Retrograde Esophagoscopy
Categories: ACQUIRING SKILLSources: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The first step is to get rid of the
gastric secretions. There is always fluid in the stomach, and this
keeps pouring out of the tube in a steady stream. Fold after fold is
emptied of fluid. Once the stomach is empty, the search begins for the
cardial opening. The best landmark is a mark with a dermal pencil on
the skin at a point corresponding to the level of the hiatus
esophageus. When it is desired to do a retrograde
the gastrostomy is done for this special purpose, it is wise to have
it very high. Once the cardia is located and the esophagus entered,
the remainder of the work is very easy. Bouginage can be carried out
from below the same as from above and may be of advantage in some
cases. Strictural lumina are much more apt to be concentric as
approached from below because there has been no distortion by pressure
dilatation due to stagnation of the food operating through a long
period of time. At retrograde esophagoscopy there seems to be no
abdominal esophagus and no cardia. The esophagoscope encounters only
the diaphragmatic pinchcock which seems to be at the top of the
stomach like the puckering string at the top of a bag.
Retrograde esophagoscopy is sometimes useful for stringing the
esophagus in cases in which the patient is unable to swallow a string
because he is too young or because of an epithelial scaling over of
the upper entrance of the stricture. In such cases the smallest size
of the author's filiform bougies (Fig. 40) is inserted through the
retrograde esophagoscope (Fig. 43) and insinuated upward through the
stricture. When the tip reaches the pharynx coughing, choking and
gagging are noticed. The filiform end is brought out the mouth
sufficiently far to attach a silk braided cord which is then pulled
down and out of the gastrostomic opening. The braided silk string
must be long enough so that the oral and the abdominal ends can be
tied together to make it endless; but before doing so the oral end
should be drawn through nose where it will be less annoying than in
the mouth. The purpose of the string is to pull up the retrograde
bougies (Fig. 35)
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Punctures Case Ix
James Joynes, aged 12, was bitten by an ass, on each side of the middle finger; the wounds were severe, and almost immediately followed by swelling and great pain. The lunar caustic was well applied within half an hour after the accident. On the ... Punctures Case V
Mr. Cocking's son, aged 12, received a stab in the palm of the hand from a penknife three days ago, which has been followed by much swelling and pain, the punctured orifice being nearly closed. I applied the lunar caustic as deep as possible within ... Punctures Case Vi
A little boy, aged 12, received a stab by a penknife a few days ago, in the fore part of the thigh; there are now great pain and swelling, the orifice is nearly closed, and he has feverishness with headach. I applied the lunar caustic deeply in the ... Punctures Case Vii
Mr. Parr, aged 30, of delicate habit, trod upon a needle which pierced the ball of the great toe; a free crucial incision was made but the needle could not be found; a poultice was applied to the wound and over the poultice a cold lotion. In the ... Punctures Case Viii
This case illustrates the mode of treatment by the lunar caustic, of those terrible effects of punctured wounds which have been neglected in the beginning. B. Unwin, aged 40, washerwoman, applied to me on July the 10th, 1820, with severe inflamma... Punctures Case X
Mr. Worth's daughter, aged six, was thrown down by a dog and bitten severely on the face and forehead in three places; one of the wounds in the cheek was deep from the penetration of the dog's front teeth, and the parts were much bruised. The lunar ... Punctures Case Xi
Mrs. G. was bitten by a little dog on forefinger about a fortnight ago. There is now a very irritable, inflamed, fungous sore. I removed the fungous by a pair of scissors and applied the lunar caustic to form an eschar. On the succeeding day, I f... Punctures Case Xii
A servant maid was bitten by a dog in four places--severely on the forearm--three days ago. Adhesive plaster had been applied. There is a wound across the arm two inches in length and three-fourths of an inch in breadth, attended by dull pain, and s... Punctures Case Xiii
Am old man applied leeches to the instep for inflammation occasioned by a bruise. Several very irritable sores were produced with some swelling. I applied the lunar caustic to form an eschar. On the following day, the eschars were adherent, the sw... Putrid Symptoms
Next to those most dangerous forms--most dangerous, because the organic power (the _vis medicatrix naturae_), from which the restoration of health must be expected, and without which no physician can remove the slightest symptom of disease, becomes ... Putrid Symptoms Gargle Solution Of Chloride Of Soda Drink: Chlorate Of Potass Liquor Calcii-chloridi
