DIAGNOSIS, SURGICAL-TREATMENT AND THE PRO GNOSIS OF ITS RESULTS IN PATIENTS WITH GENERALIZED MYASTHENIA

The work deals with the clinical analysis of the richest experience in the surgical treatment of patients with generalized myasthenia in the country. The efficacy of various methods for the diagnosis of affecti on of the thymus is studied comparatively. It is shown that for more e ffective diagnosis of neoplastic lesions of the thymus wider use of co mputerized and magneto-resonance tomography is expedient and that they must replace the insufficiently informative and invasive examination methods used today (pneumonodiastinography, phlebography, scintigraphy , etc.) which still form the basis for the system of diagnostic resear ch in patients with myasthenia. The authors determined the indications and contraindications for the optimum terms for undertaking the surgi cal intervention and its volume in neoplastic and nonneoplastic diseas es of the thymus in adults and children. Comparative evaluation of var ious means of preoperative management was conducted. It is shown that to improve the patient's condition and stabilize the myasthenic status on the possibly minimal doses of anticholesteremic agents glucocortic oid hormones should be included in the complex of preoperative managem ent. The indications for hormonotherapy were determined. The efficacy of plasmapheresis, radiotherapy, and glomectomy with denervation of th e sinocarotid zone was evaluated and their place in the complex treatm ent of patients was determined. From study of the late-term results of treatment of a large group of patients (children, adults with a thymu s) the main causes of unsuccessful surgical treatment of generalized m yasthenia were identified and the concrete means of improving the resu lts of treatment were planned. Two types of changes in the clinico-imm uno-morphological values were revealed in patients with generalized my asthenia, differing evidently in pathogenesis. New clinico-immuno-morp hological correlations and prognostic factors were discovered, and a m ethod for prognosticating the effect of thymectomy wassuggested. It is shown that splenectomy has a favorable effect in the most severe cate gory of patients in unsuccessful operative and nonoperative treatment. The tactics of management of patients accepted in the clinic led to a uncomplicated course of the postoperative period in the majority of p atients in the last years.