Artificial Pneumoperitoneum Research Articles

The Clinical Picture and Developmental Mechanism of Acute Appendicitis Complicating Artificial pneumoperitoneum.

The Clinical Picture and Developmental Mechanism of Acute Appendicitis Complicating Artificial pneumoperitoneum.

Artificial pneumoperitoneum in the treatment of pulmonary tuberculosis.

Since the pioneer efforts of Banyai6 there have emerged only a few reports up to relative recency. Since 1947 publications by Mitchell et al.,’ Trimble et al.,8 Hurst et al.’4 and several others have contributed notably to further clarification of the results which have been consistently good, particularly in the face of many instances of far advanced disease wherein prognosis once was held as being hopeless. The dilemna of having to tell a patient “nothing can be done” is partially solved through the use of pneumoperitoneum. Though so much remains yet to be done, it cannot be denied that artificial pneumoperitoneum offers new hope to many, either by itself or preparatory to surgery. Yet as many enthusiasts as there are, there are some who doubt its efficacy and rightful place in the treatment of pulmonary tuberculosis, except in a few rigidly select cases. In our experience it has proved useful and often life-saving in a rather wide variety of cases to which other forms of collapse were not readily adaptable. Mitchell and his co-workers’ conducted an exhaustive survey of the literature from 1937 to 1945 and found that those men who had employed artificial pneumoperitoneum in a large series obtained favorable results. In the smaller group of unfavorable reports it was noted that the largest single group of cases studied was only 50 cases. The largest number of cases in a single report were published by Crow and his co-workers.9 Of 546 cases they obtained good results in 60 per cent with the period of observation ranging up to five years. The authors have reviewed the literature in the past three years (1946-1948) and have found several noteworthy contributions. In 1946 Aslett and Jarman’8 reported favorable results In 42 cases, the majority of which were far advanced. During this same year Banyai’s6 monumental work on pneumoperitoneum was published. In 1947 Mitchell et al.’ published their notable paper. They received satisfactory results in 57 per cent of white and 37 per cent of colored patients with advanced pulmonary tuberculosis not amenable to conventional forms of collapse therapy. Hurst and his co-workers’4 reported results on 103 cases in which phrenic crush was an adjunct to the pneumoperitoneum. Gilmore’ found

Carbon-dioxide intoxication in emphysema: emergency treatment by artificial pneumoperitoneum.

WHEN oxygen is administered to a patient with chronic anoxemia, an elevation of the carbon-dioxide content and combining power of the blood usually occurs. In patients with marked pulmonary emphysema and fibrosis, this elevation is occasionally of profound degree, and a characteristic sequence of events ensues. The features of the clinical syndrome are headache, cutaneous vasodilatation, irrationality, stupor and coma. It is thought that these manifestations are due to carbon-dioxide intoxication. The chain of events leading to carbon-dioxide retention is believed to be as follows: removal of the anoxemic stimulus to respiration by the administered oxygen, reduced pulmonary ventilation, increase . . .

Streptomycin and Artificial Pneumoperitoneum in the Treatment of Pulmonary Tuberculosis

An analysis is made of the results obtained in the treatment of 117 patients with streptomycin and pneumoperitoneum combined and with pneumoperitoneum alone. None of them was subjected to surgical paralysis of the phrenic nerve. The damage to the drainage mechanism of the lungs and bronchial tree following the development within the lungs of irreparable pathological changes and the role of streptomycin and pneumoperitoneum in the restoration of this drainage mechanism are discussed. The sooner collapse by means of pneumoperitoneum is accomplished before cavity and advanced irreparable pathological changes develop in the lung, the more adequate will be the end results. Length of treatment with pneumoperitoneum is important in determining the eventual outcome of the case, but the extent and character of the disease at the beginning of treatment are the deciding factors in determining this.

On the Transition of Intra-abdominal Pressure by Artificial Pneumoperitoneum

On the Transition of Intra-abdominal Pressure by Artificial Pneumoperitoneum

Rupture of the diaphragm as a cause of spontaneous pneumothorax complicating artificial pneumoperitoneum

Rupture of the diaphragm as a cause of spontaneous pneumothorax complicating artificial pneumoperitoneum

Artificial Pneumoperitoneum in the Treatment of Pulmonary Emphysema: A Preliminary Report

1) The use of artificial pneumoperitoneum in the treatment of pulmonary emphysema may provide impressive symptomatic relief. Its use in seven patients is described. 2) Exercise tolerance and vital capacity may increase significantly following this procedure. 3) The physiological basis for the use of artificial pneumoperltoneum in pulmonary emphysema is discussed.

Artificial pneumoperitoneum in the treatment of pulmonary emphysema: preliminary report

Artificial pneumoperitoneum in the treatment of pulmonary emphysema: preliminary report

Artificial pneumoperitoneum complicated by pregnancy.

