[Functional studies in the prediction of postoperative complications in the presence of lung diseases]. / Funktsional'nye issledovaniia v prognoze posleoperatsionnykh oslozhnenii pri zabolevaniiakh legkikh.

Data on the functional status of the cardiorespiratory system are required to identify patients at risk for postoperative complication in the presence of lung diseases. Very many factors influence the course of an operation and the postoperative period so there is no golden standard or the only parameter for predicting how the postoperative period runs. Patients with normal spirographic values (FEV1, more than 80%??) and without cardiovascular comorbidity are at a slight risk for postoperative complications. These patients do not need to be additionally examined. A less than one-month history of myocardial infarction, instable angina pectoris, decompensated heart failure, severe valvular disease are contraindications to planned surgery. The risk of cardiovascular events is high when the signs of myocardial ischemia occur with low exercise (less than 4 MET). Stress echocardiography, loading tests, and radioisotopic study are used as auxiliary techniques, FEV1, under 60%; ppo-FEV1, and ppo-DC, under 40%; VO2max, under 15 ml/kg/min are the values of a high risk for respiratory complications.

[New approaches to the evaluation of pulmonary circulation in surgical patients with tuberculosis]. / Novye podkhody k otsenke legochnogo krovotoka u ftiziokhirurgicheskikh bol'nykh.

Prior to and following surgery, 70 patients were examined for pulmonary tuberculosis who were divided into 2 groups: 1) 27 patients with limited processes (tuberculomas, infiltrating, cavernous tuberculosis in 1-2 segments) and 2) 43 patients with disseminated tuberculosis in 4 lobes or more. A comprehensive examination including studies of pulmonary circulation by radiotracer techniques (scanning, scintigraphy) and an original contactless study of pulmonary circulation (CSPC). There was a correlation between the results obtained by the two methods. The findings indicate a high validity of CSPC6 which makes it possible to recommend it as a screening technique for detection of pulmonary circulatory disorders.

[External respiratory function in patients before and after saving lung resections]. / Funktsiia vheshnego dykhaniia u bol'nykh do i posle ékonomnykh rezektsii legkikh.

External respiratory function (ERF) was studied in 129 patients with restrictive pulmonary processes (tuberculomas, infiltrative and cavernous tuberculosis) before and after surgery. All the patients underwent saving lung resections. Changes in ERF were examined by conventional and the new method telespirography. This technique detects general and individual pulmonary ventilation disorders, which underlie criteria for assessing whether patients with pulmonary tuberculosis can be operated on. The authors show that the outcomes of surgical treatment are determined by the baseline status of the respiratory apparatus generally and each lung specifically. Distinctive features of complicated and uncomplicated postoperative periods are identified. The benefits of the new method are demonstrated.

[Myoglobin concentration in blood: a criterion in the evaluation of muscular tissue injury in patients with prolonged crush syndrome]. / Kontsentratsiia mioglobina v syvorotke krovi--kriterii otsenki povrezhdeniia myshechnoi tkani u bol'nykh s sindromom dlitel'nogo sdavleniia.

Blood serum levels of myoglobin, creatinine, urea, beta 2-microglobulin were measured in 37 patients with the prolonged crush syndrome (PCS) injured during the Yerevan earthquake. A drastic increase of myoglobin level in the blood was observed in all the patients by the moment of hospitalization, this level being the higher, the more severe the injury. If PCS complications developed, such as sepsis or acute renal failure, myoglobin level increased by several tens of times. Effective treatment normalized myoglobin level before discharge from hospital.

[B2 microglobulin in the diagnosis and prognosis of postoperative infectious complications in the pulmonary surgery]. / B2-mikroglobulin v diagnostike i prognoze posleoperatsionnykh infektsionnykh oslozhnenii v lëgochnoi khirurgii.

The radioimmunoassay was used to study blood serum B2-M levels in 56 patients with pulmonary diseases (lung carcinoma in 20, chronic suppurative lung disease in 20, and benign lung disease in 16 patients) before the operation and in the early postoperative period. The control group was formed of 21 practically healthy individuals. A direct correlation between the character of the course of the postoperative period in patients with benign and chronic pulmonary diseases and the dynamics of changes of immunoreactivity (IR) was found. A favorable course of the postoperative period was marked by an increase of IR, in postoperative infectious complications IR did not change. Dynamics of IR was not revealed in patients with lung carcinoma, irrespective of the course of the postoperative period.

[Cefoperazone in a multi-profile surgical clinic]. / Tsefoperazone v mnogoprofil'noi khirurgicheskoi klinike.

The results of the clinical trials of cefoperazone (cefobid, Pfizer, USA), a 3rd generation cephalosporin, carried out at the Research Centre of Surgery are presented. The antibiotic was used to treat and prevent postoperative infections in 44 patients. Good and satisfactory results were observed in 43 out of the 44 patients (99.9 per cent). Antimicrobial activity of cefoperazone against 182 bacterial strains isolated from the patients was assayed and compared with that of other cephalosporins i.e. cefotaxime, ceftriaxone and ceftazidime. The cefoperazone pharmacokinetics was studied in the patients with normal renal functions after surgical operations on the organs of the chest and abdominal cavity. The antibiotic was shown useful in the monotherapy of mixed infections involving anaerobic pathogens.

