[Combination of tiapride and ketamine in anesthesia for transsternal thymectomy in myasthenia gravis].
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Biomedical subjects
Publications and source records attributed to P E Marchiori.
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Epidemiologic and clinic studies of both diseases and syndromes associated in a group of 304 myasthenic patients were made. A comparative projection between the present cases and those of other authors was presented.
In a group of 304 myasthenic patients 15 cases with thyropathies were reported: nine with hyperthyroidism, one with hypothyroidism and five with nontoxic goiter. Four patients presented diffuse simple goiter and one a multinodular goiter with normal thyroid function. No patient came from an endemic goiter region, not even familial goiter. The prevalence and influence of hyperthyroidism on myasthenic symptomatology were studied. Our findings suggest that there is no clinical correlation between both myasthenia symptomatology and thyroid dysfunction, neither significant influence on myasthenic symptoms when the endocrine disorders improve.
The development of autoimmune diseases in some patients treated with D-penicillamine (DPA) suggests that the reported occurrence of a conduction disorder at the neuromuscular junction and the development of a reversible myasthenia gravis in rheumatoid disease, progressive systemic sclerosis or Wilson's disease after the use of DPA are part of a general predisposition for autoimmune disease related to DPA therapy. The case reported is an example. The DPA- induced myasthenia gravis (MG) is similar to the spontaneous MG clinically and electrophysiologically, though ocular signs prevail in the former. Antibodies to acetylcholine receptor have been demonstrated and thymic hyperplasia also has been formed. Regarding the onset of myasthenic manifestations the duration of the treatment with DPA varies from 6 to 10 months. The action of DPA on the neuromuscular junction is different from that occurring in spontaneous MG. The pathogenesis of the DPA induced MG is still obscure. The chemical properties of DPA permit it to react with many proteins and some alteration of proteins may appear, with structural changes in the composition and antigenicity of the collagen fibers. In vitro DPA causes disorder of acetylcholine receptor bridges to alpha, beta, gamma sub-units with reduction of the S-S bridges in the gamma-subunit. This decreases the linkage of high affinity and abolishes its positive cooperative system, reducing the S-S connection in the alpha-unit near the acetylcholine linkage. The interaction between DPA and receptor may induce antigenic alteration in this latter, starting the autoimmune phenomena. The other possibility is the stimulation of prostaglandin E-1 synthesis by DPA may fill the allosteric place of ACh receptor, interfering on the neuromuscular junction.
Twenty-seven patients with generalized myasthenia gravis (moderate, severe and acute fulminating forms) who underwent thymectomy were studied. The effects of several anesthetic agents were analyzed with special attention being given to immunologic considerations. The authors conclude that the association of ketamine, tiapride, droperidol, fentanil and nitrous oxide allowed fast recovery of consciousness and spontaneous respiration, and made safe extubation possible before leaving the operating room.
The neuropsychiatric aspects and both hereditary and therapeutic study from 16 patients with Huntington's chorea are presented. The differential diagnosis from a clinical approach has been emphasized. The results of this research and those of the literature were compared.
Two cases of patients with relapsing polyradiculoneuropathy with high protein level in cerebrospinal fluid are reported. The immunological features and the natural history of the relapsing polyradiculoneuropathy are discussed. This disease is considered a particular auto-immune nosologic condition, independent from acute polyradiculoneuropathy.
A 25 year old with vitiligo por 6 years now. For one year has being presenting hyperthyroidism, myasthenia gravis and periodic paralysis. The normalization of the thyroid function was followed by a significant improvement of the myasthenic syndrome that did not interfere with the paralytical attacks.
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The case of a man 34 year-old presenting upward gaze paralyses and external ophthalmoplegia without involvement of the downward gaze, accompanied by cerebellar disorders, generalized areflexia but no muscular weakness, and moderate sensory impairment of the four extremities is reported. The cerebrospinal fluid showed an albuminocytologic dissociation. Recovery was rapid and almost complete, within 3 weeks, remaining minimal paresis of the upward gaze and lateral movement in both eyes. The improvement had been coinciding with the treatment by cortrosina.
The case of a 28-year-old male affected by intracranial tuberculous arachnoiditis with unusual aspects is reported. The patient presented bilateral amaurosis and complete ophthalmoplegia with intrinsic muscle sparing in both sides. The routine laboratory findings showed only persistent leucocytosis and a Mantoux test of 10 mm. Several radiologic studies of the lungs were always normal. The spinal fluid, tomography of the cranial base and carotid angiography were normal. The diagnosis was made by histologic study after craniotomy.
The Vogt-Kayanagi-Harada sśyndrome in two negro female patients with 37 and 40 year-old, respectively, are reported. The clinic, epidemiologic, heredo-familial and immunologic aspects are discussed.
The case of 15 years old boy with an enterogenous cyst causing compression of the spinal cord at T-2 is reported. The diagnosis was made by thoracic laminectomy and confirmed by histological examination. The motor disorders improved progressively after surgery.
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