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[Anesthesia for transsternal thymectomy in myasthenia gravis].

Twenty-seven patients with generalized myasthenia gravis (moderate, severe and acute fulminating forms) who underwent thymectomy were studied. The effects of several anesthetic agents were analyzed with special attention being given to immunologic considerations. The authors conclude that the association of ketamine, tiapride, droperidol, fentanil and nitrous oxide allowed fast recovery of consciousness and spontaneous respiration, and made safe extubation possible before leaving the operating room.

Adolescent↗

[Effect of thymectomy on the functional activity of the thyroid gland in rats].

The authors examined the functional state of the thyroid gland of rats after thymectomy. The dynamics of incorporation of radioactivity I131 in the gland was examined on the 2,20 and 90th day after the operation. There was increased incorporation of the radioisotope in the thyroid giant at the early stages of the experimental period. A reduced incorporation and delayed excretion was observed in the distant periods. Changes in the activity of the thyroid gland were accepted as a manifestation of the existing functional link between the thymus and thyroid gland.

Animals↗

Injection of mouse thyroglobulin and/or adult thymectomy do not break tolerance to thyroglobulin during the lupus like graft versus host disease in mice.

In a previous paper (Gleichmann, van Elven & van der Veen, 1982), it had been reported that, in contrast to lupus like autoantibodies such as anti-DNA, autoantibodies to mouse thyroglobulin (MTg) were not detectable in serum of F1 mice suffering from a lupus like graft versus host disease (GVHD) (GVH F1). In the present paper, possible explanations for this restricted autoantibody formation during the potent allogeneic stimulation were investigated. The main question was whether the natural level of circulating MTg was too low to induce the formation of anti-MTg antibodies in GVH F1 mice. Existence, in the F1 mice studied, of B cells capable of producing anti-MTg antibodies was demonstrated by injection of lipopolysaccharide (LPS) and exogeneous MTg. However, MTg injected into various F1 mice at the onset of the GVH reaction (GVHR) failed to overcome the lack of antibody formation to MTg even though the GVHR led to a severe lupus like disease. Furthermore, adult thymectomy (ATx) of either the recipients, the donors, or both also did not break tolerance to MTg during the GVHR, irrespective of administration of exogeneous MTg. Thus, neither intravenous injection of MTg nor ATx, designed to remove T suppressor (TS) cells, is adequate to enable an autoantibody response to MTg during lupus like GVHD. Hence, the non-specific T cell help that causes lupus like GVHD seems to be intrinsically insufficient to trigger the Tg reactive B cells. We suggest that globular proteins, such as Tg, require specific T cell help. In the presence of only non-specific T help, self-antigens such as DNA seem to be more apt than globular proteins to provide an effective signal 1 to the corresponding autoreactive B cells.

Animals↗

Role of plasmapheresis in preparing myasthenic patients for thymectomy: initial results.

Between 1976 and 1981, one of the authors operated on 16 patients for myasthenia gravis. Plasmapheresis was carried out preoperatively on seven patients, while nine patients were operated upon without previous plasmapheresis. The seven patients who underwent plasmapheresis had a smooth course pre- and postoperatively. In the other group, there were two postoperative myasthenic complications. Both patients improved with medication and plasmapheresis. Also, the degree of myasthenia gravis was slightly more severe in this group. From their experience, the authors conclude that plasmapheresis is a worthwhile and safe adjuvant in the preparation of myasthenic patients for thymectomy, especially those in Osserman class IV.

Adolescent↗

Chemical carcinogen-induced transplantable fibrosarcomas in histocompatible chickens. II. Effect of age and thymectomy on tumor incidence.

