Thymectomy for myasthenia gravis: a changing perspective
J. C. Heiser, R. B. Rutherford and S. P. Ringel
A review of 28 patients with nonthymomatous myasthenia gravis who underwent
thymectomy at the University of Colorado Health Sciences Center, Denver,
from 1967 to 1979 shows significant stepwise changes in management and
results. Comparison among three periods--period 1 (1967 to 1971), when
thymectomy competed with prednisone,which were not given in the
perioperative period (seven patients); period 2 (1974 to 1976), when
thymectomy was followed by six months of prednisone therapy (ten patients);
and period 3 (1977 to 1979), when prednisone was also given to prepare the
patients for thymectomy (11 patients)--demonstrated a decreasing need for
tracheostomy and respiratory support (86% v 10% v 0%), shorter stay in the
intensive care unit (21 v 3 v 1 day), and shorter hospitalization (36 v 13
v 4 days). Remission or marked amelioration of symptoms occurred in 56% of
group 1 and 100% of both groups 2 and 3. Earlier application of thymectomy
and its performance through a short upper transverse sternotomy incision
also contributed to the improved results.