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Ann Thorac Surg 2002;73:1028
© 2002 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd, NE, Atlanta, GA 30322, USA
e-mail: jmille6331{at}aol.com
To the Editor
We thank Dr Jaretzki and colleagues for their constructive criticism of our study [1]. We also acknowledge here, as we have done in our report, the tireless work done by the Task Force of the Myasthenia Gravis Foundation of America in designing research guidelines [2]. They will no doubt greatly facilitate the standardization of future studies concerning a very important topic: thymectomy for myasthenia gravis (MG).
We agree that our classification of "improvement"—decreased number or severity of symptoms with the same or less medications—involves a measure of subjectivity on the part of both the clinician and the researcher. We would point out that the Task Force, in its guidelines, "sees no alternative but to accept the inherent imprecision of a clinical classification" in assessing MG [2]. In addition, some permutation of symptom severity and medication use has been employed as a postoperative assessment in most MG studies, many of which we have cited in our article [3–6]. As such, we feel that to reject the validity of this assessment—admittedly not perfectly objective—would thereby reject the findings of most studies ever conducted concerning MG and thymectomy.
We also acknowledge that our table comparing remission and improvement rates has not undergone any statistical comparison (though Jaretzki and colleagues have in their study [3]), and have not implied that such was the case. Concerning the issue of patient pool (or "denominator," as stated in the letter), we included only one nonoperative study [5], as some measure of the remission rates occurring in nonthymectomized MG. We feel that this is clearly indicated in our table, and that there should be no suggestion of mixing populations.
Finally, our use of the Osserman classification pertains to preoperative assessment only, and was tested by us, in our multivariate analysis, as a potential predictor of response. Therefore we used it as originally designed—to describe typical clinical patterns—and not to describe changes in disease severity, as suggested by the letter.
We look forward to seeing results of thymectomy studies using the new guidelines recently developed by the Task Force (guidelines which, we may add, were published after our study was completed and accepted for presentation).
References
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