[Bronchiectasis: a method of obtaining bronchoalveolar lavage fluid and studying its cytological characteristics]. / Bronkhoéktaticheskaia bolezn': sposob polucheniia bronkho-al'veoliarnykh smyvov i ikh tsitologicheskaia kharakteristika.

The bronchoalveolar fluid (BAF) cytology of 63 patients with bronchiectasis has been studied. BAF from 8 subjects without pulmonary pathology served as control. BAF samples were obtained after preliminary cleaning of the bronchial tree from the purulent contents. BAF cytosis was found significantly increased in bronchiectasis as compared to the control being observed even at minimal inflammatory activity in the lungs and due to elevated neutrophil count. Alveolar macrophage numbers reduced only in advanced inflammation. Lymphocyte count remained unchanged. BAF cytologic evidence objectively reflects the degree of the bronchoalveolar inflammation.

[Various clinical and roentgenological aspects of diagnosis of postoperative empyema in pulmonary surgery]. / Nekotorye klinicheskie i rentgenologicheskie aspekty diagnostiki posleoperatsionnoi émpiemy plevry v legochnoi khirurgii.

The results of a 10-year follow-up of 101 patients with pyothorax that developed after operations on the lungs, bronchi, and trachea (5.4% of all patients who underwent operation) show a stable fever of 38 degrees C and higher, pain in the chest, leucocytosis, and a shift of the peripheral blood leucocyte count to the left to be the most constant clinical signs of suppuration of the pleura in the postoperative period. Experience convinces the authors that the initial radiological signs of pyothorax are early fragmentation of the pleural cavity after pneumonectomy and a rigid residual pleural cavity after partial lung resection. Computed tomography complements the classical radiological examination and is conductive to timely diagnosis and successful treatment of postoperative pyothorax.

[Results of the surgical treatment of pleural empyema after lung resection and pneumonectomy]. / Rezul'taty operativnogo lecheniia émpiemy plevry posle rezektsii legkogo i pnevmonéktomii.

Pneumothorax was treated by operation in 189 patients, after pneumonectomy in 111 of them and after various types of lung resection in 78. The treatment was complex in character but surgery was the principal method. The choice of the operation was guided by various factors, but the determinants were the phase of the empyema, the presence of a bronchial fistula, and the volume of the first lung resection. Postoperative complications occurred in 32.8% of cases, lethality was 11.5%. Complications developed most frequently after extensive and traumatic operations for removal of remaining parts of the lung after the type of pleuropneumonectomy. On the whole, operative methods allowed recovery or improvement to be achieved in 76.2% of patients in whom nonoperative methods failed to cure of produce a stable remission.

[Several aspects of septic shock in lung surgery]. / Nekotorye aspekty septicheskogo shoka v legochnoi khirurgii.

It was established that septic shock is a rare (0.2%) but the severest (5 of 6 patients died) complication in pulmonary surgery and is a consequence of the spread of postoperative wound infection or pyo-inflammatory process in the lung for which the operation was performed. The staphylococcus and nonfermentative Gram-negative bacteria prevail among the causative agents of septicemia. The most typical clinical signs of septic shock are acute circulatory insufficiency with rapid development of insufficiency of the function of the brain, kidneys, liver, and intestinal paresis in a febrile patient with a severe postoperative wound infection or in one operated on for a disseminated pyo-inflammatory disease in the lung. Precise determination of the indications for operation, careful preoperative treatment of the pyo-inflammatory processes, immediate establishment of the diagnosis, and timely removal of the localized focus of infection are important in preventing septic shock.

[Immunological indicators as the criteria of prognosis and treatment of infectious complications in patients operated on for chronic nonspecific diseases of the lungs and pleura]. / Immunologicheskie pokazateli kak kriterii prognoza i lecheniia infektsionnykh oslozhnenii u bol'nykh, operirovannykh po povodu khronicheskikh nespetsificheskikh zabolevanii legkikh i plevry.

A correlation of clinical specific features of the postoperative period and dynamics of immunological indices in patients operated upon for chronic nonspecific diseases of lungs and pleura was established. Pyo-inflammatory complications were three times more often in decreased amount of T-lymphocytes after operation. HBO-therapy has an immunostimulating effect in the form of increased total and active T rosette-forming lymphocytes, causes more rapid elimination of purulent intoxication, purification of the pleural cavity from the purulent discharge and makes the period of treatment at the hospital shorter.

[Treatment of complicated appendicitis]. / O lechenii oslozhnennogo appenditsita.

Metronidazole (trichopol) included in the complex of curative measures in acute appendicitis complicated by local or diffuse peritonitis resulted in a substantially decreased amount of pyo-inflammatory complications after appendectomy and shorter time of staying at the hospital.