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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.48 no.3 São Paulo Sept. 1990

http://dx.doi.org/10.1590/S0004-282X1990000300002 

Diagnostico y tratamiento de la myasthenia gravis estudio de una poblacion hospitalaria

 

Diagnosis and treatment of myasthenia gravis: study of an inpatient population

 

 

Roberto D. ReyI; Olga P. SanzI; José M. FernandezII; Raul C. ReyI; Marcela PanizzaI; Norberto LucilliII; Miguel A. AstudilloII; Gloria DiazIII; Alejandro H. VillegasII; Roberto E. P. SicaI

IDivision Neurologia - Hospital J.M. Ramos Mejia
IIDivision «B» Cirugia - Hospital J.M. Ramos Mejia
IIIDivision Diagnóstico por Imagenes - Hospital J.M. Ramos Mejia

 

 


RESUMEN

Durante la observacion de 50 pacientes con Myasthenia gravis entre los anos 1974 y 1987 se encontro un predominio del sexo femenino en la proporcion de 2,5 a 1 y mayor frecuencia de presentacion en Ias 3ª y 5ª décadas de la vida. Luego de la evaluacion clínica, el diagnóstico fué confirmado mediante: (1) prueba dei edrofonio, (2) estímulo nervioso repetitivo, (3) dosaje de anticuerpos antirreceptor colinérgico y (4) transferencia pasiva del suero al raton con ulterior niedicion de la amplitud de mepp's. La positividad diagnostica vario entre el 90 y el 100%, segun el tipo de prueba empleada. El estúdio radiológico del timo fué hecho con neumomediastinografía. obteniendose excelente correlación con la descripcion histológica de la glândula, y con tomografia computada, que demostro menor eficiência diagnostica. El tratamiento fué implementado en base a anticolinesterásicos, timectomía y corticoterapia inmunosupresora, evidenciandose con esta última mejores resultados. Nueve pacientes desarrollaron peoria transitória del cuadro muscular al iniciarse el tratamiento esteroideo, 6 de ellos exhibieron posteriormente evolucion desfavorable. Esta observacion aparenta tener valor pronóstico en la evolucion de la MG.


SUMMARY

Between 1974 and 1987 we have examined 50 patients with the diagnosis of myasthenia gravis. Female preponderance (2,5: 1) was found. Also, it was observed that most of the patients were aged between 20 and 49 years. Beside the clinical examination, the following tests were performed: (1) edrofonium test, (2) supramaximal repetitive nerve stimulation, (3) serum acetylcholine antibodies titers and (4) intraperitoneal passive transference of patient's sera to mice and recording of meepp's amplitude in the phrenic-diaphragm preparation in vitro. These four tests gave positive values for myasthenia in 90 to 100% of the cases. Thymus radiological examination was carried out by pneumomediastinography, which proved to correlate with the hsitological picture of the gland, and computed tomography, which disclosed some discrepances with the histology. Treatment was based on anticholinesterase drugs, corticosteroids and thymectomy, being the corticosteroids the most valuable therapeutical tool. Nine patients treated with steroids disclosed transitory worsening of their signs and symptoms at very early stages after onset of corticosteroid therapy, 6 of them had a disfavorable course in their follow-up. This observation seem to have value in the early prognosis of the disease.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Dr. Roberto D. Rey - Division Neurologia, Hospital Ramos Mejia - Urquiza 609 - 1221 Buenos Aires - Argentina.

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