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myasthenia gravis and pulmonary disease

Masayoshi Inoue
Mechanical ventilation is a useful treatment option for respiratory insufficiency following thoracic and cardiovascular surgery. Ventilation mode is classified as volume-controlled-ventilation(VCV) and pressure-controlled ventilation(PCV). Non-invasive ventilation(NIV) without tracheal intubation has been recently developed and is effective in patients with chronic obstructive pulmonary disease (COPD) exacerbation. Several pulmonary complications by mechanical ventilation such as ventilator-induced lung injury(VILI) or ventilator-associated pneumonia(VAP) could be avoided with NIV...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Yeliz Salcı, Ecem Karanfil, Ayla Fil Balkan, Ebru Çalık Kütükçü, Ali Naim Ceren, Fatma Ayvat, Can Ebru Bekircan-Kurt, Kadriye Armutlu
INTRODUCTION: We aimed to evaluate the test-retest reliability and construct validity of the six-and two-minute walk tests (6mWT and 2mWT, respectively) in myasthenia gravis (MG) patients. METHODS: Thirty-one generalized MG patients were enrolled in this study. The 6mWT and 2mWT, MG specific quality of life (MG-QoL15T) scale, quantitative myasthenia gravis scale (QMGS), pulmonary function tests were administered. RESULTS: The intra-class correlation coefficients of 2mWT and 6mWT were 0...
September 19, 2018: Muscle & Nerve
Mohamed Momtaz, Ahmed Fayed, Khaled Marzouk, Amr Shaker
Therapeutic plasma exchange is used in treating different immunological and non-immunological diseases. We analyzed the outcome of 308 patients treated by 1783 membrane plasma exchange sessions from January 2011 until January 2017 at Cairo University Hospital. Thrombotic microangiopathies were the commonest indication [73 (23.7%) patients] with response in 63/73 patients (86.3%), followed by systemic vasculitis with pulmonary-renal involvement [40(13%) patients] with recovery in 32/40 patients (80.0%), Guillain-Barré syndrome [39(12...
July 15, 2018: Therapeutic Apheresis and Dialysis
Josef Finsterer, Claudia Stöllberger, Chen-Yu Ho
BACKGROUND: Takotsubo syndrome (TTS) is a non-ischaemic cardiomyopathy with sudden but transient systolic dysfunction. TTS mimics myocardial infarction clinically, chemically, and electrocardiographically but echocardiography typically shows apical ballooning and coronary angiography is normal. TTS has not been reported in a patient with myasthenia gravis (MG) and polymyositis due to a malignant thymoma. CASE REPORT: Two weeks prior to admission, a 76-year-old female developed dysarthria, chronic coughing and disabling myalgias of the entire musculature...
August 20, 2018: International Journal of Neuroscience
Michael Salna, Sumanth Kidambi, Jacinda Sampson, Joseph B Shrager
We describe the case of a patient with myasthenia gravis and severe pulmonary emphysema who underwent concomitant bilateral video/robotic-assisted thymectomy with unilateral lung volume reduction surgery. We review the important pathophysiological considerations that must be appreciated to ensure safe surgery in this unusual situation with two diseases that independently affect the respiratory system - each of which requires preoperative optimization.
May 25, 2018: Annals of Thoracic Surgery
Yufeng Tang, Ke Wang, Zhonglun Chen, Muke Zhou, Jingfeng Duan, Tao Liu, Dong Zhou
RATIONALE: The Lambert-Eaton myasthenic syndrome (LEMS) is a neuromuscular disease; its unique symptoms of LEMS include dry mouth with a metallic taste, constipation, and erectile dysfunction. As it is quite rare, isolated ocular muscle impairment associated with LEMS east to ignore. PATIENT CONCERNS: A 65-year-old man presented with alternating ptosis and diplopia. Isolated ocular muscle impairment had lasted for 6 years, and the patient was initially diagnosed with ocular myasthenia gravis (MG)...
June 2017: Medicine (Baltimore)
Chanchan Liu, Qiong Wang, Zhandong Qiu, Jing Lin, Bo Chen, Yue Li, Mengcui Gui, Min Zhang, Mingshan Yang, Wei Wang, Bitao Bu
OBJECTIVE: To analyze the mortality and potential risk factors for death in myasthenia gravis (MG) patients. MATERIALS AND METHODS: A total of 2195 adult patients with MG (aged older than 18 years) diagnosed during the period between 2003 and 2013 were followed-up and retrospectively reviewed. RESULTS: During the 10-year follow-up, 129 patients died and the total mortality rate was 5.88%. The risk factors associated with MG-related deaths were duration of the disease, occurrence of myasthenic crisis, severity of disease that included the Myasthenia Gravis Foundation of America (MGFA) grade III and IV at onset, elevation of acetylcholine receptor antibody (AchR-abs) titers, presence of thymic pathology, and failure of administrating immunosuppressants (P < 0...
