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. 1987 Mar;42(3):199–204. doi: 10.1136/thx.42.3.199

Surgical treatment for myasthenia gravis.

T J Otto, H Strugalska
PMCID: PMC460689  PMID: 3616980

Abstract

A new surgical technique for thymectomy is presented. Three hundred and seventeen patients with myasthenia gravis and 20 with thymomas who had myasthenic symptoms were operated on. The new surgical approach--a small transverse sternotomy--was used in 257 cases (in 240 patients with myasthenia gravis and 17 with thymomas) and conventional median sternotomy in 80. In myasthenic patients small transverse sternotomy enabled radical thymectomy to be performed with an uneventful postoperative course and very good cosmetic results. There were no hospital deaths among patients with myasthenia gravis after thymectomy. The long term results, assessed after 18-24 months, were good: the total remission rate was 39.5%, and there was a great improvement in 48.5% and an improvement in 9%. After thymectomy about 30% of patients received supplementary treatment with prednisone. A correlation between the duration of symptoms and the result of thymectomy was established: the shorter the duration of myasthenia gravis the better the results. In the small group of 20 patients with thymomas two died in hospital. In 12 patients with encapsulated thymic tumours the long term results were similar to those in patients with myasthenia gravis, whereas in patients with infiltrating thymic tumours the results were unsatisfactory.

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Selected References

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  1. Bergh N. P., Gatzinsky P., Larsson S., Lundin P., Ridell B. Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas. Ann Thorac Surg. 1978 Feb;25(2):91–98. doi: 10.1016/s0003-4975(10)63498-4. [DOI] [PubMed] [Google Scholar]
  2. Cohn H. E., Solit R. W., Schatz N. J., Schlezinger N. Surgical treatment in myasthenia gravis. A 27 year experience. J Thorac Cardiovasc Surg. 1974 Dec;68(6):876–885. [PubMed] [Google Scholar]
  3. Crile G., Jr Thymectomy through the neck. Surgery. 1966 Feb;59(2):213–215. [PubMed] [Google Scholar]
  4. Czyzewski K., Pudelski J., Dzielicki J., Guzy R. Zaburzenia czynności oddechowej w nastepstwie urazów klatki piersiowej. Pol Przegl Chir. 1979 Jan;51(1):1–6. [PubMed] [Google Scholar]
  5. EATON L. M., CLAGETT O. T. Present status of thymectomy in treatment of myasthenia gravis. Am J Med. 1955 Nov;19(5):703–717. doi: 10.1016/s0002-9343(55)80012-5. [DOI] [PubMed] [Google Scholar]
  6. Faulkner S. L., Ehyai A., Fisher R. D., Fenichel G. M., Bender H. W., Jr Contemporary management of myasthenia gravis: the clinical role of thymectomy. Ann Thorac Surg. 1977 Apr;23(4):348–352. doi: 10.1016/s0003-4975(10)64139-2. [DOI] [PubMed] [Google Scholar]
  7. Jaretzki A., 3rd, Bethea M., Wolff M., Olarte M. R., Lovelace R. E., Penn A. S., Rowland L. A rational approach to total thymectomy in the treatment of myasthenia gravis. Ann Thorac Surg. 1977 Aug;24(2):120–130. doi: 10.1016/s0003-4975(10)63720-4. [DOI] [PubMed] [Google Scholar]
  8. KEYNES G. The results of thymectomy in myasthenia gravis. Br Med J. 1949 Sep 17;2(4628):611–616. doi: 10.1136/bmj.2.4628.611. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kirschner P. A., Osserman K. E., Kark A. E. Studies in myasthenia gravis. Transcervical total thymectomy. JAMA. 1969 Aug 11;209(6):906–910. [PubMed] [Google Scholar]
  10. Klingen G., Johansson L., Westerholm C. J., Sundstroöm C. Transcervical thymectomy with the aid of mediastinoscopy for myasthenia gravis: eight years' experience. Ann Thorac Surg. 1977 Apr;23(4):342–347. doi: 10.1016/s0003-4975(10)64138-0. [DOI] [PubMed] [Google Scholar]
  11. Osserman K. E., Genkins G. Studies in myasthenia gravis: review of a twenty-year experience in over 1200 patients. Mt Sinai J Med. 1971 Nov-Dec;38(6):497–537. [PubMed] [Google Scholar]
  12. Papatestas A. E., Alpert L. I., Osserman K. E., Osserman R. S., Kark A. E. Studies in myasthenia gravis: effects of thymectomy. Results on 185 patients with nonthymomatous and thymomatous myasthenia gravis, 1941-1969. Am J Med. 1971 Apr;50(4):465–474. doi: 10.1016/0002-9343(71)90336-6. [DOI] [PubMed] [Google Scholar]
  13. Papatestas A. E., Genkins G., Kornfeld P., Horowitz S., Kark A. E. Transcervical thymectomy in myasthenia gravis. Surg Gynecol Obstet. 1975 Apr;140(4):535–540. [PubMed] [Google Scholar]
  14. Perlo V. P., Arnason B., Poskanzer D., Castleman B., Schwab R. S., Osserman K. E., Papatestis A., Alpert L., Kark A. The role of thymectomy in the treatment of myasthenia gravis. Ann N Y Acad Sci. 1971 Sep 15;183:308–315. doi: 10.1111/j.1749-6632.1971.tb30761.x. [DOI] [PubMed] [Google Scholar]
  15. SIMPSON J. A. An evaluation of thymectomy in myasthenia gravis. Brain. 1958 Mar;81(1):112–144. doi: 10.1093/brain/81.1.112. [DOI] [PubMed] [Google Scholar]
  16. Warmolts J. R., Engel W. K. Benefit from alternate-day prednisone in myasthenia gravis. N Engl J Med. 1972 Jan 6;286(1):17–20. doi: 10.1056/NEJM197201062860104. [DOI] [PubMed] [Google Scholar]
  17. Wilkins E. W., Jr, Castleman B. Thymoma: a continuing survey at the Massachusetts General Hospital. Ann Thorac Surg. 1979 Sep;28(3):252–256. doi: 10.1016/s0003-4975(10)63114-1. [DOI] [PubMed] [Google Scholar]
  18. Wolfe W. G., Sealy W. C., Young W. G. Surgical management of myasthenia gravis. Ann Thorac Surg. 1972 Dec;14(6):645–649. doi: 10.1016/s0003-4975(10)65278-2. [DOI] [PubMed] [Google Scholar]

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