis). The severity of injury in the different segments of the esophagus and stomach was graded (0, 1, 2a, 2b, 3a, 3b) by endoscopy and by EUS (0, M, SM, MP, SS). The development of complications during hospitalization and 3-month follow-up were recorded. OBSERVATIONS: All 16 patients underwent EGD with EUS without complication. The frequency of early and late complications increased as the endoscopic and the EUS severity grades increased. The accuracy of prediction of bleeding or stricture was 100% when endoscopic grade 3a was used as a cutoff. For EUS, the highest accuracy was observed in the prediction of bleeding (75%) and stricture (100%) when EUS grade MP was used as a cutoff. CONCLUSIONS: EUS can be performed safely within 24 hours of ingestive of corrosive substances. However, when used in conjunction with conventional endoscopic observation, it does not increase the accuracy for prediction of early or late complications. Standard endoscopy alone is sufficient for evaluation and prediction of bleeding and stricture complications after corrosive injury in the upper-GI tract.

Adult↗
PubMed1988

Tracheoesophageal injury secondary to disc battery ingestion.

With electronic miniaturization, disc batteries have become increasingly popular; hence, they are ingested more frequently by children. Their small size and benign appearance belie their caustic nature. This case report illustrates the principles of management, and is the eighth report of major complications from disc battery impaction in the esophagus. We believe our patient is the youngest child reported, to date, to have suffered this injury. The pathophysiology and surgical management are discussed, and a protocol for the management of suspected disc battery ingestion is presented.

Burns, Chemical↗
PubMed1998

Management of instrumental perforations of the esophagus occurring during treatment of corrosive strictures.

BACKGROUND: The initial symptoms of esophageal perforations (EP) may be subtle, but the progression is very rapid, and the outcome may be disastrous unless the diagnosis is made early and proper treatment is started immediately. METHODS: Between 1976 and 1996, 1,249 patients with caustic esophageal burns were treated at Ege University. The study group is composed of 52 patients with instrumental ER Perforations occured during dilatation attempts of esophageal strictures. Twelve patients were referred from other institutions after the occurrence of EP. RESULTS: In two patients, emergency surgical repair of the perforation was possible. Seventeen patients with unilateral and two patients with bilateral empyema were treated by pleural drainages. Anterior retrosternal mediastinal drainage was needed in one patient, and 11 patients required posterior mediastinal drainages. Three patients were treated by both anterior and posterior mediastinal drainage. Tracheoesophageal fistulas (TEF) developed in eight patients immediately after a dilatation attempt. Seven of these patients required esophageal replacement with colon to bypass the fistulas, and one patient in this group healed spontaneously. EP healed in 42.5 +/- 49.4 days. Twelve (23%) patients died of mediastinitis and sepsis. CONCLUSION: When EP is diagnosed and treated with these methods, the mortality rate should approach zero.

Burns, Chemical↗
PubMed1998

Juvenile polyp in esophageal colon interposition.

Esophageal polyps are rare in children, whereas colorectal juvenile polyps are common. An 11-year-old boy with an esophageal colonic interposition for an esophageal stricture secondary to caustic injury was found to have a polypoid mass in the interposed colon. Fiberoptic endoscopic removal with diathermy was performed. Histological examination confirmed it was a juvenile polyp. The occurrence of a polyp in a colon removed from its natural location and serving a different function suggests the possibility that an unknown factor produced by colonic cells play a pivotal role in its development.

Burns, Chemical↗
PubMed1998

A case of zinc chloride ingestion.

Zinc chloride is a powerful corrosive agent. Reports of zinc chloride ingestion are uncommon, and there is little information about its toxicity and management. The authors report the clinical course of a 10-year-old girl who accidentally ingested an acid soldering flux solution (pH, 3.0; zinc chloride, 30% to < 60%). Systemic effects after the ingestion were unremarkable except for lethargy. Thus, chelation therapy was not considered. Severe gastric corrosion was caused by local caustic action. An antral stricture of the stomach approximately 3 weeks after the ingestion developed, and she underwent a modified Heineke-Mikulicz antropyloroplasty. Postoperatively, she made an uneventful recovery. On follow-up, although she was tolerating a normal diet, results of a barium meal showed her stomach to be totally aperistaltic. Results of a nuclear medicine study showed moderately delayed gastric emptying. Careful long-term follow-up is necessary, because there is potential risk for malignancy in the damaged stomach.

Burns, Chemical↗
PubMed1983

Chemical burns of the esophagus.

The ingestion of caustic chemical agents, usually accidentally by children, produces a range of injury from minor mouth burns to necrosis of the esophagus and stomach. The type of agent, amount, concentration, and duration of exposure are the determining factors. The treatment of the average burn has been fairly well standardized, but the serious injuries require prompt recognition of complications and appropriate therapy.

Anti-Bacterial Agents↗
PubMed1989

Liquid automatic dishwashing detergents: a profile of toxicity.

The recent introduction of liquid automatic dishwashing detergents (LADDs) has resulted in numerous calls to poison information centers and, subsequently, a large number of referrals to emergency departments. As with their traditional granular counterparts, LADDs contain alkaline builders that contribute to the pH of these products. Exposure to granular automatic dishwashing detergents has been associated with caustic injury similar to the pathology produced by other alkaline corrosives. Do LADDs produce similar toxicity? There is no published information that profiles the toxic manifestations associated with exposure to LADDs. To determine their toxicity, all LADD exposures reported to a regional poison information center over a 12-month period were collected. One hundred ninety-two human exposure cases were reviewed. Pediatric patients accounted for 76% of the exposures; 76% were ingestions, 12% were dermal exposures, and 12% were ocular exposures. Seventy-nine percent of the patients were exposed to a full-strength product, and 21% contacted a dilute product or one that had already been through the dishwashing cycle. Of the patients who ingested a LADD, 91.1% remained asymptomatic, 8.2% had minor symptoms, and only one (0.7%) suffered moderate toxicity. In contrast, 91.3% of all patients who had an ocular exposure developed minor or moderate toxicity (73.9% vs 17.4%). Of dermal exposures, 69.6% were asymptomatic, and those with symptoms were the result of inappropriate use. Overall, 78.7% remained asymptomatic, 18.2% developed minor toxicity, and 3.1% developed moderate toxicity. Small oral and dermal exposures usually do not result in toxicity and do not necessitate referral to an ED. Ocular exposures are associated with a high incidence of at least minor toxicity and require ED evaluation.

Adult↗
PubMedDate not supplied

Effect of intermittent acid and pepsin exposure on burned esophageal mucosa.

PURPOSE: To determine if gastroesophageal reflux affects the healing of esophageal mucosa damaged by alkaline substances. MATERIALS AND METHODS: In a rabbit model, the effects of intermittent acid and pepsin exposure (thereby mimicking gastroesophageal reflux) on post-caustic-burn esophageal mucosa were examined. Exposures were group I (n = 9), sodium hydroxide exposure alone; group II (n = 9), daily acid and pepsin exposure; and group III (n = 8), sodium hydroxide, then daily acid and pepsin exposure. After 3 weeks, the animals were killed and their esophagi examined. RESULTS: Grossly, specimens in group II appeared normal; specimens in groups I and III were abnormal, displaying some scar tissue, but were not significantly different. Histologically, the differences between groups I and III approached significance. Increased numbers of intraepithelial eosinophils were seen in those specimens exposed to reflux. CONCLUSIONS: Gastroesophageal reflux may retard the healing of injured esophageal mucosa and should be studied further in an effort to improve the care of patients who sustain alkaline esophageal burns.

Animals↗