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Myasthenic crisis

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https://www.readbyqxmd.com/read/27907966/getting-rid-of-weakness-in-the-icu-an-updated-approach-to-the-acute-management-of-myasthenia-gravis-and-guillain-barr%C3%A3-syndrome
#1
Alexis A Lizarraga, Karlo J Lizarraga, Michael Benatar
After prompt diagnosis, severe myasthenia gravis and Guillain-Barré syndrome (GBS) usually require management in the intensive care unit. In the myasthenic patient, recognition of precipitating factors is paramount, and frequent monitoring of bulbar, upper airway, and/or respiratory muscle strength is needed to identify impending myasthenic crisis. Noninvasive ventilation can be attempted prior to intubation and mechanical ventilation in the setting of respiratory failure. Cholinesterase inhibitors should be discontinued, but resumed prior to extubation, and steroid dosage could be increased once the airway is secured...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27856933/predictors-of-extubation-outcomes-following-myasthenic-crisis
#2
Zhenguo Liu, Shiyuan Yao, Qian Zhou, Zhensheng Deng, Jianyong Zou, Huiyu Feng, Hua Zhu, Chao Cheng
OBJECTIVE: Myasthenic crisis (MC) is considered the most severe adverse event in patients with myasthenia gravis. The present retrospective study was performed to evaluate the predictors of clinical outcomes in patients with MC. METHODS: The medical charts of 33 patients (19 women, 14 men) with 76 MC attacks from 2002 to 2014 were retrospectively reviewed. Early extubation (≤7 days) and prolonged ventilation (>15 days) during the MC were used to assess patient outcomes...
November 17, 2016: Journal of International Medical Research
https://www.readbyqxmd.com/read/27781146/prevalence-and-impact-of-autoimmune-thyroid-disease-on-myasthenia-gravis-course
#3
Justyna Kubiszewska, Beata Szyluk, Piotr Szczudlik, Zbigniew Bartoszewicz, Małgorzata Dutkiewicz, Maksymilian Bielecki, Tomasz Bednarczuk, Anna Kostera-Pruszczyk
OBJECTIVES: Autoimmune thyroid diseases (ATDs) frequently accompany myasthenia gravis (MG) and may influence its course. We aimed to determine the association and impact of ATD with early- (<50 years), late-onset MG, or thymoma-MG. MATERIALS AND METHODS: Prevalence of ATD was measured in a cross-sectional study of 343 consecutive patients with MG (236 F, 107 M) aged 4-89 years; 83.8% were seropositive, in 2.9%, anti-MuSK antibodies were detected. Concentrations of antithyroid peroxidase antibodies, antithyroglobulin antibodies, antithyrotropin receptor antibodies, and TSH level were measured in all patients...
October 2016: Brain and Behavior
https://www.readbyqxmd.com/read/27744133/repetitive-nerve-stimulation-often-fails-to-detect-abnormal-decrement-in-acute-severe-generalized-myasthenia-gravis
#4
Maarika Liik, Anna Rostedt Punga
OBJECTIVE: We assessed the diagnostic pattern of repetitive nerve stimulation (RNS) test and concentric electrode (CNE) jitter analysis between patients with generalized myasthenia gravis (GMG) with acute versus slow onset. METHODS: All examinations that established the diagnosis of GMG at the department of Clinical Neurophysiology, Uppsala University Hospital, were retrospectively analyzed from January 2012 to December 2014. Patients were grouped according to disease duration at neurophysiological evaluation: acute onset (<4weeks) or slow onset (⩾4weeks)...
October 3, 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/27612903/outcome-of-extended-thymectomy-in-myasthenia-crisis-patient
#5
M Aftabuddin, S Bhandari
Myasthenic crisis is a life-threatening condition. We studied the demographic, frequency, causes and clinical presentation of isolated Myasthenic crisis, steps of treatment and to review our experience of extended thymectomy on patients with at least one episode myasthenic crisis. A prospective and retrospective study was conducted on patients with at least one episode of myasthenic crisis, from March 2010 to September 2014, at the Department of Cardiac Surgery, BSMMU, Dhaka, Bangladesh who were referred for thymectomy...
