RESUMEN
Introducción. La timectomía radical ampliada para el tratamiento de la miastenia gravis es una opción efectiva en la población adulta. No ocurre lo mismo en el caso de la miastenia gravis juvenil, ya que existen pocos reportes que demuestren su efectividad. Objetivo. El principal objetivo de esta investigación fue el de demostrar que la timectomía transesternal radical ampliada es una alternativa validada para el tratamiento de esta enfermedad en este grupo de pacientes. Resultados. Con esta técnica fueron intervenidos 23 pacientes con miastenia gravis juvenil en el periodo comprendido entre abril del 2003 y abril del 2014. La edad media fue de 12,13 años y hubo un predominio en el sexo femenino. La principal indicación quirúrgica fue, en 22 pacientes, la forma generalizada de la enfermedad (estadio II de Osserman) sin respuesta al tratamiento médico luego de 6 meses. El diagnóstico histológico fue de hiperplasia tímica en 22 pacientes y timoma linfocitico tipo I en un paciente. No hubo fallecidos y no se presentaron complicaciones mayores en el periodo postoperatorio. Con un seguimiento medio de 58,87 meses, 22 pacientes se encuentran sin tratamiento o necesitando menor cantidad de medicamentos para el control de los síntomas miasténicos. Conclusiones. La timectomía transesternal ampliada es una opción segura y efectiva para el tratamiento quirúrgico de la miastenia gravis juvenil (AU)
Introduction. Radical or extended thymectomy is an effective treatment for myasthenia gravis in the adult population. There are few reports to demonstrate the effectiveness of this treatment in patients with juvenile myasthenia gravis. Objective. The main objective of this study was to show that extended transsternal thymectomy is a valid option for treating this disease in paediatric patients. Results. Twenty-three patients with juvenile myasthenia gravis underwent this surgical treatment in the period between April 2003 and April 2014; mean age was 12.13 years and the sample was predominantly female. The main indication for surgery, in 22 patients, was the generalised form of the disease (Osserman stage II) together with no response to 6 months of medical treatment. The histological diagnosis was thymic hyperplasia in 22 patients and thymoma in one patient. There were no deaths and no major complications in the postoperative period. After a mean follow-up period of 58.87 months, 22 patients are taking no medication or need less medication to manage myasthenic symptoms. Conclusions. Extended (radical) transsternal thymectomy is a safe and effective surgical treatment for juvenile myasthenia gravis (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Miastenia Gravis/diagnóstico , Miastenia Gravis/cirugía , Timectomía , Timoma/patología , Timoma/cirugía , Inmunoglobulinas/uso terapéutico , Evaluación de Resultados de Intervenciones Terapéuticas/métodos , Timo/patología , Timo/cirugía , Estudios Prospectivos , Neurofisiología/métodos , Electromiografía/métodosRESUMEN
INTRODUCTION: Radical or extended thymectomy is an effective treatment for myasthenia gravis in the adult population. There are few reports to demonstrate the effectiveness of this treatment in patients with juvenile myasthenia gravis. OBJECTIVE: The main objective of this study was to show that extended transsternal thymectomy is a valid option for treating this disease in paediatric patients. RESULTS: Twenty-three patients with juvenile myasthenia gravis underwent this surgical treatment in the period between April 2003 and April 2014; mean age was 12.13 years and the sample was predominantly female. The main indication for surgery, in 22 patients, was the generalised form of the disease (Osserman stage II) together with no response to 6 months of medical treatment. The histological diagnosis was thymic hyperplasia in 22 patients and thymoma in one patient. There were no deaths and no major complications in the postoperative period. After a mean follow-up period of 58.87 months, 22 patients are taking no medication or need less medication to manage myasthenic symptoms. CONCLUSIONS: Extended (radical) transsternal thymectomy is a safe and effective surgical treatment for juvenile myasthenia gravis.
Asunto(s)
Miastenia Gravis/cirugía , Timectomía/métodos , Hiperplasia del Timo/cirugía , Niño , Femenino , Estudios de Seguimiento , Humanos , MasculinoRESUMEN
Proteomics and metabolomics technologies are potentially useful tool for the study of the very complex process of cell adaptation to protein-free medium. In this work, we used the iTRAQ technology to analyze different protein levels in adapted and non-adapted NS0 myeloma cell line. Several proteins with differential expression profile were characterized and quantified. Carbohydrate metabolism, protein synthesis and membrane transport were the principal pathways that change after the adaptation. Changes in lactate production rate with respect to glucose consumption rate were observed according to the changes observed by proteomic.