Digestive Tract Injury Research Articles

Utility of computed tomography in assessing caustic ingestion damage to the esogastric tract

BackgroundIngestion of corrosive substances represents a frequent and consequential medical scenario, significantly impacting both vital and functional prognoses through the emergence of acute complications or stenosis, which pose considerable therapeutic challenges. Currently, endoscopy remains the cornerstone modality for diagnostic assessment and management. Nevertheless, recent research highlights computed tomography (CT) as a promising alternative, avoiding the risks associated with endoscopy and reducing the unnecessary surgical interventions based on its findings.MethodsOur retrospective study, spanning three years, encompassed 28 patients who had ingested corrosive substances. Among them, 24 underwent both CT scanning and endoscopic evaluation using CT and endoscopic scores.ResultsEmploying Standardized CT scoring criteria alongside the Zargar’s endoscopic classification, our findings revealed significant concordance between the two modalities, particularly in discerning trans-parietal necrosis within the esophagus and stomach. Notably, radiographic evidence of digestive tract injury was found to be predictive of complications in over 80% of cases, demonstrating high sensitivity and negative predictive value. Furthermore, CT scores indicating moderate to severe injury were significantly associated with stenosis, with slightly inferior performance compared to endoscopy. Of particular note, a CT score indicative of severe injury was found to be a good predictor of mortality, further underscoring the prognostic value of CT in these cases.ConclusionWhile the utility of CT in this context is undeniable, its integration with endoscopic findings remains imperative. We advocate for a systematic approach incorporating CT scanning, with further prospective research warranted to explore the feasibility of CT as a standalone diagnostic tool, as suggested by some scholars.

Long-term outcomes of patients undergoing emergency surgery for corrosive injury of the upper digestive tract.

Emergency surgery can save patients' lives in cases of severe caustic injury. However, the long-term outcomes are not well understood. Patients who underwent emergency organ resection for severe corrosive acid injury were included. Subsequently, digestive tract reconstruction was performed to fit patients. Long-term outcomes were analyzed. Fifty patients underwent emergency digestive tract resection. The operative mortality rate was 6% (of 3/50). One of the 50 patients underwent successful immediate reconstruction. Of the 46 survivors with digestive tract discontinuity, 32 (70%) underwent subsequent reconstructive surgery, 10 (22%) died while awaiting reconstruction due to deterioration in their psychiatric and nutritional status, and 4 (9%) were unfit for reconstructive surgery. No operative mortality occurred during reconstruction. Among the 32 patients who underwent reconstruction, 30 (94%) achieved nutritional autonomy. Nutritional independence was achieved in 62% of the patients (31/50). At a median duration of 58months, the median survival time of the 50 patients was 158months. Patients who underwent reconstruction had a significantly better overall survival than those who did not (p < 0.0001). Emergency surgery remains the standard treatment for corrosive ingestion of complicated digestive tract injuries. However, only 60% of survivors can undergo subsequent digestive reconstruction and achieve long-term nutritional autonomy and a survival outcome.

Przypadek nieszczelności zespolenia wywołanej zakażeniem &lt;i&gt;Candida albicans&lt;/i&gt; u 64-letniej pacjentki po przeszczepieniu nerki, leczonej w trybie nagłym poprzez wszczepienie pomostu biodrowo-udowego z dostępu nadłonowego

IntroductionVascular complications are a rare but important risk factor for failure and loss of kidney graft, increasing the mortality of renal graft recipients.Case reportWe present the case of massive haemorrhage due to the rupture of the arterial anastomosis caused by &lt;i&gt;Candida albicans&lt;/i&gt; infection in a 64-year old female kidney graft recipient managed with suprapubic iliofemoral bypass during emergency life-saving graft nephrectomy performed in our unit. The postoperative period was complicated by femoral vein thrombosis and intraabdominal fluid collection. After 33 days, with a well-functioning iliofemoral bypass, the patient was discharged to the nephrology unit. At the 12-month follow-up, the patient is functioning well, receiving nephrological care and haemodialysis treatment.ConclusionsRoutine fungal cultures of graft preservation fluid and radiological follow-up in high-risk patients after transplantation may be helpful in the prevention of fatal complications in the high-risk patient group – especially if digestive tract injury occurred during organ harvesting. Nevertheless, histological examination remains the gold standard for the detection of fungal arteritis. Negative culture samples from the preservation fluid, blood and urine before the transplantation do not exclude the risk of fungal infection. Urgent allograft nephrectomy with resection and reconstruction of changed vessels seems to be the safest approach in ruptured anastomotic pseudoaneurysm, as shown in our case.

