• Journal of Yeungnam Medical Science
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• v.2 no.1
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• pp.287-292
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• 1985

Myasthenia gravis is usually defined as a state of abnormal fatigability. The cause of myasthenia gravis is not known. Several disorders tend to occur more frequently in patients with myasthenia gravis, such as hyperthyroidism or other thyroidal disorder. Anesthetic experience with thymectomies for two patients with myasthenia gravis has been reported. Both of them tolerated the surgical procedures under endoteracheal Nitrous oxide-Oxygen-Halothane anesthesia well. Diagnosis and clinical features including choice of preanesthetic medication, anesthetic agents, techniques and of neuromuscular blocking agents for myasthenic patients have been discussed. Paramount importance of rigid attention to ventilation, the maintenance of a patent airway and the removal of secretions whenever necessary for the patient safety throughout operative and postoperative period has been stressed.

• Journal of Chest Surgery
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• v.36 no.1
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• pp.15-20
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• 2003

Myasthenia gravis is a rare autoimmune disease involving acetylcholine receptor and its autoantibody on neuromuscular junction. The methods of treatment are medical treatment and surgical thymectomy. In this paper we analyzed the result of thymectomy and the factors affecting the postoperative symptom improvement. Material and method : This study obtained medical records of 37 patients who received the thymectomy for myasthenia gravis from March 1986 to December 1998. Result Out of 37 cases, 21 cases(57%) showed improvement, of which 8 cases (50%) in the group of thymoma(n=16), and 13 cases (62%) in the group of thymic hyperplasia(n=21) showed the improvement of symptoms. Postoperative complications were respiratory insufficiency due to aggravation of symptoms after operation, including tracheal intubation for ventilator support in 9 cases, pneumonia in 3 cases, pneumothorax in 2 cases and left vocal cord palsy in 1 case. There was one postoperative mortality. The relation between postoperative improvement and sex(P=0.3222), age(P=0.7642), thymic pathologic variants,(P=0.4335) and classification of thymoma(P=0.20) showed no statistically significant correlation. However, the lower grade of preoperative symptoms can predict the lower grade of postoperative symptoms significantly(P=0.0032). Follow up study to 36 postoperative survivors was performed in October 2002 based on the out-patient records and call with patients. Out of 36 cases, 33 cases(91.7%) could be investigated and 3 cases could not. Mean follow up period was 83.2 months. Out of 33 cases, 25 cases(75.8%) showed symptomatic improvement, of which 8 cases(53.3%) in the group of thymoma(n=15) and 17 cases(94.4%) in the group of thymic hyperplasia(n=18) showed the improvement of$\boxUl$ symptoms. Conclusion : In myasthenia gravis, thymectomy showed the good improvement, and more important factor affecting the improvement of symptoms was the grdae of preoperative symptoms. Also midterm and long term follow up results showed good symptomatic improvement.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.557-561
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• 2010

In the treatment of myasthenia gravis, thymectomy is generally accepted as the standard of therapy. For thymectomy, there have been various conventional open approaches including sternal splitting, but recently minimally invasive approaches have been increasingly applied. A 28-year-old man presenting with weakness of both hands and fatigability was diagnosed as having myasthenia gravis with thymic hyperplasia. He underwent a robot-assisted thymectomy with the 'da Vinci' surgical system. Through the right thoracic cavity, two thirds of the thymic gland was dissected, and the remainder was resected through the left; these procedures took, respectively, 1 hour and 30 minutes. The patient was discharged on the 8th postoperative day without complications. The minimally invasive approach with the 'da Vinci' surgical system is emerging as a popular choice and various advantages have been reported. Here we report the first successful case of robot-assisted thymectomy.

• Journal of Yeungnam Medical Science
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• v.18 no.2
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• pp.277-286
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• 2001

Background: This study was undertaken to evaluate the diagnostic sensitivity of several muscles in repetitive nerve stimulation test (RNST) for myasthenia gravis (MG) patients. Materials and Methods: The study population consisted of 39 MG patients classified by modified Ossermann's classification. Using Stalberg's method, RNST was systematically performed in facial (orbicularis oculi and nasalis) and upper extremity (flexor carpi ulnaris, abductor digiti quinti and anconeus) muscles. Results: The significant electrodecremental response of RNST were noted in orbicularis oculi(58.9%), nasalis (51.3%), flexor carpi ulnaris(42%), anconeus(41%) and abductor digiti quinti muscles(27%). Among the 3 muscles of upper extremity(abductor digiti quinti, flexor carpi ulnaris and anconeus), the positive electrodecremental response of anconeus muscles was significantly higher than other two muscles(p<0.05) in type IIa, IIb and there were no statistical differences of the positive electrodecremental response between orbicularis oculi and nasalis muscles. The facial muscles showed more prominent decremental responses than upper extremity muscles in type I MG(p<0.05). In type IIa MG patients, there were no significant statistical differences between facial and upper extremity muscles but significant statistical differences among upper extremity muscles. In type IIb MG patients, there were no significant statistical differences in all tested muscles in spite of the increased positive electrodecremental response of RNST. Conclusion: On the basis of this study, RNST would be initially performed for the orbicularis or nasalis in type I MG and for the anconeus in type IIa or IIb MG.

