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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.53 no.3a São Paulo Sept. 1995 

Plasmapheresis as preparatory method for thymectomy in myasthenia gravis


Plasmaferese como método preparatório de timectomia em miastenia grave



José Carlos Brant SeggiaI; Paulo AbreuII; M. TakataniIII

IHead of Clinic of the Neurologic Clinic
IIStaff member of the Nephrology Clinic
IIIResident at the Neurologic Clinic




To study the effects of plasmapheresis in preparation for thymectomy, two groups of 40 patients were selected from a sample of 286 patients with myasthenia gravis examined by the first author Group 1 included patients (15 male and 25 female; age range 8-64 yrs) who underwent thymectomy without previous plasmapheresis, whereas patients in group 2 (17 male and 23 female; age range 11-61 yrs) were thymectomized after plasmapheresis. We required patients to have a minimum follow-up period of 12 months to be included in the study. A clinical evaluation protocol composed of 76 items was developed for the study. We found significant improvement in respiratory function and muscular strength in patients thymetomized after plasmapheresis. Furthermore, the combined treatment reduced cost and length of hospital stay. Therefore, we conclude that plasmapheresis should be considered as a coadjuvant to thymectomy in the treatment of myasthenia gravis.

Key words:myasthenia gravis, thymectomy, plasmapheresis.


No intuito de estudar as repercussões de um curso de plasmaferese como método preparatório para a timectomia, tomamos duas amostras de 40 pacientes selecionados de um universo de 286 casos de miastenia gravis, em que a investigação clínica, eletrofisiológica, laboratorial, o seguimento e o protocolo foram completamente realizados. Consideramos como grupo 1 aquele em que a timectomia foi realizada sem preparação pre-operatória e grupo 2 aquele em que a plasmaferese foi executada como coadjuvante a timectomia. O grupo 1 era composto de 15 pacientes do sexo masculino e 25 do feminino; a idade variou de 8 a 64 anos com mediana de 30 anos. No segundo grupo, 17 eram masculinos e 23 femininos; a idade variou de 11 a 61 anos com mediana de 33 anos. Foi preenchida ficha de avaliação clínica sequencial de 76 itens e traçamos um curso de plasmaferese de 5 sessões seguido da timectomia, mantendo a mesma técnica operatória, realizada pela mesma equipe cirúrgica, tentando assim minimizar as distorções na análise e manuseio destes pacientes. Obtivemos melhora clínica, da insuficiência respiratória, da força muscular e reduzimos também o custo da internação quando comparada aos pacientes em que a cirurgia foi realizada sem a plasmaferese e em alguns casos em que realizamos preparação com corticosteróides. Acreditamos que a plasmaferese deva ser considerada como método coadjuvante no tratamento cirúrgico desta grave afecção.

Palavras-chave: miastenia gravis, timectomia, plasmaferese.



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Aceite: 7-fevereiro-1995.



Hospital dos Servidores do Estado, Rio de Janeiro, Brasil:
Dr. José Carlos Brant Seggia - Avenida Almirante Ary Parreiras 659 - 24230-321 Niterói RJ - Brasil.

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