RESUMO
Purpose: To evaluate the effect of topical instillation of pegaptanib sodium upon inflammatory angiogenesis induced in the rabbit cornea by alkaline cauterization. Methods: Inflammatory angiogenesis was induced by alkaline (sodium hydroxide) cauterization in the corneas of 29 male New Zealand rabbits. The animals were divided into 4 groups: a control group treated with 0.5% carboxymethylcellulose sodium eye drops, a group treated with 1.0% prednisolone acetate eye drops, a group treated with 0.5% pegaptanib sodium diluted in 15 mL 0.5% carboxymethylcellulose sodium, and a group treated with 1.0% pegaptanib sodium diluted in 15 mL 0.5% carboxymethylcellulose sodium. After cauterization, eye drops were administered every 12 hours for 21 days. The animals were evaluated every 3 days after cauterization, and the newly formed vessels were quantified from photographs. The treatment effectiveness was analyzed with 3 parameters of antiangiogenic response: neovascularization area (NA), total vascular length (TVL), and number of blood vessels (BVN). Results: Average NA, TVL, and BVN values were significantly higher in both pegaptanib groups than in the prednisolone group. A nonstatistically significant reduction in parameters on days 18 and 21 was the minimum achieved in both pegaptanib groups. The efficacy of the treatments in relation to the control was significantly greater in the prednisolone group than in the 0.5% pegaptanib group or the 1.0% pegaptanib group (P < 0.001). Conclusion: Topical instillation of 0.5% and 1.0% pegaptanib sodium diluted in 15 mL 0.5% carboxymethylcellulose sodium had no inhibitory effect on corneal neovascularization in this rabbit model.
Assuntos
Inibidores da Angiogênese/farmacologia , Aptâmeros de Nucleotídeos/farmacologia , Inflamação/tratamento farmacológico , Neovascularização Patológica/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Administração Tópica , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/uso terapêutico , Animais , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/farmacologia , Aptâmeros de Nucleotídeos/administração & dosagem , Aptâmeros de Nucleotídeos/uso terapêutico , Cáusticos/administração & dosagem , Cáusticos/efeitos adversos , Córnea/patologia , Lesões da Córnea/induzido quimicamente , Neovascularização da Córnea/induzido quimicamente , Modelos Animais de Doenças , Inflamação/diagnóstico , Instilação de Medicamentos , Masculino , Prednisolona/administração & dosagem , Prednisolona/farmacologia , Coelhos , Hidróxido de Sódio/administração & dosagem , Hidróxido de Sódio/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Occupational dermatoses are common, especially contact dermatitis. Epidemiological studies on these dermatoses are scarce in Brazil and they are necessary as part of the public policy to protect workers' health. OBJECTIVES: To identify sociodemographic and clinical profile of patients with occupational contact dermatitis seen between 2000 and 2014 at an occupational dermatology service. METHODS: It is a cross-sectional and retrospective study, based on information obtained from the service's database. RESULTS: Of 560 patients with conclusive patch test, 289 (46.9%) presented occupational dermatoses and 213 occupational contact dermatitis with predominance of the allergic type in relation to the irritative type (149:64 respectively). The odds of occupational dermatoses were higher among men and lower among patients aged 50 years or older and with higher level of education. Regarding the possibility of presenting occupational allergic contact dermatitis, only the gender variable was statistically significant. The professions most seen were cleaners, construction workers, painters, mechanics/metallurgists and cooks. The commonest allergens were nickel sulfate, potassium dichromate, cobalt chloride, carba-mix and formaldehyde. STUDY LIMITATIONS: The main limitations of this study are the fact that it was carried out in a tertiary service of occupational dermatoses and the lack of access to some allergens outside the patch test baseline series. CONCLUSIONS: It was possible to identify the sociodemographic and clinical profile of patients with suspected occupational contact dermatitis seen at the Service, beyond the professional groups and allergens related to a high risk of occupational contact dermatitis in this population.
