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PubMed1993

[Factors influencing long-term results of thymectomy for myasthenia gravis].

The long-term follow-up results after thymectomy for 92 patients with myasthenia gravis (MG) including 22 patients with thymomatous MG were discussed. All patients were followed up for 3 approximately 73 months (average 23). The surgical effective rate was 88.0% and late mortality 6.5%. Sex and disease duration were not obviously related to prognosis, but the effects were much better in 10 approximately 39 year-old groups than in the other 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 the thymus are factors affecting long-term results.

Adolescent↗
PubMed1994

Influence of alloferin on neuromuscular function in myasthenia patients undergoing thymectomy.

Myasthenia gravis patients are hypersensitive to nondepolarizing relaxants, such as alcuronium, an intermediate-long nondepolarizing agent. This study observed the effects of alcuronium treatment in myasthenia gravis patients as compared with non-MG patients during operation. Ten MG patients (Ossermann class I-IV, scheduled for thymectomy) and 10 non-MG patients (ASA class I-II, scheduled for operation) were selected. An induction dose of alcuronium 0.2 mg/kg and thiopental 4-6 mg/kg was given, followed by intubation and ventilation with 50% nitrous oxide in oxygen and 0.5-1.5% ethrane. Neuromuscular transmission was monitored using an accelerograph and degrees of neuromuscular function at different depths were recorded. There were statistically significant differences between the two groups. The effect of alloferin in the MG group was quicker and deeper. This study also found a relation between MG class and the recovery of respiration: Respiratory recovery was quicker in classes I-II than in classes III-IV.

Adult↗
PubMed1993

[A case of multiple colon cancer appeared after thymectomy for thymoma with myasthenia gravis].

A 62-year-old woman was admitted to our hospital because of diarrhea and melena. Thymectomy for thymoma with myasthenia gravis was carried out on this patient four years ago. Barium enema revealed four tumor shadows in the ascending and transverse colon. Multiple colon cancer was diagnosed and extended right hemicolectomy was carried out. The postoperative course was uneventful and she has been free from any symptom. In this paper, we discussed the relationship between thymoma and the incidence of nonthymic malignancy.

Adenocarcinoma↗
PubMed1995

Combined thoracic epidural with light general anesthesia for thymectomy in myasthenia gravis.

Forty-seven myasthenia gravis patients undergoing transsternal thymectomy were allocated into 2 groups. Group 1 which consisted of 27 patients was anesthetized using the balanced technique, while 20 patients in group 2 received the combination of thoracic and balanced anethesia. The ventilation was controlled through the endotracheal tube in both groups. The extubation criteria after performing the surgery were good consciousness, adequate muscle strength and adequate respiration. There were 29.2 per cent in group 1 but 77.8 per cent in group 2 (P = 0.002) with successful extubation immediately postoperation. Morphine 15.4 +/- 5.3 mg intramuscularly in group 1, and 6.5 +/- 1.2 mg epidurally in group 2 (P < 0.001) was given for postoperative analgesia. Adequacy of respiration was observed postoperatively in the intensive care unit (ICU). Group 1 patients required 76.9 per cent of further ventilatory support for the period of 37.11 +/- 39.54 hours and duration of the ICU stay was 65.52 +/- 85.84 hours, whereas, the patients in group 2 showed significantly different results, which were 15.8 per cent of ventilatory support (P = 0.002) for 10.33 +/- 6.03 hours (P = 0.014) and 22.8 +/- 8.06 hours for staying in ICU (P = 0.021). This study demonstrated that the combined thoracic epidural with light general anesthesia provides excellent intraoperative anesthesia together with postoperative analgesia, which reduces the need for postoperative respiratory support, as well as decreases the hospital cost.

Adult↗
PubMed1995

[Trans-sternal thymectomy in myasthenia gravis and thymoma].

In a retrospective study the role of thymectomy in the treatment of myasthenia gravis (n = 19) and of thymoma (n = 7) was analysed in 26 patients operated on between 1989 and 1994 in the Department of Surgery at the University of Cologne. The mean follow-up period was 28 months (follow-up rate: 96.2%). A transsternal incision was preferred in 24 cases (92.3%). Patients with myasthenia gravis were preoperatively classified according to Ossermann. Patients with thymoma were classified according to Masaoka. 17 patients (89.5%) with myasthenia gravis demonstrated a significant improvement. 4 patients (57.1%) with thymoma were free of recurrence. Stage II to IV thymoma should receive postoperative radiotherapy. Patients with stage IV lesions are usually offered postoperative radiation therapy plus cis-platinum based chemotherapy.

Adult↗
PubMed1996

The combined cervical and partial sternotomy approach for thymectomy.

Removal of a normal appearing thymus gland may be necessary, particularly in patients with myasthenia gravis. Complete removal is a basic tenet of this type of operation. A combined cervical and upper sternotomy incision is described. This is appropriate for thymectomy in such patients because of the minimal morbidity and excellent exposure for the thoracic portion of the thymus gland.

Cervical Vertebrae↗
PubMed1996

Extended transsternal thymectomy.

