Thymomas are rare tumours which generally account for only 0.2 – 1.5% of mediastinal tumours in adults. Around 40% of patients present with systemic symptoms such as motor weakness due to myasthenia gravis (MG), pure red cell aplasia, and hypogammaglobulinemia. Based on recent guidelines, management of advanced thymoma uses a multimodal approach, which is thymectomy followed by radiotherapy, but not all health care centers have radiotherapy facilities. A 52-year-old woman presented with nasal voice and had difficulty swallowing food. Patient was diagnosed with myasthenia gravis (MG). CT scan with contrast of the thorax showed a heterogenous solid mass in anterior mediastinum. Histopathological examination showed thymoma type B2. Thymectomy followed by seven cycles of platinum-based chemotherapy were done on the patient. Evaluation afterward showed complete remission of thymoma. The patient’s motor weakness improved after the chemotherapy. Post-chemotherapy period was uneventful at six months on follow-up visit. The dosage of acetylcholinesterase inhibitor drug is reduced periodically due to improvement in motor weakness. The case emphasizes how to manage an advanced thymoma with MG with limited therapeutic options, and the importance of multidisciplinary management involving oncologists, surgeons, and neurologists.
Thymoma ; Myasthenia Gravis ; Drug Therapy ; Thymectomy

OBJECTIVE: To compare the clinical efficacy between acupuncture combined with western medication and simple western medication for ocular myasthenia gravis (OMG), and to explore its possible mechanism. METHODS: A total of 60 patients of ocular myasthenia gravis were randomized into an acupuncture combined with western medication group (30 cases, 1 case dropped off) and a western medication group (30 cases, 2 cases dropped off). Oral pyridostigmine bromide tablet and prednisone acetate tablet were given in the western medication group. On the basis of the treatment in the western medication group, Tongdu Tiaoqi acupuncture (acupuncture for unblocking the governor vessel and regulating qi ) was applied at Baihui (GV 20), Fengfu (GV 16), Hegu (LI 4), Zusanli (ST 36), etc. in the acupuncture combined with western medication group, once a day, 6 days a week. The treatment was given 8 weeks in both groups. Before and after treatment, the OMG clinical absolute score was observed, electrophysiological indexes of orbicularis oculi (value of mean jitter, percentage of jitter >55 μs and percentage of blocks) were measured by single-fiber electromyography (SFEMG), serum levels of acetylcholine receptor antibody (AChR-Ab), interferon-gamma (IFN-γ) and interleukin-4 (IL-4) were detected by ELISA method. RESULTS: After treatment, the OMG clinical absolute scores, values of mean jitter, percentages of jitter >55 μs, percentages of blocks and serum levels of AChR-Ab, IFN-γ and IL-4 were decreased compared before treatment in both groups (P<0.05), and those in the acupuncture combined with western medication group were lower than the western medication group (P<0.05). CONCLUSION Acupuncture combined with western medication can effectively improve ptosis, palpebra superior fatigability, eye movement disorder and neuromuscular junction dysfunction in patients with ocular myasthenia gravis, the therapeutic effect is superior to simple western medication. Its mechanism may be related to down-regulating serum levels of AChR-Ab, IFN-γ and IL-4 and promoting the recovery of orbicularis oculi function.
Acupuncture Therapy ; Facial Muscles ; Humans ; Interferon-gamma ; Interleukin-4 ; Myasthenia Gravis/drug therapy*

Between January 1986 and December 1995, 24 patients were treated surgically for thymoma. There were 17 males and 7 females, and their ages ranged from 23 to 69 years old and mean age was 49 years. Thymomas were associated with fourteen my asthenia gravis, and classified histologically as lymphocytic in 12 patients, mixed in 8, epithelial in 4, and classified clinically as stage I in 11, stage II in 4, stage III in 8 and stage VI in 1 patient. Eleven patients with non-invasive thymoma had received surgical resection, and 10 out of 13 patients with invasive thymoma were able to undergo complete resection. A partial resection or tissue biopsy followed by radiation or chemotherapy was done with the remaining three patients. Three died, four had improvement of symptom, two had relapse and fifteen had no symptom during follow up ranged from 25 days to 60 months. In fourteen cases of thymoma with myasthenia gravis, one died due to myasthenic crisis, two showed symptom aggravation, six had less medical treatment and five patients had medical treatment as same as dosage received preoperatively.
Aged ; Asthenia ; Biopsy ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Myasthenia Gravis ; Recurrence ; Thymoma*

