The Influence of Streptomycin on the Incidence of Pleural Effusion Complicating the Division of Adhesions

Abstract

It is recognized that the development of an effusion following the division of adhesions in an artificial pneumothorax is a common complication and that in an appreciable proportion of the cases it leads to loss of the artificial pneumothorax from obliterative pleurisy. It predisposes to tuberculous or mixed empyema, and through the development of pleural fibrosis and thickening the lung may subsequently not expand. Fluid covering the diaphragm is generally considered to be significant and an indication for aspiration. Smaller collections of fluid usually resolve if left alone.The incidence of pleural effusion after the division of adhesions has varied greatly in the different series published in the literature. Goorwitch (1948) (Kunstler, 1947;Strandgaard, 1950 Watt's (1947) series of 820 adhesion sections there were 293 (36%) effusions within two weeks, 23 (2.8%) in the period three to eight weeks after operation, and only 60 (7%) developed later than eight weeks. It appears therefore that the great majority of post-operative effusions occur within a period of eight weeks, and it was decided for the purpose of this review to take this as an arbitary period. It is doubtful if later effusions can be blamed directly on the operation.When streptomycin became available it was used at first for the treatment of acute exudative disease. Artificial pneumothorax was induced when it was deemed that the toxaemia had abated and the disease was under control. It seemed logical to continue the streptomycin to cover the section of adhesions, and we had the impression that post-operative effusions occurred less often in these cases than in those which had not been given streptomycin as the disease was not sufficiently extensive or acute. It was already known (Levin, Carr, and Heilman, 1948) that streptomycin appeared in bacteriostatic concentrations in pleural fluid when given by the intramuscular route.In an attempt to prove this theory, it was planned to carry out a series of adhesion sections under cover of streptomycin and to compare this series with a similar one in which streptomycin was not used. The original aim was to start the on 12 May 2018 by guest. Protected by copyright.