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PubMed2004

[Thoracoscopic thymectomy].

BACKGROUND/PURPOSE: The use of videothoracoscopy in thoracic pediatric pathology has been progressively accepted in different diagnostic and therapeutic procedures along last decade. The aim of this work is to analyze our initial experience in thymectomy through this approach. PATIENTS AND METHODS: We have used the thoracoscopic approach in the last two cases of thymus pathology with surgical indication. Case 1: 9 year-old patient recently diagnosed on myasthenia gravis and several hospital admissions because of clinical worsening. Case 2: 9 year-old patient with a 7x8x3.5 cm. cervico-mediastinal tumour. FINAL DIAGNOSIS: Multilocular cystic thymoma. In both cases we used right approach in lateral decubitus, and the harmonic scalpel. RESULTS: Mean operating time was 125 minutes. No procedure-related complications. They were discharged on the 6th and 4th postoperative day. After 6 and 7 month follow-up, no incidences have been found, and case 1 has shown a sympthomatic improvement and a decrease in drug dosage. CONCLUSIONS: Thoracoscopy is a good alternative in thymus approach. Its cosmetic and recovery advantages upon transcervical and transsternal are obvious. Despite our very initial experience, we believe that this approach at least equals classic ones in the ability to resect the whole thymus.

Child↗
PubMed2005

[Imaging aid for thoracoscopic thymectomy; thymic vein visualization].

The spread and progress of thoracoscopic surgery has been remarkable. There are many important organs and blood vessels in the mediastinal space, thus, as inadvertent injury invites serious consequences, it is necessary to understand the anatomical position of existing structures. When enucleating the thymoma under a thoracoscope, one of the blood vessels to be careful about is the thymic vein. Therefore, we examined whether the thymic vein could be confirmed using a multidetector-row computed tomography (MD CT). We believed we could understand the anatomical position of the thymic vein by analyzing the high resolution slice data provided in MD CT using a work station. The diameter of the thymic is from a little less than 1 mm to 3 mm, and there were individual variations in position and the number of the vein. The thymic vein flowed into the left brachiocephalic vein in many cases. In some cases, the thymic vein flowed into the right internal thoracic vein or superior vena cava. It appears that visualization of the thymic vein could provide useful data when performing thoracoscopic thymectomy.

Adult↗
PubMed2005

[A technique of videothoracoscopic thymectomy in diseases of the thymus].

Intensive development of thoracoscopic thymectomy (Tthy) has been initiated during the last decade. Unfortunately very few instances of using the procedures have been described in Russian medical literature. So, the paper describes in detail the technique and results obtained in our clinic. At the period from 1998 through 2004 37 Tthy operations were performed in the St. Petersburg Center of intensive pulmonology and thoracic surgery. There were 21 female and 15 male patients with mean age 41.5+/-18.9 years. Myasthenia gravis (MG) was diagnosed in 19 of those patients. Different thoracoscopic approaches were used for Tthy: 20 from the right side, 15 from the left side and 2 combined approaches with neck incision. In 2 cases when invasive thymoma was suspected, sternotomy had to be used. There were 6 postoperative complications (1 haemothorax and 5 myasthenia cases). One patient died in 45 days after operation because of the ventilation-associated pneumonia. The results of treatment were followed up in 34 patients during 6-34 months. The MG course was followed up in 17 out of 19 patients, 9 (52.9%) being asymptomatic, 6 (35.3%) improved and 2 (11.8%) stable. Tthy is a novel technical possibility for a removal of the thymus gland. The procedure is quite safe and radical in the hand of a surgeon experienced in mediastinal and thoracoscopic surgery. Treatment of thymoma using Tthy requires meticulous technique and longer follow-up.

Adolescent↗
PubMed2006

[Nephrotic syndrome after extended thymectomy for thymoma with myasthenia gravis; report of a case].

