



Ping Pong Ball Plombage

Older Methods of Treating Tuberculosis



Early treatments of TB Early treatments of TB relied upon rest, proper nutrition and isolation

In late 1800’s, the concept of artificial pneumothorax was introduced by Carlo Forlanini of Milan

Speculated on the feasibility of collapsing lung by introducing air into the pleural space



Intentional production of a lung collapse was thought to allow the lung to rest



It usually did nothing except possibly to worsen the condition of the patient



By early ‘40s, thousands of refills ( reinjections of air) were being done each year to maintain the collapsed lung

Pneumoperitoneum to rest the lung followed in the late 1940s

These techniques were often combined with phrenicolysis (crushing or surgical division of the phrenic nerve) leading to ipsilateral paralysis of the diaphragm

Plombage involved the extrapleural insertion of a “ plombe ” to collapse the lung

Lucite balls (ping pong balls) appear as completely spherical densities of uniform size, usually in the upper lung field

Such plombes included

Fat



Solid paraffin wax



Lucite spheres



Plastic ping pong balls (1940s)



Sponges of inert plastic material



Oleothorax



Oil in the pleural cavity

Sanatorium movement began slower in US than Europe

Once started, many opened and became a major way of treating TB



In 1953, 839 TB sanatoria were operating in the USA stressing



Diet





Regimented exercise





High altitude (where possible)





Bedrest





Sunlight





Cold air

Chemotherapy

Streptomycin was the first, widely-used, effective anti-tuberculous agent (1946)



Subsequently, isoniazid (1952), pyrazinamide (1954), cycloserine (1955), ethambutol (1962) and rifampin (1963) were introduced



In the 1980s, drug-resistant strains emerged and the number of cases increased



Multiple drug treatment regimen is the standard of care: usually isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin

Plombage for Tuberculosis. White arrows point to lucite balls that were inserted into the right upper thorax in order to collapse the adjacent right upper lobe as an early treatment for tuberculosis to "put the lung at rest."

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