Diagnosis
Categories: MALIGNANT DISEASE OF THE ESOPHAGUSSources: 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
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.
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Condition Of The Throat And Other Internal Organs
The condition of the _throat_ requires the most constant attention. From a highly inflamed state, it often passes into a foul and sloughy condition; the breath of the patient becomes extremely fetid; the nostrils, the parotid and submaxillary glands... Conditions Causing Change In Blood Pressure
Woolley [Footnote: Woolley, P. G.: Factors Governing Vascular Dilatation and Slowing of the Blood Stream in Inflammation, THE JOURNAL A. M. A., Dec. 26, 1914, p. 2279.] quotes Starling as finding that the blood vessels dilate from physical and chemi... Congenital And Pathological Deformities Of The Prepuce And Urethra Stricture And Mechanical Obstructions Of The Urethra
When any of the central organs of the body presents in a form differing from that which we term natural, or structurally perfect and efficient, if the deformity be one which results as a malformation, ascribable to an error in the law of developme... Conium
is valuable as a _palliative_ upon cancerous tumors. As a _curative remedy_ it is useful in chronic ophthalmia, especially the purulent of children; useful also for _indurated_ swellings. ... Constant Complaints
Alice was a middle-aged woman who couldn't understand why she had always felt tired, even when she was young. Her life had been this way ever since she could remember. Most puzzling to her was why her life was so Job-like. She did everything the pro... Constipation
The medicine for this affection is _Nux vom._, to be taken at night on retiring. If there is fulness and pain in the head from costiveness, _Bell._ should be used in the morning, and at noon. Let the patient contract a habit of drinking _cold water_... Constipation Of Bowels
This disease may proceed from either a negative condition--a state of atony from lack of nutrition, or a partial paralysis of the bowels--or from a positive condition--a state of relaxation and consequent weakness of the muscular tissues of the bowe... Continuation Of Packs Convalescence
Whether the eruption appear or not, the packs should be continued during the whole course of the disorder, and as long as the throat continues troublesome; and one pack and bath a day should be given during some ten or twelve days, after every sympt... Contraindications
There is no absolute contraindication to careful esophagoscopy for the removal of foreign bodies, even in the presence of aneurism, serious cardiovascular disease, hypertension or the like, although these conditions would render the procedure inadvi... Contraindications To Direct Laryngoscopy
There are no absolute contraindications to direct laryngoscopy in any case where direct laryngoscopy is really needed for diagnosis or treatment. In extremely dyspneic patients, if the operator is not confident in his ability for a prompt and sure ... Contraindications To Esophagoscopy
In the presence of aneurysm, advanced organic disease, extensive esophageal varicosities, acute necrotic or corrosive esophagitis, esophagoscopy should not be done except for urgent reasons, such as the lodgment of a foreign body; and in this case ... Contrariness
I KNOW a woman who says that if she wants to get her father's consent to anything, she not only appears not to care whether he consents or not, but pretends that her wishes are exactly opposite to what they really are. She says it never fail... Convalescence
When compensation has been restored, the patient may be allowed gradually to resume his usual habits and work, provided these habits are sensible, and the work is not one requiring severe muscular exertion. Careful rules and regulations must be laid... Convulsions Of Children - Fits
These generally occur, either from the irritation of worms, or as precursors of ague, or they may arise from diarrhoeal irritation, affecting the brain. They sometimes occur in hooping cough. If convulsions occur from worms, the child appearing to... Cooking
Why We Cook our Food. While some of all classes of food may be eaten raw, yet we have gradually come to submit most of our foods to the heat of a fire, in various ways; this process is known as cooking. While cooking usually wastes a little, and s... Copy Of Certificate
These may Inform all whom it might Concern, that Mr. John Kaighin, of the Province of West New Jersey, hath lived with me (here under named) a considerable time, as a Disciple, to learn the Arts and Mysteries of Chymistry, Phys... Cornus Sericea
will often cure malignant ulcers both of the breast and uterus, used as a wash. ... Coronary Sclerosis
While disease of the coronary arteries may occur without general arteriosclerosis, it is so frequently associated with it that it is necessary to give a brief description of the general disease. Arteriosclerosis or arteriocapillary fibrosis is rea... Croup