Should _putrid symptoms_ make their appearance (21), I would strongly advise the acid in full and repeated doses, as well as the frequent repetition of the packs. In putrid cases, not only the syrup, but also the gargle will do good service. Garglin... Quacks And Quackery
Quackery and the love of being quacked, are in human nature as weeds are in our fields. DR. J. BROWN, Spare Hours. They are Quack-salvers, Fellowes that live by senting oyles and drugs. ... Quacks And Quackery Continued
An English physician, who practised during the early part of the reign of King James I, described the charlatan of that period as shameless, a mortal hater of all good men, an adept in cozening, legerdemain, conycatching, and all other shifts and ... Quiet Vs Chronic Excitement
SOME women live in a chronic state of excitement all the time and they do not find it out until they get ill. Even then they do not always find it out, and then they get more ill. It is really much the same with excitable women as with a m... Radiotherapy
Radium and the therapeutic roentgenray are today our only effective means of retarding the progress of esophageal malignant neoplasms. No permanent cures have been reported, but marked temporary improvement in the swallowing function and prolongatio... Rapid Relief From Colon Cleansing
During fasting the liver is hard at work processing toxins released from fat and other body deposits. The liver still dumps its wastes into the intestines through the bile duct. While eating normally, bile, which contains highly toxic substances, is... Raw Food Healing Diets
Next in declining order of healing effectiveness is what I call a raw food healing diet or cleansing diet. It consists of those very same watery fruits and nonstarchy vegetables one juices or makes into vegetable broths, but eaten whole and raw. Hea... Rebellion!
_This is preaching rebellion!_ I know it is, and it is with great reluctance that I preach it, as I am by no means in favor of taking medical matters out of the hands where they belong, to place them into the hands of such as have had no medical ... Recent Wounds Contusions And Burns
Use the B D current, strong force as can be borne. Bring the lesion under P. P., and place N. P. at discretion, in view of the location of the injury. Treat five to eight minutes, twice or thrice on the same day. Unless the injury is very severe, no... Relaxation Of Treatment Towards The End Of The Third Period Continuation Of Packs During And After Desquamation
When the patient is through the first part of the period of efflorescence the symptoms decrease, and he will be easier. Under the treatment prescribed, the time when the excitement is highest, is much abridged, and usually the treatment can be relax... Relaxed And Atrophied Conditions
I alluded, above, to a distinction between a relaxed and an atrophied condition of an organ. There is such a distinction, which should be carefully observed while treating parts so affected. An atrophied muscle or organ becomes soft and flabby from ... Remedial Virtues Ascribed To Relics
A relic has been defined as an object held in reverence or affection, because connected with some sacred or beloved person deceased. And specifically, in the Roman Catholic and Greek churches, a saint's body or portions of it, or an object suppose... Removal Of Double Pointed Tacks
If the tack or staple be small, and lodged in a relatively large trachea a version may be done. That is, the staple may be turned over with the hook or rotation forceps and brought out with the points trailing. With a long staple in a child's trach... Removal Of Foreign Bodies From The Larynx
Symptoms and Diagnosis.--The history of a sudden choking attack followed by impairment of voice, wheezing, and more or less dyspnea can be usually elicited. Laryngeal diphtheria is the condition most frequently thought of when these symptoms are pre... Removal Of Growth From The Laryngeal Ventricle
After exposing the larynx in the usual manner, if the head is turned strongly to the right, the tip of the laryngoscope, directed from the right side of the mouth, may be used to lift the left ventricular hand and thus expose the ventricle, from wh... Removal Of Open Safety Pins From The Trachea And Bronchi
Removal of a closed safety pin presents no difficulty if it is grasped at one or the other end. A grasp in the middle produces a toggle and ring action which would prevent extraction. When the safety pin is open with the point downward care must be ... Renal Calculi Gravel In The Kidneys
Take the A C current, of considerable force. Place N. P. low upon the bladder, and treat with P. P. upon the inflamed and painful point five to eight minutes, once or twice a day. If treating twice a day, continue not more than five minutes at a tim... Resistance
A MAN once grasped a very hot poker with his hand, and although he cried out with pain, held on to the poker. His friend called out to him to drop it, whereupon the man indignantly cried out the more. "Drop it? How can you expect me to th... Rest In Sleep
