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

¹ The Department of Medicine and Surgery, Veterans Administration, Oteen, North Carolina.

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.