Assuntos
Dermatite Alérgica de Contato/epidemiologia , Dermatite Ocupacional/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Cáusticos/efeitos adversos , Indústria da Construção , Estudos Transversais , Dermatite Alérgica de Contato/etiologia , Dermatite Irritante/epidemiologia , Dermatite Irritante/etiologia , Dermatite Ocupacional/etiologia , Escolaridade , Feminino , Dermatoses da Mão/induzido quimicamente , Dermatoses da Mão/epidemiologia , Humanos , Irritantes/efeitos adversos , Masculino , Pessoa de Meia-Idade , Níquel/efeitos adversos , Exposição Ocupacional/efeitos adversos , Testes do Emplastro/estatística & dados numéricos , Dicromato de Potássio/efeitos adversos , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Adulto JovemRESUMO
Abstract: BACKGROUND: Occupational dermatoses are common, especially contact dermatitis. Epidemiological studies on these dermatoses are scarce in Brazil and they are necessary as part of the public policy to protect workers' health. OBJECTIVES: To identify sociodemographic and clinical profile of patients with occupational contact dermatitis seen between 2000 and 2014 at an occupational dermatology service. METHODS: It is a cross-sectional and retrospective study, based on information obtained from the service's database. RESULTS: Of 560 patients with conclusive patch test, 289 (46.9%) presented occupational dermatoses and 213 occupational contact dermatitis with predominance of the allergic type in relation to the irritative type (149:64 respectively). The odds of occupational dermatoses were higher among men and lower among patients aged 50 years or older and with higher level of education. Regarding the possibility of presenting occupational allergic contact dermatitis, only the gender variable was statistically significant. The professions most seen were cleaners, construction workers, painters, mechanics/metallurgists and cooks. The commonest allergens were nickel sulfate, potassium dichromate, cobalt chloride, carba-mix and formaldehyde. STUDY LIMITATIONS: The main limitations of this study are the fact that it was carried out in a tertiary service of occupational dermatoses and the lack of access to some allergens outside the patch test baseline series. CONCLUSIONS: It was possible to identify the sociodemographic and clinical profile of patients with suspected occupational contact dermatitis seen at the Service, beyond the professional groups and allergens related to a high risk of occupational contact dermatitis in this population.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Exposição Ocupacional/estatística & dados numéricos , Dermatite Alérgica de Contato/epidemiologia , Dermatite Ocupacional/epidemiologia , Dicromato de Potássio/efeitos adversos , Fatores Socioeconômicos , Brasil/epidemiologia , Testes do Emplastro/estatística & dados numéricos , Cáusticos/efeitos adversos , Indústria da Construção , Fatores Sexuais , Estudos Transversais , Estudos Retrospectivos , Exposição Ocupacional/efeitos adversos , Fatores Etários , Dermatite Irritante/etiologia , Dermatite Irritante/epidemiologia , Dermatite Alérgica de Contato/etiologia , Dermatite Ocupacional/etiologia , Escolaridade , Dermatoses da Mão/induzido quimicamente , Dermatoses da Mão/epidemiologia , Irritantes/efeitos adversos , Níquel/efeitos adversosRESUMO
ABSTRACT BACKGROUND The diagnosis of corrosion cancer should be suspected in patients with corrosive ingestion if after a latent period of negligible symptoms there is development of dysphagia, or poor response to dilatation, or if respiratory symptoms develop in an otherwise stable patient of esophageal stenosis. Narrow Band Imaging detects superficial squamous cell carcinoma more frequently than white-light imaging, and has significantly higher sensitivity and accuracy compared with white-light. OBJECTIVE To determinate the clinical applicability of Narrow Band Imaging versus Lugol´s solution chromendoscopy for detection of early esophageal cancer in patients with caustic/corrosive agent stenosis. METHODS Thirty-eight patients, aged between 28-84 were enrolled and examined by both Narrow Band Imaging and Lugol´s solution chromendoscopy. A 4.9mm diameter endoscope was used facilitating examination of a stenotic area without dilation. Narrow Band Imaging was performed and any lesion detected was marked for later biopsy. Then, Lugol´s solution chromoendoscopy was performed and biopsies were taken at suspicious areas. Patients who had abnormal findings at the routine, Narrow Band Imaging or Lugol´s solution chromoscopy exam had their stenotic ring biopsied. RESULTS We detected nine suspicious lesions with Narrow Band Imaging and 14 with Lugol´s solution chromendoscopy. The sensitivity and specificity of the Narrow Band Imaging was 100% and 80.6%, and with Lugol´s chromoscopy 100% and 66.67%, respectively. Five (13%) suspicious lesions were detected both with Narrow Band Imaging and Lugol's chromoscopy, two (40%) of these lesions were confirmed carcinoma on histopathological examination. CONCLUSION Narrow Band Imaging is an applicable option to detect and evaluate cancer in patients with caustic /corrosive stenosis compared to the Lugol´s solution chromoscopy.
