Medical ArticlesMethods Of Treatment
Irritating applications probably provoke recurrences, becaus...
The Various Forms And Positions Of Strictures And Other Obstructions Of The Urethra False Passages Enlargements And Deformities Of The Prostate
Impediments to the passage of the urine through the urethra m...
The Form Of The Thoracic Cavity And The Position Of The Lungs Heart And Larger Bloodvessels
In the human body there does not exist any such space as cavi...
Before Perspiration Comes On There Is A Little More Excitement For
a few minutes (41), which must not induce the friends of the pa...
Strict aseptic technic must be observed in all endoscopic pr...
All too many of my cases are what I privately refer to as oni...
Aphonia Loss Of Voice
This affection requires treatment variously, as it depends on...
Burns Case Xxxiv
Mr. C. aged 51, scalded his leg ten days ago on the instep. H...
Prognosis And Convalescence
The duration of acute endocarditis varies greatly; it may be ...
Theory Of Man
Let the question now be raised--What is man? The answer will ...
Diagnosis Of Foreign Body In The Air Or Food Passages
The questions arising are: I. Is a foreign body present? ...
Morning Sickness Of Pregnant Females
The most efficient and certain remedy for this symptom is _Ma...
The dilatation of cicatricial stenosis of the esophagus can ...
Probably most acute infections cause more or less myocarditis...
Direct Laryngoscopy In Diseases Of The Larynx
The diagnosis of laryngeal disease in young children, impossi...
When long continued in connection with disease or accident, th...
These are often performed in cases in which proper treatment o...
This is an eruption on the skin, often coming suddenly and goi...
The Confusions About Diets And Foods
Like my daughter, many people of all ages are muddled about t...
How the Eye is Made. Next in importance after the smell and t...
Extraction Of Tacks Nails And Large Headed Foreign Bodies From The Tracheobronchial Tree
Category: MECHANICAL PROBLEMS OF BRONCHOSCOPIC FOREIGN BODY EXTRACTION
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
In cases of this sort the point presents the
same difficulty and requires solution in the same manner as mentioned
in the preceding paragraphs on the extraction of pins. The author's
inward-rotation method when executed with the Tucker forceps is ideal.
The large head, however, presents a special problem because of its
tendency to act as a mushroom anchor when buried in swollen mucosa or
in a fibrous stenosis (Fig. 83). The extraction problems of tacks are
illustrated in Figs. 84, 85, and 86. Nails, stick pins, and various
tacks are dealt with in the same manner by the author's inward
Hollow metallic bodies presenting an opening toward the observer may
be removed with a grooved expansile forceps as shown in Figs 23 and
25, or its edge may be grasped by the regular side-grasping forceps.
The latter hold is apt to be very dangerous because of the trauma
inflicted by the catching of the free edge opposite the forceps; but
with care it is the best method. Should the closed end be uppermost,
however, it may be necessary to insert a hook beyond the object, and
to coax it upward to a point where it may be turned for grasping and
removal with forceps.
[FIG. 83.--Mushroom anchor problem of the upholstery tack. If the
tack has not been in situ more than a few weeks the stenosis at the
level of the darts is simply edematous mucosa and the tack can be
pulled through with no more than slight mucosal trauma, provided
axis-traction only be used. If the tack has been in situ a year or
more the fibrous stricture may need dilatation with the divulsor.
Otherwise traction may rupture the bronchial wall. The stenotic tissue
in cases of a few months' sojourn maybe composed of granulations, in
which case axis-traction will safely withdraw it. The point of a tack
rarely projects freely into the lumen as here shown. More often it is
buried in the wall.]
 [FIG. 84.-Schema illustrating the mushroom anchor problem of
the brass headed upholstery tack. At A the tack is shown with the head
bedded in swollen mucosa. The bronchoscopist, looking through the
bronchoscope, E, considering himself lucky to have found the point of
the tack, seizes it and starts to withdraw it, making traction as
shown by the dart in drawing B. The head of the tack catches below a
chondrial ring and rips in, tearing its way through the bronchial wall
(D) causing death by mediastinal emphysema. This accident is still
more likely to occur if, as often happens, the tack-head is lodged in
the orifice of the upper lobe bronchus, F. But if the bronchoscopist
swings the patient's head far to the opposite side and makes
axis-traction, as shown at C, the head of the tack can be drawn
through the swollen mucosa without anchoring itself in a cartilage. If
necessary, in addition, the lip of the bronchoscope can be used to
repress the angle, h, and the swollen mucosa, H. If the swollen
mucosa, H, has been replaced by fibrous tissue from many months'
sojourn of the tack, the stenosis may require dilatation with the
[FIG. 85.--Problem of the upholstery tack with buried point. If pulled
upon, the imminent perforation of the mediastinum, as shown at A will
be completed, the bronchus will be torn and death will follow even if
the tack be removed, which is of doubtful possibility. The proper
method is gently to close the side curved forceps on the shank of the
tack near the head, push downward as shown by the dart, in B, until
the point emerges. Then the forceps are rotated to bring the point of
the tack away from the bronchial wall.]
Next: Removal Of Open Safety Pins From The Trachea And Bronchi
Previous: Inward Rotation Method