May 2017: Neurology India
Gillian M Keating
Sugammadex (Bridion(®)) is a modified γ-cyclodextrin that reverses the effect of the steroidal nondepolarizing neuromuscular blocking agents rocuronium and vecuronium. Intravenous sugammadex resulted in rapid, predictable recovery from moderate and deep neuromuscular blockade in patients undergoing surgery who received rocuronium or vecuronium. Recovery from moderate neuromuscular blockade was significantly faster with sugammadex 2 mg/kg than with neostigmine, and recovery from deep neuromuscular blockade was significantly faster with sugammadex 4 mg/kg than with neostigmine or spontaneous recovery...
July 2016: Drugs
Bharti Chogtu, Daliparty Vasudev Malik, Rahul Magazine
Idiopathic Pulmonary Fibrosis (IPF) is a chronic fibrosing lung condition with high morbidity and mortality, accounting for about 25% of the cases of interstitial lung diseases. It usually has a progressive course resulting in death due to respiratory failure. Myasthenia Gravis (MG) is an autoimmune neuromuscular disease, caused by antibody mediated activity against acetylcholine receptor at the neuromuscular junction. It is characterized by fluctuating muscle weakness and fatigue. Extensive literature search did not reveal any case report of an association between these two conditions...
April 2016: Journal of Clinical and Diagnostic Research: JCDR
Raquel Ramos Garcia, Nitin Bhanot, Zaw Min
A 77-year-old man with myasthenia gravis receiving prednisone and plasmapheresis was found to have right upper lobe cavitary pneumonia on radiological imaging studies after thymectomy. He had a remote history of treated pulmonary tuberculosis (TB) at the age of 19. On the basis of history of TB and current prednisone therapy, reactivation of pulmonary TB was highly suspected. Branching Gram-positive bacilli were identified on bronchoalveolar lavage (BAL). BAL Ziehl-Neelsen Acid-fast bacilli stain was negative, but a modified Kinyoun stain revealed branching, beaded, filamentous bacilli, suggestive of Nocardia spp...
July 6, 2015: BMJ Case Reports
Michał Kowalczyk, Andrzej Nestorowicz, Katarzyna Stachurska, Anna Fijałkowska, Janusz Stążka
Nowadays, even hazardous cardiac surgery can be performed on patients with autoimmune diseases like myasthenia gravis. It requires a sensitive perioperative anesthetic approach especially in relation to nondepolarizing muscle relaxant administration. Myasthenic patients produce antibodies against the end-plate acetylcholine receptors causing muscle weakness and sensitivity to nondepolarizing muscle relaxants that could lead to respiratory failure. Perioperative nurse care is critical for uncomplicated course of treatment; therefore, apprehension of surgical procedure should be helpful on an everyday basis...
June 2015: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Guilherme Fregonezi, Ingrid G Azevedo, Vanessa R Resqueti, Armèle D De Andrade, Lucien P Gualdi, Andrea Aliverti, Mário Et Dourado-Junior, Verônica F Parreira
BACKGROUND: Neuromuscular diseases (NMDs) lead to different weakness patterns, and most patients with NMDs develop respiratory failure. Inspiratory and expiratory muscle strength can be measured by maximum static inspiratory pressure (PImax) and maximum static expiratory pressure (PEmax), and the relationship between them has not been well described in healthy subjects and subjects with NMDs. Our aim was to assess expiratory/inspiratory muscle strength in NMDs and healthy subjects and calculate PEmax/PImax ratio for these groups...
April 2015: Respiratory Care
Alexandra Marie Nanzer, John Janssen, Matthew Hind
A 78-year-old man presented with severe exertional dyspnoea. He suffered from mild chronic obstructive pulmonary disease, congestive cardiac failure and seropositive myasthaenia gravis. Clinical examination of his chest and heart were unremarkable but he had speech dyspnoea and was unable to count to 20 in a single breath. Consecutive sniff nasal inspiratory measurements (SNIP) fell from 55 to 33 cm H2O and forced vital capacity (FVC) fell from 3.4 to 2.4 L. A diagnosis of myasthenic crisis was carried out and treatment with non-invasive ventilation, intravenous immunoglobulis and high-dose oral prednisolone was initiated...
