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Is simply an inflammation due to impurity of the blood. These ...
This trouble is often only aggravated and made chronic by the ...
This most important matter of good sleep for the child depends...
The Circumstances Of Life
IT is not the circumstances of life that trouble or w...
The Development Of My Own Constipation
The history of my own constipation, though it especially rela...
See Rubbing. ...
The Surgical Dissection Of The Sterno-clavicular Or Tracheal Region And The Relative Position Of Its Main Bloodvessels Nerves &c
The law of symmetry governs the development of all structures...
Legs Pricking Pains In
Sometimes curious pricking pains are felt in the legs, becomin...
Rheumatism is the cause of most instances of cardiac disease ...
See Fever, Typhoid. ...
Continuation Of Packs Convalescence
Whether the eruption appear or not, the packs should be conti...
Other Sequels Dropsy &c
Beside the ulceration of glands and deafness, some of the seq...
Often a severe pain in the toe, foot, ankle, or lower leg has ...
Teething Of Children
Affections arising from teething of children, are often of a ...
Extent Of Electric Agency
When we have settled upon the position that the electricity o...
Muscular Action Weak
The heart is the most important of all muscles. Sometimes the ...
The Lower Animals
It may, by some, be objected that, if we regard sensation as ...
Curing With Enemas
It is not wise to continue regular colonics or enemas once a ...
Diet And Baths In Heart Disease
The diet in cardiac diseases has already incidentally been ...
To Prevent Typhoid Fever
When exposed, as in nursing the sick, take _Baptisia_ 2d, and...
Category: ACQUIRING SKILL
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The first step is to get rid of the
gastric secretions. There is always fluid in the stomach, and this
keeps pouring out of the tube in a steady stream. Fold after fold is
emptied of fluid. Once the stomach is empty, the search begins for the
cardial opening. The best landmark is a mark with a dermal pencil on
the skin at a point corresponding to the level of the hiatus
esophageus. When it is desired to do a retrograde esophagoscopy and
the gastrostomy is done for this special purpose, it is wise to have
it very high. Once the cardia is located and the esophagus entered,
the remainder of the work is very easy. Bouginage can be carried out
from below the same as from above and may be of advantage in some
cases. Strictural lumina are much more apt to be concentric as
approached from below because there has been no distortion by pressure
dilatation due to stagnation of the food operating through a long
period of time. At retrograde esophagoscopy there seems to be no
abdominal esophagus and no cardia. The esophagoscope encounters only
the diaphragmatic pinchcock which seems to be at the top of the
stomach like the puckering string at the top of a bag.
Retrograde esophagoscopy is sometimes useful for stringing the
esophagus in cases in which the patient is unable to swallow a string
because he is too young or because of an epithelial scaling over of
the upper entrance of the stricture. In such cases the smallest size
of the author's filiform bougies (Fig. 40) is inserted through the
retrograde esophagoscope (Fig. 43) and insinuated upward through the
stricture. When the tip reaches the pharynx coughing, choking and
gagging are noticed. The filiform end is brought out the mouth
sufficiently far to attach a silk braided cord which is then pulled
down and out of the gastrostomic opening. The braided silk string
must be long enough so that the oral and the abdominal ends can be
tied together to make it endless; but before doing so the oral end
should be drawn through nose where it will be less annoying than in
the mouth. The purpose of the string is to pull up the retrograde
bougies (Fig. 35)
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