Timectomia na miastenia grave: avaliação dos resultados em 73 pacientes

Assis, J. Lamartine de; Curi, Nagib

doi:10.1590/S0004-282X1978000100002

Resumos

Foi feita avaliação dos resultados da timectomia transtorácica em 73 pacientes com miastenia grave generalizada, sendo 64 não timomatosos e 9 com timomas. Os resultados foram analisados à curto, médio e, em muitos casos, a longo prazo. Foi feito, também um estudo comparativo dos resultados em relação à idade, sexo, tempo de doença e à presença ou não do timoma. A experiência adquirida neste grupo de pacientes sugere que a timectomia transtorácica é método terapêutico útil na miastenia grave generalizada não timomatosa; seu efeito benéfico aparece no pós-operatório mediato e se mantém a longo prazo na maioria dos pacientes. Os resultados da timectomia em pacientes com timoma foram menos favoráveis. A análise estatística não mostrou diferenças significantes na evolução pós-operatória entre os pacientes não timomatos selecionados e não selecionados.

An evaluation of results obtained after 73 thymectomies is reported. A transthoracic approach was used on all of the patients. Thymomas were found in 9 out of the 73 patients with myasthenia. All of the 64 patients without thymomas suffered from generalized myasthenia gravis with predominance of severe forms. The results of the early, intermediate and late post-operative course were analysed. A comparative study of results as related to age, sex, duration of disease and presence or absence of thymomas was made. Statistical analysis failed to show any significant difference in the results of thymectomy between selected and randomly chosen patients without thymomas.

J. Lamartine de Assis^I; Nagib Curi^II

^IDepartamento de Neuropsiquiatria (Prof. Horácio Martins Canelas) da Faculdade de Medicina da USP

^IIDepartamento de Cirurgia da Faculdade de Medicina da USP (Prof. E. J. Zerbini)

RESUMO

Foi feita avaliação dos resultados da timectomia transtorácica em 73 pacientes com miastenia grave generalizada, sendo 64 não timomatosos e 9 com timomas. Os resultados foram analisados à curto, médio e, em muitos casos, a longo prazo. Foi feito, também um estudo comparativo dos resultados em relação à idade, sexo, tempo de doença e à presença ou não do timoma.

A experiência adquirida neste grupo de pacientes sugere que a timectomia transtorácica é método terapêutico útil na miastenia grave generalizada não timomatosa; seu efeito benéfico aparece no pós-operatório mediato e se mantém a longo prazo na maioria dos pacientes. Os resultados da timectomia em pacientes com timoma foram menos favoráveis. A análise estatística não mostrou diferenças significantes na evolução pós-operatória entre os pacientes não timomatos selecionados e não selecionados.

SUMMARY

An evaluation of results obtained after 73 thymectomies is reported. A transthoracic approach was used on all of the patients. Thymomas were found in 9 out of the 73 patients with myasthenia. All of the 64 patients without thymomas suffered from generalized myasthenia gravis with predominance of severe forms. The results of the early, intermediate and late post-operative course were analysed. A comparative study of results as related to age, sex, duration of disease and presence or absence of thymomas was made. Statistical analysis failed to show any significant difference in the results of thymectomy between selected and randomly chosen patients without thymomas.

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Agradecimento Agradecemos ao Prof. José Maria Marlet pela sua preciosa contribuição na análise estatística dos resultados.

Departamento de Neuropsiquiatria, Divisão de Neurologia Faculdade de Medicina, Universidade de São Paulo Caixa postal 3+61 01000 São Paulo, SP Brasil.

