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PubMed2006

[Thymectomy for autoimmune myasthenia gravis].

Thymectomy has been performed as surgical treatment for autoimmune myasthenia gravis (MG) since the mid-1900s. Although it has been performed for more than half a century, there has been no report objectively confirming the validity of this treatment. Many groups have reported that surgery is effective in treating patients with MG, but the indications and type of surgery differ in each case. In addition, there has been no comparative trial of the results of surgery and natural progression of the disease. To resolve this situation, it would be desirable to standardize the indications for surgery in MG patients and to establish the surgical approach, as is being attempted by the Myasthenia Gravis Foundation of America although the results have not yet been announced. With recent advances in video-assisted surgery, the number of institutions in which thoracoscopic surgery is performed has increased. However, it appears that improvement in MG symptoms is dependent on the extent of resection in thymectomy. With the cervical or thorascopic approach, the extent of resection appears to be less than that using the transsternal or cervical plus transsternal approach. Before establishing a standard surgical approach, the validity of thymectomy for the treatment of MG should be confirmed in a randomized, controlled trial.

Autoimmune Diseases↗
PubMed2006

[Long-term effects of video-assisted thoracoscopic thymectomy for myasthenia gravis: 5-year follow-up of 18 cases].

OBJECTIVE: To evaluate the long-term effects of video-assisted thoracoscopic thymectomy for myasthenia gravis (MG). METHODS: Eighteen MG patients, 7 males and 11 females, aged 33.4 +/- 9.4 (19 - 48), underwent video-assisted thoracoscopic thymectomy by the same surgical group from November 2001 to May 2005. Right side access was used in 14 of them, left side approach was used in 2, and bilateral approach in 1 of them. The thymus and fatty tissue in the front mediastinum were resected. The medical records were reviewed and telephone survey was conducted to understand the effects. The mean follow-up time was 26.4 +/- 10.9 months. RESULTS: VATS was successfully conducted except in 1 case. The bleeding volume was less than 50 ml. The average chest tube drainage time was 2.1 +/- 1.2 days, and the mean hospitalization day was 6.3 +/- 3.1 days. Three of the 18 patients needed temporary mechanical ventilation less than 72 hours, and 2 needed reintubation due to either myasthenic or cholinergic crises. Nine of the 18 patients achieved complete relief (50%) and 6 of them (33.3%) had their symptoms greatly improved, and the symptoms of one case remained stable (5.6%), and the overall effective rate was 83.3%. CONCLUSION: Video-assisted thoracoscopic thymectomy is a safe and effective method for treatment of myasthenia gravis with satisfactory long-term outcomes.

Adult↗
PubMed2006

[Case report of simultaneous coronary artery bypass grafting with cardiopulmonary bypass and total thymectomy in patient with myasthenia gravis].

In this article we want to describe the successful simultaneous operation of coronary artery bypass grafting with cardiopulmonary bypass and thymectomy in patient with ischemic heart disease and myasthenia gravis. Myasthenia gravis complicates the course of anesthesia and operation, because of the inadequate restoration of muscle function, especially of respiratory and swallowing muscles, inducing the prolonged mechanical ventilation, gastrooesophageal reflux and pulmonary infection. There are lot of different techniques of the anesthesia during myasthenia gravis - no use of any myorelaxantes, restriction of opioids, use an inhalation anaesthetics and propofol, and continuous monitoring of neuromuscular junction function. Till now it is discussable question of necessity and the time of thymectomy. This case from clinical practice shows, that the correct choice of tactics of pre- and postoperative treatment makes simultaneous coronary artery bypass grafting with cardiopulmonary bypass and thymectomy possible.

Anesthesia, General↗
PubMed1991

Thymectomy in ulcerative colitis: a report of cases over a 13 year period.

Seventy eight patients with ulcerative colitis were treated by thymectomy combined with conventional therapy. An interim analysis was made after a median follow-up of 40 months in the thymectomized group and after 25 months in 173 from a non-thymectomized group. The percentage of remission periods in the thymectomized group was significantly higher than that in the non-thymectomized group as estimated by the "patient-month" method. Histological examination of the excised thymus revealed hyperplasia of the thymic epithelial cells and/or the formation of lymphoid follicles. Anticolon antibody activity of the serum from the thymectomized patients decreased gradually and disappeared in 5 years or more. "Thymectomy via the suprasternal notch with parasternal incision" which was applied in this study, is simple and not invasive. Therefore, it is recommended that thymectomy should be considered as one of the treatment for patients who are resistant to conventional therapy.

Adolescent↗
PubMed1991

[Surgical treatment of myasthenia gravis in children using transsternal thymectomy].

