In slight cases, where the patient simply cannot sleep for tos...
Papillomata do not infiltrate; but superficial repullulation...
The Surgical Dissection Of The Superficial Structures Of The Male Perinaeum
The median line of the body is marked as the situation where ...
Diet Is Not Enough
Those isolated, long-lived peoples discovered by Weston A. Pr...
Health And Money
It will be noticed that the remedies we recommend are in almos...
Disorders Of Muscles And Bones
The Muscles and Bones Have Few Diseases. Considering how comp...
Polarization Of The Circuit
I have said, in effect, a little above, that, while the curre...
Diverticulum Of The Esophagus
Diverticula may, and usually do, consist in a pouching by her...
Division Of The Process Of The Disease Into Periods
Its course is commonly divided into four distinct periods, vi...
Although either the positive or the negative pole, applied to...
Social/cultural/psychological Obstacles To Fasting
Numerous attitudes make it difficult to fast or to provide mo...
Sources of Starch. The starches are valuable and wholesome fo...
Esophagoscopy is demanded in every case in which a foreign b...
WHEN we are tolerant as a matter of course, the nervous syste...
Classification Of Cardiac Disturbances
For the sake of discussing the therapy of cardiac disturban...
Removal Of Growth From The Laryngeal Ventricle
After exposing the larynx in the usual manner, if the head i...
The venous pressure, after a long neglect, is now again being...
Giddiness And Trembling
This comes very often as the result of loss of nerve power in ...
Ankle Twisted Or Crushed
Place the foot as soon as possible in warm water, as hot as ca...
To Prevent Typhoid Fever
When exposed, as in nursing the sick, take _Baptisia_ 2d, and...
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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