ABDOMINAL PNEUMOPERITONEOGRAPHY

[CO2 angiography: measuring blood flow with injected gas bubbles]

The use of CO2 gas as a contrast medium for visualizing blood vessels has been considerably facilitated by the development of a gas metering device for mechanical injection of CO2. The present paper describes the possibility of using CO2 not only for visualizing blood vessel morphology, but also for the diagnostic evaluation of the haemodynamics within the vessels. For this reason in vitro experiments with an artery simulation model were undertaken to examine the behaviour of injected gas bubbles. The information thus obtained was then translated to animal experiments.

[CO2 angiography: studies of gas filling of vessels and assessing the factors of influence on the injection process with a cardiovascular model]

Following the advent of digital subtraction angiography (DSA), carbon dioxide gas has become a useful contrast agent for arterial angiography. Former manual injection methods had precluded accurate dosing and reproducibility. An original gas injector was therefore developed and tested in a circulatory system model. This permitted an accurate evaluation of vascular gas-filling. it also proved possible to measure the injection parameters taking different influencing factors into account. It was shown that vessels up to 10 mm in diameter are virtually completely filled with gas. In vessels larger than 10 mm in diameter, a residual fluid level remains, which in turn reduces the possibility for complete vessel imaging. The injection flow is dependent primarily on the vascular circulation rate, vessel diameter and the inclination of the vessel. With respect to other factors examined, neither catheter size, number of holes nor the direction of the injection have any relevant influence.

Blunt traumatic rupture of the diaphragm

Blunt traumatic rupture of the diaphragm must be suspected in all patients with massive trauma and especially in those whose chest roentgenogram reveals an abnormal or obscured diaphragmatic shadow. Regular reevaluation is most important. A diagnostic pneumoperitoneum is the most accurate preoperative test available. Transthoracic approach is the operation of choice.

Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients

An analysis is made of the results of pleuropneumonectomy for diffuse malignant pleural mesothelioma in 29 patients and a comparison is made with the results of non-surgical treatment in a further 17 patients. A system of tumour staging is proposed, and the results are correlated with tumour stage and with histological type. Pleuropneumonectomy does not appear materially to affect the course of the disease in cases of mixed epithelial and mesenchymal histological type. However, stage I cases of pure epithelial histological type appear to carry a better prognosis, especially those whose histological structure consists entirely of abundant oedematous mucoid stroma with loosely arranged tumour cells. It is suggested therefore that only epithelial cases should be subjected to pleuropneumonectomy. Means of reducing operative mortality are discussed and alternative methods of treatment described.