Objective. Elaboration of the correction methodology of mitral stenosis, complicated by massive thrombosis of left atrium, for improvement of immediate and late results of surgical treatment of this pathology. Materials and methods. Into the group analyzed 344 patients with mitral stenosis, complicated by massive thrombosis of left atrium, operated in Amosov National Institute of Cardiovascular Surgery in a period from 1 January 1984 yr to 1 January 2019 yr, were incorporated. In all the patients surgical correction of mitral stenosis and thrombectomy from left atrium was performed. In 161 (46.8%) patients a radical removal of thrombotic mass together with their base–lining was performed, while in 183 (53.2%) – without it. In 256 (74.4%) patients the left atrium auricle was ligated or resected, while in 88 (25.6%) – left intact. Results. The hospital lethality index have had directly proportionally raised with enhancement of degree of the left ventricle auricle: I – 0%, II – 3.9%, III – 5.1% (p<0.05). In a general group during all period of the investigation a directly proportional dependence of index of hospital lethality due to lethal thromboembolic complications on degree of massive thrombosis of the left atrium auricle was observed: I – 0.0%, II – 3.5%, III – 5.2% (p<0.05). Best indices of hospital lethality were achieved in radical removal of thrombi together with their base–lining with ligature or resection of the left atrium auricle as a possible origin of thrombi creation. Conclusion. While doing surgical correction in patients with massive thrombosis of left atrium it is important to remove the thrombotic base–lining and to ligate or resect the left atrium auricle, what significantly lowers the risk of hospital lethality, thromboembolic complications on stationary stage of treatment.
Objective.Studying of morphological characteristics of venous angiodysplasia of the face and scalp. Materials and methods. The operation material (soft tissues of the face and scalp) was investigated in 20 patients for studying of morphological characteristics of venous dysplasia. In the histological investigation frame the material was fixed and processed in accordance to conventional method, the tissue slices were colored with hematoxilin and eosin. In 7 observations immuno–histochemical investigation with CD34 antibodies (clone QBEND10) and S100 (polyclonal) was applied. Results. Basing on patho–histological investigations of the operation material in 8 patients, morphological features, characteristic for arterio–venous angiodysplasia, were revealed, what may constitute the recurrence cause in postoperative period. Conclusion.The recurrence prognosis and further surveillance of patients with venous angiodysplasia demands decision of the question concerning the presence of arterio–venous component in clinically and instrumentally confirmed simple venous angiodysplasia, concerning every patient.
Objective. To share own experience for surgical treatment of pulmonary carcinoid tumours. Materials and methods. During last 13 yrs in Department of Thoracic Surgery and Invasive Methods of Diagnosis of Yanovskyi National Institute of Phthisiatry and Pulmonology were treated 45 patients, suffering pulmonary carcinoid. Average age of the patients have constituted 45 yrs old. Among the patients the women prevailed – 31 (68.9%). Concomitant pathology have had 15.6% patients. In 38 (84.4%) patients the disease was diagnosed accidentally in elective roentgenological examination. Pronounced clinical features of the disease were observed in 3 (6.7%) patients only. Additional 4 (8.9%) patients complained about insignificant worsening in general well-being: moderate dyspnea, dry periodical cough, frequent bronchitis. Results. There were 44 (97.8%) patients operated. The most frequent operation performed in patients with pulmonary carcinoid was lobectomy in various modifications: a classic one – in 16 (36.4%), video-assisted – 13 (29.5%), and bronchoplastic – 5 (11.4%). Operative interventions were performed in accordance to rules for thoracic surgery and for oncological surgery in particular. In a central localization of the process the diagnosis was verified preoperatively in all the patients, while in peripheral carcinoids only - in 2 (25.0%) patients, in whom transthoracic biopsy with histological investigation of biopsies was performed. In other 6 (75.0%) patients, suffering peripheral carcinoid, intraoperative histological or cytological investigations with determination of further surgical tactics were conducted. Conclusion. Pulmonary carcinoid is characterised by slow course and absence of pronounced clinical signs, what causes its late diagnosis. To select an optimal method of surgical treatment histological verification of the diagnosis is mandatory. In treatment of pulmonary carcinoid tumours, surgical method is choosed.
Objective. To study perioperative changes in hemodynamics, the oxygen state and metabolism in patients, suffering an acute calculous cholecystitis, and to determine the methods of their correction. Materials and methods. The investigation was based on 131 patients, suffering an acute calculous cholecystitis, to whom laparoscopic cholecystectomy under general anesthesy was performed. The risk value, determined in accordance to classification of American Society of Anesthesiologists, have constituted Class II-ІV. The patients were divided into two groups. The first one have consisted of 63 patients, in whom intensive therapy, directed on support of vital functions, was conducted, while in a second group (68 patients) the data of indirect calorimetry were used additionally. Results. On the stage of the patients staying in reverse position of Trendelenburg, the adjustment of pneumoperitoneum and the operation beginning the lowering of hemodynamics indices, the oxygen state and metabolic disorders have had more pronounced features in patients of the first group, and their restoration was more durable. The second group patients on background of powered infusion therapy and introduction of glucocorticoids were restored more intensively, they woke up more early, the intensive department stay was shorter, emesis and regurgitation have occurred in them in 2.4 times more rarely, and severity of postoperative pain after waking up was lower (р < 0.05). Conclusion. In patients, suffering an acute calculous cholecystitis, laparoscopic cholecystectomy is more secure on background of the hemodynamics, the oxygen state and metabolism corrected.