In a case of 46-year-old woman suffering from schizophrenia for over 20 years, she experienced frequent episodes of dyspnea and confirmed as superimposed with myasthenia gravis (MG). Throughout the seven-year follow-up period, after diagnosed as MG, she has been hospitalized 6 times and also diagnosed as colorectal cancer. Authors experienced various conditions associated with untoward effects of medication for myasthenia, schizophrenia, and colorectal cancer. Therefore, authors reported considerations for the pharmacotherapy of schizophrenia with myasthenia gravis.
Colorectal Neoplasms* ; Drug Therapy ; Dyspnea ; Female ; Follow-Up Studies* ; Humans ; Middle Aged ; Myasthenia Gravis* ; Schizophrenia*

Though thymoma is considered benign in a histopathologic specimen, its unusual behavior makes it important for surgeons to manage this neoplasm as cancerous lesion. Hence we clinically analysed the surgical cases of thymoma in our hospital, and we suggest the risk factors for its prognosis. From January 1987 to December 1994, we experienced 41 surgical cases of thymoma, excluding thymic carcinoma and cysts. There were 21 male and 20 female; age ranged from 16 to 64 years. Among them, myasthenia gravis was present in 22 patients (53.7%). Surgical treatment consisted of complete resection in 31 patients, partial resection in 7 patients, and biopsy only in 3 patients. According to Masaoka's classification, there were 27 patients in stage I, 4 patients in stage II, and 10 patients in stage III. Histopathology was of epithelial type in 14 patients, lymphocytic type in 11, and mixed type in 19. Eleven patients had adjuvant radiotherapy, chemotherapy, or both and there was no surgical mortality. Postoperative follow-up ranged from 1 to 88 months (mean 36 months) and three patients died and 5 patients suffered recurrences during the follow-up period. Postoperative risk factors were advanced Masaoka stage, invasiveness, and surgical method.
Biopsy ; Classification ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Mortality ; Myasthenia Gravis ; Prognosis ; Radiotherapy, Adjuvant ; Recurrence ; Risk Factors* ; Thymoma*

OBJECTIVE: To evaluate the efficacy and safety of tacrolimus in the treatment of children with myasthenia gravis (MG). METHODS: A total of 28 children with MG were treated with tacrolimus. MG-Activities of Daily Living (MG-ADL) scale was used to assess clinical outcome and safety after 1, 3, 6, 9, and 12 months of treatment. RESULTS: After tacrolimus treatment, the MG-ADL score at 1, 3, 6, 9 and 12 months was lower than that at baseline (P<0.05), and the MG-ADL score showed a gradually decreasing trend. The response rates to tacrolimus treatment at 1, 3, 6, 9, and 12 months were 59%, 81%, 84%, 88%, and 88% respectively. At 6, 9, 12, and 18 months of treatment, 4, 13, 14, and 15 children respectively were withdrawn from prednisone. No recurrence was observed during treatment. Major adverse reactions/events were asymptomatic reduction in blood magnesium in 5 children and positive urine occult blood in 1 child, which turned negative without special treatment, and tacrolimus was not stopped due to such adverse reactions/events. One child was withdrawn from tacrolimus due to recurrent vomiting. According to CYP3A5 genotypes, all of the patients were divided into two groups: slow metabolic type (n=19) and non-slow metabolic type (fast metabolic type + intermediate type; n=9). The non-slow metabolism group received a higher dose of tacrolimus, but had a lower trough concentration of tacrolimus than the slow metabolism group (P<0.05). The slow metabolism group had a higher response rates to tacrolimus treatment than the non-slow metabolism group (P<0.05). CONCLUSIONS Tacrolimus appears to be effective and safe in the treatment of children with MG and is thus an option for immunosuppressive therapy. CYP3A5 genotyping has a certain guiding significance for determining the dosage of tacrolimus.
Activities of Daily Living ; Child ; Humans ; Immunosuppressive Agents ; Myasthenia Gravis ; drug therapy ; Neoplasm Recurrence, Local ; Tacrolimus ; therapeutic use

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Male ; Middle Aged ; Myasthenia Gravis ; drug therapy ; therapy ; Young Adult