The incidence of primary fibrosarcoma 2-4 months after im injection of 7,12-dimethylbenz[a]anthracene (DMBA) was studied in normal, neonatally thymectomized and bursectomized SC (B2/B2) chickens. The tumor incidence was not significantly increased in thymectomized chickens inoculated at 1 week of age, but thymectomized animals inoculated at 4 weeks of age developed a higher incidence of tumors than did controls. Bursectomy did not affect tumor induction. Whereas thymectomy and bursectomy clearly reduced T- and B-cell immune responses, respectively, neither the carcinogen nor the presence of tumor had a detectable effect on the immune response. The effect of varying the age of chickens at the time of carcinogen injection was also studied. DMBA injected into chickens at 8-12 weeks of age produced a significantly lower incidence of tumors than did a similar dose of DMBA injected into chickens at 1-4 weeks of age. Thus DMBA-induced tumors in the chicken may present an interesting model for studies on immune surveillance.

9,10-Dimethyl-1,2-benzanthracene↗

The production of anti-IgG2a autoantibody in the 129/Sv mouse: onset in the lymph nodes draining the intestinal tract and prevention by neonatal thymectomy.

The histological distribution of anti-IgG-secreting cells was studied by measuring the amount of anti-IgG autoantibodies produced in vitro by cells isolated from various lymphoid organs. Before 20 wk, the production of anti-IgG autoantibody in 129/Sv mice from our Institute predominated in the mesenteric and caudal lymph nodes, which both drain the intestinal tract. After 20 wk, the production extended to the spleen and bone marrow. At that time no production was detected in the mediastinal, lumbar, and inguinal lymph nodes. A similar distribution of anti-IgG-secreting cells was observed in 25-wk-old 129/J mice from the Jackson Laboratory. These data indicate that anti-IgG autoimmunity in the 129 primarily results from a local immune response, probably induced by a specific stimulus of intestinal origin. Neonatal thymectomy prevented the production of anti-IgG, demonstrating that the mesenteric anti-IgG production did not result from the direct stimulation of B lymphocytes by endotoxin-like polyclonal activators. It was found that the anti-IgG produced in vitro had the same narrow specificity against IgG2a as its serum counterpart, indicating that this specificity resulted from the selective stimulation of anti-IgG2a-secreting cells rather than from in vivo consumption of anti-IgG antibodies recognizing other IgG subclasses.

Aging↗

Manifestation and growth of a transplantable osteosarcoma in mice: the effects of thymectomy and thymosin treatment.

Normal and thymectomized CBA mice treated with and without thymosin were injected with 2 x 10(6) viable osteosarcoma cells. The activity and weight of tumors, the cell-mediated and humoral-immune responses against the tumors, and the light microscopic characteristics suggested that thymectomy resulted in a significantly decreased tumor frequency. There were also significant increases in cell-mediated cytotoxic activity in vitro as measured by lysis of 51Cr-labeled tumor cells incubated with spleen cells, and in lymphocytic infiltration around the tumors. While thymosin treatment of thymectomized mice restored these parameters to those of intact animals, thymosin had no demonstrable effects on nonthymectomized animals.

Animals↗

Experimental autoimmune orchitis after neonatal thymectomy in the mouse.

Experimental autoimmune orchitis (EAO) developed in (C57Bl/6Cr x A/JCr)F1 mice 3-4 months after neonatal thymectomy (Tx) without any sensitization. The age of Tx was critical for induction of EAO: Tx at day 3 (Tx-3) was effective, but Tx at day 0 or day 7 was not effective. This lesion resulted in atrophy of the testis and was characterized by disappearance of mature sperms, formation of multinuclear giant cells in seminiferous tubules and infiltration of lymphocytes in the stroma. Epididymitis was observed prior to the development of EAO. Presence of circulating autoantibody(s) against sperms (ASA) was demonstrated by indirect immunofluorescence. The acrosomal area of mature sperms, but not of immature spermatids, was strongly. The incidence of EAO and titre of ASA increased when Tx-3 mice were unilaterally vasectomized (Vx). The majority of mice with high titres of circulating ASA were sterile. Epididymitis and orchitis could be prevented in Tx-3 mice by injection of adult spleen cells on day 4. The most effective source was normal male. Spleen cells from normal female donors and day-0 orchidectomized (Orx) donors were less effective, while those of Tx-3 male and female donors failed to prevent epididymis and orchitis. The cell population in normal male spleen effective in preventing epididymitis was shown to be a T cell population (Thy 1+, Ig-) by experiments with respective antisera treatment. These results showed that sensitization with sperm autoantigen occurred in the epididymis after Tx-3, more efficiently after Tx-3 plus unilateral Vx, and that this autosensitization was prevented by a specific suppressor T cell population, which was present in normal males but absent in Tx-3 mice.

