Treatment plan used for vascular injuries in the Afghanistan war.

The outcome of 961 patients with vascular injuries received in the Afghanistan war is reported. Some 755 (78.6%) patients had to have a primary amputation while only 206 (20.9%) had restorative surgery. The vessels were simply ligated in 85 cases and reconstructive surgery was performed in 121. Ligation resulted in 46 (54%) cases of limb salvage and functional restoration; 30 (35%) went on to amputation and nine (11%) died. Of the 121 patients treated by reconstructive surgery, 83 (68.5%) had completely patent vessels, 19 (15.7%) collateral compensation, 13 (10.7%) proceeded to subsequent amputation and six (4.9%) died. Although the location of the injury and the duration of the ischaemic period are important in deciding how to treat the vascular injuries of war, the decisive factor appears to be the pre-existing severity of regional ischaemia.

Indications for surgery in penetrating chest injuries.

This study is concerned with the outcome of treatment of 933 patients with penetrating gunshot chest injuries at the Medical Academy in Afghanistan. The most important factors to determine the choice of management were the general state of the patient, the type and location of the injury and the arrival time. 326 (34.9%) patients needed thoracic resuscitation. There were 117 (12.6%) cases of thoracotomy (91 emergency, 26 early operations). Of the conservative treatment group there were 636 (68.2%) cases of thoracostomy, 105 (11.2%) of repeated thoracocentesis, and as few as 75 (8.0%) required medical treatment only. There were 106 cases of the late thoracotomy because of empyema in 97 patients, fibrothorax and foreign body in eight cases and lung cystoma in one patient. The overall mortality rate was 9.4% with 5.5% in the group of isolated injuries and 26.7% in the group of combined injuries. The long-term results show that 488 (86.5%) of 564 patients were well enough to return to work and 39 (6.9%) were still suffering from secondary pulmonary disease.

[Treatment of injuries of major blood vessels of the extremities]. / Lechenie povrezhdenii magistral'nykh sosudov konechnostei.

The article analyzes an experience with operative treatment of 202 patients with penetrating injuries of major vessels of the extremities. It was found that the degree of regional ischemia state of collaterals and soft tissues rather than the time after trauma are determining factors for the reestablishment or arterial blood flow. Reestablishment of the arterial blood flow was reached in 64.6% of the patients operated upon later than the so called critical period (more than 6 hours) after the injury.

[The indications for surgical methods in treating diseases of the coronary arteries]. / Pokazaniia za khirurgichni metodi na lechenie na zaboliavaniiata na koronarnite arterii.

Included in the study were 236 operations for ischemic heart disease (IHD) aorto-coronary shunt (ACS)--88 patients; ACS + aneurysmectomy--30; ACS + endarterectomy--12, aneurysmectomy--70; skin endocoronary balloon angioplasty--34, heart transplantation--2. The postoperative mortality was 6.5 per cent. Indications for ACS were specified on the basis of the patients state of well-being, the bicycle ergometry [correction of veloergometric] test, the coronarography and ventriculography, the end diastolic pressure and the ejection fraction. Decisive in selecting patients for operative treatment were the data of selective coronarography.

[Surgical procedure in complicated mitral stenosis]. / Khirurgicheskaia taktika pri oslozhnennom mitral'nom stenoze.

The experience with the surgical treatment of complicated forms of mitral stenosis in 110 patients with the III and IV classes of the disease according to the classification of the New York Heart Association was analyzed. Closed mitral commissurotomy was performed in 36 patients, opened commissurotomy--in 33 patients, prosthetics of the mitral valve was made in 41 patients. Closed mitral commissurotomy is believed to be the simplest method of correction of the duct in mild calcinosis and deformity of the mitral valve, and fixed thrombosis of the left auricle. Opened mitral commissurotomy was justified in case of thrombosis of the left auricle and mild calcinosis and deformity of the valve. Substitution of the valve is indicated in cases of massive calcinosis and rough deformity of the valve and subvalvular structures when valve-preserving operations are impossible.