Monday, February 27, 2012

A bit of TB history

I saw an 88 year woman last week who had a history of undergoing a thoracoplasty in approximately 1946 for TB. She served in the Hospital Corp during WWII. I could not remember  the “why and how” of a thoracoplasty. Here are a few things I came across:

The first successful treatments for tuberculosis were all surgical. The initial procedures were all used in the pre-antibiotic era (the first antibiotic for TB was streptomycin-developed in 1946). The interventions were based on the observation that healed tuberculosis cavities were all closed. Surgical management was therefore directed at closing open cavities in order to promote healing.

When the tuberculosis cavity was located in the apex of the lung, a thoracoplasty could be performed. Six to eight ribs were broken (or removed) and pushed into the thoracic cavity to collapse the lung beneath. It was obviously a disfiguring operation.

Although thoracoplasty for TB is considered an obsolete procedure (and was largely discontinued by the 1950s), many underdeveloped parts of the world, where tuberculosis remained rampant, continued the procedure up until the late 1990s.

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