Effect of manual bowel decompression (milking) in the obstructed small bowel

[Nasointestinal intubation in surgery of acute intestinal obstruction and peritonitis: past, present and future]

The authors analyze history of development nasointestinal intubation for abdominal decompression in patients acute intestinal obstruction and widespread peritonitis, contribution of Russian and foreign surgical schools to improvement and popularization of this technique. Advisability, clinical efficacy, advantages and disadvantages of this method are stated. The prospects of nasointestinal intubation in the foreseeable future are considered in these patients. Certain technical features of nasointestinal intubation and complications are described. The causes of negative attitude of foreign surgeons to nasointestinal intubation and motivation for refusing of this technique are discussed. Considering the arguments of supporters and opponents, the authors conclude that complete rejection of this technique is premature. A differentiated approach to nasointestinal intubation according to strict indications seems to be more legitimate than categorical rejection.

Correspondence

The benefit of cardiac resynchronization therapy in patients with moderate to severe heart failure and atrial fibrillation has been discussed in this journal. A significant proportion of patients with heart failure have permanent atrial fibrillation, and have been excluded from trials of cardiac resynchronization therapy. Jolobe (vol 69(12), 2008, p. 716) advocates atrioventricular junction ablation in patients with permanent atrial fibrillation undergoing cardiac resynchronization therapy, ensuring 100% biventricular pacing. This is based on the Italian registry of cardiac resynchronization therapy (Gasparini et al, 2008), which found a survival advantage after atrioventricular junction ablation over rate-slowing medication in patients who at 1 month did not biventricular pace 85% of the time. These registry data are susceptible to selection bias.