HOW do we misuse our nervous force? First, let us consider, When should the body be completely at rest? The longest and most perfect rest should be during sleep at night. In sleep we can accomplish nothing in the way of voluntary activity ei... Resume Of After-care Of A Tracheotomic Case
1. Always bear in mind that tracheotomy is not an ultimate object. The ultimate object is to pipe air down into the lungs. Tracheotomy is only a means to that end. 2. Sterile tray beside bed should contain duplicate (exact) tracheotomy tube, Tr... Resume Of Emergency Tracheotomy
The following notes should be memorized. 1. Essentials: Knife and pair of hands (but full equipment better). [295] 2. Don't do a laryngotomy, or stabbing. 3. Two stage, finger guided operation better. 4. Sand bag or substitute. 5. Press ... Resume Of Tracheotomy
Instruments. Headlight Sandbag Scalpel Hemostats Small retractors Tenaculum Tracheotomic cannulae (proper kind) Long. Half area cross-section trachea. Proper curve: Radius too short will press ant. tracheal wall; too... Retrograde Esophagoscopy
The first step is to get rid of the gastric secretions. There is always fluid in the stomach, and this keeps pouring out of the tube in a steady stream. Fold after fold is emptied of fluid. Once the stomach is empty, the search begins for the cardi... Rheumatism Acute Inflammatory
First ascertain if the kidneys be morbidly positive--urine scant and too highly colored. If so, as is commonly the case, begin with the B D current, good medium force. Place N. P. at the pelvis, and treat over the kidneys with P. P. some three or fo... Rheumatism Chronic
Use the A D current always in rheumatic affections. If there be no visible inflammation or swelling in the diseased parts, approach such parts in the same manner as in acute inflammatory rheumatism, except with reversed poles. The parts affected req... Rhus Tox
applied, with water at the strength of thirty drops of the _tr._ to a gill, to parts affected with _Rheumatism_, acts very beneficially. It is also a most valuable application at half the above strength upon parts affected with Erysipelas, when the ... Roentgenray Study In Foreign Body Cases
Roentgenography.--All cases of chest disease should have the benefit of a roentgenologic study to exclude bronchial foreign body as an etiological factor. Negative opinions should never be based upon any plates except the best that the wonderful mod... Rotation Forceps
It is sometimes desired to make traction on an irregularly shaped foreign body, and yet to allow the object to turn into the line of least resistance while traction is being made. This can be accomplished by the use of the rotation forceps (Fig. 20)... Rubbing Sheet Substitute For The Half-bath
It cannot be difficult to procure a wash-tub. Should you be so situated, however, as not to be able to procure even this, you will be compelled to make shift with a _rubbing sheet_. For that purpose, a sheet and a pail of water are all you need. The... Rules For Direct Laryngoscopy
1. The laryngoscope must always be held in the left hand, never in the right. 2. The operator's right index finger (never the left) should be used to retract the patient's upper lip so that there is no danger of pinching the lip between the instr... Rules For Endoscopic Foreign Body Extraction
1. Never endoscope a foreign body case unprepared, with the idea of taking a preliminary look. 2. Approach carefully the suspected location of a foreign body, so as not to override any portion of it. [175] 3. Avoid grasping a foreign body has... Rules For Insertion Of The Catheter For Insufflation Anesthesia
1. The patient should be fully under the anesthetic by the open method so as to get full relaxation of the muscles of the neck. 2. The patient's head must be in full extension with the vertex firmly pushed down toward the feet of the patient, so... Rules For The Application Of Water In Typhoid Cases
As a general rule, in typhoid cases, bathing should form one of the principal features of the treatment; i. e. the patient should have more baths than packs in proportion to the treatment of other cases. The temperature of the baths should be in... Running The Human Automobile
The Body-Automobile. If you were to start to-morrow morning on a long-distance ride in an automobile, the first thing that you would do would be to find out just how that automobile was built; how often it must have fresh gasoline; how its differe... Rupture And Trauma Of The Esophagus
These may be spontaneous or may ensue from the passage of an instrument, or foreign body, or of both combined, as exemplified in the blind attempts to remove a foreign body or to push it downwards. Digestion of the esophagus and perforation may resu... Safety-pin Closer
There are a number of methods for the endoscopic removal of open safety-pins when the point is up, one of which is by closing the pin with the instrument shown in Fig. 37 in the following manner. The oval ring is passed through the endoscope until i... Scald Head