July 2016: Mymensingh Medical Journal: MMJ
https://www.readbyqxmd.com/read/27610255/colon-adenoma-implicating-myasthenia-gravis-a-case-report-of-a-patient-with-postcolectomy-complications
#6
Y Papachatzakis, E Tseliou, I Tatouli, I Dialoupi, F Michas, E Papadopoulou, D Kousouris, S Kontogiannis, M A Dimopoulos
We report the case of a 63-year-old patient with myasthenia gravis (MG) due to acetylcholine receptor antibodies (AChR) who underwent colectomy due to colon adenoma and developed myasthenic crisis and anastomosis leakage after surgery. The patient underwent two plasma exchanges, 4 and 6 days preoperatively, and received intravenous prednisolone and immunoglobulin infusion due to the crisis, which included primarily bulbar symptoms. The patient developed on the 10th postoperative day bowel obstruction symptoms and anastomosis leakage which required surgical repair and ileostomy...
2016: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/27576289/-clinical-behavior-in-a-myasthenic-crisis
#7
Pablo Landi, Gisell Torrejón, Leonardo Paz
No abstract text is available yet for this article.
2016: Medicina
https://www.readbyqxmd.com/read/27491460/improvement-of-quality-of-life-after-therapeutic-plasma-exchange-in-patients-with-myasthenic-crisis
#8
Izabela Rozmilowska, Monika Adamczyk-Sowa, Katarzyna Rutkowska, Krystyna Pierzchala, Hanna Misiolek
INTRODUCTION: We sought to evaluate quality of life patients with myasthenic crisis before and after therapeutic plasma exchange. MATERIALS AND METHODS: In our study we conducted an assessment of the quality of life with the use of the questionnaire SF-36, when executed eleven therapeutic plasma exchange. The assessment was made on baseline and after 4 weeks. We also did neurological clinical evaluation before and after TPE. RESULTS: Patients in the study showed significant improvement in quality of life after performed therapeutic plasma exchange...
July 28, 2016: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/27426672/video-assisted-thoracoscopic-surgery-thymectomy-versus-open-thymectomy-in-patients-with-myasthenia-gravis-a-meta-analysis
#9
Kang Qi, Bo Wang, Bin Wang, Lian-Bin Zhang, Xiang-Yang Chu
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) thymectomy has become a feasible treatment for myasthenia gravis (MG) in recent years. The objective of the present meta-analysis was to evaluate the perioperative characteristics, safety, and completely stable remission rate in patients with MG who received VATS or open thymectomy (OT). METHODS: We searched PubMed, Embase, ScienceDirect, Web of Science, and CNKI for related articles using combinations of the search terms video-assisted thoracoscopic thymectomy, transsternal thymectomy, and MG...
June 21, 2016: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/27420474/myasthenic-crisis-and-polymyositis-induced-by-one-dose-of-nivolumab
#10
Toshihiro Kimura, Satoshi Fukushima, Azusa Miyashita, Jun Aoi, Masatoshi Jinnin, Takayuki Kosaka, Yukio Ando, Masakazu Matsukawa, Hiroyuki Inoue, Kazuma Kiyotani, Jae-Hyun Park, Yusuke Nakamura, Hironobu Ihn
An 80-year-old man, who developed multiple lymph node and skin metastasis of malignant melanoma, received nivolumab monotherapy. Two weeks after the first dose, he experienced anorexia and fatigue, and suffered from progressive, severe dyspnea and muscle weakness. We diagnosed him with myocarditis, myositis, and myasthenic crisis induced by nivolumab. We commenced steroid therapy, immune absorption therapy, plasma exchange therapy, and i.v. immunoglobulin therapy, and succeeded in saving his life. Because his serum level of anti-acetylcholine receptor antibodies in a sample collected before nivolumab treatment were positive and were elevated significantly after nivolumab, we suspected that nivolumab triggered a severe autoimmune response, which progressed subclinical myasthenia gravis to myasthenic crisis...
