• Journal of Chest Surgery
• /
• 제13권4호
• /
• pp.490-494
• /
• 1980

Myasthenia gravis is a neuromuscular disorder manifested by fatigability and weakness of voluntary muscles. The basic defect in the myasthenia is reduction of available acetylcholine receptors at neuromuscuiar junctions by an autoimmune attack. Removal of the thymus gland now play an Important role in the management of this disease. We have two experiences of thymectomy for myasthenic patients. The 31-year-old housewife(J.H) was admitted to the Taegu Presbyterian Medical Center because of bilateral ptosis, mastication and swallowing difficulties. The presence of thymoma was strongly suggested by roentgenographic studies. A 99.8 gm thymoma was removed completely by total thymectomy. On the 2nd postoperative day respiratory failure developed. Tracheostomy was performed and ventilatory assist was given for 3 days. The patient was completely recovered with antichollestrase drug only. C.N. was 17-year-old girl who has the symptoms of bilateral ptosis and diplopia for 3 years. Tensilon test was positive and antichollnestrase was given for several months, but the patient showed no improvement. After thymectomy she was free from myasthenic symptoms with out anticholinestrase drug.

• Journal of Chest Surgery
• /
• 제25권8호
• /
• pp.844-849
• /
• 1992

Between 1979 and 1991 thymectomy was performed on 31 patients with myasthenia gravis at the department of thoracic and cardiovascular surgery, Keimyung University medical school. All patients were treated by transsternal thymectomy. During follow-up period that ranged from a month to 10.7 years[mean 2 years], the remission rate for the entire group was 16.1 percent and an additional 71.0 percent had improvement [87.1 percent benefited]. In those 8 patients with thymoma, the remission rate was 12.5 percent with 75.0 percent of the patients benefiting from operations The remainimg 23 patients fared better the operations: 17.4 percent had remission and a total of 91.4 percent benefited. There was no mortality, I concluded that most patients with myasthenia gravis will benefit from thymectomy, and that the improvement persists over an extended period of time in a high percentage of patients.

• Journal of Chest Surgery
• /
• 제55권5호
• /
• pp.417-421
• /
• 2022

Minimally invasive strategies are increasingly popular in patients with myasthenia gravis (MG)-associated thymomas. Within the context of video-assisted thoracoscopic surgery (VATS) as a widely known minimally invasive option, the most recent achievement is uniportal subxiphoid VATS. In MG patients, it is mandatory (1) to minimize perioperative interference with administered anesthetics to avoid complications and (2) to achieve a complete surgical resection, as the prognosis essentially depends on radical tumor resection. In order to fulfill these criteria, we merged this surgical technique with its anesthesiologic counterpart: regional anesthesia with the maintenance of spontaneous ventilation via a laryngeal mask. Non-intubated uniportal subxiphoid VATS for extended thymectomy allowed radical thymectomy in all MG patients with both rapid symptom control and fast recovery.

• Clinical and Experimental Reproductive Medicine
• /
• 제47권1호
• /
• pp.12-19
• /
• 2020

Objective: The appropriate function of the hypothalamic-pituitary-gonadal axis is essential for maintaining proper reproductive function. In female mammals, the hypothalamic-pituitary-gonadal axis regulates reproductive changes that take place in the estrus cycle and are necessary for successful reproduction. This study was conducted to investigate the effect of thymectomy on the estrus cycle in neonatally thymectomized guinea pigs. Methods: In this study, 12 female guinea pigs, six thymectomized and six sham-operated, were studied. The effects of neonatal thymectomy at 5-7 days of age on parameters of the reproductive axis were examined in female guinea pigs. Gonadotropin and 17β-estradiol levels were assessed at regular intervals (days 0, 3, 6, 9, 12, and 15) of the estrus cycle, and the time of vaginal opening in the thymectomized and shamoperated guinea pigs was determined. Results: Significant reductions in gonadotropins and 17β-estradiol levels during estrus cycle were found in neonatally thymectomized female guinea pigs compared to sham-operated guinea pigs. Conclusion: The results of this study underscore the importance of the thymus in the neonatal period for normal female reproductive function.

