| Popis: |
Summary o 1. Phrenicectomy was attempted in 1,000 adolescent and adult patients suffering from pulmonary tuberculosis. Permanent paralysis of the diaphragm was obtained in 968 patients. Four patients were lost sight of after discharge from the sanatorium. 2. The anatomy and physiology of the phrenic nerve are described. 3. The effects of successful phrenicectomy on the diaphragm, on the lung and on other organs are discussed. 4. Selective pulmonary collapse occurred in 41·9 per cent of 205 patients in whom phrenicectomy was the only collapse measure employed; and in 49·8 per cent of 339 patients in whom phrenicectomy was used in conjunction with artificial pneumothorax. 5. The effects of phrenicectomy on the signs and symptoms of pulmonary tuberculosis, and the radiological findings are described. 6. The sputum became negative after operation in 30·4 per cent of 282 patients, in whom phrenicectomy was the only collapse measure employed, and in 49·9 per cent of 647 patients in whom phrenicectomy was used in conjunction with artificial pneumothorax. The sputum was examined on at least three occasions after operation. 7. Serial sedimentation rate examinations in 443 patients showed improvement in 46·2 per cent, no alteration in 42·2 per cent, and a deterioration in 11·6 per cent. 8. Some points in the operative technique of phrenic evulsion and radical phrenicectomy are mentioned. 9. Operative complications occurred in 53 patients (5·3 per cent), 16 of which were fatal. The mortality was 26·4 per cent. 10. The indications and contraindications for phrenicectomy are indicated. 11. One hundred and eighty patients with patent cavities were treated by phrenicectomy alone. Of these, 19·4 per cent of the cavities closed; 38·8 per cent became smaller; 7·2 per cent were unaffected; 19·4 per cent became larger; and 2·2 per cent closed but later reopened. Three hundred and thirty-one pneumothorax patients with patent cavities were treated by phrenicectomy. Of these, 35·0 per cent of the cavities closed; 24·1 per cent became smaller; 9·8 per cent were unaffected; 14·5 per cent became larger; 0·8 per cent closed but reopened later. 12. One hundred and thirteen patients without cavitation were treated by phrenicectomy alone. Of these, 64·6 per cent are alive after an average follow-up of 3·5 years, 35·4 per cent are dead after an average life of 1·9 years. Three hundred and thirty-two pneumothorax patients without cavitation were treated by phrenicectomy, 73·7 per cent are alive after an average follow-up of 3·4 years; 26·3 per cent are dead after an average life of 2·4 years. 13. The conclusions are drawn that phrenicectomy is of definite value as a sole collapse measure when artificial pneumothorax is impossible, but that its greatest value is in conjunction with pneumothorax. |
