RESUMEN
The prevalence of acute poisoning with caustic substances in Russia is higher than in other countries and is reported by different authors as accounting for 10-32% cases among the patients admitted to acute poisoning treatment centres. Especially unfavorable prognosis is considered for necrotizing burns to the stomach that increase the risk of severe complications leading to disability of patients. The study aimed at improving the treatment of necrotizing chemical burn to the stomach by the infusion of a 5% Mexidole solution into the edges of a burn lesion at different stages of the treatment course. The paper presents the outcomes of patients who sustained chemical burns to the stomach with mucosa ulceration and necrosis, and provides an assessment of early endoscopic treatment effect.
Asunto(s)
Antioxidantes/uso terapéutico , Quemaduras Químicas/terapia , Gastroscopía/métodos , Terapia por Luz de Baja Intensidad/métodos , Picolinas/uso terapéutico , Úlcera Gástrica/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antioxidantes/administración & dosificación , Quemaduras Químicas/complicaciones , Quemaduras Químicas/patología , Terapia Combinada , Humanos , Tiempo de Internación , Persona de Mediana Edad , Necrosis , Picolinas/administración & dosificación , Úlcera Gástrica/etiología , Úlcera Gástrica/patología , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM OF THE STUDY: to assess the results of using endoscopic techniques to achieve hemostasis for the control of bleeding and the prevention of recurrent bleeding from esophageal and gastric varices in the patients with primary liver cancer and metastatic liver lesions. MATERIALS AND METHODS: in the period of 2009-2011,7 patients with primary liver cancer or metastatic liver lesions complicated by gastro-esophageal bleeding were treated in the Sklifosovsky Clinical and Research Institute for Emergency Medicine. The sources of bleeding were esophageal varices in 6 patients, gastric varices in 1. RESULTS: a diagnostic esophagogastroduodenoscopy (EGDS) revealed, besides the varices, an erosive hemorrhagic gastritis in 4 patients, a ruptured mucosa of cardio-esophageal transition in 1, an erosive hemorrhagic gastritis and a liver tumour invasion in the stomach antrum in 1. The hemostasis achieved by means of paravasal injections with a 20% glucose solution was efficient in 2 of 3 patients. The endoscopic ligations of esophageal varices were performed in 3 patients. Five patients died from the underlying disease progressing. In one of them, the cause of death was a recurrent bleeding from esophageal varices. CONCLUSIONS: in the patients with primary liver cancer and metastatic liver lesions, the use of mini-invasive endoscopic techniques is more appropriate, because the surgical treatment of this patient population carries a very high risk.