Extended transsternal thymectomy allows for the safe excision of the gross thymus as well as perithymic and anterior mediastinal fat and lymphatic tissue that may harbor foci of aberrant thymus. Additionally, it permits direct inspection of each pulmonary hilum for suspicious thymic remnants and even small thymomas not visualized on the CT scan. It achieves the objective of a safe, well-tolerated operation that provides the best chance for remission or improvement in the patient with myasthenia gravis.

Humans↗
PubMed1995

[Effects of thymectomy and glucocorticoid therapy on peripheral lymphocytes in myasthenia gravis].

Clinical manifestations and peripheral blood lymphocyte subset changes were studied in patients with myasthenia gravis (MG) to elucidate the mechanism of clinical improvement following treatment, with thymectomy (Tx) or glucocorticoid (GC) therapy. The changes found were: 1. There was a significant increase in percentages of CD3+, CD29+ CD4+ cells and CD4/CD8 ratio and a significant decrease in percentages of CD8+ and CD16,56+ cells in patients who had never been treated with any immune therapy. 2. After Tx or GC therapy, CD3+ and CD4+, CD29+ cells were decreased, but the number CD19+ and CD16, CD56 cells did not change. 3. Tx had a special effect on CD8+ cells. In most of the patients who showed clinical improvement after Tx, CD8+ cells were increased and CD4/CD8 ratio wad decreased. 4. Anti-acetylcholine receptor (AChRAb) titers were markedly decreased after GC therapy. These results indicate that there were obvious abnormalities in cell-mediated immunity in addition to those in humoral immunity in myasthenia gravis. These abnormalities tended to be normalized after Tx or GC therapy.

Adolescent↗
PubMed1995

[Relationship between thymectomy and syndrome differentiation-typing treatment of myasthenia gravis].

According to the theory of traditional Chinese medicine, 37 patients suffering from myasthenia gravis were Syndrome-differentiated into following types preoperationally: (1) Both Qi-Yin Deficiency of Kidney-Spleen, 21 cases. (2) Yang Deficiency of Kidney-Spleen, 15 cases. (3) Qi Deficiency of Spleen only, one case. Thymectomy were done in all cases. Among them, 19 cases had thymoma. The results showed the relationship between the types and the resectionability rate and post-operative crisis rate. On the first two types, they were 95.2% and 9.5%, 46.7% and 73.3% respectively. It was considered that Syndrome differentiation-typing in TCM in the myasthenia gravis patients would provide an positive and reliable index for predicting the resectionability and prognosis of the patient.

Adolescent↗
PubMed1977

[Appearance of nuclear formations of the "drumstick" type in neutrophilic leukocytes under the influence of neonatal thymectomy in male-rats].

The morphology of nuclei of neutrophil luecocytes was studied in neonatally thymectomized Wistar rats. In thymectomized males, the number of neutrophils with "drumsticks" increased up to 5.9 for 500 neutrophils counted, whereas no such changes were observed in females. The contents of "drumsticks" in neutrophils of the intact Wistar rats was shown to be equal in males and females therefore unfitting for sex identification. The neonatal thymectomy did not influence and absolute quantity of neutrophils but led to a greater segmentation index of the nucleus.

Animals↗
PubMedDate not supplied

Effects of thymectomy on blood neutrophils phagocytic activity and phagocytic response in mice.

The role of the thymus in maintenance of the basal phagocytosis of blood neutrophils and eliciting the phagocytic response, induced by i.v. Escherichia coli, was studied in 9 NMRI thymectomized and in 12 control mice. Thymectomy depresses the percentage of phagocyting neutrophils from 70.91 +/- 0.9 (mean +/- SEM) in controls, to 61.49 +/- 2.33 in the thymectomized rats. Phagocytic activity, as assessed by the number of bacteria engulfed by 100 neutrophils, was also lower in thymectomized mice (114.42 +/- 7.52) than in controls (163.71 +/- 4.53). A phagocytic response to i.v. Escherichia coli could nevertheless be noted in thymectomized mice, their phagocytic activity rising from the basal activity of 114.42 +/- 7.52 to 142.19 +/- 5.40 three hours after injection of Escherichia coli, while in control animals this activity rose from 163.71 +/- 4.53 to 216.46 +/- 12.91. These results may, at least partially, explain the recurrent infections and the septicemia occurring in children with Down's syndrome. It is suggested that the thymus, as an endocrine organ, may be involved in maintaining the basal phagocytic activity of blood neutrophils, while the phagocytic response is modulated by extrathymic mechanisms.

Animals↗
PubMed1977

[Effect of thymus extract and late thymectomy on interferon generation].

No production of interferon was observed in ten-day mice in response to the injection of the Newcastle disease virus. Single injection of the calf thymus extract fraction obtained by the method of Gujlling et al. to newborn mice induced the capacity of interferon genesis in the animals at the age of ten days. Adult rats produced interferon in response to Newcastle disease virus. The intensity of interferon synthesis was unaltered 2 to 3 months after thymectomy.

Animals↗
PubMed1976

[Thymectomy in myasthenia gravis (author's transl)].

