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At least 163 records · Page 9Linked to original sources
PubMed1996

Surgical treatment for caustic ingestion injury of the pharynx, larynx, and esophagus.

A 45-year-old female drank Sunpole (9.5% hydrochloric acid), an acidic toilet cleaner, in a suicide attempt. Notwithstanding intravenous administration of steroids and bougienage dilation, corrosive changes progressed. The patient underwent surgery for severe caustic ingestion injury of the pharynx, larynx, and esophagus. Colon bypass surgery from the left vallecula to the stomach was performed. Excellent results, both in deglutition and phonation, were obtained. We report on the case and stress several points of importance in dealing with severe caustic ingestion injuries.

Caustics↗
PubMed1996

[Immediate esophagojejunal anastomosis after total gastrectomy for caustic necrosis. Apropos of 5 cases].

Five patients have had an immediate recovery of the continuity after total gastrectomy for caustic necrosis by an oesophago-jejunostomy. One patient died of post operative peritonitis no linked with the oesophago-jejunostomy. Two cases had a respiratory infection and one patient had presented a jejuno-jejunostomy fistula. Three healed without sequela. The immediate recovery of the continuity after total gastrectomy for caustic necrosis with moderate lesions of the oesophagus steals the ideal therapeutic attitude.

Adult↗
PubMed1977

[Special aspects of colo esophagoplasty in post-caustic esophageal stenosis for corrosive stricture of the esophagus (author's transl)].

The author reports 12 cases which illustrate unusual aspects of colo esophagoplasty in post-caustic esophageal stenosis. 8 cases respresented post-caustic pharyngolaryngeal stenosis in which he recommended anastomosis of the colon with the oropharynx according to a personal technical variant. In 1 case associated with amputation of the epiglottis, he carried out a double pharyngo-colic Y-shaped anastomosis. He classified the pharyngotomy types in relation to the 3 main nerves, the lingual, hypoglossal and superior laryngeal nerves. In 3 cases the author carried out successfully retrosternal transposition of a colonic segement 6 months, 1 year and 4 years after pre-thoracic colo esophagoplasty. He reports 1 case of intrathoracic strangling of the colonic tube which occurred 1 year after retrosternal colo esophagoplasty, and wich was cured by intra-vascular vertical clectomy. In all cases the good results were maintained for a long period.

Burns, Chemical↗
PubMed1997

Surgical treatment and its long-term result for caustic-induced prepyloric obstruction.

OBJECTIVE: To present our long-term results of the treatment of caustic-induced prepyloric obstruction, and to set out guidelines for the management of such patients. DESIGN: Retrospective study. SETTING: General hospital (medical centre), Taiwan. SUBJECTS: 30 patients (8 male and 22 female, mean age 34 years, range 13-62) who developed prepyloric obstruction out of 271 treated for caustic injuries of the upper gastrointestinal tract. INTERVENTIONS: Gastrojejunostomy (n = 24), antrectomy and Billroth I reconstruction (n = 4), and antrectomy and Billroth II reconstruction (n = 2). Four patients required second operations: oesophageal reconstruction for stricture (n = 3), and gastrojejunostomy for restenosis of Billroth I anastomosis (n = 1). MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: No patient died postoperatively, and there were three complications--wound infection, internal bleeding, and stenosis of the Billroth I anastomosis. 21 patients were able to enjoy their normal diet postoperatively, 5 required periodic dilatation of oesophageal strictures, and 4 required further operations. CONCLUSIONS: Gastrojejunostomy gives good long term results as long as there is no oesophageal stricturing, and morbidity and mortality are low. The long term outcome is dependent on the degree of oesophageal involvement.

Adolescent↗
PubMed2002

Long-term dilatation of caustic strictures of the oesophagus.

Caustic strictures of the oesophagus (CSO) in children are managed in different ways. Our study looks into the results of long-term dilatation of such strictures. Of 109 children admitted to our hospital with caustic ingestion, 10 developed strictures. The dilatations were carried out for periods varying from 9 months to 4 years. While 3 patients needed surgical treatment, 7 did not and did well. The oesophageal perforation rate with dilatations was only 0.47% (2 perforations from a total of 424 dilatations). Long-term dilatations are successful in managing a majority of CSO in children and are associated with minimal complications.

