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received a dose of morphine and cocaine, the cough reflex was not affected locally, Lotrel 10 and an extremely irritating cough from which she had suffered for a long time persisted during the entire operation. Case II. A girl aged sixteen referred by Dr. William Dougherty of New York. The girl gave a history of having swallowed a shawl pin some five days before and had no cough or discomfort after it had disappeared. Lotrel 5 A radiographic picture taken by Dr. George S. Dixon showed the pin to be located in the upper cervical region. There was considerable swelling of the neck of the patient and she complained of pain in her throat from an attempted removal before admission. The patient had some difficulty in swallowing. The patient was prepared for an esophagoscopic examination Purchase Lotrel and the spatula esophagoscope was introduced without anesthesia. There was no pin in the larynx. There was a long rip in the cricopharyngeous constrictor and esophageal wall and the swelling we had noted in the neck was due to subcutaneous emphysema, no foreign body was visible. As the pin had dis- Lotrel Cost appeared the patient was sent again to the radio- graphic room and another picture taken of the entire chest and abdomen. The chest plate showed the pin to be lodged in the Buy Lotrel Online left bronchus with Lotrel 510 the point in the upper lobe orifice. As the patient was in a very poor condi- tion from the esophageal rupture no anesthetic was l-iG. .S, — Lotrel Mg (Case I.) X ray picture showing shadow of shawl pin. used. A dose of morphine was administered and the pin was rapidly removed through a seven mm. tube. The point of the pin was in the left upper lobe bronchus, but Lotrel Online it was easily pushed downward after grasping the shaft with forceps and disengaged. The removal of the pin from the bronchus taking three minutes. After the removal of the Discount Lotrel Lotrel Coupon pin the esoph- agus was inspected. October 30, 1920.] LVXAH: FOREIGN BODIES. 655 There was a long slit in the esophagus, the edges of Order Lotrel the wound were covered with a thick slough. A suction tube was introduced into the wound and with a twenty inch vacuum some foul smelling material was removed. The wound was then swabbed with tincture of iodine. As the patient Fig. 4. — Shawl pin in the larynx supposed to be in the upper esophagus. Radiographic plate taken before attempted removal from the esophagus. (Case II.) had Cheap Lotrel been unable to swallow for the past twenty- four hours and was suttering from water hunger, milk and water were injected by syringe into the stomach through the esophagoscope. A soft rubber stomach tube was then introduced and the patient fed by the sj'ringe method through the proximal end of the tube which extended out of her mouth. The tube was attached to the neck by tape to prevent its becoming dislodged and swallowed. By this time there was marked emphysema of the neck and face and the temperature had risen to 103.2" F. Buy Lotrel The pulse was weak and rapid. The patient was at all times conscious, and her chief complaint was a severe stabbing pain in the region of the sternum on Lotrel 5 Mg inspi- ration. There was a booming systolic heart sound over the entire precordial Lotrel Price region. The second soimd could not be elicited. Scattered rales were elicited over the anterior aspect Lotrel Coupons of the chest, but these were probably due Lotrel 20 Mg to the crackles of the subcutaneous emphysema in this area. The following day after a thorough dose of the water cure treatment, the patient requested that the tube be removed. This was done Lotrel 10 Mg and the wound in the esophagus was again swabbed with iodine after thorough evacuation of the pocket. The feeding tube was then replaced. This treatment was continued from day to day and by the end of the first week the patient showed signs of improvement. The temperature was 101.4°, pulse 110 and regular and respirations 32. There was a pleuritic rub over the -region of the sternum but the heart sounds could be distinctly heard. By the tenth day the patient continued to show improve- ment but strenuously objected to the Lotrel 10 20 method of feeding. The esophagoscope was passed and the wound inspected. The woimd had almost com- pletely healed but there was still an inflammatory

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