[Surgical treatment in parasternal diaphragmatic hernias]. / Khirurgicheskoe lechenie pri parasternal'nykh diafragmal'nykh gryzhakh.

The article presents an analysis of experiences with surgical treatment of 26 patients with parasternal diaphragmatic hernias for the period from 1969 till 1999. In most cases (88.5%) right localization was noted. The abdominal mediastinal lipomas were the most frequent cause of the hernias (88.5%). The presence of hernias is considered by the authors as an indication to operation. The thoracotomic and thoracomyorectal accesses were used, the latter being the optimal one. No recurrent hernias were noted in the patients after operation. There were no lethal outcomes.

[Congenital bronchoesophageal fistulas]. / Vrozhdennye bronkhopishchevodnye svishchi.

During the period from 1970 till 1996 six patients with congenital bronchoesophageal fistulas were operated upon which was 0.75% of all developmental defects of the lungs. The leading symptoms of bronchoesophageal fistulas in the clinical picture are cough during and after meals and discharge of food mass with sputum. Roentgeno-endoscopic examinations are thought to be the main diagnostic method. Radical treatment of patients with the respiratory-esophageal fistulas was facilitated by dissection of the fistula passage and closure of the openings in the esophagus and bronchus, covering the suture line on the esophagus with a flap of the mediastinal pleura, pericardium. The irreversible alterations in the lung tissue require a one-stage operation on the lung. Palliative operations (gastrostomy, jejunostomy) are indicated in severe pyo-destructive alterations in the lungs for preparation to radical operation.

[Congenital unilateral pulmonary emphysema (Macleod's syndrome)]. / Vrozhdennai odnostoronniaia émfizema legkogo (sindrom Makleoda).

The author analyzes the experience with diagnosis and surgical treatment of 5 patients with one-side emphysema of the lung (McLeod syndrome). The leading symptoms of the disease were respiratory and cardiovascular disorders, their degree being dependent on the stage of compensation of the emphysema, the degree of displacement of the mediastinum organs, disturbance of bronchial passability, compression of the contralateral lung and concomitant diseases. The clinical picture and findings obtained by complex X-ray and angiocontrast methods of examination are considered to be the leading factors in diagnosing this developmental defect. Operations were made on 3 patients without lethal outcomes.

[Current problems in the diagnosis and surgical treatment of rare developmental defects of the lungs]. / Aktual'nye voprosy diagnostiki i khirurgicheskogo lecheniia redkikh porokov razvitiia legkikh.

The author analyzes questions of diagnosis and surgical treatment of 168 patients with rare malformations of the lungs which made up 5.6% of the general amount of patients with surgical nonspecific diseases of the lungs and 36.1% among all defects of development of the lungs. It was established that diagnostics of rare defects of development of the lungs might be of full value but when using a complex of roentgenological, bronchiological and functional methods of examination. Surgical treatment of rare defects of the lung development is indicated to 86.1% of the patients and must be performed till the progressing of secondary alterations, when disturbances of ventilation and oxygenation are observed, there is blood flow shunt disturbances of hemodynamics of the pulmonary circus of blood circulation.

Congenital pulmonary arteriovenous aneurysms.

The authors analyse their diagnostic and therapeutic experience with 26 patients suffering from congenital pulmonary arteriovenous aneurysms. Symptoms of the disease were found to depend directly on the presence and volume of arterial blood shunted into the venous bed. The volume of shunted nonoxygenated blood varied between 20 and 48 p.c.; the reflux caused hypoxic hypoxaemia with HbO2art. = 91.2 +/- 1.43%; pO2art. = 63.6 +/- 5.54 mmHg. Aimed tomography and pulmonary angiography proved most advantageous in terms of diagnostic; with their aid it was possible to identify three variants of congenital pulmonary arteriovenous aneurysm: isolated, multiple and "of the capillary haemangioma type".

[Pulmonary sequestration]. / Sekvestratsiia legkogo.

The author discusses pulmonary sequestration which is a rare developmental anomaly difficult for diagnosis. Eleven patients were under observation and underwent operation for pulmonary sequestration (8 with intralobar and 3 with extralobar) which accounted for 2.4% of patients with congenital developmental anomalies of the lungs and for 0.48% of those with chronic unspecific disease of the lung. Complete clinical radiological examination, including aortography, made it possible to recognize the anomaly before the operation in 6 patients. In the remaining patients sequestration of the pulmonary tissue was an operative finding. Preoperative functional study of pulmonary circulation revealed a marked left-to-right shunt of the blood, increased oxygenation of blood in the superior vena cava and saturation of arterial and venous blood with oxygen (to 94 and 91%, respectively, on the average). Analysis of clinical, radiological, and morphological data allowed three main forms of pulmonary sequestration to be distinguished: cystic-abscessed, pseudotumorous, and fibrous-atelectatic.

[Long-term results of surgical treatment of rare lung malformations]. / Otdalennye razul'taty khirurgicheskogo lecheniia redkikh porokov razvitiia legkikh.

The author has analyzed long-term results of surgical treatment of 112 of 128 patients operated upon for malformations of the lungs. The terms of observations were from 1 year to 15 years, 70,5% of the patients being examined within 3-5 years after operation. Good results were noted in 94,6% of the patients examined. Incomplete disappearance of symptoms of the disease in 5,4% of the patients was due to the insufficiently exact determination of the character and spread of the involvement of the lungs before operation, palliative operations and widening the indications for surgical treatment to patients having severe coexistent diseases.

[The importance of the compensatory powers of the lungs in determining the indications for surgical treatment of hypoplasia of the lungs]. / Znachenie kompensatornykh vozmozhnostei legkikh v opredelenii pokazanii k khirurgicheskomu lecheniiu gipoplazii legkikh.

The author studied the compensatory possibilities of pulmonary respiration, gas exchange and hemodynamics of pulmonary circulation to determine the indications for operative treatment of simple hypoplasia of the lungs. The work is based on the results of examination of 58 patients. Forty-five patients underwent an operation. It was established that simple hypoplasia of the lungs is characterized by mild ventilation disorders and deep disorders of gas exchange leading to manifest and latent hypoxia in 94.6% of cases. Deficiently developed pulmonary-arterial channel, the presence of morphological foundations of pathological blood shunting (up to 24-32% of minute pulmonary circulation volume) were the causes of disturbed hemodynamics of pulmonary circulation and the development of pulmonary hypertension in 30.6% of cases. The indications and contraindications for surgical correction of simple hypoplasia of the lungs are discussed on the basis of study of the functional condition of ventilation, gas exchange, and hemodynamics of pulmonary circulation.

[Surgical correction of congenital arteriovenous aneurysms of the lungs]. / Khirurgicheskaia korrektsiia vrozhdennykh arteriovenoznykh anevrizm legkikh.

The authors have analyzed results of the surgical treatment of 24 out of 26 patients observed at the clinic for arterio-venous aneurysms of the lungs. It was found that the reduction of efficiency of the gas exchange function of the lungs before operation manifested itself by arterial and venous hypoxemia with an increased arterio-venous oxygen difference and pronounced decrease of blood oxygen strain. Good results of the operative treatment, rapid recovery of blood oxygenation, disappearance of hypoxemia symptoms make the surgical method the only radical one in treatment of such patients. The operation of choice was lobectomy. No lethal outcomes followed.