A rapid-floating natural polysaccharide gel–raft with double-effect for the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition characterized by regurgitating stomach contents into the esophagus, causing mucosal damage or erosion. Clinical physical protection treatment mainly relies on the use of floating rafts. Bletilla striata (BS) is widely regarded as the first-choice drug for treating digestive tract injuries in Chinese Medicine. The rapid-floating gel-raft (B-R) was prepared via a one-step swelling method using natural BS polysaccharide and glyceryl monooleate. Panax notoginseng saponins (PNS) were loaded to further prepare P/B-R according to clinical experience. Possessing hydrophobic dense, stratified porous structure and stable rheological properties, an outperforming floating performance of P/B-R was proven compared with Gaviscon® (alginate-antacid formulation) in vitro. In vivo imaging results showed that P/B-R can retain and adhere to the gastric mucosa of rats for up to 90 min, protecting and repairing the mucosa. Besides physical protection in situ, the systemic effects of antioxidant and anti-inflammatory actions for treating GERD were achieved through the intestinal release of PNS. Acid-labile PNS was protected by P/B-R against gastric acid, attaining the desired release and permeability. A significantly effective mucosa injury protective effect of P/B-R was found in ethanol-induced gastric damage model on rats. Moreover, P/B-R exhibits excellent biosafety at the cellular level.

A visual method of establishing preperitoneal space for totally visceral sac separation in ventral hernia repair

ObjectiveTo explore a method of visually establishing preperitoneal space. In this paper, the procedure is described in detail and its safety and efficacy evaluated. MethodsA retrospective style was adopted. The clinical data of 33 patients who accepted the total visceral sac separation (TVS) procedure from December 2019 to November 2021 were collected. Observation indices included location and area of abdominal defect; surgical method and duration of operation to establish preperitoneal space and any postoperative complications; developments during follow-up. Follow-up was performed up to December 2021 using outpatient examination and telephone interview to detect any complications of incision or recurrence of ventral hernia. ResultsFor operative indices, all patients underwent the TVS procedure successfully except for one who had to be converted to laparoscopic intraperitoneal onlay mesh (IPOM) due to failure to establish preperitoneal space. The time required to establish preperitoneal space was 185.75 ± 44.37 s and the duration of hospital stay was 8.27 ± 1.42 days. No complications, such as abdominal bleeding or digestive tract injury, occurred during hospitalization. No complications of incision were observed during follow up, which lasted 2–24 months with an average of 7 months. ConclusionsPreliminary results of the novel attempt to establish the preperitoneal space visually confirmed this to be a safe and feasible method. However, the sample size used here was small, with a short follow up. The details and notes need to be further discussed.

S2806 Biliary Stenting of Caustic Proximal Esophageal Stricture Complicated by Fistula From Prior Dilation

