Grudnaia khirurgiia (Moscow, Russia)最新文献

From study of the case records of 113 patients with isolated affection of the middle lobe or lingular segments of the left lung the authors believe that nonspecific inflammatory diseases of the lungs are the most frequent cause of the development of the syndrome. Tomography and bronchography of the involved lung play the principal role in the diagnosis of the middle-lung syndrome. The etiological factor is verified by the findings of tracheobronchoscopy. The authors consider surgery to be the main method of treatment of the middle-lobe syndrome or syndrome of the lingular segments.

The authors examined 25 patients with acute abscesses and gangrene of the lungs to study the condition of the phagocyte system and its effect on processes of fibrin formation and destruction in the focus of inflammation. They found marked increase of the number of polymorphonuclear leucocytes and decrease of alveolar macrophages in lavage fluid of the diseased lung. The fibrinolytic, procoagulant, and oxygen-dependent metabolic activity of phagocytes was increased. With the degree of these changes and the clinical and endoscopic signs of the activity of the inflammatory process taken into account, the choice of the fibrinolysis activators and inhibitors for endobronchial administration can be differentiated and the results of treatment improved.

The authors analyse 100 operations for resection of the esophagus after radiotherapy. Morphological examination before irradiation showed squamous cell carcinoma in all patients. Difficulties arise in the diagnosis of a residual esophageal tumor after radiotherapy, as a result of which 11 (14.5%) of 76 patients irradiated with a dose of 30-40 GY and 1 (4.2%) of 24 patients who received a dose of 50-70 Gy were exposed to the risk of a surgical intervention in the absence of morphological signs of a tumor in the removed esophagus. The difficulties of the diagnosis are due to resorption of the tumor under the effect of radiotherapy, its exophytic component in particular, the frequent submucosal position of the tumor, signs of therapeutic pathomorphosis of the tumor, and fibrosis of the esophageal wall.

The work deals with the results of biochemical and angiographic studies in 26 patients with thromboembolism of the pulmonary arteries (TEPA) and pulmonary hypertension of various degree. Acute occlusion of the pulmonary arterial channel calls forth a response of the organism's humoral regulating systems. The degree of hypertension of pulmonary circulation in TEPA, which is determined by the volume of affection of the pulmonary vascular channel, is directly dependent on the functional activity of the adaptation system and the severity of disorders of the intra- and intersystemic connections.

The authors conducted 76 endoscopic laser operations on 51 patients with malignant (18) and benign (9) tumors and cicatricial stenosis (24) of the trachea and bronchi. An AYG laser (on and yttrium aluminium garnet with neodymium) with a power of up to 27.5 Wt was used as the source of laser radiation. Intraoperative complications were recorded in 2 (2.6%) cases. The immediate results were good in 88.2%, satisfactory in 3.9%, and poor in 5.9% of patients. It is concluded that the endoscopic use of the AYG laser for the destruction of tumors, cicatrices, and granulations in the tracheal and bronchial lumen both as the first stage of surgical treatment and as an independent palliative method in inoperable patients is highly effective and safe.