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Takaya Kitano, Makoto Kinoshita, Kohki Shimazu, Hiroaki Fushimi, Kenichi Omori, Takanori Hazama
A 87-year-old female presented with subacute progression of cognitive decline. Fluid-attenuated inversion recovery images of brain MRI showed multifocal high-intensity lesions. Thoracic CT image revealed the presence of thymoma, and serum autoantibody screening showed positivity for anti-gamma aminobutyric acid (GABA)A receptor antibody. Histopathological analysis confirmed type B3 thymoma after thymectomy. The patient received both plasmapheresis and intravenous methylprednisolone therapy, and showed remarkable amelioration of clinical symptoms and MRI abnormal high intensity...
October 21, 2016: Rinshō Shinkeigaku, Clinical Neurology
Alison F Ward, Timothy Lee, Jennifer B Ogilvie, Kepal N Patel, Karen Hiotis, Costas Bizekis, Michael Zervos
One to two percent of ectopic parathyroid adenomas are found in the lower mediastinum and often these are best accessed via a sternotomy or thoracotomy. Video-assisted thoracoscopic surgery (VATS) is an alternative approach with less surgical trauma, decreased morbidity, shorter hospital stays, and superior cosmetic results. Ten years after the first VATS resection of an ectopic mediastinal parathyroid, a robot-assisted thoracoscopic approach was described. Here we describe a series of five robot assisted complete thymectomies in patients with primary hyperparathyroidism due to mediastinal ectopic parathyroid adenomas...
October 22, 2016: Journal of Robotic Surgery
Tiziana Cavalli, Francesco Giudici, Gabriella Nesi, Andrea Amorosi, Raffaella Santi, Maria Luisa Brandi, Francesco Tonelli
Approximately 300 cases of sporadic parathyroid cyst (PCs) have been reported to date. Only two cases have been described in MEN1 so far. Detection by imaging could be challenging, especially in multiglandular primary hyperparathyroidism (HPT) and clinical outcome could be different. During the period 1990-2014, 71 MEN1 patients were operated for primary hyperparathyroidism in our centre. We report three cases of PCs in MEN1 patients affected by HPT, who underwent a total or subtotal parathyroidectomy with transcervical thymectomy...
October 20, 2016: Familial Cancer
Hanlu Zhang, Yingcai Geng, Yu Zheng, Yun Wang
A 68-year-old female was admitted to our hospital with an acute episode of chest pain, progressive cough and fever. She underwent trans-subxiphoid video-assisted thoracoscopic extended thymectomy (TsVATET) for thymoma with myasthenia gravis (MG) 9 days ago. Chest computed tomography (CT) showed anterior mediastinal oedema, and infiltrative findings involved bilateral lung. Physical examination revealed the subxiphoid wound suppuration. We diagnosed subxiphoid incision infection, anterior mediastinitis and concomitant bilateral pneumonia...
September 2016: Journal of Thoracic Disease
Katja Schlosser, Detlef K Bartsch, Markus K Diener, Christoph M Seiler, Tom Bruckner, Christoph Nies, Moritz Meyer, Jens Neudecker, Peter E Goretzki, Gabriel Glockzin, Ralf Konopke, Matthias Rothmund
OBJECTIVE: This randomized controlled multicenter pilot trial was conducted to find robust estimates for the rates of recurrence of 2 surgical strategies for secondary hyperparathyroidism (SHPT) within 36 months of follow-up. BACKGROUND: SHPT is a frequent consequence of chronic renal failure. Total parathyroidectomy with autotransplantation (TPTX+AT) and subtotal parathyroidectomy (SPTX) are the standard surgical procedures. Total parathyroidectomy alone (TPTX) might be a good alternative, as morbidity and recurrence rates are low according to small-scale retrospective studies...
November 2016: Annals of Surgery
Daniel B Drachman
The basic abnormality in myasthenia gravis (MG) is a reduction in acetylcholine receptors (AChRs) at neuromuscular junctions due to the effects of autoantibodies that are directed against the AChRs in most patients, or against neighboring proteins involved in the clustering of AChRs (MuSK, LRP-4, or agrin). Clinically, MG is characterized by muscle weakness and fatigue, often in typical patterns. The diagnosis may be missed early, and depends on the recognition of clinical manifestations, the measurement of autoantibodies, and/or electrophysiological features...
