Grudnaia khirurgiia (Moscow, Russia)最新文献

Diffuse fibro-cavernous tuberculosis was managed in 44 patients by interventions on the cavern, the bronchi draining it, and the thoracic wall. It is shown that these operations are combined and are organ-preserving in character. The choice of the type of the operation is determined by the character of the affection of the bronchi and the activity of the tuberculous inflammation in the wall of the cavern. The use of modern technical measures (laser, ultrasonics, hemosorption) is promising.

The article analyses the results of surgical treatment of 45 patients with multivalvular acquired heart diseases which had been previously treated by operation. Stage III (terminal) circulatory disorders were diagnosed in 11 (24.1%) patients. A pathological condition of the tricuspid valve was found in almost all patients with the terminal stage of circulatory disorders. Eleven (24.4%) patients died after the operation. The most frequent causes of the fatal outcomes were: cardiac failure (in 6 patients) and hemorrhage (in 2 patients during the operation and in 1 patients on the 6th post-operative day; the bleeding occurred from varicose veins of the stomach and esophagus). Severe initial circulatory insufficiency was the main factor of operative risk. The criteria of operability must be elaborated for this contingent of patients suffering from severe cardiac insufficiency on the eve of the operation.

The article deals with the analysis of the monograph Evaluation of Performance and Analysis of Cyclic Work of the Heart written by B. A. Konstantinov, V. A. Sandrikov, and V. F. Yakovlev. It discusses the possible mechanism of the maintenance of the stability of hemodynamic indices--switching into action the contractions of nonfunctioning cardiomyocytes (the factor of functional heterogeneity).

From analysis of the findings of intracardiac examination of 35 patients with congenital fistulas of the coronary arteries the authors discuss the angiographic semeiotics of the anomaly and the mechanism of disorders of coronary circulation. The pathophysiology of the anomaly is determined by the amount of blood shunted through the fistula, the location of the fistula (whether in the proximal or distal segment of the artery), and the perfusion deficit of the distal segment of the involved artery. Fistulas with a large volume of the shunt may be accompanied both with ischemic changes in the basin of the affected coronary artery and with regional disorders of myocardial perfusion in the adjacent basins (intact coronary arteries). The last named is due to the phenomenon of "stealing" the adjacent coronary trunk. The absence of electrocardiographic signs of focal disorders cannot be considered a sign of a hemodynamically insignificant fistula because an ECG of rest does not always reflect the state of the coronary blood flow in the basin of the involved vessel. Evidence of this are asymptomatic coronary insufficiency and disorders of myocardial perfusion which are revealed by exercise tolerance tests and scintigraphy of the myocardium in patients with a normal ECG.

Suppuration of the hemithorax cavity and bronchial fistulas complicate considerably the postoperative period in patients who underwent removal of the lung for tuberculosis. Study of the dynamics of changes of the glycosaminoglycan content, activity of hyaluronidase, trypsin-like proteinases, and elastolytic activity in the postoperative exudate allows the development of purulent complications in the cavity of the postoperative hemithorax to be detected earlier and corrected in time.

The article deals with the results of the study of the quantitative anatomy and morphology of hypoplastic ventricles. The object of study were 28 specimens of the heart: 15 with hypoplasia of the left ventricle and 13 with hypoplasia of the right ventricle. The control group was composed of 10 specimens of normal hearts. Morphometry was conducted in all of the 28 specimens. At the same time angiocardiometry and calculations of the volume characteristics of the ventricles were undertaken in the diagnosis of hypoplasia of the right ventricle. The morphometric criteria of hypoplasia of the heart ventricles and their morphological variants were determined as a result. It was found that the lineal characteristics of the heart yielded sufficient information both for the diagnosis of hypoplasia and for determining its degree. Morphometry showed that constant ratios exist between the diameters of the atrioventricular valves and the lineal sizes of the ventricles in normal and pathological hearts. Knowledge of the aforesaid is of much practical importance because having determined the sizes of the atrioventricular valves during echocardiography one may calculate all linear characteristics of the heart and evaluate the sizes of the ventricles by means of the quantitative criteria. The article gives the method of such calculation, while its results are evidence of the high precision of the suggested constants.

Up to 9% of patients need to be operated on the lungs for a second time. Repeated operations on the lungs should be conducted in specialized clinics and only by an experienced thoracic surgeon. Improvement of the results of repeated operations depends on the skill of the anesthesiologist, the thoroughness of the preoperative management and examination, and skilled postoperative management.