|Joe was not a very romantic person, and furthermore he was rather stupid. But he wanted to impress his wife, so he took her out for an anniversary dinner and watched the couples around them, following their leads. He observed the couple next to h... Read more of Romantic food at Free Jokes.ca|| Informational|
Medical ArticlesImaginary Troubles
These are of two kinds, the one purely imaginary, the other wh...
I shall give a couple of illustrations: In the winter of 1...
A subacute or a chronic infective endocarditis should be trea...
Paralysis Of The Esophagus
The passage of liquids and solids through the esophagus is a ...
Essentials Of A Successful, Safe Fast
1. Fast in a bright airy room, with exceptionally good ventil...
Urticaria Zoster Rubeola
_Urticaria_, _Zoster_ and _Rubeola_, are treated in the same ...
The Anti-gastric Method
consisting in the free use of emetics or purgatives, has been...
The first step is to get rid of the gastric secretions. Ther...
Remedy Finding A
It will sometimes occur, in the case of those endeavouring to ...
The Black Hole of Calcutta is an object lesson of how necessary...
The Healing Crisis And Retracing
Certain unpleasant somatics that occur while fasting (or whil...
This plant is the Chama Cyparissos, or ground cypress. It is o...
The various articles under Nerves and Nervousness should be re...
Simple remedies such as we advocate are found of immense servi...
Radium and the therapeutic roentgenray are today our only ef...
Chronic Back Pain
Barry was a carpenter who couldn't afford to lose work becaus...
From the preceding observations it would naturally be conclud...
MICHEL DE NOTREDAME, or NOSTRADAMUS, a celebrated French phys...
The question of the advisability of strychnin is a constant s...
The treatment of a suspected coronary sclerosis is the same a...
Unsuccessful Bronchoscopy For Foreign Bodies
Category: FOREIGN BODIES IN THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The limitations of bronchoscopic removal of foreign bodies are usually
manifested in the failure to find a small foreign body which has
entered a minute bronchus far down and out toward the periphery. When
localization by means of transparent films, fluoroscopy, and
endobronchial bismuth insufflation has failed, the question arises as
to the advisability of endoscopic excision of the tissue intervening
between the foreign body and bronchoscope with the aid of two
fluoroscopes, one for the lateral and the other the vertical plane.
With foreign bodies in the larger bronchi near the root of the lung
such a procedure is unnecessary, and injury to a large vessel would be
almost certain. At the extreme periphery of the lung the danger is
less, for the vessels are smaller and serious hemorrhage less
probable, through the retention and decomposition of blood in small
bronchi with later abscess formation is a contingency. The nature of
the bridge of tissue is to be considered; should it be cicatricial,
the result of prolonged inflammatory processes, it may be carefully
excised without very great risk of serious complications. The blood
vessels are diminished in size and number by the chronic productive
inflammation, which more than offsets their lessened contractility.
The possibility of the foreign body being coughed out after
suppurative processes have loosened its impaction is too remote; and
the lesions established may result fatally even after the expulsion of
the object. Pulmonary abscess formation and rupture into the pleura
should not be awaited, for the foreign body does not often follow the
pus into the pleural cavity. It remains in the lung, held in a bed of
granulation tissue. Furthermore, to await the development is to
subject the patient to a prolonged and perhaps fatal sepsis, or a
fatal pulmonary hemorrhage from the erosion of a vessel by the
suppurative process. The recent developments in thoracic surgery have
greatly decreased the operative mortality of thoracotomy, so that this
operation is to be considered when bronchoscopy has failed.
Bronchoscopy can be considered as having failed, for the time being,
when two or more expert bronchoscopists on repeated search have been
unable to find the foreign body or to disentangle it; but the art of
bronchoscopy is developing so rapidly that the failures of a few years
ago would be easy successes today. Before considering thoracotomy
months of study of the mechanical problem are advisable. It is
probable that any foreign body of appreciable size that has gone down
the natural passages can be brought back the same way.
In the event of a foreign body reaching the pleura, either with or
without pus, it should be removed immediately by pleuroscopy or by
thoracotomy, without waiting for adhesive pleuritis.
The problem may be summarized thus:
1. Large foreign bodies in the trachea or large bronchi can always
be removed by bronchoscopy.
2. The development of bronchoscopy having subsequently solved the
problems presented by previous failures, it seems probable that by
patient developmental endeavor, any foreign body of appreciable size
that has gone down through the natural passages, can be
bronchoscopically removed the same way, provided fatal trauma is
At the author's Bronchoscopic Clinics 98.7 per cent of foreign bodies
have been removed.