Myasthenia gravis is an inmunological disease infrecuent during childhood. In recent years, thymectomy has gained increasing acceptance as the most effective treatment for acheiving sustained improvement in patients affected of myasthenia gravis. We report our experience in five children treated by trassternal radical thymectomy in the last five years. This patients were clinically staged following Osserman's classification as stage IIB (three cases) and stage III (two cases). All of them are in complete remission after a mean postoperative period of thirty three months. We add a review of the literature comparing the differents surgical approaches for thymectomy and its results in children.

Adolescent↗
PubMed1990

[Pleuropneumonectomy with thymectomy for invasive thymoma with pleural disseminations--a case report].

A case of invasive thymoma with pleural disseminations, treated with pleuropneumonectomy and thymectomy , is presented. A 30-year-old woman was admitted with abnormal shadows in left lung field and mediastinum. On chest CT examination, the tumor shadows were located anterior mediastinum and left chest wall. Thymoma with pleural disseminations was the most likely consideration by the needle biopsy specimen of the tumor under left chest wall. Preoperative radiotherapy for anterior mediastinum mass was effective. Pleuropneumonectomy and thymectomy combined with partial resections of intercostal muscles and diaphragm were performed. Histologically, the tumor was arranged in lobular structure, composed of epithelial cells, with poorly infiltration of lymphocytes, and invaded into intercostal muscles or lung. Postoperative radiotherapy for mediastinum and left chest wall was added. Tumors may be removed completely by pan-pleuropneumonectomy and thymectomy for invasive thymoma with pleural disseminations.

Adult↗
PubMed1990

Combined cervicothoracic approach in thymectomy for myasthenia gravis.

Thymectomy was performed for myasthenia gravis on 30 patients, using a new approach with a collar incision which gave full exposure of the retrothyroid space and was directly connected to a median sternotomy. The thymus was removed en bloc without pleural incision. There was no perioperative mortality and the only complications were transient respiratory insufficiency in two cases. The postoperative hospital stay was 3-9 (mean 5.8) days. The effect of thymectomy was evaluated after 2-8 years at the Department of Neurology, when changes in symptoms (stages I-IV) or medication (need for cholinesterase inhibitors) were registered. The total clinical improvement rate was 97%, with 3% of the patients improved three stages, 33% two stages and 60% one stage compared with the preoperative classification. Twenty patients (67%) were asymptomatic at follow-up and six (20%) also required no medication. The medication need was reduced in 70% of cases (mean reduction 42%). Our cervicothoracic approach resulted in the same rate of improvement as in studies using more extensive transsternal procedures, but the morbidity was lower, with no complications requiring prolonged hospital stay. The morbidity was also less than after only transcervical procedures aiming to perform total thymectomy--a prerequisite for maximal and lasting benefit from surgery. Moreover, as this cervicothoracic approach is simple and safe, it can be recommended as an option in the surgical management of myasthenia gravis.

Adolescent↗
PubMed1989

[The value of thymectomy in myasthenia gravis].

In the management of Myastenia gravis thymectomy has gained an important position. Still in discussion is whether a transsternal approach gives a superior result to a collar approach. Between 1970 and 1986 35 patients with Myasthenia gravis underwent thymectomy, in 12 by a collar approach, in 19 by sternotomy and 4 by thoracotomy. Results were equivalent independent of the approach but only after transsternal incision complications occurred in 3 patients. At 6 months after operation 18 of 35 patients were classified in a lower category following Ossermann's classification, an other 12 were stable and in 5 the information unobtainable. At the end of follow-up between 1 and 17 years, 19 out of 29 were improved; 4 unchanged and 5 demonstrated progressive disease, 1 patient died due to the disease. Almost 70% of patients judged the operation as helpful. We conclude that the collar approach is safe and effective in patient without thymoma and that in our department thymectomy has an important place in the treatment of Myasthenia gravis.

Adolescent↗
PubMed1989

[The result of extended thymectomy in patients with myasthenia gravis of pure ocular type].

We studied postoperative status of 14 patients with myasthenia gravis of ocular type who underwent extended thymectomy. Nine patients were in remission, three improved, and two unchanged. No patient became worse and died. The remission rates at one, three, five, and ten years after operation were 50.0%, 58.3%, 60.0%, and 80.0%. The palliation rates at one, three, five, and ten years after operation were 64.3%, 75.0%, 80.0%, and 100%. The remission rate at one year after operation in patients of ocular type was significantly (p less than 0.05) higher than that in generalized type (191 patients). The mean preoperative duration of symptoms in patients who obtained remission after surgery was 7.2 +/- 6.5 months, while mean duration was 85.6 +/- 45.8 months in those patients who could not obtain remission, indicating a significant difference (p less than 0.05) of duration of symptoms between two groups. Among 89 patients with generalized as well as ocular symptoms before extended thymectomy, 62 patients (69.7%) still complained of ocular symptoms and 48 patients (53.9%) had generalized symptoms with or without ocular symptoms in 1 to 12 years after operation. This result shows that ocular symptoms do not disappear more easily than generalized ones. We conclude that extended thymectomy should be performed even in patients with myasthenia gravis of pure ocular type.

