Grudnaia khirurgiia (Moscow, Russia)最新文献

The article describes the method of operation for removal of a pyothorax cavity and a bronchial fistula with the use of the latissimus dorsi muscle which is mobilized from all sites of attachment to bone structures and separated to a neurovascular pedicle. The operation was carried out on 6 patients with tuberculous and unspecific pyothorax with a bronchial fistula and a defect in the thoracic wall. Due to its large size, the presence of a long main vascular pedicle, and anatomical position, this muscle can be used successfully in the management of such patients. A good effect was produced with minimum functional loss.

The authors examined 50 patients with chronic diseases of the lungs in the pre- and post-operative period. Immunological indices, neutrophil phagocytic activity in the first place, in combination with the laboratory severity index make it possible to conduct effective control of preoperative management and the patients condition in the postoperative period.

The efficacy of surgical rehabilitation of patients with chronic osteomyelitis of the sternum is shown. Surgical treatment was divided in most cases into two stages: removal of the involved areas of the sternum and adjoining ribs and fixed muscular or musculocutaneous plastics. The obtained results are reassuring and promote further development of surgery of this region.

The article discusses the results of study of central hemodynamics in patients with acquired aortic valvular diseases who were operated on under conditions of hypothermia without perfusion. The minute circulation volume reduced at a temperature of 26.8 degrees C to 63% of the initial level. The stroke volume did not change practically. The changes of the values of central hemodynamics in the stages of hypothermia (active and passive cooling) were irregular in character. No essential inhibiting effect of hypothermia on the cardiovascular activity was noted.

After examination of 255 patients with ischemic heart disease (IHD) and concomitant arterial hypertension (AH) two groups were distinguished according the level of arterial pressure. Group 1 was formed of 89 patients (arterial pressure below 180/80 mm Hg), group 2--of 166 patients (arterial pressure above 180/100 mm Hg). Survival was determined according to certain morphofunctional indices (total affection of coronary arteries, left ventricular output fraction, left ventricular end diastolic pressure, tolerance to physical effort) in nonoperated on and operated on patients suffering from IHD and concomitant AH. It was found that the operation affects positively the "quality" of life more than the survival.

The article deals with hemodynamic evaluation of Soviet-made, and heart valve prostheses in late-term periods after operation for mitral valve replacement. Fourty-six patients were examined: a ball prosthesis was implanted in 21 patients (1st group), as disk prosthesis--in 15 patients (2nd group) and a prosthesis--in 10 patients (3rd group). A good clinical result of the operation was achieved in all patients, they were referred to functional class I and II. Catheterization of the left and right parts of the heart, left ventriculography, and test with dosed physical exertion were carried out. Loading was continued till cardiac output increased approximately by 60 per cent in 6 patients of the 1st group, 12 patients of the second group, and in all 10 patients of the 3rd group. The study showed that the prostheses do not yield to foreign models of heart valves in hemodynamic characteristics and cause a lower stenosing effect than the prostheses do. No essential differences were detected between the prostheses.