Pneumothorax Therapy Research Articles

Cerebral Air Embolism, Subcutaneous Emphysema, and Spontaneous Pneumothorax in a Tuberculous Patient: Report of an Unusual Case

An unusual case of spontaneous pneumothorax, subcutaneous emphysema, and cerebral air embolism is presented. These conditions were not due to any mechanical interference or induced by artificial pneumothorax therapy.

BASAL METABOLISM OF TUBERCULOUS CHILDREN

This paper reports the results of studies on the basal metabolism of afebrile children with the adult, or reinfection, type of pulmonary tuberculosis in whom pneumothorax therapy was instituted. The work is part of an extensive study of the basal metabolism of tuberculous children which is being made at Sea View Hospital. One hundred and fourteen basal metabolism tests were made on 66 children. Their ages ranged from 7 years and 2 months to 16 years and 6 months. There were 49 girls and 17 boys. Since it was found that neither sex nor race significantly affected the results, a differentiation on these lines was not attempted. Thirty of these children were studied before pneumothorax had been instituted and again at varying periods after the procedure. Thirty-six children were studied only after pneumothorax had been induced. In the entire series pneumothorax had been maintained for periods ranging from one month

On the frequency of relapse after pneumothorax therapy in pulmonary tuberculosis with cavity formation

Summary With the material here presented I am able to agree with Veran as to the frequency of relapse in chiefly recent cases, as we have found relapse after the cessation of pneumothorax treatment only in a few of the cases. Veran has found the frequency of relapse to be dependent upon the degree of collapse, but this is probably due in part to the correlation between the extent of adhesions and the age of the process, for in the present material of recent cases no connection could be demonstrated between the frequency of relapse and the degree of collapse. Neither the results reported by Veran nor my own findings allow of any definite statement as to the significance of the adhesions on the frequency of relapse in chronic cases; still, they seem rather to suggest that relapse is more frequent in cases with adhesions than in cases free from adhesions. Nor has it been possible to establish the significance of the duration of the pneumothorax treatment on the frequency of relapse. After three to four years' inactivity the frequency of relapse is not found to be greater than the frequency of active tuberculosis in previously healthy persons in the corresponding age-classes.

Clinical aspects of pneumothorax therapy as illustrated by the results obtained in 191 cases of completed treatment

An account is given of the late results of treatment by artificial pneumothorax in 191 patients within the period 1925–1931. The results suggest that once pneumothorax treatment is instituted it ought to be carried out more actively than has been done here—and in most other clinics. Incomplete pneumothorax ought to be given up soon and replaced by other treatment, chiefly operative. In empyema, even when purely tuberculous, the prognosis with conservative treatment is poor; hence, early radical treatment of this lesion is indicated. Solitary adhesions to the chest wall ought to be severed by cauterisation, even though the cavity and bacilli have disappeared.

RESULTS OF COLLAPSE THERAPY IN CHILDREN WITH PULMONARY TUBERCULOSIS

The various methods of collapse therapy employed for adults with pulmonary tuberculosis have also been used for children. Some of the earliest reports of the use of artificial pneumothorax for tuberculous children appeared from 1911 to 1914 in Germany (Pielsticker and Vogt¹), in France (Rist²) and in Denmark.³In 1924 Eliasberg and Cahn⁴published their report of its use for 111 children varying in age from 4 months to 14 years. In subsequent years important contributions were made to the understanding of the immediate and ultimate results of pneumothorax therapy in children by Simon,⁵Klare,⁶Armand-Delille⁷and their co-workers. There was some delay in the application of bilateral pneumothorax to children. Among the earliest reports were those by Wiese⁸in 1926 and by Armand-Delille and Lestocquoy⁹in 1927. Both Wiese and Armand-Delille have employed collapse therapy for large numbers of children