RESUMO CONTEXTO A suspeita do câncer de esôfago na lesão cáustica ocorre quando os pacientes com estenoses previamente estáveis, após um período latente sem sintomas, apresentam disfagia, baixa resposta as dilatações ou sintomas respiratórios. A cromoscopia com luz de banda estreita detecta o câncer superficial de esôfago mais frequentemente que a luz branca, com alta sensibilidade e acurácia. OBJETIVO Determinar a aplicabilidade clínica da luz de banda estreita versus a cromoscopia vital com Lugol na detecção do câncer precoce de esôfago em pacientes com lesões cáusticas. MÉTODOS Um total de 38 pacientes, entre 28 e 84 anos, foram alocados seguidamente e submetidos à cromoscopia com luz de banda estreita e com Lugol. Um gastroscópio de 4,9 mm de diâmetro foi usado para facilitar o exame da área estenosada, sem necessidade de dilatação. A cromoscopia com luz de banda estreita era realizada primeiro e as áreas suspeitas anotadas. Depois, a cromoscopia com Lugol era realizada e as áreas suspeitas biopsiadas. RESULTADOS Detectamos nove lesões suspeitas com a luz de banda estreita e 14 com o Lugol. A sensibilidade e especificidade da cromoscopia com luz de banda estreita foi de 100% e 80,6%, e a do Lugol foi de 100% e 66,67% respectivamente. Cinco (13%) lesões suspeitas foram detectadas coincidentemente pelos dois métodos, sendo duas (40%) com diagnóstico anatomopatológico de câncer de esôfago. CONCLUSÃO A cromoscopia com luz de banda estreita é opção concreta para o diagnóstico de câncer em pacientes com estenoses esofágicas por corrosões cáusticas, comparado a cromoscopia com Lugol.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/induzido quimicamente , Cáusticos/efeitos adversos , Esofagoscopia/métodos , Corantes , Imagem de Banda Estreita/métodos , Iodetos , Estudos Transversais , Sensibilidade e Especificidade , Estudos Cross-Over , Constrição Patológica , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The diagnosis of corrosion cancer should be suspected in patients with corrosive ingestion if after a latent period of negligible symptoms there is development of dysphagia, or poor response to dilatation, or if respiratory symptoms develop in an otherwise stable patient of esophageal stenosis. Narrow Band Imaging detects superficial squamous cell carcinoma more frequently than white-light imaging, and has significantly higher sensitivity and accuracy compared with white-light. OBJECTIVE: To determinate the clinical applicability of Narrow Band Imaging versus Lugol´s solution chromendoscopy for detection of early esophageal cancer in patients with caustic/corrosive agent stenosis. METHODS: Thirty-eight patients, aged between 28-84 were enrolled and examined by both Narrow Band Imaging and Lugol´s solution chromendoscopy. A 4.9mm diameter endoscope was used facilitating examination of a stenotic area without dilation. Narrow Band Imaging was performed and any lesion detected was marked for later biopsy. Then, Lugol´s solution chromoendoscopy was performed and biopsies were taken at suspicious areas. Patients who had abnormal findings at the routine, Narrow Band Imaging or Lugol´s solution chromoscopy exam had their stenotic ring biopsied. RESULTS: We detected nine suspicious lesions with Narrow Band Imaging and 14 with Lugol´s solution chromendoscopy. The sensitivity and specificity of the Narrow Band Imaging was 100% and 80.6%, and with Lugol´s chromoscopy 100% and 66.67%, respectively. Five (13%) suspicious lesions were detected both with Narrow Band Imaging and Lugol's chromoscopy, two (40%) of these lesions were confirmed carcinoma on histopathological examination. CONCLUSION: Narrow Band Imaging is an applicable option to detect and evaluate cancer in patients with caustic /corrosive stenosis compared to the Lugol´s solution chromoscopy.
Assuntos
Cáusticos/efeitos adversos , Corantes , Neoplasias Esofágicas/induzido quimicamente , Neoplasias Esofágicas/diagnóstico , Esofagoscopia/métodos , Iodetos , Imagem de Banda Estreita/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica , Estudos Cross-Over , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Many therapies involving varying degrees of complexity have been used to treat acne scars, but none is considered the gold standard treatment. OBJECTIVE: A comparative evaluation of 88% phenol and 90% trichloroacetic acid (TCA) applied using the chemical reconstruction of skin scars (CROSS) technique. MATERIALS AND METHODS: A nonrandomized, single-blinded self-controlled clinical trial was conducted among patients with ice pick-type and boxcar-type atrophic acne scars. Using 88% phenol on the left hemiface and 90% TCA on the right hemiface was adopted as the standard practice of the CROSS technique. The dermatological quality of life index (DLQI) questionnaire, acne scar grading scale Échelle d´Evaluation Clinique des Cicatrices d'Acne (ECCA), and evaluation of improvement were performed pretreatment and post-treatment. RESULTS: Regarding ECCA, significant differences were found in pretreatment and post-treatment (p < .001). Regarding tolerance to pain, it was found that the discomfort felt with 90% TCA was significantly less than that felt with 88% phenol (p = .020). Regarding the quality of life measured with the DLQI, the results showed that the mean score in post-treatment assessment was significantly lower than that in the pretreatment assessment (p < .05). Hypochromia and enlargement scar were only seen after the use of 90% TCA. CONCLUSION: This study confirmed the efficacy of both TCA and phenol for treating such scars, with less severe complications from the use of phenol.
