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PubMedDate not supplied

[Anesthesia for thymectomy in patients with myasthenia gravis].

INTRODUCTION: Anesthetic approach to patients with myasthenia gravis requires preoperative treatment with anticholinesterase drugs, corticosteroids, plasmapheresis and mechanical ventilation support, either before or immediately after the surgical procedure. MATERIAL AND METHODS: During the period of 10 years, 41 patients with myasthenia gravis (71.42% female and 28.57% male, aged between 9 and 69 years) underwent surgical procedures. All the patients were preoperatively treated with anticholinesterase drugs and corticosteroids and were in remission. Considering the fact that barbiturates and succinylcholine should be avoided during induction of anesthesia, halothane was used. The induction into the surgical stage of anesthesia was pronged. RESULTS: Intubation, as well as the surgical procedure, were successfully completed in all patients. All, except three patients, started breathing spontaneously. Two patients required respiratory support during the immediate postoperative period and one patient died. After the surgical procedure one patient had manifested gastrointestinal bleeding and three patients had pneumothorax (one iatrogenic and two during mechanical ventilation). Mechanical ventilation in postoperative period indicates inadequate respiratory function in patients with myasthenia gravis, whereas thymectomy is a therapy of choice. Volatile inhalation anesthetic with pre and postoperative anticholinesterase drugs and corticosteroids resulted in complete remission.

Adolescent↗
PubMed2001

[Prediction of the need for mechanical ventilation after transsternal thymectomy in patients with myasthenia gravis].

Between June 1992 and May 2000, transsternal extended thymectomy was performed for 70 patients with myasthenia gravis in our hospital. We were able to evaluate 64 of them in terms of prediction of the need for postoperative mechanical ventilation using the score systems reported by Leventhal et al., Kimura et al. and the criteria of Adachi et al.. For these systems, the rates of agreement between predictions and results were 85.9%, 82.8%, and 64.1%, respectively. The two former systems had some false negative cases (i.e., they predicted that ventilation would not be needed when in fact it was), but the last one gave no false negatives. We recommend Adachi's criteria for clinical safety. In our cases the patients whose value of %VC multiplied by FEV1.0% was less than 7,000 (Adachi's criterion is less in 8,300), especially, needed careful management with regard to respiratory crisis.

Adolescent↗
PubMed2000

A case with myasthenia gravis (MG) emerging after splenectomy for idiopathic thrombocytopenic purpura (ITP): possible effects of thymectomy on autoantibodies.

The combination of idiopathic thrombocytopenic purpura (ITP) and myasthenia gravis (MG) has been reported infrequently. We report here the development of MG in a patient who underwent splenectomy for ITP ten years earlier, and describe the serum levels of anti-acetylcholine receptor antibodies (anti-AchR) and platelet-associated IgG (PAIgG) followed over 11 years. The concentrations of both autoantibodies have been decreased after thymectomy, suggesting that this procedure is potentially beneficial for treating both MG and ITP.

Adult↗
PubMed2001

[Follow-up study of myasthenia gravis: evaluation of thymectomy in 300 patients].

From June 1975 to March 1999, 300 patients of myasthenia gravis(MG) have undergone thymectomy. Among these patients, 69 cases were classified as ocular type of MG(including 15 cases with thymoma), and 231 were generalized type of MG(including 86 cases with thymoma). The efficacy of the treatment was investigated by evaluating current patients' life activity, which is classified in 6 groups(Remission, Much Improved, Improved, Unchanged, Worse, and Died). Among the 214 cases without thymoma, Remission was 75, Much Improved was 56, and Improved was 55, namely 86.9% of these cases showed Improved or better. Among 86 cases with thymoma, Remission was 14, Much Improved was 21, and Improved was 32, namely 77.9% of these cases showed Improved or better. We concluded that post-operative outcome of these patients regardless of thymoma were generally satisfactory, but it was necessary to carry out long term careful follow-up.

