Forms Of Collapse Therapy Research Articles

OLEOTHORAX: INCIDENTAL FINDING AND RELIC OF THE PAST

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Preceding the advent of effective antimicrobial regimens, “collapse therapy” was the mainstay of treatment for tuberculosis. This therapy became obsolete after the discovery of potent multi-drug regimens in the 1950s. However, collapse therapy represents an important historical treatment that was lifesaving to many patients in the 1930s and 1940s. CASE PRESENTATION: A 97-year-old female presented to the emergency department with acute onset dyspnea, worsening over several days. She was tachycardic to 163 bpm. Physical examination revealed right hemithoracic basilar crackles and poor air movement over the entire left hemithorax. EKG revealed multi-focal atrial tachycardia. Troponins were negative, however pro-BNP was elevated at 2950 ng/L. Chest radiography revealed left hemithoracic mass-like opacification with calcific margins. Chest computed tomography confirmed a well-circumscribed, peripherally calcified left hemithoracic mass. Contents of the mass were heterogeneous with areas measuring -60 HU, suggestive of lipoid material. Right-sided pleural effusion was also noted. She disclosed that she had been diagnosed with tuberculosis in her twenties and spent 5 months in a sanatorium prior to undergoing surgery. She denied post-operative complications. Her dyspnea resolved with diuresis and rate control. She was discharged home in improved condition. DISCUSSION: Collapse therapy was thought to provide the lung with much-needed rest and promote healing. In reality, alterations in oxygen tension created an unfavorable environment for the obligate aerobe. Plomage thoracoplasty was a form of collapse therapy in which apicolysis was achieved through insertion of inert materials, called plombe, usually into the extrapleural space. Materials used included paraffin wax, lucite spheres, gauze, sponges and mineral or vegetable oil. Oleothorax refers specifically to plomage utilizing mineral or vegetable oil. The intra-operative mortality of this historic therapy was 10%. Successful sputum conversion rates ranged from 61-93%. Immediate complications included infection and failure to heal. Long term complications include fistulization with surrounding structures, erosion of major vessels and malignancy. Oil plombe was intended to be aspirated after sputum conversion, usually after 24 to 48 months. However, some patients were lost to follow up after release from sanatoriums. CONCLUSIONS: As patients who underwent collapse therapy continue to age, familiarity with these therapies will diminish. Importantly, extensively drug resistant (XDR) tuberculosis may herald the return of surgical treatment for tuberculosis. Thus, we encourage awareness of the historic treatments for tuberculosis and its future therapeutic potential. Reference #1: Murray JF, Schraufnagel DE, Hopewell PC. Treatment of Tuberculosis. A Historical Perspective. Annals of the American Thoracic Society. 2015;12(12):1749-1759. doi:10.1513/annalsats.201509-632ps. Reference #2: Weissberg D, Weissberg D. Late Complications of Collapse Therapy for Pulmonary Tuberculosis. Chest. 2001;120(3):847-851. doi:10.1378/chest.120.3.847. Reference #3: Kolkailah AA, Fugar S, Rey-Mendoza J, Campagnoli T, Fakhran S. Revisiting the evolution of tuberculosis therapy: historical reflections in the modern era. Oxford Medical Case Reports. 2018;2018(9). doi:10.1093/omcr/omy055. DISCLOSURES: No relevant relationships by Victoria Andarcia, source=Web Response No relevant relationships by Joe Harb, source=Web Response No relevant relationships by Joseph Henain, source=Web Response No relevant relationships by Anneka Hutton, source=Web Response No relevant relationships by Navneet Kaur, source=Web Response

Tuberculous empyema presenting 62 years after oleothorax: a case report

Oleothorax, the instillation of mineral or olive oil into the pleural space, was introduced as a form of collapse therapy for pulmonary tuberculosis by Bernou in 1922 (1). Never an established mode of treatment, it was used either to inhibit lung expansion in patients in whom a previously satisfactory artificial pneumothorax had failed, or as ‘disinfection’ treatment for tuberculous empyema (2,3). We have recently seen a patient who presented with a tuberculous empyema 62 years after oleothorax therapy.

The surgery for pulmonary tuberculosis.

The surgery for pulmonary tuberculosis.

