Caustic and Toxic Ingestions

2017 ◽  
Author(s):  
CDR Thomas Q Gallagher ◽  
CDR Robert L Ricca
Keyword(s):  
Surgical Management ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Tracheobronchial Tree ◽  
High Rate ◽  
Health Concern ◽  
Endoscopic Management ◽  
Caustic Ingestion ◽  
Stricture Formation ◽  
Accidental Ingestion

Ingestion of caustic substances remains a potentially fatal public health concern with extensive morbidity and the possibility of long-term sequelae. The management strategies of these complex injuries continue to be extensively studied in the literature. Areas of interest include the most efficacious treatment of caustic esophageal stricture to preserve the native esophagus, use of steroids, and use of esophageal stents. Prevention of accidental ingestion through strategies to limit the availability of caustic substances is a key factor in reducing the incidence of injury, but there continues to be a high rate of accidental ingestion in developing countries with less rigorous manufacturing standards. Initial evaluation includes endoscopic evaluation of the esophagus and tracheobronchial tree. Optimal treatment strategies, including the use of proton pump inhibitors to reduce gastroesophageal reflux, steroid use to prevent stricture formation, and use of stents for management of strictures, continue to be debated. Initial surgical management includes esophagectomy for full-thickness injury with abdominal exploration. Multiple surgical options exist for both restoration of gastrointestinal continuity after esophagectomy and the management of strictures refractory to medical management, including reverse gastric tube, colonic interposition, and gastric advancement. Numerous small studies have evaluated the efficacy of these interventions, but there continues to be a need for larger prospective studies to develop a worldwide consensus opinion on best practices. We provide a review of the recent literature and practice recommendations for the management of injuries due to caustic ingestion. Key words: caustic ingestion, endoscopic management, stricture, surgical management 

Caustic and Toxic Ingestions

2018 ◽  
Author(s):  
CDR Thomas Q Gallagher ◽  
CDR Robert L Ricca
Keyword(s):  
Surgical Management ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Tracheobronchial Tree ◽  
High Rate ◽  
Health Concern ◽  
Endoscopic Management ◽  
Caustic Ingestion ◽  
Stricture Formation ◽  
Accidental Ingestion

Ingestion of caustic substances remains a potentially fatal public health concern with extensive morbidity and the possibility of long-term sequelae. The management strategies of these complex injuries continue to be extensively studied in the literature. Areas of interest include the most efficacious treatment of caustic esophageal stricture to preserve the native esophagus, use of steroids, and use of esophageal stents. Prevention of accidental ingestion through strategies to limit the availability of caustic substances is a key factor in reducing the incidence of injury, but there continues to be a high rate of accidental ingestion in developing countries with less rigorous manufacturing standards. Initial evaluation includes endoscopic evaluation of the esophagus and tracheobronchial tree. Optimal treatment strategies, including the use of proton pump inhibitors to reduce gastroesophageal reflux, steroid use to prevent stricture formation, and use of stents for management of strictures, continue to be debated. Initial surgical management includes esophagectomy for full-thickness injury with abdominal exploration. Multiple surgical options exist for both restoration of gastrointestinal continuity after esophagectomy and the management of strictures refractory to medical management, including reverse gastric tube, colonic interposition, and gastric advancement. Numerous small studies have evaluated the efficacy of these interventions, but there continues to be a need for larger prospective studies to develop a worldwide consensus opinion on best practices. We provide a review of the recent literature and practice recommendations for the management of injuries due to caustic ingestion. Key words: caustic ingestion, endoscopic management, stricture, surgical management 

scholarly journals Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001440
Author(s):  
Shameer Khubber ◽  
Rajdeep Chana ◽  
Chandramohan Meenakshisundaram ◽  
Kamal Dhaliwal ◽  
Mohomed Gad ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Surgical Management ◽  
Medical Management ◽  
Cox Regression ◽  
Artery Bypass ◽  
Management Strategies ◽  
Coronary Artery Aneurysms ◽  
Kaplan Meier

BackgroundCoronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies.MethodsWe performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years.ResultsWe identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates.ConclusionOur analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.

scholarly journals Understanding the Impact of Different Landscape-Level Fuel Management Strategies on Wildfire Hazard in Central Portugal

Forests ◽  
2021 ◽  
Vol 12 (5) ◽  
pp. 522
Author(s):  
Akli Benali ◽  
Ana C. L. Sá ◽  
João Pinho ◽  
Paulo M. Fernandes ◽  
José M. C. Pereira
Keyword(s):  
Management Strategies ◽  
Treatment Strategies ◽  
Fire Season ◽  
Burned Area ◽  
Treatment Area ◽  
Fuel Treatment ◽  
The North ◽  
Wildfire Hazard ◽  
Central Portugal ◽  
The Impact

