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SYNOPSISThe clinical and thymic histological features of 23 patients who underwent thymectomy for myasthenia gravis have been examined and compared. Eighty-two per cent of patients with a nonneoplastic gland containing numerous germinal centres improved postoperatively, whereas 83% of patients with a non-neoplastic gland containing no germinal centres deteriorated or died. Glands with only slight involution and containing numerous germinal centres were more commonly seen in young female patients. The evidence relating thymic histological appearances with the postoperative progress of patients with myasthenia gravis is reviewed.An association between myasthenia gravis and the thymus gland was first suggested by Weigert in 1901. Although Schumacher and Roth (1913) reported the clinical improvement of a patient with myasthenia after removal of an enlarged non-neoplastic gland, it was not until the reports of Blalock et al. (1939) and Keynes (1949) that the beneficial effect of thymectomy was fully appreciated. Keynes concluded that, although the connection between myasthenia and abnormalities of the thymus gland was well established, there was no clue to how or why the gland acquired its abnormal function.Only recently have the histological appearances of the thymus gland and their relation to the clinical progress of patients after thymectomy received greater attention (Castleman and Norris, 1949;Mackay et al., 1968;Alpert et al., 1971;Seybold et al., 1971;Reinglass and Brickel, 1973;Vetters and Simpson, 1974). Opinions have varied from a clearly demonstrable association between thymic hyperplasia and postoperative improvement to a complete dissociation of these two parameters. It therefore seemed appropriate to make a clinical and pathological study of 23 myasthenic patients who had undergone thymectomy at the Manchester Royal Infirmary during the past 10 years. (Accepted 14 August 1975.) 38 METHODS PATIENTS Twenty-three patients with myasthenia gravis underwent thymectomy. Surgery was performed because of either increasing weakness despite treatment with anticholinesterases and in some cases steroids (19 patients) or the presence of a thymoma (four patients). At the time of operation all patients had evidence of ocular, bulbar, and limb weakness.The average age at onset of symptoms of patients without a thymoma was 32.6 years (range, 16-68 years) and the mean duration of symptoms before thymectomy was 4.9 years. The sex distribution showed a predominance of females with a ratio of 2.2: 1. Patients with a thymoma developed symptoms at 39, 49, 56, and 65 years and the mean preoperative duration of symptoms was 1.0 year. Three of these patients were male.HISTOLOGY Haematoxylin and eosin stained sections from all the paraffin blocks from each surgical section were examined by one of the authors (H.R.) without knowledge of the clinical details. The average number of sections to each specimen was three with a range of two to 10. The criteria used for assessment included the degree of gland involution, the overall ...

In this multicentre study a controlledrelease formulation of levodopa and the decarboxylase inhibitor benserazide (Madopar CR) was evaluated in patients with Parkinson's disease exhibiting doserelated fluctuations in motor performance in response to conventional levodopa preparations. The effect of Madopar CR, with or without conventional levodopa/benserazide, on the proportion of time spent "on", "off" or "intermediate" was compared with that ofprevious conventional levodopa/decarboxylase inhibitor therapy. Evaluation of the two periods of optimum therapy was based on both patient diary data and investigator opinion. Forty seven patients completed the study but full patient diaries were available for only 37. The mean optimum total daily dosage of conventional Madopar was 820 mg taken in a mean of 6-4 doses, compared with a mean optimum daily dosage of combined Madopar CR and conventional Madopar of 1088 mg, taken in a mean of 5 2 doses. Conventional Madopar was taken in addition to Madopar CR in all but eight patients. Madopar CR was felt to be advantageous in 83% and disadvantageous in 11% of patients completing the study. Considering the 37 patients for whom diary data were available, Madopar CR therapy resulted in an increase in the mean time spent "on" (p = 0-016) and a decrease in the mean time spent "off" (p = 0-029) compared with conventional Madopar alone. Individually 25 out of 37 had an increase in "on" time and 19 out of 37 experienced a decrease in "off" time. Thus Madopar CR was found to be beneficial in a significant proportion of patients experiencing fluctuations in response to conventional levodopa.