| Outcomes after thymectomy in class I myasthenia gravis. | |
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MedLine Citation:
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PMID: 23312978 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE: The role of extended thymectomy in the treatment of class I myasthenia gravis is still controversial. This study compared the long-term outcomes of operated and nonoperated patients allocated according to their will. METHODS: We retrospectively reviewed 47 patients with class I nonthymomatous myasthenia gravis undergoing extended thymectomy between 1980 and 2007. These patients were matched with 62 class I patients who refused surgery and received only pharmacologic therapy. Outcomes were stable remission and clinical or pharmacologic improvement. Predictors of remission were analyzed by Kaplan-Meier and Cox regression. RESULTS: We observed low postoperative major morbidity (n = 2; 4.2%) and no perioperative mortality. Heterotopic thymus was found in 22 patients (46%). Twenty-one patients showed active germinal centers, in the heterotopic thymus in 12 patients (57.1%). Thirty operated patients (64%) versus 34 nonoperated patients (55%) achieved stable remission, and 8 patients (17%) versus 5 patients (9%) showed pharmacologic improvement. Nine patients who had no postoperative improvement showed active ectopic thymus. Surgery was a marginal prognosticator (P = .053). Early treatment (≤6 months from symptoms onset) was the unique significant prognosticator (P = .045), but this was due to the contribution of the operated patients (P = .002). Other predictors of remission in the operated group were the absence of ectopic thymus (P = .007) with no germinal centers (P = .009). No significant predictor of remission was found in the nonoperated group. CONCLUSIONS: Extended thymectomy achieved a more rapid remission than after nonsurgical treatment of class I myasthenia gravis. Significantly better outcomes resulted when thymectomy was performed within 6 months from the onset of symptoms. |
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Authors:
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Tommaso Claudio Mineo; Vincenzo Ambrogi |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2013-1-10 |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: - ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2013 Jan |
Date Detail:
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Created Date: 2013-1-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
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Department of Thoracic Surgery, Multidisciplinary Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy. Electronic address: mineo@med.uniroma2.it. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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