Treat croup, whether membranous or spasmodic, much the same as is prescribed for diphtheria, only, in the latter part of the form, treat less. ... Croup
This is a disease of children. Comes on in consequence of a sudden cold. Children suffering from Hooping Cough are more subject to it. The cough is of a peculiar whistling kind, like the crowing of a young chicken, with rattling in the throat and di... Cuprum Aceticum
(_Acetate of Copper Verdigris_) applied to _Cancerous_ ulcers of the face, _Lupus_ or _Noli-me-tangere_, in the early stage, will in most cases effect a perfect cure, especially if for a week previously the part has been wet daily with _tr. Thuja_. ... Curing With Enemas
It is not wise to continue regular colonics or enemas once a detoxification program has been completed and you have returned to a maintenance diet. The body should be allowed its regular functioning. But because enemas immediately lower the toxic... Deafness
The prognosis is very uncertain. This infirmity is often cured by our system, even when of long standing; and often, again, the treatment fails. The uncertainty arises from the difficulty in determining the exact pathological derangement. Take th... Decannulation
When the tracheal incision is placed below the first ring, no difficulty in decannulation should result from the operation per se. When by temporarily occluding the cannula with the finger it is evident that the laryngeal aperture has regained suffi... Decannulation After Cure Of Laryngeal Stenosis
In order to train the patient to breathe again through the larynx it is necessary to occlude the cannula. This is best done by inserting a rubber cork in the inner cannula. At first it may be necessary to make a slot in the cork so as to permit some... Decompensation
To understand the physiology, pathology and the best treatment for broken compensation, it is necessary to study the physics of the circulation under the different conditions. With the mitral valve insufficient, a greater or less amount of blood is ... Deformities Of The Prostate Distortions And Obstructions Of The Prostatic Urethra
The prostate is liable to such frequent and varied deformities, the consequence of diseased action, whilst, at the same time, its healthy function (if it have any) in the male body is unknown, that it admits at least of one interpretation which may,... Deformities Of The Urinary Bladder The Operations Of Sounding For Stone Of Catheterism And Of Puncturing The Bladder Above The Pubes
The urinary bladder presents two kinds of deformity--viz., congenital and pathological. As examples of the former may be mentioned that in which the organ is deficient in front, and has become everted and protruded like a fungous mass through an ope... Demonstrations Of The Nature Of Congenital And Infantile Inguinal Herniae And Of Hydrocele
PLATE 39. Fig. 1--The descent of the testicle from the loins to the scrotum.--The foetal abdomen and scrotum form one general cavity, and are composed of parts which are structurally identical. The cutaneous, fascial, muscular, and membranous layers... Demonstrations Of The Origin And Progress Of Femoral Hernia Its Diagnosis The Taxis And The Operation
PLATE 45, Fig. 1.--The point, 3, from which an external inguinal hernia first progresses, and the part, 5, within which the femoral hernia begins to be formed, are very close to each other. The inguinal hernia, 3, arising above, 5, the crural arch, ... Demonstrations Of The Origin And Progress Of Inguinal Herniae In General
PLATE 41, Fig. 1.--When the serous spermatic tube is obliterated for its whole length between the internal ring, 1, and the top of the testicle, 13, a hernia, in order to enter the inguinal canal, 1, 4, must either rupture the peritonaeum at the poi... Destruction Of The Organ Of Hearing
When the glands pass into a sloughing state, the parts connected with them are frequently damaged. Thus the ulceration of the parotid gland often causes deafness, by the gangrenous matter communicating to the eustachian tube and the inner ear, where... Deviation Of The Esophagus
Deviation of the esophagus may be marked in the presence of a deformed vertebral column, though dysphagia is a very uncommon symptom. The lack of esophageal symptoms in deviation of spinal production is probably explained by the longitudinal shorten... Diabetes A Kidney Disease
This disease occurs in two forms--diabetes insipidus and diabetes mellitus. In the first named form, the disease is readily cured. In the latter, it is very formidable, and is rarely, if ever, cured by medicines; especially when of long standing. In... Diagnosis
If a more malignant form of endocarditis develops on a mild endocarditis, the diagnosis is generally not difficult. If, without a definite known septic process, malignant endocarditis develops, localized symptoms of heart disturbance and cardiac sig... Diagnosis
