Biomedical subjects
Publications and source records attributed to G G Radzivil.
The anatomy of the internal jugular vein at different portions of the neck is described in the article. The description of three main methods of the puncture of the internal jugular vein is given. The authors present the own material consisting of 3000 catheterizations of the internal jugular vein. Indications, contraindications and characteristics of complications are set forth.
In vitro efficacy of combinations of broad and narrow spectrum semi-synthetic penicillins, broad spectrum semi-synthetic penicillins with macrolides or aminoglycosides and tetracyclines with other biosynthetic antibiotics was studied with respect to the causative agents of surgical infections. Correlation between the sensitivity of the isolates and the antibiotics levels in the organism of the surgical patients was shown. The role of the etiological factor in the development of the post-operative complications in the patients after surgical operations on the heart was elucidated. The most rational schemes of the antibiotic use in therapy of the patients with purulent complications after operations on the open heart were developed and the maximum doses of different semi-synthetic penicillins for the treatment of patients with purulent processes after operations under conditions of artificial blood circulation were determined.
The changes in the seeming and inner viscosity and fluidity of blood in 46 patients with acute myocardial infarction were studied during 15 days after the onset of the disease. For comparison, the same parameters were studied in 30 normal individuals and in 20 patients with cardiosclerosis. The studies were conducted with the aid of a rotational viscosimeter with a speed shift range from 8.8 to 140 sec.-1. The viscosity and fluidity of blood in patients with cardiosclerosis was found not to differ from those of normals. Acute myocardial infarction is accompanied by the development of extended intravascular coagulation that manifests itself most distinctly in cardiogenic shock. The extended intravascular coagulation manifests itself in a decreased blood viscosity observed either soon after the onset of the disease, or 4-5 and 11-15 days following a preceeding increase in blood viscosity.
Methods employed in an early activation of patients operated on a "closed" heart and under extracorporeal circulation are described. The authors began activating theri patients 2--3 hours after surgery and 16--20 hours therafter inst tuted a physical effort test (walking) over a distance of 50--100 m for 2.5--5 minutes). It was shown that the re-establisment of the hemodynamics indices, factors of external respiration and internal environment in patients managed post-operatively in accordance with the routine methods took much longer time than with the active method of managing the early post-operative period. The abolishment of a protracted hypodynamia regimen against the background of a quick normalizatiion of homesotasis is conducive to an earlier adaptation of patients to new conditions reduces the incidence of post-operative complications and curtails the patients' staty in hospital.
The total content of calcium and protein was studied in 50 patients during the initial 5 days after surgery for their congenital or acquired heart diseases conducted under extracorporeal circulation; in half of them the content of the dialysing fraction of total calcium and plasma albumins were also examined. The study has demonstrated that during the 1st postoperative day the content of the total and dialysing calcium is elevated which is due to the administration of calcium for the neutralization of citrate during blood transfusions. The greatest fluctuations of these values (both decreases and increases) were observed when the heart-lung machine was primed with blood containing 18.2--23mEg Ca++ per 1 1 of citrate blood. Within the early 5 postoperative days no restoration of the impaired calcium balance is observed in these patients, while the blood content of calcium is returning to the preoperative level. The blood content of calcium was studied after repeated injections of various doses of calcium. The most rational method proved to consist in repeated injections of 5ml of 10% CaCl2 solution every 30 min--1 hour which resulted in a moderate elevation of the blood content of the total and dialysing calcium.
The informativeness of arterial pressure, central venous pressure, cardiac contractions rate in the diagnosis of blood volume disorders combined with cardiac failure was studied in cardiac patients. The examination was carried out in 150 patients 80 of whom had been operated on the heart, mainly under extracorporeal circulation. The most informative parameter appeared to be the central venous pressure. An express-index is introduced that permits to differentiate between the following states: "isolated" hypovolemia, hypovolemia combined with cardiac failure combined with normovolemia, cardiac failure combined with hypervolemia.
In the paper the authors report their experience with the prophylaxis and treatment of infectious complications in 393 patients operated upon the heart. An increase of the specific weight of gram-negative bacteria as an etiological cause of infection and also the increase incidence of infection as the main or sole cause of mortality ill patients, operated upon under artifical circulation, were noted. Based on the study of various combinations of antibiotics against principal agents of surgical infection, it was found that a combination of bactericidal drugs such such as ampicillin with gentamycin or carbencillin with gentamycin proved to be the most effective and safe. Tetraolean was shown to be not effective enought against pyocyanic bacillus. Some information concerning the dosage and methods of using various antibiotics and their combinations for prophylaxis and treatment of suppurative complications is reported.
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In 43 patients with acquired and congenital cardiac defects and in 4 others with ischemic heart disease some indices of immunological reactivity were studied before and after operations performed under extracorporeal circulation. In patients with cardiac defects and ischemic heart disease, in whom circulatory disorders were being observed for a long time and the cellular and humoral factors of the immunological reactivity of the organism were at a low level, a reduced capability of the segmentonuclear neutrophils in the peripheral blood to undergo phagocytos is along with the bactericidal properties of the serum and skin were demonstrable. With the post-operative period not complicated by an infection the normalization of these indices occur in a week's time. A moderately increased phagocytosis or, conversely, the lack of any tendency towards normalization during the 1st post-operative week is an unfavourable sign and, as a rule, is indicative of a developing infection-induced complication.
In 30 patients with acquired and 14 with congenital heart diseases operated on under extracorporeal circulation a significant decrease in the blood Mg level was noted, its amount never returning to the preoperative one within the first week. Therapy with Mg salts helped to prevent these disorders and to maintain the plasma and erythrocytes Mg levels within the normal limits throughout the whole period of therapy.
The content of total blood plasma protein and its fractions in absolute quantities was studied in patients with acquired and congenital heart lesions in different terms of the early postoperative period (82 patients) after operative procedures, performed under conditions of artificial blood circulation. The indices were compared in two groups of patients showing different regimens of protein loss replenishment and normalization of the protein metabolism during the operation and after it. There were observed considerable intraoperative losses of protein that remained also during 3-4 days following the operative procedure. Therefore, some recommendations are given as to the substitutive protein therapy.
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