• Journal of Chest Surgery
• /
• 제24권11호
• /
• pp.1125-1132
• /
• 1991

Myasthenia gravis is a disorder of neuromuscular transmission which is characterized fatigue and weakness of the voluntary muscle. From 1985. 1 to 1991.6, 34 patients underwent managed including 12 patient thymectomy, at the kyunghee medical center. A clinical analysis was performed and following result was obtained. Among the 34 patients, male to female ratio was 11 : 23 and the age was ranged from 2 years to 63 years. Thymectomy was done in 12 case and 1 case of malignant thymoma was not resectable. There were 2 deaths after operation due to respiratory failure and 1 death dur to gradually progression. THe effect of thymectomy in mtasthenia graves was 66.7% (8cases). The prognostic factors were severity of the disease and histopathological findings. Others were not related to the prognosis of the mayasthenia gravis. The severity of the myasthenia gravis was classified by Osserman modified classification.

• Journal of Chest Surgery
• /
• 제25권12호
• /
• pp.1516-1522
• /
• 1992

Thirty patients with myasthenis gravis[MG] underwent transternal extended thymectomy between 1983 and 1992 in Pusan National University Hospital. The age of patients was 11 to 62 years[mean; 35.2 years] with female dominant[M: F=l: 4]. According to modified Osserman classification, group I was in 6, II A in 7, II B in 13, III in 2, IV in 2 patients respectively. Their clinical response to thymectomy was evaluated. The follow-up period ranged from 2 months to 9.5 years[average; 51.3 months]. Fourteen patients[13.3%] had remission and eleven[43.3%] were improved after operation; half of patients were benefited from operation. Twenty patients had thymic hyperplasia and seven had non-infiltrating thymoma. In thymomatous MG one patient had remission and five were improved. Postoperative death was in a female patient. The cause of death was respiratory failure in the severe generalized MG preoperatively.

• Journal of Chest Surgery
• /
• 제28권1호
• /
• pp.78-80
• /
• 1995

We report the thoracoscopic resection of thymus and pericardial fat tissue in a patient who was in the setting of late severe myasthenia gravis[Osserman`s Group II-C-2 and previous tracheostomy state. The patient was 33-year-old female. She had been supported with mechanical ventilator for 88 days and suffered from recurrent pneumonia. Our first aim was to weaning her from mechanical ventilator. Traditional methods such as median sternotomy or transcervial thymectomy or transsternal sternotomy were difficult because of the anticipating complications of mediastinitis or morbidity, especially chest pain, following thoracotomy. We could wean her from the mechanical ventilator at postoperative 9 days. So, we concluded that video-assisted thoracoscopic thymectomy is a useful alternative tool in this case.

• Journal of Chest Surgery
• /
• 제54권4호
• /
• pp.314-318
• /
• 2021

In this paper, I present the technique of subxiphoid single-port video-assisted thoracic surgery (VATS) thymectomy for thoracic surgeons to perform this procedure safely. This procedure is indicated for all anterior mediastinal masses and may be extended to lung cancer. The patient is placed in the lithotomy position, and the operator should be on the midline. Below the xiphoid process, a skin incision is made 4-5 cm horizontally at a single thumb's width down. Under two-lung ventilation, CO₂ is insufflated, maintaining 10 mm Hg. The fat tissue and thymic tissue are all resected from the sternum and pericardium between both phrenic nerves using an articulated grasper and an energy device. After retrieval of the mass with a wrap bag, a Jackson-Pratt drain is inserted instead of a chest tube. One of the advantages of this procedure is less postoperative pain than intercostal VATS. The subxiphoid approach can be used for bilateral pneumothorax, bilateral pulmonary metastasectomy, and simple lobectomy for both upper lobes and the right middle lobe.

