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Andrew Tang, Alejandro Bribriesco, Usman Ahmad
Myasthenia gravis can develop after resection of thymic tumors. Post-thymectomy myasthenia gravis can be heralded by elevated preoperative anti-acetylcholine-receptor antibodies. Thymic tissue in isolated mediastinal areas can be the culprit lesion and identified by PET SCAN. Re-resection in selected patients can lead to remission of this rare disease.
May 17, 2018: Seminars in Thoracic and Cardiovascular Surgery
Sara Mashoof, Breanna Breaux, Michael F Criscitiello
In jawed vertebrates from sharks to mammals, the thymus is the primary (or central) lymphoid tissue where T cells develop and mature. The particular stromal cell types, cytokine environment, and tissue organization in the thymus are essential for V(D)J recombination, positive selection for major histocompatibility complex recognition, and negative selection against self-peptide recognition of most αβ T cells. The thymectomy operation on Xenopus tadpole larva described here creates a T-cell-deficient model suitable for many immunology studies...
May 16, 2018: Cold Spring Harbor Protocols
Paul A J Beckers, Rudy Mercelis, Stijn Heyman, Lies Verheuen, Patrick Lauwers, Jeroen M Hendriks, Paul E Van Schil
INTRODUCTION: Thirty to fifty percent of thymoma patients develop myasthenia gravis (MG). In 1.5-28% of cases, MG appears many years after removal of a thymoma. PATIENTS AND METHODS: We present a case report of a 72-year-old female who presented with MG four months after total thymectomy. RESULTS: A 72-year-old female patient presents with MG four months after total thymectomy. Imaging revealed a PET-positive nodule anterior to the superior vena cava...
May 17, 2018: Acta Chirurgica Belgica
Masayuki Toishi, Takao Sakaizawa, Keisuke Ozawa, Hideki Nishimura
We report a surgical case of micronodular thymoma with lymphoid stroma (MNT), which is a rare type of thymoma. A 66-year-old man was referred to our hospital for further examination and treatment of a nodule in the mediastinum. Computed tomography(CT) showed a 20-mm nodule in the anterior mediastinum, and positron emission tomography-CT showed slight uptake in the same region. Thymoma was suspected and videoassisted thymectomy was performed. Histopathological findings showed spindleshaped tumor cells forming storiform, with the background of lymphoid stroma, and the tumor was diagnosed as MNT...
March 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Dawei Zou, Honghe Luo, Yanfen Feng, Bo Zeng, Yiyan Lei
INTRODUCTION: Massive thymic hyperplasia is an extremely rare disorder, with fewer than 60 cases reported so far. Majority of the previous cases occurred in neonates, infants, and older children. PRESENTATION OF CASE: A man was found to have an anterior mediastinal mass without any symptoms at 30 years of age. Operation was done successfully. The mass measured 112 mm × 191 mm × 184 mm and weighed 2141 g. Histological and immunohistochemical findings further confirmed the diagnosis of massive thymic hyperplasia...
May 9, 2018: International Journal of Surgery Case Reports
Kazu Shiomi, Eiji Kitamura, Mototsugu Ono, Yasuto Kondo, Masahito Naito, Masashi Mikubo, Yoshio Matsui, Kazutoshi Nishiyama, Takashi Suda, Yukitoshi Satoh
Background: We have used a promising, minimally invasive thoracoscopic technique of extended thymectomy for patients with myasthenia gravis (MG). The aim of this study was to report our promising technique, a modified single-port trans-subxiphoid approach (MTXA) and to compare perioperative outcomes and effects on MG between our approach and sternotomy. Methods: We retrospectively reviewed records of all patients undergoing extended thymectomy for MG and/or thymoma between January 1, 2010 and December 31, 2016...
March 2018: Journal of Thoracic Disease
Qiang Lu, Jinbo Zhao, Juzheng Wang, Zhao Chen, Yong Han, Lijun Huang, Xiaofei Li, Yongan Zhou
Background: The approaches to thoracoscopic thymectomy in myasthenia gravis (MG) are debatable. We developed a novel approach via subxiphoid and subcostal arch, with a significantly shorter duration of operation and hospital stay, less estimated blood loss, and lower postoperative pain. Methods: From December 2012 to December 2014, 77 myasthenia gravis patients with or without thymoma underwent thoracoscopic extended thymectomy at our hospital. Among them, 41 patients were operated via the subxiphoid and subcostal arch approach and the other 36 via the conventional unilateral approach...
