A comparative study of the aortic wall in patients with Marfan's syndrome and Erdheim's disease.

The materiel of intraoperative biopsies (378) and autopsies was used to study the morphology of the aortic wall in patients with Marfan's syndrome (62) and Erdheim's disease (133). Histological, histochemical and electron microscopy research methods were employed with an assay of the results obtained. It has been demonstrated that in connective tissue dysplasia in the aorta, the histological structure of the intima undergoes substantial changes alongside the pathology of the tunica media. It is marked by the formation of a focal and diffuse thickening with the predominance of the interstitial substance, rich in glycosaminoglycans, and of a small amount of fibrous structures. The morphological signs of the impairment of endothelial permeability (vacuolisation of cytoplasm, thinning of its peripheral portions and basal membrane, expansion of intercellular fissures) are identifiabe, which leads to the disorder of aortic wall metabolism and early development of atherosclerosis. The changes in the intima together with the pathology of the tunica media ere predisposing factors of aneurysm formation, dissection and rupture of the aorta.

[Reparative regeneration of the human liver grafted from a cadaver and a relative donor]. / Reparativnaia regeneratsiia pecheni cheloveka, transplantirovannoi ot trupa i rodstvennogo donora.

The morphological features and dynamics of regeneration of the grafted human liver were studied by using data on 609 needle biopsies obtained for morphological monitoring in 38 recipients during transplantation of the liver from cadavers and relative donors. The biopsy specimens of donor organs taken prior to grafting served as a control. Irrespective of the type of grafting, regenerative processes in the grafted liver were shown to have common regularities and to run by using the mechanisms of both intracellular regeneration and proliferation. Their maximum rate was seen within a month after grafting of a cadaverous organ and within 3 months after grafting a part of the liver from a relative donor. In cadaverous transplantation, regenerative processes depended mainly on the degree of ischemic lesions; in relative donor organ transplantation, that depended on the fitness of graft mass (the index K being close to 0.5), proliferative processes and the time of higher hepatocytic ploidity increased. An adequate evaluation of the status of a cadaverous organ, estimation of the optimum mass of a grafted hepatic part from a relative donor, and effective immunosuppressive therapy ensure required reparation rates and a complete recovery of the structure of a graft.

[The use of contact impulse-periodic YAG-ND laser in surgery of major duodenal papilla]. / Primenenie kontaktnogo impul'sno-periodicheskogo AIG-Neodimovogo lazera pri operatsiiakh na bol'shom duodenal'nom sosochke.

YAG-Nd impulse-periodic laser scalpel in elimination of major duodenal papilla stenosis was tested experimentally. The direct damaging influence of the laser was tested in acute experiments and the optimal power of irradiation (5 W) was chosen. The processes of regeneration of the wound inflicted by laser irradiation were tested in chronic experiments. It is shown, that regeneration was accompanied with minimal leucocyte infiltration and complete healing of the wound is achieved in 28 days.

[The use of the contact periodic-pulse laser and microwave scalpels in liver surgery]. / Primenenie kontaktnogo impul'sno-periodicheskogo lazernogo i mikrovolnovogo skal'pelei v khirurgii pecheni.

In use of the laser (CPPLS) and microwave (MWS) scalpels, the reliability of arrest of bleeding and bile leakage has been proved not only at studies on the intact liver but on the models of jaundice with impaired coagulative blood properties as well. After hepatic resection by means of CPPLS and MWS, the impairement in its functional state lasts for a short time. In use of CPPLS, disturbance in tissue blood flow is less than in use of MWS. Healing of the wounds inflicted by CPPLS and MWS occurs in absence of pronounced exudative and inflammatory reactions. In a wound inflicted by a laser scalpel, the necrotic layer is not pronounced. It is expedient to use the CPPLS and MWS in patients with hepatic masses in technically difficult cholecystectomy as they contribute to decrease in intraoperative blood loss and prevention of the development of complications after the operation.

[Use of thermo-acoustic contact laser scalpel in surgery of the liver (an experimental study)]. / Primenenie termoakusticheskogo kontaktnogo lazernogo skal'pelia v khirurgii pecheni (Eksperimental'noe issledovanie).

Various parameters (from 15 to 40 W) of the thermo-acoustic contact YAG: Nd-laser scalpel were tested in experiments on 70 rabbits to choose the optimal operating regimens in resection of the liver. A power of 25-30 W proved to be effective. The reliability of hemo- and cholestasis was studied by means of hydro-pressure, reparation processes were studied by histological, electron microscopic, and radioautographic examination in periods of 3 hours to 30 days. The results of the study bear evidence that the use of the thermo-acoustic contact solid-body laser scalpel makes it possible to increase the rate of cutting with minimal injury to the peripheral areas of the hepatic tissue, significantly increases the reliability of hemostasis, produces fine homogeneous coagulation for the whole length, and facilitates a favourable course of the reparative processes. Besides, the contact method of laser division is controllable with regard to the depth of the beam effect and increases the surgeon's tactile sense.

[Reparative regeneration of microvascular anastomosis]. / Reparativnaia regeneratsiia mikrososudistogo anastomoza.

Dynamics of reparative regeneration of the sutural anastomosis of the abdominal aorta has been studied in 90 white mice during the time from 1 day up to 1 year. The operation has been performed by means of microsurgical technique. Histological, histochemical, electron microscopic and radioautographic (3H-thymidine and 3H-uridine labelling) methods have been used. By the 7th day fibrin is organized on the adventitia, the scar along the resection line is formed, endothelial lining and middle layer of the vascular wall are restored. As sources of regeneration in the anastomosis serve cellular elements preserved in the lesion margins. Further maturation of the formed structures and formation of the initial thickening by migrating smooth muscle cells of the middle layer take place. Completeness and typicity depend on preservation of the elastic carcass in the middle layer and adventitia.

[Role of smooth muscle cells in reparative processes in a vascular suture of the rat aorta performed using a microsurgical technic]. / Rol' gladkikh myshechnykh kletok v reparativnykh protsessakh pri sosudistom shve aorty krys, vypolnennom s pomoshch'iu mikrokhirurgicheskoi tekhniki.

The abdominal aorta in 56 white rats has been sutured by means of a microsurgical technique in order to study changes that the smooth muscle cells (SMC) of the vascular wall undergo during the restorative process of its integrity and intima formation. The material for histological investigation is fixed in 10% formalin or in Karnoy fluid and embedded in paraffin. For the electron microscopic investigation the specimens of the aorta are treated in 2% and 5% glutaraldehyde solution and in 1% tetraoxic osmium solution and embedded in epon and araldit mixture. The muscular wall SMC actively participate in the reparative processes when the vascular suture is performed by means of the microsurgical technique. The vascular wall SMC ensure the rat aorta restoration in such a way that already 3 weeks after the operation the cut line can be defined only by the presence of the suture thread and by a slight sheet of the connective tissue. Migration and accumulation of the SMC under the endothelium restored its integrity results in the intima formation. Simultaneously, an intercellular substance is forming, that is directly connected with the SMC development.