[Rethymectomy for intractable myasthenia gravis with thymus remnants].
Nine myasthenia gravis patients (including 6 thymomas) with partial or no recovery were studied from 2 to 13 years after previous thymectomy, which had been carried out by the transsternal simple thymectomy in three, transretrothoratic simple thymectomy in three and extended thymectomy in three. X-ray CT and MRI of the mediastinum showed images compatible with residual thymic tissue in 8 of 9 patients. All patients underwent reoperation by extended thymectomy, and thymic tissue was found in 7 of 9 patients. There is no patients with recurrent thymoma localized to the mediastinum. After repeated thymectomy, 7 of 9 patients improved clinical including one patient without remnant and 2 patients were unchanged. Persistence of symptoms in patients with myasthenia gravis who have undergone the first surgery has been attributed to remnant thymic tissue. There is no correlation in the improvement and corticosteroid hormone therapy before the re-exploration. Therefore, it is quite reasonable to infer that incomplete removal of the thymus was responsible, at least partly, for failure of the first procedure.
Department of Neurology, Kumamoto Chuoh Hospital.
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N
Yamanaka
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S
Araki
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D012086:Reoperation; D013934:Thymectomy