Assuntos
Acne Vulgar/complicações , Cáusticos/uso terapêutico , Cicatriz/tratamento farmacológico , Hidroxibenzoatos/uso terapêutico , Ácido Tricloroacético/uso terapêutico , Adolescente , Adulto , Atrofia , Cáusticos/efeitos adversos , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz Hipertrófica/induzido quimicamente , Feminino , Humanos , Hidroxibenzoatos/efeitos adversos , Hipopigmentação/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária , Dor/induzido quimicamente , Qualidade de Vida , Índice de Gravidade de Doença , Método Simples-Cego , Ácido Tricloroacético/efeitos adversos , Adulto JovemAssuntos
Queimaduras Químicas/etiologia , Cáusticos/efeitos adversos , Transtornos de Deglutição/etiologia , Estenose Esofágica/induzido quimicamente , Ceratose/etiologia , Idoso , Antifúngicos/uso terapêutico , Biópsia , Queimaduras Químicas/diagnóstico , Queimaduras Químicas/terapia , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/terapia , Dilatação , Endoscopia do Sistema Digestório , Estenose Esofágica/diagnóstico , Estenose Esofágica/terapia , Feminino , Humanos , Ceratose/diagnóstico , Ceratose/terapia , Recidiva , Resultado do TratamentoRESUMO
OBJETIVO: Describir las características clínicas y endoscópicas de las lesiones producidas por cáusticos en el tracto digestivo superior en pacientes del Hospital Nacional Daniel Alcides Carrión. MATERIALES Y METODOS: se realizó un estudio descriptivo, la población estudiada fue pacientes con diagnóstico de ingesta de cáusticos los cuales fueron admitidos en el servicio de Gastroenterología del HNDAC para la realización de una endoscopia digestiva alta durante el periodo de enero del 2009 a diciembre del 2012. Se documentó el tipo de sustancia caústica ingerida, causa de ingesta, cantidad ingerida, modo de ingesta, síntomas o signos presentes, hallazgos endoscópicos según la clasificación de Zargar, presencia de complicaciones y tratamiento realizado. Se realizó el análisis comparándolos según a la edad como pediátrica y adulta; y a la sustancia caústica ingerida: ácido o álcali. RESULTADOS: Se obtuvieron 98 pacientes, 91 adultos y 7 pediátricos, la edad promedio en adultos fue de 30.6±16.3 años y en pediátricos 8.7±5.3 años. Las sustancias caústicas ingeridas fueron: lejía (hipoclorito de sodio) en 75 (76 por ciento) pacientes, ácido muriático (ácido clorhídrico) en 19 (20 por ciento) pacientes, soda caústica en 3 (3 por ciento) pacientes y batería de celular (iones de litio) en 1 (1 por ciento) paciente. La cantidad promedio ingerida en adultos fue de 136ml (entre 30-500ml) y 47ml (entre 20-150ml) en pediátricos. Los síntomas y signos más frecuentes fueron: vómitos, dolor abdominal, náuseas y odinofagia. El 46 por ciento de los adultos y el 57 por ciento de los niños presentaron lesiones. El 100 por ciento de los pacientes que ingirieron ácido y el 34 por ciento de los que ingirieron álcali presentaron lesiones. Ocho (8 por ciento) pacientes presentaron lesiones orofaríngeas, 26 (27 por ciento) en esófago, 36 (37 por ciento) en estómago y 12 (12 por ciento) en duodeno. Se encontró 12 (12 por ciento) pacientes con lesiones de grado I, 16 (16 por ciento)...