Introduction: Caustic ingestions can lead to recalcitrant strictures of the upper esophagus. Endoscopic treatment options include dilations and/or covered esophageal stents; however, a stricture at a high anatomic location renders traditional stenting difficult. Dilation has the risk of perforation and fistula development. We present a patient with complex, proximal and distal esophageal strictures from caustic ingestion who was managed surgically then salvaged endoscopically using biliary stents. Case Description/Methods: A 28-year-old woman with a history of caustic ingestion of bleach and was found to have airway injuries, severe proximal digestive tract injuries, and transmural gastric necrosis. She underwent a total gastrectomy and cervical esophagostomy followed by Roux esophagojejunostomy and stepwise reconstruction. She then had esophageal strictures initially treated with Savary dilation complicated by perforation and fistula formation between upper stricture and pleura. Endoscopy revealed a 3-mm lumen at the upper esophageal sphincter (UES)(Figure). Initial contrast injection revealed no passage into esophagus, with contrast passing to pleura. XP gastroscope was used to pass a guidewire through the proximal stricture and into the esophagus. A 10mm x 6cm biliary fully covered self-expanding metal stent (FCSEMS; Gore Viabil Biliary Endoprosthesis) was deployed across the stricture, covering the fistula. The patient subsequently had repeated endoscopies for stent migration and to reach the distal stricture for stenting. Discussion: Esophageal stents are not typically placed across the UES due to foreign body sensation. In this case, the anatomic location of the stricture and presence of fistula required stenting across the UES. We chose a biliary FCSEMS that had anti-migratory features (flanges and conformability) and did not foreshorten. Despite these measures, the stent did migrate multiple times requiring re-intervention over a period of months, eventually allowing access to the distal esophageal stricture after upper esophageal remodeling around the shape of the stent. At the time of presentation to advanced endoscopy, colonic interposition was a less preferred option due to lack of healthy pharyngeal or esophageal tissue for anastomosis. Through the use of biliary stents in the esophagus, we were able to simultaneously treat a difficult stricture and fistula, allowing eventual access to a distal stricture for endoscopic treatment.Figure 1.: Endoscopic and fluoroscopic imaging showing (A) proximal esophageal stricture from caustic ingestion, (B) contrast injection showing stricture with fistula to pleura prior to stenting, (C) contrast injection through biliary FCSEMS deployed across proximal stricture without evidence of leak, and (D) proximal endoscopic view of the biliary FCSEMS above the arytenoid and close to endotracheal tube in subsequent endoscopy.

602. LONG-TERM OUTCOME OF COLON INTERPOSITION IN SEVERE CORROSIVE UPPER DIGESTIVE TRACT INJURY

Abstract Long-term outcome of colonic interposition in patients with severe corrosive upper gastrointestinal tract injury is less known. Patients diagnosed of severe corrosive upper digestive tract injury were included. Patients with full-thickness organ necrosis underwent emergent surgical resection without primary reconstruction. Subsequent esophageal reconstruction with substernal colonic interposition approximately 6 months after the ingestion was undertaken in physically and mentally fit patients. Esophageal dilatation program was applied as first line treatment in all patients with esophageal stricture at a median duration of 5 weeks after the injury. Esophageal replacement procedure was offered to the patients who had failed dilatation. Late complications, swallow function, nutritional autonomy and overall survival in patients who underwent colonic interposition were evaluated. There were 70 patients undergoing colonic interposition. Of 70 patients, 50 (71%) had cervical pharyngo-colonic and 20 had cervical esophago-colonic anastomoses. There was one (1.4%) 90-day hospital mortality. Anastomosis leakage was 8%. At median follow up of 58 months, late deaths were observed in 6 patients causing by nesidioblastosis (2), resuicidal attempt (2) and intestinal volvulus (2). Adhesive small intestinal obstruction requiring laparotomy was observed in 7(10%). Nutritional autonomy was achieved in 55 of 60 (92%) patients. Strictures were developed in 10 (16%) and dumping syndrome in 20 (30%) patients. Five- and ten-year overall survival were 72% and 61%, respectively. Colonic interposition in patients with severe corrosive upper digestive tract injury was safe and effective. Long-term survival, function and nutritional outcome are good regardless of the proximal level of cervical anastomosis. However, the late negative impact of the reconstructive procedure on metabolic derangement and small intestinal obstruction cannot be overemphasized.

Cell death mechanisms involved in cell injury caused by SARS-CoV-2.

Coronavirus disease 2019 (Covid‐19) is an emerging novel respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) that rapidly spread worldwide. In addition to lung injury, Covid‐19 patients may develop extrapulmonary symptoms, including cardiac, liver, kidney, digestive tract, and neurological injuries. Angiotensin converting enzyme 2 is the major receptor for the entry of SARS‐CoV‐2 into host cells. The specific mechanisms that lead to cell death in different tissues during infection by SARS‐CoV‐2 remains unknown. Based on data of the previous human coronavirus SARS‐CoV together with information about SARS‐CoV‐2, this review provides a summary of the mechanisms involved in cell death, including apoptosis, autophagy, and necrosis, provoked by severe acute respiratory syndrome coronavirus.

Digestive Tract Injuries Caused by Ingested Foreign Bodies Containing Magnets

We report on 16 children with ingestion of magnetic foreign bodies, who were identified by a medical record review of our hospital data for the time period between January, 2017 and May, 2018. Digestive tract wall was sandwiched in 13 (75%) children and 11 (74%) had gaptic intestinal perforation.

