Surgical resection: the mainstay of management of type II pulmonary arteriovenous malformations

Twenty percent of pulmonary arteriovenous malformations [PAVM] are type II PAVMs. This type of PAVM is characterized by less than 5 AVMs in the body and no other vascular anomalies such as AV fistulas or aneurisms. We studied seven cases of type II PAVMs in which surgical resection was the mainstay of treatment. All were free of symptoms and without relapse after the surgery. During a 26-year period, 7 subjects proven to have PAVM by imaging studies were entered in this cross-sectional study. Demographic, clinical and imaging findings along with results of catheterization and angiography were collected. All cases were operated on and followed to assess the results of surgery, complications and recurrence. Seven cases were entered in this study [five males and two females]. Seventy-one percent of our patients were in the first decade of life. Dyspnea and cough were present in 6[85%] and 5 cases [71%], respectively. Physical exam showed polycythemia in 5 [71%], clubbing in 4[57%] and arterial bruit over the chest in 2 [28%] cases. Two paradoxical emboli were seen, [one to the brain and one to the coronary artery]. Family history was negative. Chest x-rays revealed large PAVMs in 5 cases [71%]. Diagnosis was made by CT-scan, catheterization, angiography, and histopathology. Location of lesions was in the lower lobes in all cases. Surgical approach was lobectomy in 5 cases and segmentectomy in two cases. Operations were without any compilcation and the patients were symptom-free thereafter. Surgical resection of large PAVMs was completely curative without any early or late complications

Thymectomy by partial sternotomy for the treatment of non-thymomatous myasthenia gravis

Myasthenia gravis is an autoimmune disease characterized by weakness and fatigue of voluntary muscles. Thymectomy is considered an effective therapeutic option for patients with myasthenia gravis. The purpose of this study is to evaluate the efficacy of thymectomy by partial sternotomy for the treatment of non-thymomatous myasthenia gravis. From 2002 to 2006, patients with non-thymomatous myasthenia gravis who underwent thymectomy through a partial median sternotomy were studied prospectively and analyzed to evaluate the results of thymectomy performed by this technique. There were 10 patients [8 women and 2 men] and the mean age at the time of thymectomy was 25.9 years. Eight patients [80%] were in class IIA of Osserman's classification while 2 patients [20%] were in class IIB. Mean duration of symptoms before operation was 2 years. Mean follow-up was 9 +/- 3 months. Mean postoperative hospital stay was 6.1 days [5 to 10 days]. Pathology examination revealed thymus hyperplasia in all patients. There was no mortality. Complications occurred in two [20%] patients. One [10%] patient needed mechanical ventilation for 24 hours postoperatively. After 6 months of follow-up, 2 patients [20%] had complete remission of symptoms, 5 [50%] had a significant improvement, 2 [20%] had a mild improvement, whereas one patient [10%] had no improvement in his clinical symptoms. Partial median sternotomy may be a useful surgical approach to the thymus, as demonstrated by the good functional and aesthetic results, associated with low morbidity and no mortality