Comparison of different treatment methods of endometriomas by laparoscopy.

In a prospective study designed to evaluate four methods of endometrioma treatment by laparoscopy, 26 patients had the endometriomas excised, 24 had them opened and the lining stripped off, 30 had them opened and the lining evaporated by CO2 laser, and 44 had them opened and drained. Only women who had laparoscopy because of pelvic pain and who had no immediate desire for pregnancy were included in this study. Those who did not undergo a second-look laparoscopy were excluded. Pain disappeared completely from all subjects regardless of the method of treatment. At second-look laparoscopy, all women in the excision group, nine (37%) in the group who had the lining stripped, nine (30%) in the group who had the lining evaporated, and 12 (27%) in the drainage group had periadnexal adhesions. Residual endometriosis was found in 23, 25, 33, and 30% of these groups, respectively. Because there was a statistical difference between the excision group and each of the remaining three groups in the formation of adnexal adhesions and because there was no statistical difference among the four groups regarding the presence of residual endometriosis, we conclude that laparoscopic treatment of endometriomas should not include excision but rather drainage with or without elimination of the inner lining.

Ventricular fibrillation during orotracheal intubation of hypothermic dogs.

Physical manipulation of the hypothermic patient is well known to cause ventricular fibrillation. Careful review of the literature fails to demonstrate a true temporal relationship between orotracheal intubation and ventricular fibrillation (VF) when acceptable temperature-corrected arterial blood gases have been obtained. Eleven mongrel dogs were anesthetized and cooled, with orotracheal intubation and extubation performed every two degrees centrigrade, starting at 27 C. Ventilator setting were adjusted to maintain normal pH according to arterial blood gases drawn every two degrees and corrected for temperature. There was only one episode of VF during 42 intubations performed at temperatures less than 28 C (2.38%). There were eight separate episodes of spontaneous VF unrelated to intubation in five dogs. Four of these five with spontaneous VF were resuscitated with countershock only, further cooled, and reintubated an additional 11 times without a single episode of VF during intubation. Our data suggest that the incidence of VF during intubation in the hypothermic patient is much less than previously described, provided that normal pH is maintained and hypoxemia is corrected.

Rapid flow rates for the resuscitation of hypovolemic shock.

Nine dogs were hemorrhaged to approximately 40% of their blood volume and then were resuscitated with a crystalloid solution (Normosol) at various flow rates. Three study groups with three dogs in each group were resuscitated at 15 mL/min/kg (Group 1), 6 mL/min/kg (Group 2), and 4 mL/min/kg (Group 3). Central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), mean arterial pressure, and cardiac output (CO) were monitored during the hemorrhage and the resuscitation from shock. During the infusion of fluids, Group 1 animals demonstrated an elevation of the PAWP of 31 mm Hg and elevation of CVP to 23.2 mm Hg; CO rose to 8.4 L/min. In Group 2 animals CO rose to 6.1 L/min; CVP was 10.5 mm Hg; and PAWP was 25 mm Hg. Group 3 animals had a rise in CO to 5 L/min; CVP and PAWP rose to 4.5 mm Hg and 6.8 mm Hg, respectively. In this experimental shock study, infusion of crystalloids at 6 mL/min/kg appeared to result in an improved physiologic response, although no statistical difference was demonstrated. Further studies are necessary to demonstrate the optimum flow rate for resuscitation of hypovolemic shock using crystalloids.