| Thymectomy | |
|---|---|
| ICD-9-CM | 07.8 |
| MeSH | D013934 |
A thymectomy is an operation to remove the thymus. It usually results in remission of myasthenia gravis with the help of medication including steroids. However, this remission may not be permanent. Thymectomy is indicated when thymoma are present in the thymus. Anecdotal evidence suggests MG patients with no evidence of thymoma may still benefit from thymectomy. [1]
There are a number of surgical approaches to the removal of the thymus gland: transternal (through the breast bone), transcervical (through a small neck incision), and transthoracic (through one or both sides of the chest). [2]
There has been no difference in success in symptom improvement between the transsternal approach and the minimally invasive transcervical approach. [3]
Video-assisted approaches, such as thoracoscopic surgery, are increasingly prescribed since the less invasive nature of the procedure strikes a balance with the lack of actual clinical evidence supporting thymectomy in non-thymomal cases. [4]
Thymectomy is a treatment for myasthenia gravis, a neuromuscular disease. [5] For about 60% of people with myasthenia gravis, thymectomy significantly improves their symptoms of muscle weakness. In about 30% of cases, thymectomy results in permanent remission of myasthenia gravis, negating the need for any additional medication. Improvements in condition as a result of thymectomy are often delayed, typically occurring one or two years after the surgical procedure, though could be as late as five years. In some people, thymectomy does not alleviate any symptoms of myasthenia gravis. [6]
Experiments involving thymectomy in newborn mice showed that it unexpectedly resulted in wasting disease when performed before the mouse was three days old. This is because the thymus is the site where T cells are generated. Removal of the thymus resulted in autoimmunity, in which the immune cells attack the organism's own healthy cells and tissues. [7]
Those who have had their thymus removed should not receive the Yellow Fever vaccine. [8] [9]
Lambert–Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder characterized by muscle weakness of the limbs. It is also known as myasthenic syndrome, Eaton–Lambert syndrome, and when related to cancer, carcinomatous myopathy.
Myasthenia gravis (MG) is a long-term neuromuscular junction disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, drooping eyelids, and difficulties in talking and walking. Onset can be sudden. Those affected often have a large thymus or develop a thymoma.
The thymus is a specialized primary lymphoid organ of the immune system. Within the thymus, thymus cell lymphocytes or T cells mature. T cells are critical to the adaptive immune system, where the body adapts to specific foreign invaders. The thymus is located in the upper front part of the chest, in the anterior superior mediastinum, behind the sternum, and in front of the heart. It is made up of two lobes, each consisting of a central medulla and an outer cortex, surrounded by a capsule.
Morvan's syndrome is a rare, life-threatening autoimmune disease named after the nineteenth century French physician Augustin Marie Morvan. "La chorée fibrillaire" was first coined by Morvan in 1890 when describing patients with multiple, irregular contractions of the long muscles, cramping, weakness, pruritus, hyperhidrosis, insomnia and delirium. It normally presents with a slow insidious onset over months to years. Approximately 90% of cases spontaneously go into remission, while the other 10% of cases lead to death.
Pilonidal disease is a type of skin infection which typically occurs as a cyst between the cheeks of the buttocks and often at the upper end. Symptoms may include pain, swelling, and redness. There may also be drainage of fluid, but rarely a fever.
Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart, lungs, and other pleural or mediastinal structures.
A thymoma is a tumor originating from the epithelial cells of the thymus that is considered a rare neoplasm. Thymomas are frequently associated with neuromuscular disorders such as myasthenia gravis; thymoma is found in 20% of patients with myasthenia gravis. Once diagnosed, thymomas may be removed surgically. In the rare case of a malignant tumor, chemotherapy may be used.
Ocular myasthenia gravis (MG) is a disease of the neuromuscular junction resulting in hallmark variability in muscle weakness and fatigability. MG is an autoimmune disease where anomalous antibodies are produced against the naturally occurring acetylcholine receptors in voluntary muscles. MG may be limited to the muscles of the eye, leading to abrupt onset of weakness/fatigability of the eyelids or eye movement. MG may also involve other muscle groups.