Animals↗

Quantitative histological studies on the spleen of ducks after neonatal thymectomy and bursectomy.

The duck spleen was examined histoplanimetrically after neonatal surgical thymectomy, cyclophosphamide treatment, and/or X-ray irradiation. The development of the periarterial lymphoid tissues, which consisted mainly of small lymphocytes, was inhibited in the spleen of the Tx and Tx-X ducks. The peri-ellipsoidal lymphoid tissues, consisting of pyroninophilic medium or large sized lymphocytes, was greatly depleted in the Bx and/or CY ducks. The germinal centres also showed probable bursa dependency. On the other hand, the development of the perivenous lymphoid tissue was not inhibited after Tx and Bx. A number of plasma cells was distributed in the red pulp of the Bx and/or CY duck spleen.

Animals↗

[Myasthenia gravis and thymectomy in a 2 year old girl (author's transl)].

The case of a 2 year old girl with myasthenia gravis is reported. Immunological investigations did not show any major abnormalities of the thymocytes. High levels of acetylcholine receptor antibodies were present before thymectomy. After surgery they decreased significantly and there was a clear clinical improvement.

Child, Preschool↗

Immune response to the copolymer of L-glutamic acid50-L-tyrosine50 (GT): effect of adult thymectomy and genetic control of immune suppression.

The secondary antibody response to GT and GT-MBSA (GT coupled to methylated bovine serum albumin) and the ability to generate specific suppressor cells after GT preimmunization were examined in the auto-immune NZB strain and in normal and adult thymectomized C3H, BALB/c and CBA mice. As previously shown C3H, BALB/c and CBA mouse strains do not mount a secondary anti-GT antibody response after immunization with GT. On the contrary NZB mice where shown to develop a small but significant anti-GT antibody production. All the mice tested produced anti-GT antibodies after immunization with GT-MBSA. Adult thymectomy greatly decreased this anti-GT antibody response in BALB/c, C3H and CBA mice, suggesting the involvement of a short-lived T-cell subpopulation in the development of an optimal anti-GT-MBSA response. Preimmunization with GT suppressed the secondary antibody response to GT-MBSA in CBA and BALB/c mice but not in NZB and C3H mice, although all these strains bear the H-2-linked Is genes. This indicates an additional genetic control on the generation of GT-specific suppressor cells.

Animals↗

[Electropharmaceutical anaesthesia for transcervical thymectomy (author's transl)].

One case of electropharmaceutical anaesthesia for transcervical thymectomy in myasthenia gravis is reported. Easiness of procedure, slightness of pharmaceutical intoxication, quality of awakening, simplicity of postoperative course, illustrate the interest of trying this kind of anaesthesia, whenever tonic awakening is required.

Adolescent↗

[Anesthesia with continuous + infusion of propofol for trans-sternal thymectomy in myasthenic patients].

Patients with myasthenia gravis respond unpredictably to muscle relaxants and more often suffer respiratory complications after surgery. We describe the use of total intravenous anesthesia with propofol and alfentanil without muscle relaxants is three myasthenic patients classified as Osserman I-IIB. Mean time since appearance of the disease was 1 year and all were undergoing transsternal thymectomy. Time in surgery ranged from 115 to 170 min and mean total dose of propofol was 1,374 mg. In all cases total intravenous anesthesia afforded good conditions for intubation, maintenance during surgery and rapid recovery from anesthesia, with early extubation.

