Clinical examinations of thymic abnormalities and significance of thymectomy in the patients with autoimmune disease

: Results and significance of thymectomy in 427 patients with autoimmune disease, which include myasthenia gravis, ulcerative colitis. Behcet's syndrome and others, were studied. Preoperative pneumomediastinography was useful to delineate the outline of the nontumorous thymus and small "latent thymoma". The thymus was almost always successfully removed by our procedure "thymectomy via the suprasternal notch" (Method I), but the procedure combined with dissection through a parasternal incision (Method II) was frequently performed. Method II has been routinely adopted since 1976. Thymectomy was performed on a series of 180 patients with myasthenia gravis associated with nontumorous thymic abnormalities. In the resected thymuses, lymphoid follicle formations, which are often encountered in other autoimmune diseases, were found in 74% of cases. Follow-up observation, ranging 2 to 17 years after surgery, revealed complete recovery and significant improvement in 100 (75%) out of 133 patients with nontumorous thymic abnormalities. Thymectomy was also performed in 44 myasthenia gravis patients with thymoma, including 13 small "latent thymoma". Seventy-seven thymectomized patients with ulcerative colitis were also studied, and in these resected thymuses lymphoid follicle formations were fond in 45%. Follow-up observation revealed 84% inactive condition (counted by patient year) after thymectomy compared with 50% before operation. In the patients with Behcet's syndrome, recurrence and progression of skin, oral and genital lesions were markedly suppressed after thymectomy.