Taking A Laryngeal Specimen For Diagnosis
Categories: DIRECT LARYNGOSCOPY 2Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The diagnosis of
carcinoma, sarcoma, and some other conditions can be made certain only
by microscopic study of tissue removed from the growth. The specimen
should be ample but will necessarily be small. If the suspected growth
be small it should be removed entire, together with some of the basal
tissues. If it is a large growth, and there are objections to its
entire removal, the edge of the growth, including apparent
well as neoplastic tissue, is necessary. If it is a diffuse
infiltrative process, a specimen should be taken from at least two
locations. Tissue for biopsy is to be taken with the punch forceps
shown in Fig. 28 or that in Fig. 33. The forceps may be inserted
through the tube or from the angle of the mouth; the extubal method
(see Fig. 58).
[FIG. 58.--Schema illustrating removal of a tumor from the upper part
of the larynx by the author's extubal method for large tumors. The
large alligator basket punch forceps, F, is inserted from the right
corner of the mouth and the jaws are placed over the tumor, T, under
guidance of the eye looking through the laryngoscope, L. This method
is not used for small tumors. It is excellent for amputation of the
epiglottis with these same punch forceps or with the heavy snare.]
Removal of large benign tumors above the cords may be done with the
snare or with the large laryngeal punch forceps. Both are used in the
extubal method.
Amputation of the epiglottis for palliation of odynophagia or
dysphagia in tuberculous or malignant disease, is of benefit when the
ulceration is confined to this region; though as to tuberculosis the
author feels rather conservatingly inclined. Early malignancy of the
extreme tip can be cured by such means. The function of the epiglottis
seems to be to split the food bolus and direct its portions laterally
into the pyriform sinuses, rather than to take any important part in
the closure of the larynx. Following the removal of the epiglottis
there is rarely complaint of food entering the larynx. The projecting
portion of the epiglottis may be amputated with a heavy snare, or by
means of the large laryngeal punch forceps (Fig. 33).
More
-
Specular Esophagoscopy
Inspection of the hypopharynx and upper esophagus is readily made with the esophageal speculum shown in Fig. 4. High lesions and foreign bodies lodged behind the larynx are thus discovered with ease, and such a condition as a retropharyngeal absces... Spermatorrhea
The points to be gained are, to reduce the action of the amatorial organs of the brain and the secretion of the testes, and to contract and strengthen the tissue of the seminal vesicles and the prostrate gland. Take the B D current. First, treat ... Sponge-pumping
While the usually thin, watery esophageal and gastric secretions, if free from food, are readily aspirated through a drainage canal, the secretions of the bronchi are often thick and mucilaginous and aspirated with difficulty. Further-more, bronchia... Stage 2
Passing the cricopharyngeus is the most difficult part of esophagoscopy, especially if the patient is unanesthetized. Local anesthesia helps little, if at all. The handle of the esophagoscope is still pointing upward and consequently we are sure tha... Stage 3 Passing Through The Thoracic Esophagus
The thoracic esophagus will be seen to expand during inspiration and contract during expiration, due to the change in thoracic pressure. The esophagoscope usually glides easily through the thoracic esophagus if the patient's position is correct. Af... Stage 4 Passing Through The Hiatus Esophageus
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... Stage I Entering The Right Pyriform Sinus
The operator standing (as in Fig. 66), inserts the esophagoscope along the right side of the tongue as far as and down the posterior pharyngeal wall. A lifting motion imparted to the tip of the esophagoscope by the left thumb will bring the rounded... Starches
Sources of Starch. The starches are valuable and wholesome foods. They form the largest part, both in bulk and in fuel value, of our diet, and have done so ever since man learned how to cultivate the soil and grow crops of grain. The reason is clear... Starvation
It is true that ethical medical doctors use the least-risky procedure they are allowed to use. But this does not mean there are no risks to allopathic treatment. The medical doctor justifies taking the risks by saying that the risk/reward ratio is t... Stings Of Insects
The effect produced by the sting of Bees, Wasps, and Hornets of all kinds, is so nearly, if not quite identical, that I shall make no distinction between them. There are very few, if any persons, who do not know the symptoms, at least the local effe... Stokes Adams Disease Heart Block
