New. methods

in Soviet

heart surgery

MOSCOW

Y and night surgeons are

keeping watch at the bedside
of eighteen-year-old’ Lena. Only
a few days ago at the clinic of
Moscow Medical Iinstitute No. 2,
Lena underwent an extremely
complex operation for a chronic
form of congenital heart-disease.
On the second day after the op-
eration the color returned to her
lips and cheeks, and the cyanosis
of the fingers common to this
disease—a sign of acute circu-
latory disorder—began to dimin-
ish.

The head of the clinic, Profes;
sor A. N. Bakulev, member of the
Academy of Medical Sciences of
the USSR, told a Pravda corres-
pondent:

“This is not the first operation
we have performed in our clinic
on patients suffering from vari-
ous forms of congenital heart-
diseases. In May last we operat-
ed. on a seventeen-year-old lad
who had been made an invalid
by such a disase. Now he is per-
fectly healthy and goes to work.

“What is the nature of this
@Gisease? We all know that the
pulsations of the heaft pump
blood enriched with oxygen to
all organs of the body. The blood
circulates in the large and the
small circuits. In the large cir-
cuit the blood is forced first into
the main-artery, the aorta, and
then distributed through the
whole body. In the small cir-

cuit the blood flows from the ,

heart via the pulmonary artery
into the lungs, where it is oxy-
genated and then returns” 0 the
heart.

’ “With the disease in question

the flow of blood from the heart.
to the lungs is seriously hinderedg “

owing to the stenosis of the ori- ©
fice of the pulmonary artery. ig
body must live on an insufficient
supply of oxygen. Hitherto no
one had succeeded in removing
this type of defect. It has now
become possible thanks to the

achievements of Soviet surgery.
‘ This operation consists in open-

ing of the heart cavities and ‘in
inserting a special thin instru-
ment with three extensible
blades, by means of which the
surgeon dissects the edges of the
contracted orifice and thus re-
moves the obstacle preventing
normal circulation.

e 3
“For many centuries the heart

remained beyond the reach of

surgeons. But even before the

_ beginning of this century Russian

surgeons had achieved consider-

able success in the surgical treat-

ment of heart injuries. They

- were the first to stitch wounds of
the heart and the large blood

vessels.

“Our country holds first place
in the world for the,number of
such operations successfully per-

_ formed. At the present time sur-

gical treatment of: heart injuries

ae performed at many hospitals

and clinics in the Soviet Union.

“However, until recently active
intervention was considered pos-

sible only in the case of heart
injuries. Diseases of this most
important -organ, even those
which were quite incurable by
therapeutic means, still remain-
ed outside the surgeon’s field of
activity.

“A few years ago a fifteen-

year-old girl came to our clinic -

suffering from severe breathless-
ness, sharp pains in the region
of the heart, and weakness... It
was a case of incurable congeni-
tal heart-disease of a frequently
encountered form: between the
two blood circuits, which under
normal conditions are isolated
from each other, there was free
communication through the so-
called ductus Botalli.. As a re-
sult,.a considerable portion of
the blood, instead of irrigating
all the tissues of the body, re-
turned immediately to the heart.

“We already had considerable
experience of operating on the
lungs and-other organs situated

in the thorax; we had also per- °

formed operations in the region
of the pericardium. After pains-
taking investigation an attempt
was made to save the patient by
surgical intervention. I dissect-
ed the ductus Botalli. The oper-
ation was extremely complicated.
There were moments when the
patient’s pulse could not be felt
and her breathing stopped. Blood
transfusion and other measures
had to be used. In the end the
operation was completed success-
fully. Normal circulation was re-
stored and now the girl is quite
well. Such operations are no
longer uncommon in practical
Sowiet surgery.

- The insects revolt against man

By DR. J. S. KENNEDY

A FRESH reminder of the truth

that the value of a scientific
discovery depends entirely on
how it is used is a report from
the ‘British Department of Scien-
tific and Industrial Research that
the first case in Britain of flies
needing larger doses of insecti-
cide has been established.

These synthetic “wonder” in-
secticides, discovered during the
war, have indeed been achieving
wonder in checking the fly men-
ace in cities. The housewife’s
remedies now contain DDT, but
the biggest job has been done
at the garbage dumps.

At just one such dump in North
London it was estimated that
there were about 25 million fly
maggots at the height of the sea-
son. From them over 100,000
flies would have come out every
day—but the insecticides killed
them off before they got away.

What this means for public
health was shown by an experi-
ment at one dump. Radioactive
phosphorus compounds are now

. their

‘culture, where, of course,

“Patients with other heart-
diseases began to apply to the
clinic. To cure these people of

serious illnesses we had to master .

the surgery of the heart. For
three years Profssor R. V. Bogos-
lovsky, Docent E. N. Mechalkin
and others have been working
together with me on the solu-
tion of this problem.

‘During this period we. have
carried out experiments on ani-
mals and studied the results of
large-scale experimental work by
many Soviet scientists. We have
paid particuar attention to the
experiments. of N. N. Terebinsky,
who has carried out dozens of
operations on the hearts of ani-
mals. In some of these experi-
ments he has resorted to tem-
porary exclusion of the heart
function, by arranging a system
of artificial blood circulation in
the animal with the help of the
method and apparatus evolved

by another experimenter—S. S.

