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Abscess Of The Lung
Category: BRONCHOSCOPY IN DISEASES OF THE TRACHEA AND BRONCHI
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
If of foreign-body origin, pulmonary abscess
almost invariably heals after the removal of the object and a regime
of fresh air and rest, without local measures of any kind. Acute
pulmonary abscess from other causes may require bronchoscopic drainage
and gentle dilatation of the swollen and narrowed bronchi leading to
it. Some of these bronchi are practically fistulae. Obstructive
granulations should be removed with crushing, not biting forceps. The
regular foreign-body forceps are best for this purpose. Caution should
be used as to removal of the granulations with which the abscess
cavity is filled in chronic cases. The term abscess is usually
loosely applied to the condition of drowned lung in which the pus has
accumulated in natural passages, and in which there is neither a new
wall nor a breaking down of normal walls. Chronic lung-abscess is
often successfully treated by weekly bronchoscopic lavage with 20 cc.
or more of a warm, normal salt solution, a 1:1000 watery potassium
permanganate solution, or a weak iodine solution as in the following
Rx. Monochlorphenol (Merck) .12
Lugol's solution 8.00
Normal salt solution 500.
Perhaps the best procedure is to precede medicinal applications by the
clearing out of the purulent secretions by aspiration with the
aspirating bronchoscope and the independent aspirating tube, the
latter being inserted into passages too small to enter with the
bronchoscope, and the endobronchial instillation of from 10 to 30 cc.
of the medicament. The following have been used: Argyrol, 1 per cent
watery solution; Silvol, 1 per cent watery solution; Iodoform, oil
emulsion 10 per cent; Guaiacol, 10 per cent solution in paraffine oil;
Gomenol, 20 per cent solution in oil; or a bismuth subnitrate
suspension in oil. Robert M. Lukens and William F. Moore of the
Bronchoscopic Clinic report excellent results in post-tonsillectomy
abscesses from one tenth of one per cent phenol in normal salt
solution with the addition of 2 per cent Lugol's solution. Chlorinated
solutions are irritating, and if used, require copious dilution.
Liquid petrolatum with a little oil of eucalyptus has been most often
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