1. ALLISON, A. C. & TAYLOR, R. A. Observations on thymectomy and carcinogenesis. Cancer Res. 27:703, 1967.
2. BLALOCK, A.; MASON, M. D.; MORGAN, H. J. & RIVEN, S. S. - Myasthenia gravis and tumors of the thymic region: report of a case in which tumor was removed. Ann. Surg. 110:544, 1939.
3. DOWNES, J. M.; GREENWOOD, B. M. & WRAY, S. H. Autoimune aspects of myasthenia gravis. Quart. J. Med. 35:85, 1966.
4. EATON, L. M. & CLAGETT, O. T. Present status of thymectomy in treatment of myasthenia gravis. Amer. J. Med. 19:703, 1955.
5. FONKALSRUD, E.; HERMANN Jr., C. & MULDER, D. G. Thymectomy for myasthenia gravis in children. J. pediat. Surg. 5:157, 1970.
6. GENKINS, G.; PAPATESTAS, A. E.; HOROWITZ, S. H. & KORNFELD, S. -Studies in myasthenia gravis: early thymectomy. Electrophysiologic correlation. Amer. J. Med. 58:517, 1975.
7. GOLDSTEIN, G. & WHITTINGHAN, S. Experimental autoimune thymitis. An animal model of human myasthenia gravis. Lancet 11:315, 1966.
8. GOLDSTEIN, G.; STRAUS, J. L. & PICKERAL, S. Antigens in thymus and muscle effective in inducing experimental autoimune thymitis and the release of thymin. Clin. Exp. Immunol. 4:3, 1969.
9. GROB, D. Course and management of myasthenia gravis. J. Amer. med. Ass. 152:529, 1953.
10. GROB, D. Myasthenia gravis. A review of pathogenesis and treatment. Arch. intern. Med. 108:615, 1961.
11. GROB, D. & NAMBA, T. Complement fixation by muscle nucleoprotein and serum of patients with myasthenia gravis and other diseases. J. clin. Invest. 42:940, 1963.
12. HARVEY, A. M. Some preliminary observations on the clinical course of myasthenia gravis before and after thymectomy. Bull. N. Y. Acad. Med. 24:505, 1948.
13. KEYNES, G. The surgery of the thymus gland. Brit. J. Surg. 32:201, 1946.
14. KEYNES, G. The results of thymectomy in myasthenia gravis. Brit. med. J. 11:611, 1949.
15. KIMURA, J. & VAN ALLEN, M. W. Post-thymectomy myasthenia gravis. Report of a case of ocular myasthenia gravis after total removal of a thymona and review of literature. Neurology (Minneapolis) 17:413, 1967.
16. KORNFELD, P.; SIEGAL, S.; WEINER, L. B. & OSSERMAN, K. E. Studies in myasthenia gravis. Immunologic response in thymectomized and nonthymectomized patients. Ann. intern. Med. 63:416, 1965.
17. MACKAY, I. R.; WHITTINGHAM, S.; GOLDSTEIN, G.; CURRIE, T. T. & HARE, W. S. C. Myasthenia gravis: clinical serological and histological studies in relation to thymectomy. Aust. Ann, Med. 17:1, 1968.
18. MARSHALL, A. H. E. & WHITE, R. G. The immunological reactivity of the thymus. Brit. J. exp. Path. 2:379, 1961, 1961.
19. MULDER, D. G.; BRAITMAN, H.; LI WEI-I & HERRMANN Jr., C. Surgical management in myasthenia gravis. J. thorac. Cardiovasc. Surg. 63:105, 1972.
20. PAPATESTAS, A. E.; ALPERT, L. I.; OSSERMAN, K. E.; OSSERMAN, R. S. & KARK, A. E. Studies in myasthenia gravis: effects of thymectomy. Amer. J. Med. 50:465, 1971.
21. PAPATESTAS, A. E.; GENKINS, G.; KORNFELD, P.; HOROWITZ, S. H. & KARK, A. E. Transcervical thymectomy in myasthenia gravis. Surg. Gynec. Obstet. 140:535, 1975.
22. PAPATESTAS, A. E.; GENKINS, G.; HOROWITZ, S. H. & KORNFELD, P. Thymectomy in myasthenia gravis: pathologic, clinical, and electrophysiologic correlations. Ann. N. Y. Acad. Sci. 274:555, 1976.
23. PAPATESTAS, A. E.; OSSERMAN, K. E. & KARK, A. E. Relationship between thymus and oncogenesis. A study of the incidence of non-thymic malignancy in myasthenia gravis: Brit. J. Cancer 25:635, 1971.
24. PERLO, V. P.; SCHWAB, R. S.; VIETS, H. R.; POSKANZER, D. A.; OSSERMAN, K. E. & GENKINS, G. Myasthenia gravis: evolution of treatment in 1.355 patients. Neurology (Minneapolis) 16:431, 1966.
25. SAUBIER, E. C.; TRILLET, M. & PARTENSKY, C. Thymectomie pour myasthenic. Les résultates eloignés de 26 cases. Lyon chir. 70:170, 1974.
26. SCHWAB, R. S. & LELAND, C. C. Sex and age in incidence and remission. J. Amer. med. Ass. 153:1270, 1953.
27. SEYBOLD, M. E.; HOWARD Jr., F. M.; DUANE, D. D.; PAYNE, S. W. & HARRISON Jr., E. G. Thymectomy in juvenile myasthenia gravis. Arch. Neurol. (Chicago) 25:385, 1971.
28. SHAPIRO, M. S.; NAMBA, T. & GROB, D. Corticotropin therapy and thymectomy in management of myasthenia gravis. Arch. Neurol. (Chicago) 24:65, 1971.
29. SIMPSON, J. A. An evaluation of thymectomy in myasthenia gravis. Brain 81:112, 1958.
30. SIMPSON, J. A. Myasthenia gravis as an autoimune disease: clinical aspects. Ann. N. Y. Acad. Sci. 135:506, 1966.
31. STRAUSS, A. J. L.; VAN DER GELD, H. W. R.; KEMP JR., P. G.; EXUM, E. D. & GOODMAN, H. C. Immunological concomitants of myasthenia gravis. Ann. N. Y. Acad. Sci. 124:744, 1965.
32. WILKINS, E. W.; EDMUNDS Jr., L. H.; CASTLEMAN, B. Cases of thymoma at the Massachusetts General Hospital. J. thorac. cardiovasc. Surg. 52:322, 1966.
33. WOLF, S. M.; ROWLAND, L. P.; SCHOTLAND, D. L.; MCKINNEY, A. S.; HOEFER, P. F. A. & ARANOW Jr., H. Myasthenia gravis as an autoimune disease: clinical aspects. Ann. N. Y. Acad. Sci. 135:517, 1966.

