Accuracy of Endoscopy in Predicting the Depth of Mucosal Injury Following Caustic Ingestion; a Cross-Sectional Study.

INTRODUCTION: Esophagogastroduodenoscopy (EGD) is currently considered as the primary method of determining the degree of mucosal injury following caustic ingestion. The present study aimed to evaluate the screening performance characteristics of EGD in predicting the depth of gastrointestinal mucosal injuries following caustic ingestion. METHODS: Adult patients who were referred to emergency department due to ingestion of corrosive materials, over a 7-year period, were enrolled to this diagnostic accuracy study. Sensitivity, specificity, positive and negative predictive values as well as negative and positive likelihood ratios of EGD in predicting the depth of mucosal injury was calculated using pathologic findings as the gold standard. RESULTS: 54 cases with the mean age of 35 ± 11.2 years were enrolled (59.25% male). Primary endoscopic results defined 28 (51.85%) cases as second grade and 26 (48.14%) as third grade of mucosal injury. On the other hand, pathologic findings reported 21 (38.88%) patients as first grade, 14 (25.92%) as second, and 19 patients (35.18%) as third grade. Sensitivity and specificity of endoscopy for determining grade II tissue injury were 50.00 (23.04-76.96) and 47.50 (31.51-63.87), respectively. These measures were 100.00 (82.35-100) and 80.00 (63.06-91.56), respectively for grade III. Accuracy of EGD was 87.03% for grade III and 48.14% for grade II. CONCLUSION: Based on the findings of the present study, endoscopic grading of caustic related mucosal injury based on the Zargar's classification has good accuracy in predicting grade III (87%) and fail accuracy in grade II injuries (48%). It seems that we should be cautious in planning treatment for these patients solely based on endoscopic results.

Epidemiologic Features and Outcomes of Caustic Ingestions; a 10-Year Cross-Sectional Study.

INTRODUCTION: Caustic ingestions are among the most prevalent causes of toxic exposure. The present 10-year survey aimed to evaluate the epidemiologic features and outcomes of caustic ingestion cases presenting to emergency department. METHODS: This is a retrospective cross-sectional study on patients who were admitted to a referral toxicology center during 2004 to 2014, following caustic ingestion. Baseline characteristics, presenting chief complaint, severity of mucosal injury, complications, imaging and laboratory findings as well as outcomes (need for ICU admission, need for surgery, mortality) were recorded, reviewing patients' medical profile, and analyzed using SPSS 22. RESULTS: 348 patients with mean age of 37.76 ± 17.62 years were studied (55.6% male). The mean amount of ingested caustic agent was 106.69 ± 100.24 mL (59.2 % intentional). Intentional ingestions (p < 0.0001), acidic substance (p = 0.054), and higher volume of ingestion (p = 0.021) were significantly associated with higher severity of mucosal damage. 28 (8%) cases had died, 53 (15.2%) were admitted to ICU, and 115 (33%) cases underwent surgery. CONCLUSION: It seems that, suicidal intention, higher grade of mucosal injury, higher volume of ingestion, lower level of consciousness, lower serum pH, and higher respiratory rate are among the most important predictors of need for ICU admission, need for surgery, and mortality.

A comparison between IVIG and plasma exchange as preparations before thymectomy in myasthenia gravis patients.

Myasthenia gravis (MG) is one of the curable neurologic disorders. Various pharmacological therapies are administered for these patients and a thymectomy plays an important role in the therapy of myasthenia gravis, which develops a permanent or relative remission. We investigated the efficacy of intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) as a preparation before thymectomy in patients with MG. This randomized clinical trial was conducted on 24 patients with MG referred for thymectomy, which were randomized to two groups of IVIG and PLEX. The IVIG group received IVIG 1 g/kg/day for two consecutive days and the PLEX group underwent 1-L plasma exchange five times with 5 % albumin replacement fluid, every other day, 10-30 days before the procedure. The duration of hospitalization (day), length of intensive care unit (ICU) stay after surgery (day), length of intubation period (h), duration of surgery (h) and dose of steroid administered were compared between the two groups. Analysis was performed via SPSS version 20. In the PLEX group, post-operative outcomes (duration of hospitalization, ICU length of stay after surgery, intubation period and duration of surgery) were longer than those in the IVIG group. There was significant difference in intubation period (p value = 0.01) and duration of surgery (p value = 0.05) between the PLEX and IVIG groups. The administration of IVIG in comparison to PLEX can be more effective in the preparation before thymectomy in myasthenia gravis patients.

Primary retroperitoneal mature cystic teratoma in an adult: A case report.

BACKGROUND: Mature cystic teratoma is one of the most common tumors of the ovaries; however, primary retroperitoneal lesions are rare entities in adults. CASE SUMMARY: We report a case of a 33 year-old woman noticing a mass in her epigastric and left upper abdominal region without any specific signs and symptoms. Radiological evaluation revealed a retroperitoneal mass with extension from the posterior aspect of the pancreas to the pelvic cavity, composed of calcifications and cystic elements. CONCLUSION: The tumor was resected through a midline laparotomy and the pathology report confirmed the diagnosis of a mature cystic teratoma with no evidence of malignancy or immature components.

Assessing the Epidemiological Data and Management Methods of Body Packers Admitted to a Referral Center in Iran.

The incidence of smuggling and transporting illegal substances by internal concealment, also known as body packing, is on the rise. The clinical approach to such patients has been changed significantly over the past 2 decades. However, despite a recorded increase in body packing in general, there are controversies in the management of these patients. We aimed to gather data regarding the demographic characteristics, treatment, and outcome of body packers, which were that referred to Loghman Hakim Hospital, Tehran, Iran.The data of all body packers admitted to Loghman Hakim Hospital during 2010 to 2014 were evaluated retrospectively. Data regarding the demographic characteristics of the patients, findings of clinical imaging, treatment, and outcome were recorded.In this study, 175 individuals with a mean age of 31 ±â€Š10 years were assessed. The most common concealed substances were crack (37%), crystal (17%), opium (13%), and heroin (6%). According to the results of surgery and imaging (abdominal radiography or computed tomography), the most common place for concealment was stomach in 33.3% and 12% of cases, respectively. Imaging findings were normal in 18% of the individuals. Forty-eight (27%) patients underwent surgery. The main indications for surgery were clinical manifestations of toxicity (79%) and obstruction of the gastro-intestinal tract (17%). The most common surgical techniques were laparotomy and gastrotomy (50%). The mean duration of hospitalization was 3.8 ±â€Š4 days. The mortality rate was 3%.Conservative treatment of body packers seems to be the best treatment method. Careful monitoring of the patients for possible signs and symptoms of intoxication and gastro-intestinal obstruction is strongly recommended.