Caustic strictures of the oesophagus

Ingestion of caustic material is a major management problem which occurs most commonly in children. Twenty-five patients with caustic ingestion seen over a ten-year period are reported. Twelve patients had severe burns, resulting in oesophageal strictures. Of these, ten were children below six years of age (median age, 3 years). Dysphagia and vomitting were the main presenting features. Oropharyngeal burn was present in 83 percent of patients with oesophageal burns. The strictures involved the entire oesophagus in two patients, the upper third in four, the mid oesophagus in two and the lower third in four. Periodic dilatations were successful in restoring an adequate lumen in 7 patients with short strictures. Five patients required surgery. There was one death. Caustic damage to the oesophagus is preventable. Education of the public and simple measures by manufacturers of caustics are urgently needed (AU)

Visceral complications of electrical burn injury: a report of two cases and review of the literature

Two patients with high voltage electrical injury involving the trunk are presented. Both injuries were complicated by visceral damage; and one patient died from sepsis secondary to bowel perforation. The rarity of this complication is examined in light of the pathophysiology of electrical injury; and its management is discussed with reference to previously published reports on this condition. (AM)

Comparison of endoscopic brush cytology and biopsy in the evaluation of malignancies of the oesophagus and stomach - abstract

The value of brush cytology was compared to that of standard multiple biopsies in the assessment of lesions suspicious for malignancy at oesophagogastroscopy. Specimens from fifty-six patients were available for analysis: 36 from oesophageal sites and 22 from the stomach. A minimum of four slides were prepared for cytology in each case, and the results graded as negative for malignancy, suspicious, for malignancy or unsatisfactory. In twenty cases, both histology and cytology were positive for malignancy. In a further 11 cases histology was positive while cytology was graded as highly suspicious or suspicious. Three other patients with positive histology were regarded as having unsatisfactor cytological preparations. There were 2 false negative cytologies. On the other hand, there were 6 false negative biopsies with cytology positive or highly suspicious for malignancy, and two others with cytology positive and biopsies for malignancy. Eight patients had positive or highly suspicious cytology with unsatisfactory biopsies. In all cases with negative or unsatisfactory biopsies, malignancy was confirmed at operation or autopsy. One patient had a false positive (highly suspicious) biopsy and negative histology - absence of malignancy was confirmed at surgery. Three other patients had both cytology and biopsy negative; here two have had benign lesions confirmed at repeat endoscopy and one has been lost to follow-up (AU)

Epidemiology of urinary calculi - abstract

Clinicians have frequently note the high incidence of urolithiasis in Trinidad. The purpose of the study was to examine the reasons for this and evaluate the possible roles of various factors (e.g. age, race, sex, water intaked, diet and occupation). Three hundred and three (303) patients, seen at the Port of Spain General Hospital during the period 1974 - 1980 were studied. Patients ranged in age from 9 - 76 with an average of 38 years. There were 153 Negroes, 122 Indians and 28 others. Males accounted for 175 cases and females for 128. Of the calculi 189 were renal, 91 ureteric, 35 bladder and 1 urethral. There were more calculi on the right (146) than the left urolithiasis is rather uncommon in the American Negro and the African Bantu, it is relatively common in the Trinidad Negro. The age distribution in Indian and Negro populations was the same and was similar to that reported from India and Africa. However, the sex ratio in these 2 groups was quite different from that seen in Africa (M: F = 4) and India (M: F = 2.6:1). Although there is marked variation in the calcium content of water from various parts of Trinidad (2.8 - 13.1mg percent) there was no clustering of cases in the areas of higher calcium concentration. This is consistent with findings in other places. (Frankd et al, 1959). There was no definite correlation between dietary habits and the incidence of urolithiasis. The role of occupation is more difficult to assess because of the selection of patients coming to hospital (AU)