Bryukhonenko. Mention must al-
so be made of the outstanding
experiments of N. P. Sinitsyn and
V. P. Demikhov. By homoplastic
operations they transplanted aux-
iliary hearts to dogs and other
animals and performed replace-
ment of heart and lungs. —

e.

“The important achievements
of our physicians and scientist-
experimenter, and the teaching
of I. P. Pavlov, which threw en-
tirely new light on the physiology
of circulation, have helped us
to overcome serious difficulties
in the practical performing of
intracardiac surgical operations
at the clinic.

avaliable: as a byproduct of
atomic energy research. Tiny
quantities of them can be detect-

*ed with suitable instruments. So

they put some into the food of
the maggots at the dump, and
when the flies came out they were
effectively ‘‘labelled,’ wherever
they went, by their radioactivity.

By placing traps in stores, can-
teens and hospitals, around the
depot and up to two miles away,
it was found that the flies were
travelling a mile or more a day
—and all carrying germs.

It is not surprising that the

sale of these new insecticides has
been booming. The results of
systematic use against
malaria-carrying mosquitoes, in
limited areas, has been truly
spectacular. Both the mosquitoes
and the malaria were virtually
wiped out. In agriculture it has
been much the same story.

But there is another side to
this story.

The first shocks came in 1 agri-
all
kinds of insects abound and most
do no harm, acting as checks on

“The opening of the heart cav-
ities is liable to be accompanied
by heavy “haemorrhage. In these
operations we have to transplant
blood vessels and introduce into
the body pieces of extraneous
blood vessels. The method of
long-term blood-vessel conserva-
tion evolved by Soviet physicians
have given surgeons the material
for such transplantations. .Syn-
thetic preparations made by our
chemists have enabled us to com-
bat the danger of post-operative
thrombosis (blood coagulation).

.
The methods of intra-arterial

blood transfusion and artificial
respiration evolved by V. A.
Negovsky have. proved indispens-
able in the surgery of the heart
and major vessels.

“One of the serious difficulties
confronting us in our work was
that we could not always diag-
nose the type of disease from
which the patient was suffering.
We adopted new methods enabl-
ing us to determine the character
of the heart vitium. A _ special

“ opaque solution makes it possible

to obtain precise roentgenograms,
when introduced into the cavi-
ties of the heart.

each other. It is only the odd
one or two that are able to break
out of this ‘‘natural control” and
multiply up to harmful numbers.
It is only against them that in-
secticides are needed, as a ‘‘cure”
when prevention has failed.

But here, as elsewhere, pre-
vention is neglected in the com-
petitive producers’ drive for im-
mediate profitable cures, and
now the chickens are coming
home to roost. °

_When DDT was first used ina
big way against, for example,
caterpillars in orchards and cot-

‘ton fields, the immediate success

was dramatic. But very soon
new pests appeared.

The DDT itself produced them
because it also killed man’s~in-
sect friends, the parasitic wasps
that destroy aphids and the pre-
datory bugs that attack spider
mites. The aphids and mites be-
came pests as they had never
been before.

Then came another kind of
shock, not due this time to ‘“up-
setting the balance of nature,”
but to the direct development of
resistance to the poison by the
pests it was being used against.

PACIFIC TRIBUNE — SEPTEMBER 25, 1953 a

é

car

“Two years ago we began
rying out operations on 2 plan
ned basis. In this time 4 "cot
siderable number of operations
have been performed on chil
and adolescents ~suffering "s
congenital heart-diseases.
most cases the patient’s ci
tion was disturbed as a res
the senosis of the pulmon
artery.

“Successful operations a
also been performed in caseS-
acquired heart- disease

“Fruitful work is peing cat
ried out on heart surgery by
Professors B. V. Petrovsky,, #
Uglov, N. V. Antelava, P._
Kuprianov and other Soviet §
tists. The results hitherto 2°”
ieved go to show that bike
within sight or surgical ;
vention through the blood ey
sels and the myocardium, i
through obstacles the surmount
ing of which marks a whole ep? ;
in surgical progress. Ther?
every ground to hope that
united efforts of scjentists :
practical surgeons will aiff?
rapid development in this ‘ *
cult branch of Soviet medic#™

otis

it started in the fast pre eal
houseflies, first in Italy @
dinavia, and then in cout a ie
country wherever intens!¥
spraying was done.

mo

It was only what you t do
have expected. Constant, ve
with poison put a premll
flies capable of building a the
sistance to that poison, arvivors :
dose needed to kill the § it bee
rose to 100 times wha
been. It was to be expect 1.
practical experience as W

the
Repeated fumigation ras
old-established poison, citrus &%
cyanide, in Californiad “scale
chards against the “
had already made them
ant.”

The vastly increased.
new, cheap synthetic i
since the war has ma
problem out of all pro
After -the flies ie a
before reports bega
of other Putts an to
sistance. - Body-lice in
Egypt, cabbage caterP
Java, cockroaches in.
the list keeps on le
most disturbing
toes proved no exce