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Ann Thorac Surg 1999;67:593
© 1999 The Society of Thoracic Surgeons

Correspondence

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Vera Bril, MDa, Jasna Kojic, MDa, Werner K. Ilse, MDa, Joel D. Cooper, MDb

a The Toronto Hospital, General Division EN 11-209, 200 Elizabeth St, Toronto ON M9C 1G5 Canada
b Division of Cardiothoracic Surgery, Washington University School of Medicine, 3108 Queeny Tower, One Barnes Hospital Plaza, St. Louis MO 63110 USA

Jaretzki makes several important points in his letter. Perhaps the most important are that there are no standardized methods used by researchers globally to classify myasthenia gravis and no agreed-on statistical evaluation. It should be noted that before the original report of results after transcervical thymectomy, we consulted with Jaretzki about statistical methods to ensure that our results were comparable to his. The same methods were used by both authors in the published reports. Jaretzki has now reanalyzed his data using different statistical methods, as discussed in the supplement article cited, and presents better results than those originally described. In addition, he discusses the development of a thymectomy task force in the United States to define appropriate methods of evaluating response to therapy of myasthenia gravis. It remains to be seen whether the recommendations of this local task force will be accepted globally.

Jaretzki’s assumption that the Toronto patients had less severe myasthenia gravis than those in his series is difficult to comprehend, given his doubts on the comparability of clinical assessment scales of these patients. However, Jaretzki’s classes I to IV resemble the modified Osserman criteria closely. In our patient cohort, the grades ranged from 0 to 4, so that a mean grade of 2.7 does not represent solely mildly affected patients. Thirty-one of 52 patients had a mean grade of 3/4, which translates to moderate to severe generalized weakness with or without respiratory dysfunction.

In conclusion, we consider our results comparable to those of published series and continue to recommend a less aggressive surgical approach.


Related Article

Outcome after transcervical thymectomy
Alfred Jaretzki, III
Ann. Thorac. Surg. 1999 67: 592-593. [Extract] [Full Text] [PDF]




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