Artificial pneumoperitoneum complicated by pregnancy.

Artificial Pneumoperitoneum Associated with Strangulated Hernia and Scrotal Pneumoccle

Artificial Pneumoperitoneum Associated with Strangulated Hernia and Scrotal Pneumoccle

X-Ray visualization of the placenta: Experiences with soft-tissue and cystographic techniques in the diagnosis of placenta previa

It is an established fact that the placenta can be visualized in soft-tissue x-ray films in over 90 per cent of all women who are in the third trimester of pregnancy. This was forecast by Speidel and Turner1 in 1924. In a paper dealing chiefly with x-ray visualization of the uterus and adnexa with the aid of artificial pneumoperitoneum, they stated: “It should be possible, by means of the roentgenogram, by the relation that the head of the fetus bears to the lower segment of the uterus, to determine the degree of encroachment of the placenta upon the internal os, and whether we have a central, lateral, or marginal placenta previa.”During the past several years at the Boston Lying-in Hospital we have made x-ray studies of all cases of uterine bleeding and of transverse or oblique position of the fetus occurring during the third trimester of pregnancy. The purpose of this paper is to report our experience regarding the x-ray diagnosis of placenta previa through the use of the soft-tissue technique introduced by Snow and Powell2 and the cystographic method first described by Ude, Weum, and Urner3.

Pneumomediastinum complicating artificial pneumoperitoneum

An example is described of pneumomediastinum complicating induction of artificial pneumoperitoneum. Precordial pain, diminished cardiac dullness and a crackling murmur accompanying the heart beat were the presenting features. The difficulty in distinguishing this condition from pneumopericardium on radiographic examination is noted.

Pneumoperitoneum and Phreniclasia in the Treatment of Pulmonary Tuberculosis Therapeutic Observations in 550 White and Negro Cases

1) A therapeutic review of 550 patients with pulmonary tuberculosis, treated by a combination of temporary phrenic nerve interruption and pneumoperitoneum, has been presented. 2) The physiology, indications, and complications have been stated. 3) The technique of the procedure of pneumoperitoneum has been outlined. 4) It is of value in preparing the patient for thoracoplasty. 5) This method of treatment is capable of effecting a cure in many cases which unquestionably are not suitable either for pneumothorax or thoracoplasty. 6) Cavity closure occurs equally as well at the apex as in the basal portion of the lung. 7) In 134 far advanced white patients treated for six months or more, 106, or 79 per cent converted their sputum. Cavity closure occurred in 80 cases, or 72 per cent. In the far advanced 76 negro patients, 56 or 73 per cent converted their sputum; cavity closure occurred in 37, or 67 per cent. In the more favorably selected cases, the results were more impressive. 8) The duration of treatment parallels that required by other types of collapse therapy. 9) The importance of maximum elevation of the diaphragm is emphasized. 10) Artificial pneumoperitoneum combined with phrenic crush has been found a valuable treatment; it avoids the serious complications of artificial pneumothorax and gives to many patients, hopelessly ill, their chance to recover.

The Rationale of Therapeutic Pneumoperitoneum: Physiological and Mechanical Considerations

An attempt has been made to clarify some of the physiological and mechanical changes resulting from artificial pneumoperitoneum. The rationale of successful artificial pneumoperitoneum therapy is discussed. Two salient factors appear to be: (1) the initial rise of intrapleural pressure resulting from intraperitoneal injection of air, and (2) the compensatory return of the intrapleural pressure to normal between refills. The response of apical disease to this therapy is considered in contrast to disease elsewhere in the lungs. The role of phrenic nerve crush as an adjunct to pneumoperitoneum therapy is briefly considered. β) Abdominal binders are evaluated. Vital capacity and cardiac changes during artificial pneumoperitoneum therapy are discussed. Some of the reasons for weight gain and weight loss during this therapy are presented. In many institutions for the tuberculous, artificial pneumoperitoneum has become a recognized method of collapse therapy. Contrary to considered medical judgement regarding possible harmful physiological changes resulting from its use, it has been shown that the complications and physiological alterations resulting from this therapy are by no means as serious as anticipated. Norburn Clinic, Asheville, North Carolina.

