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Myasthenic crisis

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https://www.readbyqxmd.com/read/28916122/myasthenia-gravis-and-crisis-evaluation-and-management-in-the-emergency-department
#1
Jamie Roper, M Emily Fleming, Brit Long, Alex Koyfman
BACKGROUND: Myasthenia gravis (MG) is an uncommon autoimmune disorder affecting the neuromuscular junction and manifesting as muscle weakness. A multitude of stressors can exacerbate MG. When symptoms are exacerbated, muscle weakness can be severe enough to result in respiratory failure, a condition known as myasthenic crisis (MC). OBJECTIVE: This review discusses risk factors, diagnosis, management, and iatrogenic avoidance of MC. DISCUSSION: MC can affect any age, ethnicity, or sex and can be precipitated with any stressor, infection being the most common...
September 12, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28838625/-which-surgery-for-mediastinum-tumor-experience-of-the-department-of-thoracic-surgery-of-chu-hassan-ii-of-f%C3%A3-s
#2
S Rabiou, M Lakranbi, T Ghizlane, H Elfatemi, M Serraj, Y Ouadnouni, M Smahi
INTRODUCTION: Tumors of the mediastinum are a heterogeneous group of dysembryoplatic and neoplastic diseases essentially with different prognoses and therapeutic. These tumors develop slowly and remain long asymptomatic in 40-50% of cases. The purpose of our work is to bring the result of surgical management in diagnostic and therapeutic of principal mediastinum tumors framework. PATIENTS AND METHOD: We reviewed retrospectively the records of 68 patients in our training, between January 2009 and December 2013, for tumor of the mediastinum in the diagnostic framework and or therapy...
August 21, 2017: Revue de Pneumologie Clinique
https://www.readbyqxmd.com/read/28830630/false-positive-immunoassay-for-acetyl-choline-receptor-antibody-achr-ab-in-patients-exposed-to-polyvalent-antisnake-venom
#3
Kaushik Sundar, Shankar Venkatasubramanian, Sundar Shanmugam, Preetam Arthur, Ramakrishnan Subbaraya, Philo Hazeena
Acute flaccid paralysis is a neuromuscular emergency characterized by rapidly worsening weakness that evolves quickly to cause diaphragmatic failure. The challenge for the treating physician is to stabilize the patient, generate the differential diagnosis and determine the management; all in quick time. Neurotoxic snake bites have inadequate signs of inflammation and are easily missed. Myasthenic crisis, on the other hand, could be the first sign of myasthenia gravis in up to 20% of patients. Both present with acute respiratory failure and inadequate history...
August 18, 2017: Journal of Neuroimmunology
https://www.readbyqxmd.com/read/28821685/nivolumab-related-myasthenia-gravis-with-myositis-and-myocarditis-in-japan
#4
Shigeaki Suzuki, Nobuhisa Ishikawa, Fumie Konoeda, Nobuhiko Seki, Satoshi Fukushima, Kikuko Takahashi, Hisashi Uhara, Yoshikazu Hasegawa, Shinichiro Inomata, Yasushi Otani, Kenji Yokota, Takashi Hirose, Ryo Tanaka, Norihiro Suzuki, Makoto Matsui
OBJECTIVE: To report the clinical features of myasthenia gravis (MG) induced by treatment with immune checkpoint inhibitors using 2-year safety databases based on postmarketing surveys in Japan. METHODS: We studied 10,277 patients with cancer who had received monotherapy with either nivolumab or ipilimumab between September 2014 and August 2016. As the control group, 105 patients with idiopathic MG were used. RESULTS: There were 12 MG cases (0...
September 12, 2017: Neurology
https://www.readbyqxmd.com/read/28803488/clinical-outcome-and-predictive-factors-of-postoperative-myasthenic-crisis-in-173-thymomatous-myasthenia-gravis-patients-myasthenic-crisis-in-thymomatous-patients
#5
Yan Li, Haiyan Wang, Pei Chen, Zhenguang Chen, Chunhua Su, Chuanming Luo, Huiyu Feng, Weibin Liu
PURPOSE: Thymectomy is the first-line therapy for thymomatous myasthenia gravis patients. The aim of this study is to explore the clinical outcome and predictors of postoperative myasthenic crisis (POMC) in these patients. METHOD: Clinical data of 173 thymomatous myasthenia gravis patients undergoing thymectomy from January 2000 to March 2013 were retrospectively reviewed. Variables potentially affecting the occurrence of POMC were evaluated using binary logistic regression analysis...
