Thymectomy for myasthenia gravis: prognostic factors in 70 patients

Thymectomy has become increasingly accepted as an efficacious procedure for myasthenia gravis, with high rates of complete clinical remission. Predictors of the response to thymectomy for myasthenia gravis vary in the literature. We retrospectively reviewed the clinical records of 70 patients (63% female; mean age, 38 years) diagnosed with myasthenia gravis from August 1993 to August 2004, to determine the factors predicting outcome. Complications occurred in 20%, but there was no hospital mortality. Complete clinical remission was obtained postoperatively in 47%. Our results indicate that patients with less than 1 year's duration of disease have a better prognosis, and Osserman stages I, IIa, and IIb are also associated with higher clinical remission rates. Female patients have a better prognosis than males, and the younger the patient the better the outcome. Thymectomy is indicated for myasthenia gravis as early as possible in the course of the disease.     

Postoperative respiratory care after transsternal thymectomy in myasthenia gravis. A 3-year experience in 53 patients

During a three-year period, 53 patients with myasthenia gravis underwent transsternal thymectomy by a partial sternum-splitting technique at our institution. This procedure was carried out (1) because an x-ray film or a computed tomography scan had suggested the presence of a thymoma or (2) to manage symptoms of myasthenia gravis. In 41 patients the endotracheal tube was removed in the post-anesthesia recovery room. The remaining 12 patients were extubated in the Respiratory Care Unit--in five, after prolonged mechanical ventilation. From our experience, the only factor useful for predicting the probable need for prolonged postoperative mechanical ventilation is the degree of bulbar involvement. Patients in Osserman classification groups 3 and 4 have an extremely high incidence of postoperative respiratory failure. Consideration should be given to the use of preoperative plasmapheresis in myasthenia gravis patients who have significant bulbar symptoms.     

Thymectomy in the treatment of myasthenia

Thymectomy has been performed in 69 patients, 58 females and 11 males, age range 14 to 70 years, with a maximum in females between 20 to 30 years. Twenty-seven percent of the patients were older than 40 years. Considerable improvement resulting from remission and partial remission occurred in 89% of females and in about 50% of males, the figure for thymomatous myasthenia was about 65% in the first year after thymectomy. In the following years, improvements increased partially and the number of remissions rose as well. By chance the duration of the disease was longer than 6 years in 20% of our patients and in these a benefit from thymectomy was also found. There were 7 early deaths and 4 late deaths. Thymectomy cannot be called a cure but is an essential part of the whole treatment procedure of myasthenia comprising the administration of anticholinesterase and especially immunosuppressive agents. It was found difficult to estimate the effect of any single measure in this retrospective study by the major benefit of thymectomy is seen in initiating remissions or at least considerable improvements. Indication for operation is thought to be present in progressive myasthenia, acute or chronic, and thymoma, provided that the patient has reached an optimal condition preoperatively by adequate anticholinesterase adjustment, neurophysiological control and immunosuppressive treatment. Thymectomy is not an emergency operation and should be carefully planned. Since relapses after thymectomy are not rare, a careful neurological long-term follow-up appears obligatory.     

Video-assisted thoracoscopic thymectomy for myasthenia gravis

Background: Thymectomy is an effective, but radical therapy for myasthenia. Video‐assisted thoracic surgery (VATS) may allow a minimally invasive altern­ative to the standard sternotomy approach. Aims: To audit prospectively the outcome of VATS thymectomy for myasthenia gravis in a unit specializing in advanced VATS techniques. Methods: Twenty‐six patients underwent VATS thymectomy between 1997 and 2001. Most underwent preoperative plasma exchange therapy. Seventeen women and nine men with a median age of 36 years (range 17?71 years) had a right‐sided VATS approach to remove all anterior mediastinal fat and thymic tissue. Results: There was no perioperative mortality and all procedures were concluded successfully, with one patient requiring sternotomy. Twenty‐five patients were extubated in theatre and one patient required 17 h of assisted ventilation . The other significant complication was a diathermy injury to the phrenic nerve, which recovered. Median postoperative stay was 4 days (range 2?6 days), with median postoper­ative chest drainage for 2 days (range 1?3 days). Three patients had progression of disease postoperatively. The remainder were asymptomatic (7), improved (14) or stable (2). Conclusion: In a dedicated unit with neurological and intensive care support, VATS thymectomy is a safe, effective method of obtaining remission or improvement in myasthenia gravis (MG). While achieving the same surgical goal, this approach offers advantages of improved cosmesis, shorter recovery time and minimal chest wall disruption over the gold standard of sternotomy. Better patient acceptance of this minimally invasive technique may result in wider application of the benefits of thymectomy in MG. (Intern Med J 2002; 32: 367?371)     

重症肌无力的研究现状

重症肌无力(myasthenia gravis,MG)是一种由自身抗体介导的、细胞免疫依赖性、补体参与的自身免疫性疾病,它的发病可能与整个神经肌肉接头处信息传递障碍有关.MG确切的发病机制至今仍不完全清楚,它可能是一种由多基因调控、多种机制参与的复杂性疾病[1-2].近年来,随着自身免疫反应分子基础的确立、分子遗传学研究的不断深入,MG的发病机制及其治疗取得了一些进展,本文对此作一综述.     

Pericarditis in myasthenia gravis

Myasthenia gravis is an autoimmune disorder with antibodies to the acetylcholine receptors (Ach R) in skeletal muscles. Myocardial involvement can present as a myocarditis or with arrhythmias. To our knowledge, there is no documentation in the literature of pericardial involvement in myasthenia gravis. We report the presence of pericardial effusion and atrioventricular conduction block in a patient with myasthenia gravis that responded appropriately to immunosuppressive therapy and plasma exchanges.