benign smooth muscle neoplasm mediastium. by the presence of spindle cells with cigar-shaped nuclei, interlacing fascicles, and a whorled pattern.
Plasmapheresis is an effective method for controlling the resorption factor in patients with pyogenic destructive diseases of the lungs and pleura. It facilitates rapid normalization of the parameters of the patients' clinical condition and the radiological picture, and reduces endogenous intoxication. Protein-volemic disorders are more manifest in patients with a fatal outcome, which increase with the gradual progression of the disease and must be corrected before performing plasmapheresis.
Four of 28 patients who were operated on died in late-term periods, four from advancing cardiac failure and one died 5 years after an operation from cardiac tamponade. In the group of four patients one underwent Cabrol's operation, three were operated on by the Bentall-De Bono method. The condition of 25 patients considerably improved and they were related to the II and I functional classes. The result was poor in three patients due to initial severity of the process in one, dilatation of the arch of the aorta in another, the presence of a fistula in the distal anastomosis in the third. One patient treated by Cabrol's operation and another who was operated on by the Bentall-De Bono method had pseudoaneurysms in the orifices of the coronary arteries. Despite some complications which occurred in the late postoperative periods, the Cabrol and Bentall-De Bono operations are the most radical means today for surgical treatment of aneurysms of the ascending aorta.
The mechanism of compensation for disorders of ventilation after pulmonary tissue resection is discussed. It is shown that these disorders are attended with reduction of arterial pulmonary blood flow and that angiospasm occurs in the postcapillary part of the vascular channel of pulmonary circulation. The compensatory effect is achieved by a right-to-right arteriovenous shunt which prevents extreme increase of pressure in the pulmonary artery in ventilation disorders.
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 results of operations for correction of ventricular septal defects (VSD) in 97 young children (from 12 to 48 months of age) were evaluated. In 57 children the operation was conducted through a transventricular (group 1) and in 40--through a transatrial approach (group 2). The results of the operations in the two groups did not differ in essence. Essential differences were revealed in the cardiac index (CI) value and the requirements in cardiotonics: the CI was much lower and the doses of adrenalin higher in group 1 than in group 2. A more pronounced stability of hemodynamics on the first postoperative day and lesser possibility of the development of acute cardiac failure are important advantages of the transatrial approach and allow the authors to recommend it as the method of choice in closure of perimembranous VSD, particularly if they are complicated by high pulmonary hypertension.
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.
Experience in the use of the trans-sternal approach in surgical treatment of bilateral bullous disease of the lungs in 16 cases is generalized. The results of organ-preserving operations in periods of 6 months are analysed. The technical aspects of surgery for bilateral bullous disease are discussed. Hemorrhage and paresis of the right diaphragmatic dome were the postoperative complications. There were no fatal outcomes. The experience of other surgeons on the treatment of this pathological condition is discussed.
The number of operated on patients who are referred to a commission for expert medical assessment of working capacity is growing at present. Correct expert assessment of the working capacity allows the results of surgery to be reliably consolidated and promotes restoration of working ability. The duration and severity of working ability. The duration and severity of the pulmonary abscess, the method of surgical treatment, the lapse of time after the operation, the course of the restorative processes, complications and concomitant diseases, the degree or respiratory and circulatory insufficiency, the patients' age, profession, and the conditions and character of work are taken into account during examination. Timely and complete treatment and rational choice of occupation are important factors in the prevention of invalidism and enable most patients (86.8%) to resume work in full volume or with limitations as specified by the commission.
Comparative study of the peculiarities of central hemodynamics before operation and in the early postoperative periods was conducted in 48 patients with lung carcinoma managed by lobe- and pneumonectomy. Lung carcinoma of central localization is characterized by increased contractility of the right-ventricular myocardium. In the postoperative period after pneumonectomy the right ventricle experiences an increased load requiring considerable mobilization of the cardiovascular system. Lobectomy is attended by more marked and less stable changes in the function of the cardiovascular system in the early postoperative period.
In the period between 1963 and 1986 there were 189 patients with peptic stricture of the esophagus under observation. The peptic stricture was primary in 149 and secondary in 40 patients. Complex diagnosis of the disease allowed an adequate therapeutic tactics to be chosen. The management of peptic strictures should be started in all cases with nonoperative measures including bougienage. Such treatment produced a stable effect in 47% of cases. Various operative interventions were carried out in 53% of patients. Fundoplication in combination with selective proximal vagotomy was the most sparing and effective operation in primary peptic stricture; a secondary stricture had to be treated most frequently by resection of the esophagus, which was completed by valvular esophagogastroanastomosis. The late results proved best in primary peptic stricture.
The authors analysed angiograms of 34 patients who had been operated on the lungs with the use of mechanical suturing instruments to determine the effect of the mechanical suture (MS) of the bronchial stump on the development of hemoptysis and pulmonary hemorrhage. They studied the possibility of applying transcatheter endovascular occlusion (TEO) of the bronchial arteries (BA) in the management of hemoptysis of this etiology. In 70% of patients hyperplasia of the BA developed in the MS region in the late postoperative period; which was the source of pulmonary hemorrhage in 75% of cases. Among the patients, 19 were subjected to BA TEO for pulmonary hemorrhage. In 13 cases the bronchial stump with MS was the source of hemorrhage. Hemoptysis is a late complication of lung resection with the use of MS. Preference should be given to BA TEO in the management of this complication.
Various methods of aortoannuloplasty in replacement of the aortic valve in patients with a narrow root of the aorta were evaluated experimentally. It is shown that the simplest method for dilatation of the root of the aorta is that suggested by Nicks, which allows the effective diameter of the root to be increased to 4.5 mm. The Rastan-Konno operation is most radical, the diameter of the fibrous ring is increased by 13.5 mm on the average. The method, however, is technically difficult and injurious. A working classification of the severity of a narrow root of the aorta is suggested and operative methods for each case are recommended.
The authors discuss the results of mitral valve replacement in 438 patients with intraoperative selection of the prosthesis and in 77 patients with preoperative selection by means of an original method based on two-dimensional echocardiography. The intraoperative selection proved to be insufficiently effective: in the postoperative periods 13.9 +/- 2.7% of patients had marked signs of lack of correspondence of the prostheses to the size and structure of the left ventricle, which was verified at autopsy or by the findings of intravital catheterization of the heart with ventriculograph. The method of preoperative selection of the prosthesis, which was suggested by the authors, is more effective. It allows implantation of an inadequate prosthesis to be absolutely avoided. The method showed implantation of a ball prosthesis to be contraindicated for 33.7 +/- 5.4% of patients with mitral and mitral-aortic valvular diseases.
