[Pleuro-pneumonectomy in the treatment of tuberculous empyemas].

The treatment of tuberculous empyema still remains a major therapeutic problem in tuberculosis. In recent years, the use of antibiotics and pleural lavages have undoubtedly improved the prognosis of uncomplicated tuberculous empyemata; however, when a broncho-pleural fistula with subsequent mixed infection empyema is present, major thoracic intervention will still be the only way to obtain a complete cure. Lately this treatment consisted in draining the pleural cavity with a subsequent thoracoplasty, which most of the time had to be completed by a resection of the parietal pleura and one or more plastic operations. Even in the successful cases this long and painful surgical treatment finally leaves a greatly deformed and crippled patient. In this short note we shall not consider the technical side of this problem on which Daems (thoracic surgeon) will report shortly. We also refer to De Winter’s report on 1,137 cases of tuberculosis treated by thoracoplasty.1 An analysis of the experience of several authors shows the high mortality rate of these multiple surgical interventions, which most of the time have to be carried out on patients in bad physical condition. At the Hopital St. Jean in Bruges, 58 cases of broncho-pleural fistula with mixed empyema have been surgically’ treated with drainage, thoracoplasty and pleurectomy between January 1, 1945 and January 1, 1950. The results are as follows: