[Early thymectomy in the treatment of myasthenia gravis]

Over a 10-year period, 1983 through 1992, in the clinic of endocrinologic surgery--Alexander Hospital, Sofia, 89 patients with myasthenia gravis (MG), 57 women and 32 men, are subjected to operative treatment--thymectomy. The mean age in women is 32 years (range 19 to 68), and in men--45.6 years (range 25 to 70). Two age-related distributions in the series are impressive--in female patients the peak is between 20 and 30 years, whereas in men--between 45 and 55 years. The operative intervention consists in total thymectomy. Preference is given to the trans-sternal median access to the thymus gland. In the complex therapeutic approach to MG are included also a number of drugs and other agents--corticosteroids, anticholinesterase agents, immunosuppressives and the like. Patients undergoing operative thymectomy are usually given preoperative treatment with anticholinesterase drugs for different periods of time. Operation is undertaken only in stable condition of the patients. Good postoperative results are recorded in 57 per cent of those operated by the first year, with a satisfactory improvement in 29.2 per cent of them. In the third group (13.4 per cent) the postoperative results are poor, and treatment is proceeded with anticholinesterase drugs or immunosuppressives. The average follow-up term is 44.7 months. The delay in improvement is typical of patients with longer duration of the complaints, but it may be attained within 2, 3 or 5 years postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)