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PubMed1978

High-dose steroids for perioperative management of patients with myasthenia gravis undergoing thymectomy. A preliminary report.

To eliminate the morbidity associated with thymectomy, we used high-dose corticosteroids perioperatively in 32 patients who had Class II and III myasthenia gravis. All patients were extubated within 2 hours after the operation, and none required respiratory support postoperatively. The average stay in the intensive care unit was 20 hours and the average hospital stay, 6 days. Addition of high-dose corticosteroids to the perioperative managment of patients with myasthenia gravis undergoing thymectomy improved the immediate operative results and eliminated the morbidity associated with this procedure.

Adolescent↗
PubMed1984

Anaesthesia for transcervical thymectomy in myasthenia gravis.

A modified technique of total intravenous anaesthesia was used in the management of 22 patients with myasthenia gravis of varying severity undergoing therapeutic transcervical thymectomy. The relatively short-acting intravenous hypnotics, Althesin and etomidate were compared for induction of anaesthesia and for maintenance as a supplement to 50% nitrous oxide in oxygen. Moderately high doses (20 or 25 micrograms/kg) of the potent, synthetic opiate, fentanyl provided analgesia and a level of respiratory depression sufficient to facilitate control of respiration. The induction of anaesthesia was rapid and smooth, completed in under 5 minutes. Reflex response to surgical stimulation was suppressed for extremely variable periods. Complete recovery of consiousness, or adequate spontaneous respiration and of muscle tone was readily achieved, but was more rapid after Althesin (p less than 0.05). Postoperative problems were few. It is suggested that this technique of anaesthesia can provide optimum operating conditions with rapid, complete recovery and consequently low morbidity; the primary requirements of anaesthesia for therapeutic thymectomy.

Adult↗
PubMed1983

Evidence for thymic regulation of autoimmunity in BXSB mice: acceleration of disease by neonatal thymectomy.

BXSB mice spontaneously develop an autoimmune syndrome characterized by autoantibody production, immune complex renal disease, and lymphadenopathy containing B cells. The male BSXB mouse has a rapid onset of disease that is determined by defective stem cells. Although the B cell hyperactivity has been traced to the stem cell, previous studies did not evaluate the T cells of BXSB mice with regard to a role in modifying their natural history. The present study was carried out in an attempt to determine whether or not thymic regulation played a role in modulating the stem-B cell abnormalities in BXSB mice. It was found that neonatal thymectomy led to a marked increase in autoantibody production (anti-RBC, anti-DNA), a dramatic increase in lymphadenopathy, and worsening of renal disease. Flow cytometric analysis of the lymph node cells from intact and thymectomized mice demonstrated a loss of Lyt-2+ cells from the thymectomized mice and an increased proportion of Ly-1+, Thy-1.2- cells. These results indicate that although the B cell hyperactivity of BXSB mice is determined by a marrow stem cell defect, thymic regulation normally serves to dampen that B cell hyperactivity; neonatal thymectomy reduces the thymic regulation of autoimmunity in the BXSB males and leads to excessive B cell numbers and function.

Animals↗
PubMed1983

[Effect of thymectomy and syngeneic thymocytes on colony formation by hematopoietic precursor cells in the peritoneal cavity].

The influence of the T-system of immunity on the processes of the proliferation and differentiation of hemopoietic precursor cells outside the organs of the hemopoietic and lymphoid systems has been studied. Thymocytes have been found to regulate the formation of hemopoietic foci in the peritoneal cavity. The effects of the stimulation and suppression of colony formation, as well as the degree of their manifestation, depend on the initial level of the colonies. The thymectomy of the recipients or donors of hemopoietic cells leads to the increase of colony formation. Syngeneic thymocytes abolish the effect of thymectomy.

Animals↗
PubMed1983

Effect of intrauterine thymectomy on granulation tissue formation. An experimental study.

Intrauterine thymectomy was successfully performed on 9 guinea pig foetuses at the gestational age of 36-48 days. This resulted in a significant suppression of the phytohemagglutinin (PHA) response of the whole blood lymphocytes at the age of 3 mth. The in utero-thymectomized guinea pigs and their littermate non-thymectomized controls were operated on by making 4 symmetrical dorsal skin incisions and by subcutaneously implanting 8 standardized pieces of viscose cellulose sponge. On the 1st, 3rd, 5th and 10th days the tensile strength of the wounds was determined and the implants were analysed histologically and enzymehistochemically. At the time of incipient fibroplasia on the 5th post-operative day, the tensile strength of the wounds, the number of fibroblasts and the activities of aminopeptidase and succinate dehydrogenase were clearly less in the guinea pigs which had been thymectomized in utero. These findings indicate that adequate thymic function was necessary for normal fibroblast proliferation, since intrauterine thymectomy led to a temporary delay in the beginning of the fibroblastic phase in wound healing.