Adult↗
PubMed1979

The effect of neonatal thymectomy on the level of salivary and serum immunoglobulins in rats.

The effect of neonatal thymectomy on the level of salivary and serum immunoglobulins was studied in conventional rats. Salivary SIgA levels were significantly decreased from weaning (day 20) through the termination of the experiment, while salivary IgG levels were generally unaffected by neonatal thymectomy. Serum IgA was detected at a later interval after birth in samples from thymectomized rats than from normal and sham-thymectomized rats and the levels of serum IgA in the thymectomized rats remained 4-5 times lower throughout the 115 day experimental period. Serum IgG was decreased by approximately 40% from days 28 through 115 after birth in the thymectomized animals, while serum IgM was apparently unaffected by the neonatal thymectomy. These findings indicate that the synthesis of salivary SIgA is markedly influenced by the presence of thymus-derived cells and it is suggested that these cells may control and/or modify immune responses in oral secretions.

Animals↗
PubMed1979

The immunological effects of thymectomy in myasthenia gravis.

Thymus-derived (T) lymphocytes in the peripheral blood and cellular immune function have been studied in ten patients with myasthenia gravis and in fifteen different myasthenic patients more than 10 years after thymectomy. The results were compared with those of a normal control population. The non-thymectomized myasthenic patients had normal T lymphocyte concentrations measured by rosetting with native sheep red cells. These patients also showed normal sensitization and recall of delayed hypersensitivity, phytohaemagglutinin (PHA) induced lymphocyte transformation and antibody-assisted (K cell) cytotoxicity; however, PHA-induced cytotoxicity was markedly reduced (P less than 0.001). The thymectomized group exhibited a lower mean percentage and absolute number of E-rosette-forming cells, which returned toward normal after in vitro treatment with thymosin. PHA-induced lymphocyte cytotoxicity, however, was normal in the patients who had undergone thymectomy, as were lymphocyte transformation, antibody-assisted cytotoxicity and sensitization to dinitrochlorobenzene (DNCB); there was a decrease in recall of established delayed hypersensitivity. Adult thymectomy in man, therefore, produces a partial and dissociated decrease in T cell responses and it is unlikely that the beneficial effect of this operation in myasthenia gravis is related to immunosuppression.

Adolescent↗
PubMed1987

[Thymectomy in Chinese myasthenia gravis].

From 1972 to 1986, 80 Chinese myasthenia gravis patients with thymectomy were studied. There were 25 males, aged from 21 to 70 years old (mean age 44) and 55 females aged from 12 to 56 years old (mean age 34). According to Osserman's criteria 10 patients belonged to grade I, 28 to IIa, 31 to IIb, 4 to III, 2 to IV and 5 to V. The postoperative follow ups ranged from 1 month to 13 years. The thymic pathology showed: hyperplasia in 44 cases, atrophy in 17 cases and presence of thymoma in 19 cases. The postoperative improvement occurred in 50% in thymomatous patients, 81% in non-thymomatous patients. There was no relationship between the duration of illness before operation and the postoperative status. However the patients with age onset after 40 had higher incidence of thymoma, and a higher rate of death from myasthenia gravis despite short duration of illness before surgery. All of 18 patients in whom serum was examined, the antiacetylcholine receptor antibody was detectable. The mean titres of this antibody in 8 hyperplasia patients, 3 atrophy patients and 7 thymoma patients were all higher than the mean value of 67 myasthenia gravis patients who did not received any treatment except anticholinesterase. Seven cases had postthymectomy followups of the antibody titres, 3 cases showed decreased antibody titre after thymectomy. Ten ocular myasthenic patients received thymectomy, 3 had thymoma, 5 had hyperplasia and 2 had atrophic thymus. The improvement rate in this group was around 71%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Adult and pre-adult thymectomy of mice: contrasting effects on immune responsiveness, and on numbers of mitogen-responsive and Thy-1+ lymphocytes.