August 14, 2017: International Journal of Neuroscience
https://www.readbyqxmd.com/read/28789662/predictive-factors-of-prolonged-mechanical-ventilation-overall-survival-and-quality-of-life-in-patients-with-post-thymectomy-myasthenic-crisis
#6
Kun-Kun Li, Kai Qian, Yong-Geng Feng, Wei Guo, Qun-You Tan, Bo Deng
BACKGROUND: Thymectomy is the primary approach for the treatment of myasthenia gravis (MG). This retrospective study aimed to identify the clinical and demographical features that may impact the duration of mechanical ventilation (DMV), the long-term survival, and the quality of life (QOL) in patients with post-thymectomy myasthenic crisis (PTMC). METHODS: We reviewed the patients who suffered from PTMC from June 2008 to November 2015. Cox proportional hazard regression analysis was used to identify potential prognostic factors that may impact DMV and long-term survival...
August 8, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28730784/single-center-retrospective-analysis-of-162-cases-with-thymoma-complicating-myasthenia-gravis
#7
Qing Lin, Ye Zhang, Liuchun Yang
PURPOSE: We conducted this study to retrospectively analyze the clinical effects of surgical resection for patients with myasthenia gravis (MG) complicated with thymoma. METHODS: 162 patients with myasthenia gravis complicated with thymoma, that were admitted to our hospital and underwent surgical disease resection from Nov. 1993 to Nov. 2015, were selected for this study. Analyzed were the pathology (2004 WHO), Masaoka clinical stage, myasthenia gravis types (Osserman types), myasthenic crisis during the perioperative period, and the relationship between recurrence and survival rates during follow-up visits...
May 2017: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
https://www.readbyqxmd.com/read/28636535/the-correlation-of-neutrophil-to-lymphocyte-ratio-with-the-presence-and-activity-of-myasthenia-gravis
#8
De-Hao Yang, Mei-Zi Qian, Mao-Mao Wei, Jia Li, Meng-Meng Yu, Xue-Mian Lu, Hong Yang, Hai Lin, Xiang Li, Jun-Yan Zhu, Xu Zhang
Though the pathogenesis of myasthenia gravis (MG) is not fully understood, the role of inflammation has been well appreciated in the development of MG. We aimed to investigate the role of neutrophil-to-lymphocyte ratio (NLR) in MG patients and the relationship between the NLR and the activity of the disease. A total number of 172 MG patients and 207 healthy controls (HC) were enrolled in this study. The MG patients were divided into tertiles according to NLR (low NLR < 1.58, n = 57; intermediate NLR 1.58-2...
June 16, 2017: Oncotarget
https://www.readbyqxmd.com/read/28635482/diagnosis-and-management-of-myasthenia-gravis
#9
Christopher Barber
Myasthenia gravis is a rare long-term neurological condition that is characterised by fluctuating skeletal muscle weakness and fatigue, as well as respiratory difficulties. It is both an acquired autoimmune disease and a chronic neuromuscular disorder. Because of its rarity, myasthenia gravis is relatively unknown and may be unfamiliar to many nurses. While there are various types of myasthenia, this article focuses on myasthenia gravis, exploring its symptoms, diagnosis and treatment, and examining the nurse's role in managing the condition...
