Grudnaia khirurgiia (Moscow, Russia)最新文献

Roentgen--guided endovascular dilatation (RED) was conducted in 23 patients with atherosclerotic stenoses of branches of the arch of the aorta, in 20 with stenoses of the subclavian artery, and in 3 with stenoses of the brachiocephalic trunk. Before dilatation the patients had a systolic pressure gradient of 25 to 55 mm Hg in the region of the stenosis and constriction of the arterial lumen by 40 to 80%. Systolic pressure gradient disappeared completely in 17 cases and persisted at a level of 10 to 40 mm Hg in 7 cases. During RED of the left subclavian artery a complication, acute thrombosis of the distal part of the artery, occurred in one case. Indications for dilatation of stenosed subclavian arteries were elaborated on the basis of the accumulated experience.

The article analyses experience in angiocardiographic diagnosis of the localization of ventricular septal defects (VSD) in 47 patients with complete transposition of the great vessels (CTGV) and high pulmonary hypertension. Axial X-ray views ("4 chambers" and "long axis") were used in the examination. The work shows the angiographic signs of all types of VSD. It is concluded that at present there is no single X-ray view universal for all types of VSD. Two-dimensional echocardiography is important in the choice of the view in angiocardiography. The muscular type of VSD is encountered most frequently (40.5%) in CTGV. Absence of contact of the superior margin of the defect with the valve of the aorta and pulmonary artery is a characteristic angiocardiographic sign of the defect. Contact of the superior margin of the defect with the valve of the pulmonary artery and absence of contact with the aortic valve are characteristics of the perimembranous types of VSD. Subarterial types of VSD are characterized by contact of the upper margin of the defect both with the aortic valve and the valve of the pulmonary artery. In 11 patients the results of angiocardiography were compared with the findings of autopsy.

The effect of low-frequency ultrasound was studied in different conditions in 197 in vitro experiments according to the histological form of the tumor. It was found that ultrasound with a frequency of 26.6--40.5 kHz, intensity of 2--8 Wt/cm2, and fluctuation amplitude of the end of the smooth cylindrical instrument-wave guide of 60--80 mcm caused destruction of the cells of malignant tumors of humans, whatever the histological form. Experiments with transplanted tumors--Zaidel's ascitic hematoma and sarcoma M-l of rats (202 rats) showed that after transplantation of a tumor cell suspension exposed to sonic waves for 5--7 minutes a tumor does not develop in highly susceptible experimental animals.

The authors examined 125 patients with initial forms of ischemic heart disease (duration of no more than 2 months). The examination comprised coronarography, ventriculography, 24-hour ECG monitoring, and bicycle ergometry. The patients were divided into two groups: group 1 consisted of 81 patients who received nonoperative treatment; group 2 was formed of 44 patients who underwent operation for aortocoronary shunting. The results of treatment were appraised according to three parameters: a state of angina pectoris, prevention of myocardial infarction, and survival. They were studied in the hospital stage and in the long-term follow-up periods. Comparative analysis showed that surgery had some advantages over nonoperative treatment in relieving completely attacks of angina pectoris and transitory episodes of myocardial hypoxia. Patients who had been operated on possessed higher tolerance to physical exertion. None of the two methods of treatment had advantages over the other in regards to prevention of myocardial infarction, a fatal outcome, and prolongation of survival.

It was established that septic shock is a rare (0.2%) but the severest (5 of 6 patients died) complication in pulmonary surgery and is a consequence of the spread of postoperative wound infection or pyo-inflammatory process in the lung for which the operation was performed. The staphylococcus and nonfermentative Gram-negative bacteria prevail among the causative agents of septicemia. The most typical clinical signs of septic shock are acute circulatory insufficiency with rapid development of insufficiency of the function of the brain, kidneys, liver, and intestinal paresis in a febrile patient with a severe postoperative wound infection or in one operated on for a disseminated pyo-inflammatory disease in the lung. Precise determination of the indications for operation, careful preoperative treatment of the pyo-inflammatory processes, immediate establishment of the diagnosis, and timely removal of the localized focus of infection are important in preventing septic shock.

In the period between 1983 and 1987 operations were carried out on 204 children aged from 25 days to 12 months (body weight of 3 to 10 kg) for congenital heart diseases and pulmonary hypertension. Surgery for ventricular septal defect was undertaken on 173 patients (total mortality 6.9%), transposition of the major vessels with concurrent ventricular septal defect was corrected by Senning's method in 9 patients (mortality 11%), total anomalous pulmonary vein drainage was relieved in 14 patients (mortality 28.6%). No fatal outcomes occurred in correction of an aorto-pulmonary fistula, origin of the aorta and pulmonary artery from the right ventricle, and a common ventricle. In all patients, with the exception of 4 (2 with secondary and another 2 with primary pulmonary hypertension), pressure in the pulmonary artery reduced significantly.

A method for the formation of tracheal and bronchial anastomoses with a two-row suture by means of microsurgical techniques was elaborated in experiments on 52 mongrel dogs. In the control series the bronchial anastomosis was created with interrupted sutures passed through all the coats of the bronchial wall. Morphological study of the reparative processes in the tracheal and bronchial anastomoses showed that healing of the anastomosis formed by means of microsurgical techniques occurred sooner and with a lesser inflammatory reaction than healing of the communication in the control series. This is explained by the fact that the microsurgical suture of the tracheal and bronchial mucosa ensures adequate approximation of the margins of the anastomosis and reliable air-tightness and promotes healing by first intention.