role of thymectomy in patients with myasthenia gravis

Thymoma may be a negative prognostic factor with respect to the outcome of myasthenia gravis [MG]. Of 61 consecutive patients with MG undergoing thymectomy between January 1999 and January 2004, 19 had a thymoma. Postoperative radiation was administered to all patients with stage II thymoma and higher. To determine differences in presentation and outcome, thymoma patients were compared with patients with atrophic [n=34] or hyperplastic [n=27] thymus gland on final pathology. Thymoma patients were significantly older [52 +/- 14 vs 36 +/- 15 years, p <0.0001] and included a significantly higher proportion of males [54% vs 28%, p=0.006] than patients without thymoma. However, the preoperative Osserman grade and the duration of symptoms before surgery were not significantly different between groups. Mean follow-up after thymectomy was not significantly different between patients with or without thymoma [32 +/- 23 vs 37 +/- 19 months, respectively, p = 0.3]. At last follow-up, the proportion of asymptomatic patients [63% vs 70%, respectively, p= 0.5] and the mean Osserman grade [0.6 +/- 0.9 vs 0.5 +/- 0.9, respectively, p = 0.6] were similar in both groups. In addition, the rate of complete remission reached 36% at 5 years in patients with or without thymoma [p=0.8]. Although myasthenic patients with thymoma are significantly older and include a greater proportion of males, the overall outcome, including the rate of complete remission, was similar between patients with or without thymoma. Therefore, the presence of a thymoma should not necessarily be viewed as a negative prognostic factor regarding recovery from myasthenia gravis

Mediastinal tumours in children [surgery and outcome]

Mediastinal tumours in children are rare in comparison with mediastinal tumours in adults. In our study all mediastinal tumours diagnosed and treated between January 1998 and January2004 were analyzed. Twenty-three patients, age 15 years or less, with pediatric primary mediastinal tumours were identified. During the same period, 60 adult patients with primary mediastinal tumours were identified. Fifty-nine percent of the pediatric patients were mak. Median age was 11 years. Lymphoma was present in 55%, neurogenic malignancies in 23%, malignant germ cell tumors in 18%, and sarcoma in 5%. Neurogenic tumors presented in infants and lymphomas and germ cell tumors presented in teens [p = 0.005]. In treated children, surgery was used more often in neurogenic tumors and germ cell tumors than in lymphomas [p = 0002]. Two-year survival was 74% for Iymphomas, 67% for neurogenic tumors, 25% for germ cell tumors, -and 61% overall [p = 0.23]. Compared to adults, children had more neurogenic tumors [p <0.001] and fewer thymomas [p = 0.0499]. There were no significant differences in staging or survival between children and adults. Pediatric mediastinal malignancies occurred with a frequency of 1/5 patients with malignant tumors. Lymphoma, neurogenic tumors, and germ cell tumors predominated. Compared toadults, children had more neurogenic tumors and fewer thymomas. Within the pediatric group, differences were found in age of presentation between histologic groups. These differences between adults and children, and between infants and teens, should be considered when evaluating a patient suspected of having mediastinal malignancy

role of adenosine infusion preoperative in myocardial preservation in cases of off-pump coronary artery bypass surgery

This study was done to assess the myocardial protective effect of adenosine intravenous infusion for chemical preconditioning of the myocardium during off-pump coronary artery bypass [OPCAB] surgery. Thirty adult male and female patients, requiring elective OPCAB surgery were enrolled in this study. Patients were randomized into two groups: Group A [adenosine group, n=l5 patients]: received an infusion of adenosine at a rate of 70 micro/kg/mm for 10 min starting 3 min before the first coronary graft. Group C [control group, n=15]: patients received an infusion of normal saline [as placebo] using the same protocol. Measurements of cardiac enzyme profiles for CK-MB and Troponin T were withdrawn after induction of anesthesia [baseline], 6, 12, and 24 hrs post initial distal coronary occlusion. twelve lead electrocardiograms [ECGs] were recorded at the same timings, except for the baseline ECG which was recorded immediately preoperatively. Primary outcome measurements included cardiac index measured after induction of anesthesia [baseline], then 6, 12, and 24 hrs after the first coronary anastomosis. Heart rate, systemic and pulmonary arterial blood pressures, and central venous pressure were recorded as well. Secondary outcome measurements included the in-hospital mortality, length of ICU stay, vasoactive, antiarrythmic, and other adjuvant drugs requirement for more than 15 min, and/or the need for intra aortic balloon pump insertion. Both groups showed significant increase of cardiac index 6, 12, and 24 hrs after the first coronary anastomosis compared to the baseline reading for each group. The increase in cardiac index at 6 hrs after the initial anastomosis was significantly higher in group A compared to group C. Adenosine-pretreated patients released significantly less troponin T, and showed lower CK-MB levels than the control group at 12 and 24 hrs after the first anastomosis [p<0.05]. The maximum CK-MB level [12 h after the first anastomosis] was lower in the adenosine group [21.4 + 6.8 versus 31.4 +/- 13.6]. One patient in the control group developed a postoperative myocardial infarction as opposed to none in the study group. Two patients in the contrpl group developed postoperative atrial fibrillation requiring treatment as opposed to none in the study group [p<0.05]. Adenosine may be an effective and safe drug for attenuation of ischemia-reperfusion injuries in patients undergoing OPCAB