Decade-long experience with surgical therapy of myasthenia gravis: early complications of 324 transsternal thymectomies

Kas, József; Kiss, Dorottya; Simon, Veronika; Svastics, E; Major, László; Szobor, A

doi:10.1016/s0003-4975(01)03080-6

Cited by 71 publications

(43 citation statements)

References 31 publications

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“…58 A multicenter, single-blind, randomized controlled trial is currently investigating the benefit of thymectomy in non-thymomatous MG. 59 Postoperative myasthenic crisis is common after thymectomy; the incidence ranges from 12% to 34%. 60,61 Postoperative crisis in these patients has been related to a history of myasthenic crisis, preoperative presence of bulbar weakness, preoperative serum AChR antibody levels >100 nmol/L, and intraoperative blood loss of >1 L. 61 …”

Section: Thymectomymentioning

confidence: 99%

Myasthenic Crisis

Wendell

Levine²

2011

The Neurohospitalist

191

193

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Myasthenic crisis is a complication of myasthenia gravis characterized by worsening of muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation. Advances in critical care have improved the mortality rate associated with myasthenic crisis. This article reviews the epidemiology of myasthenic crisis and discusses patient evaluation. Therapeutic options including mechanical ventilation and pharmacological and surgical treatments are also discussed.

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Section: Thymectomymentioning

confidence: 99%

Myasthenic Crisis

Wendell

Levine²

2011

The Neurohospitalist

191

193

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“…Pathologically, MG is based on the generation of acetylcholine receptor antibodies which reduce the number of acetylcholine receptors. However, the amount of acetylcholine receptor antibodies in serum does not necessarily indicate the severity of MG (1)(2)(3). Approximately 90% of MG patients are concurrent with thymoma or thymus hyperplasia.…”

Section: Introductionmentioning

confidence: 99%

Effects of General-epidural Anaesthesia on the Hemodynamics in Patients with Myasthenia Gravis

et al. 2015

West Indian Med J

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“…However, these treatment methods can cause serious side effects, such as pneumonia or vascular infarction. The reported incidence of PRI varies, but can be as high as 30-50% [1,2,3]. Preoperative treatment with steroids was previously reported to decrease the risk of PRI (table 1) [1,2,3,4,5,6,7,8,9,10,11] but detailed information on the use of steroids is very limited.…”

Section: Introductionmentioning

confidence: 99%

“…The reported incidence of PRI varies, but can be as high as 30-50% [1,2,3]. Preoperative treatment with steroids was previously reported to decrease the risk of PRI (table 1) [1,2,3,4,5,6,7,8,9,10,11] but detailed information on the use of steroids is very limited. Previous studies administered high doses of steroids (80-120 mg) daily or on alternate days before thymectomy [4,5,6,7,11] and included patients with ocular MG [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies administered high doses of steroids (80-120 mg) daily or on alternate days before thymectomy [4,5,6,7,11] and included patients with ocular MG [5,6,7]. Many previous studies evaluating the usefulness of preoperative steroids (table 1) [1,4,5,6,7,8,9,10,11] included patients who received other preoperative treatments such as immunosuppressants, intravenous immunoglobulins, or plasmapheresis and showed that preoperative steroid use did not significantly decrease the risk of PRI [1,3,8,9]. Two studies showing that preoperative steroid use was significantly related to PRI included patients with ocular MG or patients who were given occasional steroid pulse therapy before thymectomy [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Preoperative Low-Dose Steroid Can Prevent Respiratory Insufficiency After Thymectomy in Generalized Myasthenia Gravis

Kataoka

Kiriyama²,

Kawaguchi³

et al. 2014

Eur Neurol

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Background: Postoperative respiratory insufficiency (PRI) in myasthenia gravis (MG) often occurs within several days after thymectomy and remains problematic. In limited studies reporting that preoperative steroids prevented PRI in patients with MG, high doses of steroids were used and detailed information on the use of steroids is limited. Because high-dose steroids significantly increase the risk of adverse effects, we studied 37 patients with generalized MG to investigate whether low-dose steroids might prevent PRI. Methods: The low-dose steroids were started orally, and the dose was gradually increased to the maximum level (30 mg/day). Immediately before thymectomy, patients received the maximum dose of oral steroids daily. PRI was defined as the development of restrictive dysfunction requiring mechanical ventilation within 3 days after thymectomy and total postoperative mechanical ventilation support time of >24 h. Results: The rate of PRI in the low-dose steroid use group was significantly lower than that in the no-steroid use group. The postoperative stay in the intensive care unit was shorter in the steroid use group. Conclusions: Extended thymectomy is a well-accepted surgical treatment for selected patients with MG. However, PRI remains problematic. Our results suggest that not only preoperative high-dose steroid treatment, but also low-dose steroid treatment can prevent PRI.

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Decade-long experience with surgical therapy of myasthenia gravis: early complications of 324 transsternal thymectomies

Cited by 71 publications

References 31 publications

Myasthenic Crisis

Myasthenic Crisis

Effects of General-epidural Anaesthesia on the Hemodynamics in Patients with Myasthenia Gravis

Preoperative Low-Dose Steroid Can Prevent Respiratory Insufficiency After Thymectomy in Generalized Myasthenia Gravis

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