|VIEW THE MOBILE VERSION of www.homemedicine.ca|| Informational|
Medical ArticlesBlood Supply Of
To supply good blood in cases where it is lacking, either from...
This results from severe damp chills, usually following exhaus...
Breath And Nerve
Difficult breathing, especially in ascending a hill, is often ...
Ice-water And Snow-bath In Malignant Cases
If no rash appear during the first pack, which will scarcely ...
As this inflammation is generally secondary to some other c...
Positive And Negative Effort
DID you ever have the grip? If you ever have you may ...
Breath And Blood
Often difficulty of breathing, especially in close air, mistak...
Position For Bronchoscopy And Esophagoscopy
The dorsally recumbent patient is so placed that the head an...
Importance Of Noting The Central Point
From the above observations, it will be plain that, when we w...
The Effect Of Drugs On Venous Blood Pressure
Capps and Matthews [Footnote: Capps, J. A., and Matthews, S. ...
Mechanical Effect Of Each Pole
The mechanical effect of the forward end of the current, or t...
From The Hygienic Dictionary
Food.  Life is a tragedy of nutrition. In food lies 99.99...
The Surgical Form Of The Male And Female Axillae Compared
Certain characteristic features mark those differences which ...
HEINRICH CORNELIUS AGRIPPA VON NETTESHEIM, a German alchemist...
_Nux Vomica_ should be used once in about four hours, for twe...
Extraction Of Open Safety-pins From The Esophagus
An open safety pin with the point down offers no particular ...
Introduction Of The Bronchoscope
No one should do bronchoscopy until he is able to expose the ...
It is well to remember that over-feeding is a relative term. T...
Giddiness And Trembling
This comes very often as the result of loss of nerve power in ...
Compression Stenosis Of The Trachea
Decannulation in these cases can only follow the removal of ...
Category: INTRODUCTION OF THE BRONCHOSCOPE
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
A whispering voice can always be had as long as air
can pass through the larynx, and this may be developed to a very loud
penetrating stage whisper. If the arytenoid motility has been
uninjured the repeated pulls on the scar tissue may draw out
adventitious bands and develop a loud, useful, though perhaps rough
and inflexible voice.
Galvano-cauterization is the best method of treatment for chronic
subglottic edema or hyperplasia such as is seen in children following
diphtheria, when the stenosis produced prevents extubation or
decannulation. The utmost caution should be used to avoid deep
cauterizations; they are almost certain to set up perichondritis which
will increase the stenosis. Some of the most difficult cases that have
come to the author have been previously cauterized too deeply.
Galvano-cautery puncture of tuberculous infiltrations of the larynx
at times yields excellent results in cases with mild pulmonary
lesions, and has quite replaced the use of the curette, lactic acid,
and other caustics. The direct method of exposing the larynx renders
the application of the cautery point easy and accurate. In severely
stenosed tuberculous larynges a tracheotomy should first be done, for
though the reaction is slight it might be sufficient to close a
narrowed glottis. The technic is the usual one for laryngeal
operations. Local anesthesia suffices. The larynx is exposed. The
rheostat having been previously adjusted to heat the electrode to
nearly white heat, the circuit is broken and the electrode introduced
cold. When the point is in contact with the desired location the
current is turned on and the point thrust in as deeply as desired.
Usually it should penetrate until a firm resistance is felt; but care
must be used not to damage the cricoarytenoid joint. The circuit is
broken at the instant of withdrawal. Punctures should be made as
nearly as possible perpendicular to the surface, so as to minimize the
destruction of epithelium and thus lessen the reaction. A minute gray
fibrous slough detaches itself in a few days. Cautery puncture should
be repeated every two or three weeks, selecting a new location each
time, until the desired result is obtained. Great caution, as
mentioned above, must be used to avoid setting up perichondritis. Many
cases of laryngeal tuberculosis will recover as quickly by silence and
a general antituberculous regime.
Radium, in form of capsules or of needles inserted in the tissues
may be applied with great accuracy; but the author is strongly
impressed with pyriform sinus applications by the Freer method.
After-care of endolaryngeal operations includes careful cleansing of
the teeth and mouth; and if the extrinsic area of the larynx is
involved in the wound, sterile liquid food and water should be given
for four days. The patient should be watched for complications by a
special nurse who is familiar with the signs of laryngeal dyspnea
(q.v.). Complications during endolaryngeal operations are rare.
Dyspnea may require tracheotomy. Idiosyncrasy to cocain, or the sight
or taste of blood may nauseate the patient and cause syncope. Serious
hemorrhage could occur only in a hemophile. The careless handling of a
bite block might damage a frail tool or dental fixture.
Complications after endolaryngeal operations are unusual.
Carelessness in asepsis has been known to cause cervical cellulitis.
Emphysema of the neck has occurred. Edema of the larynx occasionally
occurs, and might necessitate tracheotomy. Serious bleeding after
operation is very rare except in bleeders. Hemorrhage within the
larynx can be stopped by the introduction of a roll of gauze from
above, tracheotomy having been previously performed. Morphin
subcutaneously administered, has a constricting action on the vessels
which renders it of value in controlling hemorrhage.
Next: Introduction Of The Bronchoscope
Previous: Endoscopic Operations For Laryngeal Stenosis