Abstract
The authors report the clinical observations relative to the mediastinal shifts before and after the induction of pneumothorax by serial chest roentgenograms of 190 cases at authors' clinic, which were made during the period between January 1946 and August 1953. Of the entire 190 cases, 136 were unilateral, 26 were bilateral and 28 were with contralateral thoracoplasty. The follow-up observations were conducted for more than 6 months.
Exacerbations of tuberculosis among the cases of unilateral Group were as follows:
Reactivates of contralateral lesions (Group A) were 23 out of 76 cases (30.2%), and spreads of contralateral lung (Group B) were 2 out of 58 cases (3.4%) .
Mediastinal shifts:
Exacerbations in Group A: The mediastinal shifts to the operated side were 15 out of 18 cases (83.3%) ; normal mediastinums were 2 out of 19 cases (10.5%) ; mediastinal shifts to the contralateral side were 6 out of 39 cases (15.3%) .
I. Group B: The mediastinal shifts to the operated side were 15 out of 58 cases, in which spreads were 13.3%, and no exacerbation was observed in the Group of the normal mediastinum and the Group of the mediastinal shifts to the contralateral side.
Duration of pneumothorax:
Exacerbations occurred in 100 of the cases belonging to the Group of mediastinal shifts to the operated side, which received pneumothorax over 4 years. The Group of normal mediastinum and the Group of mediastinal shifts to the contralateral side often exacerbated comparatively in an early stage. However, no definite relationships of the mediastinar shifts and the duration of pneumothorax to the incidence of spread of the disease were recognized.
Exacerbation of disease in the bilateral Group were 2 out of 26 cases (7.6%) and with contralateral thoracoplasty were 2 out of 28 cases (7.1%) .
Exacerbations in contralateral lungs with thoracoplasty were observed in 13% of the cases in authors' clinic. When this percentage is compared with 30.2% observed in Group A, a remarkable difference is noted. It is well recognized that mediastinal shifts may have been the cause of these exacerbations. For that reason, although the mediastinal shifts to the contralateral side of the pneumothorax were 44.7% and to the same side of the pneumothorax were 24.6%, those to the contralateral side of the thoracoplasty were as many cases as in 80.5%
Incidences of new lesion in the contralateral side were mostly found in the Group of mediastinal shifts to the pneumothorax side, and exacerbations of the disease were found not affected by the mediastinal shifts.
According to the clinical observations, streptomycin-PAS treatment seems to be effective to prevent the spread of the diseases, though these chemotherapeutic measures were often useless when new spreads were once established.