Mediastinal Hernia

THERE has been little in the American literature of the past few years on the origin and development of mediastinal hernia or pneumatocele. During this time, however, the Italian and French schools have devoted considerable attention to this subject. Besta (1) has recently published a comprehensive review of the Continental literature with considerable original data, but there is little available in English. I, therefore, have thought that it would be of some interest to review the origin of this condition, and to consider the mechanism of its development, presenting several cases illustrating the various types. First, just what do we mean by the term mediastinal hernia? It can be defined as the projection through the mediastinum of one pleural space into the other hemithorax. It was only with the development of artificial pneumothorax therapy coupled with the greater use of the x-ray both for fluoroscopy and plate work, that the possibility of such a condition was appreciated. Artificial pneumothorax is still the most common cause of hernia of the mediastinum, although it does occur in spontaneous pneumothorax and, as we shall see, occasionally in the absence of pneumothorax. The walls of the hernial sack as it protrudes through the mediastinum are formed by the parietal pleura lining each hemithorax. This is seen as a thin line on the film or the fluoroscopic screen, protruding into the normal lung-field. Second, just where does this hernia through the mediastinum occur? Anatomically there are two so-called “weak spots in the mediastinum.” The first and the most important of these lies behind the sternum above and in front of the heart at the site of the atrophied thymus. The second lies below and posteriorly and is a space bounded below by the crura of the diaphragm, posteriorly by the spinal column, and in front by the esophagus as it bends forward to pass through the diaphragm. Once a small wedge has been driven through one of these spaces, however, the margins may be spread until the hernia occupies an area far greater than the original “weak spot.” Third, how does such a herniation of the mediastinum come about? What are the physical factors that lead to its development? It takes but little consideration to realize that the force that causes the hernia is a difference in pressure in the two halves of the thoracic cage and that this difference in pressure is the result of a difference in volume. It is also quite obvious that the mediastinum itself must be considerably more rigid than the “weak spot” otherwise the mediastinum as a whole would be shifted toward the hemithorax with the lowest pressure. It is also evident that if volume plays any part in the development of this condition then there must be a change in the size of the herniation during the different phases of respiration dependent on the changes in the size of the thorax as a whole.

AIR EMBOLISM VERSUS PLEURAL REFLEX AS THE CAUSE OF PLEURAL SHOCK

In accepting the invitation to deliver the Frank Billings lecture, I do so with humility and deep appreciation. The honor is the more highly valued because, in an association of over thirty years with Dr. Billings, I owe so much to the influence of his teaching, his example and his inspiring personality. In all operative procedures involving the pleural cavity, whether pneumothorax therapy, draining an empyema, the withdrawal of fluid by means of an aspirating needle or merely an exploratory thoracentesis, there lurks the danger of so-called pleural shock. This may take the form of faintness, or at times loss of consciousness with a pulse that becomes weaker and weaker until it can no longer be detected by the finger. Rarely convulsions occur and death. When the patient recovers, there may be a transitory hemiplegia or weakness on one side. It is my purpose in this paper to consider the

Pneumothorax Treatment of Tuberculosis

THE successful practice of artificial I pneumothorax in pulmonary tuberculosis requires the complete co-operation of the clinician and the roentgenologist. So necessary is this that it is impossible to carry the treatment to a successful conclusion without careful roentgenologic studies throughout the long period required for pneumothorax therapy. With this in mind, it behooves us as roentgenologists to have a thorough knowledge of the various phases in the treatment so as to assist accurately the clinician in the handling of the various problems that constantly arise under collapse therapy. While pneumothorax treatment has been in general use in sanatoria for the past twenty years, yet it is only recently that its use has spread to the clinic and the private office. Because of this widespread utilization, we are bound to come more and more in contact with this type of therapy. The basic principle in the treatment of pulmonary tuberculosis is rest. Pneumothorax is essentially the application of rest in the localized manner to the affected area of the lung, and thus it enhances the already accepted value of generalized rest. This localized rest to the lung under artificial pneumothorax is the result of a collapse of the lung, and not compression. Modern technic calls for a maintenance of an intrapleural pressure that is slightly less than atmospheric pressure at any time during quiet respiration, and may therefore be termed “collapse therapy.” The effects of this collapse are many, and the clinical improvement in many cases is astounding. From a mechanical point of view there are two distinct results. First, it permits the normal tendency of pulmonary elastic and connective tissues to contract and shrink, and second, if the collapse is sufficiently great, it will bring in apposition cavity walls, and thus facilitate the healing and obliteration of these excavations. Physiologically, the contracted lung shows a certain degree of passive hyperemia with a relative ischemia, and accompanying this is a distinct impedance of the lymphatic drainage. A combination of all these factors results in a marked decrease in the absorption of tuberculous toxins and a tendency to proliferation of connective tissue. The closure of cavities with consequent decrease in expectoration and eventual elimination of positive sputum relieves the patient of the constant danger of further bronchiogenic spread. It is not within the scope of this paper to discuss the technic of insufflation, but it is interesting to note that, despite the type of gas which may be insufflated into the pleural space, it is soon converted by gaseous exchange with the blood to a mixture consisting of 4 per cent oxygen, 6 per cent carbon dioxide, and 90 per cent nitrogen (1). I have used oxygen, nitrogen, and air at different times in pneumothorax treatments, and have come to the conclusion that there is no advantage in using any other gas but air.

