[The diagnosis and surgical procedure in wounds of the heart and pericardium].
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Biomedical subjects
Publications and source records attributed to N V Michurin.
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Questions of conservative and operative treatment are considered on the basis of studying 259 patients with spontaneous pneumothorax. In most of the patients the lung was spreaded by a single or permanent active aspiration of air from the pleural cavity. However, due to great amount of recurrences after the conservative treatment it should be more often followed by operative methods of treatment. Indications to operation are: failure of conservative spread of the lung, repeated collapse, recurrent pneumothoraxes and detection of subpleural bullas during thoracoscopy.
Three groups of patients with traumas of the chest were investigated: 1. 1533 patients treated by traditional methods: 2. 258 patients treated by transfusions of photo-modified blood; 3. 50 patients treated by autohemotransfusion. The authors have shown expediency of transfusions of photomodified autoblood. It decreased the amount of complications, lethality and improved biochemical parameters of blood.
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Problems of the clinical course, diagnostics and prophylactics of complications are discussed on the material of observation of 1533 patients with closed traumas of the chest. The program of medical measures included adequate anesthesia, measures of normalization of respiration, gas exchange and correction of metabolic alterations. Main indications to operation were as follows: continuous intrapleural hemorrhage, not effective active drainage in pneumothorax and compression of mediastinal organs. Posttraumatic complications developed in 16.60%, lethality--in 1.5%. The average time of treatment was 12 days.
Results of the treatment of 378 patients with unstable fracture of the femur neck were analyzed. The authors recommend to use osteosynthesis with a three-blade rod with an additional fixation by a lateral plank and screws to the femur diaphysis combined with osseous allotransplant introduced parallel to the metallic fixator. The follow-up studies for 6 years have shown the false joint to be formed in 5% of the patients operated by the proposed method while osteosynthesis by a three-blade rod only gave it in 23,8% of cases.
In 1970-1979 there were 620 patients with trochanterial fractures of the femur. The average age of the patients was 75. Skletal extension was used in 193 patients. 168 patients were treated by the derotation boot. Operations were performed on 234 patients. The operative treatment reduced the lethality from 27,4% of 18,4% as compared with conservative methods. Complications were reduced from 63,2% to 30,8% unsatisfactory results from 31,9 to 8,0%.
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The treatment of 615 elderly and senile patients with medial fractures of the femoral neck is analyzed. The average age of the patients was 76. In spite of the age and concomitant diseases, 487 patients were subjected to operations. The character of the operation depended on the kind of fracture. Remote results were studied in 210 patients within the period of 5 years. Union of fractures was observed in 200 patients.
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On the grounds of the study of 100 cases operated upon for medial fractures of the femoral neck the authors have found cases of instability of the fracture in 60 cases, which contributed to the secondary displacement of the fragments and formation of pseudoarthrosis in the postoperative period.
An original method of osteosynthesis of the clavicular-acromial juncture, that differs from the currently used technics and provides a secure fixation, is suggested. Fourty six patients were operated upon, using the technic described, with good immediate and late results.