October 2016: Seminars in Neurology
Habibeh Taghavi Kojidi, Nazanin Vagharimehr, Shahrzad Mohseni, Mohammad Pajouhi, Mohammad Reza Mohajeri-Tehrani
An ectopically placed parathyroid in the mediastinum is a rare cause of persistent or recurrent primary hyperparathyroidism. They are rarely in a huge size. We report a case of a 70-year-old man with a history of total parathyroidectomy and thymectomy presented with a lack of appetite, nausea, and generalized bone pain, polydipsia and a calcium level of 14.4 mg/dl. 99mTc-sestamibi scintigraphy with single-photon emission computerized tomography (SPECT) showed a focal zone of radiotracer accumulation in the midline of anterior chest wall (xiphoid level)...
August 2016: Acta Medica Iranica
Edvina Galié, Rosaria Renna, Domenico Plantone, Andrea Pace, Mirella Marino, Bruno Jandolo, Tatiana Koudriavtseva
Morvan's syndrome (MoS) is a rare, complex neurological disorder characterized by neuromyotonia, neuropsychiatric features, dysautonomia and neuropathic pain. The majority of MoS cases have a paraneoplastic aetiology, usually occurring prior to the diagnosis of the underlying tumour and showing improvement following its treatment. The present study reports the case of a 35-year-old Caucasian male patient who was diagnosed with stage IVA thymoma. Thymectomy, lung resection, diaphragmatic pleurectomy and pericardio-phrenectomy were performed 6 months after neoadjuvant chemotherapy...
October 2016: Oncology Letters
John-Ih Lee, Sebastian Jander
Myasthenia gravis is the most frequent acquired disorder of neuromuscular transmission. In the majority of cases, pathogenic antibodies against components of the postsynaptic muscle endplate membrane can be detected. In recent years there have been significant advances in the pathophysiological understanding and therapy of the disease. Areas covered: PubMed searches were conducted for the term "myasthenia gravis" cross-referenced with the terms "immunology", "subgroups", "antibody", "ocular", "thymoma", "treatment" and "thymectomy"...
October 3, 2016: Expert Review of Neurotherapeutics
Naohiro Nose, Kazuhiro Higuchi, Eiichi Chosa, Takanori Ayabe, Masaki Tomita, Kunihide Nakamura
A 60-year-old woman was referred to our hospital with an anterior mediastinal tumor measuring 3.5 cm in diameter on computed tomography (CT). We performed tumor resection by video-assisted thoracic surgery (VATS) with three ports. The final diagnosis was Type A Masaoka Stage I thymoma. On follow-up CT performed 36 months after the operation, two pleural tumors were detected at the port sites through which the forceps and ultrasonic scalpel had passed repeatedly during the operation. We therefore performed a second operation and enucleated the tumors while preserving the ribs...
2016: Journal of Surgical Case Reports
Julieana Muhammed, Chui Yin Chen, Wan Hazabbah Wan Hitam, Mohamad Ziyadi Ghazali
BACKGROUND: A thymectomy is considered effective for patients with myasthenia gravis (MG). Although a few studies have described the role of a thymectomy in the treatment of MG in Asians countries, there are no published data on the application of this surgical approach for MG in Malaysia. We aimed to describe the clinical outcomes of MG patients who underwent a thymectomy and the factors affecting these outcomes. METHODS: This was a retrospective study involving 16 patients with MG who underwent a thymectomy at the Hospital Universiti Sains Malaysia (HUSM) from January 2002 until December 2012, with a follow-up period ranging from 3-120 months...
July 2016: Malaysian Journal of Medical Sciences: MJMS
Mahmoud Abu Abeeleh, Amjad Bani Hani, Ata Ghaith, Tareq Alodwan, Zuhair Bani Ismail, Musa Alshehabat
Ectopic parathyroid adenomas are considered the main cause of primary hyperparathyroidism. However, concurrent parathyroid and thymic pathologies are rarely diagnosed in the same patient. A 47-year-old man with history of diabetes mellitus, hypertension, and myasthenia gravis presented with persistent hypercalcemia. Laboratory investigations, computed tomography, and technetium-99 m sestamibi scintigraphy revealed ectopic parathyroid glands, a mediastinal mass, and an enlarged thymus. The patient underwent thymectomy and mass excision via a median sternotomy...
September 15, 2016: Asian Cardiovascular & Thoracic Annals
Borislav A Alexiev, Anjana V Yeldandi
Ectopic pleural thymoma is an exceedingly uncommon clinical entity that has only been described sporadically. Because of their peculiar location and variety of histologic patterns manifested, pleural thymomas may be confused with other neoplasms and may cause diagnostic problems clinically, radiologically, and morphologically. We describe the case of a giant left-sided ectopic pleural thymoma, preoperatively suspected to be a solitary fibrous tumor. A complete surgical resection was achieved and a postoperative diagnosis of WHO Type AB, modified Masaoka stage I tumor was attained...
