Artificial pneumoperitoneum in the treatment of pulmonary tuberculosis: a clinical study.

Since the pioneer efforts of Banyai6 there have emerged only a few reports up to relative recency. Since 1947 publications by Mitchell et al.,’ Trimble et al.,8 Hurst et al.’4 and several others have contributed notably to further clarification of the results which have been consistently good, particularly in the face of many instances of far advanced disease wherein prognosis once was held as being hopeless. The dilemna of having to tell a patient “nothing can be done” is partially solved through the use of pneumoperitoneum. Though so much remains yet to be done, it cannot be denied that artificial pneumoperitoneum offers new hope to many, either by itself or preparatory to surgery. Yet as many enthusiasts as there are, there are some who doubt its efficacy and rightful place in the treatment of pulmonary tuberculosis, except in a few rigidly select cases. In our experience it has proved useful and often life-saving in a rather wide variety of cases to which other forms of collapse were not readily adaptable. Mitchell and his co-workers’ conducted an exhaustive survey of the literature from 1937 to 1945 and found that those men who had employed artificial pneumoperitoneum in a large series obtained favorable results. In the smaller group of unfavorable reports it was noted that the largest single group of cases studied was only 50 cases. The largest number of cases in a single report were published by Crow and his co-workers.9 Of 546 cases they obtained good results in 60 per cent with the period of observation ranging up to five years. The authors have reviewed the literature in the past three years (1946-1948) and have found several noteworthy contributions. In 1946 Aslett and Jarman’8 reported favorable results In 42 cases, the majority of which were far advanced. During this same year Banyai’s6 monumental work on pneumoperitoneum was published. In 1947 Mitchell et al.’ published their notable paper. They received satisfactory results in 57 per cent of white and 37 per cent of colored patients with advanced pulmonary tuberculosis not amenable to conventional forms of collapse therapy. Hurst and his co-workers’4 reported results on 103 cases in which phrenic crush was an adjunct to the pneumoperitoneum. Gilmore’ found