Timectomia na miastenia grave: avaliação dos resultados em 73 pacientes

Thymectomy in myasthenia gravis: an evaluation of results in 73 patients

Datas de Publicação

Publicação nesta coleção
28 Ago 2012
Data do Fascículo
Mar 1978

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ALLISON, A. C. & TAYLOR, R. A. Observations on thymectomy and carcinogenesis. Cancer Res. 27:703, 1967.

[2] 2. BLALOCK, A.; MASON, M. D.; MORGAN, H. J. & RIVEN, S. S. - Myasthenia gravis and tumors of the thymic region: report of a case in which tumor was removed. Ann. Surg. 110:544, 1939.

[3] 3. DOWNES, J. M.; GREENWOOD, B. M. & WRAY, S. H. Autoimune aspects of myasthenia gravis. Quart. J. Med. 35:85, 1966.

[4] 4. EATON, L. M. & CLAGETT, O. T. Present status of thymectomy in treatment of myasthenia gravis. Amer. J. Med. 19:703, 1955.

[5] 5. FONKALSRUD, E.; HERMANN Jr., C. & MULDER, D. G. Thymectomy for myasthenia gravis in children. J. pediat. Surg. 5:157, 1970.

[6] 6. GENKINS, G.; PAPATESTAS, A. E.; HOROWITZ, S. H. & KORNFELD, S. -Studies in myasthenia gravis: early thymectomy. Electrophysiologic correlation. Amer. J. Med. 58:517, 1975.

[7] 7. GOLDSTEIN, G. & WHITTINGHAN, S. Experimental autoimune thymitis. An animal model of human myasthenia gravis. Lancet 11:315, 1966.

[8] 8. GOLDSTEIN, G.; STRAUS, J. L. & PICKERAL, S. Antigens in thymus and muscle effective in inducing experimental autoimune thymitis and the release of thymin. Clin. Exp. Immunol. 4:3, 1969.

[9] 9. GROB, D. Course and management of myasthenia gravis. J. Amer. med. Ass. 152:529, 1953.

[10] 10. GROB, D. Myasthenia gravis. A review of pathogenesis and treatment. Arch. intern. Med. 108:615, 1961.

[11] 11. GROB, D. & NAMBA, T. Complement fixation by muscle nucleoprotein and serum of patients with myasthenia gravis and other diseases. J. clin. Invest. 42:940, 1963.

[12] 12. HARVEY, A. M. Some preliminary observations on the clinical course of myasthenia gravis before and after thymectomy. Bull. N. Y. Acad. Med. 24:505, 1948.

[13] 13. KEYNES, G. The surgery of the thymus gland. Brit. J. Surg. 32:201, 1946.

[14] 14. KEYNES, G. The results of thymectomy in myasthenia gravis. Brit. med. J. 11:611, 1949.

[15] 15. KIMURA, J. & VAN ALLEN, M. W. Post-thymectomy myasthenia gravis. Report of a case of ocular myasthenia gravis after total removal of a thymona and review of literature. Neurology (Minneapolis) 17:413, 1967.

