Perhaps the best procedure is to precede medicinal applications by the
clearing out of the purulent secretions by aspiration with the
aspirating bronchoscope and the independent aspirating tube, the
latter being inserted into passages too small to enter with the
bronchoscope, and the endobronchial instillation of from 10 to 30 cc.
of the medicament. The following have been used: Argyrol, 1 per cent
watery solution; Silvol, 1 per cent watery solution; Iodoform, oil
emulsion 10 per cent; Guaiacol, 10 per cent solution in paraffine oil;
Gomenol, 20 per cent solution in oil; or a bismuth subnitrate
suspension in oil. Robert M. Lukens and William F. Moore of the
Bronchoscopic Clinic report excellent results in post-tonsillectomy
abscesses from one tenth of one per cent phenol in normal salt
solution with the addition of 2 per cent Lugol's solution. Chlorinated
solutions are irritating, and if used, require copious dilution.
Liquid petrolatum with a little oil of eucalyptus has been most often
the medium.
_Gangrene of the Lung_.--Pulmonary gangrene has been followed by
recovery after the endobronchial injection of oily solutions of
gomenol and guaiacol (Guisez). The injections are readily made through
the laryngoscope without the insertion of a bronchoscope. A silk woven
catheter may be used with an ordinary glass syringe or a long-nozzled
laryngeal syringe, or a bronchoscopic syringe may be used.
_Lung-mapping_ by a roentgenogram taken promptly after the
bronchoscopic insufflation of bismuth subnitrate powder or the
injection of a suspension of bismuth in liquid petrolatum is advisable
in most cases of pulmonary abscess before beginning any kind of
treatment.
_Bronchial Stenosis_.--Stenosis of one or more bronchi results at
times from cicatricial contraction following secondary infection of
leutic, tuberculous or traumatic lesions. The narrowing resulting from
foreign body traumatism rarely requires secondary dilatation after the
foreign body has been removed. Tuberculous bronchial stenoses rarely
require local treatment, but are easily dilated when necessary. Luetic
cicatricial stenosis may require repeated dilatation, or even
bronchial intubation. Endobronchial neoplasms may cause a subjacent
bronchiectasis, and superjacent stenosis; the latter may require
dilatation. Cicatricial stenoses of the bronchi are readily
recognizable by the scarred wall and the absence of rings at or near
the narrowing.
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