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Myastenia Gravis Hastalarında Timektominin Klinik İyileşmeye Etkisi

Year 2022, Volume: 31 Issue: 1, 50 - 56, 11.03.2022
https://doi.org/10.17942/sted.1014922

Abstract

Amaç
Timektomi, Myastenia Gravis (MG) hastalarında klinik iyileşme ve remisyona en önemli etkisi olan tedavilerden biridir. Bu çalışmanın asıl amacı timektomiden görülen faydayı yordayan faktörleri bulabilmektir.
Metod
Fakültemizde MG’si olan ve timektomi operasyonu olmuş 27 hastanın 2 yıllık takiplerinde yaş, cinsiyet, timik patoloji, tanı zamanı, tanı ile timektomi arasındaki süre ve hastalık şiddeti gibi faktörlerin klinik iyileşmeye etkisi olup olmadığı; hastaların klinik durumları, MG-ADL skorları ve aldıkları tedavileri karşılaştırılarak incelendi.
Bulgular
Hastaların %59.3’ü kadın ve yaş ortalamaları 45.9 ±15.2 yıldı. Hastaların %70.4’ünde klinik iyileşme gözlendi. Timektomi öncesi MG-ADL skorlarının ortalaması 6.88±3.02 iken, 2. yıl takiplerinde MG-ADL skor ortalamaları 5.44±3.78 olarak bulundu ve iki grup arasında anlamlı fark saptandı (p<0.001). Klinik iyileşmenin en fazla olduğu (%47.4’ü) hastaların Osserman sınıflamasına göre IIb olduğu tespit edildi (p:0.047).
Sonuç
Çalışmamızda önceki çalışmalara benzer oranda timektomi klinik iyileşmeye etkili bir tedavi olarak bulundu. Timektomi öncesinde hastalık şiddeti ne kadar hafifse görülecek faydanın daha fazla olacağı tespit edildi.

References

  • 1. Drachman D. Myasthenia gravis N Engl J Med 1994; 330: 1797-1810. Länk.
  • 2. Meriggioli MN, Sanders DB. Muscle autoantibodies in myasthenia gravis: beyond diagnosis? Expert review of clinical immunology. 2012;8(5):427-38.
  • 3. Fujii Y, Monden Y, Hashimoto J, Nakahara K, Kawashima Y. Acetylcholine receptor antibody-producing cells in thymus and lymph nodes in myasthenia gravis. Clinical immunology and immunopathology. 1985;34(1):141-6.
  • 4. Cooper J, Al-Jilaihawa A, Pearson F, Humphrey J, Humphrey H. An improved technique to facilitate transcervical thymectomy for myasthenia gravis. The Annals of thoracic surgery. 1988;45(3):242-7.
  • 5. Bachmann K, Burkhardt D, Schreiter I, Kaifi J, Schurr P, Busch C, et al. Thymectomy is more effective than conservative treatment for myasthenia gravis regarding outcome and clinical improvement. Surgery. 2009;145(4):392-8.
  • 6. Nieto IP, Robledo JPP, Pajuelo MC, Montes JAR, Giron JG, Alonso JG, et al. Prognostic factors for myasthenia gravis treated by thymectomy: review of 61 cases. The Annals of thoracic surgery. 1999;67(6):1568-71.
  • 7. Aydin Y, Ulas AB, Mutlu V, Colak A, Eroglu A. Thymectomy in myasthenia gravis. The Eurasian journal of medicine. 2017;49(1):48.
  • 8. Wolfe GI, Herbelin L, Nations S, Foster B, Bryan W, Barohn R. Myasthenia gravis activities of daily living profile. Neurology. 1999;52(7):1487-.
  • 9. Budde JM, Morris CD, Gal AA, Mansour KA, Miller Jr JI. Predictors of outcome in thymectomy for myasthenia gravis. The Annals of thoracic surgery. 2001;72(1):197-202.
  • 10. Grob D, Brunner N, Namba T, Pagala M. Lifetime course of myasthenia gravis. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2008;37(2):141-9.
  • 11. Mao Z, Hu X, Lu Z, Hackett ML. Prognostic factors of remission in myasthenia gravis after thymectomy. European Journal of Cardio-Thoracic Surgery. 2015;48(1):18-24.
  • 12. Özdemir N, Kara M, Dikmen E, Nadir A, Akal M, Yücemen N, et al. Predictors of clinical outcome following extended thymectomy in myasthenia gravis. European journal of cardio-thoracic surgery. 2003;23(2):233-7.
  • 13. Bramis J, Pikoulis E, Leppäniemi A, Felekouras E, Alexiou D, Bastounis E. Benefits of early thymectomy in patients with myasthenia gravis. The European journal of surgery= Acta chirurgica. 1997;163(12):897-902.
  • 14. Genkins G, Papatestas AE, Horowitz SH, Kornfeld P. Studies in myasthenia gravis: early thymectomy: electrophysiologic and pathologic correlations. The American journal of medicine. 1975;58(4):517-24.
  • 15. Maggi G, Casadio C, Cavallo A, Cianci R, Molinatti M, Ruffini E. Thymectomy in myasthenia gravis. European journal of cardio-thoracic surgery. 1989;3(6):504-11.
  • 16. Kumar V, Kaminski HJ. Treatment of myasthenia gravis. Current neurology and neuroscience reports. 2011;11(1):89-96.
  • 17. Masaoka A, Yamakawa Y, Niwa H, Fukai I, Kondo S, Kobayashi M, et al. Extended thymectomy for myasthenia gravis patients: a 20-year review. The Annals of thoracic surgery. 1996;62(3):853-9.
  • 18. PERLO VP, ARNASON B, CASTLEMAN B. The thymus gland in elderly patients with myasthenia gravis. Neurology. 1975;25(3):294-.
  • 19. Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55(1):7-15.
  • 20. Sanders DB, Wolfe GI, Benatar M, Evoli A, Gilhus NE, Illa I, et al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology. 2016;87(4):419-25.
  • 21. Jaretzki A, Steinglass KM, Sonett JR, editors. Thymectomy in the management of myasthenia gravis. Seminars in neurology; 2004: 24(1):49-62
Year 2022, Volume: 31 Issue: 1, 50 - 56, 11.03.2022
https://doi.org/10.17942/sted.1014922

