• 제목/요약/키워드: Myasthenia gravis

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Temperature in Nerve Conduction and Electromyography (신경전도와 근전도검사에서의 체온)

  • Kim, Doo-Eung
    • Annals of Clinical Neurophysiology
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    • v.8 no.2
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    • pp.125-134
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    • 2006
  • Among the various physiological factors that affect nerve conduction velocity (NCV), temperature is the most important. Because the influence of temperature is the most important source of error. It is known from animal experiments that conduction is eventually completely blocked at low temperatures, the myelinated A fibers being the first affected and the thin fibers of group C the last. Many studies showed that the NCV decreases linearly with lowering temperature within the physiological range. The distal motor latency increased by $0.2msec/^{\circ}C$ drop in temperature between $25^{\circ}C$and $35^{\circ}C$ in the median, ulnar and peroneal nerves. The temperature affect the neuromuscular transmission; The miniature endplate potential (MEPP) and endplate potential (EPP) are increase with increasing temperature. In myasthenia gravis, the reduction in the decremental response is observed following cooling. The lowering temperature make increase the amplitude of sensory compound action potential; make enlarge the surface area of compound muscle action potential with very little increase in amplitude; make diminish the fibrillation potential and increase the myotonia in needle electromyography (EMG). Because of these findings mentioned above, the skin temperature should be routinely monitored and controlled during nerve conduction tests and needle EMG and should be taken into account when interpreting the findings.

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Clinical Characteristics and Treatment of Immune-Related Adverse Events of Immune Checkpoint Inhibitors

  • Juwhan Choi;Sung Yong Lee
    • IMMUNE NETWORK
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    • v.20 no.1
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    • pp.9.1-9.21
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    • 2020
  • Immune checkpoint inhibitors (ICIs) have been changing the paradigm of cancer treatment. However, immune-related adverse effects (irAEs) have also increased with the exponential increase in the use of ICIs. ICIs can break up the immunologic homeostasis and reduce T-cell tolerance. Therefore, inhibition of immune checkpoint can lead to the activation of autoreactive T-cells, resulting in various irAEs similar to autoimmune diseases. Gastrointestinal toxicity, endocrine toxicity, and dermatologic toxicity are common side effects. Neurotoxicity, cardiotoxicity, and pulmonary toxicity are relatively rare but can be fatal. ICI-related gastrointestinal toxicity, dermatologic toxicity, and hypophysitis are more common with anti- CTLA-4 agents. ICI-related pulmonary toxicity, thyroid dysfunction, and myasthenia gravis are more common with PD-1/PD-L1 inhibitors. Treatment with systemic steroids is the principal strategy against irAEs. The use of immune-modulatory agents should be considered in case of no response to the steroid therapy. Treatment under the supervision of multidisciplinary specialists is also essential, because the symptoms and treatments of irAEs could involve many organs. Thus, this review focuses on the mechanism, clinical presentation, incidence, and treatment of various irAEs.

Annual report of thoracic and cardiovascular surgery in Korea [II] (흉부외과 진료통계( II ) -1992년-)

