Ambulatory Pneumoperitoneum on Chinese

¹ Chief of chest clinic, St. Paul's Hospital, Hong Kong.

(1) Ambulatory pneumoperitoneum was administered to 1031 Chinese between January 1941 and January 1954.

(2) Because of few complications in pneumoperitoneum, we discontinued pneumothorax in December 1952.

(3) The poor existing economical condition and lack of free sanatorium beds in China and Hong Kong encouraged the use of ambulatory pneumoperitoneum.

(4) Of the 1031 cases, 740 (71.8 per cent) were males, One hundred and fifteen (11.1 per cent) in the 15-20 years age group, 727 (70.5 per cent) in the 21-40, 139 (13.5 per cent) in the 41-50 and 50 (4.9 per cent) in the 51-70 years age group; 596 (57.8 per cent) were far advanced, 190 (18.4 per cent) moderately advanced and 245 (23.8 per cent) minimal cases.

(5) Nineteen had air embolism of whom two died. One had massive hemorrhage in the abdominal cavity. Eleven developed hernia and pneumoperitoneum had to be discontinued in 10. Abdominal effusions were successfully treated in eight with aspirations, diuretics and improved nutrition, two died from malnutrition and one failed to continue treatment.

(6) Six hundred and twenty four terminated treatment against medical advice of whom 15.2 per cent were moderately and 65.6 per cent were far advanced cases. Over 50 per cent of these had treatment for only one to three months, and the majority began treatment before 1948, when pneumoperitoneum was little known. Recently more and more early cases have been found who were willing to take this form of treatment and for longer periods. The results on those (126) who discontinued treatment under medical advice and those (281) carried on their treatment are encouraging. Among the entire 1031, there were only 303 (29.4 per cent) with no im-improvement, 116 (11.3 per cent) improved symptomatically, 269 (26 per cent} had symptomatic and film improvement. Three hundred and forty-three have been inactive for six months to four years.

(7) Since May 1952, isoniazid and dihydrostreptomycin, alone respectively, or in combination, and streptopas with or without isoniazid, were given one to 12 months to 312 patients receiving pneumoperitoneum. Most of these patients had early and acute disease, and cannot be satisfactorily compared with those who had no chemotherapy and whose lesions for the most part were more advanced and chronic. One hundred and seventy nine of the 312 pneumoperitoneum cases who had chemotherapy have been inactive for six or more months.