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Artificial pneumothorax treatment complicated by pregnancy
112
TUBERCLE
[December, 1927
(3) The patients suffered (rom diarrhcea and abdominal pain after the injections. (4) The patient began to lose weight. Reviewing our experiences of the treatment of pulmonary tuberculosis with sanocrysin, we have come to the following- conclusions : (1) That the results of treatment are not sufficiently certain to warrant its use before routine or collapse therapy has been tried. (2) That the contra-indications are such that only a small percentage of cases are suitable (or the treatment. (3) That if the treatment is given the dosage should be regulated so as to produce only the slightest reaction, or better still, no reaction at all. (4) That more knowledge as to the elimination of the drug is needed before the treatment can be regarded as safe. (5) That certain cases have made remarkable progress, and the majority improved, but the action of the drug is so irregular that it is impossible to predict a good result in any case chosen for the treatment. (6) That the most constant successes have been in cases in which the treatment was used to supplement collapse therapy, and that further investigations along- these lines are desirable. (7) That the treatment can be given to children with beneficial results. (8) That in the majority of cases which improved under sanocrysin, after routine treatment had failed, the permanency of the degree of arrest of the disease is distinctly encouraging.
AItTIFICIAL PNEUMOTHORAX TREATMENT COMPLICATED BY PREGNANCY. By A. P.
M.R.C.S.Eng-., L.RC.P.Lond., D.P.H.Oxon. Clinical Tuberculosis Officer and Deputy County Medical o.tJiCB1· oj Health. FORD,
Hertfordshire.
AT the present time there appears to be some diversity of opinion as to the correct method to adopt when a case of pulmonary tuberculosis, which is being treated by artificial pneumothorax, is complicated by pregnancy. The following- case appears to be of interest in this respect. L.A., Do female, aged 23, was first seen on September 10, 1925, when she gave a history of cough and wasting for six weeks and presented signs of active disease extending over the whole of the right lung, and the upper lobe of the left lung. 'I'he temperature ranged from 98° F. to 100° F., her pulse rate was 120, while every twenty-fours she coughed up about 2 oz. of sputum, which contained tubercle bacilli in .considerable numbers.' Her general condition was. very poor, her weight being 7 st. The patient was admitted to sanatorium and a right artificial pneumothorax was induced on October 8, 1925. Complete collapse of the lung
December, 1\:)271
PNEUMOTHORAX 'l'REATMENT AND PHECTNANCY
113
was obtained, with the result that the patient rapidly improved and was discharged from sanatorium on March 1, 1926. She then had no cough or sputum, the temperature and pulse-rate were normal, and she weighed 7 st. 10 lb. Shortly after leaving the sanatorium, the patient married in spite of medical advice to the contrary, and in July, 1926, became pregnant. At this time she was having refills every three weeks, the manometric readings on August 11, 1920, being - 10 - 5, 500, 0 + 4. In view of the excellent condition of the patient it was decided to allow the pregnancy to pursue its normal course and to continue the refills as before. It was found that the pregnancy had no apparent' effect on the treatment, and, on the other hand, the treatment had no apparent effect on the pregnancy. The refills were given at three-weekly intervals, the readings at the last refill given five days before the confinement being - 1~ - 5, 500, - 2 + 2. The general condition of the patient remained excellent during the whole of the time, she was quite free from cough, her temperature and pulse-rate were normal, and she did not complain of dyspneea. Dr. F. G. Smyth of St. Albans has very kindly sent the following notes on the confinement which took place on April 14, 1927 :"Labour commenced about 3 a.m, and lasted seven hours, the baby (male) being born at 10 a.m. I had no scales and did not weigh the baby, but it was slightly, but not markedly, on the small side. The confinement proceeded perfectly normally and more easily than the average. She was never in any distress, had no dyspncea and did not require any chloroform. The pulse-rate did not at any time cause one anxiety. She had a normal puerperium with a pulse-rate below 90 from first to last." The refills were re-commenced on April 20, H)27, the readings being - 7 - 4, 340, 0 + 4. The artificial pneumothorax treatment is still being continued with excellent results. The patient remains free from any symptoms and at the present time weighs 7 st. 11i lb. The baby is quite healthy and is over the average weight for its age. Although it is obviously impossible to form any definite conclusions from one case, it would appear from the above that the induction of abortion is not indicated in a patient suffering from pulmonary tuberculosis who becomes pregnant during artificial pneumothorax treatment, provided the general condition remains satisfactory. The fact that one lung is completely collapsed does not appear to have any deleterious effect on the confinement. This opinion does not agree with that of so great an authority as Dr. Gravesen who states: "A pregnancy which has commenced during the collapse treatment has, as a rule, to be interrupted as soon as it is diaznosed, unless it occurs at such a late period of the treatment that the dis~ase can be considered permanently cured."l It is of interest to note that the pressures before introducing air 011 March 30, 1927, and April 20, 1927, were - 12 - 5 and - 7 - 4 respectively, while the amount of air required to bring the pressure down to atmospheric was considerably less after the confinement than it was immediately before. '!'hese manometric readings do not -bear out the generally accepted opinion that one of the reasons for the marked improvement which so frequently occurs during pregnancy is the fact that the affected lung is compressed by pr~gJ?ancy and decompressed by delivery. 1 ..
Surgical Treatment of Pulmonary and Pleural Tuberculosis," by J. Gravesen, M.D.