Scrotal pneumocele and inguinal hernia complicating pneumoperitoneum therapy

Summaryo1.Three cases of scrotal pneumocele and one case of inguinal hernia during artificial pneumoperitoneum therapy have been described.2.In only one of these cases was the phenomenon associated with induction (Case 1). In another (Case 2) it was associated with a larger than normal air injection, and in another (Case 4) with a larger than normal volume for induction purposes. In Case 3 it was apparantly of incidental occurrence.3.In agreement with Rogers and Garrett the writer has found that scrotal pneumocele is transient and does not necessarily indicate abandonment of the treatment.4.While it is impossible in such a short series and by the very nature of the condition to state dogmatically that scrotal pneumocele and inguinal hernia occurring during pneumoperitoneum therapy is the enlargement of a previously existing embryological remnant of the processus vaginalis, one of the cases (Case 1) had a contralateral congenital hernia, and it is felt that all patients upon whom pneumoperitoneum induction is contemplated should be examined carefully for hernia as a preliminary measure. Three cases of scrotal pneumocele and one case of inguinal hernia during artificial pneumoperitoneum therapy have been described. In only one of these cases was the phenomenon associated with induction (Case 1). In another (Case 2) it was associated with a larger than normal air injection, and in another (Case 4) with a larger than normal volume for induction purposes. In Case 3 it was apparantly of incidental occurrence. In agreement with Rogers and Garrett the writer has found that scrotal pneumocele is transient and does not necessarily indicate abandonment of the treatment. While it is impossible in such a short series and by the very nature of the condition to state dogmatically that scrotal pneumocele and inguinal hernia occurring during pneumoperitoneum therapy is the enlargement of a previously existing embryological remnant of the processus vaginalis, one of the cases (Case 1) had a contralateral congenital hernia, and it is felt that all patients upon whom pneumoperitoneum induction is contemplated should be examined carefully for hernia as a preliminary measure.

Scrotal pneumocele as a transient complication of artificial pneumoperitoneum

A case of scrotal pneumocele after induction of pneumoperitoneum is reported. The treatment was continued without recurrence after the pneumocele had reabsorbed spontaneously. The mechanism of production is discussed and it is suggested that a traumatic opening of an anomalous processus vaginalis occurs.

Induced Pneumoperitoneum in the Treatment of Advanced Pulmonary Tuberculosis in Children

This series of 42 patients, while not large, seems sufficient for illustration and the following tentative conclusions: Artificial pneumoperitoneum is a mechanical measure that can be safely utilized independently or jointly with some of the other accepted methods of collapse therapy in the treatment of pulmonary tuberculosis in children. In this limited number of cases analyzed, the location of the cavity or cavities had little to do with the effectiveness of pneumoperitoneum. Pneumoperitoneum should be continued in successful cases perhaps for a longer period of time than intrapleural pneumothorax, as the air seems to be absorbed more rapidly in the peritoneal cavity than in the pleural sac. This is especially noticeable when patients are put on physical exercise. The present clinical and economic status of the 10 patients in whom pneumoperitoneum was effective, warrants the conclusion that this measure has a definite but limited place, in carefully selected cases, and that it is effective in the treatment of children suffering from advanced pulmonary tuberculosis with poor prognoses.

Further Experience with Pneumoperitoneum as an Aid in Pelvic Irradiation

Radiation therapy of any part or organ must always take into account the vulnerability of the intervening body tissues. This is especially true in irradiation of the pelvic organs for carcinoma of the cervix. In the past there has been ample evidence of the extreme radiosensitivity of the intestinal mucosa. Animal experiments (1–4) and some clinical reports (5) have attested to this fact. This sensitivity of the intestinal mucosa can readily be verified by including in the same field the intestinal mucosa of a colostomy and the adjacent surrounding skin. If this area is subjected to increasing doses of roentgen radiation, the intestinal mucosa will show a severe reaction, presenting congestion, edema, pseudo-membrane, and mucosal hemorrhages, following doses which produce only a moderate skin erythema. Clinically, this radiosensitivity of the intestines is manifested by colicky abdominal pains, diarrhea, rectal tenesmus, and passage of blood and mucus in the stools. Such reactions are most severe as a result of massive dose x-ray therapy; fortunately, with our present-day divided-dose technic, such reactions are rarely encountered. There can be no doubt, however, concerning the desirability of introducing larger quantities of radiation into the pelvis in the treatment of cancer if vital normal structures can be safeguarded. Experience in the treatment of carcinoma of the cervix indicates this need only too clearly. Radiation therapy can satisfactorily destroy the local cervical lesion in most instances; it is the extension of the malignant disease into the parametrial regions which is most difficult to reach with adequate dosage. The radiation from radium applicators in the cervical canal and vagina rapidly falls off due to the operation of the inverse-square law, so that an adequate lethal dose for carcinoma cells cannot be delivered except for a very short distance into the adnexal regions (6). Likewise, external roentgen radiation applied over these areas in woefully lacking. For these reasons we were led to seek some method by which the radiation delivered into the adnexal regions could be increased. It appeared clear that if in some manner the intestines could be removed from the field of irradiation, greater quantities might be introduced with impunity. Pack and Livingston (7) and others had recommended irradiation of the pelvis with the patient in the Trendelenburg position to cause as much upward displacement of the intestines as possible. There can be no doubt that this position does have a tendency to displace the intestines upward to some degree, but roentgenographic examination with the aid of barium will readily disclose that comparatively little change takes place and that the greater portion of the bowel still remains in the lower abdomen, overshadowing the pelvic structures. The forces of cohesion prevent complete emptying of the structures from the pelvis. Obviously the abdominal cavity must be enlarged to give room for displacement of the intestines if this is to be satisfactorily accomplished. The possibility of artificial pneumoperitoneum for the purpose at once presented itself for consideration (8).

