[Surgical treatment of bronchial asthma]. / Khirurgicheskoe lechenie bronkhial'noi astmy.

Methods of surgical treatment of bronchial asthma (BA) are classified as first generation (glomectomy, gangliectomy, vagotomy, pulmonary roots denervation), second generation (implantation of neurostimulators of sinocarotid, diaphragmal nerves, vagus, sympathic trunks), third generation (implants of programmed microchips). 7-year experience of surgical treatment with second generation methods in 125 patients with BA and experience of third generation methods use are summarized. Methods of second and third generations are most promising, permit to prevent and to cure asphyxia attack without drugs--with electrostimulation of vegetative system structures by impulse current (30-150 Hz, 0.01-0.1 ms, 0.5-2.0 V). New methods increase remission period more than 2 times, reduce drug daily requirement not less than 2 times. New methods can be used with traditional drug therapy and don't lead to dangerous for life complications. From first generation methods of BA's surgical treatment, only glomectomy and pulmonary roots denervation can be performed on serious demand.

[Hernioplasty with a dermal autograft in recurrent and postoperative hernias]. / Gernioplastika autodermal'nym loskutom pri retsidivnykh i posleoperatsionnykh gryzhakh.

Long-term results of treatment of ventral recurrent and postoperative hernias by Yanov's method from 1988 till 2000 in 160 patients aged from 19 to 65 years were studied. Depending on the type of hernia the autodermal strip, flap or their combination were used for plasty of hernial ring. Recurrence was in 6.2% patients, wound suppuration--in 4.3%. One elderly patient died of postoperative pneumonia.

[Radiofrequency electrostimulation of sympathetic nerve boundary trunk in patients with bronchial asthma]. / Radiochastotnaia élektrostimuliatsiia pogranichnogo stvola simpaticheskogo nerva u bol'nykh bronkhial'noi astmoi.

In 7 patients aged from 43 to 64 years with severe infectious allergic forms of bronchial asthma with curative aims radiofrequency electrostimulator for the boundary trunk of the sympathic nerve (BTSN) has been implanted in the neck. Daily sessions of electrostimulation (ES) by the current with parameters 1-100 Hz, 0.1-0.4 m/s, 0.1-2.0 V adjusted individually by maximal broncholytic and clinical effects were performed for 5 years. It was established that ES of BTSN can produce both bronchial dilatation and bronchial spasm. Application of ES of BTSN has resulted in a decrease of bronchial hyperreactivity, frequency of asthmatic attacks 2.6-3.2 fold in consumption of antiasthmatic drugs 2.4-2.7 fold. The only complication has been detected--rejection of the electrostimulator due to the defect of its capsule. This method can be applied as an adjuvant in therapy of severe forms of bronchial asthma resistant to drug treatment.

[Radiofrequency electrostimulation of carotid sinus nerves for the treatment of bronchial asthma]. / Radiochastotnaia électrostimuliatsiia sinokarotidnykh nervov pri lechenii bronkhial'noi astmy.

Electrostimulators of synocarotid nerves (SCN) were implanted in 30 patients aged from 18 to 62 years for the treatment of bronchial asthma. The procedures of SCN stimulation (from 1 to 10 daily) were carried out with parameters of 30-100 Hz, 0.1-0.8 ms, 0.5-2.0 V. The external respiration function was examined by pneumotachometry and spirography, and cardiovascular system by the method of rheography. The attacks of apnea were effectively eliminated and prevented by electrostimulation (ES) of SCN. The frequency of the attacks 2 and 5 years after the procedures decreased 2.8 fold, and the duration of the attacks--3.5 fold. Daily consumption of antiasthmatic drugs decreased by 2.7 times. Some complications were detected: rejection of the electrostimulator (1 patient), paresis of n. hypoglottis (1), suppuration of the wound (3), abnormal mobility of the electrostimulator (1). ES of SCN can be applied in patients with complicated forms of bronchial asthma and severe drug addiction.

[Electrostimulation of the diaphragmatic muscle in bronchial asthma patients]. / Elektrostimuliatsiia diafragmal'noi myshtsy u bol'nykh bronkhial'noi astmoi.

A study was made of the effect of transcutaneous diaphragmatic electrostimulation (2 mA, 0.3 ms, 20-30 V) on the external respiratory function in 12 asthmatic patients with respiratory insufficiency. The course comprised 7 daily sessions for 20 min. The improvement in respiratory function parameters was observed in the majority of the patients. The effect of electrostimulation was related to the quantity of the procedures.

