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The problem of chronic empyema still presents many difficulties, and there is no standardized procedure applicable to all cases; each must be individualized. I believe, however, that every case of nontuberculous empyema can be soundly healed by judicious and persistent treatment.
The first step in every long-standing case of pleural suppuration should be a most painstaking study to determine the location and dimensions of the empyema cavity, the expansibility of the lung, the existence of pleurobronchial fistulas and the nature and virulence of the organisms. The general condition of the patient should also be considered in deciding on the extent and type of operation to be undertaken. Most of the patients suffering from long-standing empyema have damaged kidneys and hearts and do not tolerate long and shocking operations. I formerly used Beck's paste to outline the cavity for roentgen study, but since the introduction of iodized oil I have found
LOCKWOOD CD. THE TREATMENT OF SOME UNUSUAL AND DIFFICULT CASES OF EMPYEMA. Arch Surg. 1929;19(6):1726–1731. doi:10.1001/archsurg.1929.01150060788044
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