Metastatic Thymic Carcinoid: Does Surgeon Have a Primary Role.

Thymic carcinoids are rare mediastinal tumours. These are aggressive tumours that often present late and have poor prognosis. Primary surgical treatment is recommended even in metastatic tumours since the role of adjuvant therapy is not well established. We present a case of metastatic thymic carcinoid managed with surgical excision.

Glucocorticoids, master modulators of the thymic catecholaminergic system?

There is evidence that the major mediators of stress, i.e., catecholamines and glucocorticoids, play an important role in modulating thymopoiesis and consequently immune responses. Furthermore, there are data suggesting that glucocorticoids influence catecholamine action. Therefore, to assess the putative relevance of glucocorticoid-catecholamine interplay in the modulation of thymopoiesis we analyzed thymocyte differentiation/maturation in non-adrenalectomized and andrenalectomized rats subjected to treatment with propranolol (0.4 mg·100 g body weight-1·day-1) for 4 days. The effects of β-adrenoceptor blockade on thymopoiesis in non-adrenalectomized rats differed not only quantitatively but also qualitatively from those in adrenalectomized rats. In adrenalectomized rats, besides a more efficient thymopoiesis [judged by a more pronounced increase in the relative proportion of the most mature single-positive TCRαβhigh thymocytes as revealed by two-way ANOVA; for CD4+CD8- F (1,20) = 10.92, P < 0.01; for CD4-CD8+ F (1,20) = 7.47, P < 0.05], a skewed thymocyte maturation towards the CD4-CD8+ phenotype, and consequently a diminished CD4+CD8-/CD4-CD8+ mature TCRαβhigh thymocyte ratio (3.41 ± 0.21 in non-adrenalectomized rats vs 2.90 ± 0.31 in adrenalectomized rats, P < 0.05) were found. Therefore, we assumed that catecholaminergic modulation of thymopoiesis exhibits a substantial degree of glucocorticoid-dependent plasticity. Given that glucocorticoids, apart from catecholamine synthesis, influence adrenoceptor expression, we also hypothesized that the lack of adrenal glucocorticoids affected not only β-adrenoceptor- but also α-adrenoceptor-mediated modulation of thymopoiesis.

Appearance of Systemic Lupus Erythematosus in Patients with Myasthenia Gravis following Thymectomy : Two Case Reports

We report two cases of systemic lupus erythematosus (SLE) in myasthenia gravis (MG) patients who had undergone thymectomy. SLE developed in the patients 3 months or 13 yr after thymectomy, and polyarthritis was the main clinical manifestation of SLE. Both patients fulfilled at least four of the revised criteria for the classification of SLE. In this report, we describe two postthymectomy lupus patients and perform a comparative review of previous cases.

Características clínicas de 217 pacientes Miasténicos clasificados de acuerdo con la histología del Timo / Clinical characteristics in 217 myasthenic patients classified according to the histology of the thymus

Estudio retrospectivo de 217 pacientes con miastenia gravis, timectomizados. De los pacientes de la serie, 189 (87,1 por ciento) presentaron alguna alteración histológica y en 28 (12,9 por ciento) se encontró un timo sin anormalidades patológicas. La hiperplasia tímica fue la alteración más frecuente (73,7 por ciento), en tanto que la presencia de timoma fue menos común (13,4 por ciento). Las principales características clínicas halladas en el grupo con hiperplasia fueron la presentación de la enfermedad por debajo de los 30 años, mercado predominio del sexo femenino y baja frecuencia de complicaciones de la timectomía. En la mayoría de los casos con timoma, el inicio de la miastenia ocurrió después de la cuarta década. En estos casos hallamos formas más severas de la miastenia, mayor número de complicaciones de la timectomía y más alta mortalidad posoperatoria. También se destacan los beneficios de la timectomía sobre otros tratamientos

Myasthenia gravis in Jamaica: clinical, immunological and genetic studies

Clinical, immunological and genetic parameters were studied in 73 Jamaican patients with myasthenia gravis (Mg). The reported biomodal clinical distribution of females with early onset of disease and males with late onset was not observed. The female to male ratio was 2:1. The most frequent manifestations of disease were ptosis (84.9%), general muscle weakness (68.5%), bulbar symptoms (41.1%) and diplopia (32.9%). Unusual presenting features such as unilateral ptosis, recurrent chest infection and stumbling while walking resulted in diagnosis being missed in 5.8%of cases. The sensitivity of radiommunoassay in detecting acetylcholine receptor antibody (AchR-Ab) in sera from a subgroup of 35 MG patients was 71.4%whilst that of the ELISA was only 14.2%. There was no correlation between HLA-type, thymic pathology and course of disease. HTLV-I could not be implicated in the pathogenesis of this disease. There was a paucity of other associated autoimmune conditions among MG patients. Thymectomy was an important therapeutic modality in that improvement was observered in 22 cases and remission in 11.

Timectomía en miastenia gravis / Timectomy in myasthenia gravis

Se presentan los resultados obtenidos en 38 pacientes portadores de miastenia gravis, quienes fueron sometidos a timectomía en el Instituto Nacional de Enfermedades Neoplásicas, habiéndose logrado mejoría clínica en el 82% de los casos y remisión completa de la enfermedad en el 55% de éstos. La miastenia gravis responde mejor a la timectomía cuando es de corta evolución, los pacientes son adultos jóvenes y el estudio anatomopatológico del timo muestra sólo hiperplasia con normocelularidad. se usó esternotomía longitudinal media en el 90 de los casos y el peso promedio del timo extirpado fué de 234.6 gramos. Las complicaciones post operatorias mas frecuentes estuvieron dadas por crisis miastémica y neumopatía, habiendo fallecido tres pacientes en el inmediato post operatorio debido a crisis miasténicas

Perioperative high-dose steroids in thymectomy for patients with myasthenia gravis

Thymectomy has been shown to be the effective treatment of myasthenia gravis [MG]. However, this operation still had a significant perioperative morbidity in patients with MG class III, IV and V. Perioperative high dose steroid management had been recommended to improve the immediate operative results and eliminate the perioperative morbidity. Forty two patients with MG underwent thymectomy between 1977-1989 and followed up for a period ranging between 2 months and 8 years [mean 5.3 years]. Perioperative high-dose steroid management was given to 11 patients [26.2%] [group B]; while in 31 patients [73.8%], no such treatment was given [group A]. Patients in group A had required postoperative respiratory support for a period ranging from 1 day to 20 days, while all the patients in group B were extubated within 6 hours after operation. Intensive care unit stay in group A ranged between 1 week to 2 months; while in group B, only 5 patients died in group A because of complications of prolonged ventilatory support. Thymectomy resulted in 88% improvement. At follow up 7 patients had complete remission [class A], 27 class B, 3 had class C, 3 had class D and 2 had class F. Perioperative high-dose steroid management proved to be very effective in elimination of perioperative morbidity