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

Hazards of thrombolytic therapy in acute myocardial infarction

A variety of therapeutic strategies for management of acute myocardial infarction have become available. AMI management can range from home care to early hospital discharge to an invasive intervention with agents to salvage ischaemic myocardium and reduce infarct size Although many opinions were against thrombolytic therapy, it called achieve popularity in the last few years. In some centers and for different reasons thrombolytic therapy is going to be a routine. Here we review 5 groups of hazards which may result due to application of thrombolytic therapy [mainly streptokinasie STK] on AMI

treatment of traumatic pseudarthrosis of the clavicle by AO plate fixation and bone grafting; a retrospective review of sixteen cases

This study used AO plating techniques in sixteen with clavicular non- union since 1980. All patients have undergone recent clinical review by one of the authors. All patients had symptomatic non- union. Compression AO plating and iliac bone- grafting were used to enhance union. All patients achieved clinical union by ten weeks postoperatively with no operative or postoperative complications and had a full painless range of shoulder motion. It was concluded that patients with symptomatic clavicular non- union may be treated by open reduction and internal fixation with a compression AO plate and supplemental iliac bone graft with a high likelihood of success