Methotrexate as a Steroid-Sparing Agent in Myasthenia Gravis: A Preliminary Retrospective Study

We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD ± 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD ± 35.2); median 100.5 (extremes of 55 and 215). The mean volume of plasma exchanged in each session was 2396 ml (SD ± 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.

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Thymoma: A Clinico-Pathologic Study Based on Newly Developed Morphologic Criteria

Tumori Journal ◽

10.1177/030089168807400114 ◽

1988 ◽

Vol 74 (1) ◽

pp. 79-84 ◽

Cited By ~ 5

Author(s):

Erino A. Rendina ◽

Edoardo O. Pescarmona ◽

Federico Venuta ◽

Stefano Nardi ◽

Giovanni De Rosa ◽

...

Keyword(s):

Retrospective Study ◽

Myasthenia Gravis ◽

Superior Vena Cava ◽

Superior Vena Cava Syndrome ◽

Superior Vena ◽

Vena Cava ◽

Stage I ◽

Clinical Behavior ◽

Vena Cava Syndrome ◽

Degree Of Malignancy

A retrospective study of 28 cases of thymoma classified according to Marino and Müller-Hermelink (cortical, medullary, mixed common, mixed with cortical predominance, mixed with medullary predominance thymoma) was undertaken to determine the existence of correlations between histology and clinical behavior. Cortical thymoma was observed in 11 cases (39.2%), mixed common thymoma in 9 (32.1%), mixed with cortical predominance in 5 (18%), and medullary thymoma in 3 (10.7%). In patients with cortical thymoma the tumor was always invasive (stages II and III according to Bergh), whereas medullary thymomas were noninvasive in 2 cases (stage I) and slightly invasive with a moderate infiltration of the capsule in the remaining case (stage II). Mixed common and mixed with cortical predominance thymomas displayed intermediate behavior. Twelve patients were affected by myasthenia gravis: 1 had medullary thymoma, 6 had mixed common thymoma, 3 had mixed thymoma with cortical predominance, and 2 had cortical thymoma. One patient with cortical thymoma had superior vena cava syndrome and 1 had erythroid hypoplasia; mixed common thymoma was associated with Cushing's syndrome in 1 patient. These data confirm previously reported observations (16) showing a higher degree of malignancy in patients with cortical thymoma.

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Infliximab as a steroid-sparing agent in refractory cutaneous sarcoidosis: Single-center retrospective study of 9 patients

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2011.05.040 ◽

2012 ◽

Vol 66 (2) ◽

pp. 328-332 ◽

Cited By ~ 12

Author(s):

Thomas Sené ◽

Caroline Juillard ◽

Michel Rybojad ◽

Florence Cordoliani ◽

Céleste Lebbé ◽

...

Keyword(s):

Retrospective Study ◽

Single Center ◽

Cutaneous Sarcoidosis ◽

Steroid Sparing

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An 80-Year-Old Myasthenia Gravis Patient with Worsening Weakness

10.1093/med/9780190491901.003.0031 ◽

2016 ◽

Author(s):

Jeffrey A. Cohen ◽

Justin J. Mowchun ◽

Victoria H. Lawson ◽

Nathaniel M. Robbins

Keyword(s):

Myasthenia Gravis ◽

Respiratory Insufficiency ◽

Signs And Symptoms ◽

Treatment Modalities ◽

Positive Pressure ◽

Myasthenic Crisis ◽

Effective Management ◽

Extreme Caution ◽

Single Breath ◽

Steroid Sparing

In myasthenia gravis, weakness and respiratory insufficiency can occur quickly. It is important for the treating physician to recognize this and institute treatment rapidly. Increasing weakness of the neck may herald impending respiratory insufficiency. The single breath count is an easy way ti assess ventilatory function. Because of bulbar weakness and increasing secretions usually bi-level positive pressure airway pressure is used with extreme caution. Intubation with effective management if the airway is preferred. Differentiation of myasthenic crisis from cholinergic crisis is explained; although cholinergic crisis is relatively uncommon. Treatment modalities can include intravenous immunoglobulin, plasma exchange, and corticosteroids. Corticosteroids should be used with caution since they may exacerbate myasthenic symptoms. Treatment with a steroid sparing agent is discussed. A table is presented which lists signs and symptoms that can suggest the need for intubation.

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