Peripheral lymphoid tissues of mice which have been thymectomized at 2 or 4 weeks of age, that is, before they achieve adult body weight, have been shown to be lacking in cells responsive to the T-cell mitogen, phytohaemagglutinin, when the animals became adult, and these mice have also been shown to have a deficient immune response against sheep erythrocytes. It is suggested these effects of pre-adult thymectomy are consequent upon removal of the prime source of T cells prior to the animal having acquired complete T-cell populations of the adult. Spleens and lymph nodes of mice thymectomized at 8 weeks of age were found to have reduced numbers of cells susceptible to the cytotoxic effects of anti-Thy-1 serum as early as 4 weeks after the operation, whereas the number of lymphocytes responsive to T-cell mitogens in these lymphoid tissues was not reduced at this time. The number of spleen-borne antibody-producing cells in a primary or secondary response was not affected by 8-week thymectomy, either when the response was tested in the operated animal, or after transfer of cells from such an animal to an irradiated recipient. The results are discussed with respect to other work on the effects of thymectomy of mice during the post-neonatal and pre-adult period.

Age Factors↗
PubMedDate not supplied

[Syndrome of amyotrophic lateral sclerosis after thymectomy performed for myasthenic syndrome].

A case of amyotrophic lateral sclerosis was observed developing three months after thymectomy in a woman aged 52 years. The patient had been referred for thymectomy because of myasthenic signs increasing in intensity since 2 years. Myasthenia was confirmed by electrophysiological investigations, and the diagnosis was: myasthenic syndrome and suspected thymoma. During nearly 5 years of follow-up the following observations were made: there was a correlation between thymectomy and the development of ALS syndrome, thymosine administration produced clinical improvement, thymosine administration improved the function of thymus-dependent lymphocytes, thymosine withdrawal (due to non-availability) produced exacerbation of symptoms.

Amyotrophic Lateral Sclerosis↗
PubMed1985

[Clinical examination of thymic abnormalities and thymectomy in patients with ulcerative colitis].

Results and significance of thymectomy in 66 patients with ulcerative colitis were studied. The thymus delineated by means of pneumomediastinography was almost always successfully removed by our procedure of thymectomy via the transverse incision in the suprasternal notch, frequently combined with dissection by the mediastinoscope through the parasternal incision. Sixty-six thymectomized patients with ulcerative colitis consisted of 29 females and 37 males, ranging in age from 13 to 62 years. In the resected thymuses, lymphoid follicle formations, which are often encountered in high incidence in the thymus obtained from other autoimmune diseases, were found in over 40% of cases. Follow-up observations, ranging from 1 year to 12 years after thymectomy, revealed 84% inactive condition (counted by patient month) compared with that of these same patients before operation.

Adolescent↗
PubMed1985

Thymectomy for myasthenia gravis.

The results of 14 years' experience in the surgical treatment of myasthenia gravis are reported. Twenty-one patients (14 female, 7 male) underwent thymectomy for myasthenia gravis between 1971 and 1984. The mean age of the patients was 33 years (range 14 - 57 years). The median duration of symptoms prior to surgery was 18 months (range 5 months to 35 years). The mean follow-up was 5.3 years. There were no post-operative deaths: 76% obtained benefit from thymectomy. The patients' age, sex, duration of symptoms and histology of the thymus gland did not correlate with the result of treatment. This series suggests that, while thymectomy is often beneficial in the treatment of myasthenia gravis, there are no accurate predictors of the outcome following surgery.

Adolescent↗
PubMed1979

The influence of sialoadenectomy, thymectomy and starvation on liver glycogen in the rat.

Hepatic glycogen was assayed in young and adult rats subjected to sialoadenectomy and/or thymectomy and starvation. Sialoadenectomy in young, but not in adult rats caused the rats to stop feeding. In young, but not in adult sialoadenectomized and starved rats the glycogen level was notably higher than in unoperated and starved rats, indicating active participation of salivary glucagon in immature animals in hepatic glycogenolysis under conditions of starvation. Simultaneous sialoadenectomy and thymectomy caused glycogen depletion in the liver of young rats in spite of the absence of the salivary glands. Acceleration of glycogenolysis in these rats was not due to thymectomy, being probably a result of excessive secretion of adrenal catecholamines.

Animals↗
PubMed1982

[Evaluation of treatment of myasthenia with thymectomy (author's transl)].

The paper describes the effectiveness of treatment of myasthenia with thymectomy in 136 patients operated on, observed in hospital and 107 examined by questionnaire on late results after 10 years. Exclusive of myasthenia with thymoma, cures were obtained in 26.4%, marked improvement in 19.6%, moderate improvement in 21.4%, improved motor strength in 27.1%, and deterioration was observed in 3.8%. The assessment was based mainly on the amount of cholinergic drugs taken. Early mortality rate was 2,4%, and late mortality 1,9%. Relation of postoperative complications/respiratory and crisis of both kinds to mortality and intraoperative pleural injury also surgical approach and anatomic variants of the thymus were discussed. An influence of the number of proliferating centers on prognosis in myasthenia after thymectomy was nor demonstrated. Thymectomy in a generally accepted and most effective method of treatment in myasthenia.

Adolescent↗