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Medical ArticlesEsophageal Foreign Body
After initial choking and gagging, or without these, there m...
The Surgical Dissection Of The First Second Third And Fourth Layers Of The Inguinal Region In Connexion With Those Of The Thigh
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Practice On The Rubber-tube Manikin
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As mentioned above, bronchial aspiration is often necessary....
The treatment of shock will probably always be unsatisfactory...
Decannulation After Cure Of Laryngeal Stenosis
In order to train the patient to breathe again through the la...
Strabismus Discordance Of The Eyes
If neither of the rectus muscles have been cut and cicatrized...
The esophagoscope, like the bronchoscope, is a hollow brass ...
Inflammation Of The Brain
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Hope And Healing
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The first sign of such an illness is a brief and slight attack...
The Direction Of The Body In Locomotion
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By this term we mean not only the sensible perspiration which ...
How And Why We Breathe
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The frequent prescription in these papers of hot water, to be ...
Rules For Direct Laryngoscopy
1. The laryngoscope must always be held in the left hand, nev...
Removal Of Foreign Bodies From The Larynx
Symptoms and Diagnosis.--The history of a sudden choking atta...
The first step is to get rid of the gastric secretions. Ther...
Much, if not all, of the success in any case of treatment depe...
The Cause Of Disease
Ever since natural medicine arose in opposition to the violen...
Differential Diagnosis Of Ulcer Of The Esophagus
Category: DISEASES OF THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
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 inflammatory areola, and
they usually have thickened elevated edges, generally free from
granulation tissue, with a pasty center not bleeding readily when
sponged. The Wassermann reaction may contribute to the diagnosis; but
if negative, a thorough and prolonged test with mercury is imperative.
It must be remembered that a person with lues may have a simple,
mixed, or malignant ulceration of the esophagus, or the three lesions
may even be combined. It may be in some cases possible to demonstrate
the treponema pallidum in scrapings taken from the ulcer.
The single tuberculous ulcer is usually pale, superficial, and
granular in base. If it is a continuation from more extensive
extra-esophageal tuberculous ulceration, pale cauliflower granulations
may be present. Slight cicatrices may be seen. Tuberculosis in other
organs can almost always be demonstrated by roentgenographic,
physical, or laboratory studies. Tuberculin tests and animal injection
with an emulsion of a specimen of tissue may be required. The specimen
must be taken very superficially to avoid risk of perforation.
Sarcomatous ulcers do not differ materially in appearance from those
of carcinoma, but they are much more rare.
Carcinomatous ulcer is usually characterized by the very vascular
bright red zone, raised edges, fungations, granulation tissue that
bleeds freely on the lightest touch, and above all, it is almost
invariably situated on an infiltrated base which communicates a
feeling of hardness to the pressure of sponges or the esophagoscope
itself. A scar may be from the healing of an ulcer from stasis, or one
of specific or precancerous character. It may be a cancerous process
developing on the site of a scar, so that the presence of scar tissue
does not absolutely negative malignancy. As a rule, however, scars are
absent in cancer of the esophagus. The firm and sometimes prominent
ridge of the crossing of the left bronchus must not be mistaken for
infiltration, and the esophagoscopist must be familiar with the normal
rigidity of the cricopharyngeus.
 Mixed infection gives to all esophageal ulceration a certain
uniformity of appearance, so that laboratory studies of smears or
histologic and bacteriologic study of tissue specimens taken from
fungations or thickened edges are often required to confirm the
endoscopic diagnosis. If the edges are thin and flat, the taking of a
specimen involves some risk; fungations can be removed without risk;
so can nodules, but care must be taken that projecting folds are not
mistaken for nodules. It is always wise to push the therapeutic test
with potassium iodid and especially mercury in any case of esophageal
ulceration unassociated with stasis.
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