Spontaneous Pneumoperitoneum: A Roentgenologic Sign Found in the Supine Position

The importance of the roentgen examination in the diagnosis of perforations of the hollow viscera has been repeatedly stressed and evaluated. In all cases in which a rupture of the stomach, small bowel, or colon, whether of spontaneous or traumatic origin, is suspected, the diagnosis can be made relatively certain by means of roentgen study. The roentgen findings depend upon the occurrence of a spontaneous pneumoperitoneum, gas from the gastro-intestinal tract escaping into the free peritoneal cavity. In all the literature on this subject it has been stressed that it is necessary to have the patient in the upright position in order that the gas may rise to the upper portion of the abdomen, coming to lie just inferior to the diaphragm. Thus the shadow of the gas can be made out by contrast with the diaphragm above and the denser shadows of the solid viscera below. When the upright position is impossible, it has been suggested that films might be made in the left lateral decubitus position, a postero-anterior exposure being undertaken, so that the gas will rise under the lateral abdominal wall and again manifest itself by contrast with the surrounding tissues. In a series of cases of perforation of the colon from various causes we have observed another roentgen sign of pneumoperitoneum which is particularly valuable because it is manifested in the ordinary scout roentgenograms of the abdomen made with the patient in the supine position. Essentially, this finding consists in the ability to visualize, on the film, the outer as well as the inner wall of the bowel. It is curious that in the extensive literature on artificial pneumoperitoneum there is no specific mention of this finding, although it has undoubtedly been observed repeatedly. It appears to occur only in those cases in which relatively large quantities of gas and some fluid have entered the peritoneal cavity. Under such circumstances there is a sufficient quantity of contrast medium present to separate the individual loops of bowel from each other. The loops themselves are usually greatly distended with gas because of the peritonitis which is present. As a result, it is possible to observe both the contour of the inner wall of the bowel and of the outer, the thickness of the wall itself being quite apparent. In the ordinary case of ileus it is relatively easy to observe the inner wall of the bowel because of the contrast between it and the gas which distends the bowel. Likewise the thickness of the bowel wall can be approximately ascertained because, with two loops of bowel lying in close juxtaposition to each other, the gas filling each loop delineates its wall; thus the thickness between the two layers of gas ordinarily represents the thickness of both bowel walls. In case of effusion into the peritoneal cavity, the diagnosis can often be made because of the increased thickness of the shadow separating the layers of gas, which results from the entrance of fluid between the two loops.

Newer Aspects of the Pneumoperitoneum Treatment of Pulmonary Tuberculosis

It was demonstrated in a series of roentgenologic studies that there is a considerable shortening of the apicobasal diameter of the lung during pneumoperitoneum treatment. Following the injection of 500 1000 cc. of air at the first treatment the maximum apicobasal relaxation of the lung was on inspiration 4.2 cm., on expiration 4.5 cm.; after the fifth treatment 5.6 cm. on inspiration and 3.6 cm. on expiration; after the tenth treatment 5.1 cm. on inspiration and 5.2 cm. on expiration; and after the twenty-third treatment 7.3 cm. on inspiration and 5.8 cm. on expiration. These figures compare favorably with the elevation of the diaphragm after phrenic nerve block. I studied a group of patients who had a surgical paralysis of the phrenic nerve and found that the maximum reduction of the apicobasal diameter of the lung was 6.3 cm.; the relaxation was between 3 and 3.9 cm. in one-third of the cases, and more than 4 cm. in only 13.3 per cent. Comparative measurements of the radiological chest volume before and after treatment that were reported in a previous communication revealed that the sustained use of artificial pneumoperitoneum treatment was capable of producing a reduction of the lung volume with the exception of relatively few cases in which extensive pleural adhesions prevented the rise of the diaphragm. Complete rest of the lung cannot be established by pneumoperitoneum. This is not, however, a shortcoming of this treatment. It was shown in another study that immobilization of the lung cannot be accomplished by the most frequently used type (low tension) of artificial pneumothorax. When the respiratory expansion of the diseased portion of lung treated by pneumothorax was investigated the following findings were noted: (1) the motion of this area was less than that of the entire lung before treatment,