Utilization of Chest Tube in Pediatric Caustic Injuries: A New Method for Esophageal Stenting

Background: The management of caustic esophageal burns in the pediatric population has changed over the years, while the most optimal management with regards to effectiveness, availability, and cost-beneficent stays controvertible. Herein, along with describing the features of caustic injury, we described how to utilize a chest tube for esophageal stenting in pediatrics.Methods: Data regarding the etiology, treatment, and complications of caustic injury pediatrics during 10 years was collected retrospectively. Furthermore, data regarding the patient’s follow-up who underwent esophageal chest tube (ECT) were collected. The ECT was prepared by carving a narrowed section in the chest tube while maintaining the radiopaque section. The ECT will then be positioned from the cricopharyngeal and exited through the nostril and fixed on the patients’ cheek.Results: Data from 57 patients with an average age of 2.5 years was collected. The most common cause of esophageal burn appertained to alkaline agents (89%). Twenty-nine patients (50.8%) recovered with dilatation alone, 16 ones needed esophageal repair, and ECT was inserted for 7 patients. None of the 7 ECT cases required gastrostomy or jejunostomy.Conclusion: The ECT method introduced in our study can be used as a broadly available, economic, and easy-use facility for esophageal stenting, particularly in developing countries and emergency departments which have limited access to modern equipment. Further multicenter studies with higher volume patients are required for further deployment of this method.

The effect of melanin on the proteolytic potential of blood under alkali esophageal burn

Caustic esophageal burns are among serious medical problems of global significance. Due to a key role in biological processes proteolytic enzymes actively involved in the pathological mechanisms underpinning the development and progression of burn-related complications. Since melanin possesses a broad spectrum of biological activities we have investigated whether this compound can influence the proteolytic activity and level of proteinase inhibitors in the blood of rats with an alkali esophageal burn. Alkaline esophageal burns, which correspond to the first and second degree of burn, were induced by 10% and 20% NaOH, respectively. White, nonlinear, immature (4 weeks old) rats were used in the experiment. Total proteolytic activity was measured using casein as a substrate. The activities of α1- antitrypsin and α2-macroglobulin were measured considering the degree of inhibition of hydrolysis of N-benzoyl-L-arginineethyl ester. The fraction of serine proteinases was obtained by affinity chromatography on a benzamidine sepharose column. The qualitative composition of serine proteinases fraction was analyzed by zymography technique. According to the data obtained, the pathogenesis of alkaline esophageal burn is accompanied by a significant increase in the total proteolytic activity, activity of serine proteinases, and activity of α1-antitrypsin and α2-macroglobulin compared with the control rats. The present results clearly indicated that melanin is able to normalize the proteolytic homeostasis by affecting the activity of serine proteinases and the level of proteinase inhibitors in the plasma of rats with alkali esophageal burns.

Baby Death Due to Esophagotracheal Fistula Created by An Alkaline Battery: A Case Report

There is a limited number of case presentations in literature related to esophagus burns and complications as a result of swallowing an alkaline battery. The main purpose of this case presentation was to discuss the autopsy findings of late-developing complications of swallowing an alkali battery in the light of the relevant literature. On the chest radiography of a 9-month old baby with complaints of vomiting for three days, an opacity was observed consistent with a foreign body in the esophagus. Esophagoscopy was applied and the swallowed battery was removed. On the fifth day after the operation, no complication has been observed to oral feeding was started and on the following day the patient was discharged. Four days after discharge, the patient was again brought to hospital with complaints of blood in vomit and was again hospitalized with a diagnosis of chemical esophageal burn. The patient died on the following day....

Biochemical changes in blood serum of rats with experimental esophageal burn II degree under treatment with aqueous extract of P. vulgaris pods

During modeling of esophageal alkali burns II degree in immature rats were observed violations of various metabolic systems. It was shown that under the esophageal burns there occurred violations of protein (total protein, albumin), nitrogen metabolism (creatinine, urea), changed the activity of enzymes (GOT, GPT), violated fluid and electrolyte balance (Na+, К+, Cl-, Ca2+, Mg2+). In the groups of animals with the alkaline burn of the esophagus, that were injected aqueous extract of pod of bean (Phaseolus vulgaris) there can be traced a change of the indicators in the direction of normalization, indicating about the obvious therapeutic effect of aqueous extract of pod of bean (Phaseolus vulgaris).