OBJECTIVE: To describe the clinical and endoscopic features of caustics injuries in the upper gastrointestinal tract in patients of the National Hospital Daniel Alcides Carrión. MATERIALS AND METHODS: A descriptive study was conducted; the study population was patients diagnosed with caustic ingestion who were admitted into the Gastroenterology service of the HNDAC to perform an upper endoscopy during the period of January 2009 to December 2012. We documented the type of caustic substance ingested, cause of intake, amount ingested, intake mode, signs or symptoms present, endoscopic findings as classified by Zargar, presence of complications and treatment performed. Analysis was performed comparing them based on adult and pediatric age, and ingested caustic type: acid or alkali. RESULTS: were obtained 98 patients, 91 adults and 7 pediatrics; adults average age was 30.6±16.3 years and 8.7±5.3 years in pediatrics. Caustic substances ingested were: bleach (sodium hypochlorite) in 75 (76 per cent) patients, muriatic acid (hydrochloric acid) in 19 (20 per cent) patients, caustic soda in 3 (3 per cent) patients and cell battery (lithium-lithium) in 1 (1 per cent) patient. The average adult intake was 136ml (30-500ml) and 47ml (20-150ml) in pediatric patients. The most frequent signs and symptoms were vomiting, abdominal pain, nausea and sore throat. The 46 per cent of adults and 57 per cent of children had caustic injuries. 100 per cent of patients who ingested acid and 34 per cent who ingested alkali had lesions. Eight (8 per cent) patients had oropharyngeal lesions, 26 (27 per cent) in the esophagus, 36 (37 per cent) in the stomach and 12 (12 per cent) in the duodenum. Grade I lesions were found in 12 (12 per cent) patients, 16 (16 per cent) patients with grade II lesions and 15 (15 per cent) of patients with grade III, 12 patients who toke acid had lesions of grade III. Esophageal stricture was found in 2 patients, gastric stenosis in 7 (8 per cent) patients and...
Assuntos
Masculino , Feminino , Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Cáusticos/efeitos adversos , Endoscopia do Sistema Digestório , Trato Gastrointestinal Superior/lesões , Relatos de CasosRESUMO
AIM: The study aims to evaluate the association of oesophageal damage with clinical data and feeding practices in children who suffered a caustic substance ingestion (CSI). METHODS: Cross-sectional design was used in this study. The setting was at a paediatric referral hospital in 2006. Ninety-four children with CSI were used as study samples, with mean age of 38.4 months, and 37.2% were females. The independent variable was oesophageal damage; the dependent variables were clinical data and feeding practices. RESULTS: Main symptoms included salivation, oropharyngeal burns and vomiting. On endoscopy, 84.6% had second- or third-degree burns. Oesophageal stricture occurred in 48.9%. Severe burns were associated with oesophageal stricture and ingestion of alkaline products; dysphagia was associated with oesophageal stricture. In about one fourth of the cases, a nutritional intervention with complete and balanced liquid diets was required to maintain the adequate daily recommended intake (DRI). CONCLUSIONS: Alkali ingestion was associated with severe burns and oesophageal stricture. The presence of oesophageal strictures and dysphagia required changes in the feeding practices in order to maintain an adequate nutritional status and/or to complete their DRI.
Assuntos
Cáusticos/efeitos adversos , Esôfago/lesões , Comportamento Alimentar , Cáusticos/administração & dosagem , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitais Pediátricos , Humanos , Lactente , MasculinoRESUMO
Introducción: La ingestión de sustancias cáusticas (IC) en niños, continúa siendo un campo difícil, debido a la poca clara relación entre los signos y síntomas y la extensión del daño del esófago.Objetivo: Describir el caso de un niño con IC y revisar la literatura del tema. Reporte del caso: Se trata de un masculino de 1 año 8 meses de edad, sin antecedentes de importancia, quien luego de ingesta accidental de líquido de radiador contenido en un frasco de yogurt, presenta vómito en 15 oportunidades. En Centro de Salud luego de la colocación de sonda nasogástrica para lavado gástrico es remitido a un Tercer Nivel de Atención, donde se le realiza una endoscopia digestiva alta (EVDA) luego de 28 horas de la IC. El reporte de la EVDA, indicó esofagitis caústica grado IIc, gastropatía severa, y píloro no franqueable con lesiones concéntricas. El manejo incluyó ayuno, líquidos endovenosos, corticoides, penicilina, y ranitidina Discusión: La EVDA, es el método más eficiente para evaluar la mucosa del tubo digestivo superior luego de la IC, que puede tener efectos catastróficos o puede resultar inofensiva. Se ha intentado correlacionar los signos y síntomas iniciales con la gravedad de las lesiones para evitar la realización de una EVDA innecesaria, sin embargo, sigue siendo controversial este tema. El manejo médico de la IC incluye antibióticos, esteroides y bloqueadores H2. Entre las complicaciones de la IC se encuentran la perforación, la mediastinitis, las fístulas a grandes vasos, la penetración al estómago y las estenosis.