• Journal of Chest Surgery
• /
• 제29권9호
• /
• pp.1010-1016
• /
• 1996

중증근무력증환자에 있어서 흉선 절제술은 대상이 되는 환자의 선택 기준이나 수술시기, 수술 방법에 있어서 아직까지 논란이 되고 있지만 긍정적으로 적용될 수 있는 치료 방법이다. 연세대학교흉부외과 학교실 신촌 세브란스병원에서는 1983년 1월부터 1994년 12월까지 중증근무력증으로 흉선 절제술을 시행한 82명의 환자를 대상으로 연구하였다. 수술 사망은 1명에서 발생하였고 수술 후 추적은 75명에서 가능하였고 평균 추적기간은 56.9개월 이었다. 완전관해된 28명(37.3%)을 포함하여 64명(85.3%)에서 수술로 인한 효과를 볼 수 있었다. 동반된 질환으로는 갑상선 질환이 8예로 가장 많았는데 이중 7명(87. 5%)이 완전관해를 보여 갑상선 질환을 동반하지 않은 환자 67명중 21명(31.3%)의 완전관해보다 높은 치료 성공율을 나타내었다. 수술 전 병력 기간이 2년 미만인 환자 32명중 16명(50%), 2년 이상인 환자 43명중 12명(27.4%)이 완전관해를 보여 수술전병력 기간이 2년 미만인 경우 높은 치료율을 보였다. 결론적으로 중증근무력증환자에 있어서 흉선 절제술 후 완전관해율은 갑상선 질환의 동반 여부와 수술 전 병력기간에의해 영향을 받음을 알 수 \ulcorner었으며 병의 발생 연령(40세 이상),흉선종의 동반,고령 및 남자의 경우 수술 후 완전관해율을 떨어뜨리는 것으로 나타났지만 통계적 의의는 없었다. 흉선의 조 직학적 소견으로 정상과 흉선 비후사이에 있어서 완전관해율의 차이는 보이지 않았다. 일반적으로 흉선 절제술은 대부분의 중증근무력증환자에 있어서 효과가 있었으나 임상증상적 분류로 기 속한 환자군은 수술로 인한 효과가 없었다.

• Journal of Chest Surgery
• /
• 제29권1호
• /
• pp.73-78
• /
• 1996

1989년 6월부터 1994년 5월까지 5년 동안 임상적으로 중증근무력증으로 진단받고 흉선절제술을 시행받은 23례를 대상으로 하였고, 흉선절제술의 효과를 평가하기 위하여 연령 및 성별분포, 수술전 증상의 정도와 유병 기간, 수술후 호전정도 그리고 총선의 병리 소견과 별기에 따른 흉선절제술의 결과를 분석하였다. 수술후 추적기간은 5개월에서 60개월로 평균 15개월이었다. 흉선절제술의 효과를 환자의 수술후 임상증상의 호전정도와 수술후 약물용량으로 분류하여 본 바 a) 완전회복이 5례 (21.7%), b) 임상증상의 현저 한 호전및 얕용량 감소가 11례 (47.8%), c) 약용량은 같으나 임상증상의 현저한 호전이 3례 (13.0%), 4)호전없음이 2례 (8.7%), e)사망이 1례(4.3%), f) 재발이 1례 (4.3%)로서 23례 중 19례 (82.5%)에서 완전회복 및 임상증상의 현저한 호전을 보였다. 수술전 증상의 중증도와 흉선절제술의 효과를 분석한바, Modified Osserman Staging 분류상 제1군 9례중 6례 (66.7%)가 임상적 호전을 보였고, 3례 (33.3%)에서는 호전이 없었다. 흉선절제술의 효과가 이 두 Group (제I기, 제II기)간에서 유의한 차이는 없었다(P>0.05). 수술후 흉선의 병리 \ulcorner흉선절제술의 효과를 분석한바, 정상흉선의 4례는 전례 (100%)에서 모두 호전을 보였고, 과형 성 11례 에서는 10례 (90.9%)에서 호전을, 1례 (9.1%)에서는 변화가 없었다. 총선종이 있었던 8례 에서는 5례 (62.5%)에서 임상적 호전을 보인 반면 3례 (37.5%)에서는 변화가 없었다. 흉선조직의 병리에 따른 흉선절제술의 효과와의 유의한 차이는 보이지 않았다(P>0.05). 흉선절제술을 시행받은 대부분의 환자(82.5%)에서 완전회복 및 임상증상의 현저한 호전을 가져 왔다. 그러나 수술전 예후에 영향을 미치는 인자로 알려진 증상의 중증도나, 흉선의 병리소견과 수술후 근무력증 치료효과간에 통계적 유의성은 없었다(P>0.05).