Catheterization↗
PubMed2001

Caustic Injury to the Esophagus.

The potentially catastrophic presentation and lifelong complications that result from caustic ingestion make it one of the most challenging clinical situations in gastroenterology. Patients who present with a history of caustic ingestion, particularly with a strong alkali or acid, should undergo emergent endoscopy once stabilized to assess the degree of oropharyngeal, esophageal, and gastric damage regardless of presence or lack of symptoms. Once staged, patients with moderate to severe injury should be restricted from any oral intake, placed on intravenous fluids, and observed, provided there are no signs of perforation or transmural necrosis that require immediate esophagectomy. For those who will require lengthy periods without oral intake, feeding should be initiated through a jejunostomy tube (preferably) or through total parenteral nutrition. Patients that have survived the first several weeks of injury should be reassessed for esophageal stricture formation. Chronic strictures may require serial dilations initially to establish patency and in some patients, dilation will be needed chronically to maintain the adequate lumen diameter. More severe strictures may require esophagectomy or bypass with colon or small bowel interposition. Finally, although there is an increased incidence of esophageal carcinoma in these patients, regular endoscopic screening is not advocated.

Journal Article↗
PubMed1989

Early evaluation and therapy for caustic esophageal injury.

Forty-one patients with caustic ingestion were reviewed. Eighty-three percent were children, all of whom suffered accidental injury. Liquid drain cleaner was the agent in 57 percent and was responsible for all esophageal burns. Symptoms and physical findings were unreliable in predicting the extent of injury. Endoscopy was performed in most patients within 36 hours of ingestion and accurately estimated the risk of subsequent esophageal stricture formation. Steroid administration had no influence on the development of strictures. Esophageal strictures developed in 22 percent of the patients. One-third were successfully managed by periodic dilation, whereas the remaining two-thirds required esophagectomy and reconstruction. Early endoscopic evaluation was the best means of assessing the degree of injury after caustic ingestion. Routine steroid administration had no apparent clinical benefit.

Adult↗
PubMed2005

The oral implications of caustic soda ingestion in children.

The morbidity related to caustic soda (sodium hydroxide) ingestion is well described in the literature. The majority of publications have concentrated on the effects to the trachea and gastrointestinal tract, with little reference to the oral and peri-oral areas. Accidental ingestion of sodium hydroxide-containing substances is fortunately rare; however the consequences can be devastating. Three cases of children who drank caustic substances are described. Treatment included fitting splints, injecting steroids, local surgical procedures, and the use of dynamic appliances to maintain mouth opening. Despite these interventions, all patients developed severe scarring, resulting in stenosis of the oral musculature and extra-articular ankylosis. There is perhaps a role for further investigation of early use of antiproliferative agents to prevent scarring, more aggressive surgery, and long-term physiotherapy appliance use. These patients require lifelong follow-up.

Burns, Chemical↗
PubMed1979

Avoidance of esophageal stricture following severe caustic burns by the use of an intraluminal stent.

The high incidence of stricture following conventional therapy for caustic esophageal injuries prompted us to incorporate the esophageal stenting technique of Reyes and colleagues [3, 5, 6] into our protocol for management of such patients. Four adult patients were treated following severe esophageal burns caused by the ingestion of caustic drain cleaner. The severity of the burn was established by early esophagoscopy. Laparotomy and gastrotomy revealed severe but nontransmural gastric burns. The stent was left in place for 21 days. Antibiotics and corticosteroids were also employed. There have been no late strictures. One patient required laryngeal dilation for adhesions and another, tracheal dilation for subglottic stenosis. Contrast roentgenographic studies and esophageal manometry have revealed nearly normal esophageal function up to 20 months following the injury.

Adolescent↗
PubMed2003

Caustic esophageal strictures in children: 30 years' experience.

