• Journal of Chest Surgery
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• v.46 no.4
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• pp.312-315
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• 2013

In chest wall reconstruction after wide chest wall resection, the use of a musculocutaneous flap or prosthetic materials is inevitable for maintaining thoracic movement and a closed pleural cavity. We report a case of a 63-year-old male with a large invasive thymic carcinoma in the anterior mediastinum. The mass measured 6.8 cm and involved the sternum, left side of the parasternal area, ribs, and intercostal muscles. The patient underwent subtotal sternectomy, radical thymectomy, and reconstruction with biological mesh (Permacol). Successful chest wall reconstruction without any other complications was achieved, demonstrating the effectiveness of Permacol.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.454-461
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• 1988

Myasthenia gravis is a functional neuromuscular disorder with characteristic voluntary muscle weakness. The role of thymus in pathogenesis of this disorder has become apparent that thymectomy in treatment has gained acceptance. Between January 1976 and June 1987, twenty patients underwent thymectomy for myasthenia gravis at the Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University. A clinical study that is focused on the factors affecting the operative results was analyzed and the following results were obtained. Among the 20 patients, male to female ratio was 8:12 and the age of onset was ranged from 3 years to 67 years. The chief complaints in order of frequency were as follows; ocular symptoms such as ptosis and diplopia[7 cases], general weakness[4 cases], swallowing difficulty[3 cases], dyspnea[3 cases], dysphasia[1 case], headache[1 case] and dizziness[1 case]. The severity of disease was classified by modified Osserman`s method that Group IIa was 8 cases, Group IIb; 7 cases, Group IIc; 3 cases and Group I; 2 cases. In histopathology of thymus, the most frequent finding was hyperplasia[11 cases] followed by thymoma[4 cases], normal tissue[3 cases] and malignant` thymoma[2 cases]. There were two cases of postoperative complications; one case was wound infection and the other was mediastinitis. One case of malignant thymoma died due to respiratory failure with pulmonary metastasis. There was 16 cases[80%] of improvement after thymectomy as follows; complete remission was 4 cases[20%], marked improvement was 9 cases[45%] and subjective improvement only was 3 cases[15%]. The effect of severity and duration of disease on operative result has statistically significant. The effect of thymus histopathology on operative result was not statistically significant. But there were comparable results between thymoma cases and non-thymoma cases.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.759-764
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• 2007

Background: Thymoma occurs in approximately 10% of myasthnia gravis patients. The thymus or a thymoma plays a role in the pathogenesis of myasthenia gravis. However, there is currently no definitive position about the effect of thymectomy on patients' symptoms and prognosis. We retrospectively studied the effect of thymoma on re-mission in patients who underwent thymectomy for myasthenia gravis. Material and Method: From July, 1992 to December, 2002, we performed extended thymectomy due to myasthenia gravis for 100 patients. The thymoma group included 30 people, the non-thymoma group included 70 people and the change of the Ossermann stage between the two groups after surgery was compared. Result: For the non-thymoma group, the average age was 34.7 years (range: $12.7{\sim}47.7$). Before the surgical operation, the Ossermann stage for the non-thymoma group was an average of 3.00, and this was reduced to an average of 1.41 after operation. For the thymoma group, the average age was 50.9 years (range: $37.3{\sim}64.5$). Before the surgical operation, the Ossermann stage for the thymoma group was an average of 3.00, and this was reduced to an average of 1.47 after operation. The non-thymoma patients had a higher proportion of males than the thymoma patients (35% vs 30%, respectively), The Masaoka stage was stage of the thymoma group was I for 27 patients and stage II for 3 patients. There was no statistically significant Ossermann stage change between the thymoma and non-thymoma groups. Conclusion: Whether thymoma was present or not, there was no significant difference on remission and improvement of myasthenia symptoms after thymectomy in the myasthenia gravis patients.

• 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.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.382-385
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• 2017

A 47-year-old man with myasthenia gravis (MG) was admitted for a lung transplant. He had bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation due to acute myeloid leukemia. MG developed after stem cell transplantation. Bilateral sequential lung transplantations and a total thymectomy were performed. The patient underwent right diaphragmatic plication simultaneously due to preoperatively diagnosed right diaphragmatic paralysis. A tracheostomy was performed and bilevel positive airway pressure (BiPAP) was applied on postoperative days 8 and 9, respectively. The patient was transferred to the general ward on postoperative day 12, successfully weaned off BiPAP on postoperative day 18, and finally discharged on postoperative day 62.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.796-803
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• 1984

Pure Red-Cell Aplasia [P.R.C.A.] is rare disease characterized by absence of erythroid precursors in the bone marrow, normocytic normochromic anemia with profound reticulocytopenia in the peripheral blood, and relatively or completely spared granulopoiesis and thrombopoiesis. The association rates of P.R.C.A. with Thymoma is approximately 50%, but only 5-10% of all patients with a Thymoma have a P.R.C.A.. P.R.C.A. is thought to be a variety of autoimmune disease, and humoral inhibitor, i.e. IgG, has been demonstrated experimentally. Its treatments such as thymectomy, immunosuppressants, steroid, androgenic hormone, and splenectomy have been tried but the result is not satisfactory and the prognosis is poor. We experienced a case of P.R.C.A. with Thymoma treated with thymectomy and postoperative steroid therapy, and which showed good postoperative recovery clinically and hematologically.