PURPOSE: In order to make an accurate diagnosis, we investigated clinical manifestations and ocular findings in children with ocular myasthenia gravis that can be easily misdiagnosed. METHODS: The medical records of 7 boys and 18 girls under the age of 15 years with ocular myasthenia gravis were reviewed retrospectively. The mean follow-up period was 37 months. RESULTS: The mean age at onset was 37 months. Ptosis was found in 22 patients(88%), strabismus in 21 patients(84%) and amblyopia in 5 patients(20%). Exotropia combined with vertical heterotropia was the most frequent type of strabismus. Ocular motility abnormality was found in 17 patients(68%). The limitation of supraduction or infraduction was most frequently observed. The manifestations of strabismus and ocular motility abnormality were variable and frequently changed during follow-up period. Prednisolone was used more often than pyridostigmine as a maintenance therapy. Ptosis was more responsive to drug therapy than strabismus. CONCLUSIONS: The main ocular findings in ocular myasthenic children were ptosis and exotropia that was not commonly found in Caucasian children. Vertical heterotropia as well as ptosis were commonly accompanied with the horizontal heterotropia. The type and angle of strabismus as well as ocular motility in duction/version were variable during follow-up period
Amblyopia ; Child* ; Diagnosis ; Drug Therapy ; Exotropia ; Female ; Follow-Up Studies ; Humans ; Medical Records ; Myasthenia Gravis* ; Prednisolone ; Pyridostigmine Bromide ; Retrospective Studies ; Strabismus

OBJECTIVETo observe the efficacy of Yiqi Qushi Recipe (YQR) in treating myasthenia gravis (MG) patients and its effects on their immune functions.

METHODSRecruited were 40 type I and II MG patients from clinics and wards of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2009 to June 2011. They were randomly assigned to the treatment group (20 cases) and the control group (20 cases). Patients in the treatment group took YQR, one dose daily, while those in the control group took pyridostigmine 60 mg, three times a day. The therapeutic course consisted of eight weeks. The clinical efficacy, immunization indicators before and after treatment were observed. Meanwhile, the safety evaluation was performed.

RESULTSThe cured and effective rate was 75% and the total effective rate was 95% in the treatment group. They were 45% and 85% in the control group. Better results were obtained in the treatment group. Compared with the same group before treatment, IgA, IgG, and CD8 increased, IgM, CD4, and CD4/CD8 decreased in the treatment group, showing statistical difference (P < 0.05). There was no obvious change in each index of the control group after treatment (P > 0.05). Compared with the control group after treatment, IgA, IgG, and CD8 increased, CD4 and CD4/CD8 decreased in the treatment group, showing statistical difference (P < 0.05). During the course of treatment, mild diarrhea, nausea, and vomit occurred in two patients of the control group, while no adverse reaction occurred in those of the treatment group.

CONCLUSIONYQR could significantly improve clinical symptoms of MG patients, regulate their immune functions, with no obvious adverse reaction.

Adult ; CD4-CD8 Ratio ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Immunoglobulin A ; immunology ; Immunoglobulin G ; immunology ; Male ; Middle Aged ; Myasthenia Gravis ; drug therapy ; immunology ; Phytotherapy ; Young Adult

Hyperthyroidism may be associated or present with a variety of neuromuscular disorders, including thyrotoxic myopathy, exophthalmic ophthalmoplegia, periodic paralysis and myasthenia gravis. In contrast to muscle, peripheral nerve involvement in hyperthyroidism is exceedingly rare, and has received little attention. Paraplegia-like weakness during severe hyperthyroidism was first described by Charcot in 1889, and called Basedow's paraplegia' by Joffory in 1894. However, there has been no reported case in Korea. A 38-year-old woman was admitted for evaluation of progressive weakness and a gait disturbance. Her endocrinological results were compatible with hyperthyroidism. The polyneuropathy was also confirmed with sequential electrophysiological studies of the nerves and muscles. Drug therapy for hyperthyroidism resulted in resolution of the clinical neurological symptoms and progressive improvement of electrophysiological findings. Hyperthyroidisms are common medical disorders, which are often accompanied by diverse types of neurological and neuromuscular dysfunctions. All of these neurological manifestations are important, as they can serve as important clues to the diagnosis of a thyroid disorder. Furthermore, they are often related to the patient's presenting complaint. Therefore, the physician must be alert to the diverse manifestations of thyroid dysfunction, as they can lead to the diagnosis of potentially serious but treatable disorders. Herein is reported a case of myopathy and neuropathy associated with hyperthyroidism (Basedow's paraplegia), with a review of the literature
Adult ; Diagnosis ; Drug Therapy ; Female ; Gait ; Humans ; Hyperthyroidism ; Korea ; Muscles ; Muscular Diseases ; Myasthenia Gravis ; Neurologic Manifestations ; Ophthalmoplegia ; Paralysis ; Paraplegia* ; Peripheral Nerves ; Polyneuropathies ; Thyroid Gland