Biomedical subjects
Publications and source records attributed to D Jirava.
In 1990 due to collaboration with a vascular surgeon the care of patients with diseases of the peripheral vessels of the lower extremities improved. As compared with previous years, the rate of amputations of the thigh changed markedly as well as the rate of reoperations and the period of hospitalization was reduced.
In 12 experimental operations the authors tested the biocompatibility of a xenologous trachea from a pig which was used to replace a 5 cm defect of the trachea in a dog. After special preparation eliminating the antigenicity of the pig trachea the thus prepared graft was sutured into the thoracic portion of the dog trachea. The experiment could not be evaluated in two instances because the dog died on the operating table. In the remaining ten cases it was found that all anastomoses healed perfectly. The fibrous tissues of the tunica propria of the graft was replaced by granulation tissue. Across the anastomoses newly formed capillaries penetrated into the trachea where they caused chondrolysis. This led to a breakdown of the central portion of the prosthesis and stenosis in the airways with terminal respiratory failure. The mucosa of the graft was at some sites covered by metaplastically altered epithelium. Even a reinforcing vascular prosthesis did not prevent the breakdown of the wall of the xenologous graft. An asset for future work is the finding of a well healed suture between the graft and the trachea and evidence that newly formed blood vessels penetrated into the prosthesis.
Practical experience with the miniinvasive laparoscopic technique in abdominal surgery logically led to extension of this method to thoracic surgery. Video-assisted thoracoscopic operations hold their place in the treatment of spontaneous pneumothorax, pleural syndrome, benign tumours of the thoracic wall etc. A curative solution of malignant diseases by this route is so far controversial and is reserved only for specially defined cases. Experience from the authors' department is based on nine-month use of a thoracoscopic apparatus. The authors operated a total of 21 patients thoracoscopically, incl. pneumothorax 6x, fluidothorax 10x and tumourous disease of the lungs or mediastinum 5x. The use of thoracoscopy is controversial in metastases of the lungs and in thymectomy. With regard to the authors are against thoracoscopic indications in the latter conditions contemporary technical possibilities.