title: Thymectomy in myasthenia gravis: comparison of outcome in Santiago, Cuba and Nottingham, UK.
abstract: OBJECTIVE
  We compared the outcome of thymectomy for myasthenia gravis (MG) in two healthcare systems. In Nottingham, UK, thymectomy is performed for thymic enlargement and considered in acetylcholine receptor (AchR) antibody positive patients. In Santiago, Cuba, thymectomy is considered in all generalised MG patients irrespective of their radiological findings or AchR antibodies.
  
  
  METHODS
  22 MG patients in Nottingham and 75 in Santiago who had a thymectomy were identified and their notes reviewed. We compared the median age, stage of disease, thymic histology and clinical outcome at two years post-thymectomy.
  
  
  RESULTS
  The median ages for the Cuban and Nottingham patients were 25 and 35 years respectively. The median stage of disease was IIa by Osserman's classification in both. In Nottingham, 59% (13/22) showed an improvement compared with 88 % (66/75) in Santiago (p < 0.01). There were significantly more cases of thymoma in Nottingham whereas thymic hyperplasia and atrophy were a more frequent finding in Cuban patients. The majority of cases who improved post-thymectomy had thymic hyperplasia on histology in both Nottingham (46%) and Cuban (61%) patients.
  
  
  CONCLUSIONS
  Selecting MG patients based on thymic enlargement alone or AchR antibody positivity may be inadequate and thymectomy should perhaps be considered in all patients with generalised myasthenia.
authors.affiliation: Dept. of Neurology, Queen's Medical Centre, Nottingham NG7 2 UH, UK.
authors.forename: N
authors.initials: N
authors.lastname: Shahrizaila
authors.forename: O A
authors.initials: OA
authors.lastname: Pacheco
authors.forename: D G
authors.initials: DG
authors.lastname: Vidal
authors.forename: F R
authors.initials: FR
authors.lastname: Miyares
authors.forename: A J
authors.initials: AJ
authors.lastname: Wills
mesh_terms: D000328:Adult; D000367:Age Factors; D001284:Atrophy; D001323:Autoantibodies / Q000032:analysis; D003462:Cuba; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D008297:Male; D009157:Myasthenia Gravis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology* / Q000601:surgery*; D011950:Receptors, Cholinergic / Q000276:immunology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013934:Thymectomy; D013945:Thymoma / Q000150:complications; D013950:Thymus Gland / Q000473:pathology; D013953:Thymus Neoplasms / Q000150:complications; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D001323:Autoantibodies; D011950:Receptors, Cholinergic