A mediastinal tumor is a tumor in the mediastinum, the cavity that separates the lungs from the rest of the chest. It contains the heart, esophagus, trachea, thymus, and aorta. The most common mediastinal masses are thymoma, usually found in the anterior mediastinum, followed by neurogenic Timor (15–20%) located in the anterior mediastinum. Lung cancer typically spreads to the lymph nodes in the mediastinum.
Ptosis, also known as blepharoptosis, is a drooping or falling of the upper eyelid. This condition is sometimes called "lazy eye", but that term normally refers to the condition amblyopia. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism, so it is especially important to treat the disorder in children before it can interfere with vision development.
Aphagia is the inability or refusal to swallow. The word is derived from the Ancient Greek prefix α, meaning "not" or "without," and the suffix φαγία, derived from the verb φαγεῖν, meaning "to eat." It is related to dysphagia which is difficulty swallowing, and odynophagia, painful swallowing. Aphagia may be temporary or long term, depending on the affected organ. It is an extreme, life-threatening case of dysphagia. Depending on the cause, untreated dysphagia may develop into aphagia.
Thymic carcinoma, or type C thymoma, is a malignancy of the thymus. It is a rare cancer that is often diagnosed at advanced stages. Recurrence following treatment is common, and thymic carcinoma is associated with a poor prognosis.
Neuromuscular junction disease is a medical condition where the normal conduction through the neuromuscular junction fails to function correctly.
Thymus hyperplasia refers to an enlargement ("hyperplasia") of the thymus.
Mary Broadfoot Walker was a Scottish physician who first demonstrated the effectiveness of physostigmine in the treatment of the condition myasthenia gravis, a disease relating to muscle weakness. She was also the first to recognise the association between familial periodic paralysis and low blood potassium levels.
Thymoma with immunodeficiency is a rare disorder that occurs in adults in whom hypogammaglobulinemia, deficient cell-mediated immunity, and thymoma may develop almost simultaneously. Most reported cases are in Europe, though it occurs globally.
Philip Eugene Bernatz was an eminent American physician and thoracic surgeon at the Mayo Clinic, and an international authority on the diagnosis and treatment of thymoma and other tumors of the chest.
Arvind Kumar is an Indian surgeon and the chairman of Institute of Chest Surgery, Chest Onco Surgery and Lung Transplantation at Medanta Hospital, Gurugram and founder and managing trustee, Lung Care Foundation. He is the former chairman of the Center for Chest Surgery and director of the Institute of Robotic Surgery at Sir Ganga Ram Hospital (SGRH) New Delhi. He is a former professor of surgery and head of the Thoracic & Robotic Surgery Unit, All India Institute of Medical Sciences (AIIMS), New Delhi (1988-2012). He was president of the Association of Surgeons of India in 2019.
A parotidectomy is the surgical excision (removal) of the parotid gland, the major and largest of the salivary glands. The procedure is most typically performed due to neoplasms (tumors), which are growths of rapidly and abnormally dividing cells. Neoplasms can be benign (non-cancerous) or malignant (cancerous). The majority of parotid gland tumors are benign, however 20% of parotid tumors are found to be malignant. Parotidectomy is performed mostly by oral and maxillofacial surgeon and ENT surgeon.
Neurodegenerative diseases are a heterogeneous group of complex disorders linked by the degeneration of neurons in either the peripheral nervous system or the central nervous system. Their underlying causes are extremely variable and complicated by various genetic and/or environmental factors. These diseases cause progressive deterioration of the neuron resulting in decreased signal transduction and in some cases even neuronal death. Peripheral nervous system diseases may be further categorized by the type of nerve cell affected by the disorder. Effective treatment of these diseases is often prevented by lack of understanding of the underlying molecular and genetic pathology. Epigenetic therapy is being investigated as a method of correcting the expression levels of misregulated genes in neurodegenerative diseases.