Stokes-Adams disease, or the Stokes-Adams syndrome, is a name applied to a combination of symptoms which was described by Stokes in 1846, and had been observed by Adams in 1827. The disease is characterized by bradycardia and cerebral attacks, eithe... Stokes Adams Treatment
The treatment of true Stokes-Adams disease is unsuccessful. If general arteriosclerosis is present, that condition should be treated. Digitalis would seem almost invariably contraindicated, although it is of value in extrasystoles without heartblock... Strabismus Discordance Of The Eyes
If neither of the rectus muscles have been cut and cicatrized, and if the deformity be not congenital, it may ordinarily be cured. Take B D current, with small pointed electrodes. If the eye be turned inward, insert P. P. in the outer angle of the... Strychnin
The question of the advisability of strychnin is a constant subject for discussion. Strychnin is overused in the cases of most patients who are seriously ill. In a patient in whom we are trying to cause nervous and muscular rest, strychnin is certai... Styptic Charms
Fancy can save or kill; it hath closed up wounds, when the balsam could not, and without the aid of salves, to think hath been a cure. CARTWRIGHT. With bandage firm Ulyss... Sudden Invasion Of The Nervous Centres
Of the different forms of scarlatina maligna the most dangerous is the sudden invasion of the nervous system, particularly the _brain_, the _cerebellum_ and the _spine_, by which the patient's life is sometimes extinguished in a few hours. In other ... Sugars
Where Sugar is Obtained. The other great member of the starch, or carbohydrate, group of foods is sugar. This is a scarcer and more expensive food than starch because, instead of being found in solid masses in grains and roots like starch, it is sca... Suggestions For The Control Of Athletics
1. Gymnasiums and athletic grounds in connection with all colleges, preparatory schools, seminaries and high schools are essential, and they should be added to grammar schools whenever possible. 2. Physical training and athletic games, and perhaps... Suppression Of The Menses Amenorrhoea
For sudden suppression from taking cold, as by wetting the feet, there being headache, more or less fever, the pulse frequent and variable, pains in the small of the back and cramp like pains in the pelvic region, give, in alternation, _Aconite_ a... Sympathy
SYMPATHY, in its best sense, is the ability to take another's point of view. Not to mourn because he mourns; not to feel injured because he feels injured. There are times when we cannot agree with a friend in the necessity for mourning or feeling in... Symptomatology And Diagnosis Of Foreign Bodies In The Air And Food Passages
Initial symptoms are choking, gagging, coughing, and wheezing, often followed by a symptomless interval. The foreign body may be in the larynx, trachea, bronchi, nasal chambers, nasopharynx, fauces, tonsil, pharynx, hypopharynx, esophagus, stomach, ... Symptomatology And Treatment Of Chronic Valvular Lesions
Before discussing the treatment of broken compensation in general, it may be well to describe briefly the differences in the symptoms and treatment of the various valvular lesions. ... Symptoms
In hypertension, as long as the heart, which is probably hypertrophied, remains perfectly competent, there are few symptoms, and the person does not seek advice until he notices one or more of several possible conditions. He may be dizzy, his head m... Symptoms
The symptoms are increased tension, which means, sooner or later, hypertrophy of the left ventricle and an accentuated closure of the aortic valve. This alone means more and more tendency to aortic irritation and aortic valve irritation, with inflam... Symptoms
Malignant disease of the esophagus is rarely seen early, because of the absence, or mildness, of the symptoms. Dysphagia, the one common symptom of all esophageal disease, is often ignored by the patient until it becomes so marked as to prevent the ... Symptoms
Dysphagia is the most frequent complaint in cases of esophageally lodged foreign bodies. A very small object may excite sufficient spasm to cause aphagia, while a relatively large foreign body may be tolerated, after a time, so that the swallowing f... Symptoms And Signs Of Cardiac Disturbance
It is now recognized that any infection can cause weakness and degeneration of the heart muscle. The Streptococcus rheumaticus found in rheumatic joints is probably the cause of such heart injury in rheumatism. That prolonged fever from any cause in... Symptoms Of Gastric Foreign Body
Foreign body in the stomach ordinarily produces no symptoms. The roentgenogram and the fluoroscopic study with an opaque mixture are the chief means of diagnosis. ... Symptoms Of Laryngeal Foreign Body