PNEUMOTHORAX THERAPY IN PULMONARY TUBERCULOSIS

Medical Journal of AustraliaVolume 2, Issue 2 p. 54-55 Current Comment PNEUMOTHORAX THERAPY IN PULMONARY TUBERCULOSIS First published: 01 July 1936 https://doi.org/10.5694/j.1326-5377.1936.tb77613.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue2July 1936Pages 54-55 RelatedInformation

Surgical treatment of pleuropulmonary adhesions: In 100 thoracoscopies

p” EUROPULMONARY adhesions are a source of potentia1 danger when artificia1 pneumothorax is applied to compress tubercuIous Iung tissue. We frequentIy disregard the importance of these adhesions and continue to advocate pneumothorax therapy, even with the knowIedge that this compIication may have grave sequeIae. The efficiency of a11 coIIapse therapy depends upon two factors. First, a mechanica1 eIement, which must be considered as the degree of Iung immobility that may be produced, thereby compressing tubercuIous cavitation and Iessening the amount of septic materia1 expeIIed from the diseased area. SecondIy, a physioIogica1 factor, preventing toxemia by reason of stasis in the bIood and Iymph vesseIs, with attending anoxemia and the uItimate formation of fibrosis. It is a weII-recognized fact that when pIeuropuImonary adhesions are present, retarding compression then the effectiveness of this method of treatment is minima1 and some other surgica1 procedure shouId be advocated that wiI1 aid in compIeting the desired coIIapse. IntrapIeuraI pneumoIysis has been accepted as a necessary sequence to artificia1 pneumothorax. Its appIication to suitabIe cases is we11 recognized. The generaIIy accepted indications for intrapIeura1 pneumoIysis are open Iung cavities with positive sputum and unsatisfactory compression of diseased puImonary tissue. But these indications are dependent upon the symptomatic resuIts of artificia1 pneumothorax, the degree and the Iocation of the coIIapse that has been obtained, the character and Iocation of the offending adhesions, the presence of pIeura1 Auid, and most important, the various physioIogicaI changes affecting the structures within the mediastinum. We must consider, aIso, the duration of the disease, age of the patient, Iength of time artificia1 pneumothorax has been in force and various compIications attending its appIication. These manifestations indicating the necessity for intrapIeura1 pneumoIysis are conditiona upon a reasonabIe assurance that reIief of distressing symptoms and a satisfactory coIIapse wiI1 be obtained by operation and that no serious extensive invoIvement of other organs is present to inhibit the patient’s uItimate recovery. In IOO thoracoscopies a critica study was made of actua1 adhesions found within the pneumothorax space which the writer beIieves is more convincing than the findings observed in consecutive x-ray IiIms. We must depend upon carefu1 roentgenoIogica1 technique for our preIiminary study of the individua1 case and use Auoroscopy and stereoscopic fiIms for the determination of our operative field. RoentgenoIogicaI studies wiI1 not estabIish accurateIy the size and the contents of the adhesions observed in the x-ray fiIms, and any interpretation of these bands shouId be considered &ways as presumptive data. The x-ray is not concIusive and wiI1 often question the advisabiIity of thoracoscopy. It is surprising how much rea1 beneficia1 operative work can be accompIished in view of an adverse roentgenoIogica1 reading, for once within the thoracic waI1 the actua1 conditions seen may differ materiaIIy from those shown by

