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Desault used, in 1770, a metallic device developed to break up bladder stones. This half-moon Guaifenesin and Phenylephrine Hcl (Deconex IR Tablets)- Multum like instrument had, in its extremity, a small knife that suited perfectly to tonsils. As he did not make a formal communication when using suchdevice, Desault was left apart (1,2).

Fahnestock, in the United States, 1832, Mackenzie in London, 1880, Brunings in 1908 and Sluder in 1911 in the United States developed similar equipment. Greenfield Sluder, an ENT doctor, in Saint Louis was not the first to use the guillotine-cutter for tonsillectomy, but he published a study, in 1912, in which he affirmed to have reached 99. They all aimed to accomplish surgery as fast as they could, especially in children, for the account of the lack of anesthetic techniques.

Important steps slii the progress of the tonsillectomy were taken using mouth-gap and tongue-depressors, besides the positioning of patient with leaning and suspended head. This position was first described Cyclosporine (Restasis)- FDA Killian in 1920, but only adopted after improvements on anesthesia techniques(1,2).

At the beginning of 20th century, the use of forceps and scalpels resulted in less bleeding(1,2). From 1909, tonsillectomy surgery became a common and safe procedure, when Cohen adopted ligature of bleeding vessels to control perioperative hemorrhage.

It is estimated that in the United States 1,400,000 tonsil surgeries were performed in 1959, around 500,000 in 1979 and 250,000 ones per year in the last decade (1,2). This resulted in thousand of surgeries. Tonsils were, then, removed and, in many cases, when there was Guaifenesin and Phenylephrine Hcl (Deconex IR Tablets)- Multum symptom improvement, so were teeth (1,2,5).

As time went by, due to lack of convincing results and excess of indications, this procedure lost its reputation, and as a consequence it was not recommended even for cases when there was such need.

Therapeutical advance on medicine, especially with the use of antibiotics and improvement on work conditions on public health services and on group medicine also contributed for a reduction on tonsil removal surgery.

The use of all this, Guaifenesin and Phenylephrine Hcl (Deconex IR Tablets)- Multum so surpassed, left a stigma for the tonsillectomy, not very well accepted by some patients and even by some doctors from other areas. As result of surgery immunity acquisition anal oil the virus of poliomyelitis can be slower and greater incidence of the disease in children not vaccinated might occur.

However, it does not modify the occurrence of rheumatic fever, it can reduce outbrakes of hematuria (blood in urine) and proteinuria in kidney diseases and improve conditions of asthmatic bronchitis and allergic rhinitis.

At the current moment, knowing tonsil physiology and physiopathology adenoids tends to balance the correct recommendation of surgery. One of the most famous cases cl mg the one of the first president of the United States, George Washington, who died in 1799 of peritonsillar abscess(4).

In December 1799, George Washington fell ill in the city of Mount Vernon, Virginia, suffering from peritonsillar abscess, presenting dyspnea. He was assisted by three doctors. The newest one, Elisha C. Dick, recommended tracheostomy to improve his breath. The other two doctors' opinion prevailed. They had preferred traditional methods for treatment, such as bleedings. The president died that night, December 14, 1799.

In 1900, William Hunt proved the connection between oral Guaifenesin and Phenylephrine Hcl (Deconex IR Tablets)- Multum and systemic disease. It was already believed in that tonsil infections could cause chronic toxemia and local infections in the joints, heart or kidneys. Studies were performed with partial and total tonsillectomies regarding recurrence of infections (1,2).

At the beginning of 20th century, many authors recommended and performed partial tonsillectomy, but from the third decade of this Guaifenesin and Phenylephrine Hcl (Deconex IR Tablets)- Multum century, the total tonsillectomy became preferential procedure. In 1950 indication for tonsillectomy Guaifenesin and Phenylephrine Hcl (Deconex IR Tablets)- Multum recurrent infections, deafness in childhood, diphtheria, halitosis and others as rheumatism, hoarseness, asthma, malnutrition and fevers of unknown causes (1,2).

Practices and toolsIn 1827 Philip Physick, from Philadelphia, announced an improvement in the method of handle with cotton wire. However this method caused 12 hours of pain and discomfort to patients.

Physick tried another quicker method to perform tonsillectomy. He carried through research with old surgical instruments and found a device called uvulotome, which was originally created in the 16th Guaifenesin and Phenylephrine Hcl (Deconex IR Tablets)- Multum (1,2). Uvulotome was used to remove the uvula. An important aspect of the uvulotome was a circular opening where the uvula was introduced.

Once placed, the uvula was cut off by a zoologischer anzeiger blade. To apply the drawing of the uvulotome in journal of teaching english for specific and academic purposes tonsillectomies, Physick made two modifications in 1828.

First, he enlarged the diameter of Guaifenesin and Phenylephrine Hcl (Deconex IR Tablets)- Multum circular opening. Second, a piece Guaifenesin and Phenylephrine Hcl (Deconex IR Tablets)- Multum hemp wire soaked in oil was placed in the posterior part of the opening to supported tonsil and to obtain a clean cut.

This new instrument was called tonsilotome, which was modified along the time. William Fahnestock incorporated a small hook in order to hold tonsil. Even with an expressive speed increasing of the tonsillectomies, the tonsilotome did not prevent other ENT doctors developed new equipment and techniques to perform surgical procedure.

Gregg Dillinger used to believe that tonsilotome caused hemorrhage and then he developed a method called diathermy. Diathermy was the electric flow use in high frequency to raise tissue temperature.

In this technique a metallic needle-hook was connected to an electric source and inserted in tonsil. The electric flow burnt adjacent tissue this fell after that. The procedure required some sessions for the complete treatment, but it caused little bleeding and less infections (1,2). Even with the sprouting of this technique, the tonsilotome still persisted and continued being used instead of diathermy. New techniques using acid Guaifenesin and Phenylephrine Hcl (Deconex IR Tablets)- Multum and ligatures had also appeared.

However all of them became obsolete when new technologies were developed. From 1913, radiotherapy with x-ray in chronic or hypertrophic tonsillitis started to be recommended instead of surgery for some time, mainly in Europe. The laser of carbon dioxide, introduced in medicine in 1960, proved to better reduce and control bleedings than ruby laser, introduced soon after the World War II.

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