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These will be found dealt with under many headings throughout ...
Secondary Eliminations Are Disease
However the exact form the chain from irritation or malnutrit...
Mechanical Problems Of Bronchoscopic Foreign Body Extraction*
* For more extensive consideration of mechanical problems...
This affection of nursing women frequently comes on before th...
This very common trouble is caused by one or more of the veins ...
In some cases of this trouble the symptoms are very alarming, ...
In most cases of bronchiectasis there are strong indications...
Compression Stenosis Of The Esophagus
The esophagus may be narrowed by the pressure of any periesop...
Suppression Of The Menses Amenorrhoea
For sudden suppression from taking cold, as by wetting the ...
MICHEL DE NOTREDAME, or NOSTRADAMUS, a celebrated French phys...
Towels Cold Wet
A towel of the ordinary kind, and full size, is soaked in a ba...
Period Of Desquamation Or Peeling-off
About the sixth or seventh day, the epidermis, or cuticle of ...
Differential Diagnosis Of Laryngeal Growths In The Larynx Of Adults
Determination of the nature of the lesion in these cases usu...
For infants who cannot be nursed at the breast, cows' milk in ...
The stomach of any individual having a normal esophagus and n...
Endoscopic ability cannot be bought with the instruments. As ...
Diabetes A Kidney Disease
This disease occurs in two forms--diabetes insipidus and diab...
As this inflammation is generally secondary to some other c...
Stenosis of one or more bronchi results at times from cicatr...
Active and persistent antiluetic medication must precede and ...
Difficulties Of Esophagoscopy
Category: INTRODUCTION OF THE ESOPHAGOSCOPE
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
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introduced nor withdrawn.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 easing up of the bite block, but most often by
correcting the position of the patient's head. If the beginner cannot
start the tube into the pyriform sinus in an adult, it is a good plan
to expose the arytenoid eminence with the laryngoscope and then to
insert the 7 mm. esophagoscope into the right pyriform sinus by direct
vision. Passing the cricopharyngeal and hiatal spasmodically
contracted narrowings will prove the most trying part of
esophagoscopy; but with the head properly held, and the tube properly
placed and directed, patient waiting for relaxation of the spasm with
gentle continuous pressure will usually expose the lumen ahead. In his
first few esophagoscopies the novice had best use general anesthesia
to avoid these difficulties and to accustom himself to the esophageal
image. In the first favorable subject--an emaciated individual with no
teeth--esophagoscopy without anesthesia should be tried.
In cases of kyphosis it is a mistake to try to straighten the spine.
The head should be held correspondingly higher at the beginning, and
should be very slowly and cautiously lowered.
Once inserted, the esophagoscope should not be removed until the
completion of the procedure, unless respiratory arrest demands it.
Occasionally in stenotic conditions the light may become covered by
the upwelling of a flood of fluid, and it will be thought the light
has gone out. As soon as the fluid has been aspirated the light will
be found burning as brightly as before. If a lamp should fail it is
unnecessary to remove the tube, as the light carrier and light can be
withdrawn and quickly adjusted. A complete instrument equipment with
proper selection of instruments for the particular case are necessary
for smooth working.
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