Document Detail

Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis.
MedLine Citation:
PMID:  9339939     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The authors evaluated the response to extended cervicomediastinal thymectomy as a component of the integrated management of patients with myasthenia gravis in a large series of patients from a single institution. The authors evaluated the response to therapy with respect to a graded, multivariate, ordinal scale chosen to reflect the full range of the disease's manifestations. SUMMARY BACKGROUND DATA: A number of series, of varying sizes, describe the response of patients with myasthenia gravis to thymectomy primarily with respect to the bivariate endpoint of the presence or absence of "remission." These studies fail to describe the full spectrum of postoperative disease severity and have been unable to quantify definitively the influence of putative prognostic variables, nor to assess definitively the statistical significance of apparent improvements over time. METHODS: The authors evaluated 202 consecutive patients who underwent trans-sternal thymectomy for symptomatic myasthenia gravis from 1969 through 1996 at the Johns Hopkins Hospital. The response to surgery, combined with postoperative medical therapy, was evaluated by a standardized scale reflecting the full spectrum of the disease. These data were analyzed by a novel mean multivariate regression analysis, which allowed the quantification of the statistical significance of apparent responses over time and the evaluation of the independent influence of each of nine putative prognostic indicators. RESULTS: There was no perioperative mortality and a 33% perioperative morbidity. There was a marked clinical response at 6 months to 1 year after surgery that was sustained for at least 10 years thereafter. The median increment of improvement was two (of five) classes. Eighty-six percent and 83% of the patients had improved by at least one class at 5 and 10 years, respectively. These changes were statistically significant (p < 0.001). Whereas the use of extended cervicomediastinal thymectomy was associated with a greater than twofold chance of improvement, compared to conventional trans-sternal thymectomy, neither the pathologic diagnosis (presence of thymoma) nor the age at surgery proved to be negative predictors of postoperative response. CONCLUSIONS: Extended cervicomediastinal thymectomy is the procedure of choice as a component of the integrated management of myasthenia gravis, with significant improvement seen in the group as a whole, as well as in subgroups of patients with thymoma and those older than 40 years of age.
G B Bulkley; K N Bass; G R Stephenson; M Diener-West; S George; P A Reilly; R R Baker; D B Drachman
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  226     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  1997 Sep 
Date Detail:
Created Date:  1997-10-29     Completed Date:  1997-10-29     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  324-34; discussion 334-5     Citation Subset:  AIM; IM    
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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MeSH Terms
Confidence Intervals
Follow-Up Studies
Middle Aged
Myasthenia Gravis / classification,  surgery*
Odds Ratio
Regression Analysis
Risk Factors
Surgical Wound Infection / etiology
Survival Rate
Thymectomy / adverse effects,  methods*,  mortality
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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