The extreme 2017 fire season in Portugal led to widespread recognition of the need for a paradigm shift in forest and wildfire management. We focused our study on Alvares, a parish in central Portugal located in a fire-prone area, which had 60% of its area burned in 2017. We evaluated how different fuel treatment strategies may reduce wildfire hazard in Alvares through (i) a fuel break network with different extents corresponding to different levels of priority and (ii) random fuel treatments resulting from a potential increase in stand-level management intensity. To assess this, we developed a stochastic wildfire simulation system (FUNC-SIM) that integrates uncertainties in fuel distribution over the landscape. If the landscape remains unchanged, Alvares will have large burn probabilities in the north, northeast and center-east areas of the parish that are very often associated with high fireline intensities. The different fuel treatment scenarios decreased burned area between 12.1–31.2%, resulting from 1–4.6% increases in the annual treatment area and reduced the likelihood of wildfires larger than 5000 ha by 10–40%. On average, simulated burned area decreased 0.22% per each ha treated, and cost-effectiveness decreased with increasing area treated. Overall, both fuel treatment strategies effectively reduced wildfire hazard and should be part of a larger, holistic and integrated plan to reduce the vulnerability of the Alvares parish to wildfires.

scholarly journals Precision Surgery and Kidney Cancer: Knowledge of Genetic Alterations Influences Surgical Management

Genes ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 261 ◽  
Author(s):  
Patrick T. Gomella ◽  
W. Linehan ◽  
Mark W. Ball
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Surgical Management ◽  
Kidney Cancer ◽  
Renal Cell ◽  
Management Strategies ◽  
Genetic Alterations ◽  
Cancer Knowledge ◽  
Biological Potential

Renal cell carcinoma is a term that represents multiple different disease processes, each driven by different genetic alterations, with distinct histology, and biological potential which necessitates divergent management strategies. This review discusses the genetic alterations seen in several forms of hereditary kidney cancer and how that knowledge can dictate when and how to intervene with a focus on the surgical management of these tumors.

scholarly journals The Gender Pain Gap: gender inequalities in pain across 19 European countries

2021 ◽  
pp. 140349482098746
Author(s):  
Kweku Bimpong ◽  
Katie Thomson ◽  
Courtney L. Mcnamara ◽  
Mirza Balaj ◽  
Nasima Akhter ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Pain ◽  
Management Strategies ◽  
European Countries ◽  
Leg Pain ◽  
Health Concern ◽  
Public Health Issue ◽  
Gender Inequalities ◽  
Arm Pain ◽  
Adjusted Rate

Aims: Chronic pain is increasingly considered to be an international public health issue, yet gender differences in chronic pain in Europe are under-examined. This work aimed to examine gender inequalities in pain across Europe. Methods: Data for 27,552 men and women aged 25–74 years in 19 European countries were taken from the social determinants of health module of the European Social Survey (2014). Inequalities in reporting pain were measured by means of adjusted rate differences (ARD) and relative adjusted rate risks (ARR). Results: At the pooled pan-European level, a greater proportion of women (62.3%) reported pain than men (55.5%) (ARD 5.5% (95% confidence intervals (CI) 4.1, 6.9), ARR 1.10 (95% CI 1.08, 1.13)). These inequalities were greatest for back/neck pain (ARD 5.8% (95% CI 4.4, 7.1), ARR 1.15 (95% CI 1.12, 1.19)), but were also significant for hand/arm pain (ARD 4.6% (95% CI 3.5, 5.7), ARR 1.24 (95% CI 1.17, 1.30)) and foot/leg pain (ARD 2.6% (95% CI 1.5, 3.8), ARR 1.12 (95% CI 1.07, 1.18)). There was considerable cross-national variation in gender pain inequalities across European countries. Conclusions: Significant gender pain inequalities exist across Europe whereby women experience more pain than men. The extent of the gender pain gap varies by country. The gender pain gap is a public health concern and should be considered in future prevention and management strategies.

scholarly journals “Predator-In-First”: A Preemptive Biological Control Strategy for Sustainable Management of Pepper Pests in Florida

2020 ◽  
Vol 12 (18) ◽  
pp. 7816
Author(s):  
Vivek Kumar ◽  
Lucky Mehra ◽  
Cindy L. McKenzie ◽  
Lance S. Osborne
Keyword(s):  
Biological Control ◽  
Pest Management ◽  
Control Strategy ◽  
Frankliniella Occidentalis ◽  
Management Strategies ◽  
Control Program ◽  
Field Conditions ◽  
High Rate ◽  
Polyphagotarsonemus Latus ◽  
Consistent Performance