The swallowing function can be studied only with the fluoroscope; esophagoscopy for diagnosis, should therefore always be preceded by a fluoroscopic study of deglutition with a barium or other opaque mixture and examination of the thoracic organs to... Diagnosis
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 ... Diagnosis
After what has been said about the symptoms of scarlatina, it cannot be difficult to distinguish it from similar eruptive diseases. However, as there is much resemblance between _scarlatina_ and _measles_, at least in the milder form of the former, ... Diagnosis From Measles
In scarlatina the heat is much greater, and the pulse is much quicker than in measles.--In scarlatina the throat is inflamed, usually the brain affected, and the patient smells like salt-fish, old cheese or the cages of a menagerie; in measles, the ... Diagnosis Of Foreign Body In The Air Or Food Passages
The questions arising are: I. Is a foreign body present? 2. Where is it located? 3. Is a peroral endoscopic procedure indicated? 4. Are there any contraindications to endoscopy? In order to answer these questions the definite routine giv... Diarrhoea
This disease consists in a looseness of the bowels, generally accompanied with pain in the abdomen, more or less severe. It sometimes occurs without pain, but is _then_ attended with a sense of weakness, and a general feeling of uneasiness. It preva... Diet
As intimated in the preceding paragraph, the diet during endocarditis must be carefully regulated. It must be sufficient, and appropriate for the disease in which the complication occurs, but it must be in such dosage and administered with such freq... Diet
The diet of the sick should he nutricious, but at all times simple, free from greasy substances, and from all stimulating condiments whatsoever, as well as from vinegar, or food in which vinegar is used. In short, let the food be nutritious, easil... Diet
I have little to say with regard to _diet_, at least to physicians. During great heat and high fever, the patient should eat little or nothing; but he should drink a good deal. Substantial food must be avoided entirely. When the fever abates, he can... Diet And Baths In Heart Disease
The diet in cardiac diseases has already incidentally been referred to. The decision as to what a patient ought to eat or drink must often be modified by just what the patient will do, and, as we all know, it is absolutely necessary to make some c... Diet For A Healthy Person
I doubt that it is possible to be totally healthy in the twentieth century. Doctors Alsleben and Shute in their book How to Survive the New Health Catastrophes state that in-depth laboratory testing of the population at large demonstrated four unive... Diet For A Long, Long Life
Some people not only want to be healthy, but they want to live in good health long past the normal life span projected by statistical tables for Homo Sapiens. Dr. Roy Walford, a well-respected medical research gerontologist who has been actively stu... Diet For The Acutely Ill
The acutely ill person experiences occasional attacks of distressing symptoms, usually after indiscretions in living or emotional upsets. They have a cold, or a flu, or sinusitis, or a first bout of pneumonia, or a spring allergy attack. The intense... Diet For The Chronically Ill
The chronically ill person has a long-term degenerative condition that is not immediately life threatening. This condition usually causes more-or-less continuous symptoms that are painful, perhaps unsightly, and ultimately will be disabling or eve... Diet Is Not Enough
Those isolated, long-lived peoples discovered by Weston A. Price had to do hard physical labor to eat, had to walk briskly up and down steep terrain to get anywhere. But today, few North Americans output very much physical energy in process of daily... Diets To Heal The Critically Ill
A critically ill person is someone who could expire at any moment; therapeutic interventions are racing against death. Can the body repair itself enough before some essential function ceases altogether? If there already exists too much damage to vit... Differential Diagnosis Of Laryngeal Growths In The Larynx Of Adults
Determination of the nature of the lesion in these cases usually consists in the diagnosis by exclusion of the possibilities, namely, 1. Lues. 2. Tuberculosis, including lupus. 3. Scleroma. 4. Malignant neoplasm. In the Bronchoscopic C... Differential Diagnosis Of Ulcer Of The Esophagus
Simple ulcer requires the exclusion of lues, tuberculosis, epithelioma, endothelioma, sarcoma, and actinomycosis. Simple ulcer of the esophagus is usually associated with stenosis, spastic or organic. Luetic ulcers commonly show a surrounding infl... Difficulties In The Introduction Of The Bronchoscope
The beginner may enter the esophagus instead of the trachea: this might be a dangerous accident in a dyspneic case, for the tube could, by pressure on the trachea, cause respiratory arrest. A bronchoscope thus misplaced should be resterilized befor... Difficulties Of Direct Laryngoscopy