Animals↗
PubMed1983

A method of thymectomy in macaques.

The aim of this study was to develop an operation for total thymectomy suitable for nonhuman primates. The thymus was removed from 24 macaque monkeys from fetal to adult life by a cervicothoracotomy and blunt gauze dissection. Mean wet weight of the thymus rose from 150 mg (range 50-250 mg) in fetal animals to 2.5 gm (range 0.3-4.2 gm) in prepubertal monkeys. Nonhuman primate thymic weight fell steadily and uniformly with age by over 300% when plotted as a function of body weight. This surgical technique appears to be a valid method of total thymectomy in macaque monkeys.

Age Factors↗
PubMed1982

The physiological relationship between the hypothalamus and thymus of Wistar rats. I. Some morphological and microstructural changes in the hypothalamus in newborn rats following thymectomy.

The investigations were carried out on male Wistar rats. 12 h after birth newborn rats were subjected to thymectomy, and subsequently observed for the period of 8 weeks. The studies of the rat hypothalamus revealed that supraoptic nuclei (NSO) contained numerous cells which dyed dark. The cells were deprived of nuclei, or else they were shrunk. Similar cells were encountered in the medial eminence (EM). Measurements of cellular nuclei within NSO and NPV demonstrated that their size diminished following thymectomy what after t-test calculations yielded a statistically significant value.

Animals↗
PubMed1980

Effects of thymectomy or androgen administration upon the autoimmune disease of MRL/Mp-lpr/lpr mice.

MRL/lpr and NZB X NZW F1 mice were neonatally thymectomized or treated with androgens from 2 weeks of age, and their natural histories were studied. Neonatal thymectomy of MRL/lpr mice led to marked reduction in the usual massive lymphadenopathy as well as significant reduction in antibodies to native DNA and prolonged survival. In contrast, neonatal thymectomy of NZB X NZW F1 mice led to accelerated disease. Androgen therapy of both mice led to reduced anti-DNA and prolonged survival. This occurred in the MRL/lpr mice without significant reduction in lymphadenopathy. Taken together, these studies suggest that different T cell abnormalities may underlie the development of autoimmunity in MRL/lpr and NZB X NZW F1 mice, but that disease may be expressed through a common androgen-sensitive pathway.

Androgens↗
PubMed1980

Thymectomy for myasthenia gravis in the young adult. Long-term results.

An 8 year experience with a prospective treatment program for patients with myasthenia gravis is reviewed with particular focus on the results in patients less than 35 years of age. Twenty myasthenic young adults with an average age of 24 years and a duration of symptoms of 22 months, excluding two with the juvenile form, had thymectomy followed by short-term anticholinesterase and long-term prednisone therapy. All of the 18 patients with a short duration of symptoms are in markedly improved condition and 61% of them are in remission after a mean postoperative period of 32 months. The longest follow-up period is 7.3 years. Two patients have mild improvement. There was no correlation between thymic disease and clinical result. Complete en bloc extirpation of all thymic and adjacent tissue through a median sternotomy is advocated. The patients were treated postoperatively with prednisone, 100 mg/day, a regimen which gradually is changed to every other day medication and finally a gradual reduction of dosage. There have been no operative or late deaths and no serious complications of therapy. The effects have been long lasting, with not a single instance of significant recurrence of symptoms of myasthenia gravis 6 months after thymectomy.

Adolescent↗
PubMed1980

[Cervical thymectomy as an expanded surgical method in primary and secondary hyperparathyroidism].

From 1964 to 1979 neck explorations were performed on 135 patients with primary and 30 patients with secondary hyperparathyroidism. In 28 of 165 patients (16,9%) a cervical (23 patients) or a direct (5 patients) thymectomy after sternum splitting was carried out. In 22 of 28 patients, parathyroid tissue was found within or adjacent to the thymus (13,3%). Cervical thymectomy is a safe and effective procedure when an exact indication is present and if certain rules of operative technique are followed.

Humans↗
PubMed1995

Factors related to long-term effects of thymectomy on myasthenia gravis.

The authors report the results of long-term follow-up after thymectomy on 92 cases with myasthenia gravis (MG), including 22 cases of thymomatous MG. These patients were followed up for 6-73 months with an average of 23 months. The surgically effective rate was 88.0% and the late mortality, 6.5%. The sex of the patients and the durations of disease were not obviously related to the prognosis, however the effect of thymectomy was much better in patients aged 10-39 years than in other age groups. The modified Osserman's clinical classification, acetylcholine receptor (AchR) antibodies and citric acid extract (CAE) antibodies titers in plasma and pathological patterns of the surgical specimens of thymus including immunohistochemical observation play an important role among various factors related to the long-term effects.

Adolescent↗
PubMed1976

The effect of thymectomy on the competitive potential of C57BL/6 bone marrow graft.

