Larger chest tubes are not necessarily better when it comes to draining the mediastinum. The actual area of ingress through the sideholes is considerably less than the surface area provided by the fluted Blake drain. We believe that this system can replace standard chest tubes.

Clinical judgment is highly accurate in separating patients with tangential gunshot wounds to the abdomen from those with intra-abdominal injury but may miss patients with intra-abdominal hemorrhage. Diagnostic peritoneal lavage is highly predictive of the presence of intra-abdominal injury. The return of gross blood on aspiration or a lavage red blood cell count greater than 10 x 10(9)/L should prompt an urgent celiotomy. Missed injuries are rare and most likely to be bowel perforations. Diagnostic peritoneal lavage is an objective test that may augment clinical judgment in selecting hemodynamically stable patients with potential tangential gunshot wounds for observation and is especially useful in identifying intra-abdominal hemorrhage.

Fig 1. Cinefluoroscopy of mitral prosthetic disc moving freely in the left ventricular cavity.tions, endometrial implants, or both, an incidence of nearly 88%. If these findings do indeed tum out to be more consistent than previously appreciated, then it would seem logical to implicate their presence in the etiology of this condition.We also acknowledge the effects of systemic factors in the etiology of this disorder. Indeed, although not u5ed in the case report by Fonseca, we note the excellent results reported in the systemic management of catamenial pneumothorax with gonadotropin-releasing hormone analogs. These might be the agents of choice in systemic therapy for this increasingly recognized syndrome.