Original article: general thoracicPredictors of outcome in thymectomy for myasthenia gravis
Section snippets
Material and methods
Records of 113 consecutive patients undergoing thymectomy for MG between 1974 and 1999 were reviewed. Seventy-nine percent (89 of 113) of patients were female, and the procedures were performed by 6 faculty surgeons, with 94% (106 of 113) performed by 2 surgeons. In all cases, specimens were examined by staff pathologists. Mean patient age was 40 ± 15 years (median 38 years). Follow-up was obtained in 81% (92 of 113) of patients by review of hospital and clinic records, by mail, and by
Presentation
Patients with MG experienced symptoms for an average of 31 ± 54 months before operation; in 7 patients, this duration was not known. The most common complaint was generalized or extremity weakness (74%, 84 of 113), followed by ocular symptoms (68%, 77 of 113) and swallowing complaints (36%, 41 of 113). MG disease was assessed preoperatively using the modified Osserman classification system described by Calhoun and colleagues [5] among others. Distribution of patients by modified Osserman
Comment
Studies examining the responses of myasthenic patients to thymectomy are inherently prone to certain common limitations. Among them are the varied and fluctuating nature of clinical manifestations of disease, and the difficulty in categorizing the outcomes so that the response to thymectomy can be fully characterized [8]. The inconsistencies across studies and the difficulty in directly comparing results is commonly acknowledged, and has recently been addressed in particular by the Myasthenia
Acknowledgements
The authors thank Jessica Kidd, DVM, and John Boring, PhD, of the Emory School of Public Health, for their help with statistics, as well as Ms Gail Nechtman for her assistance in preparing this manuscript. The authors also thank neurologist Dr Linton C. Hopkins for his expert and careful treatment of so many patients over this extended period of time.
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2016, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :Our data suggest that standard resections from different technical approaches provide nearly 50% CSR after 40 years of follow-up. Many studies have shown greater rates of CSR in patients with less severe MG and decreased rates of CSR in patients with more severe symptoms.12,14,18,33 Our study confirms these findings and revealed that patients with Osserman classification III and IV were significantly less likely to achieve a CSR, 43% and 17% odds ratio, respectively.