Die Lungentuberkulose. Diagnose und Therapie

HomeRadiologyVol. 68, No. 5 PreviousNext Announcements and Book Reviews - Book ReviewsDie Lungentuberkulose. Diagnose und TherapiePublished Online:May 1 1957https://doi.org/10.1148/68.5.745aMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractBy Prof. Dr. Med. Paul-Georg Schmidt, Chefarzt der Westerwaldklinik Waldbreitbach, Tuberkulose-Krankenhaus der LVA Rheinprovinz. Third edition, completely revised. A volume of 384 pages, with 234 illustrations. Published by Georg Thieme Verlag, Stuttgart, 1956. Distributed in the United States and Canada by the Intercontinental Medical Book Corporation, New York, N.Y. Price DM 58—($13.80).The European popularity of Professor Schmidt's handbook on tuberculosis is attested by the fact that the second edition, which appeared in 1947, was out of print by 1948. The third edition, now appearing, has been enlarged especially as concerns the therapy of tuberculosis. The emphasis on treatment indicates that the work is designed for the general practitioner and the advanced student. More than one third of the text is devoted to medical and surgical treatment, including chemotherapy, antibiotics, sanatorium care, and the various forms of collapse therapy. The principles of lung resection and of decortication are also given. This is not a surgical volume and surgical technics are not described.The usual program for a text of this nature is followed. The history and the bacteriology of the tubercle bacillus are mentioned. Chapters deal with pathologic anatomy, physical findings, laboratory studies, and the clinical course. Individual sections include those on the primary complex, hematogenous spread, adult type tuberculosis, pleural involvement, and spread beyond the lungs. There is nothing on differential diagnosis. No particular effort is made to emphasize the roentgen features, although adequate illustrations in this connection are included.The book is substantially bound, adequately indexed, and moderately easy to read. The physicians most likely to benefit from its purchase are those German-reading internists who are interested in the medical management of tuberculosis.Article HistoryPublished in print: May 1957 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 68, No. 5 Metrics Altmetric Score PDF download

Pulmonary function and circulatory dynamics in artificial pneumoperitoneum. I. Studies on patients with pneumoperitoneum therapy for pulmonary tuberculosis.

Although pneumoperitoneum at present is most widely used as a form of collapse therapy in pulmonary tuberculosis, this procedure had been applied some years earlier in the treatment of chronic pulmonary emphysema. In 1924 Reich’ reported on this procedure, considering 300 to 500 cc. the ideal amount of air. He found greatly improved diaphragmatic motion, increased tidal air and respiratory minute volume, higher capillary oxygen saturation and even a decrease in alveolar carbon dioxide. There was often striking clinicalimprovement with a decrease in dyspnea, cyanosis, and coughing, and a reduction in the frequency of asthmatic attacks. Reich attributed the beneficial effects to mechanical improvement in breathing, and, because in some patients improvement persisted after resorption of the air,he concluded that these patients had regained the proper use of the diaphragm. Piaggio-Blanco in 19372 noted the effectiveness of pneumoperitoneum in patients with chronic pulmonary emphysema in a purely clinical study. Other reports34 suggested that pneumoperitoneum was effective in decreasing the frequency and severity of attacks in uncomplicated bronchial asthma. In 1950 Gaensler and Carter5’6and Furman and Callaway7 reinvestigated this procedure in emphysema. The former authors studied the effect of pneumoperitoneum on ventilatory function and pulmonary capacity in 13 patients with chronic pulmonary emphysema, 10 of whom were improved clinically by the procedure. The residual air was always reduced, averaging 26 per cent less while the Inspiratory capacity increased in all cases, averaging 24 per cent more. The vital capacity increased in 10, although the total capacity was somewhat decreased in all patients. A 33 per cent mean Increase in maximum breathing capacity was accompanied by a reduced breathing requirement at rest. With standard exercise the breathing reserve increased from 68.2 per cent of the maximum breathing capacity to 80.5 per cent after treatment. Oxygen consumption was unchanged, the ventilatory equivalent being reduced. Two patients showed increased arterial oxygen saturation and decreased carbon dioxide tension after pneumoperitoneum especially in relation to exercise. A third showed no change in blood gases. Fluoroscopy demonstrated a marked increase in diaphragmatlc motion although the amount of intraperitoneal air was

