The Results of Thoracoplasty in Pulmonary Tuberculosis

Abstract

The evaluation of thoracoplasty in the treatment of pulmonary tuberculosis depends on so many factors that accurate assessment is difficult. The present survey is submitted with this in mind. It provides, however, some general figures about the fate of the patients and the effects of the operation on their disease.The subject matter of this analysis consists of a follow-up of all cases of thoracoplasty for pulmonary tuberculosis, not complicated by empyema, performed by the writer between 1935 and the middle of 1946. The patients were traced by reference to the local authorities, chest clinics, hospitals, and private doctors; a report was then obtained from the medical man most recently in charge of the individual patient. It was inevitable that no information could be obtained about some patients, for owing to the partial destruction of the records in two hospitals in air raids and the unusual movement of population during war vears the difficulties ordinarily encountered were increased. Actually the number of cases "lost sight of" was relatively small (7.1 per cent) and could not be regarded as influencing the final results too seriously.In view of the different sources from which information was derived a very detailed analysis could not be undertaken, and attention was confined to three main points: (1) the patient's capacity for work, with a statement of the present general condition; (2) the presence of tubercle bacilli in the sputum; (3) the presence of cavities in the lung. It can be assumed that the operation was undertaken for disease with cavitation in the lung and with tubercle bacilli in the sputum. Cases of tuberculous empyema were excluded from the survey.Before analysis of the material some important points affecting the end-results of the operation must be mentioned. Firstly, thoracoplasty is only a local measure aiming at selective collapse used in the course of a general disease; it is not in itself a cure. Secondly, the criteria on which cases are selected for operation are most variable. Sometimes operation is reserved for those patients who have minimal disease of a healing character, in other words " good risk cases"; while at the other extreme the indications may be extended to cover patients for whom nothing else can be done and in whom operation is almost a measure of despair. Other factors which have to be taken into account include the general change in outlook towards thoracoplasty during the years under *Based on a paper read at the joint meeting of the Tuberculosis Association and the Scottish Tuberculosis Society

The Extracellular Matrix Regulates Granuloma Necrosis in Tuberculosis

“…A recent aptamerbased approach identified the protease-antiprotease balance and tissue remodeling as 2 key pathways that change during tuberculosis treatment, whereas cytokine pathways were not highly represented [47]. All tuberculosis treatments in the preantibiotic era, such as artificial pneumothorax, plombage, and thoracoplasty, centered on cavity collapse, and these had a cure rate of up to 70% [48], demonstrating that macroscopic stabilization of the extracellular matrix can improve host control of M. tuberculosis infection.…”

Airways obstruction in survivors of thoracoplasty: Reversibility is greater in non‐smokers

“…Tuberculosis, in itself, can cause chronic impairment of lung function 12 . Obstruction post‐TPL may result from intramural fibrosis and inflammation of the airways due to previous extensive tuberculous endobronchitis 3,13 , 14 and previous or current smoking. Another contributory factor, however, may be the thoracoplasty itself with increased airway tone and reactivity on the thoracotomy side 15 .…”

“…It has been estimated that 30 000 TPL were performed in the UK between 1951 and 1960. 2 Although reliable data are available on the early effects of this operation on pulmonary function, 3,4 little data exist on the late sequelae. These studies showed high rates of cure but frequent restrictive sequelae and respiratory failure.…”

Late sequelae of pulmonary tuberculosis treated by thoracoplasty.

“…Most appear to have led normal lives in respect of capability for work, marriage, and child bearing, which were sometimes used to judge the success of a thoracoplasty in restoring patients to normality.2 3 The care of most patients with a thoracoplasty is now in the hands of their general practitioners. It is therefore of concern that replies to the questionnaires show that many have persisting symptoms of respiratory disease that they do not report to their general practitioner.…”