Introduction: The ingestion of caustic substances (CI) in children, remains a difficult, due to lack clear relationship between the signs and symptoms and the extent of damage of the esophagusObjective: To describe the case of a child with CI and review the literature on the subject. Case report: This is a male 1 year 8 months old, with no previous medical history, who after accidental ingestion of radiator fluid contained in a jar of yogurt, vomiting occurs in 15 opportunities. Health Center after placement of a nasogastric tube for gastric lavage is referred to a tertiary care, where she underwent an upper endoscopy (UE) after 28 hours of the CI. The report of the UE, said caustic esophagitis grade IIc, severe gastropathy, and pylorus not passable with concentric lesions. The managemen included fasting, intravenous fluids, steroids, penicillin, and ranitidine Discussion: . The UE, is the most efficient method to evaluate the upper gastrointestinal mucosa after the IC, which can have catastrophic effects and can be harmless. It has tried to correlate the signs and symptoms with the severity of injuries to avoid making an unnecessary UE, however, this issue remains controversial. The medical management of IC including antibiotics, steroids and H2 blockers. Complications of the IC are perforation, mediastinitis, fistulas to large vessels, penetrationto the stomach and stenosis.
Assuntos
Humanos , Masculino , Feminino , Criança , Cáusticos/administração & dosagem , Cáusticos , Cáusticos/efeitos adversos , Cáusticos/síntese química , Cáusticos , Endoscopia do Sistema Digestório/classificação , Endoscopia do Sistema Digestório/métodos , Endoscopia do Sistema Digestório , Esofagite/classificação , Esofagite/prevenção & controle , Cáusticos/intoxicação , Cáusticos/toxicidade , Esofagite/diagnóstico , Esofagite/patologiaRESUMO
La ingestión de cáusticos en la edad pediátrica es un problema grave al producir una lesión progresiva y devastadora en el esófago y el estómago. Estudio retrospectivo y descriptivo de 421 pacientes en edades comprendidas de 2 meses a 14 años quienes ingirieron cáusticos entre 1.992 y 2.008, evaluados en el Hospital Universitario de Maracaibo. El 60,09% eran pre-escolares y el 62,23% eran del sexo masculino. La sustancia tipo álcali fue ingerida en el 90,73% de los casos y los cáusticos se encontraban almacenados en su envase original en 3,8% y trasegados en el 96,2% de los casos. La ingestión fue de origen accidental en el 99,53%. Todos los pacientes manifestaron alguna sintomatología como lesiones orofaríngeas, vómitos y sialorrea. La evaluación endoscópica se realizó en el 89,31% de los casos y se evidenció lesiones en el tracto gastrointestinal en 60,63%. Los pacientes con Esofagitis Grado III y estenosis esofágica fueron incluidos en el programa de dilatación, con una buena evolución en el 35,91% de ellos. La ingestión de cáusticos constituye un problema frecuente y serio, en su mayoría de origen accidental, afecta principalmente a menores de 6 años y el álcali es el principal agente involucrado. La Endoscopia Digestiva es el estudio por excelencia para evaluar estos pacientes. Las dilataciones esofágicas son moderadamente exitosas. El mejor tratamiento es la prevención.
The caustic ingestion in the pediatric population is a serious problem because produce a progressive and devastating injury to the esophagus and stomach. Retrospective and descriptive study of 421 patients with age from 2 months to 14 years who ingested caustic between 1.992 to 2.008 evaluated at the Hospital Universitario de Maracaibo. The 60.09% were pre-school and 62.23% were male. The substance type alkali was swallowed by 90.73% of cases and the caustics were stored in its original packaging by 3.8% and decanted in 96.2% of cases. Intake was accidental source in 99.53%. All patients showed some symptoms as oropharyngeal lesions, vomiting and drooling. Endoscopy evaluation was performed by 89.31% of cases and revealed gastrointestinal tract injuries in 60.63%. Patients with grade 3 Esophagitis and esophageal stricture were admitted in the dilatation program with a good success in 35.91% of them. The caustic ingestion is a common and serious problem, mostly from accidental origin, mainly affects children under 6 years and the alkali is the principal agent involved. The Esophagoscopy is the ideal mean for evaluate these patients. The esophageal dilatations are moderately successful. The best treatment is the prevention.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Cáusticos/efeitos adversos , Cáusticos/toxicidade , Endoscopia do Sistema Digestório/métodos , Esôfago/lesões , Estômago/lesões , Trato Gastrointestinal/anatomia & histologia , Álcalis/efeitos adversos , Cuidado da Criança , Cloro/efeitos adversos , Hipoclorito de Sódio/intoxicação , Vômito/etiologiaRESUMO
