LATE COMPLICATIONS AFTER EXTRAPLEURAL PNEUMOLYSIS FOR PULMONARY TUBERCULOSIS

The epidemic spread of tuberculosis after World War II and the deficie ncy of appropriate antituberculotic drugs led to a renaissance of surg ical procedure such as plombage thoracoplasty, initiated in 1891 by Tu ffier. Especially in Germany the insertion of paraffin and polyethylen e was used in order to achieve an extrapleural pneumothorax in order t o collapse the tuberculous cavities in the upper lobes. Due to a high rate of early complications and the assumed cancerogenicity, in a cons iderable number of cases the material was removed soon after its deplo yment. In some cases with the filling remaining in place, 30-40 years later infections and/or neoplasms occurred. From 1985 to 1996 in two c enters of thoracic surgery 13 patients underwent procedures for remove l of filling material. The patients suffered from infections (n = 11), malignant lymphoma associated with infection of the plombage (n=1) an d bronchial carcinoma (n = 1). Technically, we performed the thoracopl asty described by Schede (n = 9). Schede's thoracoplasty in combinatio n with a muscle flap repair (n = 1) or partial resection of the thorac ic wall (n = 1), an empyemectomy (n = 1), and an en-bloc pleuropneumon ectomy (n = 1). All patients suffered from multiple underlying disease s (COPD, coronary heart disease, diabetes mellitus). However, apart fr om beside two procedure related deaths (pulmonary embolism n = 1, pneu monia complicated by multi-organ failure n = 1) no other major complic ations were observed. The plombage material in the case of malignant l ymphoma is probably carcinogenic in relation to the time of exposure a nd should be removed in all cases.