acts very beneficially when applied to the surface where ther...
Bronchoscopic Appearances In Disease
The first look should note the color of the bronchial mucosa...
Foreign bodies that have penetrated the chest wall and lodge...
This drug is a West Indian gum, and is one of those remedies w...
The Brain In Its Direction Of The Body
WE come now to the brain and its direction of other p...
Ancient Medical Prescriptions
From early times it was a universal custom to place at the ...
This is often a trivial matter, but sometimes it is a symptom ...
Removal Of Growth From The Laryngeal Ventricle
After exposing the larynx in the usual manner, if the head i...
Pain Severe In Limbs
This is often not due to any trouble in the joint itself, but ...
Demonstrations Of The Origin And Progress Of Femoral Hernia Its Diagnosis The Taxis And The Operation
PLATE 45, Fig. 1.--The point, 3, from which an external ingui...
Difficulties In The Introduction Of The Bronchoscope
The beginner may enter the esophagus instead of the trachea:...
HEINRICH CORNELIUS AGRIPPA VON NETTESHEIM, a German alchemist...
are the following: Absence of internal inflammation; a bright...
This trouble is found in the double form; first, of limbs whic...
Before Perspiration Comes On There Is A Little More Excitement For
a few minutes (41), which must not induce the friends of the pa...
Part of a raw turnip is grated down to a pulp. As much of this...
Taking A Laryngeal Specimen For Diagnosis
The diagnosis of carcinoma, sarcoma, and some other conditio...
The lunar caustic is very useful in the treatment of this pai...
One of the most fruitful causes of ill-health is the habit of ...
The Living Arches of the Foot. One of the most important thin...
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.