KostyaYury P. Surgical treatment of myasthenia: improvement and estimation of efficiency (clinical examination).

Object of the study: Generalized form of myasthenia. Purpose of the study: To improve the results of surgical treatment of myasthenia by means of development of complex methods of treatment. To determine the indications and criteria for surgical treatment of myasthenia patients, to evaluate com-pensation of myasthenia process. Methods of the investigation: General clinical, biochemical, elec-trophysiological, functional, general immunological, ultrastruc-ture-morphometric, ultrasound study, computed tomography, pneumomediastonography of the anterior mediastinum. Theoretical and practical results: The sytem of specialized sur-gical aid to patients with myasthenia as well as that of prevention of death and pathogenetic treatment was improved. Two-stage technique was substantiated: stage 1 - thymectomy, stage 2 - im-plantation of fetal thymus as a means of substitution correction. Special technique for evaluation of the disease severity was intro-duced with the purpose of clinical standardization of severity evaluation. It was proven that thymectomy followed by fetal thy-mus implantation should take into consideration clinical hystere-sis: compensation and variants of immune state, which requires individualized approach to selection of the surgical tactics. When performing thymectomy and fetal thymus implantation it is neces-sary to use a substantiated complex of parameters of the functional state of the respiratory system, which determines the level of functional compensation of the respiratory impairments and con-siders various intensity of basic metabolism and energy loss, which are higher than the reference values in a mild course and are reduced in a severe diseases. To determine the efficacy of sur-gical treatment, classification of variants of clinical functional compensation in patients with myasthenia considering the fullness and stability of restoration of the functional impairments in late post-surgery period (complete, partial stable, partial unstable) was substantiated. A clinical scheme for evaluation of surgery efficacy in myasthenia was suggested with the account of compensation ef-fects forming at performing TE and FTI. Novelty: The methods to prevent myasthenic crises ("Method of myasthenic crises prevention" Patent № 58284 А) were sug-gested. A complex approach to investigation of myasthenia sever-ity as a ground for effective use of surgery with profound study of clinical-functional state of the patients before thymectomy, at long terms after thymectomy and after fetal thymus implantation was realized ("Method of evaluation of myasthenia severity" Patent № 69155 А). Systemic study of clinical signs of myasthenia severity with de-termining absolute and relative indications to thymectomy on the basis of multifactor clinical syndrome evaluation with the account of specific and general pathological criteria was done. Using the data of retrospective-prospective analysis, death rate and the fac-tors influencing surgical activity in myasthenia patients was stud-ied. Systemic analysis allowed revealing quantitative correlations of ultrastructure-organometric values of the thymus depending on myasthenia severity. Deep study of the respiratory system function in patients with different degree of myasthenia severity before and after surgery allowed studying the efficacy of thymectomy and fetal thymus implantation. The analysis of integral values of basal metabolism allowed studying the clinical signs of myasthenia se-verity, which are explained by compensation energy loss; the sys-tem for evaluation of clinical functional compensation of myas-thenia under the influence of surgery and in complex approach was substantiated. Degree of introduction: The findings of the research were intro-duced into the work of surgery departments of Kharkiv Clinical Hospital for Urgent medical Aid, hospital of Institute for Medical Radiology. They are used in training process at Surgery Depart-ment of Kharkiv State Medical University. Two innovations were prepared basing on the findings of the research. Sphere of application: medicine, surgery.