[Thymectomy in myasthenia gravis---experience with 173 surgical patients]. / Timektomiia pri myasthenia gravis--opit ot 173 operirani patsienti.

Over a 13-year period, 173 patients with myasthenia gravis--69 per cent men and 31 per cent women--undergo operative treatment in the clinic of thoracic surgery with oncology at the Military Medical Academy--Sofia. Most patients present generalized form of the disease. The operation consists in longitudinal sternotomy. In the last few years, a new approach to preoperative preparation and postoperative treatment of the patients is used. As the result of strict long-term postoperative monitoring, plasmapheresis application, immunomodulation and adequate intensive care, the rate of complications is greatly reduced with not a single fatal outcome being recorded.

[A stabilizing plastic repair method for reconstruction in extensive complete defects of the chest wall]. / Plastichno-stabilizirasht metod za rekonstruktsiia pri obshirni pulni defekti na grudnata stena.

Experience is recorded with the application of a new operative method for combined plastic-stabilizing reconstruction of the thoracic wall in complete defects larger than 8-10/10 cm (greater than 80 cm2). The method consists of covering in layers the defect with Ampoxen, auto-rib and skin-muscle flap. Nine patients were operated: 2 with recurrent tumors of the mammary gland, 2 with metastatic thoracic wall tumors, 2 with osteoradionecrosis. 2 with osteomyelitis of 3-4 ribs and 1 with wide communicating bronchopleurocutaneous fistulas. The advantages of the method are pointed out: permanent stabilization of the thoracic wall, provision of optimal biological terrain for postoperative radiotherapy, applicability in purulent-necrotic defects. The method is described in detail, as well as the results in the operated patients for a period from 1 to 4 years.

[The place and extent of thoracotomy in gunshot chest wounds]. / Miasto i obem na torakotomiiata pri ognestrelni grudni naraniavaniia.

Indications are presented for operative intervention, as well as some of the more important debatable problems in the surgical tactics and approach to firearm thoracic injuries. Emphasizing the need of differential approach and thorough preoperative preparation, the authors outline the modern trends in their operative management. On the basis of clinical, functional and X-ray methods of examination, the results of pneumorrhaphy in isolated lung injuries are evaluated. The experience of radical operative treatment of firearm lung wound, for which thoracotomy is indicated, by attempting typical pulmonary resection, is backed with arguments.

[Suppurative complications following sternotomy]. / Gnoini uslozhneniia sled sternotomiia.

For a ten-year period when 366 median sternotomies have been performed, 206 of them in cardiac operations under bypass, there were 15 dehiscences of the sternum (4.09 per cent). The method of early revision with subsequent one-story suture and persistently washing aspiration drainage was applied for treatment of grave complication. In 90 per cent of the patients the causative agent of the infection was Pseudomonas aeruginosa and in the rest--Staph.aureus. Despite the early intervention, the adequate antibacterial therapy and local application of antiseptic agents, mortality was 46.6 per cent. The authors introduced also the so called nodulating sternotomy, which provides firmer fixation. This operation was performed in 135 patients. Rigid septics and antiseptics play crucial role for nonadmission of infection in operations under bypass.