Infrared coagulation of the lung. Initial experimental and clinical results

With regard to the good results which were found using the infrared coagulator (IRC) in hemostasis of liver and spleen experimental and clinical investigations of the lung were performed. Animal experiments elucidated the necessity of ligation of greater vessels as well as bronchi. Secure plugging of lung tissue was also possible following increased positive pressure respiration. A mean maximal extend of necrosis of 3 mm was measured. Clinical use in 11 patients proved secure plugging of tissue due to IRC application. Drainages could be removed within 4 days without appearance of broncho-pleural fistulas.     

Blood coagulation changes in lung surgery and their prevention by heparin

Changes of hemocoagulation were studied in three groups of patients in different periods of surgical intervention for various forms of pulmonary tuberculosis. Mini-doses of heparin were included in the complex of preventive measures applied during the operation in group 3. It was found out that changes of blood coagulation during operation on phthisiosurgical patients develop according to the mechanism of the thrombohemorrhagic syndrome (THS). The more injurious the operation, the more manifest are the changes in the system of blood coagulation and fibrinolysis. Heparin prevents intravascular coagulation of blood, arrest the development of THS and, in this manner, the occurrence of thrombohemorrhagic complications.     

Endothelial-related coagulation in cardiac surgery

The endothelium appears to play an important degrees in theregulation of intravascular coagulation. Thrombomodulin is oneof the anticoagulant substances that is expressed by endothelialcells. The influence of age and illness on the thrombomodulin-proteinC system was studied prospectively in 80 cardiac surgery patients.Patients > 70 yr old (n = 20) were compared with patients< 50 yr (n = 20) (group I), and patients undergoing a simplecardiac procedure (n = 20) were compared with patients scheduledfor complex surgery (n = 20) (group II). Thrombomodulin (normal<40 ng ml^–1 protein C and (free) protein S plasma concentrationswere measured by enzyme-linked immunosorbent assays (ELISA)after induction of anaesthesia (baseline values), during andafter cardiopulmonary bypass (CPB), at the end of surgery, 5h after CPB and on the first day after operation. Blood lossand use of homologous blood and blood products were significantlygreater in patients > 70 yr and in those undergoing complexsurgery. At baseline, thrombomodulin concentration was increasedin patients undergoing complex surgery (mean 52 (SD 9) ng ml^–1After bypass and after operation, thrombomodulin increased mostin patients > 70 yr (from 40 (8) to 78 (10) ng ml^–1and in those patients who underwent complex cardiac operations(from 52 (8) to 79 (10) ng ml^–1 (P < 0.05). Changesin protein C and protein S concentrations were similar in allgroups. On the first day after operation only, protein C concentrationswere reduced in patients > 70 yr and in patients who underwentcomplex cardiac surgery. Older patients and those who underwentcomplex cardiac surgery had greater changes in the thrombomodulin-proteinC system which may contribute to increased postoperative bloodloss.     

骨科手术中发生的急性播散性血管内凝血

播散性血管内凝血 (DIC)是一种严重的获得性出凝血障碍 ,主要是因为病理性激活凝血级联反应导致凝血因子大量消耗而出现矛盾性的出血倾向。骨科手术发生急性DIC的报到还很少。本文报道了一例 72岁男性颈椎手术后死于严重的急性DIC的病例。我们回顾了一些关于骨科手术中发生DIC的病例报道 ,并简述了这种严重并发症的预防、诊断和治疗。     

