[Surgical treatment of congenital deformities of the thoracic wall in children].
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Biomedical subjects
Publications and source records attributed to V Micu.
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The authors stress the increased frequency in the recent years of single thoracic trauma and of thoracic trauma in the frame of polytraumatic lesions. The fact is stressed that the severity of thoracic trauma is usually determined by pathophysiological syndromes generated sometimes by minor anatomical lesions. An original classification is presented, of thoracic trauma, the present etiopathogenetic concept is discussed, as well as pathophysiologic syndromes consecutive to thoracic trauma. The major types of lesions are illustrated by clinical cases. The treatment of thoracic trauma should respect in the first place the principle of re-equilibration of vital functions that have been disturbed. Only after this has been achieved integrity of the anatomic structures of the organs involved should be attempted. Surgical indications are justified only if the anatomical lesions are the origin of a cardio-respiratory imbalance that cannot be eliminated but by surgical procedures. An original procedure is presented, that of Prof. C. Coman, which achieves immobilization of the flaps with the aid of blades, and the advantages of this system are stressed.
The authors present the experience of the Clinic for Thoracic Surgery of Bucharest, based on a total of 1206 cases of patients operated for hydatic cysts. An original classification is presented, of human hydatidosis, the indications of surgical treatment are stressed, namely the evacuation of the hydatic membrane with the peri-cystic tissue, even in cases of evacuated and suppuratec cysts--the authors objecting to the pulmonary resection in cases of hydatic cysts. The authors have performed simultaneous bilateral interventions, associated or not with phrenotomy, in bilateral and hepatic localizations. In the paper is also presented a new procedure (introduced by Prof. C. Coman) for the total extirpation of the hydatic membrane, a simple procedure which practically prevents effraction of the cyst. On the other hand the results confirm the efficiency of the procedure, very good results being obtained in 98,8% of the cases.
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On a large personal experience basis the authors discuss the present stage of surgical treatment of pleuropulmonary tuberculosis. Stress is laid on the fact that, owing to technical surgical progress and continuous improving of equipments in the thoracic surgery departments, practically there are no contraindications for surgical treatment of pleuropulmonary tuberculosis provided the functional lung and heart parameters are satisfactory. It is emphasized too the requirement of a timely indication for surgery in cases of chemotherapy failures, prior to lung and heart function impairment.
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An analysis is presented, of the experience acquired in the Clinic for Thoracic Surgery from Bucharest in the surgical treatment of thoracal empyema by the Andrews type thoracopleuroplastia. The advantages of the surgical technique are stressed, after the modifications introduced by the authors, in contrast with other surgical techniques used, such as successive-type thoracoplastia, topographical thoracoplastia, plastron removal, etc. Careful preoperative preparation is recommended, and surgical indications are indicated and the major technical and tactical principles of the intervention are described. The Clinic's experience is based on 281 interventions. Of these 206 cases were of bacillary origin and 75 were non-bacillary. The etiologic forms of these empyemas are also analyzed. In such interventions the mortality was under 1%. Recidives were noted in approximately 1% of the cases and postoperative complications were solved without raising particular difficulties. These results recommend the thoracoplastia type intervention as the choice technique in a large number of thoracic empyemas.
An analysis is presented of clinical, radiological and evolutive aspects of 106 neurogenic mediastinal tumors operated in the Clinic for Tjhoracic surgery from Bucharest. The predominance is stressed of tumours originating in the nervous sheaths (62%), and the high incidence of tumours of the nervous cells (sympatomas, ganglio-neuroblastomas) in children. An analysis is made of the various surgical aspects. and the post-operative results, mostly favourable in over 90% of the subjects that underwent surgery.
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Based on a statistic which included 700 cases of mediastinal tumours (of which 460 underwent surgery), hospitalized in the Clinic for Thoracic Surgery of the Phtysiology Institute from Bucharest, the authors stress the particularities of the surgical interventions, which were due to particularities of the surgical interventions, which were due to particularities and extension of the tumours themselves. The mortality of 2,7 percent is explained by the careful indications for surgery, and this was due to a careful preoperative diagnosis.
The authors make an analysis of the experience accumulated in the Clinic for Thoracic Surgery of Bucharest as a result of the surgical treatment of 16 patients endothoracic goiters. The authors stress the fact that these goiters should be differentiated from the "plunging goiter" variety, by their symptomatology, and by the different way of approaching their treatment. The diagnostic difficulties are stressed, especially since the uptake of iodine (radioactive iodine) can be negative in the endothoracic goiter of the functional type. The authors prefer thoracotomy, while the sternotomy is reserved only for the endothoracic goiters in the median area. The immediate results have been good in 15 cases. One patient died as a result of toxi-infectious phenomena.
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The paper points out the diagnosis of intrathoracic hemangiopericytoma in 13 patients in the "M.Nasta" Institute of Pneumophthisiology, a seldom seen disease considered quite serious because of its malignant form and its late finding out. This is due to its non-distinctive, small number of symptoms, which has a negative influence upon the disease prognosis and evolution.