[16] 16. KORNFELD, P.; SIEGAL, S.; WEINER, L. B. & OSSERMAN, K. E. Studies in myasthenia gravis. Immunologic response in thymectomized and nonthymectomized patients. Ann. intern. Med. 63:416, 1965.

[17] 17. MACKAY, I. R.; WHITTINGHAM, S.; GOLDSTEIN, G.; CURRIE, T. T. & HARE, W. S. C. Myasthenia gravis: clinical serological and histological studies in relation to thymectomy. Aust. Ann, Med. 17:1, 1968.

[18] 18. MARSHALL, A. H. E. & WHITE, R. G. The immunological reactivity of the thymus. Brit. J. exp. Path. 2:379, 1961, 1961.

[19] 19. MULDER, D. G.; BRAITMAN, H.; LI WEI-I & HERRMANN Jr., C. Surgical management in myasthenia gravis. J. thorac. Cardiovasc. Surg. 63:105, 1972.

[20] 20. PAPATESTAS, A. E.; ALPERT, L. I.; OSSERMAN, K. E.; OSSERMAN, R. S. & KARK, A. E. Studies in myasthenia gravis: effects of thymectomy. Amer. J. Med. 50:465, 1971.

[21] 21. PAPATESTAS, A. E.; GENKINS, G.; KORNFELD, P.; HOROWITZ, S. H. & KARK, A. E. Transcervical thymectomy in myasthenia gravis. Surg. Gynec. Obstet. 140:535, 1975.

[22] 22. PAPATESTAS, A. E.; GENKINS, G.; HOROWITZ, S. H. & KORNFELD, P. Thymectomy in myasthenia gravis: pathologic, clinical, and electrophysiologic correlations. Ann. N. Y. Acad. Sci. 274:555, 1976.

[23] 23. PAPATESTAS, A. E.; OSSERMAN, K. E. & KARK, A. E. Relationship between thymus and oncogenesis. A study of the incidence of non-thymic malignancy in myasthenia gravis: Brit. J. Cancer 25:635, 1971.

[24] 24. PERLO, V. P.; SCHWAB, R. S.; VIETS, H. R.; POSKANZER, D. A.; OSSERMAN, K. E. & GENKINS, G. Myasthenia gravis: evolution of treatment in 1.355 patients. Neurology (Minneapolis) 16:431, 1966.

[25] 25. SAUBIER, E. C.; TRILLET, M. & PARTENSKY, C. Thymectomie pour myasthenic. Les résultates eloignés de 26 cases. Lyon chir. 70:170, 1974.

[26] 26. SCHWAB, R. S. & LELAND, C. C. Sex and age in incidence and remission. J. Amer. med. Ass. 153:1270, 1953.

[27] 27. SEYBOLD, M. E.; HOWARD Jr., F. M.; DUANE, D. D.; PAYNE, S. W. & HARRISON Jr., E. G. Thymectomy in juvenile myasthenia gravis. Arch. Neurol. (Chicago) 25:385, 1971.

[28] 28. SHAPIRO, M. S.; NAMBA, T. & GROB, D. Corticotropin therapy and thymectomy in management of myasthenia gravis. Arch. Neurol. (Chicago) 24:65, 1971.

[29] 29. SIMPSON, J. A. An evaluation of thymectomy in myasthenia gravis. Brain 81:112, 1958.

[30] 30. SIMPSON, J. A. Myasthenia gravis as an autoimune disease: clinical aspects. Ann. N. Y. Acad. Sci. 135:506, 1966.

[31] 31. STRAUSS, A. J. L.; VAN DER GELD, H. W. R.; KEMP JR., P. G.; EXUM, E. D. & GOODMAN, H. C. Immunological concomitants of myasthenia gravis. Ann. N. Y. Acad. Sci. 124:744, 1965.

[32] 32. WILKINS, E. W.; EDMUNDS Jr., L. H.; CASTLEMAN, B. Cases of thymoma at the Massachusetts General Hospital. J. thorac. cardiovasc. Surg. 52:322, 1966.

[33] 33. WOLF, S. M.; ROWLAND, L. P.; SCHOTLAND, D. L.; MCKINNEY, A. S.; HOEFER, P. F. A. & ARANOW Jr., H. Myasthenia gravis as an autoimune disease: clinical aspects. Ann. N. Y. Acad. Sci. 135:517, 1966.