March 2018: Journal of Thoracic Disease
Hanlu Zhang, Longqi Chen, Yu Zheng, Zihao Wang, Yingcai Geng, Fuqiang Wang, Dan Liu, Andong He, Jing Li, Yun Wang
Background: Trans-subxiphoid thoracoscopic thymectomy is a promising procedure but technically demanding associated with ergonomic discomfort. In order to facilitate this complex procedure, the authors present a modified trans-subxiphoid thymectomy by the use of the Da Vinci robotic system. Methods: A 2-cm longitudinal incision for camera was made below the xiphoid process. Through this incision, the space among the posterior surface of the sternum, bilateral mediastinal pleura and diaphragm (extra pleural space) was enlarged blindly with a finger...
March 2018: Journal of Thoracic Disease
Monica Casiraghi, Domenico Galetta, Alessandro Borri, Adele Tessitore, Rosalia Romano, Daniela Brambilla, Patrick Maisonneuve, Lorenzo Spaggiari
The aim of this study was to analyse the feasibility and safety of robotic-assisted thymectomy (RoT) in patients with clinically early stage thymoma, investigating clinical and early oncological results. Between 1998 and 2017, we retrospectively reviewed 76 (42.2%) patients who underwent radical thymectomy for clinically early stage thymoma (Masaoka-Koga I and II), identifying all patients who underwent RoT (n = 28) or open thymectomy (OT) with eligibility criteria for robotic surgery (n = 48). Using a propensity-score matched for tumor size (3...
April 28, 2018: Journal of Robotic Surgery
Reza Bagheri, Reza Boonstani, Ali Sadrizadeh, Maryam Salehi, Reza Afghani, Ali Rahnama, Vahab Azmounfar, Saeed Hakimian, Mohammad Baradaran Firoozabadi
OBJECTIVE: Thymectomy considered as a standard procedure in treatment of all the steps of myasthenia gravis. Video-assisted thoracoscopic surgery (VATS) thymectomy is one of the minimally invasive procedures that because of the short duration of hospitalization, less postoperative pain, and scar after surgery, nowadays it is replaced the traditional methods of surgery for patients with myasthenia gravis, but there are still differences and concerns. The aim of this study was to compare outcomes of two different techniques of surgery, VATS versus transsternal (TS) in the treatment of myasthenia gravis...
March 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Xin Li, Meng Wang, Daqiang Sun
RATIONALE: Sclerosing thymoma is an extremely rare mediastinal neoplasm; it was recognized for the first time in 1994 and to date only 15 cases have been reported. PATIENT CONCERNS: The present study report a case of a 65-year-old man who was incidentally found to have an anterior mediastinal nodule, without clinical symptoms including fever, chest pain, and myasthenia gravis. DIAGNOSES: The chest computed tomography (CT) revealed the nodule was 4...
April 2018: Medicine (Baltimore)
Ersin Toret, Bengü Demirag, Sultan A Köker, Onur Doyurgan, Malik Ergin, Sinan Genc, Tuba H Karapinar, Yilmaz Ay, Yeşim Oymak, Canan Vergin
Thymomas are the most common masses located in the anterior mediastinum, and they are often associated with autoimmune disorders including myasthenia gravis, polymyositis, and aplastic anemia (AA). Autoreactive T-cell clones generated by the thymoma may lead to autoimmune disorders. We report the case of a 14-year-old boy who was examined for AA, and the underlying cause was determined to be an immune-mediated complication of thymoma. He had no matched sibling donors. He underwent thymectomy, and 3 months later he was treated with immunosuppressive therapy (IST), consisting of antithymocyte globulin and cyclosporine A...
April 17, 2018: Journal of Pediatric Hematology/oncology
Raghav Govindarajan, Pushpa Narayanaswami
The rapid growth in published medical literature makes it difficult for clinicians to keep up with advances in their fields. This may result in a cursory scan of the abstracts and conclusions of a study without critically evaluating study quality. The application of Evidence-Based Medicine (EBM) is the process of converting the abstract task of reading the literature into a practical method of using the literature to inform care in a specific clinical context while simultaneously expanding one's knowledge. EBM involves 4 steps: stating the clinical problem in a defined question; searching the literature for the evidence; critically appraising the evidence for its validity and applying the evidence in the context of the patient's situation, preferences and values...
