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See Paralysis. ...
Foreign Bodies In The Bronchi For Prolonged Periods
The sojourn of an inorganic foreign body in the bronchus for ...
Fever At Night
Frequently, in illness, a fever sets in as night approaches, a...
Biliary Calculi Gravel In Liver
Take A C current, strong as can be borne; and treat the infla...
Cramp In The Stomach
This very severe trouble, though resisting ordinary methods of...
Soaping The Head
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Mild Reaction Erethic
If the poison is not virulent, and the body of the patient in...
Nephritis Inflammation Of Kidneys
1. Acute. If the urinary secretion be reddish and scant, with...
Essentials Of A Successful, Safe Fast
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Among the various subjects which belong to the province of ...
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A towel of the ordinary kind, and full size, is soaked in a ba...
The Direction Of The Body In Locomotion
LIFTING brings us to the use of the entire body, whic...
This is neuralgia in an ischiatic nerve, commonly the great i...
Why People Get Sick
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Nothing is more required in healing than properly to nourish t...
The Relation Of The Internal Parts To The External Surface Of The Body
An exact acquaintance with the normal character of the extern...
Continuation Of Packs Convalescence
Whether the eruption appear or not, the packs should be conti...
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Cardiovascular Renal Disease Treatment
While it is urged, in preventing the actual development of th...
The Blue-glass Mania
As illustrative of the power of the imagination, the so-cal...
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
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