  • Sun, Kyung;Kwak, Young-Tae;Kim, Hyoung-Mook
    • Journal of Chest Surgery
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    • v.26 no.3
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    • pp.163-169
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    • 1993
  • This is the result of the annual statistic analysis of thoracic and cardiovascular surgical cases in 1992 Korea. Overall 17, 520 cases of surgery [11, 732 cases of thoracic surgery by 54 institutes / 5, 788 cases of cardiovascular surgery by 48 institutes] were done. 1. Tumor [N=2, 532] : Lung was the most frequently involved organ by tumor [54.9%],and the remainders were mediastinum [16.2%] / esophagus [14.8%] / chest wall [11.7%] / tracheobronchus [1.3%] / pleura [1.1%] in order. Of 1, 082 cases of primary lung cancer surgery,the frequency of cell type was squamous [62.6%] / adeno [21.6%] / small cell [7.1%] / large cell [2.7%]. Of 411 cases of mediastinal tumor surgery,the frequency of cell type was neurogenic [28.8%] / thymoma [27.6%] / teratoma [17.7%] / congenital cystic [17.2%]. Of 376 cases of esophageal tumor surgery,primary cancer were the most [85.4%]. 2. Infection [N=3, 157] : Pleura was the most frequently involved organ [59.0%],and the remainders were lung [31.3%] / chest wall [8.6%] / mediastinum [1.1%] in order. 3. Miscellaneous [N=6, 043] : Lung and pleural disease esp. pneumothorax [85.1%] was the most frequent surgical indication. The remainders were chest wall anomaly [3.4%] / benign esophageal disease [3.4%] / diaphragmatic pathology [2.4%] / myasthenia [1.4%] in order. Of 85 cases of thymectomy for myasthenia gravis,thymoma was noted in 58.8%. 1. Congenital heart disease [N=3, 363] : The ratio of noncyanotic to cyanotic heart disease was 3:1. Of 2, 516 cases of noncyanotic heart disease,the frequency of disease entity was VSD [44.1%] / ASD [26.0%] / PDA [19.4%] / PS [3.3%],and that of 847 cases of cyanotic heart disease was TOF [29.4%] / ECD [15.6%] / TGA [9.7%] / DORV [7.6%]. Overall mortalities were 2.1% in noncyanotic and 12.2% in cyanotic heart surgery. 2. Acquired heart disease [N=1, 929] : Of 1, 422 cases of valvular surgery,single mitral pathology was the most frequent candidate [48.0%],and total 1, 574 prosthetic valves which were mainly mechanical [95.6%] were used. Of 376 cases of coronary surgery,triple vessel was the most [35.9%],and the frequency of bypassing grafts was great saphenous vein [52.9%] / internal mammary artery [44.7%] / artificial vessel [2.4%]. Overall mortalities were 3.4% in valvular and 4.5% in coronary surgery. 3. Pericardium,Cardiac tumor,Arrhythmia,Aortic aneurysm,Assist device,and Pacemaker : There were no specific changes compared to previous survey1]. This nation-wide inquiry will be continued and reported annually by KTCS Society.

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Modulation of Bujaijung-tang and Bojungikgi-tang on Inhibitory and Excitatory Neurotransmitters Activated Ion Channels (부자이중탕과 보중익기탕의 억제성 및 흥분성 신경전달 물질에 의하여 활성화되는 이온통로 조절작용)

  • Lee, Hye-Jung;Seo, Jung-Chul;Lee, Jae-Dong;Kim, Ee-Hwa;Lee, Choong-Yeol;Chung, Joo-Ho;Shin, Min-Chul;Kim, Hyun-Bae;Kim, Youn-Jung;Kim, Chang-Ju
    • Journal of Acupuncture Research
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    • v.17 no.4
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    • pp.5-17
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    • 2000
  • To research the characteristics of ion currents induced by Bujaijung-tang and Bojungikgi-tang, nystatin-perforated patch clamp technique under voltage-c(amp condition was used. Periaqueductal gray neuron was dissociated from Sprauge-Dawley rat, 10-15 days old. Cytotoxicity of Bujaijung-tang and Bojungikgi-tang showed incubation time and concentration dependent manner. Ion current activated by Bujaijung-tang and Bojungikgi-tang were inhibited by bicuculline and strychnine and CNQX. It can be suggested that Bujaijung-tang and Bojungikgi-tang modulate inhibitory and excitatory neurotransmitters-, GABA, glycine and non-NMDA, acticvated ion channels. Modulatory effect of Bujaijung-tang and Bojungikgi-tang was more greater in inhibitory neurotransmitters. Low concentration of Bujaijung-tang which dose not elicit ion current itself, activated GABA and glycine induced chloride currents. In this study, we can found that the activation of Bujaijung-tang and Bojungikgi-tang on non-NMDA subtypes of glutamate receptor is its major action mechanism and can be used as very effective Herb treatment on Myasthenia gravis patient.

