The Treatment of Myasthenia Gravis by Removal of the Thymus Gland

Blalock, Alfred; Harvey, A. McGehee; Ford, Frank R.; Lilienthal, J. L.

doi:10.1001/jama.1941.02820440037009

Cited by 197 publications

(96 citation statements)

References 5 publications

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“…The clinical histories of these patients have been recorded before (5 Trantsmiiissioni of paired maximtal stimuili; "the two-volley curve" In the niormiial subject, when two maximal stimuli, separated by a brief interval, are delivered to the motor nerve, the amplitudes of the corresponding muscle action potentials are equal (6). In these patients with severe myasthenia gravis, a dlepressioni of neuromuscular tranismission, induced by the passage of the first volley across the unllctionl, lhad resulted in a declinie in the voltage of the second(I responise of the pair (Figure 2A) (11,7).…”

Section: Methodsmentioning

confidence: 99%

Observations on the Nature of Myasthenia Gravis. The Effect of Thymectomy on Neuro-Muscular Transmission 1

Lilienthal¹,

Talbot²

1942

J. Clin. Invest.

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This communicationi reports a study of the state of neuromuscular transmission, and the effects upon it of prostigmine and acetylcholine injected into the brachial artery, in five patients with severe myasthenia gravis, five months after the total extirpation of the thymus gland. The partial block in neuromuscular transmission and the abnormal reactions to the intra-arterial injection of prostigmine which existed pre-operatively (1, 2) have been altered profoundly. The results of these experiments indicate that in myasthenia gravis the thymus influences greatly the function of the motor nerves and the striated muscles which they innervate. These findings furnish objective evidence of an action of the thymus gland, and an analysis of the results may assist in understanding the normal physiological function of this structure.In addition to changes in the physiological and pharmacological patterns of neuromuscular function which followed thymectomy, there occurred in three of the patients an extraordinary clinical improvement which developed concomitantly with the reversion of neuromuscular function toward normal. METHODSThe methods employed in this study have been described in detail previously (3). Injections of prostigmine and acetylcholine were made into the brachial artery. The ulnar nerve was stimulated through the intact skin above the elbow, by square waves lasting about one millisecond and presented singly, in pairs, or in salvos by the delay circuits of Marshall and Talbot (4). These stimuli, transformer-coupled to the stimulating electrodes, had an amplitude greater than necessary to elicit maximum action potentials from the muscle electrodes placed on the skin over the mn. abductor digiti quiniti. These muscle action potentials were led to the input of a condenser-coupled amplifier and recorded by means of a cathode ray oscillograph.'Aided in part by a grant from the John and Mary R. Markle Foundation.

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Section: Methodsmentioning

confidence: 99%

Observations on the Nature of Myasthenia Gravis. The Effect of Thymectomy on Neuro-Muscular Transmission 1

Lilienthal¹,

Talbot²

1942

J. Clin. Invest.

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“…Encouraged by this positive result, in 1941, Blalock started to practice thymectomy in MG patients without thymus tumors. Thus, he published reports on 6 cases of transsternal thymectomy and noticed that three of them did not subsequently require drug therapy (2).…”

Section: Total Resection Of the Thymus Gland In The Treatment Of Mgmentioning

confidence: 99%

The miracle of St. Alfege’s Hospital and the history of the treatment of myasthenia gravis

Croitoru¹,

Turliuc²,

Danciu³

et al. 2017

Romanian Neurosurgery

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Abstract:Having a recent history, the neurological condition called myasthenia gravis has raised dilemmas and questions among doctors since it was first discovered in the 16th century and it has not ceased to be a challenge. Nowadays, neuroscience researchers from around the world have been striving to perfect a modern treatment of this condition. Our paper is an incursion into the past, more precisely into the history of the treatment of this disease, from its origin to date, when immunological therapy has progressed.

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“…Since the definition of thymectomy by Blalock, a consensus has been reached on the efficiency of thymectomy in the treatment of MG. However, controversies on patient selection, operation time, and operation method, particularly with the introduction of minimally invasive surgery, have sustained [2]. Although some authors have claimed that in time, better outcomes would be obtained with thymectomy, few studies have compared the short and long-term outcomes of thymectomy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the postoperative first and fifth year outcomes in patients who had undergone thymectomy for Myastenia Gravis

Dural¹,

Günal²,

Koçer³

et al. 2015

Turk J Clin Lab

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Aim:The efficiency of thymectomy for treating patients with Myasthenia gravis is a controversial issue. Thus, this study aimed to investigate the efficiency of thymectomy in the treatment of myasthenia gravis based on long-term follow-up results. Material and Methods:The first and fifth year clinical outcomes of 27 patients who had undergone median sternotomy and extended thymectomy for myasthenia gravis between January 1995 and January 2004 were compared statistically. Results:No statistically significant differences were found between the postoperative first and fifth year clinical outcomes of the patients. Conclusions:Thymectomy is a reliable method in the treatment of myasthenia gravis with respect to its long-term outcomes. The outcomes obtained at the end of the first and fifth year of thymectomy are not different.

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The Treatment of Myasthenia Gravis by Removal of the Thymus Gland

Cited by 197 publications

References 5 publications

Observations on the Nature of Myasthenia Gravis. The Effect of Thymectomy on Neuro-Muscular Transmission 1

Observations on the Nature of Myasthenia Gravis. The Effect of Thymectomy on Neuro-Muscular Transmission 1

The miracle of St. Alfege’s Hospital and the history of the treatment of myasthenia gravis

Comparison of the postoperative first and fifth year outcomes in patients who had undergone thymectomy for Myastenia Gravis

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