In cases not demonstrably tuberculous, hemoptysis may requir...
Thorough heating, with moist heat is the best treatment for th...
Bruises Case Xv
The following case was far more severe, but the mode of treat...
While the myocardium is the most important muscle structure...
The Three Great Classes Of Food-fuel
Food is Fuel. Now what is the chief quality which makes one k...
At Nauheim, under the direction of Dr. Theodore Schott, baths...
Morning Sickness Of Pregnant Females
The most efficient and certain remedy for this symptom is _Ma...
Chlorosis Green Sickness
This is a disease mostly or entirely peculiar to young women ...
Where this is advised medically, it is often taken in a manner...
Chloroform Or Ether (swallowed)
Emetic; enema of hot coffee; keep awake. If necessary, artific...
Use the A D current always in rheumatic affections. If there ...
Stage 3 Passing Through The Thoracic Esophagus
The thoracic esophagus will be seen to expand during inspira...
Punctures Case Vii
Mr. Parr, aged 30, of delicate habit, trod upon a needle whic...
Treatment Of The Mild Or Erethic Form Of Scarlatina Anginosa
The _mild_ or _erethic form_ of scarlatina anginosa requires ...
Colic Of Whatever Kind
Use A D current, pretty strong force. In severe cases, introd...
I see a lot of spiritually-induced physical illness in my pra...
If the circulation of air is necessary in any other form of ...
Signs Of Heart Weakness
It should be remembered that a normal heart may slow to about...
Memory Loss Of
A more or less complete suspension of this faculty is a not un...
The lunar caustic is very useful in the treatment of this pai...
Category: INTRODUCTION OF THE ESOPHAGOSCOPE
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Passing the cricopharyngeus is the most difficult part of
esophagoscopy, especially if the patient is unanesthetized. Local
anesthesia helps little, if at all. The handle of the esophagoscope is
still pointing upward and consequently we are sure that the lip of the
esophagoscope is directed anteriorly. Force must not be used, but
steady firm pressure against the tonically contracted cricopharyngeus
is made, while at the same time the distal end of the esophagoscope is
lifted by the left thumb. At the first inspiration a lumen will
usually appear in the upper portion of the endoscopic field. The tip
of the esophagoscope enters this lumen and the slanted end slides over
the fold of the cricopharyngeus into the cervical esophagus. There is
usually from 1 to 3 cm. of this constricted lumen at the level of the
cricopharyngeus and the subjacent orbicular esophageal fibers.
 [FIG. 67.--Schematic illustration of the author's high-low
method of esophagoscopy. In the first and second stages the patient's
head fully extended is held high so as to bring it in line with the
thoracic esophagus, as shown above. The Rose position is shown by way
[FIG. 68.--Schematic illustration of the anatomic basis for difficulty
in introduction of the esophagoscope. The cricoid cartilage is pulled
backward against the cervical spine, by the cricopharyngeus, so
strongly that it is difficult to realize that the cricopharyngeus is
not inserted into the vertebral periosteum instead of into the median
[FIG. 69.--The upper illustration shows movements necessary for
passing the cricopharyngeus.
The lower illustration shows schematically the method of finding the
pyriform sinus in the author's method of esophagoscopy. The large
circle represents the cricoid cartilage. G, Glottic chink,
spasmodically closed; VB, ventricular band; A, right arytenoid
eminence; P, right pyriform sinus, through which the tube is passed in
the recumbent posture. The pyriform sinuses are the normal food
Next: Stage 3 Passing Through The Thoracic Esophagus
Previous: Stage I Entering The Right Pyriform Sinus