The reversibility of pulmonary overdistention.

The problems of treatment posed by total pneumonectomy have always been two-fold. First, the creation of a large dead space was contrary to a cardinal principle of surgery. Secondly, the fate of the “good lung” from both the physiological and pathological standpoint, has been the subject of conjecture. The problem of a large dead space appeared frightening to Graham’ when he performed his first pneumonectomy. He solved this problem by performing a concomitant thoracoplasty to obliterate it. By so doing, he doubtlessly minimized overdistention of the remaining lung and thus solved the second problem In a satisfactory manner. Gaensler and Strieder2 have shown that early thoracoplasty appears more valuable than late thoracoplasty from a function-sparing standpoint but indicate that thoracoplasty per se, even over a dead space, results in some functional loss. Nevertheless, Strieder3 believes that post pneumonectomy thoracoplasty is a worth-while procedure, if only to prevent annoying cough and make the patient more comfortable. It Is generally agreed upon that prevention of overdistention is desirable. This Is so, especially, since the results of treatment, when overdistention has become clinically established, are not satisfactory. Furthermore, no standardized method of correction of overdistention has been evolved. Various authors have advocated thoracoplasty, pneumothorax, oleothorax, and procedures employing plombage in an effort to allow the mediastinum to stabilize in its normal position in the midline. On the other hand there are surgeons who do not employ post-pneumonectomy space obliterating procedures to preserve function. They believe overdistention is only dangerous in the tuberculous patient where it may result in breakdown of foci in the opposite lung. It was surprising to us to flnd4 5 that few statistics were available to document the clinical improvement often seen following treatment for well established postsurgical compensatory emphysema. The following case histories are presented to substantiate the authors’ impression that the often striking amelioration of symptoms following treatment of pulmonary overdistentlon must have some basis In fact.