June 21, 2017: Nursing Standard
https://www.readbyqxmd.com/read/28579974/tracheoesophageal-fistula-caused-by-tracheostomy-in-a-patient-with-myasthenia-gravis-after-a-myasthenic-crisis
#10
Chen Jiaxin, Li Jingjing, Zhu Kai, Zhou Zhou, Liu Weibin, Wang Haiyan, Feng Huiyu
A 57-year-old woman with myasthenia gravis (MG), who had experienced a myasthenic crisis, complained of coughing while drinking. At first, this appeared to be a sequela of the myasthenic crisis. However, after further investigation, the problem was identified as a tracheoesophageal fistula, a complication of tracheostomy. Here, we describe this special case in the hope that we can improve diagnostic accuracy by providing a reminder for other physicians to consider the differences between MG and tracheoesophageal fistula...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28540092/anti-musk-positive-myasthenic-crisis-in-a-7-year-old-female
#11
Harrison J Matthews, Apisadaporn Thambundit, Brandon R Allen
A seven-year-old African American female with anti-MuSK-positive Juvenile Myasthenia Gravis collapsed while at school from progressively worsening weakness and dyspnea. On initial emergency department presentation, she required 15 liters per minute of supplemental oxygen to maintain oxygen saturation above 92%. Initial pulmonary function tests and venous blood gas led to the decision to place her on noninvasive positive pressure ventilation (NPPV) with BiPAP in the emergency department. Due to worsening hypercarbia, she later required mechanical intubation in the PICU and underwent IVIG therapy followed by plasmapheresis in order to achieve a stable discharge from the hospital...
2017: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/28516329/screening-for-lipoprotein-receptor-related-protein-4-agrin-and-titin-antibodies-and-exploring-the-autoimmune-spectrum-in-myasthenia-gravis
#12
Isabell Cordts, Nicolas Bodart, Kathi Hartmann, Katerina Karagiorgou, John S Tzartos, Lin Mei, Jens Reimann, Philip Van Damme, Michael H Rivner, Alain Vigneron, Joachim Weis, Jörg B Schulz, Socrates J Tzartos, Kristl G Claeys
In autoimmune myasthenia gravis (MG), the identification of antibodies and characterization of serological subgroups is of great importance for diagnosis and management of the disease. Our aims were to study the frequency of antibodies against lipoprotein-related protein 4 (LRP4), agrin, and titin using the most recent techniques, and to characterize corresponding clinical features and autoimmune diseases (AID) in 100 MG-patients. The antibody frequencies in the 55 AChR-antibody positive patients were 7% LRP4, 5% agrin, 53% titin, and in the 45 AChR-antibody negative patients 2% MuSK, 2% LRP4, 2% agrin, and 27% titin...
June 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28505981/severe-exacerbation-of-myasthenia-gravis-associated-with-checkpoint-inhibitor-immunotherapy
#13
Dana S Cooper, Matthew N Meriggioli, Philip D Bonomi, Rabia Malik
Monoclonal antibodies that target either PD-1 or PD-L1 have recently been approved for treatment of advanced non-small cell lung cancer. These antibodies are immune checkpoint inhibitors which have been shown to exacerbate Myasthenia Gravis (MG) and other autoimmune diseases. While effective in preventing tumor cells from evading immune attack, immune checkpoint inhibitors such as nivolumab, an antibody directed against the programmed cell death protein-1 (PD-1) receptor located on T-cells, may also cause immune dysregulation and could cause or potentiate pre-existing autoimmune conditions...
2017: Journal of Neuromuscular Diseases
https://www.readbyqxmd.com/read/28488612/analysis-of-mortality-and-related-factors-in-2195-adult-myasthenia-gravis-patients-in-a-10-year-follow-up-study
#14
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
https://www.readbyqxmd.com/read/28457757/juvenile-myasthenia-gravis-in-norway-clinical-characteristics-treatment-and-long-term-outcome-in-a-nationwide-population-based-cohort
#15
T H Popperud, M I Boldingh, M Rasmussen, E Kerty
BACKGROUND: This study aimed to characterize juvenile myasthenia gravis in a national population-based cohort in Norway, and to evaluate long-term outcome and potential differences correlated with prepubertal versus postpubertal disease onset. PATIENTS AND METHODS: Patients with onset of myasthenia gravis aged ≤18 years were identified through multiple strategies. Retrospective clinical data were collected by means of medical charts. All patients had an updated clinical examination...