A 35-year-old man visited our hospital complaining of blepharoptosis and fatigability of the left arm. Under a diagnosis of myasthenia gravis (Osserman Ila), ambenonium was administered and improvements were noted. At 40-year-old, the patient underwent extended thymectomy due to the development of thymoma, which invaded the lung and pericardium (Masaoka stage Ill). Then ADOC therapy (doxorubicin hydrochloride+cisplatin+vincristine sulfate+cyclophosphamide) was initiated. At 47-year-old, we found recurrence of disseminated thymoma in thoracic cavity. Because of multiple metastatic lesions, radiotherapy in combination with chemotherapy was chosen and these lesions were reduced in size. Facial and foot edema developed at 50-year-old. Chest X-ray revealed bilateral pleural effusion. He was diagnosed as minimal change nephrotic syndrome and steroid therapy was started. The changes in cellular immunity due to thymoma is considered to be causative in the development of nephrotic syndrome. We report the clinical course of our case and discuss with reference to the literature.

Adult↗
PubMed1975

The influence of pinealectomy and of pinealectomy combined with thymectomy oncogenesis caused by polyoma virus in rats.

The inoculation of Polyoma virus suspension to neonatal pinealectomized rats did not provoke a growth of neoplasia. However, if the pinealectomy was combined with neonatal thymectomy, renal tumors occured in a rate of 50 of animals. An incidence of renal tumors was observed also in 57.6% of thymectomized rats, but not in non operated control group. The stimulating effect of pinealectomy on the growth of transplantable tumors has already been described several times (2, 3, 6, 8). The question of a possible change in the viral oncogenesis after pinealectomy was raised. For this reason Polyoma virus was used and its oncogenic effect was studied on the neonatally pinealectomized rats, on rats neonatally thymectomized and on neonatally pinealectomized rats which were simultaneously thymectomized.

Animals↗
PubMed1991

[The development of intestinal dysbacteriosis in sexually mature rats after thymectomy].

Thymectomy in puberal rats resulted in the development of pronounced enteric dysbacteriosis, correlating with the degree of T- and B-lymphocyte deficiency in the lymphoid organs and the blood stream during the first 2 months. Microbiocenosis restores probably due to more intensive functioning of alternative regulating mechanisms. A simple and informative characteristic indicating the degree of dysbacteriosis developing in the intestine is proposed: the index of dysbacteriosis.

Animals↗
PubMedDate not supplied

The influence of thymectomy on Rous sarcoma regression.

The incidence of regression of wing-web tumors induced by Rous sarcoma virus was shown to be dependent on the quantity of thymus tissue remaining after neonatal thymectomy in chickens of inbred line 6. Frequency of metastasis was associated negatively with the amount of thymus tissue present. Tumor regression and metastasis restriction both appeared dependent on the quantity of thymic tissue present.

Animals↗
PubMed1991

[A case of pure red cell aplasia appearing after thymectomy].

We present a case of pure red cell aplasia appearing four months after thymectomy for an invasive thymoma. A 61-year-old female whose chest X-ray demonstrated an anterior mediastinal mass was admitted to our hospital. Preoperative examination revealed neither anemia nor myasthenia gravis. During surgery, as it was found that the thymoma had invaded the upper left lobe of the lung and the left diaphragmatic nerve, these tissues were partially resected along with the thymus and the parathymic adipose tissue. Histologically the epithelial cells of the thymoma had round-oval nuclei with predominant lymphatic infiltration. There were some clusters of epithelial cells in the adjacent involuted thymic tissues. After postoperative radiotherapy of 40 Gy, the patient was discharged. About four months after the operation, she was readmitted because of anemia. Bone marrow aspiration demonstrated few erythroblasts but normal findings of granulopoiesis. Chest CT and radioisotopic examination revealed neither metastases nor recurrence of thymoma. Her anemia showed marked improvement by steroid therapy. After she was discharged, her condition has been uneventful in spite of tapering the steroid dose for seven months.

Female↗
PubMed1991

[The prediction of the need for postoperative mechanical ventilation in patients with myasthenia gravis undergoing transsternal thymectomy].