2014: BMJ Case Reports
Kang-Ho Choi, Tai-Seung Nam, Seung-Han Lee, Myeong-Kyu Kim
BACKGROUND: Myasthenic crisis can be occasionally a complication after surgery for thymomatous myasthenia gravis (T-MG). AIMS: The purpose of this study was to investigate the influence of thymectomy on the subsequent clinical course of T-MG. STUDY DESIGN: Retrospective study. MATERIALS AND METHODS: Only T-MG patients with at least 36 months of follow-up after transsternal thymectomy for thymoma was screened, and those with successfully weaned from a ventilator after surgery were included in the study...
March 2014: Neurology India
Jianguo Wan, Jinxiang Zhang, Wenqing Tao, Guanghui Jiang, Wen Zhou, Jian Pan, Weichuan Xiong, Hong Guo
OBJECTIVE: To report the treatment process of the first case of human pneumonia resulted from H10N8 avian influenza virus infection in the world for providing the data for clinical diagnosis and treatment. METHODS: On November 30, 2013, the first case of human infection with H10N8 avian influenza virus was discovered in Nanchang City, Jiangxi Province. Its clinical symptoms and epidemiology were analyzed and compared with the characteristics of human infection with H7N9 avian influenza virus...
February 2014: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
S Welcker, M Heckmann, R Axt-Fliedner, D Faas
Neonatal mysthenia gravis (NMG) is a rare cause of arthrogryposis multiplex congenita (AMC) due to diaplacental transfer of maternal acetylcholine receptors (AChR) antibodies. 2 cases of severe NMG complicated by chronic lung disease and pulmonary arterial hypertension are reported. With respect to the severe course of the index patient, prenatal diagnosis and immunomodulation treatment were offered during the 2nd pregnancy. The combination of prenatal immunoadsorption (IA) therapy, administration of intravenous immunoglobulin (IVIG) and prednisolone failed...
August 2013: Zeitschrift Für Geburtshilfe und Neonatologie
Vladislav Litachevsky, Shlomi Peretz, Ignat Schwartz
A 64 year old Myasthenia Gravis patient was admitted with pulmonary insufficiency. The autopsy revealed diffuse Strongyloides stercoralis infection.
June 2013: Harefuah
George Rallis, Panayotis Dais, George Gkinis, Constantinos Mourouzis, Vasiliki Papaioannou, Michael Mezitis
We present the first case of acute osteomyelitis of the mandible caused by Rhodococcus equi in an immunocompromised patient. A 53-year-old Caucasian man was referred to the outpatient clinic, because of a swelling of the left submental and submandibular spaces. The patient was immunocompromised owing to medication against myasthenia gravis and type II diabetes mellitus. The patient underwent surgical debridement under local anesthesia. Histologic examination showed acute osteomyelitis and both blood and pus cultures isolated Rhodococcus equi...
October 2012: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Marta Toni García, Emma Anda Apiñániz, Juan Pablo, Martínez de Esteban, Patricia Munárriz Alcuaz, María José Goñi Iriarte, Lluís Forga Llenas
Autoimmune polyendocrine syndrome type II (APS-II) is the most common immunoendocrinopathy syndrome. APS-II is defined by the development of two or more of the following entities: primary adrenal insufficiency (Addison's disease), Graves' disease, type 1A diabetes mellitus, autoimmune thyroiditis, primary hypogonadism, celiac disease, and myasthenia gravis. Other frequent clinical findings are vitiligo, alopecia, pernicious anemia and/or serositis. Primary adrenal insufficiency in these patients affects the adrenal cortex, which is destroyed by autoantibodies against 21-hydroxylase...
December 2008: Endocrinología y Nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
Keduovinuo K Keditsu, George Karimundackal, Nirmala A Jambhekar, C S Pramesh
A 58-year old man with thymoma and myasthenia gravis (MG) had undergone thymectomy 8 years ago with histopathologically confirmed non-invasive WHO-type AB thymoma. After 5 years of complete remission, symptoms of MG resurfaced, and a recurrent anterior mediastinal mass was detected for which he received radiotherapy. He presented to us 3 years later with productive cough and exertional dyspnoea; the positron emission tomography-computed tomography scan revealed a metabolically active pulmonary nodule in the right lung as the only site of disease for which a right lower lobectomy was done...
June 2012: Interactive Cardiovascular and Thoracic Surgery
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