The early establishment of a biocontrol agent in the production system, whether in the greenhouse, nursery, or field, is essential for the success of the biological control program, ensuring growers’ profitability. In an effort to develop a sustainable pest management solution for vegetable growers in Florida, we explored the application of a preemptive biological control strategy, “Predator-In-First” (PIF), in regulating multiple pepper pests, Bemisia tabaci Gennadius, Frankliniella occidentalis Pergande, and Polyphagotarsonemus latus Banks under greenhouse and field conditions during different growing seasons. In these studies, two bell pepper cultivars (7039 and 7141) and the phytoseiid mite Amblyseius swirskii Athias–Henriot were used as a model system. Pepper seedlings (~8 week) of each cultivar were infested with varying rates of A. swirskii (20 or 40 mites/plant or one sachet/10 plant) and allowed to settle on plant hosts for a week before planting in pots or field beds. Results showed a comparative consistent performance of the treatment with the high rate of phytoseiids (40 mites/plant) in regulating B. tabaci and F. occidentalis populations in greenhouse studies, and B. tabaci and P. latus pests under field conditions. During two fall field seasons, higher marketable yields of 12.8% and 20.1% in cultivar 7039, and 24.3% and 39.5% in cultivar 7141 were observed in the treatment with the high rate of phytoseiids compared to the untreated control, indicating yield benefits of the approach. The outcome of the study is encouraging and demonstrates that PIF can be an important tool for organic vegetable growers and a potential alternative to chemical-based conventional pest management strategies. The advantages and limitations of the PIF approach in Florida pepper production are discussed.

scholarly journals Peripheral Arteriovenous Malformations: Imaging and Endovascular Management Strategies

2021 ◽  
Author(s):  
Virender Malik ◽  
Harshith Kramadhari ◽  
Jawahar Rathod ◽  
Yadav W. Munde ◽  
Uday Bhanu Kovilapu
Keyword(s):  
Arteriovenous Malformation ◽  
Vascular Malformation ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Vascular Anomaly ◽  
Classification Systems ◽  
Vascular Anomalies ◽  
Final Decision ◽  
Life Threatening

AbstractThe peripheral high-flow vascular malformation (HFVM) comprises arteriovenous malformation (AVM) and fistula (AVF), shows varied clinical presentation (ranging from subtle skin lesion to life-threatening congestive heart failure), and frequently poses diagnostic and therapeutic challenges. Importance of assigning a specific diagnosis to the vascular malformation cannot be overstated, as the treatment strategy is based on the type of vascular anomaly. Although the International Society for the Study of Vascular Anomalies (ISSVA) classification system is the most commonly accepted system for classifying congenital vascular anomalies in clinical practice, the Cho–Do et al classification is of utmost help in guiding optimal mode of treatment in peripheral AVM. Although transarterial approach remains the most commonly employed route for peripheral AVM embolization, the role of transvenous and direct percutaneous approach is ever increasing and the final decision on the approach depends on angioarchitecture of the AVM. In this article, we review various commonly employed classification systems for congenital vascular anomalies, and describe clinical features, imaging and treatment strategies for peripheral arteriovenous malformation (PAVM).

Cholangiocarcinoma therapeutics: an update

2021 ◽  
Vol 21 ◽  
Author(s):  
Mai Ly Thi Nguyen ◽  
Nguyen Linh Toan ◽  
Maria Bozko ◽  
Khac Cuong Bui ◽  
Przemyslaw Bozko
Keyword(s):  
Treatment Outcome ◽  
Targeted Therapies ◽  
Treatment Strategies ◽  
Favourable Outcome ◽  
High Rate ◽  
Postoperative Treatment ◽  
Clinical Indication ◽  
Tumour Resection ◽  
First Line ◽  
Treatment Methods

Background: Background: Cholangiocarcinoma (CCA) is the second most common hepatobiliary cancer and associated with poor prognosis. Only one-third of CCA cases are diagnosed at operable stages. However, a high rate of relapse has been observed post-operatively. Besides screening for operable individuals, efficacious therapeutic for recurrent and advanced CCA is urgently needed. Treatment outcome of available therapeutics is important to clarify clinical indication and facilitate development of treatment strategies. Objective: This review aims to compare the treatment outcome of different therapeutics based on both overall survival and progression-free survival. Methods: Over one hundred peer-reviewed articles were examined. We compared the treatment outcome between different treatment methods, including tumour resection with or without postoperative systematic therapy, chemotherapies including FOFLOX and targeted therapies, such as IDH1, K-RAS and FGFR inhibitors. Notably, the scientific basis and outcome of available treatment methods werecompared with the standard first-line therapy. Results: CCAs at early stages should firstly undergo tumour resection surgery, followed by postoperative treatment with Capecitabine. Chemotherapy can be considered as a preoperative option for unresectable CCAs. Inoperable CCAs with genetic aberrances like FGFR alterations, IDH1 and K-RAS mutations should be considered with targeted therapies. Fluoropyrimidine prodrug (S-1)/Gemcitabine/Cisplatin and nab-Paclitaxel/Gemcitabine/Cisplatin show favourable outcome which hints on the triplet regimen to be superior to Gemcitabine/Cisplatinon CCA. Thetriplet chemotherapeutic should be tested further compared toGemcitabine/Cisplatin among CCAs without genetic alterations.Gemcitabine plus S-1 was recently suggested as the convenient and equivalent standard first line for advanced/recurrent biliary tract cancer. Conclusions: Thisreview provides a comparative outcomebetween novel targeted therapies and currently available therapeutics.

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