Clinical characteristics of patients with 2019 coronavirus disease in a non-Wuhan area of Hubei Province, China: a retrospective study

BackgroundSince December 2019, the 2019 coronavirus disease (COVID-19) has expanded to cause a worldwide outbreak that more than 600,000 people infected and tens of thousands died. To date, the clinical characteristics of COVID-19 patients in the non-Wuhan areas of Hubei Province in China have not been described.MethodsWe retrospectively analyzed the clinical characteristics and treatment progress of 91 patients diagnosed with COVID-19 in Jingzhou Central Hospital.ResultsOf the 91 patients diagnosed with COVID-19, 30 cases (33.0%) were severe and two patients (2.2%) died. The severe disease group tended to be older (50.5 vs. 42.0 years; p = 0.049) and have more chronic disease (40% vs. 14.8%; p = 0.009) relative to mild disease group. Only 73.6% of the patients were quantitative polymerase chain reaction (qPCR)-positive on their first tests, while typical chest computed tomography images were obtained for each patient. The most common complaints were cough (n = 75; 82.4%), fever (n = 59; 64.8%), fatigue (n = 35; 38.5%), and diarrhea (n = 14; 15.4%). Non-respiratory injury was identified by elevated levels of aspartate aminotransferase (n = 18; 19.8%), creatinine (n = 5; 5.5%), and creatine kinase (n = 14; 15.4%) in laboratory tests. Twenty-eight cases (30.8%) suffered non-respiratory injury, including 50% of the critically ill patients and 21.3% of the mild patients.ConclusionsOverall, the mortality rate of patients in Jingzhou was lower than that of Wuhan. Importantly, we found liver, kidney, digestive tract, and heart injuries in COVID-19 cases besides respiratory problems. Combining chest computed tomography images with the qPCR analysis of throat swab samples can improve the accuracy of COVID-19 diagnosis.

Early Achievement of Enteral Nutrition Protein Goals by Intensive Care Unit Day 4 is Associated With Fewer Complications in Critically Injured Adults.

Although robust randomized controlled trials are lacking, present data suggest that early, adequate nutrition is associated with improved outcomes in critically ill patients. Injured patients are at risk of accumulating significant protein debt due to interrupted feedings and intolerance. Critically injured adults who were unable to be volitionally fed were included in this retrospective review. Data collected included demographics, injury characteristics, number and types of operations, total prescribed and delivered protein and calories during the first 7 days of critical care admission, complications, and outcomes. Group-based trajectory modeling was applied to identify subgroups with similar feeding trajectories in the cohort. There were 274 patients included (71.2% male). Mean age was 50.56 ± 19.76 years. Group-based trajectory modeling revealed 5 Groups with varying trajectories of protein goal achievement. Group 5 fails to achieve protein goals, includes more patients with digestive tract injuries (33%, P = 0.0002), and the highest mean number of complications (1.52, P = 0.0086). Group 2, who achieves protein goals within 4 days, has the lowest mean number of complications (0.62, P = 0.0086) and operations (0.74, P = 0.001). There is heterogeneity in the trajectory of protein goal achievement among various injury pattern Groups. There is a sharp decline in complication rates when protein goals are reached within 4 days of critical care admission, calling into question the application of current guidelines to healthy trauma patients to tolerate up to 7 days of nil per os status and further reinforcing recommendations for early enteral nutrition when feasible.

The Digestive Tract Injury Secondary to Abdominal Blunt: Diagnosis and Management in Teaching Hospital of Kara (Togo)

The Digestive Tract Injury Secondary to Abdominal Blunt: Diagnosis and Management in Teaching Hospital of Kara (Togo)

Conservative treatment of caustic oesophageal injuries in children: 15 years of experience in a tertiary care paediatric centre.

