[Surgery of the thymus gland from the standpoint of thymosin factors].
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The authors studied the causes of ineffective surgical treatment of myasthenia and found residual thymus to be one of them. From analysis of 21 cases in which part of the thymus was not removed (in 19 cases the diagnosis was verified histologically), they drew the conclusion that the causes of residual thymus may be technical errors due to inadequate choice of the surgical approach of the surgeons' insufficient experience, in removal of a thymoma failure to excise part of the thymus not involved in the tumor, incomplete knowledge of the role of the thymus in the pathogenesis of myasthenia and its incomplete removal in thymectomy in patients with generalized myasthenia. Uneventful postoperative course was noted in 11 patients, crises with respiratory disorders in 6 (prolonged artificial lung ventilation had to be resorted to in 4 of them), suppuration of the wound in 2, and pneumonia in 1 patient who was under artificial lung ventilation. The late--term results were studied in follow--up periods of 12 months to 15 years. The myasthenic status improved in all patients, the results were excellent and good in 15. In view of the difficulty in establishing the diagnosis and management, this grave category of patients must be treated at specialized centers.
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The authors have analysed the data of clinical and pathoanatomical (biopsy) investigations in 41 patients, operated upon for the true tumor of the thymus (thymoma) without any signs of malignant miasthenia. Based on the literature materials and personal observations, it is considered necessary to provide for a rational clinico-anatomical classification of thymomas, which may allow certain prognostication of the results of surgical treatment. An attempt is made to work out a preliminary uniform working scheme of the histological nomenclature for thymomas.
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