Microwave coagulation therapy in canine peripheral lung tissue

BACKGROUND: New modalities for local treatments that destroy tumor effectively but which are less invasive and less damaging to normal lung tissue must be developed for patients who are unable to undergo even video-assisted thoracic surgery (VATS) due to poor cardiopulmonary function, severe adhesion, or advanced age, etc. We evaluated the use of microwave coagulation therapy (MCT), which has been used successfully for coagulation of hepatic tumors, in normal canine lung tissue to evaluate its efficacy and safety. MATERIALS AND METHODS: Measurements of thermal response and coagulation area and histological examinations after microwave coagulation were performed in normal canine lung tissue. RESULTS: The temperature in normal canine lung tissue increased to 90-100 degrees C at 5 mm from the electrode after 60 s and 70-80 degrees C at 10 mm after 90 s at 40 or 60 W. The coagulation area was approximately 20 mm in diameter at 40 W and 60 W. Histological analysis demonstrated thickening of collagen fiber shortly after coagulation, stromal edema and granulation tissue after 3 months, and, finally, scar tissue was seen after 6 months. CONCLUSIONS: Microwave coagulation therapy (MCT) is a useful modality for minimally invasive therapy in peripheral lung tumors.     

Reoperations in lung surgery

A second thoracotomy in patients who have undergone previous chest surgery can be performed soon or immediately after the first operation and is usually aimed at resolving severe or even life-threatening postoperative complications. Late reoperations, on the other hand, are either performed to resolve complications of previous surgery or to remove second primary lung tumors (SPLCs) or metastases. The most exacting reoperation in this context is completion pneumonectomy, which is particularly indicated in the case of failure of the residual lobe to re-expand after primary surgery; it is also used for--rarely occurring--fistulas of the lobar bronchi and for new ipsilateral primary lung tumors. This type of surgery is technically complicated and has been associated, in our experience and that of others, with a certain mortality. Technically less difficult is a second ipsilateral thoracotomy for exploratory purposes or minor parenchymal resection, and the same is true of contralateral lobar or sublobar resections. Lastly, Abruzzini's operation, for fistulas of the primary bronchus, is relatively complicated but often leads to good results; we have performed 15 such operations with only one death occurring due to acute myocardial infarction.     

Cardiac surgery and the coagulation system

This review focuses on the activation of the haemostatic system during cardiopulmonary bypass. The interaction of different cascade systems are examined, in particular the relation of inflammation with haemostasis. Novel strategies to supplement or replace heparin for anticoagulation during cardiopulmonary bypass have recently been described. Drug approaches to reduce activation of haemostasis reported during the review period are already well established. Their influence on the inflammatory response may offer interesting perspectives for the future.     

Physical methods of dissection and coagulation in surgery

The paper presents 20-year experience in using various devices for tissue dissection and coagulation of such as electrosurgical ones EN-57M, Efa-0201 (Russia), Karl Storz-endoscope (Germany), Force-300, Force-FX, LigaSure ("Valley-lab", USA), Erbotom ICC 350 ("Erbe"), Argo-3000 ("Soring", Germany), a Surgitrone radioknife ("Ellman", USA), ultrasonic Auto Sonix devices ("Auto Suture", USA), a harmonic Ultracision scalpel ("Ethicon Endo-Surgery", USA), laser Scalpel-1 and Romashka-1 devices (Russia), plasma Fakel-01 and Prometey devices (Russia). The results of 424 experimental studies and clinical application of different energies in 1683 patients are analyzed. The influence of different types of energy on tissue and reparative processes were revealed, morphological changes were studied. Advantages and shortcomings of each type of energy are demonstrated, recommendations for their optimum application are formulated.     

Bipolar coagulation of vessels in aesthetic plastic surgery

Bipolar coagulation for hemostasis should be used more frequently than monopolar coagulation in aesthetic plastic surgery. The advantages of the procedure are manifold: considerable reduction of the amount of current, and consequent prevention of deleterious effects on other tissues and organs; minimal devitalization of tissues during coagulation; reduction of reactive edema; total separation of the patient from the power source when coagulating forceps are not in use; avoidance of burns due to defective insulation of conductors; elimination of spark burns of the surgeon's fingers through punctured gloves; and freedom of the assistants' hands for other duties.     

Argon beam coagulation in foot and ankle surgery

In this brief report, we introduce the principles, indications, advantages, disadvantages, and surgical techniques involved in the use of argon beam coagulation in foot and ankle surgery.