When a mixture of bone marrow cells derived from mice of the CBA-T6T6 and C57BL/6 strains and Lewis rats is injected into lethally irradiated (C57BL/6 X CBA-T6T6)F1 hybrid recipients, a process of cell interaction takes place, which in less than 2 weeks leads to the complete and permanent take over in hematopoietic and lymphoid organs by the C57BL/6 cell population. This is shown by the chromosome marker technique (T6) analysis. Adult thymectomy of F1 hybrid hosts prior to irradiation and bone marrow transplantation does not alter the competitive potential of the C57BL/6 donor cell population. However, neonatal thymectomy of the prospective C57BL/6 donors significantly impairs their "superiority" as donor cells, and CBA-T6T6 dividing cells persist at all times in all tissues analyzed. The results lend support to the concept of thymus-dependent precursor cells residing in "prethymic" hematopoietic tissue.

Animals↗
PubMed1993

[Effect of extended thymectomy in myasthenia gravis of pure ocular type].

The effect of extended thymectomy in myasthenia gravis of pure ocular type was investigated in 13 patients, who were divided into the surgical group of nine and the conservative group of four. In the surgical group, the onset was at 47 +/- 20 years old. The preoperative duration of symptoms was 4 +/- 6 years. The age at the time of operation was 51 +/- 16 years old. Three patients had thymomas, including one malignant thymoma. Acetylcholine receptor antibody titer was over normal range with 34.0 +/- 49.7 nmol/l. No postoperative crisis occurred. The palliation rate of the surgical group was more higher through the whole period than that of the conservative group, and increased with progress of the course. The remission occurred in the surgical group, but did not in the conservative group. It took 7 months to improve the symptom in the surgical group, while 18 months in the conservative group. We conclude extended thymectomy is reasonable for patients with myasthenia gravis of pure ocular type.

Adult↗
PubMed1993

[Anesthesia in thymectomy. Experience with 115 cases].

The authors have conducted a retrospective study on 115 patients with myasthenia gravis undergoing transsternal or transcervical thymectomy at the Policlinico A. Gemelli of Rome in the period June 1984- to June 1991. A prolonged postoperative mechanical ventilation immediately and a few days following surgery was required respectively in 7 and 3 patients, while atelectasia and broncopneumonia have developed in 10 patients. No relationship could be established between the incidence of respiratory complications and factors such as preoperative symptomatology and treatment anesthetic agents, the surgical approach to the thymus and thymic pathology. However a significantly greater postoperative morbidity has been observed in the group of patients receiving suxametonium as compared to the patients receiving non-depolarizing muscle relaxants. Vecuronium and atracurium very frequently allowed ad adequate resumption of spontaneous respiration after anesthesia and made possible a safe early extubation of patients before leaving the operating room. The authors also stressed that all patients, irrespective of their clinical conditions, must be transferred after thymectomy. Oto the surgical ICU where anticholinesterase therapy can be safely restarted and cardiorespiratory status carefully monitored.

Adolescent↗
PubMed1996

Transcervical thymectomy.

Transcervical thymectomy has been used in the management of myasthenia gravis for over 20 years. Contraindications to this operation include advanced age, poorly controlled neurologic symptoms, and evidence for a thymoma. The procedure is associated with negligible morbidity and requires only a brief hospitalization. Remission rates are comparable with those reported for more extensive thymectomy operations.

Cervical Vertebrae↗
PubMed1996

[Thoracoscopic extended thymectomy in conjunction with a collar incision of the neck for cases of myasthenia gravis].

Extended thymectomy in conjunction with a collar incision of the neck was performed thoracoscopically for a 64-year-old women with myasthenia gravis. Although this patient had Osserman type II B myasthenia gravis not associated with a thymoma, the clinical symptoms were alleviated after the surgery. Although this surgical procedure has the disadvantage such as of being time-consuming, it also has various advantages such as: 1) extended thymectomy can be performed without a midsternotomy, 2) the wound is small and not prominent, 3) surgical invasiveness is slight, and 4) postoperative pain is mild. This method was considered to be an extremely useful surgical method which should be used in future for cases of myastenia gravis not associated with a thymoma.

Endoscopy↗
PubMed1977

[Thymectomy of adult mice and hamsters].

The author describes a method for thymectomy of adult mice and hamsters, in which he uses a new operative approach at the initial stage of the operation. The common longitudinal median skin section is replaced with semioval section of the skin which begins from the surface transversly to the median line over xiphoid process of the chest bone, passes parallely and lateralily to both sides of the chest bone in the direction to the neck and ends at the level of the clavicle. Semioval cut skin, returned to its place after comrlition of the thymectomy, forms a peculiar subcutaneous pocket in the cavity of which the mediastimum and the risk of pneumothorax, while the usage of skin sutures is replaced completely by the tissue glue.

Anesthesia↗