September 2, 2016: Pathology, Research and Practice
Candice L Wilshire, Eric Vallières, Dale Shultz, Ralph W Aye, Alexander S Farivar, Brian E Louie
OBJECTIVE: The approach to thymoma resection has usually been determined by tumor size, although established guidelines do not exist. Minimally invasive approaches have been limited to tumors smaller than 5 cm, although 3 cm has been the suggested cutoff for performing an adequate oncologic procedure. No study has compared the perioperative outcomes of patients with 3 cm or larger tumors resected robotically versus sternotomy. METHODS: We reviewed patients who underwent resection of 3 cm or larger thymomas from 2004 to 2014...
September 14, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Taro Yoneda, Hayato Koba, Kota Tanimura, Naohiko Ogawa, Satoshi Watanabe, Johsuke Hara, Miki Abo, Takashi Sone, Hideharu Kimura, Kazuo Kasahara
A 50-year-old man presented to our hospital in 1995. Invasive thymoma was diagnosed and extended thymectomy and left upper lobe partial resection were performed. In 2013, he complained of dyspnea. Chest computed tomography showed postoperative recurrence of invasive thymoma. Several chemotherapies were administered. Severe anemia and an increase in the total bilirubin level were observed with chemotherapies. In additional, an examination showed that the direct Coombs test was positive. Cold agglutinin was also high...
2016: Internal Medicine
Anil Karlekar, Devesh Dutta, Ravindra Saxena, Krishna Kant Sharma
Myasthenia gravis (MG) is a rare disorder involving neuromuscular junction. In conjunction with medical therapy, thymectomy is a known modality of treatment of MG and has shown to increase the probability of remission and overall symptomatic improvement. For minimally invasive thymectomy, video-.assisted thoracoscopic surgery has been the preferred surgical approach till recently. The robotic surgical procedure must necessarily bring new challenges to the anesthesiologists to effectively meet the specific requirements of the technique...
July 2016: Journal of Anaesthesiology, Clinical Pharmacology
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
Nao Nagata, Takuma Miyoshi, Yuzo Otake, Hitomi Suzuki, Yumiko Kagawa, Tetsushi Yamagami, Mitsuhiro Irie
Neurological signs and serum acetylcholine receptor antibody (AChR-Ab) levels before, and after thymectomy were monitored in a 6-year-old male cat with acquired Myasthenia Gravis (MG) as a paraneoplastic syndrome of thymoma. Soon after surgery, the neurological symptoms relapsed, and the cholinesterase inhibitor was administered to control them. The AChR-Ab levels increased postoperatively until 90 days after surgery. This is the first report on long term measurements of serum AChR-Ab levels in a cat with MG...
September 3, 2016: Journal of Veterinary Medical Science
Nobuyasu Kurihara, Hajime Saito, Hiroshi Nanjo, Hayato Konno, Maiko Atari, Yoshitaro Saito, Satoshi Fujishima, Komei Kameyama, Yoshihiro Minamiya
INTRODUCTION: Myasthenia gravis (MG) has been reported to correlate with earlier-stage thymoma, and theoretically does not accompany thymic carcinoma. However, we encountered two cases of thymic carcinoma with MG. PRESENTATION OF CASES: Case 1 involved a 54-year-old man who had been diagnosed with MG based on symptoms and detection of anti-acetylcholine receptor antibody (ARAB). Computed tomography (CT) revealed an anterior mediastinal tumor 30mm in diameter. Prednisolone (PSL) and tacrolimus were administered without surgery at that time...
2016: International Journal of Surgery Case Reports
Nkem Aziken, Maria Evasovich, Rafael S Andrade, Eitan Podgaetz
Mediastinal parathyroid adenomas are rare. Surgical resection is recommended. Traditionally median sternotomy has been the preferred approach; newer less invasive techniques have been described. The aim is to describe an innovative technique for thymectomy via a laparoscopic transdiaphragmatic approach avoiding any thoracic incisions and potentially chronic postoperative intercostal pain in a patient with a well localized mediastinal parathyroid adenoma. No intraoperative complications, parathyroid hormone essay normalized and the patient was discharged home on the second day...
September 1, 2016: European Journal of Cardio-thoracic Surgery
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