Myasthenia Gravis and Tumors of the Thymic Region

Blalock, Alfred; Mason, Merle; Morgan, Hugh J.; Riven, Samuel S.

doi:10.1097/00000658-193910000-00005

Cited by 430 publications

(64 citation statements)

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“…The selection of topics for which practice parameters are used is based on prevalence, frequency of use, economic impact, membership involvement, controversy, urgency, external constraints, and resources required. This paper addresses the role of thymectomy in the treatment of nonthymomatous autoimmune MG.In 1939, Blalock et al 1 reported the remission of generalized MG in a 21-year-old woman after removal of a cystic thymic tumor. Subsequently, Blalock et al…”

mentioning

confidence: 99%

“…In 1939, Blalock et al 1 reported the remission of generalized MG in a 21-year-old woman after removal of a cystic thymic tumor. Subsequently, Blalock et al…”

mentioning

confidence: 99%

“…To compare the crude rates within a given controlled study, we calculated the relative rate by dividing the thymectomy patient group's crude rate of achieving the outcome by the nonthymectomy patient group's crude rate of achieving the outcome using the formula presented in table 1.…”

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Practice parameter: Thymectomy for autoimmune myasthenia gravis (an evidence-based review) [RETIRED]

2000

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The Quality Standards Subcommittee of the American Academy of Neurology is charged with developing practice parameters for neurologists for diagnostic procedures, treatment modalities, and clinical disorders. The selection of topics for which practice parameters are used is based on prevalence, frequency of use, economic impact, membership involvement, controversy, urgency, external constraints, and resources required. This paper addresses the role of thymectomy in the treatment of nonthymomatous autoimmune MG.In 1939, Blalock et al. 1 reported the remission of generalized MG in a 21-year-old woman after removal of a cystic thymic tumor. Subsequently, Blalock et al.2,3 performed thymectomy on MG patients without thymoma, found hyperplasia in the thymus glands, and reported improvement in at least half of their patients. Since these reports, thymectomy, with or without the presence of thymoma, has gained widespread acceptance as a form of treatment for MG.Because a definitive study of the effectiveness of thymectomy has never been done, 4,5 the role of thymectomy in the management of MG remains uncertain. Nevertheless, physicians have to advise their patients regarding the benefits of thymectomy based on the existing literature. Our goal is to develop evidence-based recommendations for clinicians considering thymectomy for patients with nonthymomatous autoimmune MG by performing a systematic review and analysis of the literature. Process. Identification and selection of studies.We searched the National Library of Medicine's Medline database from 1966 to February 1998 using the medical subject headings "myasthenia gravis" (restricted to the surgery subheading) and "thymectomy." To identify articles published before 1966, or missed by our original search strategy, we reviewed the references of the identified articles.We classified the resulting articles into the following categories: Class II, controlled but nonrandomized studies describing outcomes in MG patients with and without thymectomy; and Class III, uncontrolled case series describing outcomes in patients with or without thymectomy.Within a given controlled (Class II) study, we planned to describe the therapeutic effect of thymectomy by comparing the rate MG patients receiving thymectomy achieved desirable outcomes with the rate MG patients not receiving thymectomy achieved desirable outcomes. The nonrandomized nature of Class II studies often introduces differences in the baseline characteristics of the thymectomy and nonthymectomy patient groups that can effect MG outcomes independent of thymectomy. To the extent possible, we planned to adjust for these confounding differences in baseline prognostic characteristics. In the absence of randomized controlled trials, such adjustments are critical for estimating the actual therapeutic effect, if any, of thymectomy. 6Between uncontrolled (Class III) studies, comparisons of outcome rates in thymectomy and nonthymectomy MG patients introduce additional confounding baseline differences.6 These additional confounde...

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“…In 1939, Blalock et al 1 reported the remission of generalized MG in a 21-year-old woman after removal of a cystic thymic tumor. Subsequently, Blalock et al…”

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confidence: 99%

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Practice parameter: Thymectomy for autoimmune myasthenia gravis (an evidence-based review) [RETIRED]

2000

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“…Some of them suggest to judge about the effect in a year after the surgery (35). Others allow waiting 3, 6, 9 and even 15 years (26,28,(36)(37)(38).…”

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The results of video-assisted thoracoscopic thymectomies in Saint Petersburg, Russia: 20-year of experience

Yablonsky¹,

Pischik²,

Tovbina

et al. 2017

J. Vis. Surg.

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IntroductionToday, advantages of minimally invasive surgery, particularly video-assisted thoracoscopic thymectomy (VATS-TE) are well established. However, there is no consensus what VATS-TE strategy is optimal for treatment of autoimmune myasthenia gravis (MG) and thymoma.In this report, we show the results of 254 VATS-TE and suggest that VATS-TE combined with an additional cervical approach does not give any advantages compared to VATS-TE alone, which is equally effective, but reduces the risks of specific postoperative complications. Here, we summarize our 20-year experience in performing VATS-TE, and demonstrate their effectiveness and safety in complex treatment of MG and thymomas both in a short and in a long term. Methods This study was approved by the local Ethical CommitteeOriginal Article on Thoracic Surgery

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“…Similar cases are recorded by Lindskog (1954) and Williot et al (1964). Some weight is given to this argument by the recovery of the myasthenia gravis after resection of a nondescript cyst (Blalock et al, 1939) and the appearance of local secondaries after the resection of an undiagnosable cyst (Effler and McCormack, 1956). Nonspecific cysts have also been found after irradiation of presumed thymomas associated with blood dyscrasias (Radojevic and Hahn, 1935;Havard and Bodley Scott, 1960).…”

Section: *mentioning

confidence: 99%

Cystic thymomas and thymic cysts: A Review

Dyer

1967

Thorax

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Six cases of large thymic cyst are described; five were cystic thymomas and one was nonneoplastic. Two of the thymomas were not only grossly degenerate but showed severe chronic inflammatory change, so that the diagnosis might be missed. (Davis, 1956). Although the clinical diagnosis of thymic cyst must ultimately await histological examination, it is hoped that a review of the subject will help the clinician in the differential diagnosis of mediastinal masses, especialiy as these cysts do not appear to be as rare as the literature suggests. MATERIALThe records of the Institute of Pathology and Department of Thoracic Surgery at the London Hospital were examined over the 16-year period from 1950 to 1965. Mediastinal tumours and cysts that were surgically treated during this period were reviewed. All cases of lymphoma and retrosternal goitre were excluded. The different lesions encountered are shown in Table I. The tumours classified as neurogenous included neurofibroma, ganglioneuroma, and neurilemmoma or their malignant counterparts. 'Present address:

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Myasthenia Gravis and Tumors of the Thymic Region

Cited by 430 publications

References 2 publications

Practice parameter: Thymectomy for autoimmune myasthenia gravis (an evidence-based review) [RETIRED]

Practice parameter: Thymectomy for autoimmune myasthenia gravis (an evidence-based review) [RETIRED]

The results of video-assisted thoracoscopic thymectomies in Saint Petersburg, Russia: 20-year of experience

Cystic thymomas and thymic cysts: A Review

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