Grudnaia khirurgiia (Moscow, Russia)最新文献

From studying immunological reactivity in dynamics in 107 patients with acute destructions of the lungs, the authors proved that the severity and duration of the disorders are determined to a great extent by the presence of anaerobic infection in a pure form (18 patients) or in association with aerobic microflora (23 patients).

The authors has 34 children with retention cysts of the lungs under observation. The most frequent localization of the cyst is the anterior segment of the superior lobe (20), central localization is characteristic of retention cysts. The disease must be differentiated first of all from tuberculosis. Not in all cases is this an easy problem. Before admission to the surgical clinic 16 children were given specific therapy for a long time. Two children had a suppurating cyst. The diagnosis of the cyst is based on careful study of the medical history and the characteristic findings of radiography and tomography of the chest. All of the children were operated on. The volume of the operation was determined by the condition of the surrounding segments. Segmentectomy was the most frequently performed operation.

The article deals with the first experience in the USSR in using the method of mitral valve prosthesis with complete or partial preservation of the subvalvular apparatus. The operation was performed in 10 patients with mitral insufficiency or combined mitral valvular disease of various etiology. The advantages of employing during operation by this method mechanical prostheses with an obturator element which changes its position are pointed out. Only one patient needed inotropic support in the postoperative period. There were neither complications nor fatal outcomes.

One of the causes of early postoperative complications in children after surgery for bronchiectases is the development of an abscess of the stump of the resected bronchus due to infection of the bronchial mucous membrane which remains on the stump after manipulations with YK and YO suturing apparatuses. Treatment of the end of the bronchial stump by a focused beam of the "Scalpel-1" laser (power of 100 Wt) leads to coagulation of the mucosa and considerable improvement of the immediate and late-term results of operative treatment of chronic pathological conditions of the lungs in children.

Combination of the "PEEC-D" microfocal X-ray apparatus with the DED-3 computerized detector of X-radiation and an electronic computer made it possible to produce a considerably magnified image of the lymph nodes on the display screen and study their structure. The mediastinal lymph nodes differ in structure in different pathological conditions, due to which they can be differentiated. Under normal conditions the lymph nodes have a regular density and a characteristic microcellular structure due to the uncontrasted follicles. In chronic inflammation the lymph nodes have an indistinct capsule. The contrasting and structural pattern of the parenchyma are greatly diminished. The enlarged uncontrasted follicles are spherical. Lymph nodes containing metastases change their configuration sharply and undergo three-dimensional transformation. In the presence of metastases the lymph nodes multiply by separating part of the node.

Analysis of the results of using fibrinolysis activators in 196 patients with massive embolism of the pulmonary arteries was undertaken to choose the optimum method of thrombolytic therapy. High doses of fibrinolysis activators (from 5,000,000 to 7,000,000 U) were used in 127 cases and low doses (from 125,000 to 3,000,000 U) in combination with heparin and disaggregating agents in the remaining 69 cases. A cava-filter was implanted in 161 patients before beginning treatment. Obvious advantages of thrombolytic therapy of massive pulmonary embolism with high doses of fibrinolysis activators were revealed in the process of treatment. They consist in quicker restoration of continuity of the pulmonary arteries, which leads to rapid removal of hypertension in pulmonary circulation and reduction of the number of deaths from acute cardiopulmonary failure. Treatment with such doses does not lead to an increase of the number of hemorrhagic complications, which makes possible surgical prevention of recurrent pulmonary embolism by cava-filter implantation.

The authors had 21 patients with various types of transdiaphragmatic bronchopleural fistulas which development as secondary complications of a subdiaphragmatic abscess as a consequence of late diagnosis, ineffective drainage, and use of transpleural approaches to the abscesses. Clinical and radiological diagnosis including contrast fistulo- and pleurography, bronchography and bronchoscopy, and contrast endoscopic examination of the stomach and other organs made it possible to determine the character and localization of the transdiaphragmatic fistula and the condition of the sprained organs. The therapeutic tactics were determined by the form and causes of the transdiaphragmatic bronchopleural fistulas. Nineteen patients recovered, 2 died. The success of treatment depended on the time when operative drainage was begun and on its rational application on bronchological cleansing, and on other components of complex treatment.