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Due to the high prevalence of myasthenia gravis (MG) in women of reproductive age, pregnancy in patients with MG is not uncommon. This requires special clinical and therapeutic caution. There is a two-way relationship between MG and pregnancy: Pregnancy can affect the course of the disease, but MG can affect childbirth and the occurrence of postnatal complications. The purpose of our study was to evaluate the clinical course, delivery, and neonatal outcome of pregnant women with the diagnosis of myasthenia gravis. The clinical course of the disease during pregnancy, labor, and postpartum period was reviewed, as well as the neonatal period in the 23 infants born to 15 MG mothers. Spontaneous abortion was observed in two pregnant women (8%) in the second month of pregnancy. One newborn was diagnosed with transitory neonatal MG. There were no stillbirths or physical anomalies. Clinical worsening was recorded during 10 pregnancies (40%), in 8 pregnant women. The clinical course of MG in pregnancy is variable and unpredictable, but pregnancy does not affect the long-term course of MG. Spontaneous abortion is a potential complication in pregnant women with MG. Cesarean section is a more frequent intervention in pregnant women with MG compared to the general population of women. Thymectomy in mothers with MG before pregnancy could potentially have a positive benefit for the newborn. Neonatal transient myasthenia was uncommon in our patient population. No congenital abnormalities were discovered in the 23 babies delivered at our institution. [ABSTRACT FROM AUTHOR]

Background/Aim. Thymectomy is accepted in the surgical treatment of the patients with myasthenia gravis (MG). Earlier thymectomy via sternotomy has recently been replaced by video-assisted thoracoscopic surgery (VATS), which is less invasive. The aim of this study was to determine the effectiveness and reliability of the two methods of surgical removal of the thymus by comparing the neurological outcome in patients with MG. Methods. The study included 60 patients with MG who underwent thymectomy at the beginning of their treatment: 30 patients underwent thymectomy via sternotomy, and the remaining 30 patients via VATS. In order to evaluate the effects of these two operation techniques, we compared the data related directly to the operation - the number of postoperative hospital days, the incidence of postoperative complications, as well as the data related to the neurological monitoring of these patients: directly after the operation, one year after the surgery and up to three years after the surgery. Results. The data related to the immediate postoperative period indicate a significantly shorter hospitalization after the VATS thymectomy (p < 0.001), but the percentage of postoperative complications in both groups was the same (p = 0.381). Clinical deterioration in the first year after the operation showed a uniform distribution, regardless of the type of performed operation (p = 0.470). The number of performed rethymectomies in the group that underwent thymectomy via sternotomy vs. VATS was of borderline statistical significance (p = 0.054). Complete stable remission, as a confirmation that the thymic tissue was removed in its entirety, was observed in about 11% of the patients who underwent thymectomy. For other patients, clinical remission was maintained with anticholinesterase and immunosuppressive therapy. Conclusion. The shorter hospitalization time and faster postoperative recovery, with an equal clinical efficacy and aesthetic component, favors the VATS thymectomy compared to thymectomy via sternotomy as more acceptable in the surgical treatment of the patients with MG. [ABSTRACT FROM AUTHOR]

Introduction. Autoimmune polyglandular syndrome type 2 is defined as adrenal insufficiency associated with autoimmune primary hypothyroidism and/or with autoimmune type 1 diabetes mellitus, but very rare vith myasthenia gravis. Case report. We presented a case of an autoimmune polyglandular syndrome, type 2 associated with myasthenia gravis. A 49-year-old female with symptoms of muscle weakness and low serum levels of cortisol and aldosterone was already diagnosed with primary adrenal insufficiency. Primary hypothyroidism was identified with low values of free thyroxine 4 (FT4) and raised values of thyroidstumulating hormone (TSH). The immune system as a cause of hypothyroidism was confirmed by the presence of thyroid antibodies to peroxidase and TSH receptors. Myasthenia gravis was diagnosed on the basis of a typical clinical feature, positive diagnostic tests and an increased titre of antibodies against the acetylcholine receptors. It was not possible to confirm the immune nature of adrenal insufficiency by the presence of antibodies to 21- hydroxylase. The normal morphological finding of the adrenal glands was an indirect confirmation of the condition as well as the absence of other diseases that might have led to adrenal insufficiency and low levels of both serum cortisol and aldosterone. Hormone replacement therapy, anticholinergic therapy and corticosteroid therapy for myasthenia gravis improved the patient's general state of health and muscle weakness. Conclusion. This case report indicates a need to examine each patient with an autoimmune disease carefully as this condition may be associated with another autoimmune diseases. [ABSTRACT FROM AUTHOR]

Introduction Although muscle relaxants have been widely used to facilitate endotracheal intubation, the administration of these drugs in myasthenic patients may be associated with adverse events. Material and methods After obtaining Institutional Reviewing Board approval and informed, patient consent, 30 patients with myasthenia gravis were enrolled in a prospective, double-blind, randomized clinical trial. We compared intubating conditions (ease of laryngoscopy, vocal cords, cough, jaw relaxation, limb movement) following fentanyl 2 mg/kg and propofol 2 mg/kg (group PRO, n = 15) vs fentanyl 2 mg/kg and sevoflurane 5% in a 1:2 mixture of oxygen and nitrous oxide (group SEVO, n = 15). The statistical analysis was performed using Student's t test and Chi-quadrate test, p<0.05 being regarded as significant. Results The overall intubating conditions were excellent in 67% of patients in the group PRO vs 80% of patients in the group SEVO (p>0.05). One patient in each group had clinically unacceptable conditions for intubation. The mean intubation score was 5.7±1.0 in the group PRO vs 5.9±0.9 in the group SEVO (p>0.05). Three patients receiving propofol and one patient receiving sevoflurane had mild hoarseness after the surgery (p>0.05). Conclusion Both propofol and sevoflurane, supplemented with fentanyl, provide good intubating conditions without the use of muscle relaxants in patients with myasthenia gravis. [ABSTRACT FROM AUTHOR]

Introduction. Childhood onset myasthenia gravis associated with anti-muscle-specific tyrosine kinase antibodies is very rare and atypical in presentation. Case report. As a baby, the presented patient was choking and sleeping with open eyes. She had weak cry and breathing difficulties. In childhood, there were frequent falls and fluctuating swallowing difficulties. At the age of 19 she was misdiagnosed with Miller Fisher syndrome due to the presence of diplopia, ataxia and hyporeflexia with spontaneous recovery. Repetitive nerve stimulation test was normal. Four years later, after several relapses, there was significant decrement on facial muscles. Neostigmine test was negative, provoking muscle fasciculations. Serum anti-muscle-specific tyrosine kinase antibodies were positive. With cyclosporine therapy she achieved the minimal manifestations status. Conclusion. The presented case confirms that childhood onset myasthenia gravis associated with anti-muscle-specific tyrosine kinase antibodies is often with atypical presentation and spontaneous remissions, so it could be easily misdiagnosed. [ABSTRACT FROM AUTHOR]