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The Anti-gastric Method

consisting in the free use of emetics or purgatives, has been...

Period Of Desquamation Or Peeling-off

About the sixth or seventh day, the epidermis, or cuticle of ...

Chronic Stenosis Of The Larynx And Trachea

The various forms of laryngeal stenosis for which tracheotomy...

Chest Pains

See Angina Pectoris. ...

Toxic Disturbances And Heart Rate

Under this head it is not proposed to consider disturbances...

Burns Case Xxxvi

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To Prevent Dysentery

In hot weather when bilious diseases prevail, use _Mercurius_...

Mustard Oil

Where this is recommended the cold-drawn oil is meant, not the...

Alcohol

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Bandaging

See Veins, Swollen, etc. ...

Hemorrhage

Take B D current, strong force. Apply P. P. to the open blood...

The Glands In The Skin

Sweat Glands. Like all the pavement (epithelial) surfaces of ...

The Teeth The Ivory Keepers Of The Gate

Why the Teeth are Important. The teeth are a very important...

Diagnosis Of Foreign Body In The Air Or Food Passages

The questions arising are: I. Is a foreign body present? ...

Emergency Tracheotomy

Stabbing of the cricothyroid membrane, or an attempted stabb...

Auricular Fibrillation Occurrence

This condition of auricular fibrillation occurs occasionally ...

Toothache

It is difficult to determine the cause of toothache, and more...

Sciatica

This is a severe pain in the lower back, shooting sharply down...

Oxygen Tank And Tracheotomy Instruments

Respiratory arrest may occur from shifting of a foreign body,...

Aconite

Often in cases where our treatment fails to cure, the failure ...



Diphtheria





Category: CHRONIC STENOSIS OF THE LARYNX AND TRACHEA
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

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
postdiphtheritic, since decannulation after the subsidence of the
acute stenosis would have been easy had it not been for the sequelae
of the faulty tracheotomy. Prolonged intubation may induce either a
supraglottic or subglottic tissue hyperplasia. The supraglottic type
consists in an edematous thickening around the base of the epiglottis,
sometimes involving also the glossoepiglottic folds and the
ventricular bands. An improperly shaped or fitted tube is the usual
cause of this condition, and a change to a correct form of intubation
tube may be all that is required. Excessive polypoid tissue
hypertrophy should be excised. The less redundant cases subside under
galvanocaustic treatment, which may be preceded by tracheotomy and
extubation, or the intubation tube may be replaced after the
application of the cautery. The former method is preferable since the
patient is far safer with a tracheotomic cannula and, further, the
constant irritation of the intubation tube is avoided. Subglottic
hypertrophic stenosis consists in symmetrical turbinal-like swellings
encroaching on the lumen from either side. Cautious galvanocauterant
treatment accurately applied by the direct method will practically
always cure this condition. Preliminary tracheotomy is required in
those cases in which it has not already been done, and in the cases in
which a high tracheotomy has been done, a low tracheotomy must be the
first step in the cure. Cicatricial types of postdiphtheritic stenosis
may be seen as webs, annular cicatrices of funnel shape, or masses of
fibrous tissue causing fixation of the arytenoids as well as
encroachment on the glottic lumen. (See color plates.)

As a rule, when a convalescent diphtheritic patient cannot be
extubated two weeks after three negative cultures have been obtained
the advisability of a low tracheotomy should be considered. If a
convalescent intubated patient cough up a tube and become dyspneic a
low tracheotomy is usually preferable to forcing in an oversized
intubation tube.





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