No abstract available.
Thymectomy*

Two cases of thymic tumors are presented, one cystic and the other solid. In neither case was a complete removal possible and both were subjected to post-operative irradiation. Although weakness was present in both patients, we incline to the belief that these tumors were not associated with myasthenia gravisThe literature is briefly reviewed and some general observations made. Thymic tumors associated with myasthenia gravis differ in no way from those with no such association. Diagnosis is difficult and can not be made unless myasthenia co-exists. Pleural pain is a sign of grave import as it may mean pleural implants. Thymoma are, as a rule, slow growing and spread more by invasion, although there have been reports of thyroid and pulmonary metastases. Roentgen studies for these tumors should include both PA and lateral views. In those fatal cases associated with myesthenia gravis, the cause of death was the myesthenia. In those with no myesthenia gravis, the tumor itself was usually fatal. Since they cannot be regarded as innocent and no accurate diagnosis can be made outside of histological examinations, exploratory thoracotomy is definitely urged for those patients with anterior superior mediasinal shadowsDeep x-ray may be of benefit for patients with ineradicable tumors. (Summary and Conclusion)
Thymectomy

The etiology, diagnosis, and treatment of mysthenia gravis is discussed; and a case involving the muscles of phonation and deglutition, admitted into the North General Hospital, Manila on January 30, 1947, is presentedThe use and value of the prostigmin test as a confirmatory diagnostic test was demonstrated on the basis of the chemical mediation theory of transmission of nerve impulse to effector muscle. The prostisin is assumed to inhibit the action of cholinesterase in splitting acetylcholine by hydrolysis into choline and acetic acid, thus allowing the acetylcholine to remain at the myoneural junction and making possible the efficient transmission of nerve impulseLikewise, treatment using prostigmin is based on the same premise. The amount of the drug necessary varies greatly. The initial and maintenance doses of prostigmin depend on the individual case. The amount given is just enough to bring relief, and it is calculated after an observation study period. Three other drugs are mentioned in the treatment--ephedrine sulfate, potassium chloride, and guanidine hydrochloride; but their use has been overshadowed by prostigminThe role of thymectomy in the treatment of myasthenia gravis has been gaining headway in the past few years. Statistics presented by advocates of this form of therapy, although meager, are rather encouraging. However, more time, experience, and investigate work will be required before the exact causal association between myasthenia gravis and thymus pathology can be determined and the value of thymectomy ascertainedPregnancy is said to make the condition of myasthenia gravis patients worse. Some workers, for this reason advise longer spacing of gestation or even advocate total prevention of pregnancy in severe cases. In those afflicted case with concomitant malarial infection, it is not amiss here to point out that quinine should not be given in treating the latter disease, lest the quinine may aggravate the former condition.(Summary)
Thymectomy, Deglutition

No abstract available.
Myasthenia Gravis* ; Thymectomy*

This study was performed to observe the effectiveness of thymectomy in the management of myasthenia gravis. Twenty-seven myasthenic patients were undergone thymectomy at Keimyung University Dongsan Hospital between January 1981 and December 1990. The most prevalent age group was the 3rd decade and the myasthenic syrnptom developed below thirty in most. Seven patients had remission and 10 patients fared better after thymectomy. There was no significant effect with age and duration of the disease in the result of thymectomy. Those with less severe group had better response than more severe group and non-thymoma group had higher remission rate without statistical significance than thymoma group. There were better response and more complications in the group with maximal thymectomy than simple thymectomy. This study demonstrated that the effect of thymectomy was better in less severe, nontymoma and maximal thymectomy group in myasthenia gravis.
Humans ; Myasthenia Gravis* ; Thymectomy* ; Thymoma

This study was performed to evaluate the titer of serum acetylcholine receptor antibody (AChR-Ab), the correlation between AChR-Ab titer and clinical state, clinical response to thymectomy and histopathologic finding of thymus in myasthenia gravis. Twenty-seven patients with various clinical grades of myasthenia gravis and twenty-three norrnal controls were included in this study. Mean AChR-Ab titers were 4.21+4.27nM in myasthenia gravis and 0.05+0.06nM in control group(p<0.05). Mean AChR-Ab titers of each clinical grade were 0.80+1.67nM in grade I, 5.05+3.42nN in grade Iia, 8.37+4.50nM in grade Iib, 6.67nM in grade m and 10.89nM in grade IV. There were significant correlation between clinical grade and level of AChR-AB titer. There were no correlation between degree of clinical improvement and changes of serum AChR-Ab titer after thymectomy in myasthenia gravis. There were also no correlation between level of AChR-Ab titers and histopathologic findings of thymus.
Acetylcholine ; Humans ; Myasthenia Gravis* ; Thymectomy ; Thymus Gland

This study was performed to evaluate the titer of serum acetylcholine receptor antibody (AChR-Ab), the correlation between AChR-Ab titer and clinical state, clinical response to thymectomy and histopathologic finding of thymus in myasthenia gravis. Twenty-seven patients with various clinical grades of myasthenia gravis and twenty-three norrnal controls were included in this study. Mean AChR-Ab titers were 4.21+4.27nM in myasthenia gravis and 0.05+0.06nM in control group(p<0.05). Mean AChR-Ab titers of each clinical grade were 0.80+1.67nM in grade I, 5.05+3.42nN in grade Iia, 8.37+4.50nM in grade Iib, 6.67nM in grade m and 10.89nM in grade IV. There were significant correlation between clinical grade and level of AChR-AB titer. There were no correlation between degree of clinical improvement and changes of serum AChR-Ab titer after thymectomy in myasthenia gravis. There were also no correlation between level of AChR-Ab titers and histopathologic findings of thymus.
Acetylcholine ; Humans ; Myasthenia Gravis* ; Thymectomy ; Thymus Gland

OBJECTIVE: To  report  a  case  of  tumoral  calcinosis  from  secondary hyperparathyroidism  and  to describe its surgical management.
METHODS:
 Design: Case Report
 Setting: Tertiary Public University Hospital
 Patient: One
RESULTS: A 34-year-old woman presented with progressively-enlarging bilateral upper extremity masses. Diagnostic tests revealed hyperfunctioning parathyroid glands. The patient underwent subtotal  parathyroidectomy,  right  thyroid  lobectomy  with  isthmusectomy,  and  transcervical thymectomy.    Follow-up  revealed  marked  decrease  in  parathyroid  hormone,  and  progressive resolution of the tumoral calcinosis.
CONCLUSION: Subtotal  parathyroidectomy  and  transcervical  thymectomy  have  a  role  in  the management  of  tumoral  calcinosis,  and  in  this  case  led  to  excellent  post-operative  results. The rare  presentation  of  secondary  hyperparathyroidism  and  intervention  in  this  patient  may  have potential lessons for future management of similar cases.

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

Anesthesiologists have a particular interest in myasthenia gravis, since they may need to provide anesthesia for thymectomy or other surgery, or they may have to be involved in the treatment of respiratory failure which mar complicate this disease. We report a case of balanced anesthesia, using thalamonal-N2O-O2 for thymectomy in myasthenia gravis, which posed no postoperative respiratory problem.
Anesthesia ; Balanced Anesthesia* ; Myasthenia Gravis* ; Respiratory Insufficiency ; Thymectomy*