Treatment Of Pulmonary Abscess Research Articles

Indwelling Transbronchial Catheter Drainage of Pulmonary Abscess

Adequate cavitary drainage is of paramount importance in the treatment of pulmonary abscesses. Occasionally this cannot be achieved despite vigorous chest physical therapy and the utilization of bronchoscopy. Intermittent transbronchial catheterization under fluoroscopic guidance has been suggested as a method to facilitate drainage. We have modified this technique by placing an indwelling intracavitary catheter, which allows irrigation and drainage over a prolonged period. This report describes this technique and our experience with 3 patients managed in this fashion.

Treatment of Pulmonary Abscess (Pulmonary Suppuration)

Treatment of Pulmonary Abscess (Pulmonary Suppuration)

The Treatment of Pulmonary Abscess

The Treatment of Pulmonary Abscess

Endobronchial Treatment of Pulmonary Abscess

Endobronchial Treatment of Pulmonary Abscess

The role of bronchoscopy in the treatment of pulmonary abscess

The role of bronchoscopy in the treatment of pulmonary abscess

Bronchoscopy in the Treatment of Pulmonary Abscess and Bronchiectasis

Bronchoscopy in the Treatment of Pulmonary Abscess and Bronchiectasis

Pulmonary Abscess, Bronchiectasis, and Pulmonary Neoplasms: Roentgenologic Aspect

The roentgenologist must assume definite responsibilities in the diagnosis and treatment of pulmonary abscess, bronchiectasis, and pulmonary neoplasm. His team associates, the internist, the bronchoscopist, and the surgeon, may expect from him assistance in diagnosis, help in localization, graphic recording of change, and, in certain types of newgrowth, aid in treatment. Abscess The roentgen appearance of pulmonary abscess is determined by the stage of the disease, the site of involvement, the presence of complications, and the technic of examination. At the onset it presents an almost homogeneous density, due to localized pneumonitis. The shape of the shadow depends upon the site. Near the hilum it is usually small and may resemble a collection of enlarged lymph nodes; in the center of a lobe, unlimited by an interlobar fissure or visceral pleura, it is of irregularly rounded shape, without distinct margin, dense at the center and fading off into normal tissue. Limitation by the interlobar fissure produc...

Pulmonary Abscess, Bronchiectasis, and Pulmonary Neoplasms: Surgical Aspects

The chief indication for surgical intervention in the treatment of pulmonary abscess is the failure of conservative measures to bring about a cure within a reasonable period of time. Perhaps only when the abscess is close to the chest wall, with pleural involvement, or when it is very large and the patient extremely ill, are we justified in resorting to operation without first trying other methods of treatment. Experience has shown that a large percentage of patients suffering from abscess of the lung are cured by postural drainage, bronchoscopy, and general supportive measures. The determination of the proper time for operation is important, as external drainage during the acute phase of the disease may be followed by a wide extension of the pneumonic process (1). Abscesses with markedly fibrosed walls almost certainly will require operation, but nothing is lost and often a great deal gained by bronchoscopic drainage and other remedial measures until the maximum benefit of such treatment has been obtained. The selection of the case and the determination of the proper time for operation is largely a matter of judgment and cannot be governed by hard and fast rules. Exact localization is of the utmost importance to the surgeon in planning the exposure of the abscess, and this is best accomplished by a joint consideration of the case with the internist, roentgenologist, and bronchoscopist. Whether an abscess is in the upper part of a lower lobe or in the lower part of an upper lobe or in the middle lobe cannot always be determined by physical signs and roentgenograms. The bronchoscopist, who is able to observe from which bronchial division pus comes, can usually settle the point in question. An antero-lateral exposure is the best for most upper lobe abscesses. In abscesses of the lower lobe, the approach should be posterior or postero-lateral, and in abscesses of the middle lobe, antero-lateral. Local anesthesia, alone or in combination with nitrous oxide analgesia, is preferable to general anesthesia for obvious reasons. Occasionally we have used avertin, supplemented by nitrous oxide or local anesthesia, but avertin is objectionable because it diminishes the cough reflex for too long a time. Morphine given by hypodermic injection half an hour before operation is useful in quieting the patient. An ample exposure of the involved area of lung is necessary to the successful handling of this condition. This is accomplished by the subperiosteal resection of three or four inches (7 or 10 cm.) of two or more ribs, depending upon the size and location of the abscess, followed by removal of the intervening intercostal structures and the periosteum of at least one rib. The abscess is widely opened and the cavity dealt with under direct vision. In most instances the operation is done in two stages, but in cases in which obliteration of the pleural space already exists the abscess may be opened at once.

BACTERIOLOGY OF PULMONARY ABSCESS

The clinical questions that surround the origin, the diagnosis and the treatment of pulmonary abscess are numerous. A considerable number of them may not be answered in the light of present knowledge of this condition. The answers to some of these practical and pertinent questions must come from the reciprocal orientation of the knowledge of the surgeon and the clinician with the knowledge of the specialist in correlated fields, the roentgenologist, the pathologist, the bacteriologist, and so on. These specialists have their own puzzles. With regard to the bacteriologist, it is perhaps not too much to say that pulmonary abscess, representing a mixed infection that includes a tremendous variety of bacterial types, is extremely puzzling; and it may not be too much to say that few clinical men have been able to keep up with the changing front of bacteriology, and with the status of the great number of organisms

IS BRONCHOSCOPY INDICATED IN TUBERCULOSIS?

With the general acceptance of bronchoscopy as an invaluable aid in the diagnosis of obscure pulmonary lesions and in the treatment of abscess of the lung and bronchiectasis, the question has often been asked, Is bronchoscopy indicated in tuberculosis? This is a valid inquiry and merits a discussion of the problem and the presentation of data so that conclusions may be arrived at. The principles underlying the treatment of pulmonary abscess and pulmonary tuberculosis differ in that the establishment and maintenance of adequate drainage of pus are of paramount importance in abscess, whereas they are usually not of sufficient importance to merit consideration in the treatment of uncomplicated tuberculosis. It may therefore be stated that bronchoscopy is not indicated in the treatment of uncomplicated pulmonary tuberculosis. The value of bronchoscopy in tuberculosis is limited largely to diagnosis, although certain cases may be benefited by treatment. For purposes of discussion, from

On the question of surgical, treatment of pulmonary abscesses

Scientific meetings of doctors of the State Institute for Advanced Medical Studies named after V.I. Lenin in Kazan.120th meeting 8 April 1930Dr. M.I. Oyfebakh and Dr. Yu.I. Zach. On the question of surgical treatment of pulmonary abscesses. In connection with epidemics of influenza in recent years, pulmonary suppuration is much more common and is becoming increasingly important in the work of a practical doctor.

SURGICAL TREATMENT OF PULMONARY ABSCESS.

As the surgical treatment of pulmonary abscess still presents many difficulties to be overcome and problems for solution, the personal experience of operators in this line of work, even though that experience is limited, will be of assistance in formulating rules for future guidance. No resume of the literature will be attempted, as several scholarly articles published during the past two years have anticipated and rendered unnecessary such a procedure. Experience has demonstrated that multiple lung abscesses and those accompanied by bronchiectasis are, as a rule, not benefited by operation. Tubercular abscesses and those due to the presence of a foreign body in the lung will not be considered, as they present complications placing them in classes by themselves, and with their surgical treatment I have had no experience. Metastatic and embolic lung abscesses are multiple and not amenable to surgical treatment. This leaves for our consideration those cases of