This is a disease of children. Comes on in consequence of a s...
The Brain In Its Direction Of The Body
WE come now to the brain and its direction of other p...
Tartar Emetic Or Other Antimonial Poisons
If vomiting is not present, induce it by an emetic. Give doses...
Vitamins For An Older Healthy Person
Someone who is beyond 35 to 40 years of age should still feel...
If an attack comes on from sudden cold, take _Aconite_ and _I...
Auricular Fibrillation Diagnosis
If the pulse is intermittent and there is apparently a heart ...
Scarlatina Anginosa Or Sore-throat Scarlet-fever
Wherever the _throat_ is affected, which is almost always the...
The Effect Of Drugs On Venous Blood Pressure
Capps and Matthews [Footnote: Capps, J. A., and Matthews, S. ...
This is severe pain in one part or other of the body, sometime...
Resume Of After-care Of A Tracheotomic Case
1. Always bear in mind that tracheotomy is not an ultimate ...
On The Unadherent Eschar
The eschar is generally adherent in cases of recent injuries,...
Physical Signs Of Bronchial Foreign Body
In most cases there will be limitation of expansion on the in...
No dyspneic patient should be given a general anesthetic; be...
If this grain is well grown and thoroughly well cooked, it wil...
Interpretation Of Tracings
The interpretation of the arterial tracing shows that the nea...
Angina Pectoris Management
While a number of causes of true cardiac pain may be eliminat...
Is now known to be conveyed by the bite of a certain kind of m...
Fatty degeneration of the heart muscle may be caused by acute...
Inspection Of The Party Wall In Cases Of Suspected Laryngeal Malignancy
When taking a specimen the party wall should be inspected by...
IN climbing a mountain, if we know the path and take it as a ...
Extraction Of Foreign Bodies From The Strictured Esophagus
Category: ESOPHAGOSCOPY FOR FOREIGN BODY
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
bodies of relatively small size will lodge in a strictured esophagus.
Removal may be rendered difficult when the patient has an upper
stricture relatively larger than the lower one, and the foreign body
passing the first one lodges at the second. Still more difficult is
the case when the second stricture is considerably below the first,
and not concentric. Under these circumstances it is best to divulse
the upper stricture mechanically, when a small tube can be inserted
past the first stricture to the site of lodgement of the foreign body.
Prolonged sojourn of foreign bodies in the esophagus, while not so
common as in the bronchi is by no means of rare occurrence. Following
their removal, stricture of greater or less extent is almost certain
to follow from contraction of the fibrous-tissue produced by the
Fluoroscopic esophagoscopy is a questionable procedure, for the
esophagus can be explored throughout by sight. In cases in which it is
suspected that a foreign body, such as pin, has partially escaped from
the esophagus, the fluoroscope may aid in a detailed search to
determine its location, but under no circumstances should it be the
guide for the application of forceps, because the transparent but
vital tissues are almost certain to be included in the grasp.
 Complications and Dangers of Esophagoscopy for Foreign Bodies.
Asphyxia from the pressure of the foreign body, or the foreign body
plus the esophagoscope, is a possibility (Fig. 91). Faulty position of
the patient, especially a low position of the head, with faulty
direction of the esophagoscope may cause the tube mouth to press the
membranous tracheo-esophageal wall into the trachea, so as temporarily
to occlude the tracheal lumen, creating a very dangerous situation in
a patient under general anesthesia. Prompt introduction of a
bronchoscope, with oxygen and amyl nitrite insufflation and artificial
respiration, may be necessary to save life. The danger is greater, of
course, with chloroform than with ether anesthesia. Cocain poisoning
may occur in those having an idiosyncrasy to the drug. Cocain should
never be used with children, and is of little use in esophagoscopy in
adults. Its application is more annoying and requires more time than
the esophagoscopic removal of the foreign bodies without local
anesthesia. Traumatic esophagitis, septic mediastinitis, cervical
cellulitis, and, most dangerous, gangrenous esophagitis may be
present, caused by the foreign body itself or ill-advised efforts at
removal. Perforation of the esophagus with the esophagoscope is rare,
in skillful hands, if the esophageal wall is sound. The esophageal
wall, however, may be weakened by ulceration, malignant disease, or
trauma, so that the possibility of making a false passage should
always deter the endoscopist from advancing the tube beyond a visible
point of weakening. To avoid entering a false passage previously
created, is often exceedingly difficult, and usually it is better to
wait for obliterative adhesive inflammation to seal the tissue layers
Previous: Spatula-protected Method