of children, where there is a discharge of yellow and watery pus from the sores, and the eruption extends to the ears or face, like the disease called the _crusta lactea_ (milk crust), the same washes as for itch, are the most effectual, while at th... Scarlatina Anginosa Or Sore-throat Scarlet-fever
Wherever the _throat_ is affected, which is almost always the case, the disease is called _scarlatina anginosa_, or _sore-throat scarlet-fever_. This is the form described at the commencement of this article. There are several varieties, however, of... Scarlatina Miliaris
Sometimes the red patches of the rash are covered with small vesicles of the size of mustard-seed, which either dry up or discharge a watery liquid, leaving thin white scurfs, that come away with the cuticle during desquamation. Although this form, ... Scarlatina Simplex Or Simple Scarlet-fever
In the _mildest form_ of the disease, called _scarlatina simplex_, or _simple scarlet-fever_, there is no inflammation of the throat, the fever is moderate, and the patient suffers very little. Unfortunately this form is so rare, that many experienc... Scarlatina Sine Exanthemate
There are also mild cases of scarlet-fever, when little or no rash appears, and the throat is very little affected. These are the result of a particularly mild character of the epidemy, together with a peculiar condition of the skin, the desquamatio... Scarlet Fever
This fever assumes two principal forms: Simple or mild, and Malignant. In the _Simple form_, there is great heat of the surface, extremely quick and frequent pulse, headache, and some sense of pain and soreness in the throat. After a day or two, the... Scarlet-fever Or Scarlatina
is an eruptive fever, produced by a peculiar contagious poison, and distinguished by extreme heat, a rapid pulse, a severe affection of the mucous membranes, especially those of the mouth and throat, and by a burning scarlet eruption on the skin. ... Sciatica
This is neuralgia in an ischiatic nerve, commonly the great ischiatic. Use the B D current, strong as the patient can well bear. Place the foot in warm water with N. P., or place the sponge-roll N. P. at the sole of the foot, (the former is the be... Sea-sickness
_Nux Vomica_ should be used once in about four hours, for twelve hours before sailing, as a preventive to sea-sickness. If, however, symptoms, such as dizziness or blur before the eyes, and headache, begin to come on, a dose of _Nux_ should be tak... Second Stage
The spatular end of the laryngoscope should now be tipped back toward the posterior wall of the pharynx, passed posterior to the epiglottis, and advanced about 1 cm. The larynx is now exposed by a motion that is best described as a suspension of the... Secondary Eliminations Are Disease
However the exact form the chain from irritation or malnutrition to enervation progresses, the ultimate result is an increased level of toxemia, placing an eliminatory burden on the liver and kidneys in excess of their ability. Eventually these orga... Self-consciousness
SELF-CONSCIOUSNESS may be truly defined as a person's inability to get out of his own way. There are, however, some people who are so entirely and absolutely self-conscious that everything they do, even though it may appear spontaneous and i... Self-control
TO most people self-control means the control of appearances and not the control of realities. This is a radical mistake, and must be corrected, if we are to get a clear idea of self-control, and if we are to make a fair start in acquiring i... Sentiment _versus_ Sentimentality
FREEDOM from sentimentality opens the way for true sentiment. An immense amount of time, thought, and nervous force is wasted in sentimentalizing about "being good." With many, the amount of talk about their evils and their desire to overcome them... Shock
The treatment of shock will probably always be unsatisfactory as the cause is so varied, and, although circulatory prostration and vasomotor paresis always constitute the acute condition, the physiologic health of the heart and blood vessels is so v... Signs Of Heart Weakness
It should be remembered that a normal heart may slow to about 60 during sleep, and all nervous acceleration of the pulse may be differentiated during sleep by the fact that if the heart does not markedly slow, there is cardiac weakness or some gener... Simple Dilatation
The term "simple dilatation" may be applied to the dilatation of one or both ventricles when there is no valvular lesion and when the condition may not be called broken compensation. The compensation has been sufficiently discussed. Dilatation of th... Simple Hypertrophy
Like any other muscular tissue, the heart hypertrophies when it has more work to do, provided this work is gradually increased and the heart is not strained by sudden exertion. To hypertrophy properly the heart must go into training. This training...