11/520. Limbal transplantation after chemical injuries of the eye. PURPOSE: To illustrate the benefit of limbal stem cell transplantation in three eyes with severe ocular surface failure due to chemical burns. methods: In two patients with monocular corneal scarring and vascularization after chronic chemical burns, a limbal tissue autograft was transferred from the unaffected fellow eye. A complete superficial keratectomy was performed on the host eye. One patient with bilateral ocular surface disorder received an eccentrically trephined corneolimbal allograft. To prevent immunologic rejection of the transplanted limbus, this patient was treated with systemic Ciclosporin A. RESULTS: Postoperatively the limbal autografts grew a normal epithelium on the recipient eye with less vascularization and scarring. Our two patients reported a significant reduction in symptoms (redness, pain, photophobia) and an improved visual acuity. The corneolimbal allograft has remained clear for five months postoperatively. CONCLUSION: In strictly unilateral conditions of limbal deficiency, transplantation of healthy limbal tissue from the normal fellow eye may result in a stable ocular surface and a quiet and comfortable eye. Transplantation of an eccentrically trephined corneolimbal allograft under systemic Ciclosporin A cover may be an option in the rehabilitation of patients with severe bilateral stem cell deficiencies. ( info) |
12/520. Medication-induced oesophageal injury leading to broncho-oesophageal fistula. Medication-induced oesophageal injury is one of the least recognised side-effects of oral medication and, in contrast to other oesophageal pathologies, is rarely considered in the differential diagnosis of chest pain. We describe a case of medication-induced oesophageal injury with a rare complication in which the diagnosis was not considered until the characteristic features were demonstrated at endoscopy. ( info) |
13/520. Oral cavity onlay grafting using foam impregnated with honey:--a case report. The often difficult problem of graft immobilisation in the oral cavity may be surmounted by use of a material which is cheap and readily available. A case in which honey impregnated foam material was used as a stent in oral grafting is described. Foam constitutes an ideal material which is highly recommended. ( info) |
14/520. Extensive oral mucosal ulcerations caused by misuse of a commercial mouthwash. This case report describes severe mucosal injuries following misuse of an undiluted over-the-counter mouthwash with a high alcohol content (70%), oil of peppermint and arnica. The mouthwash was to be diluted 5:1 with water. The patient used undiluted solution to better treat her self-diagnosed "contagious gum infection." She experienced burning sensation with each rinse and developed severe mucosal injuries subsequently. Her oral condition improved within 48 hours following discontinuation of use of the mouthwash and application of a mixture of Benadryl Elixir, Maalox Plain, and 2% viscous lidocaine. A detailed history and review of a patient's medical condition will help to differentiate self-induced mucosal injuries from those caused by an allergic reaction or skin diseases. ( info) |
15/520. Successful treatment of a patient with 100% total burn surface area at high altitude. A patient with 100% total burn surface area has been treated in our department which is situated at 2261 meters above sea level in July 1993. This paper reports the treatment experience. ( info) |
| Chemical burns to the lower extremity can be disabling and of serious consequence if not managed properly. The severity and rapid onset of the burns caused by hydrofluoric acid after initial contact make this a highly dangerous substance. The potential severity of injury and the following complications make it a chemical of which all physicians should have a basic understanding. ( info) |
| Chemical pleurodesis using tetracycline is an accepted and commonly employed treatment of pneumothorax and pleural effusions. We describe a case of chemical burn of the pleura in a ventilated 41-year-old who came to thoracotomy after 3 days of continuous intrapleural infusion of tetracycline at another hospital. To our knowledge this has not been previously reported although other adverse effects of this procedure are documented. We suggest that damage to the pleura and underlying lung may occur if excessive amounts of tetracycline are used in attempted pleurodesis. ( info) |
18/520. Local corticosteroid treatment of caustic injuries of the esophagus. A preliminary report. So far, no therapy has been shown to reduce the incidence of strictures in the esophagus after ingestion of caustic agents. Two patients with pronounced caustic ingestion injuries were treated locally with solutions of corticosteroids normally used for inhalation therapy in lung diseases. Serious strictures did not appear, and their swallowing returned to normal. Further studies are needed. ( info) |
19/520. Gastric injury following copper sulfate ingestion. We report the presentation and management of a 25-month-old with copper sulfate ingestion. The child suffered a gastric mucosal burn, but had no evidence of systemic copper toxicity and experienced full recovery with conservative medical management. A literature review of copper sulfate poisoning is provided. ( info) |
20/520. Microsurgical combined scapular/parascapular flap for reconstruction of severe neck contracture: case report and literature review. OBJECTIVE: The reconstruction for severe neck contracture is difficult, because it may include not only the necessity the use of a large flap but also the ability for three-dimensional movement of the neck. methods: A 41-year-old woman sustained a severe neck contracture with retraction of the lower lip and limited range of neck motion after a chemical burn. We used the combined scapular/parascapular flap to reconstruct the soft-tissue defect in the neck after excision of hypertrophic scar and release of contracture. The scapular portion was transferred to cover the defect vertically, and the parascapular portion was transferred to cover the transverse portion of the neck. This kind of design would allow the patient to move her neck more easily. RESULTS: Postoperatively, the range of motion of the neck was full in the vertical and horizontal directions after 6 months of rehabilitation. Also, the patient was satisfied with the final aesthetic results. CONCLUSION: The microsurgical combined scapular/parascapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during surgery, is a good option for reconstruction of the severe neck contracture. We classify the inset of the combined scapular/parascapular flap into three types with six subtypes, according to the location of defects and the relation of the parascapular flap to the scapular flap. ( info) |