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Single Institution Experience of Thymic Tumor Treatment and Survival in Egypt

  • Darwish, Dalia
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.2
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    • pp.771-774
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    • 2016
  • Thymic tumors are the most common tumors in the anterior mediastinum. Total resection is the main treatment and predictor of longer survival. Adjuvant radiotherapy alone or in combination with chemotherapy is recommended with incomplete excision or advanced disease. Thirty seven patients with thymic tumors were included in this retrospective study from January 2001 till December 2012. They were studied regarding age, sex, performance status, tumor size and invasion, stage, pathology, treatment given, overall and progression free survival. Myasthenia gravis was present in 18.1% of the patients. Masaoka stage III was diagnosed in 40.5% of the cases followed by stage II in 24.3% and the other stages with lower percentages. Pathology type B3 was the most frequent followed by B2 and B1 with percentages of 27, 24.3 and 21.7 respectively. Complete resection was conducted in 11 cases (29.75%). Partial resection or debulking was done in 15 (40.5%) and a biopsy was taken in 11 cases (29.8%) Adjuvant chemotherapy was given to 14 patients (37.8%) and neoadjuvant to 13 (35.2%). Adjuvant radiotherapy was given to 17 patients (46%) and neoadjuvant to 14 (37.8%). The 5-year overall survival by was 83% for stage I, 71% for stage II, 60% for stage III, and 44% for stage IV (p=0.0426). Five year progression free survival was 71% for stage I, 62% stage II, 42% stage III, and 37% for stage IV (p=0.0532). In conclusion with the rare thymic tumors early stage and complete resection have the highest impact on overall and progression free survival.

Acquired Myasthenia Gravis in a Dog

  • Park, Hyo-Jin;Park, Chul;Jung, Dong-In;Kang, Byeong-Teck;Kim, Ju-Won;Kim, Ha-Jung;Lim, Chae-Young;Ko, Ki-Jin;Cho, Sue-Kyung;Lee, So-Young;Gu, Su-Hyun;Heo, Ra-Young;Jeon, Hyo-Won;Yoon, A-Ram;Han, Sung-Kuk;Kim, Jung-Hyun;Sung, Ju-Heon;Chung, Byung-Hyun;Park, Hee-Myung
    • Proceedings of the Korean Society of Veterinary Clinics Conference
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    • 2006.05a
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    • pp.94-94
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    • 2006
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The Remission of Pure Red Cell Aplasia with a Thymoma after Surgical Resection (수술적 제거로 완치된 순수적혈구 무형성을 동반한 흉선종 1예)

  • Kim, Eun Mi;Kim, Sang-Ha;Kwon, Woocheol;Kim, Ho Young;Kim, Chong Whan;Lee, Bu Ghil;Jung, Soon-Hee;Lee, Chong Kook;Yong, Suk Joong
    • Tuberculosis and Respiratory Diseases
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    • v.63 no.5
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    • pp.454-457
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    • 2007
  • Thymomas are associated with different paraneoplastic syndromes, with the most clinically important association being with myasthenia gravis, hypogammaglobulinemia, and pure red cell aplasia (PRCA). The optimal therapy for PRCA that complicates a thymoma is unknown, given the rarity of the clinical situation. It has been suggested that remission following surgery alone is uncommon and most patients will require some other form of therapy. We report a case of PRCA with a thymoma in a 59-year-old man who remained in complete remission of the PRCA after surgical resection of the thymoma.

