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Ann Thorac Surg 2006;81:1946-1947
© 2006 The Society of Thoracic Surgeons

Correspondence

Reply

Shunsuke Endo, MD

Department of Thoracic & Cardiovascular Surgery, Jichi Medical School, Minamikawachi-machi, Kawachi-gun, Tochigi, 329-0498 Japan

(Email: tcvshun{at}jichi.ac.jp).

To the Editor:

We thank Drs Zielinski and Kuzdzal [1] for their interest in our recent article on the preoperative use of steroids in patients with myasthenia gravis (MG). As described in our article [2], 60% of our patients with ocular MG advanced to generalized MG; although ocular MG is essentially the same disease as generalized MG [3]. One of 6 patients who had postoperative respiratory failure was classified with class I myasthenia according to the Osserman classification. We recommend preoperative steroid use in patients with ocular MG as well as generalized MG. An optimal dose of steroid remains unclear; however we have recently treated at a dose of about 1 mg/kg/day. In patients with class I and IIa myasthenia according to the Osserman classification, the dose of steroid is intentionally decreased when clinical symptoms resolve. The risk of exacerbation of myasthenia, which may indeed occur in the second week of therapy, is usually taken care of by neurologists in our hospital. We greatly appreciated the comments; however it is worth noting that in the near future, the new agent of tacrolisum as an immunosuppressive treatment will constitute an alternate treatment strategy for myasthenia gravis.


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 References
 

  1. Zielinski M, Kuzdzal J. Preoperative use of steroids in patients with myasthenia gravis (letter) Ann Thorac Surg 2006;81:1946.[Free Full Text]
  2. 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]
  3. Roberts PF, Venuta F, Rendina F, et al. Thymectomy in the treatment of ocular myasthenia gravis J Thorac Cardiovasc Surg 2001;122:562-568.[Abstract/Free Full Text]

Related Article

Preoperative Use of Steroids in Patients With Myasthenia Gravis
Marcin Zielinski and Jaroslaw Kuzdzal
Ann. Thorac. Surg. 2006 81: 1946. [Extract] [Full Text] [PDF]




This Article
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