Faculty Bibliography

To compare the accuracy and safety of open abdominal paracentesis and lavage vs percutaneous paracentesis and lavage, 210 consecutive patients were prospectively randomized into two groups of 105 each. There were no false-negative diagnoses in either group. The accuracy rate for the open method was 98.1%, and 91.4% for the percutaneous method. Six major complications were encountered with the percutaneous method, for a complication rate of 5.7% compared with no major complications with the open method. The results suggest that the open technique is superior to the percutaneous method

Air embolism (AE) is a rare but lethal complication of subclavian vein catheterization (SVC). Although treatable, if recognized promptly, attention should be directed towards prevention. SVC has been used at New York University Medical Center since 1969 for parenteral nutrition; its safety and complications have been recognized and reported. Since 1976, 14 patients with AE from SVC have been observed. Thirteen occurred as a sudden catastrophic event associated with disconnection of the catheter; all had significant morbidity; 4 (29%) died; 9 (65%) had associated profound neurologic deficit from which 5 recovered completely. Five others had cardiorespiratory morbidity but also recovered. In 1 surviving patient air was aspirated from the right atrium with immediate improvement. Survivors had evidence of pulmonary AE characterized by hypoxia. AE is a syndrome of respiratory distress, hypotension, and neurologic deficit of sudden onset. Immediate treatment is aspiration through the catheter in the left lateral steep Trendelenburg position. Review of our experience with AE suggests that lack of integrity of the connection between the catheter and the intravenous tubing was the responsible mechanism in the majority of case (93%). Secure fixation of these connections is vital for the prevention of AE

A review of the management of adhesive small bowel obstruction revealed many hazards of long intestinal intubation therapy. When compared with those patients treated by fluid and electrolyte repletion and laparotomy within 24 hours, patients treated by prolonged tube suction had a longer hospital course, 22.6 versus 15.3 days; longer postoperative ileus, 7.4 versus 6.5 days, and greater technical problems at operation. This latter group also had a greater incidence of extensive postoperative complications and erroneous diagnoses. Long tubes were successful in only 21 patients and were most ineffective in those with complete obstruction as observed on roentgenograms. Patients with a prior abdominal surgical procedure, absence of any signs of strangulation and partial small bowel obstruction on roentgenograms, may be treated initially by long tube decompression and careful monitoring. Lack of definite improvement in 24 hours demands laparotomy. The value of intraoperative intestinal decompression is questionable