[Clinical-pathologoanatomic analysis of post-operative thromboembolism of pulmonary artery]. / Kliniko-patologoanatomicheskii analiz posleoperatsionnoi tromboémbolii legochnoi arterii.

Autopsy and clinical data were analysed for 803 surgical patients whose death was due to pulmonary artery thromboembolism (PAT). PAT was diagnosed intravitally in 32% of the deceased. 87% of the patients with PAT symptoms died within 2 hours. 3/4 of PATs developed in uneventful postoperative period, 1/4--in complications. The cause of PAT in 99.3% of cases were thromboses in vena cava inferior. In 88.3% of cases these thromboses ran latently. Frequency of postoperative PAT as a cause of death was 1.4% in 1972-1973, 2.1% in 1990-1991, 1.3% in 1997. The fall of the death rate is explained by introduction of drug prophylaxis of PAT.

[Abdominal trauma with injuries of the major vessels]. / Travma zhivota s povrezhdeniem magistral'nykh sosudov.

Treatment results in 87 patients (mean age 30.1 years) with traumatic injuries of major abdominal vessels were analyzed. 73 patients had stab-incised wounds, 9--blunt trauma, 5--gunshot wounds. Hemodynamics of the majority of hospitalized patients (66 from 87) was unstable. Inferior cava vein injury was revealed in 29 patients, aorta injury--in 21, iliac vessels injury--in 22, visceral vessels injury--in 15. One vascular wall was injured in 58 cases, two walls--in 27 cases, complete transection or separation of vessel was revealed in 6 cases. Major vessel injuries were associated with abdominal visceral trauma in 97% cases. Vascular operations (side suture--in 49 patients, circular suture--in 11, vein ligation--in 5, prosthesis--in 3) were performed in 17 (25%) patients by general surgeons, in the rest (75%)--by vascular surgeons. General mortality (including hospitalized but non-operated patients, and patients who died during the operation and in postoperative period) was 46%. It is necessary to teach vascular surgery to general surgeons for high-quality and timely care in patients with abdominal trauma complicated by major vessels injuries.

[Postoperative thromboembolism of pulmonary artery]. / Posleoperatsionnaia tromboémboliia legochnoi arterii.

Pathologo-morphological and clinical records of 803 surgical patients have been analysed, in whom the thromboembolism of pulmonary artery (TEPA) was the only or the main cause of the death. Intravital diagnosis of TEPA was established in 32% of all the deceased. 87% of patients with evident symptoms of the embolism died during the first 2 hours, 52.3% died during 15-30 min. 67% of all TEPA were revealed in postoperative weak 1, 15%--in week 2, and 18%--on later terms (15-45 days). 82.6% of patients who died of TEPA underwent elective operations, and 17.4%--urgent operations. The indications were absolute in 67.3% of cases and relative--in 32.7%. 3/4 of all embolisms developed during the smooth p/o period, and 1/4--on the background of various complications. The rate of TEPA with lethal outcomes made up: 4.3% after the amputation of the lower limb for acute and chronic arterial circulatory disturbances, 2.4%--after transvesical adenomectomy of the prostate, 0.7% and 0.2%--after the operations on the biliary system and the stomach, respectively, and 0.14%--after appendectomy. 410 random purposeful autopsies detected that the sources of the TEPA in 99.3% of cases were thromboses in the system of inferior caval vein which developed silently in 88.3% of cases. In 90.9% of patients thrombus came from the deep veins of the shin, and in 9.1%--from iliac and femoral veins. The rate of postoperative TEPA as a cause of death, according to the autopsies data, has increased from 1.4% in 1972-1973 to 2.1% in 1990-1991. Up to 1997 the rate of this index decreased to 1.3%, the quantity of the autopsies (in operated patients--100%) being equal, and in conditions of increased surgical activity. The positive tendency in the dynamics of lethality of TEPA in conditions of a large industrial city, according to authors' view, is referred chiefly to implementation of drug prophylaxis of postoperative thrombosis of the deep veins of the lower extremities using mini-doses of heparine.

[Treatment of heart wounds]. / Lechenie ranenii serdtsa.

Care results in 48 patients (male--38, female--10) with heart wounds (HW) were analyzed. 40 (83.2%) patients had stab-incised wounds, 7 (14.7%)--stab wounds, 1 (2.1%)--gunshot wounds. 23 (47.8%) patients were hospitalized in consciousness, 17 (35.3%)--in unconsciousness, 8 (16.9%)--in twilight state. The lethality among the latter two groups of the patients was 64%, in the former group--13%. 19 patients from 48 died: in preoperative period--3, during operation--10, in early postoperative period (more than 10 days)--2 patients. The suspected of HW patients must be transported in the nearest surgical hospital. In unstable hemodynamics it is necessary to carry out adequate infusion therapy, in obvious signs of heart tamponade the pericardium puncture must be performed. In agonizing patients, and in case of general anesthesia delay, it is necessary to begin thoracotomy before general anesthesia.

[Morphologic changes in the thrombus and venous wall in experimental phleobothrombosis and thrombophlebitis]. / Morfologicheskie izmeneniia v trombe i stenke veny pri éksperimental'nom flebotromboze i tromboflebite.

Phlebothrombosis and thrombophlebitis were induced in dogs by percutaneous intraoperative introduction of thrombotic mass, obtained in vivo (20-40 animal blood per 3-4 ml thrombin solution) into jugular vein and studied in postoperative days 1, 3, 5, 7, 10 and 14 through light microscope. The preparations were stained with hematoxylin and eosin and after Hart, Van-Gieson and MSB. Venous intima was established to alter already on the next day following thrombophlebitis modeling. On d 3 and 5 epithelium desquamation and moderate leukocytic infiltration of media between smooth myocytes were found. On d 7 signs of thrombus organization, i.e. invasion of fibroblastic series cells and small capillaries inside it, were demonstrated. Muscular layer and adventitia display leukocytic infiltration. Venous wall thickens due to disorders of blood passage in vasa vasorum. On d 10 the portion of the thrombus attached to the wall was essentially organized. Fibroblasts and capillaries invade inside the thrombus, connective tissue fibres are formed. Sclerotic changes were noted in adventitia. By the end of the 2nd week venous wall showed muscular layer atrophia and sclerosis. Middle portions of the thrombus were involved in organization, canals lined with endothelium are formed in it. In case of thrombophlebitis changes in thrombus and venous wall develop earlier and are more pronounced.

[Modeling of phlebothrombosis in experimental animals]. / Modelirovanie flebotromboza v éksperimente.

Phlebothrombosis model was elaborated in experiment. The thrombotic mass was obtained in vitro, mixing the blood of animal with thrombin. Retracted thrombus was injected by puncture into previously ligated segment of the dog's v. jugularis externa. The vein's preparation was studied up on 1, 3, 5, 7, 10th and 14th day. Up to 8-10 days the thrombus adherence to the vein wall is friable and it is possible to extract it with the help of balloon catheter. Endothelium desquamation was revealed starting from 3-5th day.