July 2016: Cancer Science
https://www.readbyqxmd.com/read/27358333/international-consensus-guidance-for-management-of-myasthenia-gravis-executive-summary
#11
REVIEW
Donald B Sanders, Gil I Wolfe, Michael Benatar, Amelia Evoli, Nils E Gilhus, Isabel Illa, Nancy Kuntz, Janice M Massey, Arthur Melms, Hiroyuki Murai, Michael Nicolle, Jacqueline Palace, David P Richman, Jan Verschuuren, Pushpa Narayanaswami
OBJECTIVE: To develop formal consensus-based guidance for the management of myasthenia gravis (MG). METHODS: In October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness methodology was used to develop consensus guidance statements. Definitions were developed for goals of treatment, minimal manifestations, remission, ocular MG, impending crisis, crisis, and refractory MG...
July 26, 2016: Neurology
https://www.readbyqxmd.com/read/27350653/sternotomy-versus-video-assisted-thoracoscopic-surgery-for-thymectomy-of-myasthenia-gravis-patients-a-meta-analysis
#12
Yingtsai Gung, Hanlu Zhang, Shizhu Li, Yun Wang
INTRODUCTION: The purpose of this study was to compare thymectomy by video-assisted thoracoscopic surgery (VATS) and trans-sternal thymectomy (TS) for myasthenia gravis patients. METHODS: A meta-analysis was conducted to compare thoracoscopic surgery and sternotomy for myasthenia gravis patients with regard to long-term effect and short-term safety. RESULTS: A total of 23 trials were included in our research. No significant differences were detected with regard to myasthenic crisis, wound infection, and muscle weakness improvement...
June 28, 2016: Asian Journal of Endoscopic Surgery
https://www.readbyqxmd.com/read/27349037/-neurophysiological-parameters-in-myasthena-gravis-in-children-in-diagnostic-and-therapeutic-view
#13
Sławomir Kroczka, Katarzyna Stasiak, Marek Kaciński
BACKGROUND: Myasthenia gravis (MG) is an autoimmunologic disorder. It is characterized by various clinical symptoms and their dependency upon the exertion and the rest as well. MATERIAL AND METHODS: Between 2002-20014 in the Neurophysiology Laboratory at the Chair of Pediatric and Adolescent Neurology, Jagiellonian University in Krakow, the electrophysiological repetitive nerve stimulation study were performed in 44 children. The clinical picture and positive electrophysiological test were the ground to diagnose MG in 19 of them (12 girls and 7 boys)...
2016: Przegla̧d Lekarski
https://www.readbyqxmd.com/read/27312319/clinical-outcomes-of-thymectomy-in-myasthenia-gravis-patients-with-a-history-of-crisis
#14
Zhenguo Liu, Yingrong Lai, Shiyuan Yao, Huiyu Feng, Jianyong Zou, Weibin Liu, Yiyan Lei, Hua Zhu, Chao Cheng
BACKGROUND: The use of thymectomy in myasthenia gravis (MG) patients with a history of myasthenic crisis (MC) has not been well established. Here, we determined the efficacy of thymectomy by assessing the long-term clinical outcomes and reviewed thymectomy reports on MC patients. METHODS: Subjects included 31 patients who suffered at least one crisis before surgery, with a cumulative total 73 episodes of MC in Southern China between May 2000 and December 2010. Long-term follow-up was performed and clinical outcomes were evaluated...
November 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27258955/myasthenia-gravis-presentation-after-a-cervical-laminectomy-with-fusion
#15
Darlene Deters, Stephanie L Fowler, Raymundo Orozco, Patrick R Smith, Shelby Spurlock, Darlene Blackmon, Samantha Thomas
Myasthenia gravis is a chronic neuromuscular disorder that causes skeletal muscle weakness. Typically, myasthenia gravis affects the ocular, bulbar, neck, proximal limbs, and respiratory muscles. Although the presentation is typically observed with complaints of vision and bulbar symptoms such as diplopia, dystonia, and dysphagia, this article presents a case study of an elderly man with a history of increasing upper extremity weakness with complaints of worsening hand dexterity and intermittent episodes of expressive aphasia...
