Grudnaia khirurgiia (Moscow, Russia)最新文献

The authors report on 64 valve-preserving operations conducted under conditions of extracorporeal circulation in patients with a history of closed mitral commissurotomy (59 patients with restenosis of the mitral orifice and 5 patients with iatrogenic mitral insufficiency); hospital lethality was 14%. The peculiarities of the diagnosis and operative techniques of the second intervention in this pathological condition are discussed in detail. From study of the immediate postoperative results the authors conclude that during the second operation after closed mitral commissurotomy the patient's own valve can be preserved in 30-35% of cases. They claim that restenosis of the mitral orifice and iatrogenic mitral insufficiency are a complicated form of mitral valvular disease and should be corrected on an open heart with extracorporeal circulation.

The authors studied disorders of central and intracardiac hemodynamics occurring in electrostimulation of the ventricles attended by retrograde stimulation of the cardia. The experiments were conducted on 8 anesthetized dogs in whom, after disclosure of intact ventriculoatrial conduction, transvenous destruction of the atrioventricular junction was performed. Clinical study was carried out in 12 patients with continuous electrostimulation of the ventricles which caused retrograde stimulation of the atria, and in 19 patients with supraventricular tachyarrhythmia who were subjected to transvenous endocardial destruction of the atrioventricular junction. Due to the development of severe hemodynamic disorders in electrostimulation of the ventricles attended by retrograde stimulation of the atria the last named condition should be changed to ventriculoatrial dissociation which promotes growth of contractile activity and stroke volume of the left ventricle. Transvenous destruction of the atrioventricular junction is a reliable method for blocking retrograde conduction.

Changes of hemocoagulation were studied in three groups of patients in different periods of surgical intervention for various forms of pulmonary tuberculosis. Mini-doses of heparin were included in the complex of preventive measures applied during the operation in group 3. It was found out that changes of blood coagulation during operation on phthisiosurgical patients develop according to the mechanism of the thrombohemorrhagic syndrome (THS). The more injurious the operation, the more manifest are the changes in the system of blood coagulation and fibrinolysis. Heparin prevents intravascular coagulation of blood, arrest the development of THS and, in this manner, the occurrence of thrombohemorrhagic complications.

Electrochemically activated 0.8% solutions of potassium chloride are marked by high bactericidal and bacteriostatic activity, do not possess toxic properties, are easily tolerated by the patients, and promote melting of fibrin and necrotic tissues. With their use granulations and epithelialization occur more rapidly and the terms of treatment and the associated economical expenditures are reduced.

In treatment of children with chronic pneumonia by 3-5 bronchoscopic cleansing procedures with endobronchial irradiation of the mucosa with a helium-neon laser beam the highest effect is produced by a dose of 15 mWt/cm2 and 2 minute exposure. Regression is stabler and occurs more rapidly in patients with moderate deformity of the bronchial tree. The mechanisms of the therapeutic effect of the method is explained by normalization of microcirculation, intensification of epithelial proliferation and biosynthetic activity which create favorable conditions for induction of reparative processes in the bronchial mucosa.

The results of surgical and combined treatment of 79 patients with cancer of the thoracic esophagus are discussed. All underwent resection of the esophagus. One-stage esophagogastroplasty was carried out in 44 patients, in 35 patients resection of the esophagus was the first stage of treatment, esophagogastroplasty was undertaken 6-8 weeks later. The authors describe their techniques of separating the upper part of the esophagus, forming the gastric tube and inserting it through the posterior mediastinum. Postoperative mortality was 15.9% in one-stage and 22.8% in postponed esophagogastroplasty. Completeness of treatment in both groups in relation to the total number of patients subjected to resection of the esophagus was 86.5 and 48.1%, respectively. Preoperative radiotherapy influenced neither the incidence of complications nor the mortality.

The author analysed the use of thoracoscopy in 12 patients with radiopaque and radiolucent foreign bodies in the pleural cavity, lung, mediastinum, myocardium, and diaphragm. The indications for the examination were specified: (1) foreign body in the pleural, cavity or its existence suspected; (2) indistinct character of an intrathoracic foreign body and injury inflicted by it to the viscera; (3) specification of surgical tactics and method for removal of the foreign body and rational surgical approach. Thoracoscopy made it possible to detect not only foreign bodies of different character, but the damages caused by them to the viscera, and the complications. Foreign bodies were removed during thoracoscopy in two thirds of cases.