RACIONAL: As estenoses benignas de esôfago são complicações decorrentes de diversas causas. Possuem tratamentos similares, na maioria dos casos necessitando de dilatação endoscópica, no entanto a resposta terapêutica, tempo ideal de tratamento, assim como intervalo entre as sessões podem ser variáveis. OBJETIVO: Analisar, do ponto de vista endoscópico, as estenoses benignas de esôfago em 14 anos de experiência no Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, RJ, avaliando etiologia, a extensão da estenose, o número de dilatações necessário para atingir resposta terapêutica satisfatória, assim como a relação entre a extensão da estenose e a resposta terapêutica. MÉTODO: Foram analisadas 2.568 dilatações endoscópicas com uso de velas de Savary-Gilliard em 236 pacientes, durante um período de 14 anos e 10 meses, até junho de 2007. RESULTADOS: A estenose péptica foi a causa mais freqüentemente encontrada, seguida pela estenose cáustica. As estenoses longas e cáusticas necessitaram de maior número de sessões para ausência de disfagia. Estenoses pépticas e curtas responderam melhor a número menor de sessões de dilatação. CONCLUSÃO: A estenose péptica foi a causa mais comum e respondeu bem à terapia endoscópica, em concordância com a literatura. As estenoses cáusticas foram as mais refratárias, principalmente as longas. Quanto maior foi a extensão da estenose, também maior foi o número de sessões necessárias. Estenoses curtas apresentaram boa evolução na maioria dos casos. O número de dilatações necessárias dependeu diretamente da causa e da extensão da estenose.
BACKGROUND: Benign esophageal strictures are complications that result from different causes. They are usually similarly approached, most of the cases needing endoscopic dilation. However the response to therapy, optimal timing for treatment and interval between sessions can vary. AIM: The authors evaluate 14 years of experience with benign stricture of the esophagus from the endoscopic point of view in the "Clementino Fraga Filho" University Hospital, Federal University of Rio de Janeiro, RJ, Brazil. They evaluated etiology, length of stricture, number of dilations needed to reach satisfactory therapeutic response, and the relation between length of stricture and therapeutic response. METHODS: We analyzed 2,568 endoscopic dilations using Savary-Gilliard dilators in 236 patients. The follow up period was 14 years and 10 months, until June of 2007. RESULTS: Peptic strictures were the more frequent, followed by caustic strictures. Long strictures and caustic strictures needed more sessions to abolish dysphagia. Peptic strictures and short ones had better response to a smaller number of sessions. CONCLUSION: In this study, peptic strictures were the commonest etiology and responded best to endoscopic therapy, in accordance with published literature. Caustic strictures were the most refractory, mainly the long segments. The longer the extension of stenosis, the greater was the number dilation sessions needed for relief. Short strictures had a good prognosis in the great majority of cases. The number of dilations depended directly on the etiology and the extension of the stricture.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Estenose Esofágica/terapia , Esofagoscopia/métodos , Análise de Variância , Queimaduras Químicas/complicações , Cáusticos/efeitos adversos , Dilatação/instrumentação , Dilatação/estatística & dados numéricos , Estenose Esofágica/classificação , Estenose Esofágica/etiologia , Esofagite Péptica/complicações , Esôfago/lesões , Esôfago/patologia , Estudos Retrospectivos , Adulto JovemRESUMO
Evaluar los procedimientos diagnósticos y el tratamiento quirúrgico en pacientes con estenosis esofágica en el Hospital Universitario de Maracaibo. Se evaluaron en 22 pacientes con estenosis cáustica, el agente etiológico, signos y síntomas presentes, procedimientos diagnósticos, tratamiento quirúrgico, complicaciones quirúrgicas y evolución postoperatoria. Las manifestaciones clínicas más frecuentes fueron disfagia (95.45 por ciento), pérdida de peso (18.18 por ciento), odinofagia (18.18 por ciento) y dolor torácico (4.54 por ciento). La endoscopia reportó estenosis esofágica en todo el trayecto en seis pacientes (27.27 por ciento) y congestión y ulceración esofágica en seis pacientes (27.27 por ciento). Las intervenciones quirúrgicas más frecuentemente realizadas fueron: esofagectomía transhiatal + ascenso gástrico en ocho pacientes (36.36 por ciento) y ascenso colónico izquierdo en siete pacientes (31.81 por ciento). Las complicaciones postoperatorias más frecuentes fueron las relacionadas con las anastomosis tales como las fístulas cervicales y las estenosis de la anastomosis. La estenosis esofágica por cáustico es una patología esofágica de difícil tratamiento debido a la morbilidad y mortalidad relacionada con los procedimientos quirúrgicos utilizados.
