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One of the most notorious charlatans of the eighteenth centur...
Site Of Lodgment
The majority of foreign bodies in the air passages occur in ...
Period Of Efflorescence Or Standing Out Of The Rash
During the first day or two of the period of efflorescence, w...
JEROME CARDAN, an Italian physician, author, mathematician an...
Precautions To Be Observed
As long as compensation is complete, there are no medication ...
See Whooping Cough. ...
Neutralise by chalk or lime water, but not by soda or any alka...
The most successful procedure in the management of intestinal...
There Is Neither A Specific Nor A Prophylactic To Be Relied On
All these different methods and remedies, and many others, ha...
Removal Of Growth From The Laryngeal Ventricle
After exposing the larynx in the usual manner, if the head i...
Breath And Blood
Often difficulty of breathing, especially in close air, mistak...
Indications For Esophagoscopy In Disease
Any persistent abnormal sensation or disturbance of function...
Climate And Soil
The soil on which one lives is a matter of primary importance;...
After the bath, the patient is rubbed dry, and either taken t...
Bathing The Feet
This apparently simple treatment, if the best results are desi...
Nervous Strain In Pain And Sickness
THERE is no way in which superfluous and dangerous te...
Rules For Direct Laryngoscopy
1. The laryngoscope must always be held in the left hand, nev...
Where the juices and organs of the body are thoroughly healthy,...
Training For Motion
"IN every new movement, in every unknown attitude nee...
Unsuccessful Bronchoscopy For Foreign Bodies
The limitations of bronchoscopic removal of foreign bodies ar...
Stage 4 Passing Through The Hiatus Esophageus
Category: INTRODUCTION OF THE ESOPHAGOSCOPE
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
When the head is
dropped, it must at the same time be moved horizontally to the right
in order that the axis of the tube shall correspond to the axis of the
lower third of the esophagus, which deviates to the left and turns
anteriorly. The head and shoulders at this time will be found to be
considerably below the plane of the table top (Fig. 71). The hiatal
constriction may assume the form of a slit or rosette. If the rosette
or slit cannot be promptly found, as may be the case in various
degrees of diffuse dilatation, the tube mouth must be shifted farther
to the left and anteriorly. When the tube mouth is centered over the
hiatal constriction moderately firm pressure continued for a short
time will cause it to yield. Then the tube, maintaining this same
direction will, without further trouble glide into and through the
abdominal esophagus. The cardia will not be noticed as a constriction,
but its appearance will be announced by the rolling in of reddish
gastric mucosal folds, and by a gush of fluid from the stomach.
[FIG. 70.--Schematic illustration of the author's high-low method of
esophagoscopy, fourth stage. Passing the hiatus. The head is dropped
from the position of the 1st and 2nd stages, CL, to the position T,
and at the same time the head and shoulders are moved to the right
(without rotation) which gives the necessary direction for passing the
[FIG. 71.--Esophagoscopy by the author's high-low method. Stage 4.
Passing the hiatus The patient's vertex is about 5 cm. below the top
of the table.]
Normal esophageal mucosa under proper illumination is glistening and
of a yellowish or bluish pink. The folds are soft and velvety,
rendering infiltration quickly noticeable. The cricoid cartilage shows
white through the mucosa. The gastric mucosa is a darker pink than
that of the esophagus and when actively secreting, its color in some
cases tends toward crimson.
Secretions in the esophagus are readily aspirated through the
drainage canal by a negative pressure pump. Food particles are best
removed by sponge pumping, or with forceps. Should the drainage
canal become obstructed positive pressure from the pump will clear the
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