Thoraxchirurgie, vaskulare Chirurgie最新文献

This work deals with 8 own cases of esophagopleural fistula observed in 807 pneumonectomies with mortality rate of 37%. The pathogenesis as well as the treatment of esophagopleural fistulae based on world literature and own experience are discussed. The esophagopleural fistula is serious complication usually connected with pneumonectomy. Esophagography which should be done in every case after pneumonectomy ensures the diagnosis and before the operation shows any pathology of esophagus in its course and position. Small esophagopleural fistulae heal best after gastrostomy but larger ones require beside a double row suture of esophageal wall and additional covering with muscle flap.

The operative risk of prosthetic replacement of the mitral valve in 97 patients and of the aortic valve in 126 patients showed a good correlation with the decrease in preoperative pulmonary function (p less than 0,01). The overall mortality rate reached 12,4% respectively 13,4% during the first 28 days after surgery. Depending upon the stage of ventilatory impairment the mortality rate varied between 0 to 50% in the mitral group and between 6,5 to 50% in the aorti group. The impairment of respiratory function is caused by the disturbed hemodynamic function demonstrated by a negative correlation between pulmonary artery pressure and vital capacity.

Following correction of a partial atrioventricular canal and closure of the atrial septum defect with a Dacron patch a severe hemolytic anemia developed caused by moderate mitral insufficiency. The clinical postoperative course and the successful treatment by reoperation is described in detail. The Dacron patch was excised, the mitral cleft was closed by four single sutures, and the septal defect was covered with a pericardial patch. In the literature ten other communications were gathered reporting hemolytic anemias following correction of endocardial cushion defects with Dacron, Teflon, or Ivalon patches. Three of six reoperated patients died postoperatively. A woman died after correction with renal failure caused by severe hemolysis. In four patients hemolytic anemia was compensated and there was no need for reoperation. In consideration of our own experience and those reported in the literature we recommend pericardium instead of synthetics for closure of atrial septum defects of Foramen-primum-type.

In 53 p.c. of 175 patients with bronchial carcinoma the carcinoembryonic antigen (CEA) was elevated at the time of diagnosis. In patients with small well bordered tumors (T 1/2) 31 p.c. proved pathological CEA-values in comparison to 80 p.c. in patients with heamatogenic metastases. After radical tumor resection (36 patients) elevated CEA-levels returned to normal ranges within 5 weeks. No decrease could be observed after palliative operations (16 patients). If there existed haematogenic metastases normal CEA-values increased postoperative. Such an increase occured up to ten weeks before metastases could be found by other methods. In cases of bronchial carcinoma CEA-measurements are usefull to evaluate the effect of operation and in the follow up time. It should be carried out on principle in those patients which can be considered for a surgical therapy.

Sequential hemodynamic and echocardiographic studies following mitral valve replacement by glutaraldehyde preserved bioprotheses have been carried out in 40 patients. These investigations have been compared to those of patients having received Björk-Shiley or Lillehei-Kaster valves. Between the two groups the data of heart catheterization showed no differences. Echocardiography however showed an earlier normalisation of the data of the left ventricle after replacement by Hancock valves. Therefore and because of low thromboembolic risc and good mechanical stability and low immunogenecity the use of bioprotheses is recommended.

The Lagergren cage electrode Elema EMT 588 K was implanted in 26 male and 21 female patients for permanent cardiac stimulation. 29 of the 47 cage electrodes were fitted with a platinum and 18 with an Elgiloy head. Acute threshold in the platinum group was 0,52 +/- 0,15 volts (x +/- s), the equivalent electrode resistance being 565 +/- 135 ohms. The threshold mean value for the Elgiloy cage electrodes was shown to be 0,36 +/- 0,11 volts, while the resistance values measured respectively 410 +/- 44 and 418 +/- 23 ohms depending on the method of measurement. In the postoperative period (up to 16 months) the following complications were observed: 3 dislocations (6,38%) and one case of rise in threshold (2,12%). The total correction rate (8,5%) corresponds almost exactly to that recorded by the author in a personal series of 400 electrode implantations of various designs. The cage electrode offers no advantages in comparison to other small surface electrodes, however, the relatively higher current consumption caused by low total electrode resistance must be regarded as disadvantages. Experience with the cage electrode has shown that the transitional resistance depends not only on the surface, but also essentially on the material and shape of the electrode tip.

Based on the experiences of 14 observations a correlation between clinical picture and histological damage of aortic wall in medio-necrosis Erdheim-Gsell is tried. In the preoperative phase the definitive diagnosis is seldom possible. Atypical pathological findings at the aorta or great arteries must be suspected to be caused by medio-necrosis Erdheim-Gsell.

Dacron vascular prostheses were preclotted with and without addition of human fibrin stabilizing factor (factor XIII). In our scanning electron microscopic examinations we found amorphous fibrin achieving a three dimensional net structure in the prostheses after addition of factor XIII.

Three cases of bronchopulmonary lipomas are reported, two sub pleural and one endobronchial. They represent 2,8% of all so-called benign bronchopulmonary tumours in our statistic. The two subpleural and asymptomatic lipomas were treated by thoracotomy and enucleation, the third, the endobronchial lipoma required lobectomy because of irreversible pulmonary damage.

In an unselected group of patients undergoing a wide variety of cardiovascular operations, the possibilities of long-term preoperative autologous blood collection combined with oxygenator hemodilution were examined. The mean number of preoperative donations was 2.5 units of blood. It was 50 p.c. higher in men than in women. One third of the men, but no female patient, collected 4-5 units of autologous blood, thus equalling the mean calculated blood requirements. Short- or long-term disavantages of the donations were not seen. --The total amount of homologous blood required could be diminished by 50 p.c., in atrial septal defects even by 70 p.c. The percentage of patients without homologous blood increased from 3 to 25 p.c. of the total material, but in atrial septal defects from 13 to 67. Further improvements of these values may be expected from an earlier entry into the program of autologous donations and, correspondingly, by an earlier iron substitution. Only thus, without special methods of storage, roughly calculated one half of all cardiovascular surgical patients may come through without homologous blood. In view of the risks of homologous blood transfusion, already now no atrial septal defect and, with limitations, no valve replacement should come to surgery without adequate autologous blood collection.