A Plea for the More Extended Use of Pneumothorax Therapy in the Home Treatment of Pulmonary Tuberculosis

A Plea for the More Extended Use of Pneumothorax Therapy in the Home Treatment of Pulmonary Tuberculosis

Artificial Pneumothorax Therapy as Observed by a Nurse

Artificial Pneumothorax Therapy as Observed by a Nurse

Artificial Pneumothorax Therapy as Observed by a Nurse

Artificial Pneumothorax Therapy as Observed by a Nurse

Observations on the Development of Contralateral Disease in Artificial Pneumothorax Therapy

Observations on the Development of Contralateral Disease in Artificial Pneumothorax Therapy

Personal experiences in artificial pneumothorax therapy

Personal experiences in artificial pneumothorax therapy

INTRA‐PLEURAL PRESSURES IN ARTIFICIAL PNEUMOTHORAX THERAPY

Medical Journal of AustraliaVolume 1, Issue 12 p. 282-288 Original Article INTRA-PLEURAL PRESSURES IN ARTIFICIAL PNEUMOTHORAX THERAPY J. Gordon Hislop M.B., Ch.B. (Melb.), M.R.C.P. (London), J. Gordon Hislop M.B., Ch.B. (Melb.), M.R.C.P. (London) Medical Clinical Assistant to Out-Patients Melbourne HospitalSearch for more papers by this author J. Gordon Hislop M.B., Ch.B. (Melb.), M.R.C.P. (London), J. Gordon Hislop M.B., Ch.B. (Melb.), M.R.C.P. (London) Medical Clinical Assistant to Out-Patients Melbourne HospitalSearch for more papers by this author First published: 01 March 1924 https://doi.org/10.5694/j.1326-5377.1924.tb65564.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume1, Issue12March 1924Pages 282-288 RelatedInformation

Endopleural operations in pulmonary tuberculosis: Jacobæus's method

Failure to obtain the desired effects in pneumothorax therapy is largely due to adhesions between lung and chest wall. In a certain proportion of cases those adhesions may be divided and complete collapse of the lung effected by the combined method of thoracoscopy and galvano-cauterisation devised by Professor Jacobæus. The technique of this method is described, special difficulties and complications are discussed, and details of nine cases are given. Since this method was adopted at Mesnalien Sanatorium, every case treated with an artificial pneumothorax has been examined with the thoracoscope, and of twenty-seven thus examined the nine cases reported above were selected for cauterisation. In five of these striking improvement was effected, and in two others there was some improvement.

The Value of Artificial Pneumothorax Therapy as Associate Treatment of Pulmonary Tuberculosis

The Value of Artificial Pneumothorax Therapy as Associate Treatment of Pulmonary Tuberculosis

ARTIFICIAL PNEUMOTHORAX AS A TREATMENT OF PULMONARY TUBERCULOSIS

Artificial pneumothorax therapy consists in the repeated injections of a slowly absorbable gas into the pleural cavity to permit and maintain for an indefinite period the collapse of a diseased lung. The investigations which form the basis of this paper were undertaken to determine the exact contributory value of this treatment ; and although equally willing to deny the efficacy of the method, should our result so persuade us, we conclude on the contrary that the establishment of artificial pneumothorax is a procedure of unquestionable value in selected cases. The element of rest is now generally accepted as an important feature in the therapeutics of all tuberculous infections. A striking example of this is found in the promptness with which an acute tuberculous infection of the hip or knee joint is quieted by rest from the application of a plaster cast. The immobilization or splinting of a tuberculous lung, whether