• Journal of Chest Surgery
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• v.26 no.3
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• pp.219-223
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• 1993

Myasthenia gravis is disorder of neuromuscular transmission that is characterized by weakness and fatigue of voluntary muscle. A clinical study of 18 cases of myasthenia gravis was performed at Chosun university college of medicine, from 1988 to 1992. Maximal thymectomy was performed in 7 cases and only medical treatment had been done in 11 cases.

• Proceedings of the KTCVS Conference
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• 1998.10a
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• pp.92-92
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• 1998

• Childhood Kidney Diseases
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• v.6 no.2
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• pp.259-265
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• 2002

Bartter syndrome is a rare disorder characterized by the association of hypokalemic hypochloremic metabolic alkalosis, hyperreninemia, hyperaldosteronemia, short stature and nephrocalcinosis. This disorder presents with hyperplasia of juxtaglomerular apparatus on renal biopsy. We experienced a case of late-onset Bartter syndrome with nephrocalcinosis in a 9-year-old boy, whose chief pictures were muscle weakness, short stature, persistent sterile pyuria and microscopic hematuria. We report this case with a brief review of related literatures.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.25 no.1
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• pp.141-150
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• 1995

종양유발성 골연화증은 종양에 의하여 생성된 활동성 펩티드호르몬과 유사한 물질이 골이나 위장관에 작용하여 칼슘대사와 인대사의 변화를 일으키거나, 정상적인 비타민 D대사에 장애를 일으킴으로써 2차적으로 발생되는 대사성 질환으로 알려져 있다. 이의 발생빈도는 매우 낮으며, 임상적으로는 체중과 신장의 감소, 전신적인 골격의 동통 및 근무력증과 병적 골절이 동반되어 나타난다. 방사선사진에서는 골소주의 전반적인 소실, 피질골의 비박, 위골절, 치조백선의 소실 등을 보이고, 실험실 소견에서는 혈청인의 농도와 신세뇨관에서 인의 재흡수율의 감소 및 혈청 알칼리성 인산화효소 농도의 상승이 관찰된다. 본질환은 종양이 제거되면 별도의 부가적인 치료 없이도 임상적, 방사선학적 소견 및 실험실 소견의 뚜렷한 개선을 보이므로 이의 치료에 있어서 정확한 진단이 매우 중요하다. 저자들은 전신적인 동통과 근무력증을 주소로 내원한 환자들에게서 발생된 종양유발성 골연화증 3예를 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.589-592
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• 1996

We report two cases of the thoracoscopic thymectomies for patients of myasthenia gratis with tracheostomy (Osserman's Group-ll-C-1). The Irst case was 47-year-old male wlth generalized myas- thenia gravis who was under the mechani al ventilator therapy with tracheostomy. The second case was 60-year-old male with deteriorating generalized myasthenia gratis after the mechanical ventilator therapy. We decided to resect the thymus by vldeo-assisted thoracoscopy to prevent the ouurrence of postoperative complications, especially mediastinitis because all two cases were under tracheostomy state. We could stop the mechanical ventilator therapy on the postoperati'fe 16th day and 3rd day respect- ively and they were recovered without mediastinitis. So we concluded that video-assisted thoracoscopic thymectomy is a good alternative surgical method for myasthenia gratis patients with tracheostomy.

• Korean Journal of Head & Neck Oncology
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• v.21 no.1
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• pp.32-34
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• 2005

Myasthenia gravis with thymoma is associated with an increased risk of second malignancy, but concurrence of myasthenia gravis and thyroid carcinoma is rarely seen. In the treatment, it is emphasized to operate in two stage to avoid myasthenic crisis after surgery. In general, a thyroid cancer surgery is performed after controlling yasthenia gravis by means of thymectomy or medical treatment with steroids and anticholine esterase. We experienced two cases of thyroid carcinoma coexisting with myasthenia gravis, which is thought to be true first report in Korea.