Observations on active domiciliary treatment of cases of pulmonary tuberculosis

Summaryo(a)The reasons why domiciliary active therapy is required are mentioned with a brief description of a scheme which takes a patient through the stages of phrenic nerve crush, pneumoperitoneum, artificial pneumothorax induction and adhesion section with an average of eleven nights in hospital. It is felt that the safety of the scheme hinges on the type of case that is picke for artificial pneumothorax therapy and for that reason the case records of 7,206 patients over a nineteen-year period are reviewed and the complications of 703 artificial pneumothoraces noted. Especial emphasis is placed on the type of artificial pneumothorax which causes complications and which, in my opinion, it is dangerous to keep resting at home.(b)Reasons are given why we consider it better to start D.A.T. with a spell of pneumoperitoneum therapy combined with phrenic nerve crush.(c)Some observations are made arising from our experience with D.A.T.(d)It is considered that the scheme has a definite place in our armamentarium as things stand today and that some form of collapse therapy is better than none in the minimal, sputum-positive case. The reasons why domiciliary active therapy is required are mentioned with a brief description of a scheme which takes a patient through the stages of phrenic nerve crush, pneumoperitoneum, artificial pneumothorax induction and adhesion section with an average of eleven nights in hospital. It is felt that the safety of the scheme hinges on the type of case that is picke for artificial pneumothorax therapy and for that reason the case records of 7,206 patients over a nineteen-year period are reviewed and the complications of 703 artificial pneumothoraces noted. Especial emphasis is placed on the type of artificial pneumothorax which causes complications and which, in my opinion, it is dangerous to keep resting at home. Reasons are given why we consider it better to start D.A.T. with a spell of pneumoperitoneum therapy combined with phrenic nerve crush. Some observations are made arising from our experience with D.A.T. It is considered that the scheme has a definite place in our armamentarium as things stand today and that some form of collapse therapy is better than none in the minimal, sputum-positive case.

Trends in the Use of Antibiotics in Thoracic Surgery

Antibiotics have revolutionized thoracic surgery. As yet streptomycin and penicillin far outweigh the other antibiotics in their value to the thoracic surgeon. Because resistance to streptomycin develops rapidly and is permanent, this antibiotic should not be used indiscriminately, but should be restricted to specific indications. The use of streptomycin as an adjunct in tuberculosis surgery has extended operative indications, and has made possible safer and more effective pulmonary resection, decortication, cavernostomy, closure of tuberculous sinuses, and pericardectomy. The administration of 1 gram a day, in one or two doses, is recommended for periods of six weeks on less. In the light of present knowledge the use of streptomycin would not seem justified in routine thoracoplasty, inasmuch as complications are already minimal. Its use is rarely justified in other forms of collapse therapy. Penicillin has proved of particular value in the surgery of bronchiectasis and lung abscess, in thoracic trauma, in exploration for intrathoracic tumors, in esophageal surgery, and in surgery of the heart and great vessels. The present trend is toward larger doses of penicillin, with penicillin G potassium the preparation of choice in active infection. In surgery, repository and aerosol penicillin are primarily applicable in prophylaxis.

Early and late results of extrapleural pneumothorax

Summary A series of 110 extrapleural pneumolyses in 107 patients carried out over a period of ten years has been followed up. In all the cases the pneumolyses were done with a view to establishing an extrapleural pneumothorax and this was satisfactorily established in 88 extrapleural spaces out of the whole series and in 48 spaces in the last 50 operations. The results are comparable with the best reported results of all forms of collapse therapy. The final result of extrapleural pneumothorax is a nearer approach to normal than can be obtained by extrapleural oleothorax or thoracoplasty. Certain notoriously difficult types of case, such as some with tension cavities and midzone cavities, can be successfully treated by this means. The success of the procedure as carried out here depends on painstaking and meticulous post-operative treatment. In the last three years the early results at least have been much better than those quoted for the whole series. Complications are now both less frequent and less serious in their effects. Even when these occur a good result may still be obtained in most cases.

Artificial Pneumothorax in Pulmonary Tuberculosis.

The author of this valuable and interesting book on artificial pneumothorax was formerly resident physician at the William H. Maybury Sanitorium (the Detroit Municipal Tuberculosis Sanitorium), Northville, Mich. The book is divided into three main sections: general considerations, choice of cases and management. The various forms of collapse therapy are considered the greatest advance in the control of tuberculosis since the value of rest in bed was first appreciated. The author points out however, that the available statistics have often been misinterpreted, and that the value of collapse therapy will be more and more evident as there comes to be a more proper selection between cases suitable for treatment by artificial pneumothorax and those in which thoracoplasty or some other method is the treatment of choice. The advance in the technic of closed intrapleural pneumolysis, without which an adequate collapse of the diseased portion of the lung is often impossible,