IntroductionEndoscopic dilatation is good choice of conservative treatment for caustic digestive tract injuries in children.AimTo set up a strategy of management of caustic digestive tract injury based on our experience and literature review.Material and methodsWe retrospectively analysed medical records of 34 paediatric patients who were admitted to the Centre of Paediatric Surgery of the Children’s Hospital between 2000 and 2017. Age at presentation, gender, anatomic location, circumstances and distribution of injury, early and late complications, clinical signs, and the first aid were analysed. Upper gastrointestinal (GI) endoscopy was performed within 12–24 h after ingestion in all cases. The Zargar classification system was used to grade the severity of the injury. Fisher’s exact test was used for statistical analysis, with p < 0.05 considered as the limit of statistical significance.ResultsThe upper GI endoscopy revealed caustic injuries in 5 (15%) and 8 (23%) patients were classified as grade IIa and IIb, respectively. Oesophageal and ventricle caustic injuries in 3 (9%) and 2 (6%) patients were classified as grade IIIa and IIIb, respectively. Thirteen patients with grade IIa and IIIb injuries suffered permanent damage and required repeated dilatation. All patients underwent stricture treatment using late or early endoscopic dilatation of the oesophagus. An average of 15 dilatation procedures were required to achieve a satisfactory lumen.ConclusionsOur experience of 34 children revealed that endoscopic dilatation may be required as a primary treatment for oesophageal strictures.

Ethnobotanical study of Hammada scoparia (Pomel) Iljin in the region of Naâma (south-western Algeria)

The Hammada scoparia is a relatively common and characteristic steppe species of the Saharan Atlas of south-western Algeria. It has several ecological, medicinal and floristic interests. The description of its ethnobotany in the region of Naâma will contribute to a better knowledge and valorization of this species. An ethnobotanical survey was carried out using 100 questionnaires undertaken from October 2014 to September 2015 with users, herbalists, traditional healers and the local population of Naâma. The exploitation of the results of the ethnobotanical survey made it possible to identify the different ways of using and exploiting Hammada scoparia . More than 45% of the population uses this plant against poisonous reptile bites such as scorpions, snakes and vipers as well as the treatment of digestive tract diseases, injuries, skin inflammations and diabetes. The species Hammada scoparia is a perennial chamaephytic plant with many therapeutic virtues, the most important of which remains its action in the treatment of scorpion stings.

Esophageal Perforation Associated With Barotrauma

Esophageal perforation continues to present a diagnostic and therapeutic challenge despite decades of clinical experience and innovation in surgical technique. The incidence of esophageal perforation has increased with the advancement of invasive diagnostic technology and the etiology has changed from spontaneous or traumatic to mostly iatrogenic. The incidence of esophageal perforation following external blast injuries is quite rare, 0.004-0.01%. We describe a case of barotrarumatic esophageal perforation. A 30-year-old male presented to hospital following a high pressure air hose injury of mid face and mouth. The patient complained of immediate shortness of breath, neck and facial pain was intubated on scene for stridor and shortness of breath. Examination was significant for facial swelling, subcutaneous emphysema to his neck and upper chest. Computed Tomography(CT) scan of chest was significant for bilateral pneumothorax, pneumomediastinum and subcutaneous emphysema. B/L chest tube were placed followed by resolution of pneumothorax. He was admitted to intensive care unit with preliminary diagnosis of bilateral traumatic pneumothorax and lung contusion. Due to concern for digestive tract injury urgent esophagoscopy (EGD) was performed which didn't reveal any perforation or tears. Further course was complicated by development of empyema and mediastinitis. Repeat CT scan with oral and IV contrast demonstrated a large 4 cm tear in the mid esophagus. The medical therapy included parenteral nutritional support and broad spectrum antibiotics. The patient refused surgical treatment and an esophageal stent was placed under endoscopic and fluoroscopic guidance. Despite the stent placement he developed persistent leak. Perforation was successfully treated by surgical repair with muscle flap followed by interval removal of the stent post surgery. Common clinical manifestations of esophageal perforation include chest pain, dysphagia, dyspnea, subcutaneous emphysema, epigastric pain, fever, tachycardia, and tachypnea. Any combination of these signs and symptoms following instrumentation of the esophagus or respiratory tract implies perforation until proven otherwise. In spontaneous perforations like blast injuries the left border of lower third of thoracic esophagus is involved in 80% of the cases, 3-6cm on average. GI Contrast enhanced CT is the initial choice of diagnosis as its sensitivity ( 92-100% ) is better than esogastroduodenal follow through.