Adolescent↗
PubMed2001

[Propofol anesthesia combined with thoracic epidural anesthesia for thymectomy for myasthenia gravis--a report of eleven cases].

We report 11 cases of thymectomy for myasthenia gravis using propofol and thoracic epidural anesthesia. Considering the influence of nitrous oxide to environment and muscular relaxation of volatile anesthetics, we selected this anesthetic method. By proper sedation with propofol and sufficient analgesia with epidural anesthesia, the hemodynamics during operation was stable and the emergence was rapid. The patients were extubated early after operation except in one case in which oxygenation was not good because of sputum. We conclude that our anesthetic method is useful. Moreover, we applied Fuchu hospital scoring system for prediction of the need of postoperative mechanical ventilation in patients with myasthenia gravis to the present 11 cases. These predictions corresponded well with the results. Therefore Fuchu hospital scoring system is useful for managing these patients by our anesthetic method.

Adult↗
PubMed1975

Distribution of thymic tissue at the anterior mediastinum. Current procedures in thymectomy.

The distribution of thymic tissue at the anterior mediastinum was examined histologically in 18 cases following the removal of the adipose tissue which was located outside the thymic capsule at the time of thymectomy for myasthenia gravis. The gross adipose tissue revealed the presence of histological thymic tissue, including Hassall's bodies, in 13 of 18 cases. In order to be sure of extirpating all of the thymic tissue, the adipose tissue at the anterior mediastinum as well as the gross thymus should be removed.

Adipose Tissue↗
PubMedDate not supplied

Peri-operative management of patients for video assisted thoracoscopic thymectomy in myasthenia gravis.

Three patients of myasthenia gravis, who under went video-assisted thoracoscopic surgery (VATS) were given general anaesthesia by propofol infusion and muscle relaxation by atracurium infusion. Isoflurane was added to control depth of anaesthesia on the basis of haemodynamic changes during surgery. One lung ventilation (OLV) was achieved by placement of Carlens left sided double lumen bronchocatheter. Right-sided surgical approach was used to perform thymectomy. Contrary to claimed short duration of surgery, in first patient, OLV lasted for 10 hours 30 minutes and patient developed re-expansion pulmonary oedema. OLV in second and third patient was for six hours thirty minutes and three hours 45 minutes respectively. Morning dose of pyridostigmine was omitted and atracurium (0.1 mg/kg) was found to be satisfactory for intubation and relaxation was maintained with atracurium infusion to get desired monitored effect. We could not extubate our patients due to longer duration of surgery and the sequelae there off. Post-operative elective ventilation and spontaneous weaning off the atracurium effect was thus preferred.

Adult↗
PubMed1975

Connective tissue alterations following neonatal thymectomy. VI. Calcium histochemical, growth-dynamical and thermoanalytical investigations on bone tissue of thymectomized rats.

Thymectomy was performed in newborn rats and the changes occurring in the epiphyseal cartilage and bone were investigated by Ca histochemical and thermoanalytical methods, one, two and six weeks following operation. Formation of Ca complexes was slowed down in the epiphyseal cartilage and the rate of growth decreased. At the same time the inorganic substance content decreased considerably in the bone tissue of operated rats as compared to the controls.

Age Factors↗
PubMed1975

Surgical treatment of myasthenia by thymectomy.

From 1967 to 1973 Thymectomies for Myasthenia gravis have been done at the Zakopane Chest Surgery Hospital. Preoperative duration of the disease was some 2 1/2 years. Histological types: Thymoma 6, Thymus persistens 61, malignant lymphatical growth 1. Postoperatively 9 patients had a myasthenic, 6 a cholinergic crisis. These and other respiratory troubles made necessary 14 prolonged intubations and 6 tracheostomies. Depending on the clinical picture small doses of cholinergic drugs were given. Lethality was 1.5%. Long-term results (1/2-6 years p.o.):22.6% needed no drug therapy, and 62.9% only in small doses, 6.5% showed subjective improvement and 6.5% no change.