1. Initial laryngeal spasm followed by wheezing respiration, croupy cough, and varying degrees of impairment of phonation. 2. Pain may be a symptom. If so, it is usually located in the laryngeal region, though in some cases it is referred to the... Symptoms Of Prolonged Foreign Body Sojourn In The Bronchus
1. The time of inhalation of a foreign body may be unknown or forgotten. 2. Cough and purulent expectoration ultimately result, although there may be a delusive protracted symptomless interval. [130] 3. Periodic attacks of fever, with chills ... Symptoms Of Tracheal And Bronchial Foreign Body
1. Tracheal foreign bodies are usually movable and their movements can usually be felt by the patient. 2. Cough is usually present at once, may disappear for a time and recur, or may be continuous, and may be so violent as to induce vomiting. I... Take Care Of Your Stomach
WE all know that we have a great deal to do. Some of us have to work all day to earn our bread and butter and then work a good part of the night to make our clothes. Some of us have to stand all day behind a counter. Some of us have to sit a... Taking A Laryngeal Specimen For Diagnosis
The diagnosis of carcinoma, sarcoma, and some other conditions can be made certain only by microscopic study of tissue removed from the growth. The specimen should be ample but will necessarily be small. If the suspected growth be small it should b... Talismans
A talisman may be described as an emblematical object or image, accredited with magical powers, by whose means its possessor is enabled to enlist the aid of supernatural beings. Frequently it is a precious stone, sometimes a piece of metal or parc... Technic
It is essential that the patient on whom the examination is to be made should be at rest, either comfortably seated, or lying down. All clothing should be removed from the arm, and there should be no constriction by sleeves, either of the upper arm ... Technic
The patient should be placed in the recumbent position, with the extended head held in the midline by an assistant. The shoulders, not the neck, should be slightly raised with a sand bag. The head should be somewhat lower than the feet, to lessen th... Technic For General Anesthesia
For esophagoscopy and gastroscopy, if general anesthesia is desired, ether may be started by the usual method and continued by dropping upon folded gauze laid over the mouth after the tube is introduced. Endo-tracheal administration of ether is, ho... Technic Of Bronchoscopy
Local anesthesia is usually employed in the adult. The patient is placed in the Boyce position shown in Fig. 51, with head and shoulders projecting over the edge of the table and supported by an assistant. The glottis is exposed by left-handed laryn... Technic Of Laryngeal Operations
Preparation of the patient and anesthesia have been mentioned under their respective chapters. The prime essential of successful laryngeal operations is perfect mastery of continuous left-handed laryngeal exposure. The right hand must be equally tr... Technic Of Specular Esophagoscopy
Recumbent patient. Boyce position. The larynx is to be exposed as in direct laryngoscopy, the right pyriform sinus identified, the tip of the speculum inserted therein, and gently insinuated to the cricopharyngeal constriction. Too great extension ... Technicalities Of The Pack And Bath
Let me give you its technicalities, and the rationale of its action: A linen sheet, (linen is a better conductor than cotton,) large enough to wrap the whole person of the patient in it (not too large, however; if there is no sheet of proper size,... Teething Of Children
Affections arising from teething of children, are often of a serious character. The most prominent of which is _Diarrhoea_. _Fever_ frequently accompanies the diarrhoea, and _convulsions_ occasionally occur. _Aconite_ and _Chamomilla_ should be used... Telephones And Telephoning
MOST men--and women--use more nervous force in speaking through the telephone than would be needed to keep them strong and healthy for years. It is good to note that the more we keep in harmony with natural laws the more quiet we are forc... Temperature Of The Sick-room
The _temperature of the sick-room_ should not be much above 65 deg. Fahrenheit; in no case should it rise above 70, whilst I do not see the necessity of keeping it below 60, as some hydriatic physicians advise. The patient, in the heat of fever, wil... Temperature Of The Water Double Sheet Changing Sheet
The water for the wet-sheet pack, in this violent form, ought to be cold; in summer it should be iced down to 46-48 deg. Fahr. The sheet ought to be coarse or doubled, in order that it should retain more water, and it should not be wrung out very ti... Testing For Electric Defects
These tests should be made beforehand; not when about to commence introduction. If the first lamp lights up properly, use it with its light-carrier to test out the other cords. If the lamp lights up, but flickers, locate the trouble before att... Tests
