RESUMO
OBJECTIVE: To identify the response to thymectomy in patients with seronegative and seropositive myasthenia gravis (SPMG). We analyzed the associated diseases, thymus histology, and the severity of symptoms between the two groups. MATERIAL AND METHODS - DESIGN: Descriptive, comparative. STUDY UNITS: Fourteen patients with seronegative myasthenia gravis (SNMG) and 57 patients with SPMG who had a thymectomy between 1987 and 1997, with at least 3 years of follow-up. The patients were divided into four groups; (1) Remission, (2) Improvement, (3) No change and (4) Deterioration. RESULTS: Fourteen patients (20%) were seronegative and 57 were seropositive (80%). In the group of patients with SNMG, three patients were in remission (21%), five with improvement (36%), five with no change (36%) and one with worsening (7%). In the group of patients with SPMG, 12 were in remission (21%), 17 with improvement (30%), 25 with no change (44%) and three (5%) with worsening. The patients with SNMG were older, with less associated diseases and with a lower frequency of thymomas. CONCLUSIONS: The response to thymectomy was similar between the two groups. It has been suggested that seronegative patients have a better prognosis, but our results show no differences.
Assuntos
Autoanticorpos/sangue , Miastenia Gravis/cirurgia , Complicações Pós-Operatórias/diagnóstico , Receptores Colinérgicos/imunologia , Timectomia , Timoma/cirurgia , Hiperplasia do Timo/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Progressão da Doença , Edrofônio , Eletromiografia , Feminino , Seguimentos , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/imunologia , Miastenia Gravis/patologia , Exame Neurológico , Timoma/imunologia , Timoma/patologia , Hiperplasia do Timo/imunologia , Hiperplasia do Timo/patologia , Neoplasias do Timo/imunologia , Neoplasias do Timo/patologia , Resultado do TratamentoRESUMO
Forty-five patients with myasthenia gravis (MG) were subjected to thymectomy by the median sternotomy technique and were followed up for 4,380 patient months. No operative deaths occurred and 93.3% of the patients benefited from surgery with 28.8% achieving remission. Forty patients (88.5%) showed improvement within one month, and 73% of those who achieved remission did so in the first 2 years. Outcome was not affected by thymic pathology except in one patient who had a thymoma removed. These results confirm the value of thymectomy in the management of MG patients with generalised disease and the efficacy of the simple median sternotomy procedure.
Assuntos
Miastenia Gravis/cirurgia , Timectomia , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/patologia , Hiperplasia do Timo/patologia , Hiperplasia do Timo/cirurgia , Fatores de Tempo , Resultado do TratamentoRESUMO
Forty-five patients with myasthenia gravis (MG) were subjected to thymectomy by the median sternotomy technique and were followed up for 4,380 patient months. No operative deaths occurred and 93.3 percent of the patients benefited from surgery with 28.8 percent achieving remission. Forty patients (88.5 percent) showed improvement within one month, and 73 percent of those who achieved remission did so in the first 2 years. Outcome was not affected by thymic pathology except in one patient who had a thymoma removed. These results confirm the value of thymectomy in the management of MG patients with generalised disease and the efficacy of the simple median sternotomy procedure (AU)