A Case of Thymolipoma Simulating Cardiomegaly (심장비대와 감별이 필요했던 흉선지방종 1예)

  • Ju, Hun Su;Kim, Sang Ha;Kim, Jung Kwon;Hong, Tae Won;Lee, Nak Won;Yong, Suk Joong;Shin, Kye Chul;Lee, Kwang Gil;Lee, Won Yeon
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.1
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    • pp.103-108
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    • 2004
  • Thymolipoma is rare benign tumor of the thymic gland and mostly occurs at anterior mediastinum. Thymolipoma comprises 2~9% of thymic tumor and less than 1% of mediastinal mass. Therefore, thymolipoma should be differentiated from anterior mediastinal tumor such as thymoma, germ cell tumor and lymphoma. These tumors resemble cardiomegaly, pleural effusion, basal atelectasis, pericardial tumor and cyst, pleural tumor, lung cancer and pulmonary sequestration, and differentiated from above mentioned diseases. Though most cases are asymptomatic, there can be dyspnea with compression of adjacent organ by mass effect, and myasthenia gravis. We experienced a thymolipoma simulating cardiomegaly and report the case with the review of literatures.

A Case of Pleural Metastasis 6 Years after Complete Surgical Resection of Invasive Thymoma

  • Woo, Kwang-Jin;Kim, Yang-Ki;Kim, Ki-Up;Uh, Soo-Taek;Kim, Dong-Won;Hwang, Jung-Hwa;Kim, Yong-Hoon;Park, Choon-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.70 no.1
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    • pp.74-78
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    • 2011
  • Herein, we report a case of recurrent pleural metastasis after complete resection of invasive thymoma that was successfully treated with surgical resection. Thymoma and thymic carcinoma are uncommon neoplasms derived from the epithelial cells of the thymus. Approximately 30% to 50% of thymomas are asymptomatic at the time of diagnosis. However, these cancers may present with constitutional or local pressure symptoms and sometimes with paraneoplastic syndromes, especially myasthenia gravis. Surgical resection is the mainstay of thymoma treatment and has been shown to remarkably improve long-term survival. Despite complete resection, local recurrences are frequent, and surgery is the cornerstone of therapy even in cases of recurrent thymoma. We experienced a 67-year-old male patient with pleural metastasis that developed 6 years after complete surgical resection of invasive thymoma. The pleural mass was excised by video-assisted thoracoscopic surgery. Histopathological examination revealed an invasive World Health Organization (WHO) type B2 thymoma.

Current Status of General Thoracic Surgery in Korea (한국의 일반 흉부수술 현황)

  • 전영진
    • Journal of Chest Surgery
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    • v.25 no.5
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    • pp.504-510
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    • 1992
  • Overall 25,095 cases of general thoracic surgery were analysed, which were performed by 48 institutes in Korea during recent 6 years[242 hospital-years]. The proportions of tumorous disease and infectious disease to be operated were 6,864 cases[27.4%] and 6,775 cases [27.0%], The most common organ involved for operation was lung-bronchus 16,542 cases [69.5%], and remainders were pleura 2,500 [10.0%], esophagus 2,433[9.7%], mediastinum 1,902[7.6%], chest wall 1,297 [5.2%], and diaphragm 421 [1.7%] in order. Among 6,864 cases of tumorous diseases, the most common causes for operation were lung-bronchus tumor 3132 cases [45.6%] and most of them were lung cancer 2,731 cases [88.7%]. In the 2,019 cases of primary lung cancer with known cell type, squamous cell carcinoma 1,296 cases [64.2%] and adenocarcinoma 460 cases [22.8%] were the most. The common types in the 1,207 cases of mediastinal tumor with known cell type were neurogenic tumor 348 cases [28.8%], thymoma 311 [25.8%], and teratoma 252[20.9%]. The annual cases of operation for tumorous disease including malignant tumor were increased steadily. Operation for infectious lung diseases [including bronchiectasis and tuberculosis] were about twice common than infectious pleural disease [i.e. empyema], and operations for tuberculous disease occupied about half cases of infectious lung disease. In 11,456 cases of other disease entities, excluding tumorous and infectious disease, there were bullous lung disease 9,074 cases[79.2%], benign esophageal disease 484[4.2%], myasthenia gravis 356[3.1%], chest wall deformity 483[4.2%], and diaphragmatic lesion 421[3. 7%] in order. We propose that above results for inquiry can be used as the basic data of general thoracic surgery in Korea.

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