Adolescent↗
PubMed1975

[Myasthenia gravis: surgical treatment with thymectomy (author's transl)].

Thymectomy may be an effective treatment of Myasthenia gravis. 25% of the 16 patients had a complete remission of the disease, 70% remarcable improvement. Half of the patients were able to resume working. Diagnostic methods, surgical and postoperative problems are discussed. Lateral left thoracotomy is recommended.

Adolescent↗
PubMed1975

Effect of neonatal thymectomy on rabbit tonsils.

An intensive lymphocyte migration takes place through the venules lined with high endothelium and situated in the extrafollicular areas of the tonsils. After thymectomy the migration of lymphocytes is less marked and in the areas surrounding the vessels lymphocyte depletion, connective tissue proliferation and a disintegration of the intimate contact between reticular cells and reticular fibres can be observed. A similar lymphocyte depletion appears also in the epithelium. Similarly as the deep cortical substance of the lymph nodes the extrafollicular regions of the tonsils belong to the peripheral lymphoid organs.

Animals↗
PubMedDate not supplied

[Use of mivacurium chloride during transsternal thymectomy in myasthenic patient].

INTRODUCTION: Myasthenia gravis is an autoimmune disease characterized by the presence of circulating IgG antibodies, which interact with acetylcholine receptors and interfere with neuromuscular transmission. OBJECTIVES: To compare neuromuscular function when mivacurium is used in patients with myasthenia gravis and patients with no impairment of transmission at the neuromuscular synapse. MATERIAL AND METHOD: Prospective study of 40 patients in two groups. Group I (n = 20) consisted of patients with no impairment of neuromuscular transmission who underwent sternotomy or mediastinoscopy and who received 2 ED95 of mivacurium. Group II (n = 20) were patients with myasthenia gravis who underwent transsternal thymectomy and received 0.5 ED95 of mivacurium (50 micrograms/Kg). The neuromuscular function of all patients was monitored by accelerometry of the thumb adductor. RESULTS: All demographic variables except sex were similar in the two groups. Time to maximal block, duration of block and the recovery at T1 25-75 were significantly greater in group II (250 +/- 10 s, 29.1 +/- 2.4 min and 8.1 +/- 1.5 min, respectively) than in group I (188 +/- 13 s, 21.2 +/- 0.4 min and 7.1 +/- 0.2 min in group I). Maintenance doses were given more often in group I. At the end of surgery and before recovery from mivacurium, the mean twitch height in group II was 89.3 +/- 0.5%, such that tracheal tubes were removed from 95% of the patients without complications. The mean time until extubation in group II was 17.8 +/- 1.3 min and was related to the extension of the blocks. The differences were statistically significant (p < 0.05). CONCLUSIONS: The anesthetic effect of mivacurium was twice as great in myasthenic patients, in whom it behaved like an intermediate-level non-depolarizing muscle relaxant. Mivacurium can reduce prolonged mechanical ventilation in patients who are myasthenic or pharmacologically immunosuppressed and at risk of sepsis arising in the respiratory tract.

Adult↗
PubMedDate not supplied

Juvenile myasthenia gravis and thymectomy: report of ten cases.

Ten patients from 7 to 12 years of age presented generalized acquired myasthenia gravis: six had a severe form and four a moderate one. All patients showed progressive worsening and poor response to the medical treatment; all of them were submitted to thymectomy by median sternotomy. Long-term results were beneficial for 60% of the patients who experimented a marked improvement or even complete remission. One patient improved without medication being followed for two years. Another patient has been in remission taking only a minimal dose of anticholinesterase drug for seven years. In most cases prednisone has been used as long-term maintenance in the postoperative phase. Short-term results were not favorable: one death occurred and 30% of the patients worsened.

Child↗
PubMedDate not supplied

Myasthenia gravis: prognostic significance of clinical data in the prediction of post-thymectomy respiratory crises.