July 2016: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/27224441/what-s-in-the-literature
#16
Nicholas J Silvestri, Gil I Wolfe, Mark Bromberg, David Lacomis
One of the first questions asked by patients and family members when a diagnosis of amyotrophic lateral sclerosis is made is "what about stem cells?" The term "stem cells" has attractiveness to it, with the assumption that stem cell treatment (stem nerve cells) can replace lost nerve cells. There are perhaps 2 types of stem cell trials, those that are vetted by the Food and Drug Administration and those that have no official oversight and whose results are infrequently published. The issue of the latter was discussed in the last edition of this column...
June 2016: Journal of Clinical Neuromuscular Disease
https://www.readbyqxmd.com/read/27065302/exacerbation-of-myasthenia-gravis-in-a-patient-with-melanoma-treated-with-pembrolizumab
#17
K H Vincent Lau, Aditya Kumar, Irene Hwa Yang, Richard J Nowak
INTRODUCTION: While anticancer immunotherapies have traditionally focused on activation of the immune system, there is recent interest in disinhibition of the natural antitumor immune response by targeting immune checkpoints such as cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) and programmed death-1 (PD-1). One humanized monoclonal antibody against PD-1, pembrolizumab, was recently approved for treatment of metastatic malignant melanoma. METHODS: We report exacerbation of myasthenia gravis (MG) after treatment with pembrolizumab and provide a brief literature review...
June 2016: Muscle & Nerve
https://www.readbyqxmd.com/read/27014472/subxiphoid-and-subcostal-arch-thoracoscopic-extended-thymectomy-a-safe-and-feasible-minimally-invasive-procedure-for-selective-stage-iii-thymomas
#18
Jinbo Zhao, Juzheng Wang, Zhengwei Zhao, Yong Han, Lijun Huang, Xiaofei Li, Qiang Lu, Yongan Zhou
BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has been applied to resection of small and well-encapsulated thymomas. However, few data are available regarding to the application of VATS in stage III thymomas. METHODS: A novel subxiphoid and subcostal arch approach for thoracoscopic extended thymectomy was developed by us. From January 2014 to August 2015, 14 patients with stage III thymoma were treated by using this new technique in the Department of Thoracic Surgery, Tangdu hospital, Xi'an, China...
March 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27000188/-myasthenia-gravis
#19
J Schodrowski, M Seipelt, I Adibi-Sedeh, C Eienbröker, B Tackenberg
Myasthenia gravis is an autoimmune disease, which leads to load-dependent weakness of voluntary skeletal muscles with recovery of function after resting. The disease is caused by autoantibodies directed against the postsynaptic nicotinic acetylcholine receptors (AChR) leading to a reduction of neuromuscular transmission. Muscles and nerves are not affected. Disorders of the thymus play a role in the pathogenesis of AChR antibody-positive myasthenia. The clinical symptoms include exercise-induced fatigue either of the ocular muscles alone (ocular myasthenia) or striated skeletal muscle and the ocular, facial and bulbar musculature (generalized myasthenia)...
April 2016: Der Internist
https://www.readbyqxmd.com/read/26962777/preoperative-anxiety-in-patients-with-myasthenia-gravis-and-risk-for-myasthenic-crisis-after-extended-transsternal-thymectomy-a-consort-study
#20
Jianyong Zou, Chunhua Su, Xueping Lun, Weibing Liu, Weiling Yang, Beilong Zhong, Haoshuai Zhu, Yiyan Lei, Honghe Luo, Zhenguang Chen
A thymectomy can ameliorate the symptoms of myasthenia gravis (MG) and prevent the progression of ocular MG (OMG) to generalized MG (GMG). However, postoperative myasthenic crisis (POMC) is a serious post-thymectomy complication. Preoperative anxiety (POA) is common but typically neglected in MG patients. The association of POA with POMC has not yet been examined.From June 2007 to December 2013, 541 cases of MG were admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). All cases underwent extended transsternal thymectomy (ETT)...
March 2016: Medicine (Baltimore)
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