Operations On The Nervous System

Abbott et al. were the first investigators to propose denervation of the lung as a treatment for emphysema (22). Such operations were undertaken in an attempt to decrease bronchospasm and secretions, as well as to improve pulmonary circulation. Abbot's technique included pulmonary plexectomy, pulmonary artery periarterial sympathectomy, upper dorsal sympathectomy and partial lung resection. Brantigan and Mueller likewise added a complex denervation procedure to their partial lung resection (7-9). This procedure included complete removal of the posterior pulmonary plexuses by ligation of all branches of the vagus nerve to the heart, lung, and mediastinum, as well as an extensive perivenous and peribronchial stripping of symppathetic nerve fibers (see Fig. 2). The numerous different techniques and the lack of adequate control groups made it difficult to interpret the results of these operations and appropriate patient selection criteria were never identified.

Nonetheless, these lung denervation operations were soon followed by nearly 4000 cases in Japan of glomectomy for the treatment of asthma and emphysema (23). A subsequent report by Overholt included more than 800 cases (24). The rationale for carotid body resection was to abolish both the hypoxic respiratory drive and bronchospasm associated with asthma and some forms of COPD. Of interest, nearly two-thirds of patients in both series noted subjective improvement from this procedure even though there is no physiologic basis for its effect. It was not until several randomized, double-blind studies were performed in which patients were subjected to either glomectomy or a sham operation that this procedure was proved worthless.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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