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Diagnostic and treatment aspects of the thymoma with myasthenic syndrome


Author: Maxim Stasiuc
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2007
Scientific adviser: Vladimir Hotineanu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 24 January, 2007
Approved by NCAA on the 1 March, 2007

Abstract

Adobe PDF document0.73 Mb / in romanian

Keywords

thymoma, myasthenia gravis, myasthenic syndrome, thymectomy

Summary

In this paper we present results of the comprehensive treatment of the 109 patients with thymoma and myasthenic syndrome treated between years 1994 and 2004. The goal of the study was to optimize diagnostic procedures and to issue the surgical treatment plan for the patients with thymoma. There is sex –specific distribution in the presented cases of the disease with 28 patients(25,69%) being men and 81patients (74,31%) being women. The age of the patients varied between 10 and 80 years with mean age 32,7 years.

As a result of study we issued contemporary diagnostic algorithm of the patient’s evaluation which includes clinical and laboratory data, pharmacological tests, functional tests ( EMG with evoked potentials, spirogram ) and imaging ( thoracic CT, chest x-ray ).

The indication for surgery in majority of cases - 98 (89,1%) was thymoma established by preoperative imaging, in 4 (3,67%) cases there was progressive evolution of the myasthenic syndrome of intermediate or severe degree with myasthenic crisis .

In all cases the access to thymus was provided by subtotal or total sternotomy.Thymectomy was done in 101 (92,66%) cases.In one (0,92%) case resection of the massive mediastinal lymphosarcoma was done.In 7 (6,42%) cases extended thymectomy was performed.

The early postoperative complications were observed in 21 (19,27%) cases. The postoperative myasthenic syndrome on postoperative day 2 to 4 developed in 4 (3,67%) patients with more then 2 years from the initial diagnosis of myasthenia, resulting in potential life threatening situation.

The cholinergic crisis as a result of neostigmine overdose was incountered in one (0,92%) patient.

In general, complete or significant remission of the disease was obtained in 83 (76,15%) patients with social rehabilitation (in 95 or 87.16% of the patients) and ability to return back to work ( in 90 or 82.57% of the patients).

There was no postoperative mortality.

Analysis of the early and late results of the surgical treatment with thymectomy gave us ability to advise this method as the treatment of choice in patients with thymoma and myasthenic syndrome, being at the same time most efficient in terms of socio-medical rehabilitation