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Medical ArticlesCicatricial Stenosis Of The Esophagus
Etiology.--The accidental swallowing of caustic alkali in sol...
Deformities Of The Urinary Bladder The Operations Of Sounding For Stone Of Catheterism And Of Puncturing The Bladder Above The Pubes
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Eyes Paralysis Of
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Ulcers Case Xxii
J. Copeland, blacksmith, aged 38, came to me with many deep ...
Clothing should be light yet warm, and sufficiently free so as...
For use in our treatment we recommend Coutts' Acetic Acid. It ...
Of Punctures Etc
In cases of recent punctured wounds the orifice and surroundi...
Auricular Fibrillation Occurrence
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We feel urged, in first considering this sore and very common ...
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The chief traumatic factors in chronic laryngeal stenosis ar...
General Tonic Treatment
Take the B D current, (A D is very good), of fair medium stre...
List Of Instruments
The following list has been compiled as a convenient basis f...
These begin like warts, and in the earlier stages poulticing a...
Rules For Endoscopic Foreign Body Extraction
1. Never endoscope a foreign body case unprepared, with the...
Treatment Of Pseudo-anginas
The treatment of these pseudo-angibas depends, of course, on ...
What Is It That Makes Me So Nervous?
THE two main reasons why women are nervous are, first...
Ulcers Case Xxiii
Mr. Marshall, aged 60, had a troublesome ulcer under the oute...
Healing-spells In Ancient Times
Neither doth fansy only cause, but also as easily cure ...
Inducing A Child To Open Its Mouth (author's Method)
The wounding of the child's mouth, gums, and lips, in the of...
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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