Medical records of 170 patients who had undergone thymectomy for myasthenia gravis were reviewed from the point of view of respiratory disturbances. In the group of patients requiring mechanical ventilation for over 24 hours after operation the incidence of high preoperative cholinesterase inhibitor intake, severe bulbar symptoms and severe myasthenia gravis with anamnestic respiratory crisis and cardiorespiratory disease were much higher than in the group of patients who could have their trachea extubation within 24 hours. The presence of a thymic tumour, patients' age over 50 years and the so-called precrisis have revealed differences between the two groups, while the patient groups were identical in mean age, duration of myasthenia gravis and sex distribution. The above clinical data are recommended to be considered in the evaluation of the need for postoperative mechanical ventilation or extubation and preparation of preventive tracheotomy.

Adolescent↗
PubMed1992

[Thymectomy and splenectomy of adult mice have no influence on the level of suppressor activity of T-lymphocytes specific to antigens of H-2 complex].

I.v. immunization of mice with irradiated (1500 rad) allogeneic spleen cells induces T cells specific to histocompatibility antigens and capable to suppress proliferation in mixed lymphocyte cultures. The lymph node cells appeared to be almost as capable as spleen cells of producing suppression. Splenectomy experiments showed that the spleen is not essential for induction of suppressive activity of T cells. The precursors of T cells with suppressive activity do not belong to the pool of short-living cells as they are insensitive to adult thymectomy, produced 6 weeks before immunization.

Age Factors↗
PubMed1992

Ectopic thymoma: a case for median sternotomy for complete thymectomy.

Thymomas are normally found in the superior mediastinum or the upper part of the anterior mediastinum. We report a case of thymoma arising in the inferior aspect of the anterior mediastinum. This case illustrates that thymic tissue may be found low in the anterior mediastinum and supports the practice of a median sternotomy approach for thorough mediastinal exploration in all cases of thymectomy.

Aged↗
PubMed1992

[Structural-functional state of the thyroid gland after thymectomy].

The dynamics of morphologic and biochemical indices of the thyroid gland in puberal rats has been considered. The data obtained suggest that the thymus hormones deficiency in blood circulation after thymectomy affect thyroid-stimulating functions of adenopituitary and thyroliberin production in hypothalamus that results in significant depression of thyroid function, whereas the enhancement of thyroid function to 20-month follow-up has no central genesis but is rather a result of autoimmune processes activation when thymus is removed.

Animals↗
PubMed1992

[Distribution of thymic tissue in the mediastinal adipose tissue removed at the thymectomy in 47 patients with myasthenia gravis].

In this report, the distribution of thymic tissue in the mediastinal adipose tissue was examined histologically in 54 patients with myasthenia gravis underwent extended thymectomy. In fourty-seven of 54 patients, the mediastinal adipose tissues were removed from 6 different parts adjacent to the thymus, i.e., right upper, right middle, right lower, left upper, left middle, and left lower, respectively. Upper area means of around the upper pole of thymus, middle area means of around hilum and lower area means of around from lower pole of thymus to diaphragma. In the mediastinal adipose tissue, thymic tissue was found outside the thymus lobes in 41 (75.9%) of 54 patients. The each prevalence (percent of occurrence) of 6 areas were as follows: 15.0% in the right upper area, 21.4% in the right middle area, 19.0% in the right lower area, 17.5% in the left upper area, 66.7% in the left middle area and 33.3% in the left lower area. There was significant differences in the prevalence of the left middle area according to the other 5 areas (p < 0.01). There were no significant differences in the prevalences among sex, Osserman type, duration of the disease, pre-operative treatment and histological findings or removal thymus. There were significant differences in the prevalence of all according to the proportion of thymic tissue in the thymus (0.01 < P < 0.05). In conclusion, it is suggested that for the removal of all thymic tissue, the sufficient procedure required utmost care especially to the left middle area around thymus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