Caustic ingestion in Jamaica: 1982-1992 - abstract

A study on caustic ingestion in Jamaica was done by reviewing all the cases treated at Bustamante Hospital for Children, Kingston Public Hospital, University Hospital and National Chest Hospital between 1982 and 1992. The objectives of the study were: (1) To find the age groups most affected. (2) To assess the effectiveness of our treatment methods (3) To understand the complications of caustic ingestion and plan preventive approaches. All the hospital records, including clinical, surgical, and radiological procedures were carefully assessed and verified. The age groups most frequently affected were 0-5 and 5-10 years and the most serious complications were oesophageal and laryngeal burns. We concluded that superficial burns were manageable with antibiotics, steroids and nasogastric feeds but deep burns ended up with surgical augmentation or replacement of organs (AU)

Hepatic glutathione S-transferase release after multiple halothane anaesthesia

Halothane is a commonly used anaethetic in paediatric practice. However, it is thought to be hepatotoxic. This study was designed to examine the effects of both single and multiple halothane anaesthesia on liver function. Heaptic glutathione S-transferase (GST) was also examined as a possible index of acute liver damage. The study group consisted of ten children who had consumed corrosive substances. This group was subdivided into two groups, depending on the number of halothane exposures, the single and the multiple halothane group. These children were compared with a surgical (n=5) and a ketamine control group (n=5). All children were studied prospectively over a 24hr. period, and the trend of liver enzyme release following anaesthesia measured. In addition, the children in the multiple halothane group were studied longitudinally. Four children from the study group, exhibited dramatic increases in the B1 subunit of liver specific GST, 24 hours after anaethesia. Twelve studies showed an early transient rise in total plasma GST, between the end of anaesthesia and 6 hrs. after. Six studies exhibited marked secondary rise at 24 hrs. after anaesthesia. These data indicate two possible phases of liver dysfunction following halothane anaesthesia. Significant changes in the level of aminotransferases were observed in the multiple halothane group, suggesting that measurement of these liver enzymes are still useful as indices of liver dysfunction following multiple halothane exposure. Cellular antioxidant systems were also measured to examine the relationship between halothane exposure and oxidative stress. A significant increase (p<0.05) in red cell GST was noted in the multiple halothane group, indicating that these children are in fact subjected to chronic oxidant stress. Collectively, these data indicate a transient impairment of hepatocellular integrity following multiple halothane exposures, despite lack of clinical evidence of hepatotoxicity. It is recommended that children undergoing repeated halothane anaesthesia be examined carefully for possible hepatic dysfunction (AU)

Morphological and histological study of the gastro-intestinal tract of the ferret

The morphology and histology of the post-pharyngeal part of the gastro-intestinal tract of the ferret were studied. The oesophagus was a distensible muscular tube. Its mucosa was lined by keratinizing stratified squamous epithelium. The muscle coat was striated throughout except near the cardia. A cardiac sphincter was present. The stomach was morphologically and histologically very similar to that of man. The duodenum appeared C-shaped and had a mesoduodenum. The bile and pancreatic ducts formed a common duct in the wall of the duodenum. The sphincter of Oddi was present. Brunner's glands were present in the pyloric part of the stomach, and up to the common opening of the bile and pancreatic ducts in the duodenum. The intestine could be differentiated macroscopically and microscopially into the small and large intestines. The small intestine distal to the duodenum formed coiled tubes suspended by a mesentery. It was not possible morphologically to differentiate jejunum and ileum. Histologically, however, the distal portion was identifiable as ileum by increasing numbers of goblet cells, and Peyer's patches in the submucosa. Villi were present in the mucosa throughout but there was no spiral or circular fold. The larg intestine was a straight dilated tube lying in the left flank and extending from the splenic flexure to the anus in the median plane. It was suspended by a short mesocolon except for the rectal portion in the pelvis. The ileo-colic junction was differentiated morphologically and histologically. There was no caecum, appendix, taeniae coli or appendices epiploicae. The large intestine was not differentiated topographically into ascending, transverse and descending colon (AU)

Achalasia of the cardia: the long term results of Heller's operation

The treatment of achalasia of the cardia is discussed, and the long-term results of Heller's operations carried out at the University Hospital over a fourteen year period are presented. The importance of excluding Chaga's disease is discussed. The modified Heller's operation is recommended as the primary treatment for achalasia

Replacement of the cervical oesophagus

The cervical oesophagus can be replaced or by-passed safely by means of an isolated segment of transverse colon brought via the chest. Two illustrative cases are discussed in which corrosive strictures of the oesophagus made this necessary. A brief history is given regarding the various methods employed in replacing the oesophagus and reasons advanced for favouring the transverse colon for this purpose (AU)