During a sixteen-year period, 51 patients with myasthenia gravis underwent trans-sternal thymectomy including extended resection of the adipose tissue around thymus. Using the criteria of risk factors described by Leventhal and Kimura, a predictive score was assessed for our 51 patients. Leventhal's scoring system achieved an accuracy of 54.3%, a sensitivity of 20.0% and a specificity of 63.9%. And, Kimura's scoring system achieved an accuracy of 75.0%, a sensitivity of 81.8% and a specificity of 73.0%. From this study it was concluded that Kimura's scoring system is statistically more adaptive for Japanese than Leventhal's scoring system, and the Leventhal's accuracy may have increased by adding "bulbar symptoms" and "preoperative crisis" as other risk factors and by decreasing "points" for "duration of myasthenia" and "pyridoxamine dosage", and the "Kimura's " accuracy may have increased by decreasing "7 points" for preoperative crisis. Consequently, patients who received postoperative ventilation were compared with the group who did not, with respect to the 19 factors. Evidence is that Osserman's type, bulbar symptoms, preoperative crisis and preoperative % VC were influenced to require the postoperative ventilation, but sex, age, thymic histology, duration of myasthenia and pyridoxamine dosage were not any influenced to require the postoperative ventilation.

Adult↗
PubMed1990

Long term effects of adult-thymectomy on natural killer activity and spontaneous tumor incidence.

Long term effects of adult-thymectomy on both natural killer (NK) activity and spontaneous tumor incidence were investigated in C57BL/6 mice maintained in specific pathogen free atmosphere. As compared with the age matched sham-thymectomized mice, a substantially low incidence of spontaneous tumour (6%) and a high level of splenic NK activity were noted one and a half year later in C57BL/6 mice thymectomized at 6 weeks of age. In contrast, sham-thymectomized mice showed a high incidence of the spontaneous tumor (57%) associated with a low level of splenic NK activity. These results suggest that NK cells play a critical role to prevent the occurrence of spontaneous tumor in vivo.

Age Factors↗
PubMed1978

Influence of thymectomy on the susceptibility of cats to feline leukemia virus and lymphosarcoma.

Twelve cats were thymectomized at 5 weeks of age. Six of these cats were inoculated at 8 weeks of age and 6 at 4 months of age with the Rickard (R) strain of feline leukemia virus (FeLV), which produces a high incidence of thymic lymphosarcoma. Two groups of age-matched nonthymectomized cats were inoculated with the same FeLV-R stock. Thymectomy prior to FeLV infection had no influence on the induction of viremia or the incidence of lymphosarcoma. In the FeLV-inoculated nonthymectomized cats, lymphosarcoma developed in the thymus. In the thymectomized cats, lymphosarcoma developed in the intestine, mesenteric lymph nodes, and bone marrow, but the malignant lymphoblasts had surface markers characteristic of feline T lymphocytes. It was concluded that the presence of the thymus per se is not required for infection and oncogenesis by FeLV and that feline T lymphocytes may be transformed after peripheralization to other tissues.

Animals↗
PubMedDate not supplied

[Myasthenia gravis: thymectomy. Muscle relaxation with atracurium besilate].

We have carried out a prospective study on the use of the muscle relaxant, atracurium besilate, in 10 patients with myasthenia gravis, seven had type IIB and three had type IIA, who were scheduled for thymectomy, using ED95 0.20 mg/kg, and ten non myasthenic patients undergoing cholecystectomy using ED95 0.50 mg/kg. After monitoring neuromuscular transmission, the time for establishing maximum blockade (EMB), clinical efficacy time (CET), recovery index (RI) and total duration time (TDT) were measured and evaluated comparatively. Results showed that in myasthenics patients, EMB was faster, CET an TDT were more prolonged and RI was higher than in non myasthenic patients. We conclude that atracurium at doses of 0.20 mg/kg is currently the non depolarizing muscle relaxant of choice in myasthenic patients because of the excellent muscle relaxation allowing extubation in the operating room without reverting muscle blockade and not needing ventilatory support during postoperative period.

Adult↗
PubMed1990

[Evaluation of immune response after thymectomy].

