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 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.

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.

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 analyses experience in the diagnosis of a pathological condition of the aorta in complete transposition of the great vessels (CTGV) in infants. Pathology of the aorta was revealed in 9 (2.6%) of the 350 patients who were examined. Six patients with CTGV had coarctation of the aorta (CA), 2 had subaortic stenosis, and one patient had complete interruption of the arch of the aorta. Our experience provides evidence that two-dimensional echocardiography allows the region of the thoracic aorta to be located from a suprasternal or a high right parasternal approach. Subaortic stenosis was diagnosed in 2 patients during autopsy. Retrospective analysis of the echocardiograms and angiocardiograms revealed characteristic signs of subaortic obstruction. Absence of the continuity of the arch and descending aorta is an echocardiographic sign of interruption of the arch of the aorta which was recognized retrospectively only after angiocardiography. Right and left ventriculography must be performed for precise anatomical diagnosis of CTGV with an intact interventricular septum combined with coarctation of the aorta. In patients with concomitant interventricular septal defect this examination is supplemented by antegrade and retrograde aortography from the ascending aorta to exclude patent ductus arteriosus and for better visualization of CA. Catheterization of all heart cavities, right and left ventriculography, aortography, and pulmonary arteriography must be carried out in all patients with total interruption of the continuity of the arch of the aorta.