Penetrating Neck Trauma in Children Causing Complex Digestive Tract Injury: A Case Report

Introduction: Pediatric traumatic esophageal perforation has high morbidity and mortality rates. It is most commonly iatrogenic in nature with penetrating trauma account for only 0.5% of cases. Case report: We report a case of pediatric penetrating trauma to the neck zone two causing both through and through cervical esophageal injury and laceration of the posterior wall of the trachea. A 6-year-old boy suffering from penetrating neck trauma due to blast explosion presented to us with severe respiratory distress and drooling of saliva. Diagnostic workup revealed both tracheal and esophageal injury. Immediate primary repair was done for both organs. Postoperatively, he developed ARDS which treated conservatively with good outcome.Conclusion: High index of suspicion is always required not to miss any injuries especially esophageal injuries, bearing in mind whenever you have one injury searching for others is rationale.

The role of computed tomography angiography in the detection of aerodigestive tract injury following penetrating neck injury

BackgroundThe purpose of this study was to audit our experience with computed tomography angiography (CTA) for the detection of aerodigestive tract injury (ADTI) following penetrating neck injury (PNI) and to assess the significance of deep surgical emphysema on CTA. MethodsA prospectively maintained trauma registry at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa was retrospectively interrogated. The data of all patients with PNI investigated with CTA over a 4-y period were reviewed. All findings of deep surgical emphysema were correlated to an aggregate standard of reference for ADTI as demonstrated by results from clinical examination, surgical neck exploration, endoscopy or contrasted swallow to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this finding. ResultsA total of 383 patients underwent a CTA for PNI. A total of 94 vascular injuries were identified on 78 positive CTA studies. The sensitivity and specificity of CTA in detecting a vascular injury were 94.4% and 96.7%. Of the 383 patients investigated a total of 38 patients were diagnosed with digestive tract injury (DTI), and all of these patients were found to have deep surgical emphysema on CTA, except for one patient with a clinically insignificant oral cavity injury. Another 126 patients also had deep surgical emphysema on CTA but no DTI. The sensitivity, specificity, PPV, and NPV of deep surgical emphysema for the diagnosis of confirmed DTI in PNI were therefore 97.4%, 63.5%, 22.7%, and 99.5%, respectively. The sensitivity and NPV were, however, 100% when clinically insignificant injuries were excluded. Including patients with confirmed airway injuries and excluding all patients with pneumothoraces yielded a sensitivity, specificity, PPV, and NPV of 94.1%, 71.9%, 30.0%, and 98.9%, respectively, for the identification of ADTI. When excluding surgically irrelevant injuries, the sensitivity and NPV were again both 100%. ConclusionsCTA for PNI has a high sensitivity and specificity for demonstrating vascular injury. The absence of deep surgical emphysema in the deep cervical fascial planes virtually excludes surgically significant ADTI. The presence of deep surgical emphysema is nonspecific but warrants further investigation.

Ten-year epidemiology of chemical burns in western Zhejiang Province, China

BackgroundChemical burns occur frequently in western Zhejiang Province. This study documents the epidemiology of chemical burns in the region using burn data from a local specialized hospital. Results from this analysis will assist in the planning of prevention strategies for high-risk occupations and groups. MethodsA 10-year retrospective analysis was conducted for all patients with chemical burns admitted to the Department of Burn and Plastic Surgery from January 2004 to December 2013. Information obtained for each patient included demographics (gender, age, occupation and education), location of the burn, cause of the burn, and categories of chemicals. Data regarding the season of admittance, prehospital treatment, wound site/size (area, region, and depth), accompanying injuries, operations, length of hospital stay and mortality were also assessed. ResultsA total of 690 patients (619 males, 71 females; average age: 30.6±12.4 years) were admitted to the department for chemical burns. Over the 10-year period, the incidence of chemical burns showed an increasing tendency. Chemical burns occurred most frequently in patients aged 20–59 years (94.79%). Most of the chemical burns were work-related, primarily in private enterprises (47.97%) and state-owned enterprises (24.93%). Operations (68.99%) and machine problems (17.26%) were the main causes of chemical burns in the workplace. With regard to burns caused by chemicals, most were caused by acids (72.01%), with hydrofluoric acid and sulphuric acid causing 51.45%. Most chemical burns occurred in the summer and autumn seasons (61.02%). The burn size was <10% of the total body surface area (TBSA) for 445 patients (64.49%), while only 26 patients (3.76%) had burns covering >40% TBSA. The most common burn sites were the upper extremities (31.57%), lower extremities (19.86%), and head and neck (28.83%). Most patients (581 (84.20%)) received water washing treatment on site immediately after exposure. The most common accompanying injuries included inhalation injury, ocular burns and digestive tract injury. The average hospital stay was 17.0±23.1 days (range 1–333 days). Surgery was performed in 146 patients (21.16%), and the overall mortality rate was 0.58%. ConclusionsChemical burns are preventable. The high morbidity of chemical burns in western Zhejiang Province is related to the industrial structure of the area. Governmental management in the fields of production, transportation, and utilization of chemicals could be improved. Workplaces have the responsibility to provide safe work environments and equipment, as well as occupational education and safety training for high-risk work groups.

