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Transsternal approach is commonly used in majority of operations in heart surgery. In 0.5-5.9% of patients after median sternotomy osteomyelitis of the sternum and the ribs develops. The authors set forth their experience in surgical treatment of 182 such patients. In 97% of them total resection of the sternum was combined with simultaneous resection of costal cartilages which were involved in pyogenous inflammatory process. Costal cartilages were resected during subtotal resection of the sternum in 95% of cases and ribs--in 25%. Limited resection of the sternum was used only in patients with suppuration in the area of sutures in the sternum. Radical one-stage resection of the pyogenous site at the anterior thoracic wall was carried out in 62 patients. In 120 patients in poor condition and who previously underwent an opening of the abscess, staged surgery (2 or more operations) was performed. The authors suggest that in patients with cardio-pulmonary and hepato-renal insufficiency it is advisable to repair the defect, developed after resection of the thoracic wall, by split and perforated cutaneous flap. Muscular flap (32 patients) and greater omentum flap (30 patients) with vascular pedicles or local tissues (28 patients) were used for plastics of the thoracic wall defects. In 98 patients for the closure of the defect autodermoplasty with free split perforated cutaneous flap was used, otherwise the wound of the thoracic wall in them recovered by secondary intention type. 168 (92%) patients have recovered, 4 patients developed recurrence of osteomyelitis, 10 patients died. The authors suggest that the treatment of such serious patients should be carried out in specialized departments which have experience in thoracic, purulent and plastic surgery.

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A total of 37 patients with postoperative chronic osteomyelitis of the sternum and ribs which had developed after various operations on chest organs and 22 patients with residual pleural empyema developed after various lung operations were followed up. In patients from the both groups the first step, a thorough sanitation of infection foci, was performed; resection of diseased segments of the sternum and ribs in sternal and costal osteomyelitis and sanitation of the residual pleural cavity in residual pleural empyema. The second step was that defect of the anterior surface of the chest, which had developed after sternal and costal resection, was eliminated in the first group of patients as well as residual pleural cavity and bronchial fistula were removed in the second group. In the two groups, the following tissues were used as a plastic material: a greater omental flap (n = 27), the musculus rectus abdominis (n = 7), and musculus pectoralis major (n = 3) in Group 1, a greater omental flap (n = 8), the musculus pectoralis major (n = 9) and musculus latissimus dorsi (n = 5) in Group 2. In Group 1 a good therapeutical result was noted in 34 (91.1%) patients, a satisfactory one in 2 (6.2%). One (2.7%) patient died. It is concluded, that displacement of tissues on the fixed vascular pedicle is a valid method for eliminating tissue deficit in thoracic surgery.

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The authors described a procedure for pleurodesis with a new plasma antibacterial glue in the surgical treatment of bullous lung disease complicated with spontaneous pneumothorax. A total of 28 patients were operated on. In 17 cases the glue was used for pleurodesis. The follow-up period was up to 1.5 years. No relapses of spontaneous pneumothorax were observed. No complications due to glue use were noted. Pleurodesis was evidenced by chest sonography from the absence of visceral pleural motion against parietal one.

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The efficacy of surgical rehabilitation of patients with chronic osteomyelitis of the sternum is shown. Surgical treatment was divided in most cases into two stages: removal of the involved areas of the sternum and adjoining ribs and fixed muscular or musculocutaneous plastics. The obtained results are reassuring and promote further development of surgery of this region.

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Platelet adhesion and aggregation studies were performed in different test systems in 25 patients with plasmapheresis-treated myasthenia patients. In vivo studies with plasmapheresis and in vitro investigation with anti-immunoglobulin antisera revealed the normalization of the impaired platelet functions.

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In ten patients with generalized myasthenia in whom disease exacerbation was noted long after thymectomy the authors employed a multiple modality treatment including therapeutic plasmapheresis (TP). The treatment was monitored by examining the status of neuromuscular transmission and parameters of external respiration, as well as the levels of immunoglobulins. It has been shown that the inclusion of TP into the complex of therapeutic measures in the given category of patients makes it possible to arrest quickly and to a considerable degree the clinical manifestations of an exacerbation, to increase the reliability of neuromuscular transmission and decrease doses of anticholinesterase drugs.

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