Predictors of outcome in thymectomy for myastuenia gravis

Thymectomy is considered an effective therapeutic option for patients with myasthenia gravis [MG] however, the optimal selection of patients for surgery remains controversial. The objective of the study is to evaluate the outcome and relevant factors influencing improvement and remission after thymectomy for MG by analyzing patients data. We retrospectively reviewed our experience in the surgical management of patients with MG over the last 10 years, and analyzed if patient's age, sex, preoperative Osserman stage, duration of symptoms and thymic histology influence outcome according to : [a] The dose of pyridostigmine and other drugs as steroids that the patient took before and after thymectomy and [b] the Osserman stage before and after thymectomy, the patients were divided into 4 groups: [1] Patients in remission. [2] Patients with improvement. [3] Patients with no change and [4] patients who were worse. There were 60 females [67%] and 30 males [33%] their age range from 20-67 years with average age 32 years. Most of them presented with Osserman stage IIA [n=36] and IIB [n=42]. Hyperplasia of the thymus was observed in 45 patients [50%], thymoma in 30 patients [33%] and the remaining 25 patients [28%] were atrophic or normal thymus. Computed tomography [CT] had a positive predictive value of 88% in detecting thymoma and of 79% in detecting hyperplasia. Over a mean follow-up of 14 months, a good response to thymectomy was observed in 61 patients [68%] while 29 patients [32%] had bad response. No relation was observed between outcome and sex, poor response is associated with old age, long duration of illness before surgery use of steroids, osserman stage I and IIA and patients with thymoma. The good response to thymectomy was high [69%] and the variable that had prognostic importance were age, Osserman stage duration of illness before surgery and thymic histology

Hepatic dysfunction after open heart surgery

This work was designed to study the changes of the liver function that may occur after open heart surgery and to stress on the factors that may precipitate or contribute to the development of postoperative hepatic dysfunction. The patients underwent valve replacement, valve repair, correction of congenital heart disease and coronary artery bypass grafting. Every patient was subjected to thorough clinical examination, chest X-ray, standard 12 leads ECG, echocardiography with its modalities, cardiac catheterization when needed. Liver function tests include serum bilirubin, SGOT, SGPT, alkaline phosphatase, plasma proteins and albumin and prothrombin concentration. This study showed that, the liver function may be impaired postoperatively with maximum changes observed on day 7 and started mostly to return to normal 14 days postoperatively. This impairment of liver function may be attributed to many factors including type of heart disease, time of operation and ischemic time, hemolysis, use of inotropic drugs and the type of anesthesia used