The Roentgenology of Gastro-Intestinal Tuberculosis

was almost as easy to get consents for thoracoplasty as for artificial pneumothorax; but in 1930 it was difficult to persuade the patient to have a thoracoplastic operation. Of course, many an ineffective pneumothorax with adhesions can be made effective by means of internal pneumonolysis. If there is any doubt as to whether the adhesions can be cut, the patient should receive the benefit of that doubt by a thoracoscopic examination. If the pneumothorax cannot be made effective, it should be abandoned. If the patient survives serious complications, more radical thoracic surgery is indicated. In this survey a great number of patients were in such critical condition that surgical intervention was contra-indicated. But in most of those cases where internal pneumonolysis or some other form of surgery was performed, the patients were able to pass the 3 or 4 year mark from the onset of pneumothorax. Even though the pneumothorax was ineffective at first, it paved the way for further treatment. Many patients have bilateral cavitations and require bilateral pneumothorax. Sometimes a contralateral lesion develops during the successful pneumothorax treatment of one lung and the patient will then require bilateral pneumothorax. It is advisable to get a fairly effective collapse on one side before attempting the other side, even if you must resort to a pneumonolysis. However, if one side is effective and the other side is ineffective, here again, the ineffective pneumothorax should be abandoned for some other form of collapse therapy, provided the patient's condition warrants it. Although pneumothorax therapy is a very effective means of combating pulmonary tuberculosis, it has its limitations. The medical profession must be prepared for all the new modern methods of treatment as soon as they are introduced.

Diagnosis of Intestinal Tuberculosis

Intestinal tuberculosis occurs as an ulcerative lesion complicating pulmonary tuberculosis, as a hypertrophic mass, and as a miliary form associated with tuberculous peritonitis. The ulcerative lesion is the most common of the three varieties and its diagnosis can be made with a high degree of accuracy. The chief method of diagnosis is roentgenological and its development has been due chiefly to the work of Pirie, Stierlin, Brown and Sampson. The taking of a careful history is of next importance. The clinician must be familiar with the natural history of the various dyspepsias to evaluate properly the symptoms present. Laboratory findings are usually of little aid in diagnosis. Ulcerative intestinal tuberculosis is always a complication of pulmonary tuberculosis and often shows an activity parallel to that of the parent lesion. However, it frequently runs an independent course and may cause severe symptoms or death after the pulmonary lesions have become inactive. A study of over 300 cases shows a similar incidence in males and females. All ages are represented and the older patients have an incidence similar to younger patients, but the older the enteritis the less distressing are the symptoms. At Hopemont Sanitarium, the autopsy incidence of enteritis is 70 per cent. Clinically, however, it occurs in 15 to 20 per cent of the sanatorium population, where a great majority show faradvanced disease in the lungs. In a tuberculosis sanatorium the non-tuberculous dyspepsias are about four times more frequent than those due to tuberculous enteritis. In this series, only 1 per cent of the cases occurred in association with minimal pulmonary disease; 9 per cent occurred with moderately advanced disease; and 90 per cent with faradvanced disease. The exudative pulmonary lesion was associated with 25 per cent of the enteritis cases, and the chronic form with the remaining 75 per cent. Pulmonary cavitation was present in 94 per cent of the cases at the time of onset of bowel symptoms; cavitation had been present in 4 per cent prior to the onset of symptoms; no cavity was found in 2 per cent of the cases whose diagnosis was made by laparotomy or autopsy. The sputum was positive for tubercle bacilli in 97 per cent at the time of onset of the symptoms. Intestinal tuberculosis may be present without symptoms. Ten per cent of the enteritis found at autopsy showed no digestive disturbances during life. Enteritis may be present long before symptoms appear and may be started clinically by a pulmonary spread, pleural effusion or an operation. The reason for such variability, we believe, is due mainly to a local neuromuscular irritability plus an afferent-parasympathetic efferent reflex to the involved segment. We feel that this neurogenic view best explains the clinical onset of enteritis, its severity, symptomatology, duration and response to treatment. The onset of symptoms was sudden in 67 per cent and gradual in 33 per cent. The rapid onset often dates back to some food or laxative or surgical intervention. Although collapse therapy benefits greatly about 40 per cent of all cases of intestinal tuberculosis, yet some cases date their onset to some form of collapse therapy and other cases show an aggravation of symptoms by these procedures. The symptoms of enteritis may be many or few, mild or severe, local or general. Systemic symptoms may include nervousness, insomnia, chills, fever and failure to gain weight. The digestive symptoms occur in the following order: Anorexia, 85 per cent; crampy pain, 80 per cent; nausea, 70 per cent; diarrhea, 65 per cent; flatulence, 50 per cent; vomiting, 45 per cent; epigastric distress or pain, 30 per cent; constipation, 20 per cent; pyrosis, 20 per cent; tender right lower quadrant, 10 per cent; acid regurgitation, 10 per cent; constipation alternating with diarrhea, 10 per cent; gross blood in stool, 6 per cent; appendicitis, 4 per cent; allergic phenomena in 2 per cent. Diarrhea and pain occur in two-thirds of all cases and should one wait for these symptoms to appear many early cases will be missed. In this group we include also the cases

A Review of Two Hundred Cases of Pulmonary Tuberculosis Treated by Collapse Therapy

A group of two hundred cases was studied. These included unilateral and bilateral cases. Various forms of collapse therapy were applied. Results and complications are enumerated in the various tables.