April 17, 2018: Muscle & Nerve
Chang-Feng Lu, Lei Yu, Yun Jing, Yun-Feng Zhang, Ji Ke
Background: The co-existence of myasthenia gravis (MG) and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiotherapy for thymoma with MG after extended thymectomy. Methods: A total of 181 patients with both MG and thymoma were recruited between 2003 and 2014 at Tongren Hospital, China. Among all the patients, 157 patients received radiation therapy after surgery (Group A); whereas the other 24 patients did not receive radiation therapy (Group B)...
April 20, 2018: Chinese Medical Journal
Constantine Farmakidis, Mamatha Pasnoor, Mazen M Dimachkie, Richard J Barohn
With specialized care, patients with myasthenia gravis can have very good outcomes. The mainstays of treatment are acetylcholinesterase inhibitors, and immunosuppressive and immunomodulatory therapies. There is good evidence thymectomy is beneficial in thymomatous and nonthymomatous disease. Nearly all of the drugs used for MG are considered "off-label." The 2 exceptions are acetylcholinesterase inhibitors and complement inhibition with eculizumab, which was recently approved by the US Food and Drug Administration for myasthenia gravis...
May 2018: Neurologic Clinics
V A Porkhanov, V A Zhikharev, I S Polyakov, V V Danilov, V B Kononenko
AIM: To present possibility and technical aspects of anesthetic management during video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. MATERIAL AND METHODS: The article describes the proposed modified anesthetic method that is suitable for video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. Nine patients with myasthenia underwent VATS-thymectomy. Anesthesia was performed with artificial airway and auxiliary ventilation without muscle relaxants administration...
2018: Khirurgiia
Dong-Tao Yin, Ling Huang, Bing Han, Xiu Chen, Shi-Min Yin, Wen Zhou, Jian Chu, Tao Liang, Tian-Yang Yun, Yang Liu
Background: Robotic thymectomy has been suggested a feasible and safe approach for myasthenia gravis (MG). Few investigations have revealed the independent effect of robotic thymectomy without the confounding impact of immunosuppressive (IM) therapy. Methods: Between May 2009 and December 2012, robotic extended thymectomy was carried out for patients with diagnosis of MG. The clinical data, subsequent neurological therapy and postintervention status were collected...
January 2018: Journal of Thoracic Disease
Lidija Dežmalj Grbelja, Radovan Vrhovac, Monika Ulamec
Myasthenia gravis is associated in 10 to 15 percent of patients with thymic tumors, rarely with aplastic anemia. We report a 45-year-old male diagnosed with myasthenia gravis -associated with thymoma. We started treatment with pyridostigmine. After thymectomy, the patient -received 30 irradiation sessions. In the postoperative course, he had mild worsening of myasthenia gravis, which improved with prednisone. Five months later, he developed severe aplastic anemia. He was dependent on blood supplement. After allogeneic transplantation of bone marrow, he improved but later he -developed graft versus host disease...
December 2017: Acta Clinica Croatica
Wentao Fang, Zhitao Gu, Keneng Chen
Surgery is the most important therapy for thymic malignances. The last decade has seen increasing adoption of minimally invasive surgery (MIS) for thymectomy. MIS for early stage thymoma patients has been shown to yield similar oncological results while being helpful in minimize surgical trauma, improving postoperative recovery, and reduce incisional pain. Meanwhile, With the advance in surgical techniques, the patients with locally advanced thymic tumors, preoperative induction therapies or recurrent diseases, may also benefit from MIS in selected cases...
April 20, 2018: Zhongguo Fei Ai za Zhi, Chinese Journal of Lung Cancer
Enrico Ruffini, Pier Luigi Filosso, Francesco Guerrera, Paolo Lausi, Paraskevas Lyberis, Alberto Oliaro
Until recently, the surgical approach to thymic tumors has remained basically unchanged. The collaborative effort led by ITMIG with the collaboration of regional and society-based interest groups (ESTS, JART) produced an enthusiastic surge of interest in testing the new technological advances in thoracic surgery and many historical dogmas in thymic surgery have been questioned and challenged. The present review addresses the new trends in the optimal surgical management of thymic tumors based on the review of the current literature...
April 2018: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
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