Melvin N. Zelefsky

Percutaneous drainage of lung abscess

Most lung abscesses are successfully treated with antibiotics. However, occasional patients with lung abscesses that drain poorly, causing persistent fever and toxic symptoms, may require surgical intervention. Lobectomy is the most frequent surgical procedure. Some patients are debilitated and have underlying medical conditions such as heart disease, chronic pulmonary disease, or liver disease that may render surgical intervention risky. Recently there have been reports of percutaneous drainage of lung abscess with good results. We have successfully carried out percutaneous drainage of lung abscess in 4 patients and an infected bulla in 1. All patients had failed to respond to therapy with antibiotics and postural drainage. There was prompt disappearance of the fluid level in the cavity, decline in temperature, and abatement of toxic symptoms with drainage. The cavities closed gradually over the next 6–12 weeks. The patients tolerated the chest tube well and there were no side effects from the tube drainage. Percutaneous tube drainage is the surgical treatment of choice in the medically complicated patient with a poorly draining lung abscess.

Chest wall configuration assessed at total lung capacity during acute asthma and after recovery

During acute asthma reversible increase in lung compliance and total lung capacity (TLC) have been observed. The magnitude of the increase in TLC, however, was found to be relatively small when TLC was measured radiographically. We wondered if structural distortion of the respiratory bellows develops during acute asthma attacks, accounting for the limited increase in TLC. We analyzed the chest wall dimensions using chest roentgenograms obtained in 32 patients who had previously participated in the study of radiographic evaluation of TLC. We found that the dimensional changes accompanying the small increase in TLC during acute asthma were nonuniform, consisting of mainly an increase in lung height (0.45 ± 0.15 cm) with limited coordinated expansion of other dimensions and a small but significant distortional contraction of lung width at the lowest portion of the rib cage (−0.25 ± 0.12 cm). These findings were interpreted to mean that in response to the decrease in elastic lung recoil (internal load) occurring during acute asthma, the diaphragm makes limited but effective further caudad descent without provoking serious structural distortion and that rib cage muscles, working at mechanical disadvantage at high lung volume, act largely as fixators.

Assessment of Regional Lung Function and Its Clinical Applications by the Combined Use of Lung Scan and Gamma Densigraphy

A combination of lung scanning for evaluation of perfusion and gamma densigraphy for evaluation of regional ventilation was applied in various clinical situations and found to be very useful. The technique involved the use of an external americium-241 source to measure changes of linear radiodensity of the chest with respiration. This combined diagnostic approach was employed to study patients with pulmonary embolism, emphysema, tuberculosis, and cancer.

The nature of the increased lung volume in asthma.

Abstract Thirty-two asthmatic patients were studied during an acute exacerbation and subsequently during remission. Four were found to increase their Total Lung Capacity during acute exacerbation when measured by a closed circuit helium dilution technique. However, concomitant use of a radiologic method for estimating total lung capacity showed no increase in TLC. It is suggested that the difference is an artifact due to helium swallowing or gas leak.