Immunological status of children after thymectomy performed at the age between 2 months and 15 years for teratoma in 5, and hyperplasia in 1. Cellular immunity parameters--as percent and total T lymphocyte count and their PHA reactivity, humoral immunity--as IgG, IgA, IgM concentrations, and phagocytosis--as phagocytosis index, NBT test, complement components--C3c, C4--concentration were evaluated between 6 and 12 years following surgery. No abnormalities within investigated parameters, nor the history of more frequent infections or other immunological disorder were detected.

Adolescent↗
PubMed1990

Evaluation of atracurium in myasthenic patients undergoing thymectomy.

Myasthenia gravis is an autoimmune disease involving the acetylcholine receptors at neuromuscular junctions. Perioperative management of patients with myasthenia gravis is complicated by their enhanced sensitivity to nondepolarizing neuromuscular blocking agents and their resistance to depolarizing drugs (1). Prolonged respiratory depression commonly occurs when these agents are used. Atracurium dibesilate is one of a new series of nondepolarizing agents and is promising by virtue of its rapid degradation by 'Hoffmann elimination', leaving products with little or no muscle blocking activity. After encouraging results were obtained with atracurium (2-6), we investigated the neuromuscular blocking effect of different doses of the drug (0.2 mg/kg, 0.5 mg/kg) in sixteen myasthenic patients undergoing thymectomy, with continuous monitoring of neuromuscular function.

Adult↗
PubMed1990

[Postoperative intensive care after thymectomy for myasthenia gravis].

The post-operative management of the myasthenic patient after thymectomy through sternotomy has changed in the last decades. After years of routine preoperative tracheostomies followed by routine prolonged intubation nowadays it is possible to wean the patients from the ventilation and to extubate them early after surgery while reintroducing the acetylcholinesterase inhibitors therapy. A series of 15 patients operated on between 1985 and 1988 for removal of thymic rests or thymoma is presented and confirms this evolution. The clinical and gazometric criteria allowing an early weaning from the ventilator are analyzed. However certain patients with the most severe forms of myasthenic still need prolonged ventilatory support.

Adult↗
PubMed1990

[Effect of thymectomy in myasthenia gravis].

In order to examine the long-term effects of sternal splitting extended thymectomy in myasthenia gravis 42 patients were evaluated on an annual basis, beginning 12 months after surgery. The effects of surgery on the patients' myasthenic symptoms were as follows: 21.4% of the patients achieved complete remission, 61.9% showed improvement; in total 83.3% had palliation. There were no significant correlation among age, sex, Osserman type, pre-operative treatment and histological findings. Patients with long duration of the disease showed a statistically lower percentage of remission; the patients with complication after operation showed a lower percentage of palliation. The annual transition of the remission rate and the palliation rate were as follows: 11.8% of patients were in remission at 12 months after surgery; 16.1% at 24 months; and 17.4% at 36 months. Moreover 91.2% of the patients were palliated at 12 months after surgery; 90.3% at 24 months; 87.0% at 36 months; and 83.3% at 48 months. There was no significant difference in annual transition rates by age, Osserman type, pre-operative treatment and histology by scattering matric analysis. There was significant differences in annual transition rates according to dyspnea, duration of the disease, sex and post-operative complication.

Adult↗
PubMed1989

[Respiratory failure after thymectomy in myasthenia gravis: evaluation of preoperative influencing factors and preventive managements against postoperative respiratory dysfunction].

Postoperative respiratory function was evaluated in 94 patients with myasthenia gravis after thymectomy. Preoperative clinical and pulmonary function data were submitted to statistical analyses. The duration of respiratory support and intratracheal intubation time were significantly correlated to % vital capacity, the clinical stage of myasthenia gravis, and the clinical stage of thymoma. Statistical analyses proved that anticholinesterase drugs taken in immediate postoperative period contributed to the improvement of postoperative respiratory function, and non-depolarizing muscle relaxants, i.e. d-tubocurarine which had been considered to be contraindicated in myasthenia gravis was found to be beneficial immediately after the operation in patients with severely deteriorated respiratory function preoperatively.

Cholinesterase Inhibitors↗