April 20, 2017: European Journal of Paediatric Neurology: EJPN
https://www.readbyqxmd.com/read/28382612/clinical-profile-and-outcome-of-myasthenic-crisis-in-central-taiwan
#16
Yi-Sin Wong, Cheung-Ter Ong, Sheng-Feng Sung, Chi-Shun Wu, Yung-Chu Hsu, Yu-Hsiang Su, Ling-Chien Hung
BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease caused by antibodies to acetylcholine receptors of the skeletal muscle. Myasthenic crisis (MC) is a complication observed during both early and late stage MG cases. In this study, we examined current treatments and three years outcomes in patients with MG and MC. We also investigated the impact of thymectomy and systemic lupus erythematosus (SLE) in patients with MG and MC. METHODS: In this retrospective study, we reviewed the medical records of all patients admitted to one teaching hospital between January 2006 and December 2014 and identified those for whom discharge diagnosis included the International Classification of Diseases, ninth revision (ICD-9) codes corresponding to MG (358...
December 15, 2016: Acta Neurologica Taiwanica
https://www.readbyqxmd.com/read/28381664/therapeutic-potential-of-docetaxel-plus-cisplatin-chemotherapy-for-myasthenia-gravis-patients-with-metastatic-thymoma
#17
Guoyan Qi, Peng Liu, Huimin Dong, Shanshan Gu, Hongxia Yang, Yinping Xue
The prognosis of myasthenia gravis (MG) in association with invasive or metastatic thymoma is usually worse, and therapeutic options are quite limited. Here, we retrospectively reported the therapeutic effect of docetaxel plus cisplatin (docetaxel/cisplatin) chemotherapy in 7 MG patients with metastatic thymoma. Previously, all patients underwent thymectomy at the first onset of thymoma. After the metastasis of thymoma, none of the patients received thymectomy due to unresectable conditions after surgeon's evaluation for great risk of myasthenic crisis (n = 5) or patients' refusal (n = 2)...
April 2017: Tohoku Journal of Experimental Medicine
https://www.readbyqxmd.com/read/28360447/botulism-outbreak-in-a-family-after-ingestion-of-locally-produced-cheese
#18
Shahram Rafie, Shokrollah Salmanzadeh, Asieh Mehramiri, Adel Nejati
Botulism is one of the most important foodborne diseases and is caused by Clostridium botulinum toxin. The main manifestations are flaccid muscle paralysis and cranial nerve palsies. Botulism is an essential health problem because of its high mortality. The diagnosis of botulism, especially in sporadic cases, is a medical challenge and a high clinical suspicion is necessary for early recognition. So, every physician should be familiar with its signs and symptoms for early detection and treatment. We describe a family with dysphasia and acute paralysis after the ingestion of locally made cheese...
March 2017: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28278141/metastatic-thymoma-associated-myasthenia-gravis-favorable-response-to-steroid-pulse-therapy-plus-immunosuppressive-agent
#19
Guoyan Qi, Peng Liu, Huimin Dong, Shanshan Gu, Hongxia Yang, Yinping Xue
BACKGROUND Our study retrospectively reviewed the therapeutic effect of steroid pulse therapy in combination with an immunosuppressive agent in myasthenia gravis (MG) patients with metastatic thymoma. MATERIAL AND METHODS MG patients with metastatic thymoma that underwent methylprednisolone pulse therapy plus cyclophosphamide were retrospectively analyzed. Patients initially received methylprednisolone pulse therapy followed by oral methylprednisolone. Cyclophosphamide was prescribed simultaneously at the beginning of treatment...
March 9, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28214292/prescription-profile-of-pyridostigmine-use-in-a-population-of-patients-with-myasthenia-gravis
#20
Jorge Enrique Machado-Alba, Luis Felipe Calvo-Torres, Andrés Gaviria-Mendoza, César Augusto Mejía-Vélez
INTRODUCTION: We determined the pyridostigmine prescription pattern in a population of patients with myasthenia gravis. METHODS: A descriptive cross-sectional study was done using a prescription database of 3.5 million individuals from which patients diagnosed with myasthenia gravis (MG) and for whom pyridostigmine was prescribed. RESULTS: A total of 306 outpatients with MG were found, and 258 were receiving pyridostigmine, mean age, 53.0±18...
February 18, 2017: Muscle & Nerve
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