• Journal of Chest Surgery
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• v.16 no.4
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• pp.571-583
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• 1983

Thymic tumor is the most common neoplasm originating in the anterior mediastinum. Histologically, thymic tumors and tumorlike conditions have been classified into thymic cyst, thymolipoma, true thymic hyperplasia, thymoma and carcinoid tumor of the thymus gland. We have experienced several tumors and a few tumorlike conditions of the thymus gland in 10 patients: thymoma 6, thymic hyperplasia 2, carcinoid tumor 1 and thymic cyst 1. The age distributions were ranging from 30 to 60 years except for one 3 year old child [malignant thymoma, lymphocytic type], and male to female ratio was 1:1.5. In 6 cases, thymic lesions were removed through lateral thoracic incision [right 2, left 4] because the mediastinal masses were growing far into the pleural space, meanwhile, medially located lesions [4 cases] through median sternotomy incision. Among these 10 patients, 3 were malignant thymomas, in which 2 were died of recurrence after tumor resection. Myasthenia gravis was all noted in 3 females [thymoma 2, thymic follicular hyperplasia 1], in which only two revealed remission in symptoms following thymectomy. The authors would like to recommend early radical thymectomy through median sternotomy incision whenever patients demonstrate suspicious thymic tumor lesions on the chest roentgenogram or generalized myasthenic symptoms.

• 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.

• 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.20 no.1
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• pp.112-127
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• 1987

Myasthenia gravis is a neuromuscular transmission function disorder characterized by fatigue and weakness of voluntary muscles. This muscular weakness is intensified by activity and stress, and improved by the use of anticholinesterase compounds. It was initially described by Erb in 1879 and later named myasthenia gravis by Jolly in 1895. Although the pathogenesis is Known to be an autoimmune related reduction in the number of available acetylcholine receptors at neuromuscular junctions, the role of thymus in myasthenia gravis is still unclear and under investigation. Thymectomy in the management of myasthenia gravis has become increasingly important since Dr. Blalock observed in 1939 that some patients with thymic tumors and myasthenia gravis improved following thymectomy. A clinical study of 102 cases of myasthenia gravis was performed at Yonsei University College of Medicine. Seoul, Korea from Jan. 1976 to Jun. 1986. In order to determine which factors are of prognostic significance, attention is focused upon pre-operative patient evaluation, problems in operative and post-operative care, and long-term follow-up observations. The results were as follows: 1. The sex distribution was 67 females and 35 males, the mean age of onset was 28.95*1.69 years, and the maximal incidence occurred between 21 and 40 years of age [56 cases: 54.9%]. 2. Clinical manifestations of ocular symptoms were seen to 70 patients [68.6%] extremities weakness in 33 [32.3%], bulbar weakness in 29 [28.4%], and dyspnea in 13 [12.7%]. 3. Study cases more than two thirds were classified as mild types [MG 1 and MG 11A] and 6 cases as grave [MG 1V] based on the modified Osserman`s classification system, 4. Thymectomy was performed in 19 cases which presented in severe myasthenia symptoms and showed no improvement with cholinergic drugs. Histologic examination of the excised thymus glands revealed no abnormalities in 4 cases, thymic hyperplasia in 5, benign thymoma in 5, and malignant thymoma in 5. 5. Immediate post-operative complications included 2 cases of pneumothorax which were treated by tube thoracostomies, there was no operative mortality. 6. The response to cholinergic drugs in 36 cases younger than 20 years old and in 27 cases older than 40 years was relatively poor, while that in 35 cases between the ages of 21 and 40 years old was good. 7. Thirty of 39 cases in groups IIB, III & IV improved markedly with medical or surgical management while only 16 of 59 cases in the mild groups [I and IIA] improved, almost all surgical cases improved in all categories. 8. There were 5 deaths. occurring between 7 months and 3 years 3 months of treatment of myasthenia gravis. The causes of death were myasthenic crisis in 2 cases, respiratory failure due to candidiasis & radiation pneumonitis in one case, cerebral hemorrhage due to high blood pressure in two case.