[A method for the internal drainage of the bile ducts].
The choledochoduodenostomy conduction method with the functionally active valve formation was proposed for the duodenocholedochal reflux via the anastomosis prophylaxis.
Biomedical subjects
Publications and source records attributed to R I Vaĭda.
The choledochoduodenostomy conduction method with the functionally active valve formation was proposed for the duodenocholedochal reflux via the anastomosis prophylaxis.
The correction method of portal hypertension, basing on the blood circulation flow reduction in the main abdominal cavity arterial vessels, was elaborated in experiments on dogs. The functional and morphological changes in vascular bed and the abdominal cavity organs after the portal hypertension modelling and its surgical correction were studied up.
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In the experiment, performed on 89 dogs, after 67-75% resection of the lungs, functional morphology of the myocardium has been studied by means of histological, electron microscopical and morphometrical methods. Bilateral extensive resections of the lungs are accompanied with hypertrophy of the cardiac muscle, that is revealed at all the levels of its structural organization. Simultaneously, the hypertrophy develops against the background of dystrophic and destructive changes of the myocardium, their depth and extensiveness correlate with duration of the postoperative observations. If an extrapulmonary anastomosis is formed between the inferior lobular pulmonary artery and the corresponding vein before the resection of 67-75% of the lungs, it eliminates the acute overloading of the right ventricle, makes better conditions for development of compensatory-adaptive processes in the myocardium, prevents advancement of the cardio-pulmonary deficiency during the postoperative period.
In the experiment performed on 107 dogs, after resection of 33-75% of the pulmonary volume, it has been stated that considerable disturbances take place in the myocardial microcirculatory bed. At early stage after the operation the amount of capillaries per 1 mm2 of the section increases, their lumens become wide. With elapse of time after the operation, as a result of myocardial hypertrophy, density in arrangement of the capillaries decreases, and the transversal section area of the cardiomyocyte per one capillary increases. In the capillary walls destructive changes are also noted; they result in myocardiodistrophy and in development of cardiac failure.
The experiment has been performed in 124 non-inbred dogs by means of a complex of morphometrical methods in order to study compensatory-adaptive processes in the heart after pulmonary resection various in its volume. After 58% resection, and especially after 67-75% resection of the lung mass, a stable pulmonary arterial hypertension appears; it results in development of a chronic cor pulmonale and terminates in its decompensation. Application of extrapulmonary arterio-venous anastomosis, before 67-75% of the pulmonary parenchyma is resected, decreases hypertension in the pulmonary circulation, improves adaptive changes of the heart in the newly formed conditions of hemodynamics, preventing development of its failure.
Hearts of 112 randombred dogs after resection of 33-75% of pulmonary tissue were studied macro- and microscopically, by stereometry, and morphological statistical analysis. Pulmonectomies (resection of 58% of pulmonary tissue) and extensive to the development of pulmonary heart. In these cases, the degree of hypertrophy correlates with the volume of the resected lung tissue, the duration of the post-operation period and terminates mostly in heart decompensation of the right type which develops most frequently when there exists a disproportion and unbalanced hypertrophy of various parts of the myocardium.
Bilateral extensive resections of lungs resulted in the development of stable pulmonary arterial hypertension, its degree correlating with the duration of the postoperative observation. Continuous hypertension in the pulmonary artery system is responsible for destructive changes in the intrapulmonary vessels and lung parenchyma promoting elevation of the vascular resistance in the small circuit and increased load to the right ventricle which further leads to decompensation of the cardio-pulmonary system. The author has shown that creation of extrapulmonary arterio-venous anastomosis in major lung resections can prevent the overloading of the right ventricle in the postoperative period, makes better conditions for compensatory changes in the remaining lung tissue without developing fibrosis.
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The proposed method of common biliary duct cannulation is simple, easily performed and permits studying bile hydrodynamics biligenesis for a necessary time. Tightness of the system is completely preserved after removal a choledochostomical tube. Walls of the invaginated stump of the cystic duct are swiftly abated as a result of hydrostatic pressure and cover its gap. The presence of purse string kapron suture in a stump orifice creates an obstacle to deinvagination. Good reparation properties of serous and subserous membranes, covering the biliary duct, promote rapid closing of stoma. Effectiveness of the proposed method of common biliary duct cannulation by means of the invaginated stump of the cystic duct is confirmed by the smooth postoperative course and absence of a biliary fistula after the tube removal.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.