TUBERCLE
[December, 1927
(3) The patients suffered (rom diarrhcea and abdominal pain after the injections. (4) The patient began to lose weight. Reviewing our experiences of the treatment of pulmonary tuberculosis with sanocrysin, we have come to the following- conclusions : (1) That the results of treatment are not sufficiently certain to warrant its use before routine or collapse therapy has been tried. (2) That the contra-indications are such that only a small percentage of cases are suitable (or the treatment. (3) That if the treatment is given the dosage should be regulated so as to produce only the slightest reaction, or better still, no reaction at all. (4) That more knowledge as to the elimination of the drug is needed before the treatment can be regarded as safe. (5) That certain cases have made remarkable progress, and the majority improved, but the action of the drug is so irregular that it is impossible to predict a good result in any case chosen for the treatment. (6) That the most constant successes have been in cases in which the treatment was used to supplement collapse therapy, and that further investigations along- these lines are desirable. (7) That the treatment can be given to children with beneficial results. (8) That in the majority of cases which improved under sanocrysin, after routine treatment had failed, the permanency of the degree of arrest of the disease is distinctly encouraging.
AItTIFICIAL PNEUMOTHORAX TREATMENT COMPLICATED BY PREGNANCY. By A. P.
M.R.C.S.Eng-., L.RC.P.Lond., D.P.H.Oxon. Clinical Tuberculosis Officer and Deputy County Medical o.tJiCB1· oj Health. FORD,
Hertfordshire.
AT the present time there appears to be some diversity of opinion as to the correct method to adopt when a case of pulmonary tuberculosis, which is being treated by artificial pneumothorax, is complicated by pregnancy. The following- case appears to be of interest in this respect. L.A., Do female, aged 23, was first seen on September 10, 1925, when she gave a history of cough and wasting for six weeks and presented signs of active disease extending over the whole of the right lung, and the upper lobe of the left lung. 'I'he temperature ranged from 98° F. to 100° F., her pulse rate was 120, while every twenty-fours she coughed up about 2 oz. of sputum, which contained tubercle bacilli in .considerable numbers.' Her general condition was. very poor, her weight being 7 st. The patient was admitted to sanatorium and a right artificial pneumothorax was induced on October 8, 1925. Complete collapse of the lung
December, 1\:)271
PNEUMOTHORAX 'l'REATMENT AND PHECTNANCY
113
was obtained, with the result that the patient rapidly improved and was discharged from sanatorium on March 1, 1926. She then had no cough or sputum, the temperature and pulse-rate were normal, and she weighed 7 st. 10 lb. Shortly after leaving the sanatorium, the patient married in spite of medical advice to the contrary, and in July, 1926, became pregnant. At this time she was having refills every three weeks, the manometric readings on August 11, 1920, being - 10 - 5, 500, 0 + 4. In view of the excellent condition of the patient it was decided to allow the pregnancy to pursue its normal course and to continue the refills as before. It was found that the pregnancy had no apparent' effect on the treatment, and, on the other hand, the treatment had no apparent effect on the pregnancy. The refills were given at three-weekly intervals, the readings at the last refill given five days before the confinement being - 1~ - 5, 500, - 2 + 2. The general condition of the patient remained excellent during the whole of the time, she was quite free from cough, her temperature and pulse-rate were normal, and she did not complain of dyspneea. Dr. F. G. Smyth of St. Albans has very kindly sent the following notes on the confinement which took place on April 14, 1927 :"Labour commenced about 3 a.m, and lasted seven hours, the baby (male) being born at 10 a.m. I had no scales and did not weigh the baby, but it was slightly, but not markedly, on the small side. The confinement proceeded perfectly normally and more easily than the average. She was never in any distress, had no dyspncea and did not require any chloroform. The pulse-rate did not at any time cause one anxiety. She had a normal puerperium with a pulse-rate below 90 from first to last." The refills were re-commenced on April 20, H)27, the readings being - 7 - 4, 340, 0 + 4. The artificial pneumothorax treatment is still being continued with excellent results. The patient remains free from any symptoms and at the present time weighs 7 st. 11i lb. The baby is quite healthy and is over the average weight for its age. Although it is obviously impossible to form any definite conclusions from one case, it would appear from the above that the induction of abortion is not indicated in a patient suffering from pulmonary tuberculosis who becomes pregnant during artificial pneumothorax treatment, provided the general condition remains satisfactory. The fact that one lung is completely collapsed does not appear to have any deleterious effect on the confinement. This opinion does not agree with that of so great an authority as Dr. Gravesen who states: "A pregnancy which has commenced during the collapse treatment has, as a rule, to be interrupted as soon as it is diaznosed, unless it occurs at such a late period of the treatment that the dis~ase can be considered permanently cured."l It is of interest to note that the pressures before introducing air 011 March 30, 1927, and April 20, 1927, were - 12 - 5 and - 7 - 4 respectively, while the amount of air required to bring the pressure down to atmospheric was considerably less after the confinement than it was immediately before. '!'hese manometric readings do not -bear out the generally accepted opinion that one of the reasons for the marked improvement which so frequently occurs during pregnancy is the fact that the affected lung is compressed by pr~gJ?ancy and decompressed by delivery. 1 ..
Surgical Treatment of Pulmonary and Pleural Tuberculosis," by J. Gravesen, M.D.