ABSTRACT
Esophageal Strictures in our country are commonly due to caustic ingestion. Other causes include strictures which are congenital, follow esophageal reflux disease and following sclerotherapy for varices. The aim of this prospective study was to assess the causes of benign esophageal strictures in pediatric patients and evaluate the safety and efficacy of endoscopically guided balloon dilatation [EBD] in their management. This observational prospective study was carried out at the Department of Pedicatric Gastroenterology, Children's Hosptial Lahore from Oct 2004- Dec. 2006. All patients in whom diagnosis of Benign Esophageal Strictures was confirmed by barium meal were included. Mode of management was endoscopically guided balloon dilatation [EBD]. All dilatations were performed under general anesthesia, with airway protection. All procedures were done as outpatients. A total of 29 children and adolescents aged between one year and 16 years [median = 6 year] were included in the study. There were 19 males and 10 females. Corrosive intake was the commonest cause of the stricture. These patients were submitted to a total of 74 dilatations], with a range of 1 to 6 sessions/patient. [mean = 2.6 sessions; median = 2 sessions]. No patients had complications secondary to the procedure. Dilatations were successful in 27/29 [93.1%] patients and remaining 2 patients were referred for surgery. This study shows that the endoscopic balloon dilatation of esophageal strictures is efficacious and safe with low rates of complications. Only an occasional patient needs to be referred for surgery. Since accidental corrosive intake is the commonest cause of the stricture, there is urgent need for health education of mothers and other caregivers in this country
ABSTRACT
Mistakes made during administration of drugs to patients can be lethal. In order to analyse these mishaps we need to study the particular circumstances of each accident and define the reasons behind the mistake or lapse. This paper reports the findings of a confidential pilot study designed to highlight the frequency of such unfortunate incidences and formulate recommendations applicable in our society to prevent some of these tragic outcomes. Sixty doctors and nurses from different hospitals were randomly enquired about the personal knowledge of pharmacological mistakes with which they were either closely associated or they had first hand information of the incident. All data was collected in confidence on condition of anonymity. We discovered 21 instances of drug administration errors. Dispensation of wrong drug to a patient was the commonest mistake discovered. Nurses gave majority of these injections during the night. Half the victims of these mishaps lost their lives. From this confidential inquiry, we have found that tragedies with loss of life are not infrequent in our set up: Typical scenario involved muscle relaxant given instead of narcotic analgesic by a student nurse during the night. When the mistake was not detected in time it frequently ended in tragic loss of life. It is disturbing to note that minimum basic facilities of proper cardiopulmonary resuscitation were not available in some hospitals. Recommendations: Only senior nurses / doctors should give IV injections. Conscious effort should be made to minimise the use of IV medication, drugs should be used only with proper indications when suitable oral alternatives are not feasible. The nurses' training as well as nurse patient ratio needs to be improved. Muscle relaxants should not be available outside operating rooms and critical care units. We need to set up a central confidential data-reporting centre for voluntary [anonymous