Abstract
One of the difficulties in carrying out surgical compressive therapy for various lung diseases is that in some individuals the mediastinal contents are so little stabilized that such procedures as artificial pneumothorax and theracoplasty merely result in crowding the affected lung over into the opposite side of the chest instead of producing the desired compression of pulmonary cavities. The theoretical considerations, together with the demonstration of the importance of having a fixed mediastinum in such conditions, upon which is based the modern treatment of acute empyema have been described by Graham.
The method producing fixation must be innocuous, i. e., should not produce “Pick's syndrome” of adhesive mediastino-pericarditis, and furthermore the duration of the various types of fixation should be of differing degree.
The anterior mediastinal space of rabbits is potentially large with ready extension to the anterior portion of the superior mediastinum. This space accommodates 15 cc. of fluid. Roentgenograms of injections of this space with radiopaque fluids demonstrate the feasibility of filling this space with fluid substances which either by action as mechanical barriers or by evocation of a benign, slowly progressive, productive inflammation would secure fixation of the mediastinum in the mid-line sufficient to resist large alterations of intrapleural pressure.
The standard of control was the shift of the mediastinum (adult rabbits) in response to 20 cc. of air introduced into the left pleural cavity. Uniformly in the 6 control animals such a pneumothorax succeeded in shifting the mediastinum far over to the right so that the left cardiac border coincided on the roentgenograms with the left margin of the vertebral column.
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