Many children in developing countries continue to sustain caustic esophageal injures. The first line of treatment is dilatation, unless contraindicated, where 60% to 80% success rate is expected. In cases of failure, esophageal replacement is the only hope for achieving normal swallowing. Over the last 30 years, more than 850 cases of esophageal replacement were done in the Pediatric Surgery Department at Ain-Shams University. Three types of replacement were performed, gastric pull-up (75 cases), retrosternal colon replacement (550 cases), and, in the last 12 years, transhiatal esophagectomy with posterior mediastinal colon replacement (225 cases). Complications in the last 475 cases include 10% cervical leakage, 5% proximal strictures, 2% postoperative intestinal obstruction, 1% mortality, and 0.6% late graft stenosis. Colonic replacement of the esophagus is the ideal treatment in cases of caustic esophageal strictures after failure of dilatation. The posterior mediastinal route is shorter, and in long-term follow-up results show improved evacuation and less reflux than with the retrosternal route.

Acids↗
PubMed1989

Caustic ingestions and foreign bodies in the aerodigestive tract of children.

Caustic ingestions, both accidental and intentional, continue to cause significant morbidity and mortality. This article recommends the best methods of managing caustic ingestion and the related problems of foreign bodies in the digestive tracts of small children, and also stresses the need for prevention as the best defense.

Burns, Chemical↗
PubMed2003

[Endoscopic dilatation of caustic esophageal strictures].

OBJECTIVE: To evaluate the results of endoscopic dilatation in caustic esophageal strictures and to analyze the factors associated with a favorable response. PATIENTS AND METHOD: We performed a retrospective study of 33 patients who underwent dilatation with Savary bougie between 1989 and 2001. Response to initial dilatation and outcome during follow-up were analyzed. RESULTS: The mean age was 50 years (8-83) and 58% were women. Intake was accidental in 29 (88%). In all patients, the caustic substance ingested was alkali. Dilatation was started in the acute phase in 12 patients (36%) and 13 presented inflammatory phenomena adjacent to the stenosis. During initial dilatation, 2 1.6 sessions (2-18) were performed and a favorable response was obtained in 18 patients (54%). At the end of follow-up, 68% of the patients presented satisfactory health status. The comparative study revealed that statistically significant variables for a favorable response to treatment were: accidental alkali intake, instauration of treatment in the chronic phase, absence of inflammatory phenomena, and a small number of initial dilatation sessions. CONCLUSIONS: In our series, more than half the patients with esophageal stenosis due to intake of corrosive alkalis showed a favorable initial response. In these patients with acute-phase stenosis who required a greater number of initial dilatation sessions, endoscopic therapy was less effective.

Adolescent↗
PubMed2003

Practical procedure for coma-free alignment using caustic figure.

The practical procedure for coma-free alignment using a single defocused transmission electron microscopy (TEM) image is presented. Caustic figures observed in the defocused TEM image of a focused probe are utilized. Coma-free alignment can be carried out by coinciding a bright-field spot with the center of a caustic curve as observed in an underfocus TEM image. With this method, beam tilt misalignment is reduced to the sub-mrad order (e.g. 0.3mrad for 300kV FEG-TEM). This can be done without intentional beam tilting, an amorphous specimen, high-resolution TEM images, or fast Fourier transform for diffractogram or cross-correlation, which are used in previous methods. Residual coma aberration is detected using the multiple Bragg images of a known crystal. Similarity between the present coma-free alignment and well-known STEM alignment using shadow image is discussed.

Journal Article↗
PubMed1979

Caustic esophageal and gastric erosion without evidence of oral burns following detergent ingestion.

The effects of accidental ingestion of a caustic detergent are studied in the report of 14 patients seen in the Hennepin County Medical Center. Since the history of amount ingested was unclear, all patients underwent endoscopy. Four patients had esophageal injury serious enough to warrant hospitalization. None of the patients had evidence of oropharyngeal burns, thus challenging the validity of the widely held notion that oral lesions nearly always accompany esophageal injury following caustic ingestion. The importance of analyzing the ingested substance is emphasized, as is the need for emergency departments to have wide range pH paper available to help determine the necessity for endoscopy.

Adult↗
PubMed1986

Ingestion of Compound W, an unusual caustic.

A case of an unusual caustic ingestion involving Compound W, an over the counter wart remover is presented. Chemical burns of the tongue, pharynx and larynx developed. The active ingredient in this preparation: salicylic acid in a flexible collodion vehicle produces caustic injury through a keratolytic action, which may be enhanced by the presence of collodion.

Administration, Oral↗
PubMed2004

Microwave-assisted sample treatment in a fully automated flow-based instrument: oxidation of reduced technetium species in the analysis of total technetium-99 in caustic aged nuclear waste samples.

