Grudnaia khirurgiia (Moscow, Russia)最新文献

The calcium binding activity of xenograft tissue in stages of modification with papain, diphosphonates, and heparin was studied on a model of accelerated calcification in subcutaneous implantation of cusps of pig's aortic bioprostheses to 42 rats. In immobilization of 3-amino-1-oxypropylidendiphosphonic acid and xydiphon the amount of calcium in the implants reduced 50 times as compared to the control. The first stage of ion-covalent heparin immobilization--treatment with albumin--increased the calcium-binding activity of the biomaterial, but subsequent heparinization reduced again the calcium content in the cusp tissue to the level attained in the stage of diphosphonate immobilization. The results of the chemical analysis correlated with the findings of morphological examination. Besides, the new method of treatment made it possible to increase the strength of the biological tissue by 20%. This method of storage of bioprostheses is promising for clinical approbation.

The authors examined 47 patients with recurrent cardiospasm or achalasia of the cardia after dilatation or operations in normal or low esophago-gastric pressure gradient. The findings of clinical, radiological, endoscopic, and esophagomanometric examination of patients are shown. The article discusses the results of drug treatment, pneumatic dilatations, operative interventions in this group of patients. The probable causes of the development of dysphagia in normal values of pressure in the physiological cardia are considered.

The article analyses experience in the use of beams of various types of lasers in treatment of 152 patients with different forms of pyothorax of tuberculous and nontuberculous origin. Semiconductor and carbon dioxide laser devices were used in the stages of surgical treatment. Methods for the use of lasers in the pre- and postoperative periods and during the operation are described. With the use of laser beams in the stages of surgical treatment the traumatic character of the intervention is lessened, blood loss during the operation reduced, the walls of the empyema are sterilized effectively, the incidence of postoperative complications diminishes, and the clinical efficacy of surgical management of this severe contingent of patients is improved.

The authors discuss their experience with balloon valvuloplasty (BVP) in aortic valvular stenosis (AVS) in 3 patients aged 10 months, 15 and 16 years. BVP was carried out in all of them with exposure of the right subscapular artery. Left ventricular (LV) systolic pressure before BVP was 198 +/- 45 mm Hg on the average, systolic pressure gradient between the LV and the aorta was 102-32 mm Hg. After BVP systolic pressure in the LV reduced by 26.5% and was 146 +/- 27.8 mm Hg, the systolic pressure gradient between the LV and the aorta reduced by 64.8% and was 36.0 +/- 7.5 mm Hg. No increased regurgitation of contrasted blood through the valve into the LV was demonstrated by repeated aortography. Complications connected with BVP were not encountered. Thus, BVP may be an alternative to surgery in congenital AVS. This method is evidently indicated for patients of early age with AVS, which allows operations with extracorporeal circulation to be avoided. According to the authors, BVP is expedient in congenital AVS in older patients when the diameter of the aortic valvular ring is less than 20 mm.

The authors examined 152 children with congenital heart diseases complicated by pulmonary hypertension. 109 patients were operated on under conditions of hypothermic perfusion and 43--under deep hypothermia with extracorporeal circulation. Combination of disturbed mechanics of respiration and gas exchange was determined as the respiratory distress syndrome. The initial value of lung expansibility was found to be in inverse proportion to the degree of pulmonary hypertension. With the increase of pulmonary hypertension lung expansibility reduced before extracorporeal circulation and gas exchange became worse. Hypothermic perfusion at volumetric rates of 1.7-2.55 l/min/m2 led to diminished lung expansibility in the early postperfusion period of the operation, the mechanics and gas exchange grew worse. In patients who underwent operation under conditions of deep hypothermia the values of lung expansibility and gas exchange were stable. The incidence of the respiratory distress syndrome was 56.3% after hypothermic perfusion and 7.2% after deep hypothermia.