Operazioni toracoplastiche nel trattamento della tubercolosi polmonare

Operazioni toracoplastiche nel trattamento della tubercolosi polmonare

March, 1937] SURGERY OF CttEST 271 ABSTRACTS. S U R G E R Y OF T H E CHEST. PETERS, L. S., and CORNISH, P. G. Results in Intrapleural Pneumolysis...

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March, 1937]

SURGERY

OF CttEST

271

ABSTRACTS. S U R G E R Y OF T H E CHEST. PETERS, L. S., and CORNISH, P. G. Results in Intrapleural Pneumolysis. Amer. Rer. Timber., 1936, 3~i, 44. In this paper the writers review in retrospect twenty-three years of artificial pneumothorax treatment. At the beginning of this period the treatment was adopted in less than 5 per cent. of the patients, but at present compression therapy in some form is given to some 30 per cent. A pncumothorax cau only be called successful if it has effccted closure of cavities and rendered the sputum free of tubercle bacilli. Short of this, it is waste of time to drag out a partial collapse over months and years. The medical profession is slow to learn the value of a satisfactory collapse, and the writers lament the fact that so few pneumothorax workers are availing themselves of intrapleural pneumolysis, although it is a method that converts over 78 per cent. of partial collapse into total collapse cases, turning failure into success for the patients. During the past seven years the writers have given artificial pueumothorax to 244 patients, of whom more than 60 per cent. obtained a complete collapse. Of the remainder, 9 per cent. were found on thoracoscopy to be unsuitable for operation, leaving 88 cases for pueumolysis. Of ~hese, 69, or 78 per cent., were converted into successful collapse with cavity closed; 9 per cent. showed clinical improvement, and 6 per cent. no improvement. TWo patients bled rather freely, hut the bleeding was controlled, and one patient died the day of operation, death in this case being thought ~o be due to embolism, or possibly to a mechanical interference with the heart. For the last three years the writers have used thee electrosurgical method, with the result that there is much less tluid formation and bleeding is less liable to occur. The eight cases which showed clinical improvement without cavity closure doubtless attained this through better compression of infiltrative areas around the cavity, and in all these other forms

of compression were ultimately advised. Six of the 88 pneumolysis cases developed a natural pneumothorax, but, of these, one was a case operated on seven years ago which looked suitable from an X-ray standpoint, but further experience, using the thoracoscope for exploration, would have shown the case to be unsuitable. In two of the other cases the natural pneumothorax developed two months after the operation, so that the pneumolysis was not necessarily responsible. BANKOFF, G. Operazioni toracoplastiche nel trattamento della tubercolosi polmonare. Riv. di Patol. e Clin. d. T~tbercolosi, 1936, t0, 111. The writer, who records 16 illustration cases in patients aged from 23 to 38, comes to the following conclusions. In an attempt to determine the results obtained by thoracoplasty in the treatment of pulmonary tuberculosis it should not be forgotten that patients with chronic tuberculous cavities in the lungs are not condemued to immediate and absolute invalidism. Experience in any large town brings the practitioner into contact with persons who have been engaged in laborious occupations for many years in spite of their having pulmonary cavities and tubercle bacilli in their sputum. Several of these. patients who had contracted the disease in their twenties reach the age of i0, 50, or 60 before having an acute attack. If a patient presents few or no symptoms before operation, the satisfactory result should not necessarily be attributed tosurgical intervention. A postoperative mortality of 9 per cent. (3 deaths among 33 cases) in less titan twenty days after the operation and of 9,5 per cent. (10 deaths among 40 cases) in less than a year after the operation is higher than that found with any other mode of treatment or in untreated cases which are in a fit state to undergo an operation. The author's impression is that if his patients had undergone ,~ more suitable treatment or even if they had been left untreated, the results would have been much better.