Myasthenia gravis, thymectomy: early outcome

This study was conducted on twenty four patients with myasthenia gravis [grade IIA and IIB], with a median duration of the disease of 12 weeks. All the patients were subjected to trans-sternal thymectomy because acetylcholine estirase inhibitors failed to give a favour clinical improvement. Our results showed that 87.5% 21 out of 24 and 8.33% 2 out of 24 of patients had thymic hyperplasia and malignant thymoma, respectively, Postoperatively, none of the patients required assisted respiration, corticosteroids, or excessive doses of acetylcholine esterate inhibitors. We conclude and advocate that thymectomy should be considered early and specifically for patients with grade IIA and IIB

Myasthenia gravis response to treatment. Clinical and physiological criteria.

Twenty three patients with myasthenia gravis, eight males and 65% respectively were admitted to Al-Yarmok Teaching Hospital in Baghdad. The most commonly affected age group was between 10-30 years[78%]. A complete clinical examination with special examination with special emphasis on the peripheral and central nervous systems was done. Laboratory investigations included electromyography, CT scanning for thymomas in addition to the routine work. By classification of the patients according to the clinical criteria presented seven patients were found to have stage I myasthenia gravis, six were stage IIA and eight stage IIB, while only two patients with stage IV is recorded. Investigations revealed that six patients only had enlarged thymus gland and two patients had increased immunoglobulins. The Tensilon test was positive in almost all the patients. All patients were treated with Mestinon [Pyridostigmine bromide 100-600 mg/day] eleven of them, any how needed prednisolone in addition. The response to medical treatment was good in 16 patients and moderate in six while poor in only one patient. One patient only needed tracheostomy and other needed surgical removal of the thymus gland [thymomectomy]. These two patients were both of stage III on clinical examination

Non steroidal management of patients with Guillain-barre syndrome

17 patients with Guillain- Barre syndrome were diagnosed on clinical electrophysiological and CSF grounds, observed over a period of 1.5 years. This group is composed of 13 males and four females, their age ranged from 6 to 64 years. All of the patients had areflexic flaccid weakness of the four limbs in an ascending fation. Nine patients had bilateral facial nerve weakness. All the patients included in this study received no steroids during the follow up period. One patient needed assisted respiration, and one died because of severe vasomotor collapse. Most of the others were ambulant, walking unaided after 1.5 years. Only three needed assistance of another person or article. This study demonstrates the good prognosis of the disease and the non relevance in its management