Adult↗

Pathogenesis of post-thymectomy autoimmunity. Role of syngeneic MLR-reactive T cells.

Thymectomy of 3-day-old mice results in the development of multi-organ-specific autoimmune diseases. The disease process is mediated by CD4+ T cells and is characterized by an inflammatory infiltrate in the affected organ(s) and the presence of autoantibodies. Our analysis of the phenotype of the CD4+ T cells that remain in the 3-day thymectomized animal revealed that the majority (approximately 80%) of the CD4+ lymph node cells express an activated (MEL-14low) phenotype and a smaller percentage expressed the T cell activation Ag CD69 and IL-2R alpha-chain. Thymectomized animals also had an increase in the frequency of mitogen-induced CD4+ IL-4 producers and significantly higher levels of total serum IgG. Functional studies demonstrated that lymph node T cells from 3-day thymectomized mice had an enhanced response in the syngeneic MLR and appeared to preferentially respond to syngeneic dendritic cells. To determine whether the syngeneic MLR-reactive T cells were involved in the pathogenesis of the organ-specific disease, we developed a model that mimicked the 3dTx model by grafting neonatal thymi to adult nu/nu recipients followed by removal of the thymus graft on day 3 or 4. When compared with mice transplanted with an untreated thymus, nu/nu mice transplanted with adult APC-containing thymi demonstrated a decrease in the incidence and severity of gastritis, a marked decrease in the titer of anti-parietal cell Ab, and a decrease in total serum IgG. Thus, intrathymic tolerization to complexes of self-peptides and MHC class II on adult APC prevents organ-specific autoimmune disease.

Animals↗

Efficacy of thymectomy in myasthenia gravis.

We sought to determine the efficacy of thymectomy in patients with myasthenia gravis (MG). The roles of age, gender, age of onset of MG, acetylcholine receptor antibodies (AchR's) titers, and pathology of the thymus gland were evaluated. Twenty-one patients were analyzed retrospectively. Twenty patients belonged to Osserman Class IIA or higher; 71.42% belonged to IIB. All patients were on either anticholinesterase and/or immunosuppressive agents. The mean follow up was three years. Seventy-six percent of the patients showed improvement by Osserman and by "results of treatment" classification, 14.28% were in complete remission, on no medications. The age, gender, age of onset, thymic pathology and AchR titers had no correlation with post-operative improvement. With longer follow up the beneficial effect is more apparent.

Adolescent↗

[A concomitant operation of coronary artery bypass grafting and thymectomy: a case report].

A 63-year-old man was successfully operated upon concomitantly for coronary artery disease and invasive thymoma. The chest roentogenogram showed a mass shadow in the anterior mediastinum, which was 6.0 x 4.0 cm in size and irregular. Coronary angiography revealed complete obstruction of the right coronary artery and 90% stenosis of the first diagonal branch (#9). Following thymectomy combined with the resection of the left phrenic nerve and the mediastinal pleura, coronary artery bypass grafting with the major saphenous vein was performed to #4 PD and #9. This is the first report of concomitant surgery for the ischemic heart disease and invasive thymoma in Japan.

Coronary Artery Bypass↗

Modification of the tolerant state by neonatal thymectomy.

Immunological tolerance of sheep erythrocytes was induced by repeated antigenic challenge of rats which had been thymectomized on the day of birth. Thoracic duct lymphocytes from these thymectomized tolerant rats failed to mount adoptive responses against sheep erythrocytes and interfered with the capacity of normal lymphocytes to mount such responses. However, in sharp contrast with non-thymectomized tolerant rats, thymectomized animals responded well to sheep erythrocytes if challenge was accompanied by the injection of normal syngeneic lymphocytes. It is likely that the cells that are lacking from tolerant rats as a consequence of neonatal thymectomy are identical with the radiosensitive cells that suppress normal lymphocytes transferred to intact tolerant rats.

Animals↗