Abstract

References

  • 1. Drachman D. Myasthenia gravis N Engl J Med 1994; 330: 1797-1810. Länk.
  • 2. Meriggioli MN, Sanders DB. Muscle autoantibodies in myasthenia gravis: beyond diagnosis? Expert review of clinical immunology. 2012;8(5):427-38.
  • 3. Fujii Y, Monden Y, Hashimoto J, Nakahara K, Kawashima Y. Acetylcholine receptor antibody-producing cells in thymus and lymph nodes in myasthenia gravis. Clinical immunology and immunopathology. 1985;34(1):141-6.
  • 4. Cooper J, Al-Jilaihawa A, Pearson F, Humphrey J, Humphrey H. An improved technique to facilitate transcervical thymectomy for myasthenia gravis. The Annals of thoracic surgery. 1988;45(3):242-7.
  • 5. Bachmann K, Burkhardt D, Schreiter I, Kaifi J, Schurr P, Busch C, et al. Thymectomy is more effective than conservative treatment for myasthenia gravis regarding outcome and clinical improvement. Surgery. 2009;145(4):392-8.
  • 6. Nieto IP, Robledo JPP, Pajuelo MC, Montes JAR, Giron JG, Alonso JG, et al. Prognostic factors for myasthenia gravis treated by thymectomy: review of 61 cases. The Annals of thoracic surgery. 1999;67(6):1568-71.
  • 7. Aydin Y, Ulas AB, Mutlu V, Colak A, Eroglu A. Thymectomy in myasthenia gravis. The Eurasian journal of medicine. 2017;49(1):48.
  • 8. Wolfe GI, Herbelin L, Nations S, Foster B, Bryan W, Barohn R. Myasthenia gravis activities of daily living profile. Neurology. 1999;52(7):1487-.
  • 9. Budde JM, Morris CD, Gal AA, Mansour KA, Miller Jr JI. Predictors of outcome in thymectomy for myasthenia gravis. The Annals of thoracic surgery. 2001;72(1):197-202.
  • 10. Grob D, Brunner N, Namba T, Pagala M. Lifetime course of myasthenia gravis. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2008;37(2):141-9.
  • 11. Mao Z, Hu X, Lu Z, Hackett ML. Prognostic factors of remission in myasthenia gravis after thymectomy. European Journal of Cardio-Thoracic Surgery. 2015;48(1):18-24.
  • 12. Özdemir N, Kara M, Dikmen E, Nadir A, Akal M, Yücemen N, et al. Predictors of clinical outcome following extended thymectomy in myasthenia gravis. European journal of cardio-thoracic surgery. 2003;23(2):233-7.
  • 13. Bramis J, Pikoulis E, Leppäniemi A, Felekouras E, Alexiou D, Bastounis E. Benefits of early thymectomy in patients with myasthenia gravis. The European journal of surgery= Acta chirurgica. 1997;163(12):897-902.
  • 14. Genkins G, Papatestas AE, Horowitz SH, Kornfeld P. Studies in myasthenia gravis: early thymectomy: electrophysiologic and pathologic correlations. The American journal of medicine. 1975;58(4):517-24.
  • 15. Maggi G, Casadio C, Cavallo A, Cianci R, Molinatti M, Ruffini E. Thymectomy in myasthenia gravis. European journal of cardio-thoracic surgery. 1989;3(6):504-11.
  • 16. Kumar V, Kaminski HJ. Treatment of myasthenia gravis. Current neurology and neuroscience reports. 2011;11(1):89-96.
  • 17. Masaoka A, Yamakawa Y, Niwa H, Fukai I, Kondo S, Kobayashi M, et al. Extended thymectomy for myasthenia gravis patients: a 20-year review. The Annals of thoracic surgery. 1996;62(3):853-9.
  • 18. PERLO VP, ARNASON B, CASTLEMAN B. The thymus gland in elderly patients with myasthenia gravis. Neurology. 1975;25(3):294-.
  • 19. Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55(1):7-15.
  • 20. Sanders DB, Wolfe GI, Benatar M, Evoli A, Gilhus NE, Illa I, et al. International consensus guidance for management of myasthenia gravis: executive summary. Neurology. 2016;87(4):419-25.
  • 21. Jaretzki A, Steinglass KM, Sonett JR, editors. Thymectomy in the management of myasthenia gravis. Seminars in neurology; 2004: 24(1):49-62
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Orijinal Research
Authors

Ayşe Çağlar Sarılar 0000-0001-7818-1209

Emel Köseoğlu 0000-0001-9620-9949

Çağla Eröz This is me 0000-0003-2254-3957

Gönül Gülmez This is me 0000-0001-8865-5092

Fahri Oğuzkaya 0000-0003-4791-0848

Büşra Sümeyye Arıca Polat 0000-0001-9337-4041

Early Pub Date March 11, 2022
Publication Date March 11, 2022
Published in Issue Year 2022 Volume: 31 Issue: 1

Cite

Vancouver Sarılar AÇ, Köseoğlu E, Eröz Ç, Gülmez G, Oğuzkaya F, Arıca Polat BS. Myastenia Gravis Hastalarında Timektominin Klinik İyileşmeye Etkisi. JCME. 2022;31(1):50-6.