The larynx can be directly exposed in any patient whose mouth can be opened, although the ease varies greatly with the type of patient. Failure to expose the epiglottis is usually due to too great haste to enter the speculum all the way down. The s... Difficulties Of Esophagoscopy
The beginner may find the esophagoscope seemingly rigidly fixed, so that it can be neither introduced nor withdrawn. This usually results from a wedging of the tube in the dental angle, and is overcome by a wider opening of the jaws, or perhaps by ... Diffuse Dilatation Of The Esophagus
This is practically always due to stagnation ectasia, which is invariably associated with either organic or spasmodic stricture, existing at the time of observation or at some time prior thereto. The dilating effect of the repeatedly accumulated foo... Dimensions Of The Trachea And Bronchi
It will be noted that the bronchi divide monopodially, not dichotomously. While the lumina of the individual bronchi diminish as the bronchi divide, the sum of the areas shows a progressive increase in total tubular area of cross-section. Thus, the... Diphtheria
Chronic postdiphtheritic stenosis may be of the panic, spasmodic or, rarely, the paralytic types; but more often it is of either the hypertrophic or cicatricial forms. Only too frequently the stenosis should be called posttracheotomic rather than p... Diphtheria
Use the A D current, strong force. Place the N. P., long cord, upon the lower cervical vertebrae, and then treat, first, with the tongue instrument, P. P., in the mouth, as far back on the tongue as can be borne, three to five minutes. Next, manipul... Direct Laryngoscopy Adult Patient
Before starting, every detail in regard to instrumental equipment and operating room assistants, (including an assistant to hold the arms and legs of the patient) must be complete. Preparation of the patient and the technic of local anesthesia have... Direct Laryngoscopy In Children
The epiglottis in children is usually strongly curled, often omega shaped, and is very elusive and slippery. The larynx of a child is very freely movable in the neck during respiration and deglutition, and has a strong tendency to retreat downward ... Direct Laryngoscopy In Diseases Of The Larynx
The diagnosis of laryngeal disease in young children, impossible with the mirror, has been made easy and precise by the development of direct laryngoscopy. No anesthetic, local or general, should be used, for the practised endoscopist can complete t... Direction Of The Esophagus
The esophagus enters the chest in a decidedly backward as well as downward direction, parallel to that of the trachea, following the curves of the cervical and upper dorsal spine. Below the left bronchus the esophagus turns forward, passing through... Diseases And Disturbances Of The Skin
Their Chief Causes. Skin troubles are of two main kinds according to their cause: internal, due to the irritation of waste-poisons, or toxins, in the blood; and external, from direct injury or irritation of the skin from without. The latter are o... Diseases Of The Esophagus
The more frequent causes of the one common symptom of esophageal disease, dysphagia, are included in the list given below. To avoid elaboration and to obtain maximum usefulness as a reminder, overlapping has not been eliminated. 1. Anomalies. ... Disorders Of Muscles And Bones
The Muscles and Bones Have Few Diseases. Considering how complex it is, and the never-ceasing strain upon it, this moving apparatus of ours, the nerve-bone-muscle-machine, is surprisingly free from disease. The muscles, though they form nearly half ... Distinctive Use Of Each Pole
I have said that every disease is preternaturally either positive or negative. I have further said, that the application of either pole to a given part produces an effect the opposite of what would be produced in the same part by a reversal of the p... Disturbances Of The Heart In General
Of prime importance in the treatment of diseases of the heart is a determination of the exact, or at least approximately exact, condition of its structures and a determination of its ability to work. This is not the place to describe its anatom... Diverticulum Of The Esophagus
Diverticula may, and usually do, consist in a pouching by herniation, of the whole thickness of the esophageal wall; or they may be herniations of the mucosa between the muscular layers. They are classified according to their etiology, as traction a... Division Of The Process Of The Disease Into Periods
Its course is commonly divided into four distinct periods, viz.: the period of incubation, the period of eruption, the period of efflorescence, and the period of desquamation; to which may be added: the period of convalescence. ... Do Not Hurry
HOW can any one do anything well while in a constant state of rush? How can any one see anything clearly while in a constant state of rush? How can any one expect to keep healthy and strong while in a constant state of rush? But most of m...