Can computed tomography esophagography reliably diagnose traumatic penetrating upper digestive tract injuries?

ObjectiveTo determine the sensitivity and specificity of computed tomography (CT) esophagography in diagnosing penetrating esophageal and hypopharyngeal injuries in trauma patients and to see if it can be used as the only imaging method in diagnosing these injuries. The confidence of radiologists using only CT esophagography was also measured. Patients and methodsA prospective cross-sectional analytic study was done on haemodinamically stable patients requiring multidetector CT after external penetrating neck or chest trauma. Each patient was given oral contrast consisting of 50 ml 50% iohexol solution, within 5 min of commencement of the CT examination and in the supine position. An attempt was made to confirm all CT esophagography findings with at least one secondary method. Images were evaluated separately by two general departmental radiologists who were blinded to the results of the confirmation method. ResultsBetween December 2012 and November 2014, 102 patients were included, of which 93 (91.2%) were male. Stab wounds were responsible for 85.3% (n=87) of penetrating wounds. Ninety-four patients (92.2%) had CT angiography (CTA) in conjunction with CT esophagography. There were 20 confirmed upper digestive tract injuries; 11 (55.0%) in the hypopharynx and 9 (45.0%) in the esophagus. With the exception of one case, all upper digestive tract injuries were diagnosed using only CT esophagography. No upper digestive tract injuries were correctly identified in 70 and 75 out of 82 true negative cases respectively, suggesting a sensitivity of 95.0% for both radiologists and specificity of 85.4% and 91.5% for CT esophagography. A number of false positive diagnoses were reported when CT esophagography was done in conjunction with CTA, resulting in a positive predictive value of 61.3% and 79.1% for this technique. Reviewers were positive to very confident about the CT esophagography findings in 90.0% and 100% of patients with injuries and 79.0% and 87.0%, respectively, in the no injury group. ConclusionCT esophagography is reliable in diagnosing penetrating upper digestive tract injuries. In conjunction with CTA, false positive findings may occur. Radiologists were generally positive to very confident about their CT esophagography findings, not needing further imaging in more than 60% of cases.

Study of the influence of the ph of water in the initiation of digestive tract injury in cadmium poisoning in rats

Cancer has genetic and environmental causes, one of which is the ingestion of heavy metals such as cadmium. ObjectiveTo evaluate the lesions caused by cadmium poisoning in the digestive tract and the possible effect of the drinking water pH in the initiation of these lesions. Methods90 male Wistar rats were used, divided into six groups (n=15): A – received 400mg/l cadmium chloride (CdCl2) in drinking water at a neutral pH of 7.0; B – received CdCl2 (400mg/l) in drinking water at an acidic pH of 5.0; C – received CdCl2 (400mg/l) in drinking water at a basic pH of 8.0; D – received water at an acidic pH of 5.0; E – received water at a basic pH of 8.0; and F – received water at a neutral pH of 7.0. Animals were euthanized after 6 months. Samples of the esophagus, stomach, small intestine and large intestine of each rat were removed for microscopic analysis. ResultsThere were no microscopic changes in either the esophagus or small and large intestines. Only cadmium-exposed animals showed mild dysplasia of the gastric mucosa (p=0.012), regardless of the pH (p>0.05). ConclusionCadmium exposure led to the formation of dysplastic lesions in the gastric glandular epithelium, regardless of the water pH.