Treatment of flail chest. Use of intermittent mandatory ventilation and positive end-expiratory pressure

For the past two years we have treated patients with flail chest injuries and concomitant respiratory failure with intermittent mandatory ventilation (IMV) and positive end-expiratory pressure (PEEP). Prior to 1972 these patients were treated with controlled mechanical ventilation (CMV) until gross flailing ceased and inspiratory force and vital capacity measurements were adequate. We retrospectively studied the charts of 37 consecutive patients to compare the length of mechanical ventilatory support of patients managed by conventional CMV with those ventilated with IMV and PEEP. The mean ventilation time of patients treated with IMV and PEEP (5.1 +/- 4.7 days) was significantly less than that of the patients treated with CMV (18.8 +/- 14.4 days) (P less than .001).

Cryosurgery for neoplasia

Certain laboratory findings are presented which we think directly relate to the clinical problems of cryosurgery. Our experience in dealing with a variety of neoplasms is recorded. It is our opinion that the majority of skin tumours, benign and malignant, are best treated in this way and the advantages over radiotherapy and conventional excision are pointed out. Cryotherapeutic results on large tumours such as sarcomas and rectal carcinomas we regard as less satisfactory because of technical reasons.

Cryoprostatectomy on a highly selected group of patients has produced encouraging results although we would still regard this method of treatment as in its infancy and requiring further assessment. A brief comment is made on 33 cases of benign enlargement and 3 carcinomas of the prostate.