An automated flow-based instrument for microwave-assisted treatment of liquid samples has been developed and characterized. The instrument utilizes a flow-through reaction vessel design that facilitates the addition of multiple reagents during sample treatment and removal of the gaseous reaction products and enables quantitative removal of liquids from the reaction vessel for carryover-free operations. Matrix modification and speciation control chemistries that are required for the radiochemical determination of total (99)Tc in caustic aged nuclear waste samples have been investigated. A rapid and quantitative oxidation procedure using peroxydisulfate in acidic solution was developed to convert reduced technetium species to pertechnetate in samples with high content of reducing organics. The effectiveness of the automated sample treatment procedures has been validated in the radiochemical analysis of total (99)Tc in caustic aged nuclear waste matrixes from the Hanford site.

Journal Article↗
PubMed2006

Use of caustic magnesia to remove cadmium, nickel, and cobalt from water in passive treatment systems: column experiments.

In the present study caustic magnesia obtained from calcination of magnesium carbonate was tested in column experiments as an alternative material for passive remediation systems to remove divalent metals. Caustic magnesia reacts with water to form magnesium hydroxide, which dissolves increasing the pH to values higher than 8.5. At these pH values, cadmium is precipitated as otavite and to a minor amount as a hydroxide. Cobalt and nickel are precipitated as hydroxides which form isostructural solids with brucite. Thus, metal concentrations as high as 75 mg/L in the inflowing water are depleted to values below 10 microg/L. Magnesia dissolution is sufficiently fast to treat flows as high as 0.5 m3/m2 x day. For reactive grain size of 2-4 mm, the column efficiency ends due to coating of the grains by precipitates, especially when iron and aluminum are present in the solution.

Cadmium↗
PubMed2001

Effects of caffeic acid phenethyl ester and epidermal growth factor on the development of caustic esophageal stricture in rats.

BACKGROUND/PURPOSE: An experimental study was performed to modify the healing response in caustic esophageal burns to prevent stricture development. Two different agents with different modes of actions, caffeic acid phenethyl ester (CAPE) and epidermal growth factor (EGF), were studied. CAPE has antiinflammatory, immunomodulatory, antioxidant, and antimitotic properties. EGF has known properties in supporting wound healing and in protecting esophagus from injuries. METHODS: The model described by Gehanno and its modification by Liu was used to create standard esophageal burns with 50% NaOH. The study was performed with 76 rats in 4 main groups (sham, CAPE, EGF, and control) and 2 subgroups in each for 5 and 28 days of observation. Efficacy of treatment was assessed in 28-day subgroups by measuring weight gain, contrast esophagograms on day 27, histologic evaluation by measuring stenosis index (wall thickness/lumen diameter), and collagen deposition, and biochemically by determining tissue hydroxy proline (OHP) content. RESULTS: In the end of the study, increase rates of mean body weights of the animals in the 28-day subgroups were as follows: sham, 30%; CAPE, 23%; EGF, 22%; and control, 14%. Although all the animals in subgroups significantly gained weight, the mean weight gain was significantly low in controls when compared with sham, CAPE, and EGF groups (P <.05). Contrast esophagograms on day 27 showed no stenosis in the sham, mild stenosis in CAPE and EGF, and severe stenosis with proximal dilatation in controls. Stenosis indices of the subgroups were as follows: sham, 0.29; CAPE, 0.41; EGF, 0.41; control, 0.84. Index was significantly higher in controls (P <.05). Collagen accumulation scores in the esophageal wall were as follows: Sham, 0.0; CAPE, 0.87; EGF, 0.30; control, 2.70. Scores also were significantly higher in controls (P <.05). Tissue (OHP) levels were as follows (mg/g dry tissue): Sham, 1.48; CAPE, 1.53; EGF, 1.90; control, 4.01. Production of OHP was significantly higher in controls. CONCLUSIONS: The results of the parameters in the study indicate that administration of CAPE and EGF has beneficial effects in the prevention of caustic esophageal strictures. Those effects of CAPE may occur through its antiinflammatory, immunomodulatory, and antioxidant properties, and EGF may occur through its induced proliferative properties on the esophagus.

Animals↗