Plasmapheresis as preparatory method for thymectomy in myasthenia gravis.

To study the effects of plasmapheresis in preparation for thymectomy, two groups of 40 patients were selected from a sample of 286 patients with myasthenia gravis examined by the first author Group 1 included patients (15 male and 25 female; age range 8-64 yrs) who underwent thymectomy without previous plasmapheresis, whereas patients in group 2 (17 male and 23 female; age range 11-61 yrs) were thymectomized after plasmapheresis. We required patients to have a minimum follow-up period of 12 months to be included in the study. A clinical evaluation protocol composed of 76 items was developed for the study. We found significant improvement in respiratory function and muscular strength in patients thymetomized after plasmapheresis. Furthermore, the combined treatment reduced cost and length of hospital stay. Therefore, we conclude that plasmapheresis should be considered as a coadjuvant to thymectomy in the treatment of myasthenia gravis.

[Pseudotumor cerebri without optic papilledema]. / Pseudotumor cerebral sem edema de papila óptica.

Four cases of benign intracranial hypertension in two nonobese women (23 and 35 yr. old) and two nonobese men (both 47 yr. old) are presented. The most remarkable finding of the clinical investigation of these cases was the absence of papilledema. Our finding is consistent with other reports, and suggest that the presence of papilledema should not be considered critical for the diagnosis of benign intracranial hypertension. Additionally, the authors present a hypothesis for the absence of papilledema in cases otherwise typical of benign intracranial hypertension.

Pseudotumor cerebral sem edema de papila óptica / Pseudotumor cerebri without optic papilledema

Os autores apresentam quatro casos de síndrome de hipertensäo intracraniana benigna em duas mulheres e dois homens jovens e magros em que todos os critérios diagnósticos foram preenchidos exceto a presença de edema de papila óptica. Considerando que casos semelhantes já foram descritos por outros, pareceu-lhes justificada a proposiçäo que fazem de näo ser obrigatória a presença de edema de papila óptica para o diagnóstico da síndrome. Apresentam uma hipótese para explicar o fato e discutem outros detalhe dos casos

[Plasmapheresis in neurology. Critical analysis of indications and protocols]. / Plasmaferese em neurologia. Análise crítica da indicação e protocolos.

Therapeutic plasmapheresis (plasma exchange) in neurology is a matter of discussion. We review the main articles on clinical trials, both controlled and uncontrolled, trying to establish the efficacy and safety of the procedure. Humoral aspects involved in the genesis of the disorder play an important role for its indication in the present time. In myasthenia gravis indications for plasmapheresis are established: in the preparation for thymectomy, in patients with respiratory insufficiency and requiring respiratory prosthesis, after long immunosuppression therapy with rebound effect, when all other forms of therapy failed, and in neonatal myasthenia gravis with special technics. We discuss the indication of plasmapheresis in Guillain-Barré syndrome, multiple sclerosis, chronic inflammatory demyelinating polyneuromyelopathy, HTLV-1 myelopathy, HIV peripheral neuropathy and myelopathy, paraproteinemias, polymyositis, and dermatomyositis. Indications for other diseases are mentioned. Reference is made to the results we observed in 31 cases followed consecutively at Hospital dos Servidores, Rio de Janeiro, from June 1984 to June 1990. In our series 26 were myasthenic patients, 4 patients presented Guillain-Barré syndrome, and 1 multiple sclerosis. Therapeutic plasmapheresis protocols suggested by us are summarized.