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Ann Thorac Surg 2006;81:1946
© 2006 The Society of Thoracic Surgeons

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Correspondence

Preoperative Use of Steroids in Patients With Myasthenia Gravis

Marcin Zieliski, MD, PhD, Jaroslaw Kuzdzal, MD

Department of Thoracic Surgery, Pulmonary Hospital, ul.Gadkie 1, Zakopane, 34-500 Poland

(Email: marcinz{at}mp.pl; j.kuzdzal{at}mp.pl).

To the Editor:

We read with interest the article by Endo and colleagues [1]. We agree that the use of steroids before thymectomy in patients with myasthenia gravis markedly decreases the rate of postoperative respiratory insufficiency. As did Endo and coworkers [1], we found that the rate of infectious complications after transsternal thymectomy is not increased, even if high doses of steroids exceeding 1 mg/kg/day of prednisone are used [2]. The difference between our strategy and that described by Endo and colleagues [1] concerns the indications for steroids. Contrary to Endo and colleagues [1], we do not use steroids in patients with class I and IIa myasthenia according to the Osserman classification. In these patients the risk of a postoperative myasthenic crisis is negligible, and in our opinion there is no need for steroids, which may cause complications. The patients in class I and IIa represent a considerable part of Endo and colleagues' [1] programmed steroid treatment group (class I, 17 patients; class IIa, 12 patients; overall 29 of 67 patients). In addition, we usually start steroid therapy at lower doses (about 0.5 mg/kg/day of prednisone), and increase the dose every second day until the optimal dose of about 1 mg/kg/day is reached. It usually takes 2 to 3 weeks to stabilize the patient's status before thymectomy. This mode of steroid treatment decreases the risk of exacerbation of myasthenia, which may occur in the second week of therapy.

The author's statement, "Remission occurred not after a thymectomy but after steroid treatment in 4 patients in the occasional treatment group" suggests that steroids affect the complete remission rate after thymectomy. It must be stressed that such a relation has never been proven.

In conclusion, we congratulate Endo and coworkers [1] on their approach to operative treatment of myasthenia; however we suggest more selective use of steroids and stress that steroids have no proven impact on late results of myasthenia.

	References

Top References

 

1. Endo S, Yamaguchi T, Saito N, et al. Experience with programmed steroid treatment with thymectomy in nonthymomatous myasthenia gravis Ann Thorac Surg 2004;77:1745-1750.[Abstract/Free Full Text]
2. Zielinski M, Kuzdzal J, Staniec B, et al. Safety for preoperative use of steroids for transsternal thymectomy in myasthenia gravis Eur J Cardiothorac Surg 2004;26:407-411.[Abstract/Free Full Text]

This article has been cited by other articles:

				S. Endo Reply. Ann. Thorac. Surg., May 1, 2006; 81(5): 1946 - 1947. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marcin Zielinski Jaroslaw Kuzdzal Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zielinski, M. Articles by Kuzdzal, J. Search for Related Content PubMed PubMed Citation Articles by Zielinski, M. Articles by Kuzdzal, J. Related Collections Mediastinum Related Article