[Laparoscopic treatment of Morgagni diaphragmatic hernia]. / Laparoskopsko lechenie na diafragmalna khernia v otvora na Morgani.

Morgagni-Larey diaphragmatic hernias are very rare. The defect of diaphragm is usually small and the disease passes asymptomatically. If complaints are present and surgical treatment is needed, two types of operative access could be performed--thoracic and abdominal. A 18 years old man with asymptomatic flow of the disease is presented. The laparoscopic treatment was successful. The possible aspects of operative technique are discussed.

[Set for hermetization during transportation and draining of the pleural cavity]. / Set za transportna khermetizatsiia i drenirane na plevralnata kukhina.

In a situation of continuously growing road-and-traffic traumatism serious chest traumas with the presence of penetrating wounds are not a rare case. The correct transportation of the injured requires hermetization of the open pneumothorax with ensured draining of the pleural cavity in order to eliminate the possibility of the appearance of a valve pneumothorax. With the means, existing up to now, it is difficult to achieve hermetization during transportation and draining of the pleural cavity at the same time. The article presents the structure and the way of usage of the created by the authors so-called 'SET FOR HERMETIZATION DURING TRANSPORTATION AND DRAINING OF THE PLEURAL CAVITY'. The product is tested in an experiment on dogs. The SET is designed to render medical assistance in emergencies and to transport injured people with penetrating wounds in the chest wall and injuries in the lungs.

[Post-gastrectomy reconstruction versus enteral alimentation--a one year follow-up study]. / Rekonstruktsiia sled gastrektomiia i enteralno khranenie--ednogodishni rezultati.

This is a report on various post-gastrectomy reconstructive procedures, proceeding from personal experience had with 14 patients undergoing gastrectomy for carcinoma of the stomach and five patients with operations of esophagus and stomach for various pathological conditions. An assessment is done of the reconstructive methods used on the ground of objective indicators. All patients are subjected to enteral alimentation through nutritive jejunostomy. In the pre- and postoperatived periods, the trophic state of patients is evaluated on basis of biochemical, anthropometric and immunologic study data. Postoperatively, in those with small-intestinal reservoir a lower degree negative symptomatology is established, along with life style improvement. Post-gastrectomy patients presenting I-II (UICC) stage of the oncological disease are indicated for small-intestinal reservoir formation. In the overall therapeutic approach to post-gastrectomy patients adequate clinical therapeutic feeding proves absolutely indispensable.

[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.

[Total lipids and cholesterol in the serum of clinically healthy and ketotic cows]. / Obshtite lipidi i kholesterinut v seruma na klinichno zdravi i bolni ot ketoza kravi.

The total lipids and cholesterin were determined in the serum of 26 normal cows in an advanced lactvery. It was found that the rise of the total lipids in the diseased cows was negligible and was statistically significant only with regard to those that have recently calved, which showed the lowest values. No conceivable differences were established after recovery. The drop of the total cholesterin in the fresh and ketosis-affected animals was not accompanied by substantial changes in the coefficient of esterification; these variations disappeared with recovery. Anologous were the changes in the ester cholesterin the rise of which was visible after recovery although statistically insignificant. The changes observed were characteristic of the glucose deficiency present in ketosis-affected cows.

[Blood sugar and ketone body content in cows with clinical ketosis]. / Sudurzhanie na kruvna zakhar i ketonovi tela pri kravi s klinichna ketoza.

The investigation confirms hypoglycaemia and hyperketonaemia as typical for ketosis. A reverse correlation has been found between the level of blood sugar and that of ketone bodies. The changes observed in both blood sugars and ketones have not been shown to manifest any definite relation to the feeding regime, which may not have been perfectly balanced but has supplied metabolizable energy and digestible protein for maintenance and production in excess. Five-day starving of freshly calved, clinically normal cows may cause a dependable drop of the blood sugar level and rise of the ketone bodies to an extent that vary from that observed in ketosis-affected cows showing no clinical picture characteristic of the disease. The glycaemic reaction observed with the glucose-tolerance and the adrenaline tests shows that there is no apparent differences in the carbohydrate metabolism and the glycosynthetic capacity of the liver between diseased and clinically normal animals. The use of the two tests as auxiliary clinical methods has not been effective in registering the deviations in the status of the adrenal cortex and the pituitary gland.