ADOPTING the phrase of our forefathers, with all its force and brevity, we say, "The proof of the pudding is in the eating." If the laws adduced in this book are Nature's laws, they should preserve us in health and strength. And so they do... Tests Of Heart Strength
If both systolic and diastolic blood pressure are taken, and the heart strength is more or less accurately determined, mistakes in the administration of cardiac drugs will be less frequent. Besides mapping out the size of the heart by roentgenoscopy... Tetanus
This is substantially the same thing as trismus, except that it extends to other parts, and often to nearly all the muscles of the organism. Under ordinary treatment, it is almost invariably fatal. I am not aware that it has been sufficiently submit... The Ammonium Carbonicum
recommended by Peart, has been considered by many as a specific capable of neutralizing the scarlatinous poison, whilst others have used it only as a powerful tonic in torpid cases. Experience has shown that it is not a specific, and that its use as... The Anti-gastric Method
consisting in the free use of emetics or purgatives, has been recommended by some eminent practitioners. Withering, Tissot, Kennedy and others are in favor of the former, and find fault with the latter, whilst Hamilton, Willard, Abernethy, Gregory, ... The Blood Vessels
Where the Body Does its Real Eating. When once the food has been dissolved in the food-tube and absorbed by the cells of its walls, the next problem is how it shall be sent all over the body to supply the different parts that are hungry for it; for ... The Blood-mesh Of The Skin
The Blood Vessels under the Skin. Not merely the nails and the lips, but the whole surface of the skin is underlaid with a thick mat, or network, of blood vessels. These vessels are all quite small, so that a cut has to go down completely through th... The Blue-glass Mania
As illustrative of the power of the imagination, the so-called blue-glass mania, which prevailed extensively in this country, affords a striking example. About the year 1868, General Augustus J. Pleasanton, of Philadelphia, made some experiments t... The Brain In Its Direction Of The Body
WE come now to the brain and its direction of other parts of the body. What tremendous and unnecessary force is used in talking,--from the aimless motion of the hands, the shoulders, the feet, the entire body, to a certain rigidity of car... The Care Of An Invalid
TO take really good care of one who is ill requires not only knowledge but intelligent patience and immeasurable tact. A little knowledge will go a great way, and we do not need to be trained nurses in order to help our friends to bear the... The Care Of The Heart-pump
The Effect of Work upon the Heart. Whatever else in this body of ours may be able to take a rest at times, the heart never can. When it stops, we stop! Naturally, with such a constant strain upon it, we should expect it to have a tendency to give wa... The Cause Of Disease
Ever since natural medicine arose in opposition to the violence of so-called scientific medicine, every book on the subject of hygiene, once it gets past its obligatory introductions and warm ups, must address The Cause of Disease. This is a require... The Central Point Of The Circuit
The central point of the circuit--that point which divides between its positive and negative halves--is reckoned, in practice, to be the midway point in the line over which the current passes, in its whole course from the positive post around to the... The Child As An Ideal
WHILE the path of progress in the gaining of repose could not be traced thus far without reference to the freedom of a baby, a fuller consideration of what we may learn from this source must be of great use to us. The peace and freshness ... The Circumstances Of Life
IT is not the circumstances of life that trouble or weigh upon us, it is the way we take them. If a man is playing a difficult game of chess, the more intricate the moves the more thoughtfully he looks over his own and his opponent's men, an... The Coal Foods
Kinds of Coal Foods. There are many different kinds of Coal foods, such as pork, mutton, beef, bread, corn-cakes, bacon, potatoes, rice, sugar, cheese, butter, and so on. But when you come to look at them more closely, and to take them to pieces, ... The Confusions About Diets And Foods
Like my daughter, many people of all ages are muddled about the relationship between health and diet. Their confusions have created a profitable market for health-related information. And equally, their confusions have been created by books, magazin... The Contagion Of Scarlatina Very Active
The _contagion_ of scarlatina is very active, and adheres for a long time to the sick-room, bedding, clothes and furniture. The best means to destroy it, is plenty of air. It is difficult to say when the contagion is over, as much depends on the sea...