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Medical ArticlesThe Effect Of Drugs On Venous Blood PressureCapps and Matthews [Footnote: Capps, J. A., and Matthews, S. ... Hoarseness This arises generally, from inflammation of the mucous membra... Lessons From Nutritional Anthropology The next logical pair of questions are: how healthy could goo... Diarrhoea This disease consists in a looseness of the bowels, generally... Treatment Pedunculated malignant growths are readily removed with snar... Positive And Negative Manifestations Acute diseases are to be regarded as electrically positive, a... Head Baths See Baths for Head. ... Ice-water And Snow-bath In Malignant Cases If no rash appear during the first pack, which will scarcely ... General Tonic Treatment Take the B D current, (A D is very good), of fair medium stre... Pleurisy This is inflammation of the Pleura of one or both lungs, gene... Early Symptoms Of Irritating Foreign Body Such As A Peanut Kernel In The Bronchus 1. Initial laryngeal spasm is almost invariably present wit... Contraction Of Sinews This often occurs at the knee, bending the joint so that the p... Benign Growths Primary In The Tracheobronchial Tree Extension of papillomata from the larynx into the cervical tr... Hydrocele See Dropsy. ... Fomentation Armchair This is applied as follows. Over a large armchair spread a fol... Water For Drinking Every care should be taken to have drinking water absolutely p... Feet Cold Continued coldness of the feet gives rise to many more serious... Rules For Direct Laryngoscopy 1. The laryngoscope must always be held in the left hand, nev... Strangulation Or Hanging Often accidentally caused in children or intoxicated persons. ... Extent Of Electric Agency When we have settled upon the position that the electricity o... |
DiagnosisCategory: MALIGNANT DISEASE OF THE ESOPHAGUS Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery It has been estimated that 70 per cent of stenoses of the esophagus in adults are malignant in nature. This should stimulate the early and careful investigation of every case of dysphagia. When all cases of persistent dysphagia, however slight, are endoscopically studied, precancerous lesions may be discovered and treated, and the limited malignancy of the early stages may be afforded surgical treatment while yet there is hope of complete removal. Luetic and tuberculous ulceration of the esophagus are to be eliminated by suitable tests, supplemented in rare instances by biopsy. Aneurysm of the aorta must in all cases of dysphagia be excluded, for the dilated aorta may be the sole cause of the condition, and its presence contraindicates esophagoscopy because of the liability of rupture. Foreign body is to be excluded by history and roentgenographic study. Spasmodic stenosis of the esophagus may or may not have a malignant origin. Esophagoscopy and removal of a specimen for biopsy renders the diagnosis certain. It is to be especially remembered, however, that it is very unwise to bite through normal mucosa for the purpose of taking a specimen from a periesophageal growth. Fungations and polypoid protuberances afford safe opportunities for the removal of specimens of tissue. The esophagoscopic appearances of malignant disease, varying with the stage and site of origin of the growth, may present as follows:-- 1. Submucosal infiltration covered by perfectly normal membrane, usually associated with more or less bulging of the esophageal wall, and very often with hardness and infiltration. 2. Leucoplakia. 3. Ulceration projecting but little above the surface at the edges. 4. Rounded nodular masses grouped in mulberry-like form, either dark or light red in color. 5. Polypoid masses. 6. Cauliflower fungations. In considering the esophagoscopic appearances of cancer, it is necessary to remember that after ulceration has set in, the cancerous process may have engrafted upon it, and upon its neighborhood, the results of inflammation due to the mixed infections. Cancer invading the wall from without may for a long time be covered with perfectly normal mucous membrane. The significant signs at this early stage are: 1. Absence of one or more of the normal radial creases between the folds. 2. Asymmetry of the inspiratory enlargement of lumen. 3. Sensation of hardness of the wall on palpation with the tube. 4. The involved wall will not readily be made to wrinkle when pushed upon with the tube mouth. In all the later forms of lesions the two characteristics are (a) the readiness with which oozing of blood occurs; and (b) the sense of rigidity, or fixation, of the involved area as palpated with the esophagoscope, in contrast to the normally supple esophageal wall. Esophageal dilatation above a malignant lesion is rarely great, because the stenosis is seldom severely obstructive until late in the course of the disease. Next: Treatment Previous: Symptoms
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