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It is essential for the welfare of the patient, especially af...
From the preceding observations it would naturally be conclud...
The venous pressure, after a long neglect, is now again being...
The Blood Vessels
Where the Body Does its Real Eating. When once the food has b...
Technic Of Specular Esophagoscopy
Recumbent patient. Boyce position. The larynx is to be expos...
The Organic Versus Chemical Feud
Now, regrettably, and at great personal risk to my reputation...
Acute Cardiac Symptoms Acute Heart Attack
It is not proposed here to describe the condition of sudden...
Fever arising from bad state of the blood may be treated by ca...
The Surgical Dissection Of The Axillary And Brachial Regions Displaying The Relative Order Of Their Contained Parts
All surgical regions have only artificial boundaries; and the...
These are often piled on the front of the body, while the far ...
JOHANN JOSEPH GASSNER, who was regarded as a thaumaturge by h...
Cheap, ill-printed literature is responsible for much eye trou...
Deviation Of The Esophagus
Deviation of the esophagus may be marked in the presence of a...
The Vegetable Kingdom
As to the vegetable kingdom, there is here, so far as we can ...
The gastroscope is of the same construction as the esophagos...
We give this name to a trouble from which we have been able to...
Rheumatism is the cause of most instances of cardiac disease ...
The Surgical Dissection Of The First Second Third And Fourth Layers Of The Inguinal Region In Connexion With Those Of The Thigh
The common integument or first layer of the inguino-femoral r...
If the operator has no refractive error he will need two pai...
The Surgical Dissection Of The Popliteal Space And The Posterior Crural Region
On comparing the bend of the knee with the bend of the elbow,...
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.
Next: Treatment Of Acute And Subacute Inflammation And Ulceration Of The Esophagus
Previous: Ulceration Of The Esophagus