10 myasthenia patients were treated surgically during a four year period, 1970 TO 1973. Thymectomy was only resorted to in the most severe cases of the disease. A sternum splitting incision was preferred. Postoperative diffculties were usually avoided by routine use of a volume-controlled respirator. Oro-tracheal intubation was preferred to tracheostomy in order to avoid infection. In 9 patients it was possible to reduce the daily dose of medicine. Clinical improvement, sometimes delayed, occurred in 8 patients. All the patients had been incapacitated preoperatively but in 6 cases they were able to return to work. The mortality rate was nil. There was one case of postoperative pneumonia and one delayed sternal union.

Evaluation Studies as Topic↗
PubMed1997

[Survival of patients with myasthenia gravis after thymectomy. Analysis of 100 cases].

In order to evaluate the survival of patients with myasthenia gravis (MG) after thymectomy (T), 100 patients with MG in which T had been performed between 1967 and 1995 were studied. Patients were divided into different groups for their analysis: patients with thymoma (TI), 22 cases; and patients without thymoma (NTI), 78 cases. In addition those patients belonging to the latter group were further separated according to the date of their surgery into two other subgroups: patients operated before 1980 (A80), 43 cases; and after 1980 (D80), 35 cases; trying to evaluate the prognostic implications of the therapeutical advances achieved over the last 15 years. The population studied was composed mainly of women (78%) but with a slight predominance of men in TI. The mean age was 29.47 years (range 10-70) for the entire population, with a tendency toward older ages in TI (mean 46 years, range 23-70). The mean follow-up period was 4.3 years (range 0.08-23.2) without significant differences between TI and NTI. The results showed that the overall mortality rate was 16/100 (16%) [Fig. 1], with nine of those deaths corresponding to TI (9/22, 40.91%) and only the remaining seven to NTI (7/78, 8.97%). These differences in mortality rate between TI and NTI were statistically significant in all the specific times of follow-up analyzed up to 10 years after surgery (p < 0.05) [Fig. 2]. Notoriously, all deaths in NTI occurred in the A80 subgroup giving a p value < 0.001 when compared with D80 [Fig. 3]. In terms of morbidity, 55/100 (55%) reached complete clinical remission (CCR) defined by the complete absence of symptoms related to MG: 8/22 (36.36%) in TI and 47/78 (60.25%) in NTI [Fig. 4]. Most interestingly the differences were statistically significant (p < 0.01) when the rates of CCR in A80 and D80 were compared for all the times assessed [Fig. 5-6-7-8]. It can be concluded that the best results in survival in MG after T are obtained in patients without thymoma and also that the benefits of the rational use of modern therapeutic modalities, including surgery and immunosuppression with drugs, can offer those patients high possibilities of leading completely normal lives.

Adolescent↗
PubMed1976

Effect of fetal thymectomy on IgG, IgM, and IgA concentrations in sheep.

Serum concentrations of immunoglobulins (Ig) IgG, IgG, IgM, and IgA were compared for normal and thymectomized lambs. Fetal thymectomies were performed in utero from 55 to 67 days of gestation. High serum IgG, IgM, and IgA concentrations occurred in all lambs after they ingested colostrum; however, the concentration of these Ig, as measured by single radial immunodiffusion, decreased exponentially during the first 16 days after birth. The half-life values for IgG, IgM, and IgA during this period in both normal and thymectomized lambs were about 25, 6, and 2 days, respectively. Increasing amounts of IgG were not detected in the serums of either group until 1 month of age. At 64 to 128 days, significantly smaller quantities of IgG and IgG were found in thymectomized lambs, whereas concentrations of IgA and IgM were similar in both groups. The results indicate that the thymus may regulate production of IgG in sheep.

Animals↗
PubMed1978

[T-Lymphocyte regulation of contact sensitivity: effect of thymectomy in adult mice].

6 weeks after adult thymectomy (ATx) in the Mouse, the contact sensitivity reaction to dinitrofluorobenzene (DNFB) is enhanced. 4 to 7 months after ATx, this reaction is deeply, but incompletely depressed, whereas the concomitant antibody response is not affected. These results suggest that both a suppressor, and an amplifier, T lymphocytes, the life span of which is different after ATx, are involved in the regulation of contact sensitivity. The effect of circulating thymic factor on this reaction suggests that this factor acts exclusively, at least in short treatments, on the suppressor function.

Animals↗
PubMed1981

Genetic susceptibility to post-thymectomy autoimmune diseases in mice.

The strain distribution pattern of five different post-thymectomy autoimmune diseases was determined in 21 inbred and two congenic, resistant strains of mice. The results indicated that susceptibility genes outside the H-2 complex may be involved in the development of localized autoimmune diseases in neonatally thymectomized mice. Studies of recombinant inbred strains also showed that susceptibility to gastritis was not associated with the H-2 haplotype but appeared to be influenced by a minor histocompatibility locus. Possible linkage to the H-2 complex was suggested only in the development of coagulating gland adenitis. Although one experiment showed that susceptibility to orchitis and coagulating gland adenitis was inherited as a recessive trait, further studies are required to determine the exact mode of inheritance in each disease system.

Animals↗