[Indications and contraindications to glomectomy in patients with bronchial asthma]. / Pokazaniia i protivopokazaniia k gloméktomii u bolnykh bronkhialnoi astmoi.

Thirty-year experience in surgical treatment of more than 3,000 patients with severe and moderately severe bronchial asthma showed that unilateral glomectomy produces a stable positive result in 69.5% of patients in follow-up repiods of two and more decades. Clinical recovery occurred in 23.2% of patients. Immunocorrection methods, such as hemosorption, plasmapheresis, plasmacytopheresis, xenosplenoperfusion, and the use of splenoperfusate raise the efficacy of the operation to 80-90%. The indications and contraindications for glomectomy in patients with bronchial asthma and methods for immunocorrection treatment of patients after glomectomy were developed.

[Diaphragmatic electrostimulation in bronchial asthma patients]. / Elektrostimuliatsiia diafragmy u bol'nykh bronkhial'noi astmoi.

A study was made of the effect of transcutaneous diaphragmatic electrostimulation (DES) on the external respiratory function (ERF) and central hemodynamics (CH) in 36 asthmatic patients. The ERF and CH were examined by microprocessor spiroanalyzers and rheography. DES (2 mA, 0.3 ms, 20-30 v, frequency 13-17 imp/min) was performed for 7 days, 20 minutes daily. The improvement in respiratory function parameters and a positive clinical effect were achieved in the majority of patients, especially in asthmatic patients with respiratory insufficiency. The parameters of CH did not noticeably changed.

[Xenogeneic splenic perfusion in the treatment of bronchial asthma patients]. / Ksenosplenoperfuziia v lechenii bol'nykh bronkhial'noi astmoi.

Blood morphology, external respiratory function, central hemodynamics, cellular and humoral immunity, circulating immune complexes, average molecules and leucocytic index were examined in 40 patients with a severe and average severe course of infection-dependent bronchial asthma before and after xenosplenoperfusion. Positive clinical results were noted manifested in an increase of the immune reactivity, improvement of external respiratory function. The method should be used with care due to additional sensibilization of the patient and possible bronchospasm.

[Glomectomy, plasmapheresis and plasmacytapheresis in the treatment of bronchial asthma patients]. / Gloméktomiia, plazmaferez i plazmatsitoferez v lechenii bol'nykh bronkhial'noi astmoi.

Plasmapheresis was used in 9 patients and plasmacytapheresis in 27 patients with bronchial asthma. This was in 35 patients preceded by glomectomy. Inefficiency of the operation, presence of immunological changes was the basis for the apheresis procedures. No serious complications were observed. Both methods further the elimination of immune complexes. The treatment was positive in 33 of the 36 patients.

[Role of intrathoracic pressure in changes in the greater and lesser circulation hemodynamics in patients with bronchial asthma]. / Rol' vnutrigrudnogo davleniia v izmenenii gemodinamiki bol'shogo i malogo kruga krovoobrashcheniia u bol'nykh bronkhial'noi astmoi.

The greater and lesser circulation hemodynamics was examined in 59 patients with bronchial asthma and 23 controls by tetrapolar rheography, kinetocardiography, and ultrasonic Doppler cardiography. Simultaneously measurements of intrathoracic pressure (ITP) were carried out with an esophageal controller. Reduced stroke index, increased total peripheral resistance of the vessels, and elevated systolic pressure in the pulmonary artery were revealed in the patients as against the controls. ITP values in asthmatics surpassed twofold those in the reference group. To reveal elevated ITP effects on the hemodynamics, the authors have examined the hemodynamic parameters during Valsalva's test (with elevation of oral pressure up to 25-35 mm Hg) in 16 reference subjects. The results evidence the leading role of elevated ITP on the greater and lesser circulation hemodynamics in asthma. Elevated ITP lowers the venous blood flow to the heart and reduces the preload thus decreasing the blood flow to the lesser circulation and not increasing the pulmonary artery systolic pressure.

[Regional cerebral blood flow in patients with bronchial asthma]. / Issledovanie regionarnogo mozgovogo krovotoka u bol'nykh bronkhial'noi astmoi.

The regional cerebral blood flow was studied in 75 patients with bronchial asthma. The Xe133 inhalation method was used. Two groups were distinguished: with a severe course (41), average severe course (34). It was established that patients with a severe course of bronchial asthma showed a reduction of the cerebral blood flow and phenomena of respiratory acidosis with an increase of oxygen utilization by the tissues.