Assuntos
Humanos , Masculino , Adulto , Feminino , Cáusticos/efeitos adversos , Endoscópios , Esofagectomia/métodos , Estenose Esofágica/cirurgia , Estenose Esofágica/etiologia , Estenose Esofágica/patologia , Compostos Químicos/efeitos adversos , Gastroenterologia , Mediastinite/etiologiaRESUMO
BACKGROUND: Benign esophageal strictures are complications that result from different causes. They are usually similarly approached, most of the cases needing endoscopic dilation. However the response to therapy, optimal timing for treatment and interval between sessions can vary. AIM: The authors evaluate 14 years of experience with benign stricture of the esophagus from the endoscopic point of view in the 'Clementino Fraga Filho' University Hospital, Federal University of Rio de Janeiro, RJ, Brazil. They evaluated etiology, length of stricture, number of dilations needed to reach satisfactory therapeutic response, and the relation between length of stricture and therapeutic response. METHODS: We analyzed 2,568 endoscopic dilations using Savary-Gilliard dilators in 236 patients. The follow up period was 14 years and 10 months, until June of 2007. RESULTS: Peptic strictures were the more frequent, followed by caustic strictures. Long strictures and caustic strictures needed more sessions to abolish dysphagia. Peptic strictures and short ones had better response to a smaller number of sessions. CONCLUSION: In this study, peptic strictures were the commonest etiology and responded best to endoscopic therapy, in accordance with published literature. Caustic strictures were the most refractory, mainly the long segments. The longer the extension of stenosis, the greater was the number dilation sessions needed for relief. Short strictures had a good prognosis in the great majority of cases. The number of dilations depended directly on the etiology and the extension of the stricture.
Assuntos
Estenose Esofágica/terapia , Esofagoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Queimaduras Químicas/complicações , Cáusticos/efeitos adversos , Criança , Pré-Escolar , Dilatação/instrumentação , Dilatação/estatística & dados numéricos , Estenose Esofágica/classificação , Estenose Esofágica/etiologia , Esofagite Péptica/complicações , Esôfago/lesões , Esôfago/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
La lesión digestiva aguda por caústicos es una patología que con cierta frecuencia se observa como motivo de consulta a los servicios de urgencias. Tiene un pronóstico reservado dada la cantidad de complicaciones quirúrgicas, médicas e infecciosas a las que están expuestos estos pacientes. Las secuelas que el paciente debe enfrentar en diferentes etapas de su evolución requieren de cuidados intensivos durante un tiempo prolongado además de muchos controles posteriores al alta para evaluar y tratar proiblemas de consideración, estenosis y otras lesiones faringo-esofágicas. Presentamos el caso de un adulto masculino que debido a un síndrome depresivo mayor cursa un intento suicida ingiriendo ácido muriático por boca con severa lesiones digestivas muy poco sintomáticas durante su evolución precoz, pero con un resultado fatal debido a sangrado digestivo agudo masivo.
The acute gastrointestinal injury by caustics is a condition that frequently is observed as a cause of consultations to emergency department. These patients have reserved prognosis given the number of surgical complications, medical and infections. The aftermath that the patient must face at different stages of their development require intensive care for a long time and post-discharge many patients required assess and treat problems, primarily stenosis and other injuries pharynx-esophageal. We report the case of an adult male with depressive syndrome and by suicide attempt with ingesting muriatic acid by mouth, he developed very little injuries digestive during his early trends, but with a fatal outcome due to acute massive gastrointestinal bleeding.
Assuntos
Humanos , Masculino , Adulto , Ácido Clorídrico/efeitos adversos , Trato Gastrointestinal Superior/lesões , Cáusticos/efeitos adversos , Tentativa de SuicídioRESUMO
Se realizó un estudio descriptivo, transversal y retrospectivo de 40 pacientes ingresados por ingestión accidental de una sustancia cáustica en el Hospital Pediátrico Universitario de Centro Habana entre 1993 y 1998. Se observó que la ingestión de cáusticos fue más frecuente en varones de 1 a 4 años de edad. Los álcalis predominaron como sustancia ingerida y dominaron la sintomatología las lesiones orales, la sialorrea y la disfagia. En la mayoría de los pacientes se realizó la endoscopia a las 48 h y predominaron las lesiones de grado II y en el tercio medio. Un gran número de pacientes presentó complicaciones, entre las cuales la estenosis fue la más frecuente. En más de la mitad de los pacientes se emplearon medidas para neutralizar el cáustico y se aplicó tratamiento médico con antibióticos y esteroides